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Studies on obesity in Chinese children in Beijing and Chinese adults in Sweden

Studies on obesity in Chinese children in Beijing and Chinese adults in Sweden. Presented to an international symposium Chonbuk National University, Korea February 27, 2009. By Ted Greiner, Professor of Nutrition Dept of Human Ecology, Hanyang University Seoul, Korea.

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Studies on obesity in Chinese children in Beijing and Chinese adults in Sweden

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  1. Studies on obesity in Chinese children in Beijing and Chinese adults in Sweden Presented to an international symposium Chonbuk National University, Korea February 27, 2009 By Ted Greiner, Professor of Nutrition Dept of Human Ecology, Hanyang University Seoul, Korea

  2. 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

  3. 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

  4. 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

  5. 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

  6. 2. Determinants of overweight in infants in Beijing • A 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%

  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

  8. 3. Risk factors in children 2-6 • Cross-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

  9. 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)

  10. 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

  11. 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

  12. Intervention • Nutrition 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

  13. 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)

  14. Results: baseline No statistically significant differences

  15. 6. Cardiovascular disease risk factors in Chinese residents in Sweden • Based on interviews with a sample of 80 individuals aged 18-64 years • Born in China but lived in Sweden > 3 months • Participants 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

  16. Results • 81.3% thought that cardiovascular disease could be prevented • Risk 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%

  17. Results cont • Risk 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)

  18. 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

  19. CV risk factors by gender Gender Male Female n 40 40 % Smoking 15 5 overweight 15 7.5 hypertension* 22.5 5 Physical inactivity 52.5 52.5 family history 47.5 55 mean±SD BMI** 23.2±2.5 21.4±2.5 SBP** 121.6±15.8 110.4±15.1 DBP** 79.0±11.070.8±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

  20. 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 42.9 Family history 48.9 51.7 51.7 mean±SD BMI** 21.2±1.8 23.0±3.1 23.8±2.1 SBP 114.1±12.0 113.6±13.1 126.3±27.0 DBP* 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

  21. 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

  22. 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 4.3 Current 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.

  23. 7. Dietary acculturation of Chinese residents in Uppsala • 76 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

  24. 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 %)

  25. 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 %)

  26. Changes in Factors that influenced dietary habits after coming to Sweden

  27. 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

  28. 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)

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