Childhood obesity in Tunisia: Prevalence and risk factors

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Maryam Naifar
Yosra Htira
Chaima Jemai
Imene Hedfi
Zohra Haj Ali
Faika Ben Mami

Abstract

Introduction: Obesity in children is currently a major public health problem in Tunisia.


Aim: To determine the prevalence of obesity among pre-schoolchildren in the city of Bardo and to identify risk factors.


Methods: We carried a cross-sectional study of 220 children between 4 and 6 years of age, recruited from kindergartens in the city of Bardo. Children with endocrinal, tumoral or genetic diseases causing secondary obesity, children on corticosteroids and children with two illiterate parents were not included. The weight status of the children was defined according to the curves of the international obesity task force. A parent is considered obese if his BMI>30 Kg/m².


Results: The average age was 4.65±0.77 years. A female predominance was noted (55.9% girls and 44.1% boys). The average BMI of the children was 16.93±2.46 kg/m². The prevalence of overweight among all children was 10.9% and that of obesity was 11.4%. The frequency of overweight (including obesity) was 22.3%. In multivariate analysis, factors independently related to childhood obesity were child age, child medical history and hospitalization, parental obesity, parental dyslipidemia, snack type and snacking.


Conclusions: Overweight is common in pre-school children. It should be detected at an early age, especially if risk factors are present.

Keywords:

Overweight, Obesity, Children, Risk Factors, Epidemiology, Tunisia, North Africa

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References

  1. Frelut LM. Obésité de l’enfant et de l’adolescent. Encycl Med Chir.2009 ;29(3) :1-15
  2. Tounian P. Conséquences à l’âge adulte de l’obésité de l’enfant. Arch Pediatr. 2007;14(6):718–20.
  3. Ben Rabeh R, Ahmed A, Mazigh S, Missaoui N, Atitallah S, Yahyaoui S, et al. Élaboration of a Tunisian pediatric risk score for hospital undernutrition: Prospective cohort study. Nutr Clin Metab. 2023;37(1):21–30.
  4. Jebeile H, Kelly AS, O'Malley G, Baur LA. Obesity in children and adolescents: epidemiology, causes, assessment, and management. Lancet Diabetes Endocrinol. 2022;10(5):351-365.
  5. Unicef, WHO, World Bank. Joint child malnutrition (JME). Prevalence of overweight (modeled estimate, % of children under 5) [En ligne]. Unicef [cité le 07/09/2022]; [environ 39 écrans]. Disponible à l’URL : https://data.worldbank. org/indicator/SH. STA.OWGH.ME.ZS https://donnees.banquemondiale.org
  6. Institut national de la statistique et des études économiques. Nomenclatures des professions et catégories socioprofessionnelles 2022 [En ligne]. Insee [cité le 07/09/2022] ; [environ 39 écrans]. Disponible à l’URL : https://www.insee.fr/fr/information/2406153
  7. Deloison C. Les facteurs de risques maternels prédictifs d’obésité infantile [Thèse]. Médecine : Toulouse ; 2015. 50p.
  8. Dolata S. Indice du statut socioéconomique du milieu familial des élèves du SACMEQ: construction avec le modèle de Rasch et analyses. Mesure Evaluation Education.2008 ;31(1):121-49.
  9. Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain During Pregnancy: Reexamining the Guidelines. Rasmussen KM, Yaktine AL, editors. Washington (DC): National Academies Press (US); 2009. PMID: 20669500.
  10. Organisation Mondiale de Santé Cibles mondiales de nutrition 2025: Note d’orientation sur l’allaitement au sein[En ligne]. OMS [cité le 07/09/2022]; [environ 3écrans]. Disponible à l’URL :https://www.who.int/fr/publications-detail/WHO-NMH-NHD-14.7
  11. Symon B, Crichton GE, Muhlhausler B. Does the early introduction of solids promote obesity? Singapore Med J. 2017;58(11):626-631.
  12. Haute Autorite de Sante. Surpoids et obésité de l’enfant et de l’adolescent [En ligne]. HAS [cité le 07/09/2022]; [environ 11 écrans]. Disponible à l’URL: https://www.has-sante.fr/jcms/p_3320587/fr/surpoids-et-obesite-chez-l-enfant-vers-une-prise-en-charge-globale-et-multidimensionnelle
  13. Valerio G, Balsamo A, Baroni MG, Brufani C, Forziato C, Grugni G, Licenziati MR, Maffeis C, Miraglia Del Giudice E, Morandi A, Pacifico L, Sartorio A, Manco M; on the behalf of the Childhood Obesity Group of the Italian Society of Pediatric Endocrinology and Diabetology. Childhood obesity classification systems and cardiometabolic risk factors: a comparison of the Italian, World Health Organization and International Obesity Task Force references. Ital J Pediatr. 2017 ;43(1):19.
  14. Kêkê LM, Samouda H, Jacobs J, di Pompeo C, Lemdani M, Hubert H, et al. Body mass index and childhood obesity classification systems: A comparison of the French, International Obesity Task Force (IOTF) and World Health Organization (WHO) references. Rev Epidemiol Sante Publique . 2015;63(3):173–82.
  15. Unicef Tunisie. Analyse de la situation des enfants en Tunisie [En ligne] .OMS [cité le 07/09/2022]; [environ 237 écrans]. Disponible à l’URL : https://www. unicef.org/tunisia/media/2986/file/SITAN-11-2020.pdf
  16. Taleb S, Agli AN. Obesity of the child: Role of the socio-economic factors, parental obesity, food behavior and physical activity in schoolchildren in a city of east Algeria. Cah Nutr Diet. 2009;44(4):198–206.
  17. Rachid B, Ahcene C, Hacene I, Touhami B. L’obésité, entre facteurs pré-déterminants parentaux et sédentarité. Revue Sciences Humaines. 2018;49:75-87.
  18. Sbai M, Aboussaleh Y. Statut nutritionnel et surcharge pondérale chez les enfants préscolaires de la ville de Kenitra (nord-ouest du Maroc). Antropo. 2014 ;32:45-53.
  19. Abdelkafi A, Younes K, Gabsi Z, Bousalah A, Maalal I, May M El, et al. Facteurs de risque de l’obésité chez l’enfant. Tunis Med. 2011;90(05):387–93.
  20. Raiah M, Talhi R, Mesli MF. Overweight and obesity in children aged 6-11 years: prevalence and associated factors in Oran. Sante Publique. 2012;24(6):561–71.
  21. Lifshitz F. Obesity in children. J Clin Res Pediatr Endocrinol. 2008;1(2):53-60.
  22. Martin CL, Vladutiu CJ, Zikry TM, Grace MR, Siega-Riz AM. Maternal lipid levels during pregnancy and child weight status at 3 years of age. Pediatr Obes. 2019;14(4):e12485.
  23. Gademan MG, Vermeulen M, Oostvogels AJ, Roseboom TJ, Visscher TL, van Eijsden M, Twickler MT, Vrijkotte TG. Maternal prepregancy BMI and lipid profile during early pregnancy are independently associated with offspring's body composition at age 5-6 years: the ABCD study. PLoS One. 2014 ;9(4):e94594.
  24. Machałowski T, Młyńczyk J, Piskozub M, Niedzielska K, Krzywińska-Zdeb E, Piotrowska-Depta M. Childhood overweight and obesity - Analysis of the risk factors, including the patient’s family’s lifestyle, based on research results collected from two academic centres in Poland. Pediatr Pol. 2018;93(5):383–8.
  25. Murakami K, Barbara M, Livingstone E. Associations between meal and snack frequency and overweight and abdominal obesity in US children and adolescents from national health and nutrition examination survey (NHANES) 2003-2012. Br J Nutr. 2016;115(10):1819-29.
  26. Boukthir S, Essaddam L, Mazigh Mrad S, Ben Hassine L, Gannouni S, Nessib F, Bouaziz A, Brini I, Sammoud A, Bouyahia O, Zouari B. Prevalence and risk factors of overweight and obesity in elementary schoolchildren in the metropolitan region of Tunis, Tunisia. Tunis Med. 2011;89(1):50-4.
  27. Lê KA. Boissons sucrées et obésité: Aspects épidémiologiques et physiopathologiques. Obesite. 2012 ;7(1):10–7.
  28. Abdelkafi A, Younes K, Gabsi Z, Bousalah A, Maalal I, Elmay M, et al. Facteurs de risque de l’obésité chez l’enfant. Tunis Med.2011;90(5):387-93.
  29. Rahman M, Reza S, Islam M, Rahman A, Nath A. Prevalence of Obesity and Overweight among English Medium School Children of Dhaka City in Bangladesh. J Environ Sci Nat Resour. 2015;7(1).
  30. Tripicchio GL, Kachurak A, Davey A, Bailey RL, Dabritz LJ, Fisher JO. Associations between Snacking and Weight Status among Adolescents 12-19 Years in the United States. Nutrients. 2019 ;11(7):1486.
  31. Kammerer L. Etude des facteurs de risque d’obésité chez l’enfant de moins de 6 ans en Moselle-est proposition d’un outil de dépistage des facteurs de risque lors du rebond d’adiposité précoce pour le médecin généraliste [Thèse]. Médecine: Nancy; 2011. 107 p.
  32. Ji M, Tang A, Zhang Y, Zou J, Zhou G, Deng J, Yang L, Li M, Chen J, Qin H, Lin Q. The Relationship between Obesity, Sleep and Physical Activity in Chinese Preschool Children. Int J Environ Res Public Health. 2018 Mar 15;15(3):527.
  33. Herbenick SK, James K, Milton J, Cannon D. Effects of family nutrition and physical activity screening for obesity risk in school-age children. J Spec Pediatr Nurs. 2018 Oct;23(4):e12229.
  34. Organisation Mondiale de Santé: Activité physique [En ligne]. OMS [cité le 15/07/2023]; [environ 16 écrans]. Disponible à l’URL : https://www.who.int/fr/news-room/fact-sheets/detail/physical-activity