OBJECTIVES: The review objectives were to summarize the evidence on prevalence of childhood overweight and obesity within developing countries in Asia and to synthesise the best epidemiological association between the dietary patterns of children in the developing countries in Asia and their weight status in terms of obesity.
INCLUSION CRITERIA: This review considered any studies that included children under 18 years of age who live in developing countries in Asia.This review of epidemiological association considered any analytical observational studies (case-control studies, cohort studies and analytical cross-sectional studies).The focus was to summarise the prevalence of childhood overweight and obesity within developing countries in Asia and synthesise the best available evidence on the relationship between dietary patterns as the exposure variable and childhood overweight and obesity as the outcome.
SEARCH STRATEGY: A three-step search strategy was utilised, with an initial limited search of MEDLINE, CINAHL and EMBASE to identify search terms. A second search using all identified keywords and index terms was undertaken across all included databases. Thirdly, the reference list of all identified reports and articles were searched for additional studies. Additional electronic databases searched included: ProQuest, Web of Science, and Scopus. Each database was searched from inception to September 2011, with an English language restriction.
METHODOLOGICAL QUALITY: All papers selected for retrieval were assessed independently by two reviewers using standardised critical appraisal instruments from the Joanna Briggs Institute.
DATA COLLECTION: Data was extracted from included studies by two reviewers independently using an adapted version of the standardised data extraction form from the Joanna Briggs Institute.
DATA SYNTHESIS: Meta-analysis was not possible because of the heterogeneity of studies in terms of methodology, statistical analyses and outcomes. A narrative summary of results is provided.
RESULTS: Fifteen studies were included in the review. The prevalence rates of childhood overweight and obesity in Asian developing countries ranged from 5.1% to 19.9% with no specific trend in age or gender. Several significant but inconsistent statistical associations between dietary patterns and overweight/obesity in children and adolescents were found [high energy diet (OR: 1.80 95%CI 1.10 to 2.90, p<0.05 vs 0.80 95%CI 0.60 to 1.10, p>0.05), low intake of fruit and vegetables (OR: 2.34 95%CI 1.04 to 5.24, p<0.001; 2.00 95%CI 1.10 to 3.40, p<0.05 vs 1.33 95%CI 0.44 to 4.05, p>0.05; 0.70 95%CI 0.50 to 1.00, p>0.05), high meat consumption (RR: 2.40 95%CI 1.00 to 5.60, p<0.05 vs 1.70 95%CI 1.00 to 2.70, p>0.05), eating out (OR: 12.0 95%CI 7.7 to 18.7, p<0.001; 1.70 95%CI 1.04 to 2.90, p<0.05 vs 1.20 95%CI 0.60 to 2.40, p>0.05), fast food intake (OR: 1.50 95%CI 1.12 to 2.02, p<0.05), presence of snacking (OR: 2.34 95%CI 1.01 to 5.54, p=0.05; 1.26 95%CI 1.13 to 1.40, p<0.05 vs 0.80 95%CI 0.48 to 1.32,p=0.377; 0.60 95%CI 0.30 to 0.99, p<0.05; 0.60 95%CI 0.40 to 0.90, p<0.05) and drinking sugar sweetened beverages (OR: 1.60 95%CI 1.02 to 2.50, p<0.05; 1.70 95%CI 1.10 to 2.70, p<0.05 vs 0.93 95%CI 0.82 to 1.05, p>0.05)]. The key limitation was the heterogeneity of studies in terms of measures of dietary patterns and obesity standards.
CONCLUSIONS: The prevalence rates of childhood overweight and obesity in Asian developing countries ranged from 5.1% to 19.9% with no specific trend in age or gender. From the practice perspective, several significant yet inconsistent statistical associations between dietary patterns and childhood overweight/obesity in children and adolescents were found.This review highlights the need for clinicians to monitor the effects of dietary change on the weight and health status of children in Asian countries.There is a need for valid measures of dietary intake and use of standardised international cut-offs for overweight and obesity, and for future researchers to conduct prospective studies to determine the causal relationship between Asian children's dietary pattern and their weight status.
METHODS: The cross-sectional Family Diet Study (n = 236) was conducted at five primary schools in central of Peninsular Malaysia. Each family consisted of a Malay child, aged 8-12 years, and their main caregiver(s). Information on socio-demographics, dietary intake and anthropometry were collected. Correlations and regression analyses were used to assess dietary relationships within family dyads.
RESULTS: Approximately 29.6% of the children and 75.0% parents were categorised as being overweight or obese. Intakes of nutrients and food groups were below the national recommended targets for majority of children and adults. A large proportion of energy intake mis-reporters were identified: mothers (55.5%), fathers (40.2%) and children (40.2%). Children's body mass index (BMI) was positively associated with parental BMI (fathers, r = 0.37; mothers, r = 0.34; P < 0.01). For dietary intakes, moderate-to-strong (0.35-0.72) and weak-to-moderate (0.16-0.35) correlations were found between mother-father and child-parent dyads, respectively. Multiple regression revealed that maternal percentage energy from fat (β = 0.09, P < 0.01) explained 81% of the variation in children's fat intake.
CONCLUSIONS: Clear parental dietary relationships, especially child-mother dyads, were found. Despite a significant proportion of families with members who were overweight or obese, the majority reported dietary intakes below recommended levels, distorted by energy mis-reporting. The findings of the present study can inform interventions targeting parent-child relationships to improve family dietary patterns in Malaysia.
MATERIALS AND METHOD: The Family Diet Study was conducted with urban Malay families and included a child aged 8-12 years and their main carer(s). Seven domains of parent-child feeding practices were assessed using the child feeding questionnaire and familial demographics, including socio-economic status, child anthropometry and dietary intake were collected. Inferential statistics were used to explore the relationships between variables.
RESULTS: Of the 315 families enrolled, 236 completed all measures, with the majority of parent-reporters being mothers (n = 182). One-third of the children were classified as overweight/obese. Three domains of parent-child feeding practices had median scores of 4.0 out of 5.0 [concern about child overweight (CCO) (Interquartile range (IQR): 3.3, 4.7); pressure-to-eat (PTE) (IQR: 3.3, 4.5) and food monitoring (IQR: 3.0, 5.0)]. The domain of 'perceived child overweight' was positively associated with child age (r = 0.45, p