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AIMS Public Health

2024, Volume 11, Issue 3: 803-818. doi: 10.3934/publichealth.2024040
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Research article

Association of nutrition behavior and food intake with overweight and obesity among school-aged children and adolescents in Pakistan: a cross-sectional study

  • 1.
    School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai 200438, China
  • 2.
    Department of Allied Health Sciences, Health Services Academy, Islamabad 44000, Pakistan
  • 3.
    Department of Mass Communication, University of Lahore, Lahore 54000, Pakistan
  • 4.
    School of Physical Education, Shanxi University, Taiyuan 030006, China
  • 5.
    Department of Education, International Islamic University, Islamabad 44000, Pakistan
  • 6.
    Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
  • 7.
    School of Physical Education, Xi'an Physical Education University, Shaanxi 710064, China
  • 8.
    Department of Physical Education and Sport Science, University of Thessaly, Trikala 42100, Greece
  • Received: 28 February 2024 Revised: 27 April 2024 Accepted: 09 May 2024 Published: 21 June 2024

  • Purpose 

    This study aimed to assess the association between nutrition behavior, food intake, being overweight, and obesity among school-aged children and adolescents aged 9 to 17 years. Additionally, it sought to examine how these factors influence being overweight and obese within this population.

    Methods 

    A population-based cross-sectional study was conducted with a representative multistage cluster sample of 4200 Pakistani school-aged children and adolescents aged 9 to 17 years from 62 schools across seven random districts in Punjab province, Pakistan. Underweight (BMI < 5th percentile), overweight (85th ≤ BMI < 95th percentile), and obese (95th percentile ≤ BMI) were defined using the US Center for Disease Control (CDC) 2000 criteria, and a Chi-square test utilized for comparison. The Pearson correlation coefficient (r) assessed any correlations, while a linear regression analysis explored the predictive power of Nutrition Behavior/Food Intake factors (independent variables) on body-weight (dependent variable). A logistic regression analysis estimated the simultaneous influence of multiple factors on the dichotomous outcomes, and the 95% confidence intervals (CI) were calculated. The statistical significance level was set at p < 0.05.

    Results 

    The study was comprised of 4108 Pakistani school children aged 9 to 17 years (mean age = 13.92 years, 59.3% boys) from 62 schools. Among them, the prevalence of being overweight and obese individuals was 19.4% and 10.7%, respectively. Factors such as skipping breakfast (OR 2.45, 95% CI 1.53–3.93, p < 0.001), consuming vegetables less than once a week (OR 4.12, 95% CI 3.06–5.55, p < 0.001), consuming soft drinks three or more times a week (OR 4.74, 95% CI 3.73–6.04, p < 0.001), and consuming fast food three or more times a week (OR 10.56, 95% CI 8.16–13.67, p < 0.001) were associated with a higher risk of obesity.

    Conclusion 

    Being overweight and obese pose significant concerns among school-aged children and adolescents in Pakistan, showing a troubling upward trend. Poor nutrition behaviors, including frequenting fast-food restaurants and low consumption of fruits and vegetables, contribute to these issues. It is imperative to comprehend these risk factors to formulate impactful policies and dietary interventions that target childhood obesity in Pakistan. Identifying vulnerable populations and implementing tailored intervention strategies are essential for public health efforts. While further interventions may be needed to reduce the body mass index (BMI) and manage being overweight and obese, the findings of this study provide valuable insights into addressing these critical health challenges.

    Citation: Moazzam Tanveer, Ejaz Asghar, Umar Tanveer, Nadeem Roy, Asifa Zeba, Sameer Badri Al-Mhanna, Xiaoran Ma, Alexios Batrakoulis. Association of nutrition behavior and food intake with overweight and obesity among school-aged children and adolescents in Pakistan: a cross-sectional study[J]. AIMS Public Health, 2024, 11(3): 803-818. doi: 10.3934/publichealth.2024040

    Related Papers:

  • Purpose 

    This study aimed to assess the association between nutrition behavior, food intake, being overweight, and obesity among school-aged children and adolescents aged 9 to 17 years. Additionally, it sought to examine how these factors influence being overweight and obese within this population.

    Methods 

    A population-based cross-sectional study was conducted with a representative multistage cluster sample of 4200 Pakistani school-aged children and adolescents aged 9 to 17 years from 62 schools across seven random districts in Punjab province, Pakistan. Underweight (BMI < 5th percentile), overweight (85th ≤ BMI < 95th percentile), and obese (95th percentile ≤ BMI) were defined using the US Center for Disease Control (CDC) 2000 criteria, and a Chi-square test utilized for comparison. The Pearson correlation coefficient (r) assessed any correlations, while a linear regression analysis explored the predictive power of Nutrition Behavior/Food Intake factors (independent variables) on body-weight (dependent variable). A logistic regression analysis estimated the simultaneous influence of multiple factors on the dichotomous outcomes, and the 95% confidence intervals (CI) were calculated. The statistical significance level was set at p < 0.05.

    Results 

    The study was comprised of 4108 Pakistani school children aged 9 to 17 years (mean age = 13.92 years, 59.3% boys) from 62 schools. Among them, the prevalence of being overweight and obese individuals was 19.4% and 10.7%, respectively. Factors such as skipping breakfast (OR 2.45, 95% CI 1.53–3.93, p < 0.001), consuming vegetables less than once a week (OR 4.12, 95% CI 3.06–5.55, p < 0.001), consuming soft drinks three or more times a week (OR 4.74, 95% CI 3.73–6.04, p < 0.001), and consuming fast food three or more times a week (OR 10.56, 95% CI 8.16–13.67, p < 0.001) were associated with a higher risk of obesity.

    Conclusion 

    Being overweight and obese pose significant concerns among school-aged children and adolescents in Pakistan, showing a troubling upward trend. Poor nutrition behaviors, including frequenting fast-food restaurants and low consumption of fruits and vegetables, contribute to these issues. It is imperative to comprehend these risk factors to formulate impactful policies and dietary interventions that target childhood obesity in Pakistan. Identifying vulnerable populations and implementing tailored intervention strategies are essential for public health efforts. While further interventions may be needed to reduce the body mass index (BMI) and manage being overweight and obese, the findings of this study provide valuable insights into addressing these critical health challenges.


    加载中

    Acknowledgments


    The authors would like to express their gratitude to the children, parents, guardians, and teachers for their invaluable participation in this study. Special thanks are extended to the Department of Rescue-1122 for their generous grant support, which facilitated data collection. Appreciation is also extended to the Education Department for granting permission for data collection. Furthermore, the authors acknowledge the School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China, for approving the study, and the Department of Physical Education and Sport Sciences, Health Services Academy, Islamabad 44000, Pakistan, for providing partial financial support.

    Conflict of interest


    The authors have declared they have no competing interests.

    [1] Cai Y, Zhu X, Wu X (2017) Overweight, obesity, and screen-time viewing among Chinese school-aged children: national prevalence estimates from the 2016 Physical Activity and Fitness in China—The Youth Study. J Sport Health Sci 6: 404-409. https://doi.org/10.1016/j.jshs.2017.09.002
    [2] Chen ST, Liu Y, Tremblay MS, et al. (2021) Meeting 24-h movement guidelines: Prevalence, correlates, and the relationships with overweight and obesity among Chinese children and adolescents. J Sport Health Sci 10: 349-359. https://doi.org/10.1016/j.jshs.2020.07.002
    [3] Mushtaq MU, Gull S, Mushtaq K, et al. (2011) Dietary behaviors, physical activity and sedentary lifestyle associated with overweight and obesity, and their socio-demographic correlates, among Pakistani primary school children. Int J Behav Nutr Phy 8: 1-13. https://doi.org/10.1186/1479-5868-8-130
    [4] Di Cesare M, Sorić M, Bovet P, et al. (2019) The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Med 17: 1-20. https://doi.org/10.1186/s12916-019-1449-8
    [5] Tanveer M, Hohmann A, Roy N, et al. (2022) The current prevalence of underweight, overweight, and obesity associated with demographic factors among Pakistan school-aged children and adolescents—An empirical cross-sectional study. Int J Environ Res Public Health 19: 11619. https://doi.org/10.3390/ijerph191811619
    [6] Tanveer M, Roy N, Zeba A, et al. (2022) Prevalence of Body Mass Index and Associated with Demographic Factors among Pakistan School-Aged Adolescents. Pak J Med Health Sci 16: 212. https://doi.org/10.53350/pjmhs22166212
    [7] Katsoulis M, Lai AG, Diaz-Ordaz K, et al. (2021) Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records. Lancet Diabetes Endo 9: 681-694. https://doi.org/10.1016/S2213-8587(21)00207-2
    [8] Koca T, Akcam M, Serdaroglu F, et al. (2017) Breakfast habits, dairy product consumption, physical activity, and their associations with body mass index in children aged 6–18. Eur J Pediatr 176: 1251-1257. https://doi.org/10.1007/s00431-017-2976-y
    [9] Makri R, Katsoulis M, Fotiou A, et al. (2022) Prevalence of overweight and obesity and associated diet-related behaviours and habits in a representative sample of adolescents in Greece. Children 9: 119. https://doi.org/10.3390/children9010119
    [10] Mancino L, Todd J E, Guthrie J, et al. (2014) Food away from home and childhood obesity. Curr Obes Rep 3: 459-469. https://doi.org/10.1007/s13679-014-0121-z
    [11] Stea TH, Tveter ET, Te Velde SJ, et al. (2018) The effect of an extra piece of fruit or vegetables at school on weight status in two generations-14 years follow-up of the Fruit and Vegetables Makes the Marks study. PLoS One 13: e0205498. https://doi.org/10.1371/journal.pone.0205498
    [12] Newby PK (2009) Plant foods and plant-based diets: protective against childhood obesity?. Am J Clin Nutr 89: 1572S-1587S. https://doi.org/10.3945/ajcn.2009.26736G
    [13] Ford ND, Patel SA, Narayan KMV (2017) Obesity in low-and middle-income countries: burden, drivers, and emerging challenges. Annu Rev Public Health 38: 145-164. https://doi.org/10.1146/annurev-publhealth-031816-044604
    [14] Tanveer M, Tanveer U, Zeba A, et al. (2024) Prevalence of body mass index and its association with interpersonal family-level factors among school-aged children and adolescents in Pakistan. J Popul Ther Clin Ph 31: 2365-2376. https://doi.org/10.53555/jptcp.v31i2.4576
    [15] Tanveer M, Tanveer U, Afzal M, et al. (2022) Community-Level Factors Associated with Body Mass Index Among Pakistani School-Aged Adolescents. Pak J Med Health Sci 16: 463. https://doi.org/10.53350/pjmhs22169463
    [16] Tanveer M, Tanveer U, Tanveer N, et al. (2022) Parental health attitudes and knowledge factors associated with body mass index among Pakistani school-aged adolescents. Pak J Med Health Sci 16: 479. https://doi.org/10.53350/pjmhs22169479
    [17] The Express Tribune. Available from: https://tribune.com.pk/story/714845/pakistan-9th-most-obese-country-study/?amp=1
    [18] World Health Organization-Noncommunicable Diseases (NCD) Country Profiles. Available from: http://www.who.int/nmh/publications/ncd-profiles2014/en/
    [19] Lobstein T, Brinsden H Atlas of childhood obesity, World Obesity Federation, 211 (2019). Available from: https://www.worldobesity.org/membersarea/global-atlas-on-childhood-obesity
    [20] World health organization (2016). Available from: https://www.who.int/diabetes/country
    [21] Mansoori N, Nisar N, Shahid N, et al. (2018) Prevalence of obesity and its risk factors among school children in Karachi, Pakistan. Trop Doct 48: 266-269. https://doi.org/10.1177/0049475518786664
    [22] Li XH, Lin S, Guo H, et al. (2014) Effectiveness of a school-based physical activity intervention on obesity in school children: a nonrandomized controlled trial. BMC Public Health 14: 1-12. https://doi.org/10.1186/1471-2458-14-1282
    [23] Keykhaei F, Shahraki M, Sargolhosseinzadeh E, et al. (2016) Correlation of body mass index and physical activity among 7- to 11-year children at Zahedan, Iran. Food Nutr Bull 37: 364-374. https://doi.org/10.1177/0379572116657225
    [24] Kuczmarski RJ (2000) CDC growth charts: United States. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2000 .
    [25] BMI AWS.Stature Weight-for-age percentiles-for-age and. Age 16: 18-19.
    [26] Syahrul S, Kimura R, Tsuda A, et al. (2016) Prevalence of underweight and overweight among school-aged children and it's association with children's sociodemographic and lifestyle in Indonesia. Int J Nurs Sci 3: 169-177. https://doi.org/10.1016/j.ijnss.2016.04.004
    [27] Mushtaq MU, Gull S, Abdullah HM, et al. (2011) Prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children. BMC Public Health 11: 1-10. https://doi.org/10.1186/1471-2458-11-724
    [28] Ahmed J, Laghari A, Naseer M, et al. (2013) Prevalence of and factors associated with obesity among Pakistani schoolchildren: a school-based, cross-sectional study. E Mediterr Health J 19: 242-247. https://doi.org/10.26719/2013.19.3.242
    [29] Anwar A, Anwar F, Joiya HU, et al. (2010) Prevalence of obesity among the school-going children of Lahore and associated factors. J Ayub Med Coll Abbottabad 22: 27-32.
    [30] Khan S, Abbas A, Ali I, et al. (2019) Prevalence of overweight and obesity and lifestyle assessment among school–going children of Multan, Pakistan. Isra Med J 11: 230-233.
    [31] Pakistan-Global Obesity Observatory. Available from: https://data.worldobesity.org/country/pakistan-167/#data_prevalence
    [32] Ogden CL, Carroll MD, Curtin LR, et al. (2006) Prevalence of overweight and obesity in the United States, 1999–2004. Jama 295: 1549-1555. https://doi.org/10.1001/jama.295.13.1549
    [33] Poorolajal J, Sahraei F, Mohamdadi Y, et al. (2020) Behavioral factors influencing childhood obesity: a systematic review and meta-analysis. Obes Res Clin Pract 14: 109-118. https://doi.org/10.1016/j.orcp.2020.03.002
    [34] Newby PK (2009) Plant Foods and Plant-Based Diets: Protective against Childhood Obesity?. Am J Clin Nutr 89: 1572S-1587S. https://doi.org/10.3945/ajcn.2009.26736G
    [35] Czyż SH, Toriola AL, Starościak W, et al. (2017) Physical fitness, physical activity, sedentary behavior, or diet—what are the correlates of obesity in polish school children?. Int J Environ Res Public Health 14: 664. https://doi.org/10.3390/ijerph14060664
    [36] Ali K, Sadaf A, Kousar S, et al. (2014) Standard of Physical Education in Pakistan as Compare to USA. Glob J Hum Soc Sci .
    [37] Shang X, Liu A, Li Y, et al. (2010) The association of weight status with physical fitness among Chinese children. Int J Pediatr : 515414. https://doi.org/10.1155/2010/515414
    [38] Myszkowska-Ryciak J, Harton A, Lange E, et al. (2019) Nutritional behaviors of polish adolescents: Results of the wise nutrition—Healthy generation project. Nutrients 11: 1592. https://doi.org/10.3390/nu11071592
    [39] Myszkowska-Ryciak J, Harton A, Lange E, et al. (2020) Reduced screen time is associated with healthy dietary behaviors but not body weight status among Polish adolescents. Report from the wise nutrition—healthy generation project. Nutrients 12: 1323. https://doi.org/10.3390/nu12051323
    [40] Alamirew SK, Lemke S, Stadlmayr B, et al. (2023) Dietary Behaviour and Sociocultural Determinants of Dietary Diversity among Rural Women of Reproductive Age: A Case of Amhara Region, Ethiopia. Nutrients 15: 3369. https://doi.org/10.3390/nu15153369
    [41] Davis C, Huggins CE, Kleve S, et al. (2024) Conceptualizing weight management for night shift workers: A mixed-methods systematic review. Obes Rev 25: e13659. https://doi.org/10.1111/obr.13659
    [42] Lytle LA (2009) Examining the etiology of childhood obesity: The IDEA study. Am J Community Psychol 44: 338-349. https://doi.org/10.1007/s10464-009-9269-1
    [43] Campbell KJ, Crawford DA, Salmon J, et al. (2007) Associations between the home food environment and obesity-promoting eating behaviors in adolescence. Obesity 15: 719-730. https://doi.org/10.1038/oby.2007.553
    [44] Story M, Nanney MS, Schwartz MB (2009) Schools and obesity prevention: creating school environments and policies to promote healthy eating and physical activity. Millbank Q 87: 71-100. https://doi.org/10.1111/j.1468-0009.2009.00548.x
    [45] Leech RM, McNaughton SA, Timperio A (2014) Clustering of children's obesity-related behaviours: associations with sociodemographic indicators. Eur J Clin Nutr 68: 623-628. https://doi.org/10.1038/ejcn.2013.295
    [46] Bruening M, Eisenberg M, MacLehose R, et al. (2012) Relationship between adolescents' and their friends' eating behaviors: breakfast, fruit, vegetable, whole-grain, and dairy intake. J Acad Nutr Diet 112: 1608-1613. https://doi.org/10.1016/j.jand.2012.07.008
    [47] Tanveer M, Asghar E, Tanveer U, et al. (2024) Intrapersonal level unhealthy behaviors (smoking, drinking alcohol, and tobacco use) and their association with body mass index among school-aged children and adolescents in Pakistan. J Popul Ther Clin Ph 31: 50-62. https://doi.org/10.53555/jptcp.v31i3.4706
    [48] Tanveer M, Asghar E, Tanveer U, et al. (2024) Community-Level Physical Activity Opportunities, Safe and Supportive Environment Factors, and Their Association with Overweight and Obesity Among School-Aged Children and Adolescents in Pakistan-A Cross-Sectional Study. Kurd Stud 12: 6425-6432.
    [49] Roy N, Tanveer M, Liu YH (2022) Stress and coping strategies for international students in China during COVID-19 pandemic. Int Res J Educ Innov 3: 1-12. https://doi.org/10.53575/irjei.v3.01.1(22)1-12
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