Impact of self-efficacy and parenting practice on physical activity among school children.

As insufficient engagement in physical activity (PA) is becoming a major health concern in Thailand, we aimed to investigate the impact of parenting practices and children's self-efficacy on a child's PA level and further in the subgroups, stratified by the child's sex and weight status. A total of 609 primary school children recruited by cluster sampling in two schools were asked to complete questionnaires, and general familial factors and parenting practice related to activities were completed by parents. Multivariate linear regressions were conducted to calculate the standardized beta-coefficients (ß). Children's PA level was positively related to greater support seeking self-efficacy (ß=0.281) for engaging in PA, and parenting practices, including less limit setting (ß=-0.124) and more discipline (ß=0.147) in the total sample. In the analyses of subgroups by a child's sex and weight status, parenting practice, such as less limit setting and discipline played a more important role in children's PA in normal weight children and girls as taking account of around 10% of variance of the child's PA, while only seeking support self-efficacy showed great impact in overweight children and boys. In conclusion, impacts of children's self-efficacy and parenting practices on children's PA were different by child's sex and weight status. This can suggest that future interventions to increase children's PA might need to consider different strategies to increase children's self-efficacy as well as parenting strategies when targeting different groups of children.

Low Sleeping Time, High TV Viewing Time, and Physical Inactivity in School Are Risk Factors for Obesity in Pre-Adolescent Thai Children.

OBJECTIVE: Explore the association between physically active behavior and obesity in 7- to 12-years-old Thai children. MATERIAL AND METHOD: As part of SEANUTS Thailand, information on anthropometry, physical activity, and sociodemographic variables were collected in 7- to 12-years-old urban and rural Thai children. Multi-stage sampling technique was used and 1,345 children (32% urban, and 50.3% boys) participated in the study. Anthropometric measurements included weight, height, and BMI-for-age Z-scores (BAZ) using World Health Organization Growth Reference. Obesity was defined as BAZ > 2SD. Physical activity was assessed using a validated physical activity questionnaire (PAQ). The PAQ provided an activity score, activity time in school, sleeping hours, and TV watching time as categorical variable, low, moderate, and high. Chi-square by likelihood ratio test and logistic regression were used to compare obese and non-obese groups. RESULTS: The overall prevalence of overweight and obesity was 10.2 and 10.8% respectively, whereas 8.2% was classified as thin. Maternal education and religion did not differ between obese and non-obese children. However, obese children's family income was higher. After controlling for family income, maternal education, and religion, obese children were significantly less active during break times in school, slept less, and watched more TV than non-obese. However, there was no difference in the activity score of obese and non-obese children. CONCLUSION: The study showed that physical activity during break time in school, sleep duration, and hours of TV viewing were associated with obesity in pre-adolescent Thai children. It is important to note that activity score was not associated with obesity. One of the most important benefits to be physically active in childhood is the potential to maintain this behavior into adulthood. Therefore, programs that encourage healthy behaviors and address these modifiable risk factors should be incorporated in the school curriculum.

FACTORS ASSOCIATED WITH VITAMIN D STATUS AMONG THAI CHILDREN AGED 3-13 YEARS.

The impact of vitamin D status on bone health and other health conditions is receiving increasingly attention. We aimed to determine the association between environmental factors and vitamin D intake by examining serum 25-hydroxy vitamin D [25(OH)D] levels in Thai children. We conducted a cross sectional study among 477 Thai children from 4 regions in Thailand. Vitamin D intake was assessed using a self-administered questionnaire completed by the older children or by the parents for younger children. Dietary vitamin D intake was assessed using a semi-quantitative food frequency questionnaire. A serum 25(OH)D level was examined for each subject using a chemiluminescence immunoassay. We used structural equation modeling (SEM) to assess the association between studied factors and the serum 25(OH)D level. The final model showed a significant association between sunlight exposure and the serum 25(OH)D level (ß = 0.65, p < 0.01), but not between dietary vitamin D intake and the serum 25(OH)D level (p = 0.01, p = 0.77), suggesting sunlight exposure is more important for the vitamin D status than dietary vitamin D intake.

The Effect of Breakfast Type on Total Daily Energy Intake and Body Mass Index Among Thai School Children.

The study investigated the association between breakfast types consumed, daily energy intake, and body mass index for age Z-score (BAZ). Cross-sectional data from 1258 children aged 7 to 12.9 years were analyzed for breakfast type, nutrient intakes, BAZ, and proportion of overweight or obesity. Analysis of covariance was used to compare energy and nutrient intakes, BAZ, and proportion of overweight/obese children between breakfast groups. Only 19% of children had adequate energy intake from breakfast. Those consuming snacks had a significantly lower BAZ (Z = -0.73), with 5% of them being overweight/obese. Those consuming beverages and desserts had the lowest total daily energy intake (1314 kcal) and lowest protein intake (8.4 g). The results suggest that breakfast type is associated with daily energy intake and BAZ. Most breakfasts are not adequate. School-based nutrition education programs involving families, teachers, and health professionals can contribute to improve this situation.

ASSOCIATION OF ENVIRONMENTAL FACTORS AND ADIPOSITY IN THAI SCHOOL CHILDREN: A STRUCTURAL EQUATION MODELING APPROACH.

This study used structural equation modeling (SEM) to examine associations between environmental factors and indicators of adiposity. We analyzed data from a cross-sectional Southeast Asian Nutritional Survey of 1,161 Thai children aged 7.0-12.9 years who were recruited by multi-stage sampling. Standardized questionnaires provided data on socio-economic, health status, and physical activity, while a 24-hour dietary recall provided dietary intake data. SEM analysis show that socio-economic, health status, physical activity, and nutrient intake were not associated directly with adiposity, but their relationship with adiposity was via the environment. This analysis confirms many relationships between possible causal factors and adiposity, and it enables insight into the complex mechanisms leading to higher body fat. As such, it could serve as a working model to combat the increasing prevalence of obesity (excess body fat) affecting many countries.

SEANUTS: the nutritional status and dietary intakes of 0.5-12-year-old Thai children.

In the present study, we investigated nutritional status and health-related factors in a multistage cluster sample of 3119 Thai urban and rural children aged 0·5-12·9 years. In a subsample, blood samples were collected for the measurement of Hb, transferrin receptor, vitamin A and vitamin D concentrations. The prevalence of stunting and underweight was higher in rural children than in urban children, whereas the wasting rate was similar in both rural and urban areas. Among children aged 3·0-5·9 years, the prevalence of overweight was significantly higher in urban areas than in rural areas and so was the obesity rate in children aged 6·0-12·9 years. Protein intakes of all age groups were relatively high in both the areas. Intakes of Ca, Fe, Zn and vitamin C were significantly higher in urban areas than in rural areas. The prevalence of anaemia in rural areas was twice as high as that in urban areas, particularly in infants and young children. However, the prevalence of Fe-deficiency anaemia was similar in both urban and rural areas. While the prevalence of vitamin A deficiency (by serum retinol cut-off < 0·7 µmol/l) seemed to be very low, vitamin A insufficiency (by serum retinol cut-off < 1·05 µmol/l) was more prevalent (29·4-31·7%) in both the areas. The prevalence of vitamin D insufficiency ranged between 27·7 and 45·6% among the children. The present study indicates that the double burden of malnutrition is still a major public health problem in Thailand. Further studies need to explore the associated risk factors for these nutrient deficiencies. Effective strategies and actions are needed to tackle the nutritional problems in Thai children.

Waist circumference and body fat distribution indexes as screening tools for the overweight and obesity in Thai preschool children.

BACKGROUND: Evidence shows that waist circumference (WC) is one reliable index to predict abdominal obesity in children. This study aims to examine the relationship of WC to other anthropometric indexes and to determine the ability of WC as obesity screening tool. SUBJECTS: 811, 5-6 years old children in Saraburi province, central region of Thailand. METHODS: Anthropometric measurements were performed in children; 406 boys and 405 girls. WC measurement was performed at the umbilicus level. Subcutaneous skinfold was measured on subscapular, suprailiac and abdominal regions. Total body fat was measured with bioelectrical impedance analyzer. Receiver operating characteristic (ROC) analysis was employed to determine WC cut-offs for predicting obesity in children. RESULTS: WC highly correlated with weight-for-height Z-score (WHZ) (r = 0.92-0.94, p = 0.01), body mass index (BMI) (r = 0.95-0.96, p = 0.01), trunk skinfold (r = 0.92-0.93, p = 0.01) and total body fat (r = 0.94-0.95, p = 0.01) for both genders. Based on Thai national reference, the optimal WC cut-offs for predicting obesity were 59.6 cm for boys and 60.5 cm for girls. When IOTF-BMI was employed as reference, WC thresholds were 64.4 cm for boys and 63.1 cm for girls. The latter WC cut-offs provided the slightly underestimated obesity prevalence compared with national reference. CONCLUSION: The strongly positive correlation between WC and weight-height based index and between WC and body fat in Thai preschool children suggests that WC should be the additional index for obesity screening in young children. Further study needs to explore the association between the increased WC and other adverse health outcomes.

Hypercholesterolemia in Thai primary school children: relation to maternal and nutritional factors.

BACKGROUND: There is evidence to show that atherosclerosis can occur in young children and that elevated total cholesterol and low density lipoprotein cholesterol concentrations are risk factors for atherosclerosis. The aim of the present cross-sectional study was to investigate the influence of maternal and nutritional factors on blood cholesterol in primary school children. METHODS: One hundred and ninety-five population-based mother-child pairs (obese child-overweight mother pairs, n = 60; obese child-normal-weight mother pairs, n = 48; wasted child-overweight mother pairs, n = 37; normal-weight child-normal-weight mother pairs, n = 50), were enrolled in the study. Various anthropometric parameters were measured and serum lipids of subjects were further determined. Biological data and children's eating behavior were obtained from the mothers through interviews. RESULTS: Hypercholesterolemia was found in 64.6-65% of obese children, 24.3% of wasted children and in 56% of the normal-weight children; whereas the proportion of children in all groups who had normal blood cholesterol levels was in the lower range. Multivariate logistic regression indicated that mother's serum cholesterol (odds ratio [OR], 2.41; 95% confidence interval [CI]: 1.12-4.78), child obesity defined by weight-for-height Z-score > +2SD (OR, 2.56; 95%CI: 1.33-4.98), and child's energy intake >/=75th percentile (OR, 2.59; 95%CI: 1.01-6.66) were the significant factors associated with hypercholesterolemia in children. CONCLUSION: Hypercholesterolemia in school children is associated with familial factor, bodyweight and nutrient intake. Elevated blood cholesterol was also found in some of the normal-weight and wasted children. Effective family-based intervention programs are urgently needed to modify risk factors predisposing to coronary heart disease.

Study on different sites of waist circumference and its relationship to weight-for-height index in Thai adolescents.

OBJECTIVE: To compare waist circumference (WC) measured at different sites of trunk region and to determine predictive WC values that were corresponding to weight-for-height index in Thai adolescents. MATERIAL AND METHOD: The authors conducted the cross-sectional study in 509 adolescents, aged 10-18 years old WC was measured at four different sites of trunk region, WC1; at midway between the lowest rib and the iliac crest, WC2; at the narrowest waist, WC3; at immediately above the iliac crest and WC4; at the umbilicus level. Receiver operating characteristic analysis was also performed to determine WC cutoffs to maximize the sensitivity and specificity. RESULTS: WC measured at all four sites provided small different powerful value in prediction of trunk fat and total body fat (TBF) in adolescents and that WC4 provided slightly better predictive value than other WC. In boys, WC provided better prediction of trunk fat than the prediction of TBF, whereas in girls, the prediction of trunk fat and TBF from WC were of similar magnitude. By receiver operating characteristic analysis, WC risk threshold for predicting the overweight adolescents using Thai weight-for-height Z score > or = 1.5 SD as reference was 73.5 cm for boys (sensitivity 96.8%, specificity 85.7%) and 72.3 cm for girls (sensitivity 96.1%, sensitivity 80.5%). WC threshold was increased to 75.8 cm. (sensitivity 96.3.%, specificity 86.4%) for boys and 74.6 cm for girls (sensitivity 95.1%, specificity 85.7%) in order to detect the obese children. CONCLUSION: Waist circumference has been proposed as the simple tool for screening the overweight adolescents and when measured at the umbilicus level, it is considered the feasible site for self-evaluation. Further study is needed to investigate the relationship between the increased WC and metabolic risk factors for obesity in adolescents.