Insufficient Physical Fitness and Deficits in Basic Eating Habits in Normal-Weight Obese Children Are Apparent from Pre-School Age or Sooner.

Normal-weight obesity appears to be an extended diagnosis/syndrome associated with insufficient physical fitness levels and inadequate eating habits at least from school years. However, its relation to long term health parameters in pre-school children remains unknown, even though pre-school age is crucial for the determining healthy lifelong habits. Therefore, the aim of the current study was to investigate the differences in physical fitness level and basic eating habits between normal-weight obese, normal-weight non-obese, and overweight and obese preschoolers. The research sample consisted of 188 preschoolers aged 4.0-6.9 years (Mage = 5.52 ± 0.8 year), normal-weight obese = 25; normal-weight non-obese = 143, overweight and obese = 20. Body composition was measured using bio-impedance InBody230. Six tests assessed the physical fitness level: sit-ups; standing long jump; shuttle running 4 × 5 meters; throwing with a tennis ball; multistage fitness tests; sit and reach. A four-item eating habits questionnaire for parents focusing on breakfast regularity, consumption of sweet foods and drinks, selection of food and attitude towards eating was used. A non-parametric analysis of variance and Fisher's exact test along with suitable effect sizes were used for data processing of physical fitness tests and the basic eating habits questionnaire, respectively. Normal-weight obese children performed significantly worse (from p = 0.03 to p < 0.001, ES ω2-G = low to medium) in muscular fitness, cardiorespiratory fitness and running agility compared to normal-weight non-obese counterparts and did not significantly differ in the majority of physical fitness performance tests from overweight and obese peers. In basic eating habits, normal-weight obese boys preferred significantly more sweet foods and drinks (p = 0.003 ES = 0.35, large), while normal-weight obese girls had significantly more negative attitude towards eating (p = 0.002 ES = 0.33, large) in comparison to their normal-weight non-obese peers. Normal-weight obesity seems to develop from early childhood and is associated with low physical fitness and deficits in eating habits which might inhibit the natural necessity for physically active life from pre-school age or sooner.

Secular Changes in Body Build and Body Composition in Czech Preschool Children in the Context of Latent Obesity.

Changes in lifestyle can be significantly reflected in growth and development. Adaptations to reduced levels of physical activity, together with non-corresponding nutritional intakes, can result in body build and body composition changes at an early age. The present cross-sectional study aimed to evaluate the secular trend of modifications of body composition and body mass index (BMI) in Czech preschoolers over the last two to three decades. Boys and girls (386 boys and 372 girls) aged 4 to 6 years in 2014-2019 were measured. Outcome data were compared with the reference sample of preschoolers from 1990: 911 boys and 896 girls. Body height, BMI, and percentage of body fat, muscle, and bone mass were evaluated. Height and BMI have not changed. Body fat increased in both genders (p < 0.01), and contrarily, a significant reduction of muscle and skeletal mass was revealed (p < 0.001). Significant changes in body composition and unchanged BMI indicate the development of latent obesity during the last few decades. Due to latent obesity in a recent cohort, the differences in the prevalence of overweight and obesity markers according to BMI and fat percentage were tested. The prevalence of overweight and obesity was higher by 7.2% in boys, and by 6.5% in girls, as compared to children evaluated according to only their BMI results. Secular changes in preschoolers' physical builds over the last 25 years are not reflected in body height and BMI, but in body composition. Insufficient development of active, lean body mass proportionally compensated by increased fat mass was also indicated.

Poor Skeletal Robustness on Lower Extremities and Weak Lean Mass Development on Upper Arm and Calf: Normal Weight Obesity in Middle-School-Aged Children (9 to 12).

Background: Normal weight obesity in children has been associated with excessive body fat, lower bone density and decreased total lean mass. However, no studies have been done into whether normal weight obese children differ in skeletal robustness or lean mass development on the extremities from normal weight non-obese, overweight, and obese peers although these are important indicators of healthy development of children. Methods: Body height, body weight, BMI, four skinfolds, and two limb circumferences were assessed. We calculated total body fat using Slaughter's equations, the Frame index for skeletal robustness and muscle area for the upper arm and calf using Rolland-Cachera equations. Using national references of BMI and measured skinfolds, three subgroups of participants (9-12 years) consisting of 210 middle-school-aged children (M-age = 11.01 ± 1.05)-110 girls and 100 boys-were selected: (A) overweight obese (OWOB) (n = 72); (B) normal weight obese (NWO) (n = 69); and, (C) normal weight non-obese (NWNO) (n = 69). All values, were converted to Z-scores to take account of participant's sex and age. Results: NWO children had significantly poorer skeletal robustness on lower extremities and poorer muscle area on the upper arm and calf compared to NWNO counterparts with significantly higher evidence in boys-skeletal robustness NWO boys: Z-score = -0.85; NWO girls: Z-score = -0.43; lean mass on the calf: NWO boys Z-score = -1.34; NWO girls: Z-score = -0.85. The highest skeletal robustness-but not muscle area on the calf-was detected in OWOB children. Conclusions: Further research should focus on whether this poor skeletal and lean mass development: (1) is a consequence of insufficient physical activity regimes; (2) affects physical fitness of NWO children and could contribute to a higher prevalence of health problems in them. We have highlighted the importance of the development of a simple identification of NWO children to be used by pediatricians.

Secular Changes of Adiposity in Czech Children Aged from 3 to 6 Years: Latent Obesity in Preschool Age.

BMI, skinfold thickness, and circumferential measures were assessed in groups of normal healthy Czech boys (n = 1764) and girls (n = 1762) 3-6 years of age in the late 1950s and 1960s (sample C), in the 1990s (sample B), and in 2014-2016 (sample A). During these decades BMI has not changed significantly, and in selected groups (boys 3, 5, and 6, girls 3 and 6 years) it was most recently found to be significantly lower (P ≤ 0.05). Subscapular, suprailiac, triceps, midthigh, and above patella skinfold thicknesses significantly increased in sample A as compared to sample C (P ≤ 0.001). Comparison of the same skinfolds measured in the nineties (sample B) and more recently (sample A) showed similar increase of subcutaneous fat (P ≤ 0.001). The increase of adiposity characterized by skinfolds occurring in spite of not markedly changed BMI indicates significant changes of body composition-latent (also hidden) obesity. The increase of adiposity was relatively greatest on the trunk (P ≤ 0.001)-which is considered a marker of the greatest health risk. The decrease of femoral circumference (P ≤ 0.05) along with simultaneous increase of thigh skinfold (P ≤ 0.01) revealed the decrease of muscle mass in the lower extremity, obviously due to the reduction of weight-transferring physical activity.

Secular Changes of Adiposity and Motor Development in Czech Preschool Children: Lifestyle Changes in Fifty-Five Year Retrospective Study.

Secular trends of adiposity and motor development in preschool children since the fifties of the last century up to the beginning of this millennium were analyzed so as to reveal possible changes due to continuously differentiating lifestyle. In preschool children (n = 3678) height, weight, skinfold thickness over triceps, subscapular, and suprailiac were measured by Harpenden caliper in 1957, 1977, 1980, 1985, 1990, and 2012. Simultaneously, motor performance was tested by evaluating the achievements in broad jump and throwing a ball, as a marker of adaptation to changing level of physical activity, free games, and exercise. Along the period of five decades the values of skinfold thickness increased significantly until 2012, mainly on the trunk. Simultaneously, the level of motor performance significantly decreased. Modifications of the way of life during the mentioned five decades characterized by sedentarism and inadequate food intake as related to energy output influenced negatively both adiposity and motor performance already in preschool children. Mostly increased deposition of fat on the trunk which is considered as a marker of possible development of metabolic syndrome was apparent already in preschool age, indicating the importance of early intervention concerning also physical activity and availability for exercise since early life.

[Overweight, obesity and underweight prevalence in 7-year-old children in the Czech Republic since 1951]. / Prevalence nadváhy, obezitya podváhy u sedmiletých detí v Ceské republice od roku 1951*

BACKGROUND: Childhood overweight prevalence increases worldwide. The aim of the study was to clarify the change in underweight, overweight and obesity in seven year old Czech children since 1951. METHODS: Data on underweight, overweight and obesity prevalence were obtained using repeated cross-sectional surveys. In 1951-2001 six Czech National Anthropological Surveys were conducted. In years 2008 and 2010 the data were collected as a part of the WHO Europe initiated Childhood Obesity Surveillance Initiative (COSI). The data were evaluated according to WHO references (2007), in 2010 results were assessed also according to the Czech reference standards (1991). RESULTS: From 1951, overweight and obesity prevalence increased in both genders up to 2001. In 2008, a modest decrease in obesity and stable overweight prevalence in girls and in boys a slight increase in obesity and decrease in overweight were found. In 2010, a modest increase in obesity prevalence in girls achieving the levels assessed in 2001 and stable level of overweight were found; in boys the levels remained as in 2008. BMI z score increased significantly between 1951 and 2001. CONCLUSION: These results suggest stabilisation of obesity and overweight prevalence in the Czech Republic in 7 years old children during the last 10 years. Underweight prevalence has remained low.

From an inactive and obese to a fit child: how long is the way? Czech experiences.

To achieve a higher level of overall fitness and to prevent obesity with accompanying comorbidities requires life-long effort starting early in life during the prenatal period. A sufficiently intense, regular, and ongoing physical activity regime and adequate exercise are indispensable, along with monitored diet. Once acquired, a desirable level of body composition and functional capacity can be lost relatively quickly due to regime interruption. Adhering to the optimal regime of diet and activity that not long ago used to be the norm is especially difficult under present life conditions, and new and innovative procedures have to be defined and introduced.

[Relation between dietary and physical activity patterns and obesity in seven year old children--current situation--WHO study]. / Soucasný stav stravování a pohybové aktivity ve vztahu k obezite u sedmiletých detí--studie WHO.

BACKGROUND: Childhood obesity is a global health problem. For monitoring of trends in obesity prevalence and comparison between countries standardized methods are necessary. WHO/Europe launched the "Childhood Obesity Surveillance Initiative" project in 2006 aiming to monitor childhood obesity and associated factors in European countries. This paper provides an overview of the situation in the Czech Republic with focus on diet and physical activity. METHODS AND RESULTS: The cohort included 1704 seven-year olds who were examined by paediatricians in 2008 (essential anthropometric measurements). Questionnaires on children's eating habits, physical activity, family, and school environment were filled in. Statistical methods employed. Multivariate regression with reduction of dimensionality (bi-directional orthogonal projection to the latent structure), one-way ANOVA. Low-fat milk intake frequency was positively correlated with BMI (p = 0.0001), while full-fat milk intake was negatively correlated (p = 0.005). These results probably reflect the change in the diet due to increasing BMI. Number of preventive school programmes aimed on health promotion was negatively associated with BMI (p = 0.026). CONCLUSIONS: Surprisingly, low-fat milk consumption was associated with higher BMI in seven years old children, while full-fat milk consumption was associated with lower BMI. School preventive programmes positively affect children's weight.

Impact of education on food behaviour, body composition and physical fitness in children.

The increasing prevalence of obesity during growth and development is significantly related to the education of children, and also to that of parents who influence food intake and physical activity from the beginning of life. The effect of maternal level of education has been shown in regular anthropometric surveys in 10-year intervals since 1951. This concerns the mother's own nutrition and physical activity regimen as well as the child's nutrition since birth, including the duration of breast-feeding. Children of parents with overweight and obesity were shown more often to be obese, as was the case for children from families with the lowest level of education, or from smaller communities where the level of education is usually lower than in larger cities. The composition of the mother's diet during pregnancy had, for example, an effect on the blood lipids of newborns. During preschool age, less body fat, a higher level of HDL, and higher levels of cardiorespiratory fitness, skill and physical performance were found in active children. In school-age children, when obesity increases, a number of prevention programmes using diet, exercise and behavioural intervention have been developed for schools, communities, churches, and/or have been organized by special institutions and medical centres, which were most efficient in family groups. The greatest reduction of weight, BMI and fatness, and improvement of functional capacity, and hormonal and metabolic parameters were achieved in summer camps or spas, with consistent and monitored nutrition, exercise and behavioural treatment. Fluctuation of positive outcomes occurred due to the interruption of the educational process during the school year, and repeated long-lasting interventions have been always necessary for permanent desirable results.

Influence of vitamin A consumption on resting metabolic rate and fasting respiratory quotient in severely obese subjects.

OBJECTIVE: To study whether or not the amount of vitamin A consumed affects the resting metabolic rate (RMR) and fat oxidation at rest in severely obese subjects. MATERIALS AND METHODS: In 239 obese subjects, RMR and fasting respiratory quotient (RQ) were determined by indirect calorimetry. Vitamin A consumption was calculated by the Czech PC program 'Nutrition'. The relation between the intake of vitamin A and RMR and RQ was tested by simple regression. High and low vitamin A consumers were defined by an upper and a lower quintile of vitamin A intake (>842 vs. <382 IU/day). RESULTS: The RMR for high and low vitamin A consumers were 7,693.5 +/- 1,557 and 7,479.8 +/- 1,708 kJ/day, respectively, while the corresponding values for fasting RQ were 0.800 +/- 0.077 and 0.809 +/- 0.049, respectively. No significant correlation was found between vitamin A consumption and both RMR and RQ. Similarly, there was no significant difference in RMR and RQ, as well as weight, body mass index, body fat, waist girth and food quotient between the two groups characterized by high and low consumption of vitamin A. However, the energy intake of high vitamin A consumers was significantly higher than that of low vitamin A consumers, due to higher carbohydrate and protein intake. CONCLUSION: There was no significant correlation between the vitamin A intake and RMR or RQ in obese subjects determined in this study.

Development of centrality indices of subcutaneous fat during growth.

Changes of fat distribution were followed up in Czech and Slovak children from 1.5 to 15 years of age, using centrality indices, which relate the values of skinfolds on the trunk to the skinfolds on the extremities, head and neck. Up to 5 years of age, subcutaneous fat was deposited relatively more on the extremities, head and neck than on the trunk, which was expressed by lower values of the centrality indices. After the age of 5 years, the accumulation of subcutaneous fat was greater on the trunk, which was also expressed by higher values of the centrality indices. The comparison of the individual indices revealed in both genders a relatively higher amount of subcutaneous fat on the trunk in boys until 12 years of age. During puberty subcutaneous fat over triceps and on the forearm was reduced. In girls the deposition of the subcutaneous fat was relatively greater at different sites of the trunk than in boys, with the exception of the age of 14-15 years. The deposition of subcutaneous fat was greater on the trunk than on the head (cheek) and on the extremities in Czech compared to Slovak children, except for 12-year-old girls. During the period between the fifties and the seventies of the last century, in Czech children, especially in girls, the deposition of subcutaneous fat on the trunk was relatively smaller than on other parts of the body surface, which was expressed by the reduction of the centrality indices. Index 12 was therefore considered as the most valuable for the characterization of fat distribution on the body surface.

Assessment of dietary and genetic factors influencing serum and adipose fatty acid composition in obese female identical twins.

Fourteen pairs of obese female monozygotic twins were recruited for a study of genetic influences on serum and adipose fatty acid (FA) composition. Following 1 wk of inpatient stabilization, fasting serum and adipose tissue obtained by surgical excision were analyzed by thin-layer and gas chromatography. Intrapair resemblances (IPR) for individual FA were assessed by Spearman rank correlation and by analysis of variance and were found in serum cholesteryl esters (CF), triglycerides (TG), and adipose TG. With two exceptions (CE linoleate and adipose eicosapentaenoate), these IPR were limited to the nonessential FA. Palmitate had significant IPR in four lipid fractions; in serum CE and adipose TG palmitate was strongly correlated with multiple measures of adiposity. In contrast to other lipid fractions, serum phosphatidylcholine (PC) FA had 12 [PR, of which 6 were essential FA including arachidonate (r = 0.76, P < 0.0005), eicosapentaenoate (r = 0.78, P < 0.0005), and docosahexaenoate (r = 0.86, P< 0.0001). The PC [PR could not be explained by analysis of preadmission 7-d food records. After dividing the pairs into two groups differing and nondiffering according to fat intake of individuals in the pair, there was no evidence of a gene-environment interaction between fat intake and FA composition. The IPR for nonessential FA indicate that there is active genetic control of either food choices or postabsorptive metabolic processing. The high level of IPR in the PC fraction in contrast to the other lipid fractions suggests strong genetic influence over selection of specific FA for this membrane fraction independent of diet.