Prevalence, trends and risk factors of thinness among Greek children and adolescents.

INTRODUCTION: Thinness affects more children and adolescents than obesity. Thus, the aim of the study is to examine the recent estimates of thinness and associated risk factors, and to identify trends in thinness, among Greek schoolchildren. METHODS: Epidemiological study. Population data from the recent estimates are derived from a school-based health survey polled in 2015 on 336,014 participants aged 4- to 17-years-old. To assess trends of thinness (1996-2015) we included a total of 300,104 children aged 8- to 9-years-old. Physical activity, dietary habits and sedentary activities were assessed through self-completed questionnaires. The gender and age-specific body mass index cut-off points proposed by International Obesity Task Force were used in order to define weight groups. RESULTS: Percent 8.4% of girls and 6.5% of boys were thin (all grades included). The prevalence of thinness decreased with age more in boys (from 13.8% at 4-years-old to 5.1% at 17-years-old, p < 0.001), than in girls (from 10.9% at 4-years-old to 8.7% at 17-years-old, p < 0.001). Sufficient dietary habits (OR: 0.87, 95% CI: 0.77-0.97) and adequate physical activity levels (OR: 0.92, 95% CI: 0.85-0.99) were associated with decreased risk of thinness. Thin schoolchildren performed better in aerobic fitness test than normalweight ones. Between 1996 and 2015, thinness rates decreased from 8.0% to 6.5% in boys (p = 0.046) and from 10.6% to 8.4% in girls (p = 0.036). CONCLUSIONS: Our results suggest that thinness is a significant overlooked phenomenon. Although the prevalence of thinness has decreased the last two decades among Greek schoolchildren, actions need to be taken from public policy makers in order to establish and maintain a healthy body weight.

Current data in Greek children indicate decreasing trends of obesity in the transition from childhood to adolescence; results from the National Action for Children's Health (EYZHN) program.

INTRODUCTION: The aim of the study is to present the most recent estimates of obesity (total and central) prevalence in Greek children and associated risk factors. METHODS: Population data are derived from a yearly, school-based health survey polled in 2015 on 336,014 (51% boys) children aged 4 to 17 years old from almost 40% of all schools of primary and secondary education in Greece. Anthropometric and physical fitness measurements were obtained by trained investigators. Dietary habits, physical activity status, sedentary activities and sleeping hours were assessed through self-completed questionnaires. The gender and age-specific Body Mass Index (BMI) cut-off points were used in order to define BMI groups. RESULTS: The prevalence of overweight and obesity in the whole population was 22.2% and 9.0% in boys and 21.6% and 7.5% in girls, respectively. Obesity presented decreasing trends in the transition from childhood to adolescence. Central obesity was diagnosed in 95.3% and 93.5% of the simple obese boys and girls, respectively, in almost two to three of overweight children (68.6% of boys and 64.3% of girls), and in 12% of normal weight children. Age, physical fitness, low adherence to Mediterranean diet, insufficient sleeping hours, inadequate physical activity levels and increased screen time were all associated with higher odds of total and central obesity. CONCLUSIONS: Serious and urgent actions need to be taken from public health policy makers in order not only to prevent a further increase in obesity rates but, more important, to treat obesity and/or the obesity associated co-morbidities.

Establishing cross-sectional curves for height, weight, body mass index and waist circumference for 4- to 18-year-old Greek children, using the Lambda Mu and Sigma (LMS) statistical method.

BACKGROUND: We sought to establish cross-sectional curves for body weight, height, body mass index (BMI), and waist circumference for 4- to 18-year-old Greek boys and girls, using the empirical distribution and the Lambda Mu and Sigma (LMS) statistical method. METHODS: From March 2014 to May 2014, a total of 473,837 boys and girls aged 4 to 18 years who attended school in Greece were enrolled. The studied sample was representative, in terms of age-sex distribution and geographical region. Anthropometric indices measurements (i.e., height, weight and waist circumference) were performed and BMI was calculated and used to calculate normative values, using the percentiles of the empirical distributions and the LMS method. RESULTS: Updated growth references for 4- to 18-year-old Greek children tabulated as critical percentiles and LMS values from 3 to 97 (P3, P10, P25, P50, P75, P90, P97) and smoothed curves are presented. Positive secular trends of height, weight and waist circumference were observed in children and adolescents 4 to 18 years old (all p values <0.001). At all ages, boys had higher anthropometric measurements than girls (all p values <0.01). Compared to 1998 data, mean height and weight were greater in 2014 for boys and girls at all ages. CONCLUSION: Current national percentile curves for anthropometric indices could provide a more accurate estimation to assess physical growth in Greek children and adolescents. Hippokratia 2015; 19 (3): 239-248.

Effect of eating frequency on body composition in 9-11-year-old children.

The aim of this study was twofold: a) to examine the association between eating frequency and body composition in children, and b) to identify possible factors that may explain this relationship. Body composition (anthropometry) and dietary intake (3-day food records) were assessed in a cohort of 151 children. After excluding the underreporters (n = 20), data from 131 children (66 boys and 65 girls) aged 9.9 +/- 0.1 yr with a BMI of 19.6 +/- 0.4 kg/m (2) (means +/- se) were used for further analysis. Children were categorized in tertiles based on the daily number of eating episodes. Physical activity was assessed in a subgroup of 48 volunteers with 4-day accelerometry (RT3, Stayhealthy Inc., Monrovia, CA, USA). The number of eating episodes was inversely associated (p < 0.05) with the sum of skinfolds (r = - 0.17) and % body fat (r = - 0.18) after controlling for age and sex. Frequent eaters presented lower total (p < 0.05) and central adiposity (p < 0.01) compared with the infrequent ones. This was despite the fact that energy intake was higher for the frequent eaters (2077.0 +/- 64.3 vs. 1813.0 +/- 37.8 kcals/day for the frequent and the infrequent eaters, respectively, p < 0.05). Actually, frequent eaters devoted more time to physical activity than infrequent ones (624.7 +/- 13.5 vs. 559.2 +/- 23.1 min/day, p < 0.05). In conclusion, high eating frequency was associated with more favorable body composition in this cohort of school children. Increased energy expenditure due to physical activity may, at least in part, explain the favorable body composition of children who eat frequently.

Central and total adiposity are lower in overweight and obese children with high cardiorespiratory fitness.

OBJECTIVE: To examine the influence of cardiorespiratory fitness on total and truncal fatness in children. It was hypothesised that high cardiorespiratory fitness would result in lower total and central obesity. DESIGN: Observational cohort study. SETTING: Primary and secondary schools in Athens, Greece. SUBJECTS: A total of 1362 healthy children aged 6-13 y (742 boys and 620 girls). METHODS: Anthropometric data (height, body mass, four skinfolds thickness) were collected and per cent body fat was calculated. Body mass index (BMI) sex- and age-specific cutoff points were used for overweight and obesity definition and children were placed in two groups: overweight/obese and nonoverweight. Cardiorespiratory fitness (CRF) was assessed with the endurance shuttle-run test. Participants were grouped into high (upper two quintiles) and low (lower two quintiles) CRF based on age and sex distributions. T-test and Mann-Whitney test were used for comparisons between fit and unfit children within each BMI category. RESULTS: Sum of skinfolds, subscapular and truncal skinfold thickness, BMI and per cent body fat were lower in overweight and obese youths with high CRF in comparison with youths at the same BMI category with low CRF (P<0.01). The beneficial effect of high CRF was also presented in nonoverweight children (P<0.01). The influence of CRF on body composition remained even after correcting body fatness for BMI. CONCLUSIONS: Central and total obesity were lower in overweight and obese children with high CRF. This is the first study to show that a high CRF may reduce the hazards of obesity in children.