Presented to an international symposiumChonbuk National University, Korea

February 27, 2009

By

Ted Greiner, Professor of NutritionDept of Human Ecology, Hanyang University

Seoul, Korea

Topics/papers to be covered Determinants of obesity in children in Beijing

Influence of grandparents: Jiang J, Rosenqvist U, Wang H, Greiner T, Lian G,

Sarkadi A. Influence of grandparents on eating behaviors of young children in Chinese three-generation families. Appetite. 2007 May;48(3):377-83

Impact of infant feeding patterns: Jiang J, Rosenqvist U, Wang H, Koletzko H, Ma Y,

Greiner T. Relationship of parental characteristics and feeding practices to obesity in infants and young children in Beijing, China. Public Health Nutr. 2008; Aug 15:1-6

Topics/papers covered Other risk factors in children 2-6 years old:

Jiang JX, Rosenqvist U, Wang H, Greiner T, Ma Y, Toschke AM, Risk factors for overweight in 2- to 6-y-old children in Beijing, China. International Journal of Pediatric Obesity 2006;1(2):103-108.

Intervention studies to treat and prevent obesity in children in Beijing:

Jiang JX, Xia XL, Greiner T, Lian GL, Rosenqvist U. A two year family based behaviour treatment for obese children. Arch Dis Child. 2005;90(12):1235-8

Jiang J, Xia X, Greiner T, Wu G, Lian G, Rosenqvist U. The effects of a 3-year obesity intervention in schoolchildren in Beijing. Child Care Health Dev. 2007 Sep;33(5):641-6

Topics/papers Issues related to diet, overweight and health

among Chinese adults living in Sweden Chen Wen. Cardiovascular disease risk factors

in Chinese residents in Uppsala, Sweden. Masters thesis, Uppsala University Department of Women's and Children's Health, 2004.

Su Hebate. Dietary acculturation of Chinese residents in Uppsala. Masters thesis, Uppsala University Department of Women's and Children's Health, 2003.

Seven studies in total will be summarized

1. A qualitative study based on interviews with parents, grandparents 90% of children <6yr in Beijing are only child >50% of children in urban China are cared for

by grandparents Sample: 12 parents, 11 grandparents; majority

women; 13 had an obese child Grandparents were the primary caregivers in 3-

generation families They believed that heavy eating early in

childhood made children strong and protected their health and nutrition

They expressed love with food They used food rewards as educational and

emotional tools

2. Determinants of overweight in infants in BeijingA cross-sectional study of

anthropometry among 4654 children aged 1–35 months in twelve communities in Beijing

Interviews among a subsample of 215 families with overweight and 215 with normal weight children

The overall prevalence of overweight was 4.7%

2 (cont)Parental overweight and low parental

education were slightly more common in families with overweight children

Overweight children were more likely to have been introduced to infant formula and semi-solid foods during the first 4 months

They were also breastfed for a shorter period of time

3. Risk factors in children 2-6Cross-sectional study of 930 families with

2- to 6-year-old children in five kindergartens

Families were randomly selected from two of all six urban districts in Beijing

Data were obtained from parental self-report forms

The overall prevalence of overweight and obesity was 10.7% and 4.2%, respectively, increasing with age

Risk factors, cont.After adjusting for sex, age, family income

and kindergarten (for cluster study design), child overweight was associated with: parental overweight (Odds Ratio [OR] 2.43,

95% CI 0.78, 6.59) low maternal education level (OR 2.22, 95%

CI 1.39, 3.55)food restriction (OR 2.68, 95% CI 1.64, 4.29),television watching >2h/d (OR 1.56, 95% CI

1.17, 2.09)

4. A two year family based behaviour treatment for obese children

68 obese children in grades 7-9 from a single school in Beijing were randomly assigned to a control group or to a family based behavioral treatment program for two years

Components of the intervention included: Behavior modification for one or two

behaviors at a time per child Children kept a diary, monitored by parents Monthly home visits by researchers PE teachers provided an extra 2 hours of

exercise per week

5. The effects of a 3-year obesity intervention in schoolchildren in Beijing

Five primary schools were selected randomly in the Beijing urban area

Two were allocated to the intervention group and three to the control group

Each group of schools was located in two different districts

1029 children in intervention schools and 1396 children in control schools took part

Focused both on treatment and prevention

InterventionNutrition education from lead

researcher to collected parents once per semester (attendance >90%)

Educational materials on childhood obesity prevention were distributed to all the parents

Teachers were trained in the use of a special text book to give one classroom lesson on obesity per fortnight

Intervention cont.Extra meetings were held with

parents of obese children once per semester (attendance >74%)

Separate meetings for obese children once per semester (>80% attendance)

Meetings involved lectures, group discussion, Q&A, experience sharing

20 minutes of monitored running 4 days a week (50-70% attendance)

Results: baseline

Overweight

13.3 12.6

Obesity 11.7 11.5

Intervention

Control

No statistically significant differences

6. Cardiovascular disease risk factors in Chinese residents in SwedenBased on interviews with a sample of 80

individuals aged 18-64 yearsBorn in China but lived in Sweden > 3

monthsParticipants were identified by a

modified “snowball” method beginning with a list provided by the Chinese association in Uppsala

Height, weight and blood pressure were measured

Results 81.3% thought that cardiovascular

disease could be preventedRisk factors they listed were:

Fat in food, 58.8% Lack of exercise, 47.5% Stress, 31.3%Smoking, 13.8%obesity, 7.5% diabetes, 2.5% Hypertension, 3.8%

Results contRisk factors they had:

Smoking, 10%, but none>10 cigarettes/day; 7.5% quit after arriving in Sweden

Overweight, 11.3% (mean BMI 22.3±2.6)Obesity, 1.3%Hypertension, 13.8% (mean SBP and DBP

were 116.1±16.4mmHg and 74.9±10.9mmHg respectively)

Physical inactivity, 52.5% family history of CVD, 51.3% (37.5%

father; 43.8% mother)

Determinants Gender, age, education level, income level, living status and length of stay in Sweden were examined for both knowledge and possession of risk factors

The findings are presented in the following slides

CV risk factors by genderGender Male Female n 40 40 %Smoking 15 5overweight 15 7.5hypertension* 22.5 5Physical inactivity 52.5 52.5family history 47.5 55

mean±SDBMI** 23.2±2.5 21.4±2.5

SBP** 121.6±15.8 110.4±15.1 DBP** 79.0±11.0 70.8±9.2 Chi-square test for differences in proportions between groups. One-way

ANOVA was used to compare means difference between groups.* p<.05; ** p<.01

CV risk factors by age Age in years ≤34 35-44 ≥45 N 37 29

14 %Smoking 8.1 10.3

14.3 Overweight* 0 20.7

21.4 Hypertension* 5.4 13.8

35.7 Physical inactivity 59.5 48.3

42.9Family history 48.9 51.7

51.7 mean±SDBMI** 21.2±1.8 23.0±3.1

23.8±2.1SBP 114.1±12.0 113.6±13.1

126.3±27.0DBP* 72.2±8.7 75.1±11.0

81.5±13.7 Chi-square test for differences in proportions among groups. One-way

ANOVA was used to compare means difference among groups.* p<.05; ** p<.01

CV risk factors by length of stay in Sweden months 3-12 13-60 61-120 >120 n 24 23 19

14 %

Smoking 4.2 8.7 15.8 14.3

Obesity 4.2 13.0 15.8 14.3

Hypertension 12.5 4.3 10.5 35.7

Physical inactivity ´ 41.7 47.8 78.9 42.9

Family history 58.3 39.1 57.9 50

mean±SD

BMI 22.6±2.7 21.9±2.5 21.7±2.8 23.3±2.4

SBP 115.8±10.9 114.0±12.9 114.2±18.1 122.5±25.1

DBP 74.6±10.9 72.3±8.1 75.7±10.6 78.6±14.8

 

Chi-square test for differences in proportion among groups. One-way ANOVA was used to compare means differences among groups.* p<.05; ** p<.01

Comparison of risk factors between hypertensives and non-hypertensives

Hypertension non-hypertension

N 11 69 mean±SD BMI** 25.0±3.4 21.9±2.2

%Overweight 27.3 8.7

Smoking**

Never 36.4 89.9 Former 27.3 4.3Current 36.4 5.8 Chi-Square test or Fisher’s exact test for the frequencies difference

between groups. One-way ANOVA for means differences between groups. *P<0.05; **P<0.01.

7. Dietary acculturation of Chinese residents in Uppsala76 Chinese residents in Uppsala,

Sweden were interviewed; data were complete on 68

Participants were identified by a modified “snowball” method beginning with a list provided by the Chinese association in Uppsala

Born in China but lived in Sweden > 3 months

>18 years of age

Results The following foods were consumed more in

Sweden than had been in China:cheese (72.1%)butter (64.7%)milk (54%)chicken/poultry (70.6%)fruit (57.4%) coffee (61.8%)potato (48.5 %)egg (47.1 %)

Results, cont The following foods were consumed less in

Sweden than had been in China: legumes and legume products (89.7%) animal fat (51.5%) fatty meat (52.9%) fish/shellfish (54.4%) dark green leaves vegetables (85.3%) other green leafy vegetables (66.2%) other vegetables (61.8%) snack food (66.2%) alcohol (48.5 %)

Factors IncreasedN %

Same N %

DecreasedN %

Concern about health

22 32.4

40 58.8

6 8.8

Concern about weight

10 14.7

48 70.6

10 14.7

Concern about price

38 55.9

21 30.9

9 13.2

Changes in Factors that influenced dietary habits after coming to Sweden

Determinants of Dietary Change Women decreased lard consumption more

than men (68 vs 35%) People living with someone else increased

consumption of poultry and fruit more than those living alone

Those with higher income ate more fruit and cheese but less legumes

Those who had lived longer in Sweden increased fruit consumption more

Those who most increased their fruit consumption were more likely to have gained weight after coming to Sweden

Thank you!Full text copies of these and a few

other studies on obesity can be downloaded at:

http://global-breastfeeding.org/category/obesity/

(Or go to www.global-breastfeeding.org and click on obesity on the right side)