WHO European Childhood Obesity Surveillance Initiative: School Nutrition Environment and Body Mass Index in Primary Schools

Abstract

Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children’s weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children’s BMI/A Z-scores was calculated. Results: Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%−95% of schools) and school nutrition environment scores (range: 0.30−0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20−1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed. Conclusions: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the “unhealthy” school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.

A Prevalência de Pré-Obesidade/Obesidade nas Crianças do Ensino Pré-Escolar e Escolar na Autarquia de Vila Nova de Gaia, Portugal

“…Relativamente aos resultados encontrados verificamos que eles se encontram em concordância com outros estudos nacionais e internacionais em que a prevalência de excesso de peso, se apresenta a rondar os 30%. 14,18,30,50 São poucos os trabalhos nacionais e/ou internacionais que apresentem uma gama de idades desde a idade pré--escolar (três anos) até aos 10 anos (fim do primeiro ciclo de ensino básico). A nível Europeu, no âmbito do projeto Identification and prevention of Dietary -and lifestyle -induced health Effects In Children and infantS (IDEFICS) 51 que estudou crianças com menos de 10 anos de idade, tal como noutros trabalhos, verificou-se uma maior prevalência de excesso de peso nos países do sul da Europa 52 com a Itália a liderar com 42,4%.…”

“…55 Para a análise dos resultados encontrados para o subgrupo dos cinco aos 13 anos de idade o principal estudo de comparação é o COSI. À semelhança do descrito por Wijnhoven T et al 18 As diferenças evidenciadas neste estudo poderão dever-se ao facto de a amostra corresponder à quase totalidade da população em estudo, bem como ao intervalo alargado de idades abrangido, uma vez que a maioria dos estudos o restringe a um ou dois anos de idade a população avaliada.…”

“…16 Alguns estudos sugerem que o excesso de peso durante a infância é um fator de risco para o desenvolvimento de obesidade na idade adulta, calculando-se que cerca de 60% das crianças que se apresentem nestas condições antes da puberdade, manterão, enquanto jovens adultos, o excesso de peso, com efeitos adversos a curto e a longo prazo, que afetam a morbilidade e a mortalidade do adulto. 9,12,13,17,18 As consequências da obesidade durante a infância e adolescência, incluem não só problemas a nível de saúde física, como hipertensão arterial, hipercolesterolemia, síndrome metabólica, diabetes tipo 2, problemas osteoarticulares, apneia do sono, asma e cirrose hepática, mas também consequências a nível psicológico, social e comportamental, como baixa autoestima, isolamento social, insucesso escolar, descriminação, depressão e diminuição da qualidade de vida em geral. 13 Consequentemente, a avaliação e intervenção precoces, ainda durante a infância, tornam-se fundamentais para prevenir a disseminação desta epidemia e comorbilidades associadas.…”

Early Vascular Ageing (EVA): Definitions and Clinical Applicability

“…Even if, so far, no other study has determined the prevalence of EVA, it is noteworthy to analyze two different aspects that could offer partial explanation for these results: a) following a political revolution approximately 40 years ago, Portugal has experienced a significant change in both living / nutritional habits and social behavior; the truth to the matter is that nowadays, statistics show high levels of childhood and teenager overweight and obesity as well as physical inactivity and elevated blood pressure levels [66,67] -for subjects below 40 years of age, for instance, blood pressure levels are significantly above the minimum theoretical exposure risk values for the development of cardiovascular disease [68]; b) in several studies looking into another vascular biomarker (cIMT), an inverse relationship has been found between the maintenance of ideal cardiovascular health behaviors in childhood and measured values of cIMT [69][70][71].…”

Sweetened beverages, snacks and overweight: findings from the young lives cohort study in Peru

“…Diet patterns, mainly the consumption of high-ener gydense foods (i.e. unhealthy snacks, junk foods and sweetened beverages), are also involved in the development of overweight (10)(11)(12)(13)(14)(15)(16). Snacks and sweetened beverages are an important target in the prevention of overweight as they are modifiable components of diet (17).…”