Association of nutrition behavior and food intake with overweight and obesity among school-aged children and adolescents in Pakistan: a cross-sectional study
Authors: Tanveer Moazzam , Asghar Ejaz , Tanveer Umar , Roy Nadeem , Zeba Asifa , Al-Mhanna Sameer Badri , Ma Xiaoran , Batrakoulis Alexios 
Published: June 2024

<abstract><sec>
<title>Purpose</title>
<p>This study aimed to assess the association between nutrition behavior, food intake, being overweight, and obesity among school-aged children and adolescents aged 9 to 17 years. Additionally, it sought to examine how these factors influence being overweight and obese within this population.</p>
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<title>Methods</title>
<p>A population-based cross-sectional study was conducted with a representative multistage cluster sample of 4200 Pakistani school-aged children and adolescents aged 9 to 17 years from 62 schools across seven random districts in Punjab province, Pakistan. Underweight (BMI &lt; 5th percentile), overweight (85th ≤ BMI &lt; 95th percentile), and obese (95th percentile ≤ BMI) were defined using the US Center for Disease Control (CDC) 2000 criteria, and a Chi-square test utilized for comparison. The Pearson correlation coefficient (r) assessed any correlations, while a linear regression analysis explored the predictive power of Nutrition Behavior/Food Intake factors (independent variables) on body-weight (dependent variable). A logistic regression analysis estimated the simultaneous influence of multiple factors on the dichotomous outcomes, and the 95% confidence intervals (CI) were calculated. The statistical significance level was set at <italic>p</italic> &lt; 0.05.</p>
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<title>Results</title>
<p>The study was comprised of 4108 Pakistani school children aged 9 to 17 years (mean age = 13.92 years, 59.3% boys) from 62 schools. Among them, the prevalence of being overweight and obese individuals was 19.4% and 10.7%, respectively. Factors such as skipping breakfast (OR 2.45, 95% CI 1.53–3.93, <italic>p</italic> &lt; 0.001), consuming vegetables less than once a week (OR 4.12, 95% CI 3.06–5.55, <italic>p</italic> &lt; 0.001), consuming soft drinks three or more times a week (OR 4.74, 95% CI 3.73–6.04, <italic>p</italic> &lt; 0.001), and consuming fast food three or more times a week (OR 10.56, 95% CI 8.16–13.67, <italic>p</italic> &lt; 0.001) were associated with a higher risk of obesity.</p>
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<title>Conclusion</title>
<p>Being overweight and obese pose significant concerns among school-aged children and adolescents in Pakistan, showing a troubling upward trend. Poor nutrition behaviors, including frequenting fast-food restaurants and low consumption of fruits and vegetables, contribute to these issues. It is imperative to comprehend these risk factors to formulate impactful policies and dietary interventions that target childhood obesity in Pakistan. Identifying vulnerable populations and implementing tailored intervention strategies are essential for public health efforts. While further interventions may be needed to reduce the body mass index (BMI) and manage being overweight and obese, the findings of this study provide valuable insights into addressing these critical health challenges.</p>
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