published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Community Medicine / Master / Master of Public Health

Systematic reviews were conducted to investigate the relationships between anthropometric assessments of nutritional status (adiposity) and caries experience among preschool and school-age (aged 6-12 years) children. Four relevant databases were searched for publications up to December 2011. Qualitative assessments were conducted and rated according to STROBE statement. Where feasible, quantitative syntheses were conducted. From a total of 2013 studies, 39 effective studies were identified for preschool children and 53 effective studies for school-age children. The mean ‘quality of reporting’ were 20.4 (SD 3.8) for the preschool studies and 21.4 (SD 3.9) for school-age studies. Qualitative syntheses were inconclusive about their relationships. Meta-analyses identified that preschoolers with high BMI had a greater dmfs/defs than those with normal BMI: pooled mean difference 0.93, 95% CI 0.65, 1.22, P < 0.05; and that children with low BMI had a lower dmft than those with normal BMI: pooled mean difference - 0.29, 95% CI -0.42, -0.15, P < 0.05. Among school-age children meta-analyses failed to identify any significant association. Among a random sample of 5-year-old children in Hong Kong, with a response rate of 83.1% (324/390), caries experience was associated with general adiposity (as assessed by W/H) and central adiposity (as assessed by WC). Regression analyses (adjusted for oral health behaviours and socio-demographic factors) identified that W/H z-score was associated with having caries, OR 1.41, 95% CI1.04, 1.91, P = 0.03; and ‘very high’ caries OR 1.62, 95% CI 1.05, 2.50, P = 0.03. WC z-score was associated with ‘very high’ caries experience, OR 1.72, 95% CI 1.06, 2.81, P = 0.03. Oral hygiene status was not associated with adiposity. Among a random sample of 12-year-old children in Hong Kong, with a response rate of 76.9% (514/668), oral health status was associated with adiposity. Regression analyses (adjusted for oral health behaviours and socio-demographic factors) identified that WHR z-score was associated with caries experience: ‘high’ (OR 1.33, 95% CI 1.05, 1.70, P = 0.02), and ‘very high’ (OR 1.52, 95% CI 1.10, 2.11, P = 0.01). TRSKF z-score was associated with ‘very high’ caries experience (OR 1.47, 95% CI 1.10, 1.96, P = 0.01). WC z-score was associated with ‘unhealthy’ periodontal status (OR 1.33, 95% CI 1.01, 1.76, P = 0.04). Infant growth during the first year of life was associated with oral health at 12-year-old. Accounting for birth characteristics, socio-demographics and oral health behaviours, those with slow growth trajectories (Ⅰ- smallest birth weight and slow weight gain; and Ⅱ- smallest birth weight and average weight gain) had a greater likelihood of having a ‘high’ caries experience: OR 2.68, 95% CI 1.00, 7.16, P < 0.05 and OR 3.03, 95% CI 1.22, 7.51, P < 0.05, respectively, compared to average growth trajectory subjects. In addition, those with the fastest growth trajectory (heaviest birth weight and accelerated weight gain) had a greater likelihood of having a ‘high’ caries experience, OR 2.64, 95% CI 1.01, 6.91, P <0.05. Growth trajectories were not associated with periodontal health status at 12-year-old (P > 0.05). / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Yeung, Daniel Chi Shing. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 69-83). / Abstracts in English and Chinese; appendix B also in Chinese. / ACKNOWLEDGMENTS --- p.i / ABSTRACT --- p.ii / TABLE OF CONTENTS --- p.vi / INTRODUCTION --- p.1 / Purpose and Significance --- p.3 / Hypothesis --- p.5 / Delimitation --- p.5 / Limitation --- p.5 / Operational Definitions --- p.6 / REVIEW OF LITERATURE --- p.9 / The Epidemic of Childhood Obesity --- p.9 / Increase in Childhood Obesity Over the World --- p.9 / Factors Contribute to Childhood Obesity --- p.12 / Health Consequence --- p.14 / Childhood Obesity Interventions --- p.15 / Measurement of Body Composition in Children --- p.17 / Body Composition Models --- p.17 / Measurement Methods --- p.20 / Laboratory Methods --- p.20 / Hydrodensitometry --- p.20 / Air displacement plethysmography --- p.22 / Hydrometry --- p.23 / Dual energy X-ray absorptiometry --- p.25 / Pros and cons of body fat criterion measures --- p.26 / Field Methods --- p.27 / Bioelectric impedance analysis --- p.27 / Anthropometry --- p.28 / Skinfold thickness measurement --- p.29 / Summary --- p.33 / METHODOLOGY --- p.36 / Participants --- p.36 / Experimental Protocols and Procedures --- p.36 / Criterion Measurement --- p.36 / Field Measurements --- p.38 / Statistical A nalysis --- p.39 / RESULTS --- p.41 / Comparison of ADP and DXA in Measuring Percent Fat Criterion --- p.41 / Sample Distribution and Descriptive Statistics --- p.41 / Correlations --- p.44 / Reliability --- p.46 / Cross Validation of Slaughter Equations --- p.47 / Exploration of Alternative Equations --- p.51 / DISCUSSION --- p.59 / Limitations --- p.66 / Recommendations for Future Study --- p.67 / Conclusions --- p.68 / REFERENCES --- p.69 / APPENDIX / Chapter A --- Standardized Description of Skinfold Sites --- p.84 / Chapter B --- Informed Consent --- p.85 / Chapter C --- Data Sheet --- p.87

本研究的目的在於以電阻抗法測定的脂肪比例作為標準，評價各種兒童肥胖定義診斷脂肪過量時的診斷準確性。爲了達到這項研究目的，本研究分為三個部份。首先，研究的第一部份評價了生物電阻抗法（Bio-electrical impedance analysis, BIA）在測量中國兒童青少年身體成份時的效度。隨後，幾種被廣泛應用的電子脂肪磅測量身體脂肪比例時的測量準確度被進行了評價。最後，在大規模人群測試中，利用精確的電子脂肪磅及幾種人體測量學指標決定的脂肪水平，不同兒童肥胖定義的診診斷脂肪過量的斷準確性被進行了評價。共有255名9至19歲的中國兒童青少年參與了第一和第二部份的測試，利用雙能X光骨密度儀（Dual-energy X-ray absorptiometry, DEXA）測量的體成份作為標準，比較了通過標準電阻抗法以及幾種被廣泛電子脂肪磅測量而來的體成份。研究結果顯示，生物電阻抗法是測量中國兒童青少年體成份有效的方法，然而，所有以前研究發展的BIA預測方程均未能準確估計受試者的去脂體重（Fat-free mass, FFM）。四種商業電子脂肪磅在測量受試者的體脂有類似的診斷準確度。隨後，另外的2,134名兒童青少年參與了本研究第三部份的測試，利用經過第二部份經過調整的脂肪磅測量受試者的體脂比例，同時測量人體測量學指標。研究結果發現，現有關於兒童肥胖的定義在診斷香港兒童、青少年脂肪過量的診斷準確性不夠。此外，受試者工作特徵曲綫分析（Receiver operating characteristics, ROC）發現利用基於身高和體重的指數來定義兒童肥胖在診斷肥胖兒童時較基於腰圍的指數有更好的敏感度和特異性。因此，研究者可以通過調整這些身高和體重的指數的劃分點來獲得對兒童肥胖更好的診斷準確性。 / 研究一（第3章）的目的在於評價生物電阻抗（Bio-electrical impendence analysis, BIA）方法在預測中國兒童青少年的去脂體重（Fat-free mass, FFM）中的效度，同時，也驗證已有的利用BIA方法發展的方程預測中國兒童、青少年FFM的效度。共有255名9-19歲健康的中國兒童、青少年（127名男生、128名女生）自願參與此次測試。利用傳統的單頻（50 kHz）的手腳電阻抗儀測試人體的電阻與電抗。利用雙能X光骨密度儀（Dual-energy X-ray absorptiometry, DEXA）作為測量FFM的標準。以DEXA測試的FFM為標準，對24個已有的BIA預測FFM的方程進行交互驗證。研究結果顯示，在本研究的人群中，利用24個已有的BIA預測方程所預測FFM與DEXA測量而來FFM高度相關。然而，這24個方程都未能準確預測本研究測試人群中由DEXA測量而來的FFM。利用多元線性回歸及交互驗證的方法，本研究發展了一個預測中國兒童、青少年FFM的預測方程：FFM (kg) = 1.613 + 0.742 × 身高(cm)²/電抗 (Ω) + 0.151 × 體重 (kg); R² = 0.95; SEE = 2.45kg; CV = 6.5%。本研究的研究結果表明，已有的BIA預測FFM的方程均不能通過交互驗證，從而準確的預測本研究人群的FFM。利用本研究人群發展而來的BIA預測FFM的方程，對預測中國兒童、青少年的FFM有良好的效度。本研究證明利用BIA方法可以準確的預測中國兒童、青少年的體成份。 / 研究二（第4章）旨在驗證4種利用BIA原理發展而來的商業電子脂肪磅在測量中國兒童、青少年體脂比例時的效度，以及判斷這些脂肪磅診斷身體脂肪過量時的診斷表現。參與研究一的255名中國兒童、青少年也參與本研究。利用DEXA作為測量體成份的標準測量。同時，4種電子脂肪磅（Model A, Biodynamics-310; Model B, Tanita TBF-543; Model C, Tanita BC-545 和 Model D, InBody 520）利用製造商內置的BIA方程測量受試者的體成份。研究結果表明，採用製造商內置的BIA方程測量體脂比例時，在男性中，Model B和Model C測量的體脂比例與DEXA測量的體脂比例有明顯差異 （p < 0.05）；Model C低估了脂肪過量兒童、青少年在在受試人群中的百分比（X²=10.714, p=0.001）。在女性中，Model B、Model C和Model D測量的體脂比例與DEXA測量的體脂比例有明顯差別，脂肪過量兒童在占受試人群中的比例被這三種脂肪磅所低估。由於在這四種脂肪磅和DEXA測量的%BF有著較高的相關性，回歸分析被用於調整這四種脂肪磅所測量的體脂比例。在調整后，在男性和女性中，所有調整的脂肪磅測試的體脂比例與DEXA測量的體脂比例之間沒有分別。在男性和女性受試者中，卡方檢驗結果顯示，所有校正的脂肪磅診斷的脂肪過量兒童、青少年占受試人群中的比例與DEXA的診斷比例之間沒有發現明顯區別。 此外，在女性中，與未校正的脂肪磅的對脂肪過量兒童、青少年診斷的敏感度比較，調整后的Model B 和 ModelC 脂肪磅對脂肪過量的兒童診斷的敏感度得到明顯改善 (Model B, X²=9.818,p=0.002; Model C, X²=4.615, p=0.032)。本研究的研究結果建議在利用電子脂肪磅內置方程測量中國青少年、兒童的體脂比例時，其效度需要進行驗證。因為在脂肪磅和DEXA測量之間有較高的相關性和較小的偏差，經調整的脂肪磅可以用於在進行大規模人群測試時，測量中國青少年、兒童的體脂比例，以及作為對脂肪過量兒童、青少年的診斷工具。 / 研究三（第5章）的目的在於調查基於身高體重的指數和基於腰圍的指數在診斷香港兒童、青少年脂肪過量時的總體診斷表現；以及判斷現有兒童肥胖定義診斷香港兒童、青少年脂肪過量時的診斷表現。共有來自香港多所中小學的2134名9-19歲的受試者，包括1135名男性、999名女性參與本研究。利用研究二調整的便攜式足對足電子脂肪磅測量受試者的體脂比例。基於體脂比例的兒童肥胖，即脂肪過量，被定義為體脂比例在男性高於25%，女性高於30%。四種基於BMI的兒童肥胖定義、兩種基於香港數據利用腰圍對兒童肥胖的定義、以及香港現有的兒童肥胖定義用於此研究。受試者工作特徵曲綫分析（Receiver operating characteristics, ROC）被用於分析身高體重指數（BMI）、標準身高體重（PWH）、腰圍（WC）和腰圍身高比（WHtR）在診斷香港兒童、青少年脂肪過量時的總體診斷表現。診斷試驗的指標被用來判斷現有兒童肥胖的定義診斷香港兒童、青少年脂肪過量時的診斷表現。本研究發現，在男性中，BMI、PWH、WC和WHtR在診斷香港兒童、青少年脂肪過量時有相同的良好的診斷表現[受試者工作特徵曲綫下面積(area under the curve of ROC, AUC) = 0.909-0.923]。然而，在女性中，WC（AUC=0.840）和WHtR（AUC=0.850）診斷香港兒童、青少年脂肪過量時的診斷表現差於BMI（AUC=0.900）和 PWH （AUC=0.903）。此外，現有兒童肥胖定義在診斷香港兒童、青少年脂肪過量時診斷敏感度較低，敏感度在男性中為0.325-0.761；女性中為0.128-0.588。利用最好診斷準確度的方法來確定的BMI、PWH、WC和WHtR的劃分點在診斷脂肪過量時，在男性中有相似的診斷表現，診斷敏感度在0.816-0.868之間，診斷特異度在0.803-0.869之間；對於女性，BMI和PWH 較WC和WHtR有較高的敏感度和特異度。本研究的發現表明，在診斷脂肪過量時，基於身高和體重的指數總體診斷表現好於基於腰圍的指數；現有兒童肥胖定義在診斷香港兒童、青少年脂肪過量時的診斷表現不佳。進一步，通過調整以身高和體重為基礎指數的劃分點可以使其在診斷脂肪過量時有更好的診斷表現。 / The purpose of this study was to evaluate the diagnostic accuracy of various childhood obesity definitions using bioelectrical impedance analysis (BIA) as a criterion measure of body fat. To achieve such an objective, the study involved three phases. First, the validity of BIA in measuring body composition in Chinese children and adolescents was evaluated. Then, examination on measuring accuracy of several popular BIA scales was performed. Finally, mass testing of body fat levels using an accurate BIA scale, as well as other anthropometric measures, was conducted to evaluate the diagnostic accuracy of childhood obesity definitions. A total of 255 healthy Chinese children and adolescents aged 9 years to 19 years participated in the first and second phases of the study. Body composition was measured from BIA using a criterion device (Biodynamics 310) and four popular commercial BIA scales and compared with measurements from dual-energy X-ray absorptiometry (DEXA). BIA provided excellent predictions of body composition among Chinese children and adolescents. However, all of the previously developed BIA equations yielded biased estimation. The four commercial BIA scales had similar diagnostic accuracy in measuring body fat. Subsequently, another 2,134 boys and girls were recruited to take part in body fat measurements using the best BIA scale identified in the second phase with adjusted equations, as well as other anthropometric measurements. The diagnostic accuracy of all existing definitions of childhood obesity was poor in both genders. Moreover, Receiver Operating Characteristics (ROC) analysis found that childhood obesity definitions using weight-and-height based indices [Body mass index (BMI) and weight-for-height) had superior sensitivity and specificity in identifying obese children compared with waist circumference-based indices. Therefore, with adjusted cut-off criteria for weight-and-height indices, the diagnostic accuracy of childhood obesity would be improved. / Study I : Validity of BIA method in predicting FFM / The first study (Chapter 3) aimed to examine the validity of the BIA method in predicting fat-free mass (FFM) in Chinese children and adolescents and of various published BIA equations in estimating FFM in this particular group. A total of 255 healthy Chinese children and adolescents (127 boys and 128 girls) aged 9 years to 19 years participated in this study. BIA variables (e.g., resistance and impedance) were measured at 50 kHz between the hand and foot using a traditional BIA device. The criterion of FFM measurement was also assessed using DEXA. FFM estimated from 24 published BIA equations were cross-validated against the criterion measure from DEXA. FFM estimated from the 24 published BIA equations yielded high correlations with the directly measured FFM from DEXA. However, none of the 24 equations was statistically equivalent with the DEXA-measured FFM. Using multiple linear regression and cross-validation against the DEXA measurement, an alternative prediction equation was developed as follows: FFM (kg) = 1.613 + 0.742 × height (cm)²/impedance (Ω) + 0.151 × body weight (kg); R² = 0.95; SEE = 2.45 kg; CV = 6.5%. None of the previously developed BIA equations was able to cross-validate the FFM estimates of the present sample. An alternative BIA equation, with evidence of validation and cross-validation, was thus proposed. The method based on the BIA principle provides a valid estimation of body composition among Chinese children and adolescents. / Study II: Validity of popular BIA consumer scales in measuring body fat / The second study (Chapter 4) examined the validity in measuring body fat and the diagnostic performance of four different consumer BIA scales. The 255 Chinese children and adolescents from the first study also participated in this study. DEXA was used as the criterion measurement for %BF, which was also assessed using four BIA scales [Model A (Biodynamics 310), Model B (Tanita TBF-543), Model C (Tanita BC-545), and Model D (InBody 520)]. The validity in measuring body fat and the diagnostic performance in screening excess body fat of these BIA scales was first examined. In boys, differences in %BF between Models B, C, and DEXA were significant (p < 0.05). In girls, significant differences in %BF were observed between Models B, C, D, and DEXA (p < 0.05). The prevalence of overfat in boys was underestimated by Model C (X² = 10.714, p = 0.001). For girls, the prevalence of overfat was underestimated in Models B, C, and D. Because of the high correlation between the BIA scales and DEXA (r = 0.770.94), regression analysis was used to adjust the BIA scales in measuring %BF in this sample. After adjustment, the paired t-tests did not show differences in %BF between the adjusted BIA scales and the DEXA measurement in both genders. All adjusted BIA scales except Model A in girls showed substantial agreement with the DEXA measurement. In addition, compared with overfat classification using DEXA measurement, X² test showed that the prevalence of overfat in the present samples was classified correctly by all adjusted BIA scales in both genders. Compared with the original BIA measurements, the use of the adjusted Models B and D offered significant improvements in sensitivity for girls. These findings suggest that the embedded equations in BIA scales should be validated in assessing body compositions among Chinese children and adolescents. The adjusted BIA scales can be used in large population surveys due to the high correlation and small mean bias between the BIA scales and the DEXA measurements. In conclusion, the adjusted BIA scales can serve as diagnostic tools to classify overfat Chinese children into relevant subgroups. / Study III: Diagnostic accuracy of definitions of childhood obesity / The third study (Chapter 5) aimed to investigate the diagnostic performance of weight-and-height-based indices and waist circumference (WC-based indices as diagnostic tests to screen excess body fat in Hong Kong children and adolescents and to investigate the diagnostic accuracy of existing definitions of childhood obesity in Hong Kong. A total of 2,134 participants (1,135 boys and 999 girls) were recruited from local schools. The adjusted foot-to-foot BIA scale (Model B) in the second study was applied to assess %BF. The criterion of childhood obesity (i.e., overfat) was defined as over 25%BF for boys and over 30%BF for girls. Childhood obesity was also determined from four BMI-based references, two WC-based references, and the 1993 HK reference. The diagnostic accuracy of the existing definition for childhood obesity in screening excess body fat was evaluated using diagnostic indices. The Receiver Operating Characteristics (ROC) analysis was used to evaluate the general performance of BMI, PWH, WC, and WHtR in detecting overfat. In boys, ROC analysis showed no significant difference among the four indices in screening overfat [(area under the curve of ROC, AUC) = 0.909-0.923]. In girls, BMI and PWH performed better in detecting overfat than WC and WHtR (AUC of BMI = 0.900; AUC of PWH = 0.903; AUC of WC = 0.840 and AUC of WHtR = 0.850). All definitions for obesity showed low sensitivity (boys, 0.325-0.761; girls, 0.128-0.588) in detecting overfat. Cut-offs derived for best accuracy showed similar diagnostic performance in each index in boys but not in girls. In boys, the cut-offs of BMI, WC, WHtR, and PWH can provide similar sensitivity (0.816-0.868) and specificity (0.803-0.869) in screening overfat. In girls, BMI and PWH can provide higher sensitivity and specificity than WC and WHtR. This study’s findings demonstrate that the diagnostic performance of all existing definitions for obesity is poorer than expected in both genders. BMI and PWH are superior to use as proxy measures in screening overfat among Hong Kong Chinese children and adolescents for both genders. Moreover, the diagnostic performance of these indices can be improved by adjusting the existing cut-offs. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wang, Lin. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 166-197). / Abstract and appendixes also in Chinese. / ABSTRACT --- p.i / 摘要 --- p.v / ACKNOWLEDGEMENT --- p.ix / PUBLICATIONS --- p.xi / LIST OF TABLES --- p.xv / LIST OF FIGURES --- p.xvii / ABBREVIATIONS --- p.xviii / Chapter CHAPTER 1. --- INTRODUCTION --- p.1 / Chapter 1.1. --- Background --- p.1 / Chapter 1.2. --- Purposes and significance --- p.4 / Chapter 1.3. --- Operational definitions --- p.5 / Chapter 1.3.1. --- Childhood overweight and obesity --- p.5 / Chapter 1.3.2. --- Body composition --- p.6 / Chapter 1.3.3. --- Bioelectric impedance analysis (BIA) --- p.6 / Chapter 1.3.4. --- Validity --- p.6 / Chapter 1.3.5. --- Diagnostic performance --- p.6 / Chapter 1.4. --- Hypothesis --- p.6 / Chapter 1.5. --- Limitations --- p.7 / Chapter 1.6. --- Delimitations --- p.7 / Chapter CHAPTER 2. --- LITERATURE REVIEW --- p.9 / Chapter 2.1. --- The epidemic and health consequence of childhood obesity --- p.10 / Chapter 2.1.1. --- Prevalence of childhood obesity --- p.10 / Chapter 2.1.2. --- Health consequence of childhood obesity --- p.15 / Chapter 2.2. --- Contributors of Childhood obesity --- p.16 / Chapter 2.2.1. --- Genetics --- p.17 / Chapter 2.2.2. --- Dietary intake --- p.17 / Chapter 2.2.3. --- Physical activity --- p.18 / Chapter 2.2.4. --- Sedentary behaviors --- p.18 / Chapter 2.3. --- Definitions of overweight and obesity in children and adolescents --- p.19 / Chapter 2.3.1. --- General definition of obesity --- p.19 / Chapter 2.3.2. --- Definitions and prevalence of childhood obesity in different countries --- p.21 / Chapter 2.3.3. --- Methods and current practices for identifying childhood obesity --- p.21 / Chapter 2.4. --- Methods for assessing body composition --- p.42 / Chapter 2.4.1. --- Body composition models --- p.42 / Chapter 2.4.2. --- Measurements methods to estimate body composition --- p.44 / Chapter 2.4.3. --- Specific issues of body fat in childhood --- p.60 / Chapter 2.5. --- Diagnostic accuracy of different definitions of childhood obesity --- p.61 / Chapter CHAPTER 3. --- STUDY I: VALIDITY OF BIOELECTRICAL IMPEDANCE MEASUREMENT IN PREDICTING FAT-FREE MASS OF CHINESE CHILDREN AND ADOLESCENTS --- p.67 / Chapter 3.1. --- Introduction --- p.67 / Chapter 3.2.1. --- Participants --- p.69 / Chapter 3.2.2. --- Measurements --- p.70 / Chapter 3.2.3. --- Data reduction and statistic analysis --- p.72 / Chapter 3.3. --- Results --- p.78 / Chapter 3.3.1. --- Descriptive statistics --- p.78 / Chapter 3.3.2. --- Cross-validation of published BIA equations --- p.79 / Chapter 3.3.3. --- Development of alternative BIA equations --- p.84 / Chapter 3.4. --- Discussion --- p.86 / Chapter 3.5. --- Conclusion --- p.92 / Chapter CHAPTER 4. --- STUDY II: VALIDITY OF FOUR COMMERCIAL BIA SCALES IN MEASURING BODY FAT AMONG CHINESE CHILDREN AND ADOLESCENTS --- p.93 / Chapter 4.1. --- Introduction --- p.93 / Chapter 4.2. --- Methods --- p.97 / Chapter 4.2.1. --- Participants --- p.97 / Chapter 4.2.2. --- Anthropometrics measurement --- p.97 / Chapter 4.2.3. --- Measurement of body composition --- p.97 / Chapter 4.2.4. --- Statistical analysis --- p.99 / Chapter 4.3. --- Results --- p.102 / Chapter 4.3.1. --- Characteristics of participants --- p.102 / Chapter 4.3.2. --- Reliability of BIA analysis --- p.103 / Chapter 4.3.3. --- Comparison of measuring body composition between BIA commercial devices (manufacturers’ equations) and DEXA measurement-Step 1 --- p.103 / Chapter 4.3.4. --- Comparison of measuring body composition between BIA commercial devices (adjusted equations) and DEXA measurement-Step 2 --- p.110 / Chapter 4.4. --- Discussion --- p.116 / Chapter 4.5. --- Conclusion --- p.123 / Chapter CHAPTER 5. --- STUDY III: DIAGNOSTIC ACCURACY OF DIFFERENT DEFINITIONS OF CHILDHOOD OBESITY IN IDENTIFYING OVERFAT AMONG CHINESE CHILDREN AND ADOLESCENTS --- p.124 / Chapter 5.1. --- Introduction --- p.124 / Chapter 5.2. --- Methods --- p.126 / Chapter 5.2.1. --- Participants --- p.126 / Chapter 5.2.2. --- Anthropometrics measurement --- p.127 / Chapter 5.2.3. --- Body fat measurement --- p.127 / Chapter 5.2.4. --- Definition of excess fatness --- p.128 / Chapter 5.2.5. --- Classification of participants --- p.128 / Chapter 5.2.6. --- Data reduction and statistic analysis --- p.129 / Chapter 5.3. --- Results --- p.131 / Chapter 5.3.1. --- Characteristics of participants --- p.131 / Chapter 5.3.2. --- Age-adjusted correlation among the different indices of obesity --- p.133 / Chapter 5.3.3. --- Prevalence rates of overweight/obesity --- p.134 / Chapter 5.3.4. --- Diagnostic agreement in assessing excess fat between %BF and anthropometric-based definitions --- p.137 / Chapter 5.3.5. --- Sensitivity and specificity --- p.138 / Chapter 5.3.6. --- Diagnostic performance of anthropometric indices in assessing excess fat --- p.141 / Chapter 5.3.7. --- Cut-offs of the anthropometric indices for screening excess fat --- p.143 / Chapter 5.4. --- Discussion --- p.148 / Chapter 5.5. --- Conclusion --- p.157 / Chapter CHAPTER 6. --- GENERAL DISCUSSION AND CONCLUSION --- p.158 / REFERENCE --- p.166 / APPENDIX A --- p.198 / APPENDIX B --- p.202 / APPENDIX C --- p.204 / APPENDIX D --- p.206 / APPENDIX E --- p.210

Kwok Man Ki. / Accompanying CD-ROM entitled: DRAGON program 2005. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 193-203). / Abstracts in English and Chinese; appendices also in Chinese. / Abstract --- p.i / Abstract (Chinese version) --- p.iii / Acknowledgement --- p.v / Table of contents --- p.vi / List of tables --- p.xi / List of figures --- p.xviii / Presentations --- p.xix / Chapter Chapter one: --- Introduction --- p.1 / Hong Kong preschoolers' nutritional health situation --- p.1 / Chapter (I) --- Breastfeeding & complementary feeding practices --- p.1 / Chapter (II) --- "Diet, mealtime and physical activity patterns" --- p.3 / Chapter (III) --- Weight status --- p.6 / Health risk factors accumulated up to preschool age --- p.8 / Childhood Obesity Prevention: School-based intervention --- p.12 / Chapter (I) --- Primary obesity prevention and health promoting schools --- p.12 / Chapter (II) --- Feasibility of health promotion initiatives in Hong Kong kindergartens --- p.14 / Chapter (III) --- Nutrition and physical activity intervention studies --- p.18 / Chapter (IV) --- Hong Kong kindergarten health initiative: DRAGON Program --- p.23 / Aim and scope of the DRAGON Program --- p.28 / Chapter Chapter two: --- Methodology --- p.30 / Kindergarten recruitment --- p.30 / Formative preparatory stage --- p.32 / Chapter (I) --- Teaching kit development --- p.32 / Chapter (II) --- Teaching kit pretesting --- p.33 / Chapter (III) --- Parents' focus group --- p.35 / Chapter (IV) --- Questionnaires development --- p.35 / Chapter (V) --- Ethics approval --- p.37 / Subject recruitment --- p.37 / Pre-intervention stage --- p.37 / Chapter (I) --- Anthropometric measurements --- p.37 / Chapter (II) --- Parental questionnaires --- p.38 / DRAGON Program implementation --- p.38 / Chapter (I) --- Preschoolers' health curriculum --- p.38 / Chapter (II) --- Pre-intervention data management and analysis --- p.39 / Chapter (III) --- Booster activities planning and implementation --- p.40 / Chapter (IV) --- Parents' newsletters --- p.42 / Post-intervention stage --- p.42 / Chapter Chapter three: --- Results --- p.46 / Enrollment and response rate --- p.46 / Between schools baseline comparison --- p.50 / Education vs. Control Schools baseline comparison --- p.53 / Chapter (I) --- Demographic and socioeconomic characteristics --- p.53 / Chapter (II) --- Children's dietary patterns --- p.60 / Chapter (III) --- "Regular meals, snack patterns and other mealtime behaviors" --- p.65 / Chapter (IV) --- Usual activity patterns --- p.67 / Chapter (V) --- Parents' health knowledge and preferred communication channels --- p.72 / Chapter (VI) --- Child's height and weight measurements --- p.77 / Chapter (VII) --- Factors associated with children's weight status --- p.79 / Chapter (VIII) --- "Associations between socioeconomic status (SES) and children's dietary, mealtime and activity patterns" --- p.81 / Process and outcome evaluations of the Dragon Program --- p.90 / Part a) 1st follow up after finishing all health curriculum --- p.90 / Chapter (I) --- Children's dietary patterns --- p.90 / Chapter (II) --- Mealtime behaviors --- p.95 / Chapter (III) --- Usual activity patterns --- p.99 / Chapter (IV) --- Health curriculum effectiveness evaluation by AM/PM sessions --- p.103 / Part b) 2nd follow up after finishing promotional activities --- p.107 / Chapter (I) --- Children's dietary patterns --- p.108 / Chapter (II) --- Mealtime behaviors --- p.116 / Chapter (III) --- Usual activity patterns --- p.122 / Between subgroups comparisons --- p.131 / Chapter (I) --- First follow up --- p.131 / Chapter (II) --- Second follow up --- p.132 / Parent Focus groups (baseline) --- p.136 / Chapter (I) --- Awareness of local adults' and preschoolers' health status --- p.136 / Chapter (II) --- Children's dietary habits and lifestyle --- p.137 / Chapter (III) --- Factors affecting their children's health behaviors --- p.139 / Parent Focus groups (booster activities) --- p.140 / Teachers´ةquestionnaires --- p.142 / Teachers after class assessment --- p.149 / Teachers´ة focus groups --- p.155 / Principals´ة Interviews --- p.157 / Chapter (I) --- Importance of creating healthy school environment --- p.157 / Chapter (II) --- Students' & teachers´ة performance in first half-year DRAGON Program --- p.158 / Chapter (III) --- Comments on implementing second half-year DRAGON Program --- p.160 / Chapter (IV) --- Recommendations for the development of the Program --- p.161 / Chapter Chapter four: --- Discussion --- p.163 / Implications of the findings --- p.164 / Chapter (I) --- Socioeconomic and demographic factors associated with preschoolers' diet and lifestyle at baseline --- p.164 / Chapter a) --- Association between SES and children´ةs dietary habits --- p.164 / Chapter b) --- Association between SES and children's weight status and their mealtime interactions with parents --- p.166 / Chapter c) --- "Association between children's weight status and their dietary mealtime, and activity patterns" --- p.167 / Chapter (II) --- Local preschool age children´ةs health situation --- p.170 / Chapter (III) --- Program Effectiveness assessment --- p.173 / Chapter a) --- After the implementation of the one-term health curriculum --- p.173 / Chapter b) --- After the implementation of health curriculum and promotional activities --- p.179 / Chapter (IV) --- Program acceptability and feasibility --- p.186 / Limitations --- p.189 / Recommendation for future preschool health program --- p.190 / Chapter Chapter five: --- Conclusion --- p.192 / References --- p.193 / Appendices --- p.204 / Chapter A1 --- School invitation letter with program briefing details (English version) --- p.204 / Chapter A2 --- School invitation letter with program briefing details (Chinese version) --- p.209 / Chapter B1 --- School background information (English version) --- p.213 / Chapter B2 --- School background information (Chinese version) --- p.217 / Chapter C1 --- DRAGON Program Teacher's Guide for nursery grade (Chinese version) --- p.221 / Chapter C2 --- DRAGON Program Teacher's Guide for lower level (Chinese version) --- p.244 / Chapter C3 --- DRAGON Program Teacher's Guide for upper level (Chinese version) --- p.269 / Chapter D1 --- Parents´ة focus group (Jan) (English version) --- p.297 / Chapter D2 --- Parents´ة focus group (Jan) (Chinese version) --- p.301 / Chapter E1 --- Teachers´ة self-administered questionnaires (English version) --- p.305 / Chapter E2 --- Teachers´ة self-administered questionnaires (Chinese version) --- p.324 / Chapter F1a --- Parents´ة self-administered questionnaires [baseline] (English version) --- p.344 / Chapter F1b --- Parents´ة self-administered questionnaires [1st follow up] (English version) --- p.349 / Chapter F1c --- Parents' self-administered questionnaires [2nd follow up] (English version) --- p.354 / Chapter F2a --- Parents´ة self-administered questionnaires [baseline] (Chinese version) --- p.359 / Chapter F2b --- Parents´ة'self-administered questionnaires [1st follow up] (Chinese version) --- p.364 / Chapter F2c --- Parents´ة self-administered questionnaires [2nd follow up] (Chinese version) --- p.369 / Chapter G1 --- Parents´ة consent form (English version) --- p.374 / Chapter G2 --- Parents´ة consent form (Chinese version) --- p.376 / Chapter H1a --- Sample health lesson worksheet for nursery grade (Chinese version) --- p.378 / Chapter H1b --- Sample health lesson worksheet for lower level (Chinese version) --- p.379 / Chapter H1c --- Sample health lesson worksheet for upper level (Chinese version) --- p.380 / Chapter 11 --- Sample parents´ة newsletter (English version) --- p.382 / Chapter 12 --- Sample parents´ة newsletter (Chinese version) --- p.387 / Chapter J1 --- Questions for pretest parents´ة newsletter (Chinese and English version) --- p.392 / Chapter K1 --- Principals´ة interview (English version) --- p.395 / Chapter K2 --- Principals´ة interview (Chinese version) --- p.397 / Table A_1 to A_17 --- p.399 / DiscAl DRAGON Program: teaching materials for health lessons --- p.414 / DiscA2 DRAGON Program: materials for three booster activities --- p.414 / DiscA3 DRAGON Program: health lesson worksheets --- p.414 / DiscA4 DRAGON Program: parents´ة newsletters --- p.414

Cheung Yuk Lin Porky. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 236-248). / Abstracts in English and Chinese; appendices also in Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / 論文摘要 --- p.iv / Table of Contents --- p.vi / List of Figures --- p.xii / List of Tables --- p.xiii / List of Abbreviations --- p.xix / Presentations --- p.xx / Chapter CHAPTER 1: --- INTRODUCTION --- p.1 / Chapter 1.1 --- Overview on Childhood Obesity --- p.1 / Chapter 1.1.1 --- Worldwide Situation --- p.1 / Chapter 1.1.2 --- Hong Kong Situation --- p.3 / Chapter 1.2 --- Consequences of Childhood Obesity --- p.4 / Chapter 1.2.1 --- Physiological Problems --- p.4 / Chapter 1.2.2 --- Psychosocial Problems --- p.6 / Chapter 1.2.3 --- Economic Problems --- p.6 / Chapter 1.3 --- Possible Causes and Associated Factors of Childhood Obesity --- p.7 / Chapter 1.3.1 --- Genetics --- p.7 / Chapter 1.3.2 --- Lifestyle Patterns --- p.8 / Chapter 1.3.2.1 --- Physical Activity --- p.8 / Chapter 1.3.2.2 --- Dietary Factors --- p.8 / Chapter 1.3.3 --- Environmental Influence --- p.10 / Chapter 1.3.3.1 --- Parental Influence and Home Environment --- p.10 / Chapter 1.3.3.2 --- Other External Environmental Factors --- p.10 / Chapter 1.4 --- Prevention and Treatment of Childhood Obesity --- p.12 / Chapter 1.4.1 --- Clinical Trials --- p.12 / Chapter 1.4.2 --- Family Based Interventions --- p.13 / Chapter 1.4.3. --- School Based Interventions --- p.14 / Chapter 1.4.4 --- Other Possible Measures --- p.17 / Chapter 1.5 --- Local Intervention Implementation --- p.17 / Chapter 1.6 --- "Study Rationale, Design，Aims and Objectives" --- p.18 / Chapter 1.6.1 --- Study Rationale --- p.18 / Chapter 1.6.2 --- Study Design --- p.19 / Chapter 1.6.3 --- Study Aims and Objectives --- p.21 / Chapter 1.7 --- Conceptual Framework and Hypothesis --- p.21 / Chapter 1.7.1 --- Conceptual Framework --- p.22 / Chapter 1.7.2 --- Hypothesis --- p.23 / Chapter CHAPTER 2: --- METHODOLOGY --- p.23 / Chapter 2.1 --- Sample --- p.23 / Chapter 2.1.1 --- School Recruitment --- p.23 / Chapter 2.1.2 --- Subject Recruitment --- p.23 / Chapter 2.2 --- Parental Consent --- p.24 / Chapter 2.3 --- Focus Groups --- p.24 / Chapter 2.4 --- Assessment Tools --- p.25 / Chapter 2.4.1 --- Weight and Height measures --- p.25 / Chapter 2.4.2 --- Physical Fitness Tests --- p.25 / Chapter 2.4.3 --- Student Questionnaire --- p.26 / Chapter 2.4.4 --- Parental Questionnaire --- p.27 / Chapter 2.4.5 --- Questionnaires Pre-testing --- p.27 / Chapter 2.5 --- Intervention --- p.28 / Chapter 2.5.1 --- Intervention A: Mighty Heart Health Promotion Program --- p.28 / Chapter 2.5.1.1 --- Materials --- p.28 / Chapter 2.5.1.2 --- Procedures --- p.30 / Chapter 2.5.2 --- Intervention B: Health Club --- p.31 / Chapter 2.5.2.1 --- Materials --- p.31 / Chapter 2.5.2.2 --- Procedures --- p.32 / Chapter 2.6 --- Evaluation --- p.35 / Chapter 2.6.1 --- Qualitative Evaluation --- p.35 / Chapter 2.6.2 --- Quantitative Evaluation --- p.35 / Chapter 2.7 --- Data Manasement --- p.36 / Chapter 2.8 --- Statistics --- p.37 / Chapter 2.8.1 --- Health Knowledge and Food Preferences Scores of Students --- p.37 / Chapter 2.8.2 --- "Health Knowledge, Dietary Habits and Home Food Availability Scores of Parents" --- p.40 / Chapter 2.9 --- Ethical Approval --- p.42 / Chapter CHAPTER 3: --- RESULTS --- p.43 / Chapter PART A: --- Baseline Focus Groups Results / Chapter 3.1 --- Baseline Focus Groups Results --- p.43 / Chapter 3.1.1 --- General Description of Participants --- p.44 / Chapter 3.1.2 --- "Views of ""Health"" held by students" --- p.44 / Chapter 3.1.3 --- "Views of ""Health"" of parents" --- p.45 / Chapter 3.1.4 --- "Views of ""Healthy Eating"" of students" --- p.46 / Chapter 3.1.5 --- "Views of ""Healthy Eating"" held by parents" --- p.47 / Chapter 3.1.6 --- "Perceived views on ""Physical Activity"" by students" --- p.48 / Chapter 3.1.7 --- "Views on ""Physical Activity"" of parents" --- p.49 / Chapter 3.1.8 --- Preferred delivery mode of activities communication channels --- p.50 / Chapter PART B: --- Baseline Profile of Participants / Chapter 3.2 --- Response Rate --- p.52 / Chapter 3.3 --- Baseline Characteristics and Socio-dem ograph ic Profile of Participants --- p.54 / Chapter 3.3.1 --- Students --- p.54 / Chapter 3.3.2 --- Parents --- p.56 / Chapter 3.4 --- "Self-perceived Important Values, Health and Weight Status at baseline" --- p.60 / Chapter 3.4.1 --- Students --- p.60 / Chapter 3.4.2 --- Parents --- p.62 / Chapter 3.5 --- Baseline Physical Activity --- p.63 / Chapter 3.5.1 --- Students --- p.63 / Chapter 3.5.2 --- Parents --- p.69 / Chapter 3.6 --- Baseline Dietary Aspects --- p.71 / Chapter 3.6.1 --- Students --- p.71 / Chapter 3.6.2 --- Parents --- p.81 / Chapter 3.7 --- Summary of Baseline associations between students，and parents 'parameters --- p.94 / Chapter 3.7.1 --- Factors associated with Students' weight status --- p.94 / Chapter 3.7.2. --- Factors associated with Studente´ة Dietary Habits --- p.97 / Chapter 3.7.3 --- Factors associated with students´ة physical Activity Habits --- p.104 / Chapter 3.8 --- Summary of Baseline Profile of Participants --- p.108 / Chapter PART C: --- Outcome Evaluation / Chapter 3.9 --- The Final MH activities Conducted --- p.111 / Chapter 3.10 --- Comparisons of Weight Status --- p.112 / Chapter 3.11 --- Comparisons of Self-perceived Health Status and Important Values --- p.114 / Chapter 3.12 --- Comparisons of Physical Activity Parameters --- p.118 / Chapter 3.12.1 --- Students --- p.118 / Chapter 3.12.2 --- Parents --- p.126 / Chapter 3.13 --- Comparisons of Dietary and Health Related Aspects --- p.129 / Chapter 3.13.1 --- Students --- p.129 / Chapter 3.13.2 --- Parents --- p.148 / Chapter 3.13.3 --- Home Food and Meal Environments --- p.167 / Chapter PART D: --- Results of Health Club / Chapter 3.14 --- Baseline Profile of the Participants --- p.180 / Chapter 3.14.1 --- Characteristics and Health Status --- p.180 / Chapter 3.14.2 --- Baseline Physical Activity --- p.181 / Chapter 3.14.3 --- Baseline Dietary Related Parameters --- p.183 / Chapter 3.15 --- The Final HC Lessons Conducted --- p.187 / Chapter 3.16 --- Outcome Evaluation of HC program --- p.188 / Chapter 3.16.1 --- Physical Fitness and Anthropometric Parameters --- p.188 / Chapter 3.16.2 --- Self-perceived Health Status and Important Values --- p.192 / Chapter 3.16.3 --- Physical Activity Related Aspects --- p.193 / Chapter 3.16.4 --- Dietary Aspects --- p.196 / Chapter 3.17 --- Summary of results of the HC Program --- p.201 / Chapter PART E: --- Process Evaluation / Chapter 3.18 --- Process Evaluations of Mighty Heart --- p.203 / Chapter 3.18.1 --- Students --- p.203 / Chapter 3.18.1.1 --- Comments on Program Activities and Materials --- p.203 / Chapter 3.18.1.2 --- Comments on Program Effectiveness and Acceptability --- p.204 / Chapter 3.18.1.3 --- Overall Comments and Suggestions --- p.204 / Chapter 3.18.2 --- Teachers --- p.205 / Chapter 3.18.2.1 --- Comments on Program Activities and Materials --- p.205 / Chapter 3.18.2.2 --- Comments on Program Effectiveness and Acceptability --- p.205 / Chapter 3.18.2.3 --- Overall Comments and suggestions --- p.206 / Chapter 3.19 --- Process Evaluations of the Health Club --- p.207 / Chapter 3.19.1 --- Students --- p.207 / Chapter 3.19.1.1 --- Comments on Program Activities and Materials --- p.207 / Chapter 3.19.1.2 --- Comments on Program Effectiveness and Acceptability --- p.208 / Chapter 3.19.1.3 --- Overall Comments and Suggestions --- p.208 / Chapter 3.19.2 --- Teacher --- p.209 / Chapter 3.19.2.1 --- "Comments on Program Activities, Educational Materials/Resources" --- p.209 / Chapter 3.19.2.2 --- Comments on Program Effectiveness and Acceptability --- p.210 / Chapter 3.19.2.3 --- Overall Comments and Suggestions --- p.211 / Chapter Chapter 4: --- Discussion --- p.212 / Chapter 4.1 --- Overall Effects of the MH Program --- p.213 / Chapter 4.1.1 --- Changes in PA-related Aspects --- p.213 / Chapter 4.1.2 --- Changes in Dietary-related Aspects --- p.216 / Chapter 4.1.3 --- Changes in Health Status related Aspects --- p.225 / Chapter 4.1.4 --- Acceptability and Appropriateness of the MH --- p.225 / Chapter 4.2 --- Overall Effects of the HC Program --- p.226 / Chapter 4.2.1 --- Changes in PA Related Aspects --- p.226 / Chapter 4.2.2 --- Changes in Dietary-related Aspects --- p.227 / Chapter 4.2.3 --- Changes in Health Status related Aspects --- p.228 / Chapter 4.2.4 --- Acceptability and Appropriateness of the HC --- p.229 / Chapter 4.3 --- Strengths and Limitations of the Study --- p.231 / Chapter 4.4 --- Implications and Recommendations for Future Research --- p.233 / Chapter Chapter 5: --- Conclusions --- p.234 / References --- p.236 / Appendix A Principal/ teacher Questionnaire --- p.249 / Appendix B Consent form for parents --- p.252 / Appendix C Focus group questionnaire - Students --- p.258 / Appendix D Focus group questionnaire - Parents --- p.262 / Appendix E Survey questionnaire -Students --- p.266 / Appendix F Survey Questionnaire - Parents --- p.274 / Appendix G Powerpoint material for teachers´ة monthly sharing --- p.282 / Appendix H Working sheets --- p.283 / Appendix I Newsletters for parents --- p.287 / Appendix J Teachers´ة guide for the “Mighty Heart´حprogram --- p.302 / Appendix K Teachers' guide for Health Club --- p.307 / Appendix L The student workbook --- p.311 / "Appendix M Discussion guide for students participating in the ""Mighty Heart ""program" --- p.312 / Appendix N Discussion guide for students participating in the Health Club --- p.313 / Appendix O Discussion guide for teachers conducting the Mighty Heart program --- p.314 / Appendix P Discussion guide for the teachers conducting the Health Club --- p.316

Lo Wing-sze. / One booklet (14 p. : col. ill. ; 21 cm.) mounted on leaf 156. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 100-113). / Abstracts in English and Chinese; questionnaires also in Chinese. / Acknowledgements --- p.ii / Abstract --- p.iii / Abstract (Chinese Version) --- p.v / Publications / Table of Contents --- p.viii / List of Figures --- p.xiii / List of Tables --- p.xv / List of Abbreviations --- p.xviii / Chapter Chapter One: --- Introduction / Chapter 1.1 --- Childhood obesity trends and measurement in Hong Kong and Elsewhere in the recent decade --- p.1 / Chapter 1.2 --- Health consequences of childhood obesity --- p.3 / Chapter 1.3 --- Determinants of childhood obesity --- p.4 / Physical inactivity --- p.4 / High-fat diet --- p.5 / Chapter 1.4 --- Parental eating attitudes on family food environments --- p.6 / Home food purchasing and availability --- p.6 / Family meal frequency and location --- p.7 / Child feeding practices- the food and eating rules --- p.8 / Chapter 1.5 --- The relationship of socioeconomic status and obesity --- p.8 / The economic status of households in Hong Kong --- p.10 / Chapter 1.6 --- Targeting children aged three and four years --- p.12 / Chapter 1.7 --- Conceptual framework and study objectives --- p.13 / Chapter Chapter Two: --- Survey Design / Chapter 2.1 --- Sample design and subject recruitment --- p.15 / Chapter 2.2 --- Survey methods --- p.17 / Anthropometric measurement --- p.17 / Lifestyle questionnaire --- p.18 / Three-day 24-hour dietary intake recall --- p.20 / Chapter 2.3 --- Data management and analysis methods --- p.23 / Anthropometric measurements --- p.23 / Lifestyle questionnaire --- p.24 / Three-day 24-hour dietary intake recall --- p.24 / Socioeconomic status (SES) of the subjects (Households) --- p.25 / Chapter 2.4 --- Ethics --- p.25 / Chapter Chapter Three: --- Results / Chapter 3.1 --- Responses to various components of the survey --- p.26 / Chapter 3.2 --- Socioeconomic status and related characteristics of the households --- p.28 / Chapter 3.3 --- Characteristics of the preschooler and their carers --- p.34 / Preschooler s weight status --- p.34 / Preschooler s growth --- p.35 / Other characteristicsof the preschoolers --- p.37 / Chapter 3.4 --- Home food purchasing and its determinants --- p.40 / Chapter 3.5 --- Family meal frequency and location --- p.43 / Chapter 3.6 --- Preschoolers' meal preparation activities --- p.48 / Chapter 3.7 --- Food and eating rules and mealtime activities --- p.50 / Chapter 3.8 --- Child's sedentary activities patterns and parental perceptions --- p.53 / Chapter 3.9 --- "Parental perceptions of preschooler's height and weight, and eating habits" --- p.57 / Chapter 3.10 --- Nutrient intakes of the preschoolers --- p.59 / Chapter 3.11 --- Food consumption patterns of the preschoolers --- p.63 / Chapter 3.12 --- Meal and snack patterns of the preschoolers --- p.67 / Chapter 3.13 --- Main contribution of food sub-groups to energy and various nutrient intakes for preschoolers --- p.69 / Chapter 3.14 --- Intakes of energy and various nutrients from foods eaten at home and outside home --- p.72 / Chapter 3.15 --- "Associations of parental feeding practices, preschoolers' nutrient intakes and physical activity patterns with childhood overweight and obesity" --- p.75 / Parental feeding practices and attitudes toward healthy eating by preschoolers'weight status --- p.75 / Activity patterns of the preschoolers by weight status --- p.76 / Energy and various nutrient intakes of the preschoolers by weight status --- p.77 / Chapter Chapter Four: --- Discussion / Chapter 4.1 --- Childhood obesity rate by SES group --- p.80 / Chapter 4.2 --- Characteristics of the preschoolers and the households --- p.81 / Chapter 4.3 --- High SES families dined together less frequently than their low SES counterparts --- p.84 / Chapter 4.4 --- Preferences of family members as an influential factor in purchasing fruits and vegetables --- p.86 / Chapter 4.5 --- Encouraging healthy food shopping practices with the preschoolers --- p.87 / Chapter 4.6 --- Food and eating rules imposed by parents may influence preschooler's eating habits and nutrient intakes --- p.88 / Chapter 4.7 --- Preschooler's sedentary activities patterns --- p.89 / Chapter 4.8 --- Incorrect parental perceptions of preschooler's weight --- p.91 / Chapter 4.9 --- Nutrient intakes of the preschoolers overall --- p.91 / Chapter 4.10 --- Comparing the nutrient intakes of the preschoolers with another study carried out in 2000 --- p.93 / Chapter 4.11 --- Parental/preschooler association on fruit and vegetable consumption --- p.94 / Chapter 4.12 --- Main contributors of food sub-groups to energy and various nutrient intakes for the preschoolers by SES group --- p.95 / Chapter 4.13 --- "Differences in family food environments, feeding practices, eating habits and nutrient intakes of preschoolers by maternal education level and mother's employment status" --- p.95 / Chapter 4.14 --- Strengths and limitations of the study --- p.96 / Chapter Chapter Five: --- Conclusions and Recommendations --- p.99 / References --- p.100 / Appendices / Chapter A1 --- Invitation letter to principals (English version) --- p.114 / Chapter A2 --- Invitation letter to principals (Chinese version) --- p.117 / Chapter B --- Summary of the background information of the participating schools --- p.120 / Chapter C1 --- Consent form and letter to parent(s) or guardian(s) (English version) --- p.121 / Chapter C2 --- Consent form and letter to parent(s) or guardian(s) (Chinese version) --- p.123 / Chapter D --- Paper fans with food and physical activity pyramid pictures --- p.125 / Chapter E --- Health report --- p.126 / Chapter F1 --- Lifestyle questionnaire (English version) --- p.127 / Chapter F2 --- Lifestyle questionnaire (Chinese version) --- p.136 / Chapter G1 --- 24-hour dietary recall forms (English version) --- p.144 / Chapter G2 --- 24-hour dietary recall forms (Chinese version) --- p.150 / Chapter H --- Food photo booklet --- p.156 / Chapter I1 --- Table: Households receiving social benefits by paternal occupations (p<0.001) --- p.157 / Chapter I2 --- Table: Summaries some of the characteristics of the surveyed preschoolers by gender and altogether --- p.158 / Chapter I3a --- Table: Preschooler's parents' age --- p.159 / Chapter I3b --- Table: Parents age by SES --- p.159 / Chapter I4 --- Table: Factors considered by interviewee when buying food items --- p.160 / Chapter I5 --- Table: Cost as a factor of buying queried food items by SES income group --- p.161 / Chapter I6 --- Table: Frequencies of eating out or having takeaway meals in/from different types of caterers by SES group --- p.162 / Chapter I7 --- Type of utensils used to feed the preschoolers by SES group --- p.162 / Chapter I8 --- Preschoolers' activities during dinner by SES group --- p.163 / Chapter I9 --- "Proportion of interviewees with adequate fruit, vegetable, and both fruit and vegetable intakes per day by SES group" --- p.163

Chan, Yun Kwan. / Accompanying CD-ROM contains appendix H, I, J, and K. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 161-170). / Abstracts in English and Chinese; three appendixes in Chinese only. / Library's copy: lacks accompanying CD-ROM. / Acknowledgement --- p.i / Abstract --- p.ii / Abstract (Chinese) --- p.iv / List of publications --- p.vi / Table of Contents --- p.viii / List of Figures --- p.xvi / List of Tables --- p.xvii / List of Abbreviations --- p.xxv / Chapter CHAPTER ONE: --- INTRODUCTION --- p.1 / Chapter 1.1 --- Global prevalence of childhood overweight --- p.1 / Chapter 1.2 --- Preschool health situation in HK --- p.2 / Chapter 1.2.1 --- Breastfeeding --- p.2 / Chapter 1.2.2 --- Diet and physical activity patterns --- p.3 / Chapter 1.2.3 --- Prevalence of childhood overweight --- p.5 / Chapter 1.2.3.1 --- Definition of childhood overweight --- p.5 / Chapter 1.2.3.2 --- Local prevalence of childhood overweight --- p.6 / Chapter 1.3 --- Consequences of childhood overweight --- p.7 / Chapter 1.3.1 --- Health consequences of childhood overweight --- p.7 / Chapter 1.3.2 --- Economic consequences of childhood overweight --- p.9 / Chapter 1.4 --- Risk factors of childhood overweight and obesity --- p.11 / Chapter 1.4.1 --- Family Socioeconomic status --- p.11 / Chapter 1.4.2 --- Parental overweight --- p.11 / Chapter 1.4.3 --- Breastfeeding --- p.12 / Chapter 1.4.4 --- Birth order --- p.13 / Chapter 1.4.5 --- Breakfast consumption --- p.13 / Chapter 1.4.6 --- Beverage consumption --- p.14 / Chapter 1.4.7 --- High calcium intake --- p.15 / Chapter 1.4.8 --- Fruit and vegetable consumption --- p.15 / Chapter 1.4.9 --- Physical inactivity --- p.15 / Chapter 1.4.9.1 --- Physical activity recommendations for preschoolers --- p.17 / Chapter 1.4.9.2 --- Screentime recommendations for preschoolers --- p.18 / Chapter 1.5 --- Child development --- p.18 / Chapter 1.5.1 --- Onset of overweight --- p.18 / Chapter 1.5.2 --- Early establishment of lifelong habits at preschool age --- p.19 / Chapter 1.5.3 --- Interaction with parents --- p.20 / Chapter 1.6 --- Justification of preschool multi-component health intervention in Hong Kong --- p.22 / Chapter 1.6.1 --- Local health promotion initiative at preschool --- p.22 / Chapter 1.6.2 --- Justification for DRAGON2006 modifications --- p.23 / Chapter 1.6.2.1 --- Inclusion of family-home component in school- based health intervention --- p.24 / Chapter 1.6.2.2 --- Child BMI monitoring and health report to parents --- p.24 / Chapter 1.7 --- Present school-based preschool health intervention --- p.25 / Chapter 1.8 --- Summary --- p.27 / Chapter 1.9 --- Aims and objectives --- p.27 / Chapter CHAPTER TWO: --- METHODOLOGY --- p.28 / Chapter 2.1 --- Recruitment of preschools and preschoolers --- p.28 / Chapter 2.2 --- Development of DRAGON2006 --- p.33 / Chapter 2.2.1 --- Ethics approval --- p.35 / Chapter 2.2.2 --- Focus groups with parents --- p.35 / Chapter 2.2.3 --- Amendment and pretest of the questionnaires --- p.35 / Chapter 2.2.4 --- Health lessons --- p.36 / Chapter 2.2.4.1 --- Development and adaptation of the health lessons --- p.36 / Chapter 2.2.4.2 --- Improvement of the teaching materials --- p.37 / Chapter 2.2.4.3 --- Lyrics reproduction and CD production --- p.37 / Chapter 2.2.4.4 --- Worksheets --- p.38 / Chapter 2.2.4.5 --- Process evaluation --- p.38 / Chapter 2.2.5 --- Teachers´ة training --- p.38 / Chapter 2.3 --- Intervention Activities and Components --- p.39 / Chapter 2.3.1 --- Opening ceremony --- p.39 / Chapter 2.3.2 --- Health Talks --- p.40 / Chapter 2.3.3 --- Health report --- p.40 / Chapter 2.3.4 --- Parental newsletters --- p.41 / Chapter 2.4 --- Outcome evaluation --- p.42 / Chapter 2.5 --- Data collection --- p.43 / Chapter 2.5.1 --- Recruitment of subjects --- p.43 / Chapter 2.5.2 --- Anthropometric measurements --- p.43 / Chapter 2.5.3 --- Parental baseline and evaluation questionnaire administration --- p.44 / Chapter 2.5.4 --- Teachers´ة pre- and post-intervention evaluation and process evaluation --- p.44 / Chapter 2.6 --- Data management --- p.44 / Chapter 2.6.1 --- Verification of data from the questionnaires --- p.44 / Chapter 2.6.2 --- Data coding --- p.45 / Chapter 2.6.3 --- Data entry and verification --- p.45 / Chapter 2.6.4 --- Data analysis --- p.45 / Chapter 2.5.4.1 --- Descriptive and association analysis --- p.45 / Chapter 2.5.4.2 --- Construction of BMI-for-age percentile and z- score curves --- p.46 / Chapter 2.5.4.3 --- Evaluation of the effectiveness of the program --- p.47 / Chapter CHAPTER THREE: --- RESULTS --- p.48 / Chapter 3.1 --- Organization of the results --- p.48 / Chapter 3.2 --- Baseline comparability between the EG and CG --- p.48 / Chapter 3.2.1 --- General sociodemographic characteristics --- p.48 / Chapter 3.2.2 --- Preschoolers' diet and meal behaviors --- p.54 / Chapter 3.2.3 --- Preschoolers´ة dental health --- p.61 / Chapter 3.2.4 --- Parental child feeding behaviors --- p.62 / Chapter 3.2.5 --- Preschoolers´ة physical activity and sedentary behaviors --- p.66 / Chapter 3.2.6 --- Summary --- p.67 / Chapter 3.3 --- Baseline comparability between the completes and dropouts --- p.69 / Chapter 3.3.1 --- Participant flow in the EG and CG --- p.69 / Chapter 3.3.2 --- General sociodemographic characteristics --- p.70 / Chapter 3.3.3 --- "Preschoolers´ة diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.74 / Chapter 3.3.4 --- Summary --- p.75 / Chapter 3.4. --- Evaluation of the effectiveness of the DRAGON2006 --- p.76 / Chapter 3.4.1 --- General demographic characteristics --- p.76 / Chapter 3.4.2 --- Effects on preschoolers´ة anthropometry and weight status --- p.77 / Chapter 3.4.3 --- Effects on preschoolers' diet and meal behaviors --- p.79 / Chapter 3.4.4 --- Effects on parental child feeding behaviors --- p.89 / Chapter 3.4.5 --- Effects on preschoolers´ة physical and sedentary activities --- p.92 / Chapter 3.4.6 --- Summary --- p.94 / Chapter 3.5 --- "Teaching staff members´ة attitudes, perceptions and practices with respect to addressing childhood overweight" --- p.95 / Chapter 3.5.1 --- General demographic characteristics --- p.95 / Chapter 3.5.2 --- Teachers' attitude toward addressing childhood overweight --- p.98 / Chapter 3.5.3 --- Teachers' behaviors toward addressing childhood overweight --- p.99 / Chapter 3.5.4 --- Teachers' perceived abilities to deal with some childhood overweight topics --- p.100 / Chapter 3.5.5 --- Teachers´ة reported helpful factors to implementing a new preschool health program --- p.101 / Chapter 3.5.6 --- Teachers´ة reported helpful factors for and barriers to parents´ة participation --- p.102 / Chapter 3.5.7 --- Comparisons between staff with and without self-reported weight and height --- p.103 / Chapter 3.5.8 --- Summary --- p.105 / Chapter 3.6 --- EG teachers´ة evaluation of the program --- p.106 / Chapter 3.6.1 --- Teachers' perception of DRAGON2006 program before the intervention --- p.106 / Chapter 3.6.2 --- DRAGON teachers´ة process evaluation of the DRAGON2006 curriculum --- p.113 / Chapter 3.6.3 --- DRAGON teachers´ة evaluation of DRAGON2006 program after the intervention --- p.118 / Chapter CHAPTER FOUR: --- DISCUSSION --- p.127 / Chapter 4.1 --- "Baseline findings about the preschoolers' weight status, diet, meal and physical and sedentary activity situation" --- p.127 / Chapter 4.1.1 --- Preschooler and parental overweight and obesity --- p.127 / Chapter 4.1.2 --- Preschoolers´ة diet and meal behaviors --- p.128 / Chapter 4.1.3 --- Preschoolers´ة physical and sedentary activity behaviors --- p.130 / Chapter 4.2 --- "Gender associations with preschoolers´ة diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.131 / Chapter 4.2.1 --- Gender associations with preschoolers´ة diet and meal behaviors --- p.132 / Chapter 4.2.2 --- Gender associations with parental child feeding behaviors --- p.134 / Chapter 4.2.3 --- Gender associations with preschoolers´ة physical and sedentary activity behaviors --- p.135 / Chapter 4.3 --- "Age associations with preschooler diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.136 / Chapter 4.3.1 --- Preschoolers' age associations with their anthropometry --- p.137 / Chapter 4.3.2 --- Preschoolers´ة age associations with their diet and meal behaviors --- p.137 / Chapter 4.3.3 --- Preschoolers' age associations with their dental health --- p.139 / Chapter 4.3.4 --- Preschoolers´ة age associations with parental child feeding behaviors --- p.139 / Chapter 4.3.5 --- Preschoolers´ة age associations with their physical and sedentary activity behaviors --- p.140 / Chapter 4.4 --- "Family income associations with preschooler diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.141 / Chapter 4.4.1 --- Family income associations with some general demographic characteristics of the sample --- p.143 / Chapter 4.4.2 --- Family income associations with preschoolers´ة diet and meal behaviors --- p.144 / Chapter 4.4.3 --- Family income associations with parental child feeding behaviors --- p.147 / Chapter 4.4.4 --- Family income associations with preschoolers' physical and sedentary activity behaviors --- p.148 / Chapter 4.5 --- Factors associated with preschool overweight and obesity --- p.148 / Chapter 4.5.1 --- Preschooler overweight and obesity associations with some general demographic characteristics of the baseline participants --- p.149 / Chapter 4.5.2 --- Preschooler overweight and obesity associations with parental overweight and obesity --- p.150 / Chapter 4.5.3 --- Preschooler overweight and obesity associations with preschoolers' meal behaviors --- p.150 / Chapter 4.5.4 --- Preschooler overweight and obesity associations with their physical and sedentary activity behaviors --- p.150 / Chapter 4.6 --- The evaluation of the effectiveness of DRAGON2006 --- p.151 / Chapter 4.6.1 --- Baseline comparison between the education (EG) and control group (CG) --- p.151 / Chapter 4.6.2 --- Baseline comparison between completers and dropouts --- p.151 / Chapter 4.6.3 --- Follow up comparison between the education (EG) and control groups (CG) --- p.152 / Chapter 4.6.3.1 --- The changes in preschooler anthropometry --- p.153 / Chapter 4.6.3.2 --- The changes in preschooler diet and meal behaviors --- p.154 / Chapter 4.6.3.3 --- The changes in preschooler physical and sedentary activity behaviors --- p.155 / Chapter 4.6.3.4 --- Parental child feeding behaviors --- p.156 / Chapter 4.7 --- The teachers´ة evaluation results of DRAGON2006 and of Color Me Healthy --- p.156 / Chapter 4.7 --- Strengths and limitations of the study --- p.157 / Chapter 4.8 --- Suggestions for improvement of DRAGON --- p.159 / Chapter CHAPTER FIVE: --- CONCLUSION --- p.160 / References --- p.161 / Appendices / Chapter AI --- Invitation letter for preschool (English) --- p.171 / Chapter AIII --- Invitation letter for preschool (Chinese) --- p.172 / Chapter AIII --- Invitation letter for CG preschool (Chinese only) --- p.173 / Chapter BI --- Research proposal (English) --- p.174 / Chapter BII --- Research proposal (Chinese) --- p.178 / Chapter CI --- Purpose and structure of DRAGON2006 health lessons (English) --- p.181 / Chapter CII --- Purpose and structure of DRAGON2006 health lessons (Chinese) --- p.185 / Chapter DI --- Teacher evaluation Part A (pre-intervention) (English) --- p.189 / Chapter DII --- Teacher evaluation Part A (pre-intervention) (Chinese) --- p.191 / Chapter EI --- Teacher evaluation Part B (process evaluation) (English) --- p.193 / Chapter EII --- Teacher evaluation Part B (process evaluation) (Chinese) --- p.205 / Chapter FI --- Teacher evaluation Part C (post-intervention) (English) --- p.218 / Chapter FII --- Teacher evaluation Part C (post-intervention) (Chinese) --- p.222 / Chapter GI --- Child health report (English) --- p.224 / Chapter GII --- Child health report (Chinese) --- p.226 / Chapter H --- Teaching kit --- p.228 / Chapter I --- Music sound track --- p.228 / Chapter J --- Curriculum worksheets (Chinese only) --- p.228 / Chapter K --- Parents´ة newsletters (Chinese only) --- p.228 / Chapter LI --- Focus group study questions (English) --- p.229 / Chapter LII --- Focus group study questions (Chinese) --- p.231 / Chapter MI --- Consent form for EG parents (English) --- p.233 / Chapter MII --- Consent form for EG parents (Chinese) --- p.235 / Chapter MII --- Consent form for CG parents (English) --- p.237 / Chapter MI --- Consent form for CG parents (Chinese) --- p.238 / Chapter NI --- Pre-internvetion parental questionnaire (English) --- p.239 / Chapter NII --- Pre-intervention parental questionnaire (Chinese) --- p.245 / Chapter OI --- Post-intervention parental questionnaire (English) --- p.250 / Chapter OII --- Post-internvetion parental questionnaire (Chinese) --- p.256 / Chapter PI --- Post-intervention staff survey (English) --- p.262 / Chapter PII --- Post-intervention staff survey (Chinese) --- p.264 / Chapter Q --- "Gender differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.266 / Chapter R --- "Age differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.296 / Chapter S --- "Income differences in preschoolers' diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.313 / Chapter T --- Factors associated with preschooler weight status --- p.334 / Chapter U --- "Maternal education level differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.352 / Chapter V --- "Maternal birth place differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.374 / Chapter W --- Test-retest reliability of DRAGON2006 questionnaire --- p.394