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Comparison of BMI Derived from Parent-Reported Height and Weight with Measured Values: Results from the German KiGGS Study  [PDF]
Anna-Kristin Brettschneider,Ute Ellert,Angelika Schaffrath Rosario
International Journal of Environmental Research and Public Health , 2012, DOI: 10.3390/ijerph9020632
Abstract: The use of parent-reported height and weight is a cost-efficient instrument to assess the prevalence of children’s weight status in large-scale surveys. This study aimed to examine the accuracy of BMI derived from parent-reported height and weight and to identify potential predictors of the validity of BMI derived from parent-reported data. A subsample of children aged 2–17 years (n = 9,187) was taken from the 2003–2006 cross-sectional German KiGGS study. Parent-reported and measured height and weight were collected and BMI was calculated. Besides descriptive analysis, linear regression models with BMI difference and logistic regression models with weight status misclassification as dependent variables were calculated. Height differences varied by gender and were generally small. Weight and BMI were under-reported in all age groups, the under-reporting getting stronger with increasing age. Overall, the proportion for overweight and obesity based on parental and measured reports differed slightly. In the youngest age group, the proportion of overweight children was overestimated, while it was underestimated for older children and adolescents. Main predictors of the difference between parent reported and measured values were age, gender, weight status and parents’ perception of the child’s weight. In summary, the exclusive use of uncorrected parental reports for assessment of prevalence rates of weight status is not recommended.
Potential determinants of obesity among children and adolescents in Germany: results from the cross-sectional KiGGS study
Christina Kleiser, Angelika Schaffrath Rosario, Gert BM Mensink, Reinhild Prinz-Langenohl, B?rbel-Maria Kurth
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-46
Abstract: Data were collected in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a nationally representative and comprehensive data set on health behaviour and health status of German children and adolescents. Body height and weight were measured and body mass index (BMI) was classified according to IOTF cut-off points. Statistical analyses were conducted on 13,450 non-underweight children and adolescents aged 3 to 17 years. The association between overweight, obesity and several potential determinants was analysed for this group as well as for three socio-economic status (SES) groups. A multiple logistic regression model with obesity as the dependent variable was also calculated.The strongest association with obesity was observed for parental overweight and for low SES. Furthermore, a positive association with both overweight (including obesity) and obesity was seen for maternal smoking during pregnancy, high weight gain during pregnancy (only for mothers of normal weight), high birth weight, and high media consumption. In addition, high intakes of meat and sausages, total beverages, water and tea, total food and beverages, as well as energy-providing food and beverages were significantly associated with overweight as well as with obesity. Long sleep time was negatively associated with obesity among 3- to 10-year olds. Determinants of obesity occurred more often among children and adolescents with low SES.Parental overweight and a low SES are major potential determinants of obesity. Families with these characteristics should be focused on in obesity prevention.The increased prevalence of overweight and obesity among children and adolescents is a severe public health problem across the developed and the developing world [1]. Nationally representative data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) show that in Germany, currently 15% of the 3- to 17-year olds are considered overweight or
Juvenile obesity and its association with utilisation and costs of pharmaceuticals - results from the KiGGS study
Christina M Wenig, Hildtraud Knopf, Petra Menn
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-340
Abstract: Based on data from 14, 836 respondents aged 3-17 years in the German Interview and Examination Survey for Children and Adolescents (KiGGS), drug intake and associated costs were estimated using a bottom-up approach. To investigate the association of BMI with utilisation and costs, univariate analyses and multivariate generalised mixed models were conducted.There was no significant difference between BMI groups regarding the probability of drug utilisation. However, the number of pharmaceuticals used was significantly higher (14%) for obese children than for normal weight children. Furthermore, there was a trend for more physician-prescribed medication in obese children and adolescents. Among children with pharmaceutical intake, estimated costs were 24% higher for obese children compared with the normal weight group.This is the first study to estimate excess drug costs for obesity based on a representative cross-sectional sample of the child and adolescent population in Germany. The results suggest that obese children should be classified as a priority group for prevention. This study complements the existing literature and provides important information concerning the relevance of childhood obesity as a health problem.Obesity is one of the biggest public health problems worldwide, not only in adults but also in children and adolescents. In the WHO European region, the prevalence estimates of overweight (including obesity) in 11- to 13-year-old children range between 5% and 25% [1]. The data from the German Interview and Examination Survey for Children and Adolescents (KiGGS) show that, among 3- to 17-year-olds, 15% are overweight (including obese) and 6.3% are obese according to a national reference. Extrapolated to the German population, this leads to a total of 1.9 million overweight children, including 800, 000 who are obese [2].Overweight and obesity in adulthood are recognised as important risk factors for numerous chronic diseases [3]. Obesity in childhood als
Validity of Self-Reported Weight and Height of Adolescents, Its Impact on Classification into BMI-Categories and the Association with Weighing Behaviour  [PDF]
Tineke De Vriendt,Inge Huybrechts,Charlene Ottevaere,Inge Van Trimpont,Stefaan De Henauw
International Journal of Environmental Research and Public Health , 2009, DOI: 10.3390/ijerph6102696
Abstract: This paper investigated the validity of self-reported height and weight of adolescents for the diagnosis of underweight, overweight and obesity and the influence of weighing behaviour on the accuracy. A total of 982 adolescents reported their height, weight, weighing behaviour and eating patterns in a questionnaire. Afterwards, their height and weight were measured and their Body Mass Index (BMI)-categories were determined using age- and gender-specific BMI cut-off points. Both girls and boys underreported their weight, whilst height was overestimated by girls and underestimated by boys. Cohen’s d indicated that these misreportings were in fact trivial. The prevalence of underweight was overestimated when using the self-reported BMI for classification, whilst the prevalence of overweight and obesity was underestimated. Gender and educational level influenced the accuracy of the adolescents’ self-reported BMI. Weighing behaviour only positively influenced the accuracy of the self-reported weight and not height or BMI. In summary, adolescents’ self-reported weight and height cannot replace measured values to determine their BMI-category, and thus the latter are highly recommended when investigating underweight, overweight and obesity in adolescents.
Determinants of agreement between self-reported and parent-assessed quality of life for children in Germany-results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)
Ute Ellert, Ulrike Ravens-Sieberer, Michael Erhart, B?rbel-Maria Kurth
Health and Quality of Life Outcomes , 2011, DOI: 10.1186/1477-7525-9-102
Abstract: The German Health Interview and Examination Survey for Children and Adolescents included the KINDL-R questionnaire on health-related quality of life. 6388 children and adolescents filled in the questionnaire while their parents answered the proxy version. Means and standard deviation for the self- and proxy ratings, and also the Pearson und Intra-Class correlation coefficients for the absolute agreement were calculated. The relationship between other variables and parent-child agreement were determined by means of logistic regression.In the 'Physical', 'Self-esteem' and 'School' dimension and for the 'Total' score, the parents significantly overestimated the quality of life of their child. In contrast, the quality of life of the children in the dimensions 'Psychological well-being' and 'Family' were considerably underestimated by the parents. The proportion of parent-child ratings in agreement (difference < 0.5 standard deviations) ranges from 34.9% for the 'Self-esteem' scale to 51.9% in the 'Psychological' scale. The most important factor explaining parents rating was the level of the child's self-assessment followed by the parent's assessment of the subjective health, or reported emotional abnormalities.Our study shows that parental reports cannot adequately replace self-assessment for 11-17 year olds. In view of the different underlying perspectives, the parental assessments should where possible only be regarded as providing supplementary information.In recent years, increasing importance has been attached to health-related quality of life (HRQoL) in child and adolescent medicine. The measurement of HRQoL of children and adolescents is meanwhile at least as important as for adults in clinical and public health studies [1]. The focus of interest is on the perception and evaluation of an individual's own life from a subjective perspective. For this reason, self-reporting is generally preferable to proxy assessments. However, this is only possible for children and
Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001-2006
Manfred Stommel, Charlotte A Schoenborn
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-421
Abstract: Using the combined 2001-2006 data from the continuous National Health and Nutrition Examination Survey, discrepancies between BMI measures based on self-reported and physical height and weight measures are estimated and socio-demographic predictors of such discrepancies are identified. Employing adjustments derived from the socio-demographic predictors, the self-reported measures of height and weight in the 2001-2006 National Health Interview Survey are used for population estimates of overweight & obesity as well as the prediction of health risks associated with large BMI values. The analysis relies on two-way frequency tables as well as linear and logistic regression models. All point and variance estimates take into account the complex survey design of the studies involved.Self-reported BMI values tend to overestimate measured BMI values at the low end of the BMI scale (< 22) and underestimate BMI values at the high end, particularly at values > 28. The discrepancies also vary systematically with age (younger and older respondents underestimate their BMI more than respondents aged 42-55), gender and the ethnic/racial background of the respondents. BMI scores, adjusted for socio-demographic characteristics of the respondents, tend to narrow, but do not eliminate misclassification of obese people as merely overweight, but health risk estimates associated with variations in BMI values are virtually the same, whether based on self-report or measured BMI values.BMI values based on self-reported height and weight, if corrected for biases associated with socio-demographic characteristics of the survey respondents, can be used to estimate health risks associated with variations in BMI, particularly when using parametric prediction models.The use of the Body Mass Index (BMI) based on self-reported height and weight in epidemiologic studies remains controversial, both because it is an imperfect measure of a person's percentage of body fat [1] and because self-reported heig
Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS)
Emily Finne, Jens Bucksch, Thomas Lampert, Petra Kolip
International Journal of Behavioral Nutrition and Physical Activity , 2011, DOI: 10.1186/1479-5868-8-119
Abstract: The 11- to 17-year-old subsample of the German Health Interview and Examination Survey (KiGGS) was used (n = 6 813; 51.3% male, response rate = 66.6%). Through sex-specific sequential multinomial logistic regressions we analysed the univariate and independent associations of chronological age, absolute pubertal status, relative pubertal timing, and BDS with the frequency of PA.Chronological age showed a significantly negative association with PA in both sexes, independent of puberty. The odds of inactivity in contrast to nearly daily PA increased about 70% in boys and 35% in girls for each year of age, respectively. Adjusted for age and other possible confounders, inactivity was significantly less likely for boys in late pubertal stages (OR = 0.27, 95% CI = 0.09-0.78). The risk of inactivity was more than doubled in boys maturing earlier than peers in terms of relative pubertal timing (OR = 2.20, 95% CI = 1.36-3.56). No clear significant puberty effects were found in girls, but the inactivity was more likely for those with irregular menstruation (OR = 1.71, 95% CI = 1.06-2.75). BDS also contributed to the prediction of PA in both sexes. It partially mediated puberty effects in boys but not in girls.Overall, chronological age was a far more important predictor of PA in German adolescents than absolute pubertal status or relative pubertal timing. Further possible explanatory variables like sociocultural influences, social support or increasing time requirements for education should be analysed in conjunction with chronological age in future studies.Various health benefits of physical activity (PA) have been demonstrated in adolescents [1]. Despite this, most youths from Europe are not sufficiently active to meet current PA recommendations [2]. Furthermore, the adolescent years have been identified as a risk period for declining PA levels in studies using different methods, including accelerometry [3]. In Germany, only PA prevalence rates based on self-report data have
Seroprevalence of Measles-, Mumps- and Rubella-Specific IgG Antibodies in German Children and Adolescents and Predictors for Seronegativity  [PDF]
Christina Poethko-Müller, Annette Mankertz
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0042867
Abstract: We have undertaken a seroprevalence study with more than 13,000 children, who had been included in the German KIGGS survey, a representative sample of children and adolescents 0–17 years of age. The IgG titres against measles, mumps and rubella were determined in 1 to 17 year olds While 88.8% of the children were MMR-vaccinated at least once, 76.8% of children aged 1 to 17 years showed prevalence of antibodies to MMR. The highest seronegativity was seen with respect to mumps. Gender differences were most pronounced with regard to rubella IgG titres: girls aged 14 to 17 years were best protected, although seronegativity in 6.8% of this vulnerable group still shows the need of improvement. Search for predictors of missing seroprevalence identified young age to be the most important predictor. Children living in the former West and children born outside of Germany had a higher risk of lacking protection against measles and rubella, while children with a migration background but born in Germany were less often seronegative to measles antibodies than their German contemporaries. An association of seronegativity and early vaccination was seen for measles but not for mumps and rubella. A high maternal educational level was associated with seronegativity to measles and rubella. In vaccinated children, seronegativity was highest for mumps and lowest for rubella. For mumps, high differences were observed for seronegativity after one-dose and two-dose vaccination, respectively. Seronegativity increases as time since last vaccination passes thus indicating significant waning effects for all three components of MMR.
Overweight in Adolescence Can Be Predicted at Age 6 Years: A CART Analysis in German Cohorts  [PDF]
Christina Riedel, Rüdiger von Kries, Anette E. Buyken, Katharina Diethelm, Thomas Keil, Linus Grabenhenrich, Manfred J. Müller, Sandra Plachta-Danielzik
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0093581
Abstract: Objective To examine, whether overweight in adolescents can be predicted from the body mass index (BMI) category, at the age of 6, the mother's education level and mother's obesity and to quantify the proportion of overweight at the age of 14 that can be explained by these predictors. Method Pooled data from three German cohorts providing anthropometric and other relevant data to a total of 1 287 children. We used a classification and regression tree (CART) approach to identify the contribution of BMI category at the age of 6 (obese: BMI>97th percentile (P97); overweight: P90P90) at the age of 14. Results While 4.8% [95%CI: 3.2;7.0] of 651 boys and 4.1% [95%CI: 2.6;6.2] of 636 girls with a BMIP97 (similar results for girls). BMI≥P75 at the age of 6 explained 63.5% [95%CI: 51.1;74.5]) and 72.0% [95%CI: 60.4;81.8] of overweight/obesity at the age of 14 in boys and girls, respectively. Conclusions Overweight/obesity in adolescence can be predicted by BMI category at the age of 6 allowing for parent counselling or risk guided interventions in children with BMI≥P75, who accounted for >2/3 of overweight/obesity in adolescents.
Social ideological influences on reported food consumption and BMI
Wei C Wang, Anthony Worsley, Everarda G Cunningham
International Journal of Behavioral Nutrition and Physical Activity , 2008, DOI: 10.1186/1479-5868-5-20
Abstract: A survey was conducted among shoppers aged between 40 and 70 years at Eastland Shopping Centre, Melbourne, Australia. The hypothesized model was tested with this empirical data (n = 410) for younger (n = 151) and older (n = 259) age groups using structural equation modelling.The findings generally support the study hypotheses. For both groups, egalitarianism had a direct and positive influence on perceptions of the importance of health behaviours. Materialism and masculinity impacted negatively on health attitudes, which positively influenced importance of health behaviours. Perceptions of importance of health behaviours impacted positively on the consumption of healthy foods such as vegetables and fruits, but negatively on consumption of unhealthy foods including sweets and fats. However, BMI was significantly influenced by the consumption of unhealthy foods (e.g., sugar and fats) only for the younger age group. Hence, the associations between beliefs, attitudes, consumption behaviours, and BMI outcomes differed between younger and older age populations.Social ideological beliefs appear to influence health attitudes and thereafter, the consumption of healthy and unhealthy foods and BMI via different pathways.Current demographic trends indicate the presence of ageing populations in most industrialized countries [1]. The ageing population has been linked to the post World War II baby boom [2]. Baby boomers are classified as those born between 1946 and 1964 [3]. This generation has had a profound impact on society and the economy throughout all stages of their lives [4]. For instance, it is anticipated that as the baby boomers age, there will be a substantial increase in the number of people aged over 65 years after 2010. As such, it will be imperative to prevent or ameliorate exposure to ill-health conditions and avoid associated medical costs. For example, dietary behaviour plays an important role in people's health [5], and it will be important to understand the pr
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