The associations between meeting 24-hour movement guidelines and adiposity in Asian Adolescents: The Asia-Fit Study.

Less is known about how compliance with 24-hour movement guidelines for physical activity (PA), sedentary behavior, and sleep affects adiposity in young people. The purposes of this study were to compare compliance with 24-hour movement guidelines in Asian adolescents and to examine the associations between compliance with 24-hour movement guidelines and body fat percentage. A sample of 12 590 adolescents aged 13.63 (± 1.01) years from eight Asian metropolitan cities including Bangkok (Thailand), Hong Kong SAR, Kuala Lumpur (Malaysia), Seoul (South Korea), Shanghai (China), Singapore, Taipei (Taiwan), and Tokyo (Japan) completed interviewer-administered questionnaires to assess moderate-to-vigorous PA, recreational screen time, sleep duration, and covariates. Body fat percentage was measured using bioelectrical impedance analysis. We found that compliance with 24-hour movement guidelines differed in Asian adolescents across the eight cities. Adjusting for covariates, there was a negative association between number of the guidelines being met and body fat percentage in Asian adolescents. In addition, meeting only the sleep guideline and both the PA and sleep guidelines had negative associations with body fat percentage compared with no guidelines being met. Our findings improve the understanding about how compliance with 24-hour movement guidelines benefit a healthy body weight in adolescents, as well as contribute to development of evidence-based 24-hour movement guidelines for Asian young people. Future research is needed to gain better insights into the directionality of the associations between compliance with 24-hour movement guidelines and adiposity, as well as the mechanisms underlying the associations in Asian adolescents.

Physical activity and health-related fitness in Asian adolescents: The Asia-fit study.

Purpose: The present study aimed to investigate and compare physical activity (PA) and health-related fitness in Asian adolescents, and to examine the associations between meeting PA guidelines and attaining fitness standards. Methods: A sample of 12,590 adolescents (Mage = 13.63 years, SD = 1.01) from eight Asian metropolitan cities completed measurements of PA, five field-based fitness tests, and covariates. The fitness test scores were further classified into Healthy Fitness Zone (HFZ) or Needs Improvement Zone (NIZ). Results: Findings showed that adolescents' levels of PA and fitness components differed by cities. City differences were also found in proportions of meeting PA guidelines and achieving the HFZs of aerobic capacity, muscular fitness, and body composition. After controlling covariates, meeting PA guidelines positively associated with being in the HFZs of aerobic and muscular fitness, but the association was not significant with being in the body composition HFZ. Conclusion: There was a large variation in PA and health-related fitness in adolescents across the eight Asian cities. Asian adolescents achieving PA guidelines were more likely to be in the HFZ of aerobic and muscular fitness. Prospective follow-up studies are warranted to gain better insights into the relationships between objectively-measured PA and fitness.

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.

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.

Multicompartment model comparison of body fat assessment in Thai adolescents.

OBJECTIVE: To examine the limits of agreement of percent body fat (%BF) assessed by different compartment models (2C and 3C compared to 4C). MATERIAL AND METHOD: Fifty-one healthy Thai adolescents (25 males and 26 females) aged 16 to 19 years volunteered in the present study. Underwater weighing (UWW) and dual energy X-ray absorptiometry (DEXA) were used for measurement of %BF for 2C and 3C models. UWW was also used for body density, DEXA for bone mineral content and protein content, and deuterium oxide dilution method for total body water (TBW), used in Lohman's equation for 4C model. RESULTS: Body density total body water; bone mineral density, and fat free mass were significantly higher in males than in females, whereas females had significantly higher fat than males (p < 0.001). Compared to %BF4C, %BF(UWW) did not show significant deviations from the line of identity in males and females (R2 = 0.85 and 0.75 respectively), whereas %BF(DEXA) showed significant deviations from the line of identity in females (R2 = 0.59), but not in males (R2 = 0.60). Bland & Altman analysis demonstrated that UWW and DEXA tended to underestimate %BF in leaner adolescents and overestimate %BF in fatter adolescents. CONCLUSION: Percent body fat using underwater weighing (2C model) may be used interchangeable with the 4C model in both genders. However; DEXA (3C model) can only be used in males and not in females, which require further research. A regression equation to relate 2C and 3C models to 4C was developed to enable a better estimation of percent body fat in Thai adolescents.

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.

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.