Relationship between 8/9-yr-old school children BMI, parents' BMI and educational level: a cross sectional survey

Lazzeri Giacomo, Pammolli Andrea, Pilato Valentina, Giacchi

Description

Parents are responsible not only for the genetic structure of their children, but also for passing onto them their behaviours and attitudes toward life. The aim of this study was to analyse the connection between school-age children's obesity and that of their parents as well as between child obesity and parents' educational level, as a proxy indicator of the socio-economic status (SES) of families in Tuscany. Methods The children sample was selected from " OKkio alla Salute 2010" (a cross sectional survey carried out by the Italian Institute of Health) and consisted of 1,751 (922 males and 855 females) 8-9 year-old school children. Weight and height were measured by ad hoc trained personnel, and Body Mass Index (BMI) categories were calculated using Cole et al .'s cut-off. Parents' weight, height and educational level were collected by a self-administered questionnaire. The educational levels were classified as high, medium and low. Results The prevalence of obese children increased along the parents' BMI category: from 1.4% for underweight mothers to 30.3% for obese mothers and from 4% for under-normal-weight fathers to 23.9% for obese fathers (p < 0.001). An inverse relationship was observed between the parents' educational level and child obesity, the lowest educational level corresponding to the highest prevalence of obese children: 9.3% for mothers with a low educational level compared to 5.8% for mothers with a high educational level (p = 0.15); similarly, the corresponding prevalence for fathers was 9.5% compared to 4.5% (p = 0.03). Conclusion Parents' obesity and the cultural resources of the family, particularly the father's, seem to influence the prevalence of overweight and obesity in Tuscan children.

Sujets

• Childhood
• Obesity
• Underweight

Informations

• Publié par: biomed
• Publié le: 01 janvier 2011
• Nombre de lectures: 11
• Langue: English

Extrait

Lazzeri et al. Nutrition Journal 2011, 10:76
http://www.nutritionj.com/content/10/1/76
RESEARCH Open Access
Relationship between 8/9-yr-old school children
BMI, parents’ BMI and educational level: a cross
sectional survey
*Giacomo Lazzeri , Andrea Pammolli, Valentina Pilato and Mariano V Giacchi
Abstract
Background: Parents are responsible not only for the genetic structure of their children, but also for passing onto
them their behaviours and attitudes toward life. The aim of this study was to analyse the connection between
school-age children’s obesity and that of their parents as well as between child obesity and parents’ educational
level, as a proxy indicator of the socio-economic status (SES) of families in Tuscany.
Methods: The children sample was selected from “OKkio alla Salute 2010” (a cross sectional survey carried out by
the Italian Institute of Health) and consisted of 1,751 (922 males and 855 females) 8-9 year-old school children.
Weight and height were measured by ad hoc trained personnel, and Body Mass Index (BMI) categories were
calculated using Cole et al.’s cut-off. Parents’ weight, height and educational level were collected by a self-
administered questionnaire. The educational levels were classified as high, medium and low.
Results: The prevalence of obese children increased along the parents’ BMI category: from 1.4% for underweight
mothers to 30.3% for obese mothers and from 4% for under-normal-weight fathers to 23.9% for obese fathers (p <
0.001). An inverse relationship was observed between the parents’ educational level and child obesity, the lowest
educational level corresponding to the highest prevalence of obese children: 9.3% for mothers with a low
edu level compared to 5.8% for mothers with a high educational level (p = 0.15); similarly, the
corresponding prevalence for fathers was 9.5% compared to 4.5% (p = 0.03).
Conclusion: Parents’ obesity and the cultural resources of the family, particularly the father’s, seem to influence the
prevalence of overweight and obesity in Tuscan children.
Keywords: childhood, obesity, underweight, parents?’? nutritional status, educational level
Background complex phenomenon regulated by a series of physiolo-
The prevalence of childhood obesity is increasing rapidly gical mechanisms, some of which are still unknown.
in industrialized nations. Childhood obesity can create Therefore, the genetic factor in families seems to play
many complications at the cardiovascular, endocrine, an important role in the risk of obesity for a child,
pulmonary, musculoskeletal and gastrointestinal levels, although it only partly explains the phenomenon [2-5].
as well as possible psycho-social consequences (poor self Numerous studies have shown that the risk of becoming
esteem, depression, eating disorders) [1]. For this reason, obese is higher in children of obese parents [6-9]. Par-
ents are responsible not only for the genetic structure ofrecent studies have focused on the possible causes and
risk factors associated with obesity in paediatric ages. their children, but also for passing onto them their
Obesity is known to be a multi-factorial disorder origi- behaviours and attitudes toward life. The lifestyle of the
nating from the interaction of genetic and environmen- family plays an important role in the nutritional and
tal factors; the accumulation of body fat is a very behavioural choices of the child and this can be the
result of both social and economic factors, such as the
place of residence; the parents’ cultural level; the eco-* Correspondence: [e-mail]
CREPS-Research Center for Health Education and Promotion, University of nomic assets of the family; and their income. It is well
Siena, Via A. Moro 2 Siena 53100, Italy
© 2011 Lazzeri et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.Lazzeri et al. Nutrition Journal 2011, 10:76 Page 2 of 8
http://www.nutritionj.com/content/10/1/76
known that there is an inverse relationship between and obesity of 30%, a precision of 3% using a 95% confi-
socio-economic conditions and the health status of the dence intervals, and a design effect of 2 [16].
population in developed countries. In Italy, it has been Specifically trained personnel using appropriate and
shown that people from a low socio-economic level are standardised instruments measured the children’s height
subject to a higher risk of morbidity and mortality and weight. To measure the anthropometric values, we
[10,11]. A study by Mackenbach JP et al.showedthat, followed the recommendations of the World Health
during the 1990s, in the six countries considered (Fin- Organization [17].
We used electronic scales with a liquid crystal displayland, the Netherlands, Denmark, the United Kingdom,
that measured every 100 grams of weight. Height wasSweden and Italy), the differences in mortality rates
among population groups in high and low socio-eco- measured with a portable stadiometer, with a precision
nomic conditions were growing, compared with an over- of 0.1 cm; exact decimal age was calculated from the
all reduction in mortality rates [12]. Studies have shown date of birth and day of measurement; BMI was then
an inverse relationship between children Body Mass calculated from weight and height, using the following
Index (BMI) and family educational level; in this con- formula: weight (kg)/height (m²). BMI classes of the
text, the parents’ educational level is one of the most children were set using the Cole et al. Method [18,19];
commonly used indicator [13-15]. this allowed us to have specific cut-off points for males
In the context of the program “Gaining Health in Eur- and females at every age as recommended by the Inter-
ope” launched by WHO-Europe in 2006, the first popu- national Obesity Task Force (IOTF). We thus obtained
lation based nutritional surveillance system named sixclassesofBMI:thinnessgrades3,2,1,normal
“OKkio alla Salute” was launched in Italy. weight, overweight and obesity. According to the Cole’s
Theaimofthepresentstudyistofocusontherisk definition, the term “underweight” in children includes
factors for obesity in paediatric age and, particularly, on thinness grades 3 and 2 (underweight group) while thin-
the possible association between parental and child obe- ness grade 1 and normal weight go into another class
sity and the influence that parents’ educational level (normal group) [19] as shows in table 1.
could exert on children’s weight status. The weight, height and educational level of both parents
were recorded in a self-administered questionnaire.
Methods Weight (kg) and height (m) were used for the calculation
The protocol for the “Okkio alla Salute” survey devel- of the BMI (kg/m²); the parents’ BMI classes (underweight,
oped by the National Institute of Health and reviewed normal weight, overweight or obese) were established
in collaboration with regional coordinators and mem- using international cut-off points for adults [17]. For 132
(7.4%) mothers and 202 (11.4%) fathers the BMI calcula-bers of the technical committee is described elsewhere
[16]. tion was not possible due to lack of the necessary data.
In this study we will report data regarding the 2010 Three levels of education were then established: high
Tuscany Regional project. In our region, to guarantee (university degree), medium (secondary school diploma)
the maximum level of territorial coverage, all 12 Local and low (middle school, elementary school or none).
Health Units were invited, and all agreed to join, and Data were analyzed using SPSS (ver.16) and EpiInfo
collaborate in, the project. Once enrolled, all 12 Local (ver.3.5.1.). Descriptive statistics (e.g., mean, proportion,
Health Units met for an explanation of the protocol and standard deviation) were used to describe the character-
2 2to arrange the operational formalities of the activities in istics of the sample. The c -test and c -test for trend
Tuscany. were used to explore the relationship between: a) chil-
Overall, opt-out consent was signed by 95.5% (1983 dren’s BMI classes and parents’ BMI classes, b) chil-
children) of the parents of the children enrolled in the dren’s BMI and parents’ educational level.
99 classes selected; 91.3% (1811 children) of all invited
children were present on the day of the study. After
Table 1 Nutritional status of 8-9 year old school-childrendata cleaning, 60 more children were discarded (34 out
No. % IC95%of age range or with missing age); the remaining 88.3%
Underweight Thinness 3 6 0.3 0.06-0.63(1,751 children: 922 males and 855 females) out of all 2 5 0.3 0.02-0.54enrolled children were analysed.
Normal Thinness 1 91 5.4 4.24-6.53Students were selected by a stratified one-stage sample
Normal 1113 64.3 61.96-66.63
with classes as clusters of students and primary stratifi-
Overweight Pre-obese 387 21.8 19.73-23.92
cation by relative health district and municipality size.
Obese Obese 149 7.9 6.54-9.19
The number of children to be enrolled was estimated
Total 1751 100
on the basis of an expected prevalence of overweightLazzeri et al. Nutrition Journal 2011, 10:76 Page 3 of 8
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The Kendall’s τ coefficient was used to calculate the percentage of o