Prevalence of Obesity and Overweight among School-Aged Children in Saudi Arabia and Its Association with Vitamin D Status Prevalence of Obesity in School Children

Main Article Content

Adnan Al Shaikh
Fayssal Farahat
Bahaa Abaalkhail
Ibrahim Kaddam
Khalid Aseri
Yousef Al Saleh
Ali Al Qarni
Ahmed Al Shuaibi
Waleed Tamimi

Keywords

Obesity, Overweight, School-Aged Children, Vitamin D

Abstract

Background: Childhood obesity is a significant global public health problem. Worldwide data showed an increasing trend over the years. We aimed to explore the prevalence of obesity, and its association with vitamin D status. Methods: This cross-sectional study was conducted during the period from 2016 to 2017. The study included 3613 schoolchildren aged 6-19 years in the western, central, and eastern regions in Saudi Arabia. Anthropometric data including age, sex and body mass index (BMI) was collected and the serum 25OH- vitamin D (25OHD) was measured. Age-sex standardized BMI Z-scores using the 2007 World Health Organization growth standards were applied. Results: Data from 3613 school-aged children (females = 51.8%), with equal percentage of participants from each region were analyzed. Prevalence of obesity and overweight was estimated at 7.1% and 14.4% respectively. An increasing trend was detected with age (p: 0.006). Obesity started to increase at the age of 10 years and continued to increase until 19 years. Most of the obese children (64.2%) had deficient vitamin D levels, compared to 33.7% of them with suboptimal levels and only 2.0% with optimal levels (p: <0.001). Conclusions: This large cohort study revealed a high prevalence (21.5%) of obesity and overweight in school children aged between 6-19 years with increasing trend with age.  Children with high BMI showed extremely high prevalence of VDD and VDI. These findings are alarming and point to the need for effective national interventions that include improving and encouraging access to physical activity and exposure to sunlight, educational activities for students, parents, and schoolteachers and possible enrichment of staple food with vitamin D.

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References

1. de Onis M, Blössner M, Borghi E. Prevalence and trends of stunting among pre-school children, 1990-2020. Public Health Nutr. 2012;15:142-148.
2. NCD Risk Factor Collaboration (NCD-RisC) – Africa Working Group. Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies. Int J Epidemiol. 2017;46:1421-1432.
3. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128•9 million children, adolescents, and adults. Lancet. 2017;390:2627-2642.
4. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006;1:11-25.
5. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766-781.
6. Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance - United States, 2015. MMWR Surveill Summ. 2016;65:1-174.
7. Aryeetey R, Lartey A, Marquis GS, Nti H, Colecraft E, Brown P. Prevalence and predictors of overweight and obesity among school-aged children in urban Ghana. BMC Obes. 2017;4:38. Published 2017 Dec 4. doi:10.1186/s40608-017-0174-0.
8. Sarokhani D, Sarokhani M, Dehkordi A, Gheshlagh R, Fakhri M. Prevalence of Obesity and Overweight in Iranian Students: A Systematic Review and Meta-Analysis. J Pediatr Endocrinol Metab. 2020;33:453-468.
9. Roth CL, Elfers C, Kratz M, Hoofnagle AN. Vitamin d deficiency in obese children and its relationship to insulin resistance and adipokines. J Obes. 2011;2011:495101. doi:10.1155/2011/495101
10. Ashraf A, Alvarez J, Saenz K, Gower B, McCormick K, Franklin F. Threshold for effects of vitamin D deficiency on glucose metabolism in obese female African-American adolescents. J Clin Endocrinol Metab. 2009; 94:3200–3206.
11. Motlaghzadeh Y, Sayarifard F, Allahverdi B, Rabbani A, Setoodeh A, Sayarifard A, et al. Assessment of vitamin D status and response to vitamin D3 in obese and non-obese Iranian children. J Trop Pediatr.2016; 62:269–275.
12. Khor GL, Chee WS, Shariff ZM, et al. High prevalence of vitamin D insufficiency and its association with BMI-for-age among primary school children in Kuala Lumpur, Malaysia. BMC Public Health. 2011;11:95. Published 2011 Feb 11. doi:10.1186/1471-2458-11-95
13. He Y, Cai M, Huang X. Prevalence of vitamin D insufficiency/deficiency among overweight and obese preschool children in Yuelu District of Changsha. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2017; 42:565–569.
14. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab.2011; 96:1911–1930.
15. Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab. 2008;93(Suppl 1):S9-S30.
16. Kelishadi R. Childhood overweight, obesity, and the metabolic syndrome in developing countries. Epidemiol Rev. 2007;29:62-76.
17. Atienza M. Trends of childhood obesity in ASEAN. Southeast Asian J. Trop. Med. Public Health. 2014;45 (Suppl 1):149-152.
18. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377:13-27.
19. Rankin J, Matthews L, Cobley S, et al. Psychological Consequences of Childhood Obesity: Psychiatric Comorbidity and Prevention. Adolesc Health Med Ther. 2016;7:125-146.
20. Park MH, Falconer C, Viner RM, Kinra S. The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev. 2012;13:985-1000.
21. Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet. 2010;375:1737-1748.
22. Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care. 2015;4:187-192.
23. Al Shehri A, Al Fattani A, Al Alwan I. Obesity among Saudi children. Saudi J Obesity 2013;1:3-9.
24. http://www.who.int/dietphysicalactivity/childhood_consequences. WHO | Why does childhood overweight and obesity matter?
25. Davison KK, Birch LL. Childhood overweight: A contextual model and recommendations for future research. Obes Rev. 2001;2:159-171.
26. OMS. WHO reference 2007. Http://Www.Who.Int/ Growthref/Who2007 _Bmi_for_ Age/En.
27. WHO Multicentre Growth Reference Study Group. WHO child growth standards : length/height-for-age, weight-for-age, weight-for-length, weight-forheight and body mass index-for-age : methods and development. WHO Child Growth Standards .2006. doi:10.4067/S0370-41062009000400012
28. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007; 85: 660-667.
29. Bouillon R, Van Schoor NM, Gielen E, et al. Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. J Clin Endocrinol Metab. 2013; 98:1283–1304.
30. Rosen CJ, Abrams SA, Aloia JF, et al. IOM committee members respond to Endocrine Society vitamin D guideline. J Clin Endocrinol Metab. 2012;97:1146-1152.
31. Malik M, Bakir, A. Prevalence of overweight and obesity among children in the United Arab Emirates. Obes Rev. 2007;8:15-20.
32. Adom T, Kengne AP, De Villiers A, Puoane T. Association between school-level attributes and weight status of Ghanaian primary school children. BMC Public Health. 2019;19(1):577. Published 2019 May 15. doi:10.1186/s12889-019-6937-4
33. Gautam S, Jeong HS. Childhood Obesity and Its Associated Factors among School Children in Udupi, Karnataka, India. J Lifestyle Med. 2019; 9:27-35.
34. Negash S, Agyemang C, Matsha TE, Peer N, Erasmus RT, Kengne AP. Differential prevalence and associations of overweight and obesity by gender and population group among school learners in South Africa: a cross-sectional study. BMC Obes. 2017;4:29. Published 2017 Jul 17. doi:10.1186/s40608-017-0165-1
35. Karki A, Shrestha A, Subedi N. Prevalence and associated factors of childhood overweight/obesity among primary school children in urban Nepal. BMC Public Health. 2019;19(1):1055. Published 2019 Aug 6. doi:10.1186/s12889-019-7406-9
36. El Mouzan MI, Foster PJ, Al Herbish AS, et al. Prevalence of overweight and obesity in Saudi children and adolescents. Ann Saudi Med. 2010;30:203-208.
37. Al-Hussaini A, Bashir MS, Khormi M, et al. Overweight and obesity among Saudi children and adolescents: Where do we stand today? Saudi J Gastroenterol. 2019;25:229-235.
38. Fruhstorfer BH, Mousoulis C, Uthman OA, Robertson W. Socio-economic status and overweight or obesity among school-age children in sub-Saharan Africa - a systematic review. Clin Obes. 2016;6:19-32.
39. Drenowatz C, Eisenmann JC, Pfeiffer KA, et al. Influence of socio-economic status on habitual physical activity and sedentary behavior in 8- to 11-year old children. BMC Public Health. 2010;10:214. Published 2010 Apr 27. doi:10.1186/1471-2458-10-214.
40. Drewnowski A. Obesity, diets, and social inequalities. Nutr Rev. 2009;67 (Suppl 1):S36-S39.
41. Rogers R, Eagle T, Sheetz A, et al. The Relationship between Childhood Obesity, Low Socioeconomic Status, and Race/Ethnicity: Lessons from Massachusetts. Child Obes. 2015;11:691-695.
42. de Silva-Sanigorski A, Elea D, Bell C, et al. Obesity prevention in the family day care setting: impact of the Romp & Chomp intervention on opportunities for children's physical activity and healthy eating. Child Care Health Dev. 2011;37:385-393.
43. Hu EY, Ramachandran S, Bhattacharya K, Nunna S. Obesity Among High School Students in the United States: Risk Factors and Their Population Attributable Fraction. Prev Chronic Dis. 2018;15:E137. Published 2018 Nov 8. doi:10.5888/pcd15.180122
44. Gidding SS, Dennison BA, Birch LL, et al. Dietary recommendations for children and adolescents: a guide for practitioners. Pediatrics. 2006;117:544-559.
45. Stokic E, Kupusinac A, Tomic-Naglic D, et al. Obesity and Vitamin D Deficiency. Angiology. 2015;66:237-243.
46. Al-Agha A, Shaikhoon S, Sultan M, Alsheikh H. Weight and Body Mass Index in Relation to Vitamin D Status in Healthy 4–13 Years Old Children in Saudi Arabia. RRJMHS. 2016;5: 20-24
47. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72:690-693.
48. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80(6 suppl):1678S-1688S.
49. Mcgill AT, Stewart JM, Lithander FE, Strik CM, Poppitt SD. Relationships of low serum vitamin D3 with anthropometry and markers of the metabolic syndrome and diabetes in overweight and obesity. Nutr J. 2008;7:1-5.