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Diet and physical activity in pre-school children: a pilot project for surveillance in three regions of Italy
- Claudia Carletti, Anna Macaluso, Paola Pani, Margherita Caroli, Mariano Giacchi, Marcella Montico, Adriano Cattaneo
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- Journal:
- Public Health Nutrition / Volume 16 / Issue 4 / April 2013
- Published online by Cambridge University Press:
- 16 August 2012, pp. 616-624
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Objective
To test a surveillance system on diet and physical activity based on data gathered at well-child visits.
DesignCross-sectional data collection on growth, diet, physical activity and sociodemographic variables.
SettingOffices of 179 paediatricians in three Italian regions.
Subjects26 898 children for a total of 32 915 well-child visits at 1, 3, 5–6, 8–9, 12, 18, 24, 36 and 60–72 months of age.
ResultsThe BMI Z-score was lower than the WHO standard at 1 and 3 months but higher from 8–9 months onwards. The rates of breast-feeding at 1, 3, 5–6, 8–9 and 12 months were 88 %, 75 %, 64 %, 52 % and 32 %, respectively, with 5 % and 3 % continuing up to 24 and 36 months. Exclusive breast-feeding was 64 %, 54 % and 20 % at 1, 3 and 5–6 months, respectively; 57 % at 5 months and 85 % at 6 months were given complementary foods. Only 8 % and 10 % of children were taking five portions of fruit and vegetables daily, while 47 % and 51 % were consuming sugar-sweetened beverages at 36 and 60–72 months, respectively. At 60–72 months, less than 10 % reported at least 1 h of moderate-to-vigorous physical activity on 5–7 d/week, and 32 % watched television or played videogames for more than 2 h/d, every day. The majority of paediatricians rated the surveillance system as reliable and feasible.
ConclusionsSurveillance for diet and physical activity in pre-school children, with data gathered during well-child visits, is feasible and potentially useful to plan and evaluate activities for the prevention of obesity.
14 - Dietary management
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- By Margherita Caroli, Nutrition Unit, Department of Prevention, Brindisi., Walter Burniat, University Hospital for Children ‘Reine Fabiola’, Free University of Brussels
- Edited by Walter Burniat, University of Brussels, Tim J. Cole, Institute of Child Health, University College London, Inge Lissau, National Institute of Public Health, Copenhagen, Elizabeth M. E. Poskitt, London School of Hygiene and Tropical Medicine
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- Child and Adolescent Obesity
- Published online:
- 02 November 2009
- Print publication:
- 29 August 2002, pp 282-306
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Summary
Introduction
Why diet? Obesity is the consequence of a patchwork of environmental factors and specific genetic and biological features. Nutrition is only one environmental factor, albeit an important one (Chapter 4). In this chapter we:
review studies presenting with dietary programmes from the 1950s;
discuss and compare the evolution of the nutritional procedures;
evaluate the positive and negative effects of dieting;
propose nutritional guidelines related to different clinical situations.
History of dietary therapy
In 1957, Hoffman reported on the treatment of 60 obese children and adolescents, 30 boys and 30 girls (age range 5.4–16.3 years). The average excess weight was respectively, 47.9% and 42.9% above average for the age. The dietary instructions were those of a classic low-calorie diet. At 4 months, mean weight losses were 27% (range: 7.3–66.4%) body weight in boys and 18.3% (range: 3.5–51.8%) body weight in girls. The wide range in individual weight losses can be appreciated in this early paper and remains a feature of most more recent studies. Hoffman's 1957 paper can be considered a pioneering study but it is quite empirical and confused. The author limited fruit intakes with the aim of avoiding ‘simple sugar’. Various anorexigenic drugs were prescribed. These were largely dexedrine sulphate and amphetamine but in some cases combined with amylobarbital. So, it is not clear how much the diet or the drugs were the main determinants of the weight losses observed. Further, there were no follow-up data.
Following Hoffman's paper and until the end of the 1970s, a number of other publications appeared presenting the effects of low-calorie diets (LCD) and/or simple nutritional counselling.
7 - Clinical features, adverse effects and outcome
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- By Karl F.M. Zwiauer, Department of Paediatrics, General Hospital, Saint Poelten., Margherita Caroli, Preventive Medicine, Francavilla Fontana (Brindisi)., Ewa Malecka-Tendera, Department of Pathophysiology, Silesian School of Medicine, Katowice., Elizabeth M.E. Poskitt, International Nutrition Group, London School of Hygiene and Tropical Medicine
- Edited by Walter Burniat, University of Brussels, Tim J. Cole, Institute of Child Health, University College London, Inge Lissau, National Institute of Public Health, Copenhagen, Elizabeth M. E. Poskitt, London School of Hygiene and Tropical Medicine
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- Book:
- Child and Adolescent Obesity
- Published online:
- 02 November 2009
- Print publication:
- 29 August 2002, pp 131-153
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Summary
Clinical findings and immediate adverse effects
Obesity is one of the few conditions often diagnosed as easily by the layperson – even from a distance – as by the clinician. However, distinguishing normal fatness from abnormal fatness can be extremely difficult. This has been discussed in earlier chapters. Once obesity has been diagnosed, it is important to recognize the small proportion of obese children who have specific syndromes or pathology underlying their obesity. The vast majority of obese children remain those whose obesity does not seem associated with any underlying medical cause: simple, exogenous or nonpathological obesity. It is important to distinguish the obese children with underlying clinical disease or syndrome, but children with simple obesity also have specific problems and clinical signs. Tables 7.1 and 7.2 list the particular points to elicit in the clinical history and in clinical examination of children with simple obesity. Assessment is not easy. Too often, the subjective assumption – not totally unjustified – is that any symptomatology in these children must be secondary to their overweight and can therefore be cured by weight reduction alone. Further, the examination of grossly obese children, even when they are happy to be examined thoroughly, which is not always the case, is clinically difficult. Signs have to be elicited through the mass of fat. Equipment such as sphygmomanometers are not designed for use with the grossly obese. Thus, important symptoms and signs can easily be missed or ignored.