| Abstract |
Childhood overweight and obesity is a growing public health problem worldwide, especially in countries undergoing severe financial and/or social reforms; including Greece. Increased immigration, lower socio-economic status, changes in food type, overconsumption of high fat and protein goods, pre-prepared and fast foods, low intake of fiber and increased intake of sugar and sweetened drinks, as well as a decline in physical activity, with high exposure on screen-based and sedentary leisure activities outline the main changes of modern multicultural world; leading to obesity and overweight even in under 5 years old children.
It is within this background that the current cross-sectional study has been conceptualized, aiming to assess Greek and immigrant preschoolers and their families regarding Body Mass Index (BMI), nutritional habits and adherence to the Mediterranean Diet, during the Greek austerity period, as well as to investigate the parental dietary and lifestyle trajectories that most strongly predict and determine native Greek and immigrant preschoolers’ BMI and KIDMED score. Moreover, current levels of vigorous physical activity (outdoor play, sports participation, active transport to/from school) or sedentary behaviors (television viewing, video/DVD and computer game use) among native and immigrant preschoolers in Attica region were investigated and compared.
The cross-sectional study was performed in Attica, Greece, during the school year 2016-2017. A total sample of 578 guardian parents and 578 preschoolers (5-6 year-old), both native Greeks (n=451) and other nationalities (n=127), from a geographically representative sample of 63 public kindergartens, in 36 municipalities within Attica region, randomly selected, were enrolled in the study.
The Food Frequency Questionnaire (FFQ) and the KIDMED score were utilized as main tools, to assess dietary habits and adherence to the Mediterranean Diet, while other collected information included; parental demographic profile, parents’ and children’s BMI and lifestyle. The Physical Activity Questionnaire in preschoolers (developed by Rhea study and tested in Greek settings) was, also, utilized to assess PA status, both vigorous PA and sedentary behavior, along with core related lifestyle behaviors and habits.
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Summarizing the results in one sentence, family’s nutritional pattern, lifestyle choices and cultural particularities seem to determine child’s behaviors, BMI, KIDMED Score and Physical Activity participation levels, with ethnicity playing role, both in familial dietary and lifestyle habits of Greeks and other ethnicity preschoolers and their guardian parents.
In particular, no significant differences were observed in BMI rates between Greeks and non-indigenous guardian parents; mean BMI was 24.9 (13.2) in Greeks and 24.8 (4.5) in other nationalities (between limits of normal and overweight). Significant, however, weight gains in immigrant parents upon permanent stay in Greece were reported. Statistically significant variations in lifestyle habits including Greek parents’ heavier smoking and other ethnicity guardian parents’ higher physical activity were depicted. Poor levels of adherence to the Mediterranean diet were observed in all preschoolers, while factors positively associated with child’s BMI were: guardian parent’s age and BMI, guardian parent’s smoking status and alcohol consumption. Guardian parent’s, child’s physical activity and child’s KIDMED score were protective factors, pointing out that family’s lifestyle seems to strongly impact on preschoolers’ dietary habits and BMI, regardless ethnicity.
Significantly high level of concordance of guardian parents’ and preschoolers’ dietary habits was revealed. The following dietary and lifestyle characteristics of (both Greek and other nationalities) parents’ found to be the strongest predictors significantly increasing BMI in preschoolers: Low levels of KIDMED score, low frequency of removing fat from meat prior eating, low parental frequency of following Mediterranean Diet. Contrariwise, family’s breakfast and brunch consumption, high frequency of consuming vegetables or fruits, as well as physically active parents who control preschoolers’ diet, were predictors of diminishing the risk for high BMI in children. Child’s increased physical activity and parents’ frequency of following the Mediterranean Diet were found to decrease the risk for low KIDMED score in preschoolers.
Focusing on preschoolers’ obesity and dietary differences between the two nationality groups, children’s BMI didn’t vary since it was 15.7 and 15.8 (normal/healthy weight) in Greeks and those of other nationalities, respectively. Similarly, KIDMED score was “poor” in the majority of both groups (p value=0.7). Nevertheless, several differences were observed in the sub-categories of KIDMED score measuring Mediterranean diet habits. In particular, more children
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of other nationalities consume fish regularly (p value=0.04) and visit more than once per week a food restaurant, comparing to Greek children (p value<0.001). Furthermore, the 70.9% of the children of other nationality consumes pasta or rice almost every day (p value<0.001), the 80.2% of them have cereals or grains for breakfast (p value=0.02). Significantly less (p value<0.001) Greek children skip breakfast (10.9%) comparing to other nationalities (29.4%), whereas more Greeks use olive oil at home (Greek: 99.6%, other nationalities: 94.5%, p value<0.001). In addition, the 18.4% of other nationalities chooses commercially baked goods or pastries for breakfast (Greek: 9.1%, p value=0.003) and the 37% takes two yoghurts and/or 40g cheese daily (Greek: 50.2%, p value=0.008).
Frequency of physical activity was inversely correlated to body mass index, indicating that the less they exercise the more body mass index rises in both ethnic groups. Physical activity was found to be an independent indicator of increased body mass index, but some particular habits tended to increase risk of high body mass index in preschoolers; Such as TV watching daily and in weekends, mother’s time spending in watching TV or using the computer and parent’s attempting to provide food even when the child is not hungry.
Additionally, current levels of vigorous physical activity (outdoor play, sports participation, active transport to/from school) or sedentary behaviors (television viewing, video/DVD and computer game use) among native and immigrant preschoolers in Attica region were described and found to vary partially between Greek and other ethnic groups. Preschoolers of other ethnicity tended to watch TV more hours daily comparing to Greek (p<0.001), and during weekends (p <0.001).
Nevertheless, duration of playing basketball in the kindergarten’s yard was also found to vary significantly (p=0.03) in favor of those of other ethnicity (mean=20.3 minutes/day vs 14.8 minutes/day in Greeks). Similarly, they played more (p=0.04) both in actively and sedentary position in the kindergarten (mean=59.5 minutes/day vs 48.4 minutes/day in Greeks). The majority of Greek preschoolers, on the other hand, tend to play in the playgrounds (56.7% vs 38.1% in other ethnicities, p<0.001) and have several scheduled afternoon activities (74.1% vs 40.2% in other ethnicities, p<0.001).
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Greek preschoolers seemed to have more intense PA during summer as well (e.g. swimming, p<0.001) playing at the sand, p=0.02), as well as frequent skating (p=0.02). Still they reported less frequently that they went for calm or intense walk with their parents (88.2% in other ethnicity vs 66.1% in Greeks).
Furthermore, the vast majority of parents of Greek preschoolers reported that spent almost no personal time to facilitate child’s physical activity (mothers: 41.4%; fathers: 39.9%). Although slightly lower proportions were reported by the other ethnicities (mothers: 39.2%; fathers: 35.8%) in “almost no time” response, more of them tend to offer at least ½ hour/week (mothers: 11.2%; fathers:17.5%) or 1 hour/week (mothers: 12.8%; fathers: 13.3%) and more than 7 hours/week (mothers: 6.4%; fathers: 6.6%).
As family's lifestyle appears to have a strong impact on dietary habits and the Mass Index, regardless of ethnicity, the determination of dietary patterns in preschool can be a reliable indicator for monitoring the epidemic of obesity at an early age. Families should be encouraged to promote optimal eating habits to achieve better health outcomes for their children.
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