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12-13 Dec 2012, Indonesia

Complementary food among infants obesity age from birth to 24 months in Thailand : Based on the Prospective Cohort Study of Thai Children (PCTC). By Aroonsri Mongkolchati Ph.D. Uraiporn Chittchang Ph.D. Ladda Mo- Suwan,MD Jiraporn Chompikul , Ph.D. Chanpen Choprapawon,MD

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12-13 Dec 2012, Indonesia

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  1. Complementary food among infants obesity age from birth to 24 months in Thailand : Based on the Prospective Cohort Study of Thai Children (PCTC) By AroonsriMongkolchati Ph.D. UraipornChittchang Ph.D. Ladda Mo-Suwan,MD JirapornChompikul, Ph.D. ChanpenChoprapawon,MD ASEAN Institute for Health Development (AIHD), Mahidol University 12-13 Dec 2012, Indonesia

  2. Outline of the presentation Introduction • Research question • Objective Methodology • Study Design/ Study area • outcome measurement • data analysis Results • Prevalence • Predictors Discussion • Discussion/ Recommendation Conclusion

  3. Background • child obesity: refers toa problem of growth in child weight -height for age level higher than +2 Z-Score BMI higher than > 95 percentile, (WHO, 2008) • Child obesity is associated with serious health problems (De Onis M., 2006) • Obesity is emerging as a morbid disease both in developing and Westernized countries. (Mercedes de Onis, 2006) • In 2010, 43 million children in developing countries were estimated • Increased from 4.2 in 1990 to 9.5% in 2010 (De Onis M., 2006)

  4. Child Obesity & Trend • The problem of child obesity in early age arise more important, (De Onis M., 2006, Kosti RI., 2005, WHO, 2008)

  5. Child Obesity & Trend

  6. Childhood Obesity Epidemic

  7. Background • Obesity is linked to the development of type 2 diabetes, HT and cardiovascular disease (Wang Y., Lobstein T., 2006) • Moreover, psychosocial, pulmonary, gastrointestinal, neurogical system, endocrine

  8. Complication of Childhood Obesity

  9. Background • Potential factors related >child obesity; • Genetic, Obesity mother • Nutrition, Increase caloric intake, Dietary Pattern, fast food, Type of food • Parent Life style • Physical activity, TV • Family Socio economic (John Reilly, 2005)

  10. Background • Focusing on nutrition factors; • Exclusive Breast milk until 6 months • Introduction Solid or semi solid food or soft food during 6-9months (WHO, 2003) • CF introduced at 4-6 months, (MOPH, old rec. Thai) recently, > 6 mo, • Complementary food (CF) should be timing from 6 months toward and should be cover period from 6-24 mo. In addition to breast milk (WHO, 2003) • Adequacy safe, and appropriate type of CF (WHO, UNICEF, CF Indicators, 2010) • However, few study was explored on an earlier feed of CF, in infant & cohort study

  11. Research question • What is the prevalence of child obesity from birth-24 months? • What are the association between factors and child obesity from 12-24 months?

  12. Objectives: • To determine the percentages of prevalence of child obesity age at birth 6, 12, 18 and 24 months • To investigate the association between factors and child obesity

  13. Material and Method: • The Prospective Cohort Study of Thai Children (PCTC), it is an observational study and was carried out during 2000-2002 • Inclusion criteria • All 4,245 children from 5 areas in Thailand were included • Exclusion criteria • have frequently migration, and family who were Burma, Karien or Laotien/who were delivered as twin, dead, had significant health problem such as abnormality detection

  14. Study Area

  15. Material and Method: Anthropometric measurements (Dependent Variables) • the physician /well trained research assistants • WHO’s growth reference standard year 2006 • Using BMI >95 percentile, weight-height +2Z score for child obesity Independent Variables • Child gender, weight, Maternal weight, height/ Maternal Education • Family income and the study Areas • Nutrition factors , cut-point, using 4 mo., 6 mo., 7 mo. Data analysis • Numbers and percentages were used to describe prevalence and incidence • Multiple Logistic Regression (GLM) • Generalized Estimation Equation (GEE) model

  16. 3,898 children were in the final analysis • Socio demographic Characteristic; • 50% girl, 52.7 % mother were primary school • 71% were gain normal weight • 96 % of mothers were tall higher than 145 cm. • 76% children taken care by mothers • From 19 types of CF, children were introduced CF, mostly age between 6-7 mo.

  17. The prevalence, WHO ref., of child obesity presented an increasing rate, age at birth,6, 12, 18 and 24 months was 0.9%, 2.1%, 2.0%, 3.7%, and 4.9 %, respectively.

  18. Result

  19. We adjusted for confounding factors, • Child Sex, mother-height,education, weight-gain pregnancy, family income, and study area(clusters), BKK, Hill tribe, Nan- city, Muslim, Buddhist, were adjusted variables

  20. The interested variables, the factor of complementary food showed associated with child obesity significantly (p-value<0.05) • at age from12,18,24 months • Breast feeding, were protective effects, was 90%,was 86% , and 40% respectively • Rice+ Banana, Rice (RR=1.9, 1.5, 1.6) • At age 24 months • oily food, sweet drink, early age < 7 months (RR=2.32, 95% CI,0.89-6.04)

  21. For GEE (General Equation Estimation) analysis, population average, • Gender and Bangkok areas was significantly correlated with child obesity (p< 0.001) • Nutrition factors, Breast feeding stopped at ,1-3 months were risky to child obesity, significantly adj. OR= 1.02 (95%CI,=1.00-1.05) • However, Oil, sweet drink, snack showed low association with obesity

  22. Discussion • Prevalence of child obesity, this study showed an increasing rate from birth to 24 months. • To reduce infant’s obesity this study suggests that to identify new case, follow up sentinel system should be established for an early diagnosis.

  23. Discussion • Nutrition factors, this report did not explore freq. of CF and also quality of food, next research • Bangkok area, this study showed highest association, however, BKK is a hospital base, hence more study is needed to be confirmed • Hill tribe area, since this study showed small sample size • further research /qualitative research are also needed. • However, many factors influenced onchild obesity in early young age were not investigated;

  24. Conclusion: • child obesity early young age reported an increasing trend of problem in Thailand • Early age of introduction CF related with child obesity • to reduce child obesity in Thailand in early infant’s life an early nutritional interventions, eg. CF counseling course for care taker, integrated training course for health worker and quality antenatal care are vital

  25. Acknowledgements • Thank you for the funders, TRF, HSRI, MOPH, DUMEX science, the families who participated in the study, the PCTC’s researchers team • For more related published paper: • http://www.mat.or.th/journal/ • http://www.scopus.com/home.url • http://www.jhr.cphs.chula.ac.th

  26. for your attention

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