Lifestyle factors associated with overweight and obesity among Saudi adolescents

BMC Public Health

Abdulrahman O Musaiger¹  Dina M Qahwaji²  Hana I Al-Sobayel⁴  Nada A Abahussain⁵  Hazzaa M Al-Hazzaa³ 

[1] Arab Center for Nutrition, Manama, Bahrain, and Nutrition and Health Studies Unit, Deanship of Scientific Research, University of Bahrain, Manama, Bahrain;Department of Clinical Nutrition, College of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia;Scientific Boards, Obesity Research Chair, King Saud University, Riyadh, Saudi Arabia;Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia;Director of School Health, Ministry of Education, Eastern Province, Saudi Arabia

关键词: Sedentary behaviors;    Saudi Arabia;    Physical activity;    Obesity;    Overweight;    Lifestyle;    Dietary habits;    Adolescents;   

Others  :  1163621
DOI  :  10.1186/1471-2458-12-354

 received in 2011-12-15, accepted in 2012-05-16,  发布年份 2012

【 摘 要 】

Background

A better understanding of the relationships between obesity and lifestyle factors is necessary for effective prevention and management of obesity in youth. Therefore, the objective of this study was to evaluate the associations between obesity measures and several lifestyle factors, including physical activity, sedentary behaviors and dietary habits among Saudi adolescents aged 14–19 years.

Methods

This was a school-based cross-sectional study that was conducted in three cities in Saudi Arabia (Al-Khobar, Jeddah and Riyadh). The participants were 2906 secondary school males (1400) and females (1506) aged 14–19 years, who were randomly selected using a multistage stratified cluster sampling technique. Measurements included weight, height, body mass index (BMI), waist circumference, waist/height ratio (WHtR), screen time (television viewing, video games and computer use), physical activity (determined using a validated questionnaire), and dietary habits (intake frequency per week). Logistic regression was used to examine the associations between obesity and lifestyle factors.

Results

Compared with non-obese, obese males and females were significantly less active, especially in terms of vigorous activity, had less favorable dietary habits (e.g., lower intake of breakfast, fruits and milk), but had lower intake of sugar-sweetened drinks and sweets/chocolates. Logistic regression analysis showed that overweight/obesity (based on BMI categories) or abdominal obesity (based on WHtR categories) were significantly and inversely associated with vigorous physical activity levels (aOR for high level = 0.69, 95% CI 0.41–0.92 for BMI and 0.63, 95% CI 0.45–0.89 for WHtR) and frequency of breakfast (aOR for < 3 days/week = 1.44; 95% CI 1.20–1.71 for BMI and 1.47; 95% CI 1.22–1.76 for WHtR) and vegetable (aOR for < 3 days/week = 1.29; 95% CI 1.03–1.59 for WHtR) intakes, and consumption of sugar-sweetened beverages (aOR for < 3 days/week = 1.32; 95% CI 1.08–1.62 for BMI and 1.42; 95% CI 1.16–1.75 for WHtR).

Conclusions

The present study identified several lifestyle factors associated with obesity that may represent valid targets for the prevention and management of obesity among Saudi adolescents. Primary prevention of obesity by promoting active lifestyles and healthy diets should be a national public health priority.

【 授权许可】

   
2012 Al-Hazzaa et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Lobstein T, Baur L, Uauy R, IASO International Obesity Task Force, IASO International Obesity Task Force: Obesity in children and young people: a crisis in public health. Obes Rev 2004, 1(Suppl):4-104.
• [2]Musaiger A: Overweight and obesity in eastern mediterranean region: prevalence and possible causes. J Obesity 2011, 2011:407237.
• [3]Ng SW, Zaghloul S, Ali HI, Harrison G, Popkin BM: The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States. Obes Rev 2011, 12(1):1-13.
• [4]Mirmiran P, Sherafat-Kazemzadeh R, Jalali-Farahani S, Azizi F: Childhood obesity in the Middle East: a review. East Mediterr Health J 2010, 16:1009-1017.
• [5]El Mouzan MI, Foster PJ, Al Herbish AS, Al Salloum AA, Al Omer AA, Qurachi MM, Kecojevic T: Prevalence of overweight and obesity in Saudi children and adolescents. Ann Saudi Med 2010, 30:203-208.
• [6]Abalkhail B: Overweight and obesity among Saudi Arabian children and adolescents between 1994 and 2000. East Mediterr Health J 2002, 8:1-8.
• [7]Al-Hazzaa HM: Rising trends in BMI of Saudi adolescents: evidence from three national cross sectional studies. Asia Pac J Clin Nutr 2007, 16:462-466.
• [8]Al-Hazzaa HM: Prevalence and trends in obesity among school boys in Central Saudi Arabia between 1988 and 2005. Saudi Medical J 2007, 28:1569-1574.
• [9]Monteiro CA, Conde WL, Lu B, Popkin BM: Obesity and inequities in health in the developing world. Int J Obes Relat Metab Disord 2004, 28:1181-1186.
• [10]Barlow SE; Expert Committee: Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007, 120(Suppl 4):S164-S192.
• [11]Must A, Anderson SE: Effects of obesity on morbidity in children and adolescents. Nutr Clin Care 2003, 6:4-12.
• [12]Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L, Kelnar CJ: Health consequences of obesity. Arch Dis Child 2003, 88:748-752.
• [13]Nathan BM, Moran A: Metabolic complications of obesity in childhood and adolescence: more than just diabetes. Curr Opin Endocrinol Diabetes Obes 2008, 15:21-29.
• [14]The NS, Suchindran C, North KE, Popkin BM, Gordon-Larsen P: Association of adolescent obesity with risk of severe obesity in adulthood. JAMA 2010, 304(18):2042-2047.
• [15]Deshmukh-Taskar PR, Nicklas TA, O’Neil CE, Keast DR, Radcliffe JD, Cho S: The relationship of breakfast skipping and type of breakfast consumption with nutrient intake and weight status in children and adolescents: the National Health and Nutrition Examination Survey. 1999–2006. J Am Diet Assoc 2010, 110:869-878.
• [16]Esmaillzadeh A, Mirmiran P, Azizi F: Clustering of metabolic abnormalities in adolescents with the hypertriglyceridemic waist phenotype. Am J Clin Nutr 2006, 83:36-46.
• [17]Maffeis C, Banzato C, Talamini G: Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology: Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children. J Pediatr 2008, 152:207-213.
• [18]McCarthy HD, Ashwell M: A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message–'keep your waist circumference to less than half your height'. Int J Obes (Lond) 2006, 30:988-992.
• [19]Taylor RW, Jones IE, Williams SM, Goulding A: Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3–19 y. Am J Clin Nutr 2000, 72:490-495.
• [20]Duncan S, Duncan EK, Fernandes RA, Buonani C, Bastos KD, Segatto AF, Codogno JS, Gomes IC, Freitas IF: Modifiable risk factors for overweight and obesity in children and adolescents from Sao Paulo, Brazil. BMC Public Health 2011, 11(1):585.
• [21]Lazarou C, Soteriades ES: Children's physical activity, TV watching and obesity in Cyprus: the CYKIDS study. Eur J Public Health 2010, 20(1):70-77.
• [22]Croezen S, Visscher TL, Ter Bogt NC, Veling ML, Haveman-Nies A: Skipping breakfast, alcohol consumption and physical inactivity as risk factors for overweight and obesity in adolescents: results of the E-MOVO project. Eur J Clin Nutr 2009, 63:405-412.
• [23]Dupuy M, Godeau E, Vignes C, Ahluwalia N: Socio-demographic and lifestyle factors associated with overweight in a representative sample of 11–15 year olds in France: results from the WHO-Collaborative Health Behaviour in School-aged Children (HBSC) cross-sectional study. BMC Public Health 2011, 11:442.
• [24]Bradlee ML, Singer MR, Qureshi MM, Moore LL: Food group intake and central obesity among children and adolescents in the Third National Health and Nutrition Examination Survey (NHANES III). Public Health Nutr 2010, 13:797-805.
• [25]de Gouw L, Klepp KI, Vignerová J, Lien N, Steenhuis IH, Wind M: Associations between diet and (in)activity behaviours with overweight and obesity among 10-18-year-old Czech Republic adolescents. Public Health Nutr 2010, 13(10A):1701-1707.
• [26]Vanselow MS, Pereira MA, Neumark-Sztainer D, Raatz SK: Adolescent beverage habits and changes in weight over time: findings from Project EAT. Am J Clin Nutr 2009, 90:1489-1495.
• [27]Burke V, Beilin LJ, Durkin K, Stritzke WG, Houghton S, Cameron CA: Television, computer use, physical activity, diet and fatness in Australian adolescents. Int J Pediatr Obes 2006, 1:248-255.
• [28]Collison KS, Zaidi MZ, Subhani SN, Al-Rubeaan K, Shoukri M, Al-Mohanna FA: Sugar-sweetened carbonated beverage consumption correlates with BMI, waist circumference, and poor dietary choices in school children. BMC Public Health 2010, 10:234.
• [29]Mahfouz AA, Abdelmoneim I, Khan MY, Daffalla AA, Diab MM, Al-Gelban KS, Moussa H: Obesity and related behaviors among adolescent school boys in Abha City, Southwestern Saudi Arabia. J Trop Pediatr 2008, 54:120-124.
• [30]Farghaly NF, Ghazali BM, Al-Wabel HM, Sadek AA, Abbag FI: Life style and nutrition and their impact on health of Saudi school students in Abha, Southwestern region of Saudi Arabia. Saudi Med J 2007, 28:415-421.
• [31]Al-Rukban MO: Obesity among Saudi male adolescents in Riyadh, Saudi Arabia. Saudi Med J 2003, 24:27-33.
• [32]Al-Hazzaa HM, Musaiger AO, ATLS Research Group, ATLS Research Group: Arab Teens Lifestyle Study (ATLS): Objectives, design, methodology and implications. Diabetes Metab Syndr Obes 2011, 4:417-426.
• [33]Cole T, Bellizzi M, Flegal K, Dietz W: Establishing a standard definition of child overweight and obesity worldwide: International survey. BMJ 2000, 320:1240-1243.
• [34]Al-Hazzaa HM, Abahussain N, Al-Sobayel H, Qahwaji D, Musaiger A, Al-Hazzaa HM, Abahussain N, Al-Sobayel H, Qahwaji D, Musaiger AO: Physical Activity, Sedentary Behaviors and Dietary Habits among Saudi Adolescents Relative to Age, Gender and Region. Int J Behav Nutr Phys Act 2011, 8:140.
• [35]Al-Hazzaa HM, Al-Ahmadi M: A Self-reported questionnaire for the assessment of physical activity in youth 15–25 years: Development, reliability and construct validity. Arab J of Food & Nutrition 2003, 4(8):279-291.
• [36]Al-Ahmadi M, Al-Hazzaa HM: Validity of a self-reported questionnaire for youth 15–25 years: Comparison with accelerometer, pedometer and heart rate telemetry. Saudi Sports Med J 2004, 7:2-14.
• [37]Al-Hazzaa HM, Al-Sobayel HI, Musaiger AO: Convergent validity of the Arab Teens Lifestyle Study (ATLS) physical activity questionnaire. Int J Environ Res Public Health 2011, 8:3810-3820.
• [38]Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS: 2011 Compendium of Physical Activities: A Second Update of Codes and MET Values. Med Sci Sports Exerc 2011, 43:1575-1581.
• [39]Ridley K, Ainsworth B, Olds T: Development of a compendium of energy expenditure for youth. Int J Behav Nutr Phys Act 2008, 5:45.
• [40]American Academy of Pediatrics: Committee on Public Education. American Academy of Pediatrics: Children, adolescents, and television. Pediatrics 2001, 107:423-426.
• [41]Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM: Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA 2010, 303(3):242-249.
• [42]Sweeting HN: Gendered dimensions of obesity in childhood and adolescence. Nutr J 2008, 7:1.
• [43]Wang Y: Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status. Int J Epidemiol 2001, 30:1129-1136.
• [44]Janssen I, Katzmarzyk PT, Boyce WF, Vereecken C, Mulvihill C, Roberts C, Currie C, Pickett W, Health Behaviour in School-Aged Children Obesity Working Group, Health Behaviour in School-Aged Children Obesity Working Group: Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes Rev 2005, 6:123-132.
• [45]Al-Hazzaa HM: Pedometer-determined physical activity among obese and non-obese 8- to 12-year-old Saudi schoolboys. J Physiol Anthropol 2007, 26:459-465.
• [46]Kelishadi R, Ardalan G, Gheiratmand R, Gouya MM, Razaghi EM, Delavari A, Majdzadeh R, Heshmat R, Motaghian M, Bareketi H, Mahmoud-Arabi MS, Riazi MM: Association of physical activity and dietary behaviours in relation to the body mass index in a national sample of Iranian children and adolescents: CASPIAN Study. B World Health Organ 2007, 85:19-26.
• [47]Patrick K, Norman G, Calfas K, Sallis J, Zabinski M, Rupp J, Cella J: Diet, physical activity and sedentary behaviors as risk factors for overweight in adolescence. Arch Pediatr Adolesc Med 2004, 158:385-390.
• [48]Moliner-Urdiales D, Ruiz JR, Ortega FB, Rey-Lopez JP, Vicente-Rodriguez G, España-Romero V, Munguía-Izquierdo D, Castillo MJ, Sjöström M, Moreno LA, HELENA Study Group, HELENA Study Group: Association of objectively assessed physical activity with total and central body fat in Spanish adolescents; the HELENA Study. Int J Obes (Lond) 2009, 33:1126-1135.
• [49]Parikh T, Stratton G: Influence of intensity of physical activity on adiposity and cardiorespiratory fitness in 5–18 year olds. Sports Med 2011, 41:477-488.
• [50]Martinez-Gomez D, Moreno LA, Romeo J, Rey-López P, Castillo R, Cabero MJ, Vicente-Rodriguez G, Gutiérrez A, Veiga OL: Combined influence of lifestyle risk factors on body fat in Spanish adolescents–the Avena study. Obes Facts 2011, 4(2):105-111.
• [51]Tremblay MS, Colley RC, Saunders TJ, Healy GN, Owen N: Physiological and health implications of a sedentary lifestyle. Appl Physiol Nutr Metab 2010, 35:725-740.
• [52]McMurray RG, Harrell JS, Deng S, Bradley CB, Cox LM, Bangdiwala SI: The influence of physical activity, socioeconomic status, and ethnicity on the weight status of adolescents. Obes Res 2000, 8:130-139.
• [53]Lowry R, Wechsler H, Galuska DA, Fulton JE, Kann L: Television viewing and its associations with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: differences by race, ethnicity, and gender. J Sch Health 2002, 72:413-421.
• [54]Ekelund U, Brage S, Froberg K, Harro M, Anderssen SA, Sardinha LB, Riddoch C, Andersen LB: TV viewing and physical activity are independently associated with metabolic risk in children: the European Youth Heart Study. PLoS Med 2006, 3(12):e488.
• [55]Janssen I, Katzmarzyk PT, Boyce WF, King MA, Pickett W: Overweight and obesity in Canadian adolescents and their associations with dietary habits and physical activity patterns. J Adolesc Health 2004, 35:360-367.
• [56]Eisenmann JC, Bartee RT, Smith DT, Welk GJ, Fu Q: Combined influence of physical activity and television viewing on the risk of overweight in US youth. Int J Obes (Lond) 2008, 32:613-618.
• [57]Rey-López JP, Vicente-Rodríguez G, Biosca M, Moreno LA: Sedentary behaviour and obesity development in children and adolescents. Nutr Metab Cardiovasc Dis 2008, 18:242-251.
• [58]D'Addesa D, D'Addezio L, Martone D, Censi L, Scanu A, Cairella G, Spagnolo A, Menghetti E: Dietary intake and physical activity of normal weight and overweight/obese adolescents. Int J Pediatr 2010, 201:785649.
• [59]Kontogianni MD, Farmaki AE, Vidra N, Sofrona S, Magkanari F, Yannakoulia M: Associations between lifestyle patterns and body mass index in a sample of Greek children and adolescents. J Am Diet Assoc 2010, 110:215-221.
• [60]World Health Organization: Global Strategy on Diet, Physical Activity and Health. WHA57.17. WHO, Geneva; 2004.
• [61]Ludwig DS, Peterson KE, Gortmaker SL: Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001, 357(9255):505-508.
• [62]Phillips SM, Bandini LG, Naumova EN, Cyr H, Colclough S, Dietz WH, Must A: Energy-dense snack food intake in adolescence: longitudinal relationship to weight and fatness. Obes Res 2004, 12:461-472.
• [63]Ledoux TA, Hingle MD, Baranowski T: Relationship of fruit and vegetable intake with adiposity: a systematic review. Obes Rev 2011, 12(5):e143-50.
• [64]Musaiger A: Food Consumption Patterns in Eastern Mediterranean Countries. Arab Center for Nutrition, Manamah; 2011.
• [65]Niemeier HM, Raynor HA, Lloyd-Richardson EE, Rogers ML, Wing RR: Fast food consumption and breakfast skipping: predictors of weight gain from adolescence to adulthood in a nationally representative sample. J Adolesc Health 2006, 39:842-849.
• [66]Shan XY, Xi B, Cheng H, Hou DQ, Wang Y, Mi J: Prevalence and behavioral risk factors of overweight and obesity among children aged 2–18 in Beijing, China. Int J Pediatr Obes 2010, 5:383-389.