Clustering of Activity-Related Behaviors in Relation to Self-Reported Causes of Stress among Pre-Adolescents: Results from a National Epidemiological Study.

An epidemiological study was conducted among 1728 10-12-year-old students (55.1% girls) and their parents during 2014-2016 in Greece. This study aimed to identify the dominant clusters of physical activity/sedentariness among preadolescents and investigate their association with self-reported sources of stress. Children's physical activity levels and sources of stress were evaluated using validated questionnaires that assessed daily hours of activities, both on weekdays and on weekends, including physical activity, screen-based sedentary time, and non-screen-based sedentary time. The k-means algorithm of cluster analysis was applied. Three clusters of children's physical activity/sedentariness were revealed. Cluster 1 was characterized as "Inactive-Non sedentary", cluster 2 as "Active -Non-screen sedentary", and cluster 3 as "Inactive-Sedentary". Parental needs/expectations were associated with physical activity patterns (p = 0.009), i.e., children assigned to the third and second clusters had 36% and 51% lower odds to be stressed due to parental requirements [(OR for cluster 3 = 0.64, 95% CI = 0.41-0.99), (OR for cluster 2 = 0.49, 95% CI = 0.32-0.76)], compared with their first-cluster counterparts. Considering the need to promote physical activity in early life stages, the identification of these complex activity-related patterns along with their significant interaction with parental expectations as a cause of stress could enhance the effectiveness of targeted behavior change interventions among those parent-child dyads most in need.

The Synergetic Effect of Soft Drinks and Sweet/Salty Snacks Consumption and the Moderating Role of Obesity on Preadolescents' Emotions and Behavior: A School-Based Epidemiological Study.

The consumption of ultra-processed foods (UPFs) is high along with the prevalence of emotional and behavioral problems among children and adolescents. The present study sought to investigate the synergetic effect of soft drinks and sweet/salty snacks consumption, and the moderating role of obesity on preadolescents' emotions and behavior. A cross-sectional study was conducted among 1728 Greek preadolescents aged 10-12 and their parents, during the school years 2014-2016. Parental and child characteristics were collected anonymously, through self-administered and validated questionnaires. Among others, soft drinks and sweet/salty snacks consumption was recorded, classifying preadolescents as low or at least moderate consumers, while anthropometric characteristics (height, weight, Body Mass Index (BMI)) were also recorded. Approximately 6 out of 10 preadolescents were characterized by at least moderate consumption of either sweet/salty snacks, or soft drinks, while 22.7% of the participants had at least moderate consumption of both soft drinks and sweet/salty snacks. Boys and preadolescents with a lower level of adherence to the Mediterranean diet, as well as those living in a more obesogenic family environment were more likely to be in the higher consumption groups. When compared to just either the moderate consumption of sweet/salty snacks, or the moderate consumption of soft drinks, the combination of both unhealthy eating habits was associated with significantly higher odds of both aggressiveness and loneliness, while the examined relationships were significantly stronger in overweight/obese children. The positive synergistic effect of soft drinks and sweet/salty snacks consumption on preadolescents' emotions of loneliness and aggressive behavior is even burdened by obesity status highlighting the urgent need for policymakers to take preventive measures to halt the detrimental consequences of UPFs consumption on health outcomes, particularly in overweight/obese children. The importance of the improvement of children's unhealthy eating habits by emphasizing the association between food intake and emotional and behavioral status is highlighted.

Association between Family and School Pressures, Consumption of Ultra-Processed Beverages, and Obesity in Preadolescents: A School-Based Epidemiological Study.

The aim of the present work was two-fold. Firstly, to evaluate the association between the consumption of ultra-processed beverages (UPB) on preadolescents' likelihood of being obese. Secondly, to investigate the potential impact of family and school environmental stressors on this unhealthy lifestyle habit. A cross-sectional study was conducted among 1718 Greek preadolescents and their parents, during the school years 2014 to 2016. Parental and child characteristics were collected anonymously, through self-administered and validated questionnaires. Among others, UPB consumption (soft and flavored drinks) was recorded, classifying children as low, moderate, or high consumers, while anthropometric characteristics [height, body weight, Body Mass Index (BMI)] were also recorded. Almost seven out of ten preadolescents were classified as at least moderate UPB consumers, while approximately three out of ten were classified as high UPB consumers. Higher UPB consumption was associated with significantly higher levels of BMI, while preadolescents living in a more stressful family and school environment were found to consume significantly higher amounts of UPB. Stakeholders should implement programs that raise awareness among parents and teachers about the sources of stress in preadolescence as a potential "triggering factor" of unhealthy dietary preferences.

The path between breakfast eating habit, sleep duration and physical activity on obesity status: An epidemiological study in schoolchildren.

Background: Although the literature suggests that skipping breakfast, insufficient sleep, and reduced physical activity are associated with childhood obesity their co-influence and their in-between interactions on weight status have rarely been studied. Aim: To examine the co-influence of breakfast eating habits, sleep duration, and physical activity on the weight status of children 10-12 years old from several schools of Greece. Methods: A cross-sectional study was conducted on 1688 students in Greece, during 2014-2016. Children's Body Mass Index (BMI) was calculated and classified according to the International Obesity Task Force (IOTF) classification. Logistic regression models and path analysis were used. Results: Overweight/obesity prevalence was higher in boys (32.5% vs. 20.4%; p < 0.001). Average sleep duration decreased the odds of overweight/obesity [OR (95% CI): 0.86 (0.76, 0.97)] independently of the frequency of breakfast habit. Interaction between sleep duration with breakfast habit (p = 0.002) and physical activity (p < 0.001) was observed. Path analysis showed a negative association of BMI with sleep duration (standardized beta = -0.095, p < 0.001). A third-order interaction between breakfast habit, sleep duration, and physical activity revealed that daily breakfast eating along with adequate sleep and moderate/adequate physical activity levels, decreased the odds of over-weight/obesity by 55% [OR 0.45, 95% CI (0.27, 0.72)]. Conclusion: Although sleep duration is inversely associated with weight status independently of breakfast habit, the co-influence of adequate sleep duration with frequent breakfast eating and moderate/adequate physical activity seems to be a profoundly higher associated as a result of synergy against childhood obesity.

The Association of Junk Food Consumption with Preadolescents' Environmental Influences: A School-Based Epidemiological Study in Greece.

The aim of the present study was to evaluate the impact of environmental influences on Greek preadolescents' junk food consumption. A cross-sectional study, was conducted among 1718 preadolescents (mean (standard deviation(SD)) age: 11.2(0.8) years old; 54% girls) and their parents, during the school years 2014-2016. Parental and child characteristics were collected anonymously, through self-administered and validated questionnaires. Among others, junk food consumption was recorded, classifying children as low, moderate, and high consumers. The majority of the preadolescents were classified as at least moderate junk food consumers, while almost 3/10 children were classified as high junk food consumers. A significantly lower junk food consumption was observed among preadolescents with a healthier family environment, consisting of normal-weight parents who consume junk foods less frequently, prefer home-cooked meals and adhere more to the Mediterranean diet, while more frequent family meals were also associated with lower junk food consumption. In addition, influence from teachers and participation in extracurricular sports activities were significantly associated with lower junk food consumption, while advertisements were found to have a significant negative impact on preadolescents' eating habits. Notwithstanding, peers were not found to influence their dietary choices in terms of junk food consumption. Both parents and teachers seem to be positive influencers on preadolescents' low junk food consumption. The detrimental role of advertisements on junk food consumption is reconfirmed, while peers' influence is not significant on junk food consumption. The need for urgent public health initiatives for the promotion of healthy dietary habits among preadolescents is warranted.

The Association between Breakfast Macronutrient Composition and Body Weight, in Preadolescence: An Epidemiological Study among Schoolchildren.

Over the last few decades, childhood overweight and obesity tend to reach epidemic proportions. The present study aimed to examine whether the composition of breakfast, through the prism of its macronutrient content, could play a part in the development of excess body weight in children. A sample of 1728 Greek students from 47 primary schools was enrolled for the purposes of this study. Their weight and height were measured and their Body Mass Index was calculated and classified according to the International Obesity Task Force criteria. Their dietary habits, breakfast foods of choice, and physical activity were assessed through the use of a self-completed questionnaire. Further assessment of breakfast composition was carried out in order to evaluate its macronutrient content. Initial analysis, which was only energy-adjusted, showed a negative association between body weight and breakfast protein content and a positive association for lipid content. After further adjustment for age, sex, level of adherence to the Mediterranean diet, and physical activity, there was a significant negative association between breakfast protein and excess body weight in children (p = 0.029), as well as a significant positive association of breakfast lipid content (p = 0.028). Breakfast macronutrient content seems to have an effect on body composition in children, independently of overall adherence to the Mediterranean diet and physical activity, however further research is needed in order to elucidate potential pathways.

The Role of Milk on Children's Weight Status: An Epidemiological Study among Preadolescents in Greece.

Milk consumption contributes greatly to children's diet, playing a pivotal role in the development and structure of bones and the functioning of the musculoskeletal system and the heart. This study investigated the association between the type of milk and childhood overweight/obesity. In the school period 2014-2016, 1728 students aged 10-12 years and their parents participated. The measurement and classification of their weight status were performed through the criteria of the International Obesity Task Force. Among others, the type of milk consumption was recorded. Four categories of the type of milk children consumed were classified (white milk, chocolate milk, both types of milk, and no milk at all). Children consuming only white milk were 33.1% less likely to be overweight/obese in comparison with children who were not consuming milk at all [OR (95% CI): 0.669 (0.516, 0.867), p = 0.002]. The consumption of chocolate milk showed a protective role against childhood overweight/obesity although its association was not consistently significant. This study highlights the significant contribution of milk (and particularly of white milk) consumption to weight management, and thus its promotion should be consistently encouraged. More studies are needed to shed light on the effects of different dairy foods on weight status in childhood.

The Association between Stress and Children's Weight Status: A School-Based, Epidemiological Study.

Given the evidence on how stress affects weight status in children, this research examined this association among Greek students aged 10−12 years old. Overall, 1452 children and their parents from several urban areas participated in an observational study conducted during the period 2014−2016. Participants completed validated questionnaires. International Obesity Task Force guidelines were used for children's weight status classification. Descriptive statistics and nested logistic regression models were used. Multivariate correspondence analysis was also used to construct a score to evaluate the children's stress levels. The overall prevalence of overweight/obesity was 27%. More than 80% of the children appeared to have a medium or high level of stress, mainly due to the school environment. School-related stress increased the odds of obesity in children. The association between stress and overweight/obesity status showed a consistent trend (adjusted odds ratios varied from 1.44 to 1.52, p-values < 0.01). Children's weight status was associated with several school-related stressors. Although the school environment may play an aggravating role in the weight status of children, family plays a catalyst role in this direction. Therefore, actions have to be promoted in the school community so that children become more health literate on a public health level.

The Association of Sugar-Sweetened Beverages to Children's Weights Status Is Moderated by Frequency of Adding Sugars and Sleep Hours.

Adding extra sugars in milk and the moderating effect of sleep has yet to be investigated, setting the aim of this study. A total of 1361 school-aged children were included, aged 10−12 years old, by randomly sampling schools. Data were interview-obtained by trained personnel using a validated 17-item food frequency questionnaire, with specifics on type of milk and extra sugar additions. Analyses were stratified by average recommended hours of sleep. Predictive probability margins were obtained following necessary adjustments. Mean BMI was significantly lower, the level of SSB intake was higher, and the prevalence of adding sugars to milk four or more times per week was higher in children that slept ≥10 h. Most children (64%) consumed full fat milk, 21% had low fat, and 19.7% chocolate milk, with a significantly larger proportion of overweight or obese children consuming full fat or chocolate milk, also adding extra sugars four or more times per week (4.1% compared to 9.6%, and 12.2% compared to 39.5%, respectively). The predictive probability of being overweight or obese exponentially increased for children consuming >0.5 SSB/day while also adding sugars to their milk frequently, although this effect remained significant only for children sleeping <10 h/day. In conclusion, to accurately address the effect of SSBs on children's body weight, frequency of any type of sugar addition in milk should be accounted for, as well as average sleep hours that may further moderate the effect.

Inverse Association Between Health Literacy and Obesity Among Children in Greece: A School-Based, Cross-Sectional Epidemiological Study.

Children's health literacy is a crucial pillar of health. This study is aimed to examine the association between health literacy and weight status among Greek schoolchildren aged 10 to 12 years old. A population-based, cross-sectional observational study enrolling 1,728 students (795 boys), aged 10 to 12 years old, was conducted during school years 2014-2016. A health literacy index (range 0-100) was created through an item response theory hybrid model, by combining a variety of beliefs and perceptions of children about health. The mean health literacy score was 70.4 (±18.7). The majority of children (63.8%) had a "high" level (i.e., >67/100) of health literacy, 30.5% had a "medium" level (i.e., 34-66/100) of health literacy, while a small proportion of children (5.7%) had a "low" level (i.e., <33/100). Girls exhibited a higher level of health literacy than boys (71.7 ± 18.3 vs. 68.8 ± 19.1, p < .01). Regarding body weight status, 21.7% of children was overweight and 5.0% was obese. Linear regression models showed that the health literacy score was inversely associated with children's body mass index (regression coefficient [95% CI]: -0.010 [-0.018, -0.001]), after adjusting for dietary habits, physical activity levels, and other potential confounders. Health literacy seems to be a dominant characteristic of children's weight status; therefore, school planning, as well as public health policy actions should emphasize on the ability of children's capacity to obtain, process, and understand basic health information.

The psychological effect of COVID-19 quarantine on Greek young adults: Risk factors and the protective role of daily routine and altruism.

To save lives and slow the spread of COVID-19 Greece imposed a country-wide, 6-week lockdown and a stay-at-home order at an early stage. This study examines the effect of quarantine on young adults by assessing depression, anxiety, stress and the experience of positive and negative affect. The role of potential risk factors such as disruption of normal life, perceived threat of the disease, acquaintance with someone infected and gender; and protective factors, such as adherence to a daily routine and altruism was evaluated. An online questionnaire entailing demographics, the Depression, Anxiety and Stress Scales (DASS-21), the Positive and Negative Affect Schedule (PANAS), measures of life disruption, perceived threat and adherence to a daily routine and an altruism scale was completed by 1018 undergraduates. Increased levels of depression, anxiety, stress and negative affect were found. Life disruption and perceived threat of the disease were risk factors in all psychological distress measures, while a stable, satisfying daily routine and altruism mitigated the negative consequences. Gender was a moderator. Acknowledging the psychological effect of quarantine on young adults should be the starting point for interventions. Helping people build a new routine and assign an altruistic meaning to the confinement can protect psychological health.

Assessing the association between breastfeeding, type of childbirth and family structure with childhood obesity: results from an observational study among 10-12 years old children.

This study examined the association between breastfeeding, type of childbirth, and family structure with childhood obesity. During 2014-2016, 1728 Greek students attending primary schools and their parents were enrolled. Children's weight status was measured and classified according to the International Obesity Task Force criteria. A self-administered questionnaire assessing the type of childbirth, the family structure, and several perinatal and demographic characteristics was used. Factors associated with higher breastfeeding rates were the type of childbirth, high maternal educational level, and nuclear family structure. No association was found between childhood obesity and type of childbirth (p = 0.64) and family structure (p = 0.26). Although the short-term beneficial effects of breastfeeding on childhood obesity are undeniable and it is of great importance to all health professionals to promote breastfeeding, no significant long-term effects on obesity in adolescence were observed. More studies are needed in order to elucidate the role of breastfeeding in obesity status in adolescence.

Dietary Patterns, Weight Perception and Obesity Status, among 10-12-Year-Old Children; an Epidemiological Study in Greece.

Adherence to certain dietary patterns influences obesity status in both children and adults. Weight perception influences dietary habits. The aim of this study was to examine children's dietary habits and obesity status, in relation to weight perception. One thousand seven hundred Greek students enrolled in this study during 2014-2016. Children's characteristics were assessed through validated questionnaires, and weight status was classified according to the criteria of the International Obesity Task Force. Dietary patterns were assessed through exploratory factor analysis. Overall, 52.2% of children characterized themselves as normal weight, 34.5% as low weight, and 13.3% as overweight/obese; 52.5% of children were in accordance with their actual weight status, with girls being more likely to overestimate their weight. Children followed three dietary patterns, i.e., starchy and protein foods, unhealthy/high-fat foods, and healthy foods. Children who followed the healthy dietary pattern and had accurate weight perception (in accordance with their actual weight), had lower odds of being overweight/obese (p < 0.001). Accurate weight perception in conjunction with healthy dietary habits may play a determinant role in the prevention of obesity. From a public health perspective, early identification of children's weight misperception along with healthy dietary habit promotion shape a crucial role in childhood obesity confrontation.

Household food spending, parental and childhood's diet quality, in financial crisis: a cross-sectional study in Greece.

BACKGROUND: Over the past decade, the financial crisis has affected harshly the household income of Greek people. This study aimed to investigate whether the effect of the financial crisis on food spending has affected the dietary habits in the family environment. METHODS: Under a cross-sectional study conducted during 2014-2016, 1145 children and their parents completed questionnaires examining socio-economic and dietary characteristics. The MedDietScore and the KIDMED Score were used to assess parental and childhood adherence to the Mediterranean diet, respectively. RESULTS: The parents who reported that the financial crisis has affected food spending used to consume weekly fewer fruits (3.26 ± 0.94 vs. 3.41 ± 0.90, P = 0.016), carbohydrate foods (3.16 ± 0.57 vs. 2.99 ± 0.55, P < 0.001) and legumes (3.28 ± 0.76 vs. 3.14 ± 0.67, P = 0.001) and more nutrient-poor/energy-dense foods (2.55 ± 0.98 vs. 2.20 ± 0.82, P < 0.001) compared with non-affected parents. Their children showed a decreased weekly consumption of vegetables (2.82 ± 0.90 vs. 2.97 ± 0.98, P = 0.019) and increased weekly consumption of nutrient-poor/energy-dense foods (2.38 ± 0.97 vs. 2.19 ± 0.80, P < 0.001). The affected parents had a lower MedDietScore than non-affected parents (25.76 ± 8.10 vs. 27.03 ± 8.11, P = 0.034). No difference was revealed on the KIDMED Score (P = 0.294). CONCLUSIONS: The constrained food spending due to financial crisis has an independent and inverse impact on parent's diet quality while keeping unaffected preadolescent's diet quality. This finding highlights the role of parents as a protective 'wall' against the deterioration of their children's diet quality. The modification on the prices of healthy food and the provision of food aid particularly in economically disadvantaged households is underlined.

Sleeping patterns and childhood obesity: an epidemiological study in 1,728 children in Greece.

STUDY OBJECTIVES: Sleep is an essential normal function for children's growth and development, but over the years, lifestyle changes have resulted in insufficient sleep, a factor that may be associated with increased childhood obesity. The aim of this study was to evaluate the association between sleep duration and sleep patterns separately on weekdays and weekends regarding children's weight status. METHODS: This study was conducted among Greek students (55.1% girls) in 2014-2016. Children's weight status was classified according to the International Obesity Task Force tables and guidelines. Sleep duration was determined based on the sleep and wake time that children reported, separately for weekdays and weekends. Classification and regression tree analysis was used to derive sleep patterns and evaluate their relation to children's weight status. RESULTS: Multiadjusted analysis revealed an inverse association between average duration of sleep on weekdays and weekends with the likelihood of being overweight/obese (odds ratio per 1 hour 0.82; 95% confidence interval, 0.73-0.92). This was more prominent on weekends than on weekdays. Children who had lower duration on weekdays, but catch-up sleep duration on weekends, were 2% (95% confidence interval, 0.97-0.99) less likely to be overweight/obese compared to those children having both less or increased sleep duration on weekdays and weekends. CONCLUSIONS: Sleep duration and sleep patterns seem to be associated with childhood weight status. Interventions should be developed to educate parents on the importance of an adequate sleep duration and healthy sleep patterns for their children's healthy development.

The association between adherence to the Mediterranean diet and childhood obesity; the role of family structure: Results from an epidemiological study in 1728 Greek students.

BACKGROUND: Childhood obesity is among the leading public health challenges, worldwide. AIM: To examine the association between children's adherence to the Mediterranean diet (MD) and weight status taking into account family structure and related behaviors. METHODS: 1728 primary-school Greek students (46% males), from Athens metropolitan area, island of Crete, and the Peloponnese region, were enroled during school years 2014-2016. Children and their parents completed questionnaires which, among others, recorded family structure (i.e., married/cohabited, divorced, single parent, and widowed), dietary and lifestyle habits. Adherence to the MD was assessed through the KIDMED score (range - 4 to 12). Children's body mass index was calculated and classified as normal, overweight/obese, according to the International Obesity Task Force classification. The working sample was 1142 children (44% males) with a recorded family structure. RESULTS: The prevalence of overweight was 21.7% and obesity was 5.0%; overweight/obesity prevalence was higher among males than females (32.4% vs. 23.3%; p < 0.001). Overweight/obese children had a lower KIDMED score compared to normal weight (median (range): 4 (-2, 11) vs. 5 (-1, 10), p = 0.05). An inverse association between KIDMED score and children's weight status (odds ratio (OR) (95% confidence interval (CI)): 0.95 (0.89-0.99)) was observed. Interaction between family structure and KIDMED was observed (p < 0.001); stratified analysis revealed that in children from nuclear families the KIDMED score was inversely associated with the likelihood of overweight/obesity (OR (95% CI): 0.95 (0.88-1.00)), whereas in children from single-parent families it was not (OR (95% CI): 0.94 (0.79-1.12)). CONCLUSION: Adherence to the MD plays a protective role against childhood overweight/obesity, particularly among children living in nuclear families.

The Influence of Adherence to the Mediterranean Diet among Children and Their Parents in Relation to Childhood Overweight/Obesity: A Cross-Sectional Study in Greece.

Background: Childhood overweight/obesity constitutes a serious issue, as may cause several health problems. The main characteristics of the Mediterranean Diet have been acknowledged as the most appropriate shield mainly for obesity. Methods: The study was performed on 1728 primary students, during school years 2014-2016, in Greece. Children and their parents completed questionnaires which included dietary and lifestyle habits. The KIDMED score (range -4 to 12) was used to assess the level of childhood adherence to the Mediterranean diet and the MedDietScore (range 0 to 55) was used to assess parental adherence. For the purposes of this analysis, the examined sample was n = 875 of students (522 girls)-parents pairs whose level of adherence to the Mediterranean diet was able to be evaluated. Results: The prevalence of overweight and obesity in the Greek sample was 26.0%, according to International Obesity Task Force (IOTF) cutoff criteria for children. KIDMED Score was significantly lower in children with overweight/obesity compared with children with normal weight (4.65 ± 2.14 vs. 5.16 ± 2.05, p = 0.002). The multiadjusted analysis revealed that children close to the Mediterranean diet were less likely to be overweight/obese (p < 0.001), either parents are away from or close to the Mediterranean diet. Conclusions: This study revealed that children's adherence to the Mediterranean diet was inversely associated with weight status either parents are away from or close to this dietary pattern. Future interventions against childhood obesity have to take into consideration the crucial importance of familial aggregation of healthy food choices and interfamily influences in the home environment on children's weight status.

Lack of association between dietary fibres intake and childhood obesity: an epidemiological study among preadolescents in Greece.

The aim of this study was to evaluate whether dietary fibres intake is associated with childhood obesity. From 2014 to 2016, a sample of 1728 Greek boys and girls students, 10-12 years and their parents were enrolled in the study. Dietary fibres intake was assessed through food questionnaires and child's body mass status was defined according to the International Obesity Task Force (IOTF)'s criteria. Prevalence of combined overweight/obesity was 26.7%, with boys having significantly higher prevalence than girls (31.5 versus 24.7%, p < 0.001). Logistic regression analysis, after various adjustments were made, revealed no association between dietary fibres intake and obesity/overweight (Odds Ratio = 0.76; 95% CI 0.48, 1.19). The lack of an association between dietary fibres intake and overweight/obesity status among pre-adolescents could be attributed to various reasons such as, methodological issues reflecting the study's design, the measurement of exposure or due to true absence of a relationship. Nevertheless, fibres consumption should not be prevented, but, promoted under the context of a balanced diet, because of their numerous pleiotropic health effects.

Breakfast consumption and obesity among preadolescents: An epidemiological study.

BACKGROUND: This study aimed to examine the association between breakfast consumption and childhood weight status, in relation to various socioeconomic and lifestyle factors. METHODS: A cross-sectional survey was conducted including 1,728 children aged 10-12 years and their parents, during the school years 2014-2016. Primary schools from five Greek counties (including the Athens metropolitan area) were randomly selected. Parental and child data were collected through self-administered, anonymous questionnaires. Children's weight status was based on gender- and age-specific tables derived from the International Obesity Task Force body mass index cutoffs. Logistic regression was used to determine the association between frequency and type of breakfast consumption and children's weight status. RESULTS: The frequency of breakfast consumption was not associated with childhood overweight or obesity, even when other factors were included in the analysis like sex, age, physical activity, meals / day, family annual income, parental weight status, parental physical activity level, parental educational level and parental employment status. From the nine foods that were included only the consumption of bread or rusks and chocolate milk were found to have a negative association with childhood overweight or obesity (odds ratio: 0.51; 95% CI: 0.34, 0.79 and OR: 0.50; 95% CI: 0.28, 0.87, respectively). CONCLUSIONS: The result that frequency of breakfast consumption was not associated with children's overweight / obesity may lead to a deeper investigation of the foods consumed during breakfast. Bread or rusks and chocolate milk seemed to have a protective effect; further nutritional analysis is needed to explore the potential mechanisms of this observation.

Parental weight status and early adolescence body weight in association with socioeconomic factors.

BACKGROUND: Childhood obesity remains a major health issue. The understanding of the multifactorial nature of childhood obesity remains the cornerstone to eliminate the rising trends. This study aimed to examine the association between parental and childhood weight status, in relation to various socioeconomic (SE) factors. METHODS: A cross-sectional survey was conducted including 1190 children aged 10-12 years and their parents, during school years 2014-2016. Primary schools from five Greek counties (including Athens metropolitan area) were randomly selected. Parental and child data were collected through self-administered, anonymous questionnaires. Children's weight status was based on gender- and age-specific tables derived from the International Obesity Task Force body mass index (BMI) cut offs. General Linear Model (GLM), Univariate and multivariate analyses were applied. Multiple logistic regressions was used to determine the association between children and parents' weight status. RESULTS: Childhood prevalence of overweight and obesity was 25.9% (21.8% overweight and 4.1% obese), with prevalence being significantly higher in males (31.7% compared to 21.3%; P for gender differences < 0.001). The percent of overweight and obese male (34.4% and 43.1%) and female children (20.3% and 31.8%) significantly increased with paternal overweight and obesity status, respectively. The same relationship was observed between male children and maternal overweight and obesity status (43.4% and 65.7%). This was not evident among females (27% and 23.2%). Regression analysis showed a significant positive association with parental BMI, a negative association with both parental educational levels (low to high), living space, and parental age (P < 0.05, for all). Children's likelihood of being overweight or obese increased significantly with increasing parental weight status (P < 0.001). CONCLUSIONS: Parental weight status remained the most significant predictive factor for early adolescence obesity among various SE factors. Health promotion strategies should consider parental education as an effective childhood obesity preventive measure.