Help us improve our products. Sign up to take part. Data of Jena children Germany show increases in the prevalence estimates of overweight and obesity between and Our objective was to determine if these increases contribute to changes in the distribution of body mass index BMI in the entire population of children.
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The decade —, which includes the time of German reunification, is of particular interest because of the significant socio-economic changes in East Germany, in which Jena is located. Overweight and obesity were estimated by German reference data and the reference of Cole et al. Mean difference plots were used to investigate the changes in the BMI distributions within sexes between the studies.
Between and , the prevalence of overweight and obesity increased significantly in both sexes, whereas nonsignificant changes were found between and Although there is a tendency towards increased overweight between and , the differences were nonsignificant. Comparing data from and , the mean difference plots showed virtually no changes in the BMI distribution. In the plots comparing the BMI distribution for data and data, the whole distribution tended to shift upwards with a greater shift in the upper BMI range.
The entire population of children in Jena gained weight during this period of time. This increase may be linked to a transition towards a more Western lifestyle, that is, usually by lower energy expenditure and nutritional transitions, caused by the process of reunification of Germany in Weight gain appears to be a characteristic feature of the entire population studied and does not seem to be a separate problem of the obese children.
This suggests that reported changes in the prevalence may be underestimating the looming public health crisis. The prevalence of overweight and obesity is increasing in adults as well as in children worldwide Livingstone, ; Bundred et al. Epidemiological data show that obesity and overweight are multi-determined chronic health problems resulting from complex interactions between genes and an environment that promotes high-energy intake and low-energy expenditure, resulting in a positive energy balance Gunnell et al.
In this environment, some individuals are more vulnerable than others to weight gain and developing obesity. Comparison of the entire body mass index BMI distribution showed that for both adults and children, the distribution is becoming more skewed in all sex—age groups. In younger children and to some extent in adolescents, the principal effect is increased positive skewness at the upper part of the distribution. These observations suggest that there is a distinct subgroup that is genetically susceptible to obesity and that for adults some factors causing increases in BMI are affecting the entire population.
In most epidemiological studies concerning obesity, prevalence rates were reported. To investigate the interaction between the individuals and the environment, BMI distribution changes at the population level should be studied, in order to identify subgroups at high risk for obesity. To prevent obesity in a child population, strategies that encourage healthful diets and plentiful physical activity will benefit the health of all children, whether at risk of obesity or not.
A recent study on Jena school children indicated a rapid increase in the prevalence of overweight and obesity between and , whereas between and only small changes in the prevalence estimates occurred Zellner et al. This rapid increase in Jena children may be linked to enormous environmental transitions during the s in East Germany. As a result of the reunification of Germany in , Western lifestyle, characterized by a ready access to an abundance of food and low levels of physical activity, was introduced in East Germany, in which Jena is located.
In this study, it was investigated whether this trend was accompanied with changes in the distribution of BMI in the population. The analyses were based on data from four successive growth studies — carried out in , , and — on samples of children from Jena. Study approval was obtained from the University ethics committee and from school authorities. Parents gave their informed written consent.
All subjects were of German origin and the distribution of socio-demographic characteristics in the samples was representative of the local population indicating no bias selection in participation. Measurements in all studies were performed by a well-trained staff according to standardized guidelines Martin and Saller, Height and weight were measured using a Martin anthropometer and a beam balance scale to the nearest 0.
The number of subjects with complete height and weight data by age in the cohorts is given in Table 1. For the comparison between the four cohorts concerning the prevalence of overweight and obesity, the data were examined according to national reference data — BMI percentiles from German children — as recently recommended by the AGA Kromeyer-Hauschild et al.
According to the national reference data, the prevalence of overweight and obesity was estimated as the percentage of children whose BMI was above the 90th and 97th age- and sex-specific percentile of this reference, respectively. All individual BMI data were also converted to SD scores using this national reference data, allowing the comparison — adjusted for age — between the four cohorts. Analysis of variance followed by Tamhane-T2 post hoc test — which does not require variances homogeneity — was performed for BMI-SDS comparisons between the studies and the sexes. One-sample t -test was used to compare the cohorts to the national reference.
Mean difference plots were used to investigate the changes in the BMI distributions within sex—age groups between the studies. Mean difference plots allowed for qualitative visual comparison of distributions to be made Flegal and Troiano, With this method, shifts in distributions are investigated by comparing the corresponding percentiles from two distributions. Therefore, we calculated even percentile values for , , and 1st, 2nd, 3rd percentile up to the 99th percentile using Cole's LMS method.
Then, we calculated the individual percentile levels for each subject. If there are subjects with BMI values on the corresponding percentile levels in the compared years, the mean of these percentiles from the 2 years e. Each point on the plots represents the mean graphed on the x axis and the difference graphed on the y axis for the corresponding percentiles from the compared years.
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The mean difference plots were presented by single year of age. The number of marks in the plots depends on the number of corresponding percentiles in the compared years. The location of the plotted point on the y axis shows the direction and magnitude of any shift between distributions. The shift is assessed by judging differences from the horizontal line representing zero, whereas general patterns are more important than the individual details.
The prevalence estimates of overweight and obesity by sex and by survey according to the two different definitions are illustrated in Table 2. The table shows comparable time trends in the prevalence rates of overweight and obesity using the two references. It should be mentioned that the time periods compared are not the same. The investigations were carried out every 10 years until , whereas there were only 6 years between and and this may cause the different changes.
Comparing the two references, we found that Cole et al. In , and , the values found in children from Jena were consistently lower than the national reference the German reference has a mean of 0 and a standard deviation of 1. Figure 2 shows mean difference plots by single year of age for boys and girls aged 7—10 years. The plots display differences between the distributions, whereas the general shape of the line formed by the points is more important than the individual details. Although there are differences in detail, the patterns for children aged 7—10 years are broadly similar.
When and were compared, the distribution showed virtually no directed changes. In the plots comparing and , the whole distribution tended to shift upwards in both sexes, except the lower end of the distribution in 7-year-old boys. The changes were most pronounced in girls aged 7—8 years. The changes in the distribution of BMI for boys and girls between and are characterized by increasing differences with increasing BMI range. Thus, an increasing skewness and large changes in the upper BMI range were found.
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This shift was also seen in the changes between and , except in 7-year-old girls. In girls aged 7—8 years, the BMI data showed a slight decrease in the lower part of the distribution during this period of time. BMI distribution mean difference plots in Jena children aged 7—10 years, by age group and time interval. Mean difference plots comparing the distribution of BMI in the different intervals are shown in Figure 3 by single year of age for boys and girls aged 11—14 years. There are some broad similarities in the changes seen in the younger children between and as well as between and Whereas the first interval is characterized by little differences, pronounced increases in skewness with large shifts at the upper end of distribution were found between and except for year-old boys and girls.
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Between and , a slight upward shift of the entire distribution was found, especially in boys. In the older age ranges, the variability in the BMI changes is greater than for younger children. BMI distribution mean difference plots in Jena children aged 11—14 years, by age group and time interval. Data in Jena children Germany show increases in the prevalence estimates of overweight and obesity between and The prevalence estimates depend on the selection of the reference population. But the used reference does not affect trend estimates over time of overweight and obesity.
The trends are similar, independent of criteria.