Dietary intake, physical activity and energy expenditure of Malaysian adolescents. Infrequent Breakfast Consumption Is Associated with Higher Body Adiposity and Abdominal Obesity in Malaysian School-Aged Adolescents A Cross-Cultural Comparison of Health Behaviors between Saudi and British Adolescents Living in Urban Areas: Gender by Country Analyses Lifestyle Habits: Diet, physical activity and sleep duration among Omani adolescents. Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Risk factors associated with abdominal obesity in suburban adolescents from a Malaysian district. The Nutrition and Enjoyable Activity for Teen Girls (NEAT girls) randomized controlled trial for adolescent girls from disadvantaged secondary schools: rationale, study protocol, and baseline results Relative Contribution of Physical Activity, Sedentary Behaviors, and Dietary Habits to the Prevalence of Obesity among Kuwaiti Adolescents Modifiable risk factors for overweight and obesity in children and adolescents from São Paulo, Brazil Physical activity, sedentary behaviors and dietary habits among Saudi adolescents relative to age, gender and region Lifestyle intervention improves fitness independent of metformin in obese adolescents. Randomized controlled trial of a good practice approach to treatment of childhood obesity in Malaysia: Malaysian Childhood Obesity Treatment Trial (MASCOT). A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents Relative Contribution of Obesity, Sedentary Behaviors and Dietary Habits to Sleep Duration Among Kuwaiti Adolescents Intervention of childhood and adolescents obesity in Shantou city. Reversal of obesity-related hypoadiponectinemia by lifestyle intervention: a controlled, randomized study in obese adolescents. Imagine HEALTH: results from a randomized pilot lifestyle intervention for obese Latino adolescents using Interactive Guided ImagerySM Multiple health behaviors in an ethnically diverse sample of adults with risk factors for cardiovascular disease. A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study Biological cardiovascular risk factors cluster in Danish children and adolescents: the European Youth Heart Study. Prevention of type 2 diabetes - where is the evidence? Etiology of overactive bladder: a diet and lifestyle model for diabetes and obesity in older women. The effect of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women: a systematic review protocol
INTRODUCTION Paediatric obesity is a public health concern worldwide as it can track into adulthood and increase the risk of adult morbidity and mortality . While the aetiology of obesity is multi-factorial , the roles of diet and physical activity are controversial . Thus , the purpose of this study was to report on the differences in  energy intake , diet composition , time spent doing physical activity and energy expenditure  among underweight ( UW ) , normal weight ( NW ) and at-risk of overweight ( OW ) Malaysian adolescents ( 317 females and 301 males ) aged 11 - 15 years . METHODS This was a cross-sectional study with 6,555 adolescents measured for weights and heights for body mass index ( BMI ) categorisation . A total of 618 subjects were r and omly selected from each BMI category according to gender . The subjects '  dietary intake and physical activity  were assessed using self-reported three-day food and activity records , respectively . Dietary intake components included total energy and macronutrient intakes .  Energy expenditure was calculated as a sum of energy expended for basal metabolic rate and physical activity . Time spent ( in minutes ) in low , medium and high intensity activities was also calculated . RESULTS The OW adolescents had the highest crude energy intake and energy expenditure . However , after adjusting for body weight , the OW subjects had the lowest energy intake and energy expenditure ( p-value is less than 0.001 ) . The study groups did not differ significantly in time spent for low , medium and high intensity activities . Macronutrient intakes differed significantly only among the girls where the OW group had the highest intakes compared to UW and NW groups ( p-value is less than 0.05 ) . All study groups had greater than 30 percent and less than 55 percent of energy intake from fat and carbohydrate , respectively . CONCLUSION The data suggested that a combination of low energy expenditure adjusted for body weight and high dietary fat intake may be associated with overweight and obesity among adolescents . To prevent overweight and obesity among children and adolescents , strategies that address eating behaviours and physical activity are required . Various segments of the society must be involved in efforts to promote healthful dietary intakes and active lifestyle in children and adolescents Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents . However , the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined . Thus , the aim of the present study was to assess any associations between breakfast consumption practice s and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years . A self-administered question naire on dietary behaviour and lifestyle practice s and a dietary food frequency question naire were used . Body composition and adiposity indices were determined using st and ard anthropometric measurement protocol s and dual energy χ-ray absorptiometry ( DXA ) .  Mean age of the participants was 15.3±1.9 years . The majority of participants ( 71.2 % ) fell in the normal body mass index ( BMI ) ranges . Breakfast consumption patterns showed that only half of the participants ( 50 % ) were consuming breakfast daily . Gender-specific multivariate analyses ( ANCOVA ) showed that in both boys and girls , those eating breakfast at least 5 times a week had significantly lower body weight , body mass index ( BMI ) , BMI z-scores , waist circumference , body fat mass and percent body fat ( % BF ) compared to infrequent breakfast eaters , after adjustment for age , household income , pubertal status , eating-out and snacking practice s , daily energy intakes , and daily physical activity levels . The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity . Therefore , daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth This study investigated the cross-cultural differences and similarity in health behaviors between Saudi and British adolescents . A school-based cross-sectional study was conducted at four cities in Saudi Arabia ( Riyadh and Al-Khobar ; N = 1,648 ) and Britain ( Birmingham and Coventry ; N = 1,158 ) . The participants ( 14–18 year-olds ) were r and omly selected using a  multistage stratified cluster sampling technique . Measurements included anthropometric , screen time , vali date d physical activity ( PA ) question naire and dietary habits . The overweight/obesity prevalence among Saudi adolescents ( 38.3 % ) was significantly ( p < 0.001 ) higher than that found among British adolescents ( 24.1 % ) . The British adolescents demonstrated higher total PA energy expenditure than Saudi adolescents ( means ± SE = 3,804.8 ± 81.5 vs. 2,219.9 ± 65.5 METs-min/week ) . Inactivity prevalence was significantly ( p < 0.001 ) higher among Saudi adolescents ( 64 % ) compared with that of British adolescents ( 25.5 % ) . The proportions of adolescents exceeding 2 h of daily screen time were high ( 88.0 % and 90.8 % among Saudis and British , respectively ) . The majority of Saudi and British adolescents did not have daily intakes of breakfast , fruit , vegetables and milk . MANCOVA showed significant ( p < 0.05 ) gender by country interactions in several lifestyle factors . There was a significant ( p < 0.001 ) gender differences in the ratio of physical activity to sedentary behaviors . In conclusion , Saudi and British adolescents demonstrated some similarities and differences in their PA levels , sedentary behaviors and dietary habits . Unhealthy lifestyle behaviors among adolescents appear to be a cross-cultural phenomenon OBJECTIVES This study aim ed to investigate the  lifestyle habits-physical activity ( PA ) , eating habits ( EH ) , and sleep duration (SD)-of  Omani adolescents , and to examine gender differences in such variables . METHODS 802 Omani adolescents ( 442 females and 360 males ) , aged 15 - 18 years were r and omly recruited .  Anthropometric indices , PA level , and EH and SD  were evaluated by the Arab Teenage Lifestyle question naire . A semi-quantitative food frequency question naire for dietary assessment was also administered . RESULTS The results showed that although the study subjects had a sedentary lifestyle ( lack of PA , average of 6.7 hours sleep , and consumption of high calorie foods ) , they maintained a normal body mass ( less than 25 Kg/m(2 ) ) . Males were more than twice as active as females . With respect to EH , there were few gender differences , except in dairy and meat consumption where 62.5 % and 55.5 % of males consumed more than 3 servings , respectively , compared to 18.78 % and 35.2 % of females , respectively . In addition , waist/height ratio , height , reasons for being active , energy drinks , potato consumption , eating sweets , vigorous PA and breakfast EHs were statistically significant independent predictors for BMI , P < 0.05 for both males and females . CONCLUSION This study revealed a high prevalence of sedentary behaviors and a low level of physical activity , especially among females . Unhealthy dietary habits were also widely found among both genders . There is an urgent need for more research as well as a national policy promoting active living and healthy eating and discouraging sedentary behaviour among Omani adolescents Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : INTRODUCTION We aim ed to determine the risk factors associated with abdominal obesity ( AO )  in suburban adolescents . METHODS This cross-sectional study included adolescents aged 15 - 17 years from five r and omly selected secondary schools in the Hulu Langat district of Selangor state , Malaysia .  Waist circumference ( WC ) was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest . Information on sociodemographic data , dietary habits , physical activity levels and duration of sleep was obtained via interviewer-administered question naires . Participants ' habitual food intake was determined using a 73-item Food Frequency Question naire . RESULTS Among 832 participants , 56.0 % were girls ; 48.4 % were Malay , 40.5 % Chinese , 10.2 % Indian and 0.8 % of other ethnic groups . Median age and WC were 16 ( interquartile range [ IQR ] 15 - 16 ) years and 67.9 ( IQR 63.0 - 74.6 ) cm , respectively . Overall prevalence of AO ( > 90th percentile on the WC chart ) was 11.3 % . A higher proportion ( 22.4 % ) of Indian adolescents were found to have AO compared with Malay and Chinese adolescents . Logistic regression analysis showed that female gender ( adjusted odds ratio [ OR ] 7.064 , 95 % confidence interval [ CI ] 2.087 - 23.913 ; p = 0.002 ) , Indian ethnicity ( adjusted OR 10.164 , 95 % CI 2.182 - 47.346 ; p = 0.003 ) , irregular meals ( adjusted OR 3.193 , 95 % CI 1.043 - 9.774 ; p = 0.042 ) and increasing body mass index ( BMI ) ( adjusted OR 2.867 , 95 % CI 2.216 - 3.710 ; p < 0.001 ) were significantly associated with AO . CONCLUSION AO was common among Malaysian adolescents . Female gender , Indian ethnicity , irregular meals and increasing BMI were significant risk factors Background Child and adolescent obesity predisposes individuals to an increased risk of morbidity and mortality from a range of lifestyle diseases . Although there is some evidence to suggest that rates of pediatric obesity have leveled off in recent years , this has not been the case among youth from low socioeconomic background s. The purpose of this paper is to report the rationale , study design and baseline findings of a school-based obesity prevention program for low-active adolescent girls from disadvantaged secondary schools . Methods / Design The Nutrition and Enjoyable Activity for Teen Girls ( NEAT Girls ) intervention will be evaluated using a group r and omized controlled trial . NEAT Girls is a 12-month multi-component school-based intervention developed in reference to Social Cognitive Theory and includes enhanced school sport sessions , interactive seminars , nutrition workshops , lunch-time physical activity ( PA ) sessions , PA and nutrition h and books , parent newsletters , pedometers for self-monitoring and text messaging for social support . The following variables were assessed at baseline and will be completed again at 12- and 24-months : adiposity , objective ly measured PA , muscular fitness , time spent in sedentary behaviors , dietary intake , PA and nutrition social-cognitive mediators , physical self-perception and global self-esteem . Statistical analyses will follow intention-to-treat principles and hypothesized mediators of PA and nutrition behavior change will be explored . Discussion NEAT Girls is an innovative intervention targeting low-active girls using evidence -based behavior change strategies and nutrition and PA messages and has the potential to prevent unhealthy weight gain and reduce the decline in physical activity and poor dietary habits associated with low socio-economic status . Few studies have reported the long-term effects of school-based obesity prevention programs and the current study has the potential to make an important contribution to the field . Trial registration Australian New Zeal and Clinical Trials Registry No : Background The increasing rate of obesity among Kuwaiti adolescents is associated with immediate and long term-risks to their health and well-being . Objective To up date data on the prevalence of overweight and obesity among Kuwaiti adolescents and to examine the relative contribution of selected lifestyle factors to overweight and obesity in this population . Methods The present study is part of the Arab Teens Lifestyle Study ( ATLS ) . A total of 906 adolescents ( 463 boys and 443 girls ) aged between 14 and 19 years were selected from Kuwaiti schools by a multistage stratified r and omization process . A vali date d question naire was used to collect data on  physical activity , sedentary lifestyle , and eating habits . The International Obesity Task Force ( IOTF ) cutoff values for adolescents under 18 years of age were used to define overweight and obesity . Total energy expenditure was calculated using metabolic equivalent-minutes per week . A general linear model was used to establish the proportion of the variance ( expressed in partial eta squared ) in excess weight attributable to differences in eating habits and physical activity . Results The prevalence of overweight and obesity was 50.5 % in boys and 46.5 % in girls . Among boys , moderate and vigorous activities were found to be significantly negatively associated with overweight and obesity ( p < .05 ) , whereas in girls , only those with not less than moderate activities were negatively associated with overweight and obesity ( p < .05 ) . Sedentary behaviors , time spent watching television , and time spent working on the computer were not significantly associated with obesity in either sex . Consumption of breakfast , vegetables , and fast foods ( boys and girls ) and potatoes , cakes and doughnuts , and sweets ( girls only ) was significantly associated with overweight and obesity ( p < .05 ) . In general , the partial eta square explained by physical activity was less than 3.6 % in boys compared with less than 1.0 % in girls , and eating habits explained less than 1.8 % in boys compared with 2.5 % in girls . Conclusions Physical activity explains a greater proportion of variation in body mass index than do eating habits , particularly in boys . Eating habits explain a greater proportion of variation in body mass index than does physical activity in girls . Prospect i ve studies are needed to clarify the relative effects of sedentary behaviors on overweight in adolescents Background Brazil is currently experiencing a nutrition transition : the displacement of traditional diets with foods high in saturated fat , sodium , and cholesterol and an increase in sedentary lifestyles . Despite these trends , our underst and ing of child obesity in Brazil is limited . Thus , the aims of this study were ( 1 ) to investigate the current prevalence of overweight and obesity in a large sample of children and adolescents living in São Paulo , Brazil , and ( 2 ) to identify the lifestyle behaviors associated with an increased risk of obesity in young Brazilians . Methods A total of 3,397 children and adolescents ( 1,596 male ) aged 7 - 18 years were r and omly selected from 22 schools in São Paulo , Brazil . Participants were classified as normal weight , overweight , or obese based on international age- and sex-specific body mass index thresholds . Selected sociodemographic , physical activity , and nutrition behaviors were assessed via question naire . Results Overall , 19.4 % of boys and 16.1 % of girls were overweight while 8.9 % and 4.3 % were obese . Two-way analysis of variance revealed that the prevalence of overweight and obesity was significantly higher in boys and in younger children when compared to girls and older children , respectively ( P < 0.05 for both ) . Logistic regression analysis revealed that overweight was associated with more computer usage , parental encouragement to be active , and light soft drink consumption after controlling for differences in sex , age , and parental education ( P < 0.05 for all ) . Conversely , overweight was associated with less active transport to school , eating before sleep , and consumption of breakfast , full-sugar soft drinks , fried food and confectionery ( P < 0.05 for all ) . Conclusions Our results show that obesity in São Paulo children and adolescents has reached a level equivalent to that seen in many developed countries . We have also identified three key modifiable factors related to obesity that may be appropriate targets for future intervention in Brazilian youth : transport mode to school , computer usage , and breakfast consumption Background Few lifestyle factors have been simultaneously studied and reported for Saudi adolescents . Therefore , the purpose of the present study was to report on the prevalence of physical activity , sedentary behaviors and dietary habits among Saudi adolescents and to examine the interrelationships among these factors using representative sample s drawn from three major cities in Saudi Arabia . Methods This school-based cross-sectional study was conducted during the years 2009 - 2010 in three cities : Al-Khobar , Jeddah and Riyadh . The participants were 2908 secondary -school males ( 1401 ) and females ( 1507 ) aged 14 - 19 years , r and omly selected using a multistage stratified sampling technique . Measurements included weight , height , sedentary behaviors (  TV viewing  , playing video games and computer use ) , physical activity using a vali date d question naire and dietary habits . Results A very high proportion ( 84 % for males and 91.2 % for females ) of Saudi adolescents spent more than 2 hours on screen time daily and almost half of the males and three-quarters of the females did not meet daily physical activity guidelines . The majority of adolescents did not have a daily intake of breakfast , fruit , vegetables and milk . Females were significantly ( p < 0.05 ) more sedentary , much less physically active , especially with vigorous physical activity , and there were fewer days per week when they consumed breakfast , fruit , milk and diary products , sugar-sweetened drinks , fast foods and energy drinks than did males . However , the females ' intake of  French fries and potato chips , cakes and donuts , and c and y and chocolate was significantly ( p < 0.05 ) higher than the males ' . Screen time was significantly ( p < 0.05 ) correlated inversely with the intake of breakfast , vegetables and fruit .  Physical activity had a significant ( p < 0.05 ) positive relationship with fruit and vegetable intake but not with sedentary behaviors . Conclusions The high prevalence of sedentary behaviors , physical inactivity and unhealthy dietary habits among Saudi adolescents is a major public health concern . There is an urgent need for national policy promoting active living and healthy eating and reducing sedentary behaviors among children and adolescents in Saudi Arabia PURPOSE Obesity in adolescence increases the risk for early adult cardiovascular disease . We recently showed that 6 months of diet , exercise , and metformin result ed in reductions in adiposity and that diet/exercise alone reduced proinflammatory factors and intrahepatic fat in pubertal children with uncomplicated obesity . The purpose of the present study was to determine whether changes in cardiorespiratory fitness ( CRF ) after 6 months of structured diet and exercise ( DE ) or DE plus metformin are related to the previously observed changes in adiposity , markers of inflammation , and intrahepatic fat . METHODS Sixteen obese pubertal adolescents between the ages of 10 and 17 were r and omized into a structured lifestyle program consisting of DE or DE plus metformin . Subjects performed aerobic and resistance exercise 3 d·wk⁻¹ , 30 min per session . Cycle ergometer maximal oxygen consumption ( V˙O2max ) , body composition , blood markers ( glucose , insulin , homeostatic model assessment -insulin resistance , interleukin-6 , hsCRP ) , and intrahepatic fat were measured at baseline and 6 months . RESULTS In the cohort , as whole-body weight decreased by 4.0 % ( P = 0.009 ) , body mass index decreased by 4.9 % ( P = 0.003 ) , percent body fat decreased by 8.8 % ( P < 0.001 ) , and V˙O2max improved in 10 of 16 subjects . The addition of metformin provided no further effect on body composition , CRF , or inflammatory factors . More favorable changes in adiposity , adiponectin , and a trend toward blood glucose and interleukin-6 concentrations ( P = 0.07 ) were observed in subjects who increased V˙O2max at 6 months ( n = 10 ) compared with no change in these variables in those who did not improve V˙O2max . CONCLUSIONS Metformin did not provide benefits above lifestyle modification for improving CRF in obese adolescents .  Improvements in V˙O2max seem to be associated with more favorable metabolic outcomes CONTEXT Few r and omized controlled trials ( RCTs ) of interventions for the treatment of childhood obesity have taken place outside the Western world . AIM To test whether a good practice intervention for the treatment of childhood obesity would have a greater impact on weight status and other outcomes than a control condition in Kuala Lumpur , Malaysia . METHODS Assessor-blinded RCT of a treatment intervention in 107 obese 7- to 11-year olds . The intervention was relatively low intensity ( 8 hours contact over 26 weeks , group based ) , aim ing to change child sedentary behavior , physical activity , and diet using behavior change counselling . Outcomes were measured at baseline and six months after the start of the intervention . Primary outcome was BMI z-score , other outcomes were weight change , health-related quality of life ( Peds QL ) , objective ly measured physical activity and sedentary behavior ( Actigraph accelerometry over 5 days ) . RESULTS The intervention had no significant effect on BMI z score relative to control . Weight gain was reduced significantly in the intervention group compared to the control group ( + 1.5 kg vs. + 3.5 kg , respectively , t-test p < 0.01 ) . Changes in health-related quality of life and objective ly measured physical activity and sedentary behavior favored the intervention group . CONCLUSIONS Treatment was associated with reduced rate of weight gain , and improvements in physical activity and quality of life . More substantial benefits may require longer term and more intensive interventions which aim for more substantive lifestyle changes ABSTRACT Lack of  physical activity  (  PA  ) and high levels of sedentary behaviour ( SB ) have been associated with health problems . This systematic review evaluates the effectiveness of school-based interventions to increase PA  and decrease SB  among 15–19-year-old adolescents , and examines whether intervention characteristics ( intervention length , delivery mode and intervention provider ) and intervention content ( i.e. behaviour change techniques , BCTs ) are related to intervention effectiveness . A systematic search of r and omised or cluster r and omised controlled trials with outcome measures of PA and /or SB rendered 10 results . Risk of bias was assessed using the Cochrane risk of bias tool . Intervention content was coded using Behaviour Change Technique Taxonomy v1 . Seven out of 10 studies reported significant increases in PA . Effects were generally small and short-term ( Cohen 's d ranged from 0.132 to 0.659 ) . Two out of four studies that measured SB reported significant reductions in SB . Interventions that increased PA  included a higher number of BCTs , specific BCTs ( e.g. , goal setting , action planning and self-monitoring ) , and were delivered by research staff . Intervention length and mode of delivery were unrelated to effectiveness . More studies are needed that evaluate long-term intervention effectiveness and target SBs among older adolescents The aim of this study was to investigate whether body mass index ( BMI ) , eating habits and sedentary behaviours were associated with sleep duration among Kuwaiti adolescents . The study is part of the Arab Teens Lifestyle Study ( ATLS ) , which is a school-based cross-sectional multi-center collaborative study . A sample of 906 adolescents ( boys and girls ) aged 14 - 19 years was r and omly selected from 6 Kuwaiti Governances using a multistage stratified cluster sampling technique . The findings revealed that the prevalence of overweight and obesity was 50.5 % in boys and 46.5 % in girls . The majority of boys ( 76 % ) and of girls ( 74 % ) fell into the short sleep duration category ( 6 hours/day or less ) . Sleep duration were found to be negatively associated with BMI ( girls only ) . Watching television  ( boys and girls ) and working on computers ( boys only ) were also negatively associated with sleep duration . While the consumption of breakfast ( both genders ) and milk ( boys only ) was positively associated with sleep duration ( p<0.05 ) . In contrast , the consumption of fast foods ( both genders ) , sugar-sweetened drinks and sweets ( boys only ) potatoes ( girls only ) were negatively associated with sleep duration ( p<0.05 ) . It can be concluded that the majority of Kuwaiti adolescents exhibit insufficient sleep duration which was associated with obesity measure , a combination of poor eating habits and more sedentary behaviors . The findings also suggest gender differences in these associations . Therefore , adequate sleep is an important modifiable risk factor to prevent obesity and was positively associated with some unhealthy lifestyle habits OBJECTIVES The purpose of this study was to evaluate the effects of multicomponent school based intervention constituted of diet modification , regular exercise and psychosocial consultation on body status in overweight and obese children and adolescents . And to come up with an appropriate intervention protocol for controlling children and adolescents obesity in Shantou city . METHODS Two schools were r and omised to intervention group and control group respectively . A total of 41 students enrolled were diagnosed as overweight or obese . Twenty-six students of the intervention group completed the one-year intervention programme consisted of diet modification , regular exercise and psychological consultation except two of them were transferred to another school . The differences of BMI , anthropometric measures , metabolic profile and the scores of question naire and the scale were compared to evaluate the effects of the intervention programme . RESULTS After one-year intervention , it observed in the intervention group that BMI -Z score , WHR and WHtR had significant improvements , and there was a nonsignificant trend ( P=0.053 ) for a decrease in BMI -P. Fasting plasma glucose , cholesterol ( CH ) and low-density-lipoprotein cholesterol ( LDL-C ) levels in the intervention group showed nonsignificant trend for a decrease ( PFPG=0.084 , PCH=0.057 , PLDLC=0.098 ) , compared with a significant increase of triglycerides ( TG ) and LDL-C levels in the control group ( PTG=0.041 , PLDL-C=0.038 ) . There were some positive dietary , physical activity , or sedentary behaviour changes found in the students of the intervention group as the scores of the question naire got significant improvement ( P=0.04 ) . CONCLUSIONS Our one-year multicomponent school-based intervention programme did have positive effects to some extents on health state and lifestyle behaviour of overweight and obese children and adolescents , which indicated that it is feasible and important to implement such a school-based intervention programme in Shantou city CONTEXT Hypoadiponectinemia and chronic sub clinical inflammation in adults are associated with the development of diabetes and cardiovascular disease . The potential relationship between adiponectin and inflammation and its modulation by lifestyle intervention in the pediatric obese population remain unclear . OBJECTIVES The objectives were to investigate in adolescents 1 ) the relationship between adiponectin and obesity-related inflammatory factors , C-reactive protein , and IL-6 ; and 2 ) the effect of a lifestyle intervention on adiponectin and whether these effects are related to changes in inflammatory factors . RESEARCH METHODS AND PROCEDURES Twenty-one obese and age-matched lean adolescents ( age , 14 - 18 yr ; Tanner stage , > or = IV ) were studied cross-sectionally . Fifteen obese adolescents also underwent a r and omized , controlled physical activity-behavior-diet-based lifestyle intervention for 3 months . Associations among adiponectin , fat mass , insulin resistance , and inflammatory factors at baseline as well as after the intervention were assessed . RESULTS Plasma adiponectin concentration was lower ( P < 0.001 ) in the obese vs. age-matched lean adolescents . Significant inverse relationships were observed between adiponectin and inflammatory factors , insulinemia , insulin resistance , and fat mass . Intervention produced a 34 % increase in adiponectin concentration ( P = 0.0004 ) despite negligible weight loss but with reductions in fat mass , hyperinsulinemia , insulin resistance , and inflammatory factors ( all P < 0.01 ) . CONCLUSIONS The data suggest that in adolescents , obesity-related hypoadiponectinemia is associated with sub clinical inflammation , and a short-term lifestyle intervention augments adiponectin concentrations . These effects appear to be related to reductions in fat mass and inflammatory factors . Based on our current underst and ing of adiponectin physiology , reversal of hypoadiponectinemia in obese adolescents may protect against risks for cardiovascular disease and diabetes Background There is an urgent need for innovative and developmentally appropriate lifestyle interventions to promote healthy lifestyle behaviors and to prevent the early onset of type 2 diabetes and cardiovascular disease risk in obese Latino adolescents . Guided imagery offers promise to reduce stress and promote lifestyle behavior change to reduce disease risk in obese adolescents . Our objectives were : 1 ) To pilot test a new 12-wk lifestyle intervention using a r and omized trial design in obese Latino adolescents , in order to determine the effects of the mind-body modality of Interactive Guided ImagerySM ( IGI ) , over and above those of a didactic lifestyle education , on insulin resistance , eating and physical activity behaviors , stress and stress biomarkers ; and 2 ) To explore the role of intervention-related changes in stress and stress biomarkers on changes in metabolic outcomes , particularly insulin resistance . Methods Obese ( BMI > 95th percentile ) , Latino adolescents ( n = 35 , age 14 - 17 ) were r and omized to receive either 12 weekly sessions of a lifestyle education plus guided imagery program ( GI ) , or lifestyle education plus a digital storytelling computer program ( DS ) . Between-group differences in behavioral , biological , and psychological outcomes were assessed using unpaired T-tests and ANCOVA in the 29 subjects who completed the intervention . Results The GI group demonstrated significant reductions in leisure sedentary behavior ( p < .05 ) and increases in moderate physical activity ( p < .05 ) compared to DS group , and a trend toward reduced caloric intake in GI vs DS ( p = .09 ) . Salivary cortisol was acutely reduced by stress-reduction guided imagery ( p < .01 ) . There were no group differences in adiposity , insulin resistance , perceived stress , or stress biomarkers across the 12-week intervention , though decrease in serum cortisol over the course of the intervention was associated with improved insulin sensitivity ( p = .03 ) independent of intervention group and other relevant co-variates . Conclusions The improvements in physical activity and stress biomarkers following this pilot intervention support the role of guided imagery in promoting healthy lifestyle behavior change and reducing metabolic disease risk in obese Latino adolescent population s. Future investigations will be needed to determine the full effects of the Imagine HEALTH intervention on insulin resistance , stress , and stress biomarkers . Trial registration Clinical trials.gov Registry # : BACKGROUND Health behaviors of adults living with cardiovascular disease ( CVD ) risk factors affect additional risk , where lifestyle behavioral choices become even more important in controlling disease and preventing additional negative health outcomes . In addition , both lifestyle behaviors and CVD risk factor prevalence can vary by ethnicity . OBJECTIVE We compared multiple health behaviors of adults with diabetes , hypertension , high cholesterol , and obesity to the behaviors of adults without those conditions in a diverse ethnic sample to determine if significant differences existed between groups . METHODS Data were obtained from  30-minute r and om-digit-dial telephone surveys in 2007 ( n = 3607 ) . All data were self-reports . Healthy behaviors  included meeting recommendations for intake of fruits and vegetables ; consuming low or very low amounts of dietary fat ; eating breakfast six or seven days per week ; having a healthy diet ; and meeting recommendations for walking , moderate , and vigorous physical activity . Unhealthy behaviors included  frequent consumption of soda and fast food , smoking , binge drinking ,  and high stress .  RESULTS More than 6 % of respondents had diabetes , 15.9 % had hypertension , 16.4 % had high cholesterol , and 18.5 % were obese . Significantly fewer healthy and more unhealthy behaviors were reported for those who had CVD risk factors than were reported by those who did not have such conditions . Ethnic differences in CVD risk factor prevalence and health behaviors existed as well ( p < 0.001 ) . Logistic regression models indicated that not eating a healthy diet ( odds ratio [ OR ] = 1.82 ) was a significant predictor for diabetes ; not eating a healthy diet ( OR = 1.52 ) and not doing vigorous physical activity ( OR = 1.79 ) were significant predictors for hypertension ; consumption of high amounts of dietary fat ( OR = 1.70 ) and of fast food ( OR = 1.51 ) were significant predictors for high cholesterol levels ; and not eating a healthy diet ( OR = 1.52 ) , high consumption of dietary fat ( OR = 2.20 ) , not eating breakfast ( OR = 1.33 ) and not performing vigorous physical activity ( OR = 1.63 ) , but less consumption of fast food ( OR = 0.64 ) were significant predictors for obesity . CONCLUSIONS Specifically tailored and culturally sensitive interventions that address multiple health behaviors may be necessary for these high-risk population Background Physical activity ( PA ) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior ( SB ) may be detrimental to children 's health independent of PA . The primary aim of the Transform-Us ! study is to determine whether an 18-month , behavioral and environmental intervention in the school and family setting s results in higher levels of PA and lower rates of SB among 8 - 9 year old children compared with usual practice ( post-intervention and 12-months follow-up ) . The secondary aims are to determine the independent and combined effects of PA and SB on  children 's cardio-metabolic health risk factors ; identify the factors that mediate the success of the intervention ; and determine whether the intervention is cost-effective . Methods / design A four-arm cluster-r and omized controlled trial ( RCT ) with a 2 × 2 factorial design , with schools as the unit of r and omization . Twenty schools will be allocated to one of four intervention groups , sedentary behavior ( SB-I ) , physical activity ( PA-I ) , combined SB and PA ( SB+PA-I ) or current practice control ( C ) , which will be evaluated among approximately 600 children aged 8 - 9 years in school year 3 living in Melbourne , Australia . All children in year 3 at intervention schools in 2010 ( 8 - 9 years ) will receive the intervention over an 18-month period with a maintenance ' booster ' delivered in 2012 and children at all schools will be invited to participate in the evaluation assessment s. To maximize the sample and to capture new students arriving at intervention and control schools , recruitment will be on-going up to the post-intervention time point . Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey . Discussion To our knowledge , Transform-Us ! is the first RCT to examine the effectiveness of intervention strategies for reducing children 's overall sedentary time , promoting PA and optimizing health outcomes . The integration of consistent strategies and messages to children from teachers and parents in both school and family setting s is a critical component of this study , and if shown to be effective , may have a significant impact on educational policies as well as on pedagogical and parenting practice s . Trial registration ACTRN12609000715279 ; Current Controlled Trials IS RCT BACKGROUND The aim of this study was to determine whether the number of participants with multiple coronary heart disease ( CHD ) risk factors exceeded the number expected from a r and om distribution . METHODS A cross-sectional study of 1020 r and omly selected boys and girls , 9 and 15 years old , was conducted . Risk factors were total cholesterol , HDL-cholesterol , triglyceride , serum insulin , and blood pressure . Physical fitness was assessed from a maximal cycle test and body fat from the sum of four skinfolds . Risk factors selected in the analysis were those related to the metabolic syndrome . RESULTS More participants than expected had four or five CHD risk factors . Four risk factors were found in 3.03 ( 95 % confidence interval ( CI ) : 2.24 - 4.10 ) times as many participants as expected from a r and om distribution and five risk factors were found in 8.70 ( 95 % CI : 4.35 - 17.4 ) times as many participants as expected . Fifty ( 5.4 % ) had four or five risk factors and in these individuals physical fitness was 1.2 st and ard deviation ( SD ) lower and body mass index ( BMI ) 1.6 SD higher than mean values for the population . CONCLUSION Clustering of risk factors for the metabolic syndrome was found in children and adolescents . Low levels of physical fitness and raised BMI in these individuals indicate that lifestyle factors such as physical activity and diet may influence the development of these unhealthy risk profiles Diabetes is an “ old disease ” . The first description of diabetes written on papyrus about 3500 years ago is found in the Ebers papyrus  , which was discovered in Egypt in 1873 by the German archeologist Georg Ebers . Humans , like most mammals , may develop diabetes , if sufficient environmental exposure to physical inactivity , unhealthy diet and obesity are present . Genetic effects are important for the individual risk of type 2 diabetes ( T2D ) but twin studies have shown that the genetic effects combined explain less than 50 % of the risk of T2D ( 1 ) . Today we know almost 100 susceptibility genes associated with T2D but the relative importance of each of these genes is low ( 2 ) , and together they explain only a small part of the disease risk . Thus , genetic screening can not be used for the prediction of T2D for individuals . On the other h and , healthy lifestyle can also prevent T2D in people who are genetically at high risk , e.g. those with positive family history ( 3 ) . Thus , the importance of lifestyle factors for the development and prevention of T2D is overwhelming . The strongest evidence in medicine is considered to come from r and omized controlled trials ( RCTs ) . They are also important in providing the link to causal inference that in most observational studies can not be derived . At the same time , observational studies are necessary for the identification of factors associated with an increased or decreased risk of a disease , and for generation of hypotheses on potential means for prevention based on modifiable risk factors . Observational studies have by now identified a large number of factors that are associated with the development of T2D or with the protection against it . Most of them are related to physical activity , diet and obesity . It has also been shown unequivocally that exposures ( poor nutrition , infections , smoking , etc . ) during fetal life and early infancy result ing in insufficient development ( often shown as low birth weight ) also predict T2D later in life ( 4 ) . Traditionally , T2D has been considered to be a disease of the elderly . However , with increasing obesity and sedentary lifestyle in children , there are increasing numbers of cases of T2D already occurring at a young age in many population s ( 5 ) . In the past two decades several innovative RCTs have repeatedly shown that interventions on modifiable risk factors can reduce the incidence of diabetes in high-risk groups . The evidence has been summarized in several systematic review s and meta-analyses ( 6,7 ) . There is compelling scientific evidence from RCTs that T2D can be prevented or its onset delayed . The key for prevention is a multimodal package of lifestyle changes that is a sum outcome of dietary and physical activity behaviours . The power of lifestyle was dramatically illustrated by the Finnish Diabetes Prevention Study ( DPS ) that explicitly showed that when the study participants with impaired glucose tolerance reached all five modest lifestyle intervention targets , none of them progressed to T2D ( 8) . Importantly , lifestyle intervention lasting for 3–6 years has been shown to have a carry-over effect on T2D incidence that lasts for several years ; up to 15 in the Finnish Diabetes Prevention Study ( 9 ) and 20 years in the China Da Qing Diabetes Prevention Study ( 10 ) . The observed sustained risk reduction seems to be a result of sustained lifestyle changes , but the legacy effect of improved glycaemia during the early intervention may also have contributed to the long-term effect . The follow-up data from the Chinese study indicate moreover that vascular risks are also reduced by lifestyle management . Several prognostic question naires exist for detecting people at risk of T2D ( 11 ) . One of the screening tools with an adequately high sensitivity and specificity is the Finnish Diabetes Risk Score ( FINDRISC ) developed in Finl and ( 12 ) . The FINDRISC has been successfully implemented in the Finnish primary health care system and used also in many other countries . The FINDRISC was also tested in the Omani population and as a result a slightly modified Omani Diabetes Risk Score was developed ( 13 ) which may be a suitable screening tool for the Arab population s in the Middle East . Lifestyle interventions aim ing at translating evidence from efficacy RCTs on T2D prevention into “ real world ” intervention programmes have also been carried out in various population s. Such data were recently combined in a meta- analysis considering the relationship between intervention effectiveness and adherence to guidelines ( 14 ) . The primary meta- analysis included 22 studies with outcome data for weight loss at 12 months . The pooled result of the direct pairwise meta- analysis shows that OBJECTIVE To evaluate a coherent , evidence -based hypothesis that specific modifiable lifestyle factors implicated in the development of diabetes and associated obesity are related to the onset of OAB . METHODS A hypothetical causative model for OAB involving modifiable lifestyle factors implicated in the development of diabetes and obesity was constructed , based on a systematic literature review . Secondary analysis of data was undertaken in a prospect i ve cohort of women aged 40 and over , living in Leicestershire , UK . Subjects included 3,411 women free from OAB at baseline and 277 incident cases of OAB . Reported diet , lifestyle , morbid , and social factors were measured at baseline and incident cases at 1-year follow-up . Graphical chain modeling was used to estimate the associations between variables and identify likely pathways involved . RESULTS All hypothesized lifestyle factors ( physical activity , high glycemic index , and high energy intake ) plus diabetes and obesity were retained within the graph as potential contributors . However , low physical activity was the only direct risk factor linked prospect ively to the onset of OAB ( RR 2.47 ; 95 % CI 1.82 , 3.36 ) , in addition to older age . CONCLUSIONS Poor lifestyle factors causally linked to diabetes and obesity may contribute to the onset of OAB ; low physical activity appears to be an important modifiable causal factor for OAB operating directly as well as indirectly via pathways involving obesity or diabetes . Further research is needed to demonstrate a causal link between lifestyle and OAB Review question / objective What are the effects of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women ? The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aim ed at limiting gestational weight gain and postpartum weight retention in women . The second objective of this systematic review is to investigate included intervention components with respect to effect on weight‐related outcomes . This may include , but is not limited to : length of intervention , use of face‐to‐face counselling , group or individual consultations , use of other interventions components including exercise , use of goals and use of support tools like food diaries , coaching , including email or text message support . Background Around half of all women of reproductive age are either overweight or obese,1,2,3 with women aged 25‐34 years having a greater risk of substantial weight gain compared with men of all ages.1,4 Excessive gestational weight gain ( GWG ) and postpartum weight retention ( PPWR ) may play a significant role in long term obesity . Having one child doubles the five‐ and 10‐year obesity incidence for women , with many women who gain excessive weight during pregnancy remaining obese permanently.5 Excessive GWG and /or PPWR can also significantly contribute to short‐ and long‐term adverse health outcomes for mother , baby and future pregnancies.6,7 Maternal obesity increases the risk of pregnancy related complications such as pre‐eclampsia , gestational diabetes mellitus , stillbirth and the rate of caesarean section.8 Childhood obesity is a further long term complication of maternal obesity for offspring , which may persist in to adulthood.9 Excess GWG is also a risk factor for PPWR both in the short and long‐term.10,11 Nehring et al. conducted a meta‐ analysis with over 65,000 women showing that , compared to women who gained weight within recommendations during pregnancy , women with GWG above Institute of Medicine weight gain recommendations , 12 retained an additional 3.1 kg and 4.7 kg after three and greater than or equal to 15 years postpartum , respectively.13 The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index ( kg/m2 ) between consecutive pregnancies ( an average of two years ) was much higher compared with women whose BMI changed from ‐1.0 and 0.9 units.14 Long‐term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post‐partum has been found to be a predictor of maternal overweight 15 years later.15With around 14‐20 % of women retaining 5 kg or more 12 months postpartum,16,5 the risk of developing conditions like diabetes , metabolic syndrome and cardiovascular disease may be increased.17 It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage . Lifestyle factors of overweight , having poor diet quality , and not undertaking enough moderate‐to‐vigorous physical activity are amongst the top five predictors of mortality in women.18 Additionally it is noted that , for many women , pregnancy and the postpartum period are associated with a reduction in physical activity.19 It is known that a combination of poor dietary choices , an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity . With this in mind , current research has focused on lifestyle interventions to limit GWG and PPWR . Thangaratinam et al. review ed 44 r and omized controlled trials ( 7278 women ) where interventions including diet , physical activity or both were evaluated for their influence on maternal weight during  pregnancy.20 Results indicate that all were significantly effective in reducing GWG compared with the control group . More specifically , dietary interventions were the most effective in reducing weight gain , with a mean weight loss of ‐3.84 kg compared with ‐0.72 kg and ‐1.06 kg for physical activity and the mixed ( diet plus physical activity ) approach , respectively.20 This finding is supported by Hill and colleagues ' recent systematic review of theory based interventions to limit GWG.21 Included studies in this review reported an underpinning theory base and were classified as adopting a dietary , physical activity or mixed approach . Hill et al. concluded that studies which included a diet intervention were significantly more effective at limiting GWG.21 In 2011 Tanentsapf et al. review ed the effect of dietary interventions alone for reducing GWG in normal weight , overweight and obese pregnant women.22 This review analysed 13 r and omized controlled trials and quasi‐r and omized controlled trials with a dietary intervention to prevent excessive GWG in women . The review concluded that dietary interventions during pregnancy were effective in reducing GWG with an effect of ‐1.92 kg ( n=1434 ) compared with the control group.22 Tanentsapf et al. identified that trials differed in the conduct of the interventions with various diet and non‐diet related components utilised . Dietary approaches were highly variable with some trials focusing only on calorie restriction and others included additional target macronutrient distribution for intake . Some trials further provided feedback based on maternal weight gain guidelines .12 Interventions also varied in delivery method with a variety of modes used , including face‐to‐face , individual or group consultations and /or written correspondence . The frequency of communication , despite the type or mix , also changed from trial to trial with additional methods via telephone , posted material s , feedback or food diaries utilised . The inclusion of physical activity in addition to diet intervention was also common . Whilst the recent review by Tanentsapf et al.22 identified that dietary interventions are effective in reducing GWG , the review did not investigate the impact that different intervention components , delivery methods or dietary counselling approaches had on gestational weight management . It remains unclear as to which intervention components optimize GWG in women . The impact of lifestyle interventions has also been investigated in the postpartum period . The recent systematic review from van der Pligt et al. reported seven of 11 studies review ed were successful in limiting PPWR.23 As with studies aim ed at limiting GWG , interventions included in van der Pligt et al. 's review differed greatly in their conduct . Six of these seven studies included both dietary and physical activity components for the intervention , with the final successful study including a diet only intervention . Five of the successful studies recruited overweight or obese women only . Intervention time varied considerably in successful studies with some running for as little at ten days , and others up to six months . Bertz et al. demonstrated that their 12‐week behavior modification intervention which targeted diet alone or diet and exercise , including two individual sessions with a dietitian and physical therapist , provision of scales for weight self‐monitoring and bi‐weekly text messages was successful in achieving significant weight loss following the intervention , and sustained at one year.24 The diet intervention and the diet and exercise intervention  yielded significant weight loss compared to the control . Following 12 weeks a reduction of ‐8.3 + /‐ 4.2 kg for diet intervention and ‐6.9 + /‐ 3.0 kg for diet and exercise was observed . Additionally after one year , the diet intervention showed ‐10.2 + /‐ 5.7 kg reduction and ‐7.3 + /‐ 6.3 kg for the diet and exercise intervention (p<0.001).24 Colleran et al. also found significant weight change results by implementing a 16‐week intervention which consisted of weekly individual sessions with a dietitian regarding calorie restriction , two additional home visits regarding exercise , weekly food diary completion and email support.25 The intervention group had greater weight loss compared to the control group ( ‐5.8 kg + /‐ 3.5 kg vs ‐1.6 kg + /‐ 5.4 kg ) . It can be seen that various methods have been utilized in investigating the impact of diet and physical activity interventions on PPWR . The review by van der Pligt et al.23 highlights the impact successful lifestyle interventions can have on postpartum weight change . However , this review did not investigate the different intervention strategies utilized . It remains unclear as to the optimal setting , delivery method , diet strategy , contact frequency or intervention length to limit PPWR . Previous systematic review s for both GWG and PPWR have focused on the effectiveness of lifestyle interventions as a whole for weight management in pregnant and postpartum women.20,23 And despite Tanentsapf et al. 's focus on dietary interventions for GWG,22 much is still unknown about the effectiveness of differing diet interventions over the antenatal and postpartum period . Specifically , the impact of differing diet intervention strategies on maternal weight gain is not known . Firstly , this systematic review will focus on whether  weight management interventions which include a dietary component  are effective in pregnant and postpartum women . In addition to this , this review will investigate the different intervention strategies utilized and their effectiveness in maternal weight management . A search of systematic review protocol data bases has shown that there is no current review underway for this topic
The studies showed that obese and overweight adolescents consume significantly more energy and macronutrients .
They are also more likely to skip their daily meals compared to their normal weight peers .
In most studies , the direction of the PA effect on body weight was unclear .
Some studies found that higher PA is associated with a lower risk of overweight and obesity .
Conclusions This review identified a lack of evidence and well-conducted prospect i ve studies on the effect of diet and PA on cardio-metabolic health of Malaysian adolescents
Background A sedentary lifestyle and an unhealthy diet are major factors in the increasing prevalence of obesity among Malaysian adolescents .
The purpose of this systematic review is to compile the evidence from observational and intervention studies among Malaysian adolescents to evaluate the associations between diet and physical activity ( PA ) as determinants of cardio-metabolic risk factors .