NUTRITIONAL ASSESSMENT OF OBESE PRESCHOOL CHILDREN (3-5 YEARS) AND THE ASSOCIATED FACTORS
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Date
2011-03
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ACHARYA N.G. RANGA AGRICULTURAL UNIVERSITY
Abstract
The prevalence of overweight and obesity appear to be increasing at an
alarming rate. Pressures from the “obesogenic” environment are driving up obesity rates
and it is observed that a large number of obese children maintain their obesity into
adulthood when the risk of obesity-associated morbidity is much higher. Therefore an
attempt was made to assess the nutritional status of obese preschool children and
identify the associated factors of obesity among these preschoolers. The objective of the
study was to assess the nutritional status of obese preschool children by anthropometric
assessment and dietary assessment and identify the causative factors for childhood
obesity and study the knowledge, attitude of mothers related to childhood obesity and
find out the dietary practice followed by the mothers in regard to their children.
From the selected five private schools boys and girls of preschool age, 3-5 years
were screened for BMI and 30 children with BMI >95th percentile were selected as
obese children and 30 children with BMI between 25th - 50th percentile were selected as
non-obese controls.
Nutritional status of preschool children was assessed by taking their height,
weight, mid upper arm circumference and triceps skin fold measurements. Parent’s BMI
was assessed from their height and weight measurements. A three day- 24 hour diet
recall survey on obese and non obese preschool children and their parents provided
average food intake of each individual, from which proximate nutrients and energy
intake was calculated. Mothers of non-obese and obese children were assessed for their
knowledge, attitude and practices related to obesity in children using the questionnaire
developed as part of the research work.
The demographic and socio-economic and cultural factors associated with obesity
indicated that more number of girls compared to boys and more number of 4-5 year
old children compared to 3-4 year preschool children were found to be obese. The
incidence of obesity among preschool children was high whose mothers had graduate
level of education and were homemakers and fathers who had PG/professional level of
education. All the obese preschool children belonged to nuclear family with a family
size of < 4 members and medium size 5-6 members.
Mothers of obese children in general entered pregnancy with a greater body weight
compared to non-obese group mothers. The incidence of obesity among preschoolers
born under cesarean delivery was 1.7 times more than children born under normal
delivery. Sixty three percent of obese children were born under cesarean delivery. In
any birth order girls were found to be more obese than boys and more of first born
children were obese compared to second and third born children. Seventy percent of the
obese children had a birth weight of 3.0- 4.0 kg. Early introduction of supplementary
foods among obese children has been observed. The higher percentage of commercial
food supplements fed to the obese children laid foundation for obesity at infancy, which
must have continued to preschool age. Majority of obese children were reared by the
mothers unlike some non obese, who were taken care either by grandmothers or care
takers.
Both boys and girls of obese category were taller (>50th percentile) indicating the
lack of association between stunting and obesity among preschoolers. There was a
significant difference between the weights and BMI of non-obese and obese children,
but triceps skin fold measurements of the preschool children showed similar trends in
percentile distribution. The MUAC of obese boys and girls matched with 75th, 90th and
95th percentiles of NHANES I. Irrespective of wide variation in body weight and BMI
of both the groups the individual Mid upper arm circumference was found to be a
determinant of BMI of obese children (p<0.05) after applying linear regressions
equations.
The average height of parents of both the groups showed no significant difference.
The weight was significantly high among mothers (p<0.05) and fathers (p< 0.01) of
obese children compared to the mothers and fathers of non obese children. The BMI of
mothers of non-obese was low (p<0.05) compared to mothers of obese preschool
children. Fathers of obese children also had high BMI (p<0.01). Mothers (90%) and
fathers (70%) of obese children were obese or overweight. BMI of mothers of nonobese
children influenced their children’s BMI (p<0.05) and the height of fathers of
non-obese children influenced their children heights (p<0.01).
Obese children relatively had a very high intake of carbohydrate (251 + 87 gm),
protein (46 + 11.8gm), fat (71.4 + 18 gm) and a total energy intake (1857 + 525 kcals)
which were significantly high compared to non obese children. The percent calories
consumed from carbohydrates, protein and fat showed no significant difference between
the groups. Obese children of 3-4 years consumed on an average 184% more fat, 187%
more protein, 96% more energy while, non obese also consumed 84% more fat,122%
more protein, 10% more energy compared to recommended dietary allowances. The
obese children of 4-5 years showed a high fat intake of 177% Vs 7% in non-obese,
protein of 199% Vs 93% non-obese and 37% energy compared to age specific
requirements. The carbohydrate intake of 3 -4 yr children strongly influenced their
energy intake (p<0.01), whereas, carbohydrate and fat intake among the 4-5 year old
obese children and only fat intake in non-obese children showed a strong influence on
their energy intake (p<0.01). Results also indicated that anthropometric measurements
of non-obese and obese children did not determine their energy intake. Though majority
of fathers and mothers were found to be obese, their dietary intake, especially energy
and protein were found to be around 30- 34% less than the recommended dietary
allowances.
Response to knowledge and attitude tests showed that mothers of obese children
had better knowledge and attitude compared to mothers of non-obese children. The
practice of consuming snacks several times a day, binging snacks while watching
television, between meals and all the day was observed to be relatively high in obese
children. Obese children spent longer hours sitting and watching television and more
mothers of obese children didn’t allow them to play outdoors. A marked difference was
found in the readiness of non-obese children for physical activity compared to the obese
children.
Attitudes and practices outweigh the role of parental knowledge in maintaining
normal nutritional status of preschool children. Children of obese or over weight
parents, the first born children, commercial supplements fed at infancy, ignoring binge
habits in children, allowing passive TV watching, not allowing any outdoor physical
play, feeding high calorie nutrients in quantities of two to three times more than
requirements for their age were found to be the crucial factors in causing obesity among
preschool children. Motivation and training of parents for acquiring skills of correct
feeding and engaging the preschoolers in more physical play might be the solution.
Description
Keywords
biological phenomena, fats, fruits, sexual reproduction, nutrient intake, beverages, animal husbandry, proteins, diseases, carbohydrates, OBESE, PRESCHOOL CHILDREN