Trends in the Prevalence of Morbid Obesity among Children and Adolescents in Shandong, China, 1995-2014.

Background: Childhood obesity has increased dramatically during the past decades; however, data on the prevalence of morbid obesity is limited. The present study examined the prevalent trends in morbid obesity among children and adolescents during the past 19 years (1995-2014) in Shandong, China. Methods: Data for this study were obtained from five cross-sectional surveys (1995, 2000, 2005, 2010 and 2014) of schoolchildren in Shandong Province, China. A total of 41 500 students aged 7-18 years were included in this study. Body mass index cutoffs recommended by the International Obesity Task Force were used to define morbid obesity. Results: The prevalence of morbid obesity was increasing continuously during the past 19 years (1995-2014), from 0.25% for boys and 0.11% for girls in 1995 to 2.73% for boys and 1.29% for girls in 2014. Boys had higher prevalence of morbid obesity than girls (p<0.01). Regional socioeconomic status (SES) inequalities in morbid obesity were observed; children and adolescents from high SES district had a rapid increase in the prevalence of morbid obesity than their counterparts from moderate SES and low SES districts in the past 19 years. Conclusion: Although the current prevalence of morbid obesity was at a relatively low level, a continuous increasing trend was observed between 1995 and 2014. We should not relax our vigilance, and policymakers and experts should pay more attention to the monitoring and prevention of morbid obesity among children and adolescents in the future decades.

Truncal pattern of subcutaneous fat distribution is associated with obesity and elevated blood pressure among children and adolescents.

BACKGROUND: The association between elevated blood pressure (BP) and childhood obesity has been documented in several studies. However, little is known the difference in BP levels among children and adolescents with different patterns of fat distribution. The present study examined the association of subcutaneous fat distributional pattern with obesity and elevated BP among children and adolescents. METHODS: A total of 38,687 students (19,386 boys and 19,301 girls) aged 7-17 years participated in the study. Body mass index (BMI) cutoff points recommended by the International Obesity Task Force (IOTF) were used to define overweight and general obesity. Abdominal obesity was defined as waist-to-height ratio (WHtR) ≥ 0.5. Relatively high BP (RHBP) status was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥ 95th percentile for age and gender. All individuals were classified into four groups (Q1-Q4) according to the age and sex-specific quartiles of subscapular to triceps skinfold thickness ratio (STR), the prevalence rates of overweight, general obesity, abdominal obesity and RHBP among the four groups were compared. RESULTS: In both boys and girls, significant differences in the prevalence rates of overweight, general obesity, abdominal obesity and RHBP were observed among the four groups, an increasing trend was observed from the Q1 (STR <25 th) group to the Q4 (STR ≥ 75th) group (p < 0.01). Children and adolescents with high STR had higher prevalence of overweight, obesity and RHBP than their counterparts with low STR (p < 0.01). CONCLUSION: Truncal pattern of subcutaneous fat distribution is associated with obesity and elevated BP among children and adolescents. Public health attention should not only focus on the amount of body fat, but also on the distributional pattern of body fat.

Blood pressure profiles of children and adolescents categorized by waist-to-height ratio cutoffs: study in a large sample in Shandong, China.

BACKGROUND: Waist-to-height ratio (WHtR) is proposed as a simple and effective screening tool for abdominal obesity and cardiovascular disease risk factors. The present study examined the profiles of blood pressure (BP) among children and adolescents categorized by WHtR cutoffs. PATIENTS AND METHODS: A total of 28 074 (14 015 boys and 14 059 girls) students aged 7-17 years participated in the study. Height, waist circumference and BP of all patients were measured, and WHtR was calculated. Relatively high blood pressure (RHBP) status was defined as systolic BP and/or diastolic BP of at least the 95th percentile for age and sex. All patients were divided into three groups (low, moderate and high) according to their WHtR. BP level and the prevalence of RHBP among the three groups were compared. RESULTS: In both boys and girls, significant differences in BP level and the prevalence of RHBP were observed among the three groups (P<0.01). Children and adolescents aged 7-17 years in the 'high WHtR group' (≥0.5) had higher systolic BP and diastolic BP compared with those in the 'low WHtR group' (<0.4) by 6.07-11.49 and 3.28-6.34 mmHg for boys and 5.62-9.76 and 3.14-5.95 mmHg for girls; the 'high WHtR group' had the highest (34.02% for boys and 30.87% for girls) and the 'low WHtR group' had the lowest prevalence of RHBP (15.23% for boys and 12.53% for girls). CONCLUSION: High WHtR is associated with elevated BP. These findings emphasize the importance of the prevention of abdominal obesity to prevent future problems such as hypertension in children and adolescents.

The current prevalence and regional disparities in general and central obesity among children and adolescents in Shandong, China.

BACKGROUND: Childhood obesity has increased dramatically during the past decades, both in developing and developed countries. The present study examined the prevalence and regional disparities in general and central obesity among children and adolescents in Shandong, China. METHODS: A total of 30,459 students (15,249 boys and 15,210 girls) aged 7-18years participated in the study. Height, weight and waist circumference (WC) of all subjects were measured, body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. The BMI cutoff points recommended by the International Obesity Task Force (IOTF) were used to define general obesity. Central obesity was defined as WHtR≥0.5. Both BMI and WHtR were used to define three types of obesity as follows: general obesity only, central obesity only and combined obesity. RESULTS: The overall prevalences of general obesity only, central obesity only and combined obesity were 10.99, 8.47 and 8.70% for boys and 9.47, 5.12 and 3.19% for girls, respectively. The sum of the prevalence of the three types of obesity was 28.16% for boys and 17.78% for girls, boys had higher prevalence of obesity than girls (P<0.01). Substantial urban-rural and regional disparities exist in childhood obesity, children and adolescents from urban, coastal and high socioeconomic status (SES) districts showed a higher prevalence of obesity than their counterparts from rural, inland and low SES districts (P<0.01). CONCLUSION: The widespread prevalence of obesity in children and adolescents has become an important public health concern. Results from this study also suggested that the additional measurement of WC (WHtR) is better than BMI alone to identify obese individuals, distinguishing the types of obesity and examining the prevalence of various types of obesity is useful in practice.

Profiles of body mass index and the nutritional status among children and adolescents categorized by waist-to-height ratio cut-offs.

BACKGROUND: Waist-to-height ratio (WHtR) is proposed as a simple, valid and convenient measure of abdominal obesity and health risks in practice. The present study examined the distribution of nutritional status among children and adolescents categorized by WHtR cut-offs. METHODS: A total of 30,459 students (15,249 boys and 15,210 girls) aged 7-18years participated in the study. Height, weight and waist circumference (WC) of all subjects were measured, body mass index (BMI) and WHtR were calculated. The grades of nutritional status (thinness, normal weight, overweight and obesity) was defined by the international BMI cut-offs. All subjects were divided into three groups (low, moderate and high) according to their WHtR, BMI level and the distribution of nutritional status among the three groups were compared. RESULTS: In both boys and girls, significant differences in BMI level and the nutritional status were observed among the three groups. Children and adolescents aged 7-18years in the 'high WHtR group' (≥0.5) had higher BMI than those in the 'low WHtR group' (<0.4) by 6.00-10.15kg/m2 for boys and 5.24-9.51kg/m2 for girls. 'low WHtR group' had higher prevalence of thinness, and 'high WHtR group' had higher prevalence of overweight and obesity. The optimal distribution of nutritional status is found in the 'moderate WHtR group' (between 0.4 and 0.5) with the highest proportion of normal weight and low prevalence of thinness and obesity. CONCLUSION: WHtR is associated with nutritional status, which could be an indicator of nutritional status and early health risk. It is necessary to develop optimal boundary values in the future.

Profiles of blood pressure among children and adolescents categorized by BMI and waist circumference.

BACKGROUND: BMI and waist circumference (WC) are two commonly used measurements for defining general and central obesity. The present study examined the profiles of blood pressure (BP) among children and adolescents categorized by BMI and WC in Shandong, China. PARTICIPANTS AND METHODS: A total of 38 810 students (19 453 boys and 19 357 girls) aged 7-17 years participated in this study. Height, weight, WC, and BP of all participants were measured, and BMI was calculated. Relatively high BP status was defined as systolic BP and/or diastolic BP ≥95th percentile for age and sex. All individuals were classified into four groups (Q1-Q4) according to the age-specific and sex-specific quartiles of BMI and WC; the BP level and the prevalence of relatively high BP among the four groups were compared. RESULTS: In both boys and girls, significant differences in BP level and the prevalence of relatively high BP were observed among the four groups categorized by BMI and WC separately (P<0.01). Children and adolescents in the high BMI group (Q4) had higher systolic BP and diastolic BP than their counterparts in the low BMI group (Q1) in all age groups (P<0.01), the range of differences being 5.7-10.3, 3.6-5.6 mmHg for boys and 3.9-8.7, 2.2-5.3 mmHg for girls, respectively. Similar differences were also observed among different groups categorized by WC. CONCLUSION: High BMI and WC are associated with elevated BP. Our findings emphasize the importance of the prevention of general and central obesity to prevent future-related problems such as hypertension in children and adolescents.

Children and adolescents with low body mass index but large waist circumference remain high risk of elevated blood pressure.

BACKGROUND: Body mass index (BMI) and waist circumference (WC) are two commonly used measurements for defining general and central obesity. The present study examined the profiles of blood pressure (BP) among children and adolescents with low BMI but large WC in a large population in Shandong, China. METHODS: A total of 38,810 students (19,453 boys and 19,357 girls) aged 7-17years participated in this study. Height, weight, WC, and BP of all subjects were measured, and BMI was calculated. Relatively high BP (RHBP) status was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥95th percentile for age and gender. 'Low BMI with large WC' was defined as BMI<25th and WC≥75th. RESULTS: The Z-scores for SBP and DBP in the 'low BMI with large WC' group were 0.21 and 0.31 for boys and 0.19 and 0.35 for girls respectively, significantly higher than the average level of the total sample (P<0.01). The prevalence of RHBP in the 'low BMI with large WC' group was significantly higher than the average level of the total sample (34.1% vs. 26.2% for boys and 29.5% vs. 20.3% for girls). CONCLUSION: Children and adolescents with low BMI but large WC might have an increased risk of elevated BP, their health risks would be underestimated if screening by BMI alone. These findings suggest that measurement of WC may be an assistive tool when using BMI to identify high BP risks.

Prevalence of overweight and central obesity and their relationship with blood pressure among college students in Shandong, China.

BACKGROUND: BMI and waist circumference (WC) are the two most common anthropometric measurements for general obesity and central obesity. The present study examined the distributions of BMI and WC and their relationship with blood pressure (BP) among college students in Shandong, China. PARTICIPANTS AND METHODS: A total of 5838 college students (2915 men and 2923 women) aged 19-22 years participated in the study. Height, weight, WC, and BP of all participants were measured, and BMI and waist-to-height ratio were calculated. The BMI cutoffs recommended by the Working Group on Obesity in China were used to define underweight, normal weight, and overweight. Central obesity was defined as waist-to-height ratio of at least 0.5. High BP was defined as systolic blood pressure of at least 140 mmHg and/or diastolic blood pressure of at least 90 mmHg. All individuals were classified into four groups (Q1-Q4) according to the quartiles of BMI and WC, and the BP level, and the prevalence of high BP among the four groups was compared. RESULTS: The prevalences of overweight, central obesity, and high BP were 22.74, 7.85, and 8.79% for men and 8.42, 3.02, and 1.92% for women, respectively; these figures were all significantly higher in men than in women (P<0.01). In both men and women, overweight and central obesity are associated with elevated BP. CONCLUSION: College students with high BMI and high WC might have an increased risk of elevated BP. These findings emphasize the importance of the prevention of overweight and obesity to prevent future-related problems such as hypertension in young individuals.

Trends in overweight and obesity among rural children and adolescents from 1985 to 2014 in Shandong, China.

BACKGROUND: Childhood overweight and obesity has increased dramatically during the past decades, both in developing and developed countries. The present study examined the prevalent trends in overweight and obesity among rural children and adolescents over the past 29 years (1985-2014) in Shandong, China. METHODS: Data for this study were obtained from six cross-sectional surveys (1985, 1995, 2000, 2005, 2010 and 2014) of schoolchildren in Shandong Province, China. A total of 27,840 rural students aged 7-18 years were included in this study. Body mass index cut-off points recommended by the Working Group on Obesity in China (WGOC), the International Obesity Task Force (IOTF) and the World Health Organization (WHO) were used to define overweight and obesity. RESULTS: The prevalence of overweight and obesity has been increasing continually in rural areas over the past 29 years (1985-2014). Using WGOC criteria, for boys, the prevalence of overweight and obesity increased from 0.74% and 0.03% in 1985 to 16.35% and 17.20% in 2014, and for girls it increased from 1.45% and 0.12% in 1985 to 13.91% and 9.11% in 2014, respectively. A similar increasing trend was observed by IOTF and WHO criteria. CONCLUSION: The prevalence of overweight and obesity among children and adolescents in Shangdong rural areas increased rapidly between 1985 and 2014. Rural areas should not be neglected in obesity intervention, policy-makers and experts should pay more attention to the new tendency.

Prevalence of Overweight and Obesity among Children and Adolescents in Shandong, China: Urban-Rural Disparity.

BACKGROUND: The pattern of urban-rural disparity in childhood obesity varies across countries. The present study examined the change trend of urban-rural disparity in childhood overweight and obesity from 1985 to 2014 in Shandong, China. METHODS: Data for this study were obtained from four cross-sectional surveys of school children carried out in 1985, 1995, 2005 and 2014 in Shandong Province, China. In this study, 39 943 students aged 7-18 years were included (14 458 in 1985, 7198 in 1995, 8568 in 2005 and 9719 in 2014). Height and weight of all subjects were measured; body mass index (BMI) was calculated from their height and weight. The BMI cutoff points recommended by the International Obesity Task Force were used to define overweight and obesity. RESULTS: The prevalence of overweight and obesity was increasing continuously both in urban and rural areas over the past 29 years (1985-2014). The prevalence of combined overweight and obesity was significantly higher in urban than in rural children and adolescents in 1985, 1995 and 2005 (p < 0.01). However, a rapid increase in the prevalence of combined overweight and obesity was observed in rural areas after 2005; as a result, the urban-rural disparity was getting narrower, and no significant urban-rural disparity was observed in 2014 (p > 0.05). CONCLUSION: The change trend of urban-rural disparity should be concerned in the future; policies and interventions focused on childhood overweight and obesity should pay attention to rural areas.

Percentiles of waist-to-sitting-height ratio and its relationship with obesity and elevated blood pressure among children and adolescents in Shandong, China.

BACKGROUND: Waist circumference (WC) and related anthropometric indices have been recognized as useful measures of abdominal obesity. However, little is known about the association of waist-to-sitting-height ratio (WSHtR) with obesity and elevated blood pressure (BP). PARTICIPANTS AND METHODS: Data for this study were obtained from a large cross-sectional survey of school children. A total of 6889 students (3438 boys and 3451 girls) aged 7-17 years participated in this study. Height, sitting height, weight, WC, triceps and subscapular skinfold thickness, systolic blood pressure (SBP), and diastolic blood pressure (DBP) of all participants were measured. WSHtR was calculated as WC divided by sitting height. The BMI cutoff points recommended by the Working Group on Obesity in China (WGOC) were used to define overweight and obesity. Relatively high BP status was defined as SBP and/or DBP greater than or equal to the 95th percentile for age and sex. RESULTS: WSHtR was positively correlated with BMI, skinfold thickness, SBP, and DBP in both boys and girls in all age groups (7-17 years). Children and adolescents with high WSHtR (≥75th) had a higher prevalence of overweight and obesity and a relatively high BP compared with their peers with low WSHtR (<25th). The prevalence of overweight plus obesity was 0.57 versus 90.91% for boys and 0.81 versus 61.03% for girls, and the prevalence of relatively high BP was 6.78 versus 31.35% for boys and 6.04 versus 22.18% for girls. CONCLUSION: Large WSHtR is associated with obesity and elevated BP. Our results suggest that WSHtR may be a new useful index for screening obesity and related health risks.

Monitoring of blood pressure among children and adolescents in a coastal province in China: results of a 2010 survey.

BACKGROUND: Several studies have provided ample evidence that hypertension in adults has its onset in childhood; children and adolescents with elevated blood pressure (BP) are more likely to become hypertensive adults. The present study examined the prevalence of relatively high BP among children and adolescents in Shandong, China. SUBJECTS AND METHODS: Data for this study were obtained from a large cross-sectional survey of schoolchildren carried out in 2010. A total of 38 860 students (19 481 boys and 19 379 girls) aged 7 to 17 years participated in this study. Relatively high BP status was defined as systolic blood pressure and/or diastolic blood pressure ≥95th percentile for age and gender. RESULTS: Shandong children had a high BP level, with the 50th percentiles of systolic and diastolic blood pressure of children and adolescents aged 7 to 17 years in Shandong being above the reference values for Chinese children and adolescents by 3 to 12 mm Hg and 3 to 7 mm Hg for boys, and by 3 to 6 mm Hg and 3 to 5 mmHg for girls, respectively. The overall prevalence of relatively high BP was 26.22% for boys and 20.27% for girls. CONCLUSION: There is a high prevalence of relatively high BP among children and adolescents in Shandong, China. It has become a threatening hazard to children and adolescents and should arouse special attention.

Percentiles and regional distribution of skinfold thickness among children and adolescents in Shandong, China.

OBJECTIVE: Skinfold thicknesses (SFT) have long been considered important and valid measurements of subcutaneous fat. The present study reported the percentiles and regional distribution of SFT among children and adolescents in Shandong, China. METHODS: Data for this study were obtained from a large cross-sectional survey of schoolchildren. A total of 42,268 students (21,200 boys and 21,068 girls) aged 7-18 years from 16 districts participated in this study. Triceps, subscapular, and abdomen SFT of all subjects were measured. RESULTS: Shandong children and adolescents had a high SFT level and substantial regional disparities in SFT were observed. Boys and girls resident in high socioeconomic status (SES) districts had higher SFT level than those living in moderate and low SES districts. CONCLUSION: The SFT level of children and adolescents is associated with regional SES in Shandong, China. This may be interpreted as a result of geographic variation between the districts in the process of urbanization, living standards, nutritional conditions, dietary patterns, and public health.