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  • NINA VUORELA

    Body Mass Index, Overweight andObesity Among Children in Finland

    A Retrospective Epidemiological Study inPirkanmaa District Spanning Over Four Decades

    ACADEMIC DISSERTATIONTo be presented, with the permission of

    the board of the School of Medicine of the University of Tampere,for public discussion in the Jarmo Visakorpi Auditorium,

    of the Arvo Building, Lkrinkatu 1, Tampere, on June 1st, 2011, at 12 oclock.

    UNIVERSITY OF TAMPERE

  • NINA VUORELA

    Body Mass Index, Overweight andObesity Among Children in Finland

    A Retrospective Epidemiological Study inPirkanmaa District Spanning Over Four Decades

    A c t a U n i v e r s i t a t i s Tam p e r e n s i s 1 6 1 1Tam p e r e U n i v e r s i t y P r e s s

    Tam p e r e 2 0 1 1

  • ACADEMIC DISSERTATIONUniversity of Tampere, School of MedicineTampere Health Centres, Department of Social Services and Health Care, TampereRuovesi and Vilppula Health Centres, Health Care District of Yl-Pirkanmaa RegionVirrat Health Centre, VirratKanta-Hme Central Hospital, Department of Pediatrics, HmeenlinnaFinland

    Supervised by Reviewed byDocent Matti Salo Docent Minna AromaaUniversity of Tampere University of TurkuFinland FinlandDocent Marja-Terttu Saha Docent Pivi TapanainenUniversity of Tampere University of OuluFinland Finland

    DistributionBookshop TAJU Tel. +358 40 190 9800P.O. Box 617 Fax +358 3 3551 768533014 University of Tampere taju@uta.fiFinland www.uta.fi/taju http://granum.uta.fi

    Cover design byMikko Reinikka

    LayoutSirpa Randell

    Acta Universitatis Tamperensis 1611 Acta Electronica Universitatis Tamperensis 1071ISBN 978-951-44-8445-2 (print) ISBN 978-951-44-8446-9 (pdf)ISSN-L 1455-1616 ISSN 1456-954XISSN 1455-1616 http://acta.uta.fi

    Tampereen Yliopistopaino Oy Juvenes PrintTampere 2011

  • To my beloved family

  • Contents

    List of Original Publications.............................................................................................. 7

    Abbreviations ....................................................................................................................... 8

    Abstract ................................................................................................................................ 9

    Tiivistelm ...........................................................................................................................11

    1 Introduction ................................................................................................................. 13

    2 Review of the Literature ..............................................................................................142.1 Definition of obesity .........................................................................................142.2 Assessment of body composition in a child ..................................................14

    Simple methods for measuring adiposity ...........................................14 Additional tools for measuring adiposity .......................................... 16

    2.3 Classification of overweight and obesity ...................................................... 172.4 Origin of obesity ............................................................................................... 19

    Genetic factors ....................................................................................... 19 Environmental factors .......................................................................... 20

    Diet ......................................................................................... 20 Physical activity pattern ...................................................... 21 Information and communication technology ................. 22 Sleep ...................................................................................... 22 Socioeconomic and demographic differences ................. 23

    Critical periods for the development of overweight and obesity .. 24 Obesity associated medical disorders ................................................ 25

    2.5 Epidemiology of overweight and obesity in children ................................. 25 Prevalence and trends .......................................................................... 25 Changes in waist circumference ......................................................... 26

    2.6 Prevalence of underweight .............................................................................. 272.7 Perception of weight class ............................................................................... 272.8 Consequences of childhood obesity ............................................................. 282.9 Secular trends in growth and maturation .................................................... 29

  • 3 Aims of the Study .........................................................................................................31

    4 Subjects and Methods ................................................................................................. 324.1 Study design of the Tampere Childrens Obesity Study (TCOS) ............... 324.2 Subjects .............................................................................................................. 334.3 Methods ............................................................................................................. 354.4 Statistical analyses ............................................................................................ 364.5 Reliability and validity of the data ................................................................ 374.6 Ethics .................................................................................................................. 38

    5 Results ........................................................................................................................... 395.1 Prevalence of overweight and obesity ........................................................... 395.2 Prevalence of underweight .............................................................................. 445.3 Growth of children in birth cohorts from four decades............................. 455.4 Association between weight class at the age of 2 years and overweight at the age of 15 years .................................................................... 565.5 Perception of the weight class ......................................................................... 57

    6 Discussion ..................................................................................................................... 62 General discussion ................................................................................ 62 Future considerations ........................................................................... 68

    7 Conclusions .................................................................................................................. 69

    8 Acknowledgement ....................................................................................................... 70

    9 References ..................................................................................................................... 73

    Appendix 1. Studies reporting the prevalence of overweight and obesity in children. Overweight and obesity defined primary by the International Obesity Task Force criteria (IOTF). .......................................................................... 89

    Original communications ................................................................................................ 95

  • List of Original Publications

    This dissertation is based on original publications referred in text by their Roman numerals (IIV):

    I Vuorela N, Saha MT, Salo M (2009). Prevalence of overweight and obesity in 5- and 12-year-old Finnish children in 1986 and 2006. Acta Paediatr 98: 507512.

    II Vuorela N, Saha MT, Salo MK (2011). Change in prevalence of overweight and obesity in Finnish children comparison between 1974 and 2001. Acta Paediatr 100: 109115.

    III Vuorela N, Saha MT, Salo MK (2011). Toddlers get slimmer while adolescents get fatter BMI distribution in five birth cohorts from four decades in Finland. Acta Paediatr 100: 570577.

    IV Vuorela N, Saha MT, Salo MK (2010). Parents underestimate their childs overweight. Acta Paediatr 99: 13741379.

    In addition, some unpublished data is presented.

  • Abbreviations

    AHLS Adolescent Health and Lifestyle Survey BIA Bioelectrical impedance analysis BMI Body mass index, kg/m BMI SDS Body mass index Standard Deviation Score CDC the US Centers for Disease Control and PreventionCRF Cardiorespiratory fitnessCT Computed tomography DEXA Dual energy x-ray absorptiometry E% Daily energy intake HBSC Health Behavior in School-aged Children StudyIOTF International Obesity Task Force MC4R Melanocortin 4 receptor MRI Magnetic resonance imaging POMC Pro-opiomelanocortin SD Standard deviation SES Socioeconomic status SF Skinfold thickness STRIP Special Turku Coronary Risk Factor Intervention Project for Children TCOS Tampere Childrens Obesity StudyWC Waist circumference WHR Weight-for-height ratio WHTR Waist to height ratio

  • Abstract

    Body mass index, overweight and obesity among children in Finland

    Increasing prevalence of overweight and obesity in childhood has been reported worldwide. The prevalence figures vary; approximately 30% in the USA and the Mediterranean countries, 20% in other parts of Europe with lower rates, under 10%, in Africa and Asia. The aims of present studies were to evaluate the secular trends in BMI distribution and the prevalence of overweight and obesity of children in birth cohorts from four decades in Pirkanmaa district, Finland. The ability of parents to

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