Globally, overweight and obesity in childhood has already reached pandemic proportions, and this condition is associated with various health problems such as, insulin-resistance, Type 2 diabetes mellitus, and cardiovascular problems, such as hypertension, ischaemic heart disease, and stroke. Overweight and obesity are increasing in most countries, especially developing countries where the rates of obesity have tripled in those that have adapted a Western lifestyle. In low- and middle-income populations, particularly in urban areas, overweight and obesity in children is on the increase. Thus body composition profiles are used to determine the risk category of children such as underweight, normal, overweight, and obese. Overweight and obesity have a negative impact on both the physical and psychological levels of wellbeing during childhood and adolescence. Research on African and South African children living in rural areas on the body composition and prevalence rates will provide an opportunity to understand the role of development in children and adolescents and the importance thereof. The purpose of this study was to determine the status of body composition and the effect of gender, age, and race on body composition. This dissertation comprises four chapters, of which one chapter can be read independently as it is written in the form of a research article. MAIN FINDINGS A literature review was conducted to gain more insight regarding body composition status of children throughout the world, and in Africa and South Africa, and the role that body composition plays in children and adolescents. The importance of these aspects is highlighted and discussed in Chapter Two. Cross-sectional data on a total of 280 learners (109 boys and 171 girls) aged 14 years, who are part of the Physical Activity Longitudinal Study from the Tlokwe municipality area, are participants in the study. Body mass, stature, and skinfolds were used to determine body composition and body mass index of the participants. All data was analysed using SPSS Version 21.0 (SPSS Inc., 2012). The statistical level was set at p-value ≤ 0.05. The results of this study indicate that out of 280 learners 13.1% are overweight, 29.1% normal weight and 57.8% underweight. Boys had a lower overweight value when compared to the girls (9.1% vs 15.7%). In addition, the results show that African girls had a higher prevalence for overweight (15.8% vs 15.4%) than their Caucasian counterparts. As for the impact of gender, age and race-independent effects on body composition or BMI, the results also show no significant (p ≥ 0.05) age-independent effect on body composition measures of percentage body fat, sum of six skinfolds, fat free mass and waist-to-height ratio. In conclusion, overweight and obesity is a growing problem among children and adolescents, especially African girls and Caucasian girls in the Tlokwe municipality. Furthermore, recommendations are made about the implementation of school-screening programmes in semi-urban areas. The role of the government, parents, and teachers, and the importance of health professionals must also be considered. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2015

Globally, overweight and obesity in childhood has already reached pandemic proportions, and this condition is associated with various health problems such as, insulin-resistance, Type 2 diabetes mellitus, and cardiovascular problems, such as hypertension, ischaemic heart disease, and stroke. Overweight and obesity are increasing in most countries, especially developing countries where the rates of obesity have tripled in those that have adapted a Western lifestyle. In low- and middle-income populations, particularly in urban areas, overweight and obesity in children is on the increase. Thus body composition profiles are used to determine the risk category of children such as underweight, normal, overweight, and obese. Overweight and obesity have a negative impact on both the physical and psychological levels of wellbeing during childhood and adolescence. Research on African and South African children living in rural areas on the body composition and prevalence rates will provide an opportunity to understand the role of development in children and adolescents and the importance thereof. The purpose of this study was to determine the status of body composition and the effect of gender, age, and race on body composition. This dissertation comprises four chapters, of which one chapter can be read independently as it is written in the form of a research article. MAIN FINDINGS A literature review was conducted to gain more insight regarding body composition status of children throughout the world, and in Africa and South Africa, and the role that body composition plays in children and adolescents. The importance of these aspects is highlighted and discussed in Chapter Two. Cross-sectional data on a total of 280 learners (109 boys and 171 girls) aged 14 years, who are part of the Physical Activity Longitudinal Study from the Tlokwe municipality area, are participants in the study. Body mass, stature, and skinfolds were used to determine body composition and body mass index of the participants. All data was analysed using SPSS Version 21.0 (SPSS Inc., 2012). The statistical level was set at p-value ≤ 0.05. The results of this study indicate that out of 280 learners 13.1% are overweight, 29.1% normal weight and 57.8% underweight. Boys had a lower overweight value when compared to the girls (9.1% vs 15.7%). In addition, the results show that African girls had a higher prevalence for overweight (15.8% vs 15.4%) than their Caucasian counterparts. As for the impact of gender, age and race-independent effects on body composition or BMI, the results also show no significant (p ≥ 0.05) age-independent effect on body composition measures of percentage body fat, sum of six skinfolds, fat free mass and waist-to-height ratio. In conclusion, overweight and obesity is a growing problem among children and adolescents, especially African girls and Caucasian girls in the Tlokwe municipality. Furthermore, recommendations are made about the implementation of school-screening programmes in semi-urban areas. The role of the government, parents, and teachers, and the importance of health professionals must also be considered. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2015

Weight stigma is associated with negative health outcomes across the BMI continuum. However, few studies have examined weight discrimination targeting people with low body weights. This investigation explored the presence of anti-thin bias, defined as the belief that people with low BMIs have undesirable personality characteristics. Participants were randomly assigned to read one of six vignettes about women that differed by race (White and Black) and weight status (slightly underweight, normal weight, and slightly overweight). Negative personality characteristics were more likely to be ascribed to both underweight and overweight women, compared with normal weight women. Furthermore, participants were significantly more likely to attribute underweight women’s body weight to biological factors. Results indicate that underweight women might be more stigmatized for their body weight than normal weight women. Weight bias literature should continue to research the impact of weight discrimination for individuals across the BMI spectrum.

While the role of obesity in health outcomes has been well described, the role of low body mass index (BMI), body weight relative to height, has largely been ignored. Those with low BMI are commonly excluded completely or combined with the normal BMI category in BMI studies. However, there have been some studies indicating poorer health outcomes among those with lower BMI, particularly that of increased risk of mortality. The purpose of this study is to explore the role of low BMI throughout the lifespan. Data from the Health and Retirement Study was used to evaluate 1) the association between childhood health and socioeconomic status (SES) exposures and low BMI in midlife adulthood, 2) the association between low BMI and health related outcomes in midlife adulthood (ages 50 to 65), and 3) the association between low BMI in midlife and health related outcomes, including mortality, over a longer follow-up (maximum of 20 years). To increase sample size, two low BMI definitions were used: the traditional Few significant results were found. Low BMI status was consistently associated with older age and female gender as well as current smoking status. Childhood exposure of respiratory disease and greater SES disadvantages was more common among those with low BMI in adulthood. In midlife adulthood, low BMI status was associated with increased difficulties with activities of daily living with either definition of low BMI. Increased risk of fracture was associated with a low BMI definition of <18.5. Increased risk of lung disease and decreased risk of high blood pressure was associated with a low BMI definition of ≤20. An analysis of those 30 years old or older found low BMI to be associated with increased risk of mortality and decreased risk of diabetes regardless of low BMI definition. When low BMI was defined as <18.5, those with low BMI were also more likely to experience difficulty with one or more activities of daily living. When low BMI was defined as ≤20, low BMI status was associated with greater risk of lung disease and decreased risk of high blood pressure. Further research is needed to fully characterize the role of low BMI on health outcomes as well as the role of SES on low BMI. Additionally, there is a need for greater understanding of the potential biological mechanisms of low BMI for health outcomes. Currently, there are few studies evaluating health outcomes and SES of low BMI. Limiting studies to the extreme upper end of the BMI spectrum limits the overall understanding of the role of BMI in health and may overlook unique characteristics and challenges those with low BMI may face.

Body composition profiles including stunting, wasting and underweight, overweight and obesity, can all affect the health, motor development and academic achievements of children. South Africa (SA), a developing, middle-income country, with large socio-economic inequalities, is one of the most complex nations with regard to race and ethnicity. It therefor results in different body composition profiles of children and adolescents, where undernutrition and obesity can occur among children and adolescents in the same socio-geographic population in disadvantaged communities, as well as in the same household. The aim of this study was firstly, to determine the incidence of overweight and obesity among Grade 1-learners in the North West Province of SA and to determine whether this incidence is related to gender, race and the socio-economic circumstances in which these learners live. Secondly, the study aimed to determine the incidence of stunting, wasting and underweight among this group of Grade 1-learners and to determine whether these incidences are related to gender, race and the socio-economic circumstances in which these learners live. The anthropometric measurements that were used in the study were height (cm), body mass (kg), 3 skinfolds [(sub-scapular, triceps and medial calf)] (mm) and waist circumference (cm). These measurements were taken by trained researchers according to the guidelines International Society for the Advancement of Kinanthropometry (ISAK). Body mass index (BMI) [(body mass (kg)/height (m)2)] was calculated and international age-specific cut-off points for BMI was used to determine whether a learner was overweight or obese. Z-scores of less than -2 standard deviation (SD) for height-for-age and weight-for-age were calculated to determine the prevalence of stunting and underweight, while the Z-scores for wasting was determined using BMI-for-age, under the 5th percentile from an international reference population. The Statistica-computer programme (Statsoft, 2011) and AntroPlus software (version 1.0.2) in SAS (Statistical Analysis System) were used to analyse the data. Data were descriptively analysed by using percentages, means (), minimum and maximum values and standard deviations (SD). Two-way frequency tables were used to analyse the incidence for overweight, obesity, stunting, wasting and underweight. Pearson Chi Square analysis p≤0,05 was used to determine statistical significance of differences in stunting, wasting and underweight between school types, race and genders. Practical significance of differences was determined using effect sizes (d≥0,1 which indicates a small effect, d≥0,3 indicating a medium effect and d≥0,5 indicating a large effect). Tukey’s Post Hoc tests were used to determine the significance of differences between the groups and genders. The results revealed an incidence of 11,6% of overweight and obesity in the group (N=816) of Grade 1-learners. Overweight in the group was 7,8% and overweight was more prevalent in 7 year old learners with 10,5%, compared to 6 year old learners with 6,3%. Obesity (3,8%) showed a lower incidence compared to overweight, were 2,5% learners at 6 years and 0,7% learners at 7 years were obese. The boys showed the highest prevalence for severe obesity at 6 and 7 years (2,4%). White learners showed the highest prevalence for overweight, obesity and severe obesity at 6 and 7 years. The group of Grade 1-learners furthermore showed lower percentages of stunting (4,3%), wasting (7,4%) and underweight (4,3%) compared to overweight and obesity incidences. A higher prevalence of wasting and underweight were found among the boys (8,4%; 6,0%) compared to the girls (6,3%; 2,5%), although the difference was only significant for underweight (p=0,02), while stunting was similar among girls (4,5%) and boys (4,1%; p>0,05). Black learners showed the highest incidence for underweight (5,5%; p<0,01), while small percentages of underweight were found in the white learners. Only the black learners showed stunting (p<0,01), while wasting occurred in black (n=39) and white (n=15) learners. Quintile 1-3 schools had the highest prevalence of underweight (5,1% – 8,2%) and stunting (3,9% – 10,7%), which was significantly higher than in Quintile 4 and 5 schools (p<0,01), and agreed with higher prevalences found in rural areas in other South African studies. Knowledge about the body composition profiles of young school beginners is important since extremes such as obesity, stunting and wasting play an important role in the further development and health of children. The results of this study make a valuable contribution to knowledge that can be used in this regard for preventative purposes. / Thesis (MSc (Kinderkinetics))--North-West University, Potchefstroom Campus, 2013.

Body composition profiles including stunting, wasting and underweight, overweight and obesity, can all affect the health, motor development and academic achievements of children. South Africa (SA), a developing, middle-income country, with large socio-economic inequalities, is one of the most complex nations with regard to race and ethnicity. It therefor results in different body composition profiles of children and adolescents, where undernutrition and obesity can occur among children and adolescents in the same socio-geographic population in disadvantaged communities, as well as in the same household. The aim of this study was firstly, to determine the incidence of overweight and obesity among Grade 1-learners in the North West Province of SA and to determine whether this incidence is related to gender, race and the socio-economic circumstances in which these learners live. Secondly, the study aimed to determine the incidence of stunting, wasting and underweight among this group of Grade 1-learners and to determine whether these incidences are related to gender, race and the socio-economic circumstances in which these learners live. The anthropometric measurements that were used in the study were height (cm), body mass (kg), 3 skinfolds [(sub-scapular, triceps and medial calf)] (mm) and waist circumference (cm). These measurements were taken by trained researchers according to the guidelines International Society for the Advancement of Kinanthropometry (ISAK). Body mass index (BMI) [(body mass (kg)/height (m)2)] was calculated and international age-specific cut-off points for BMI was used to determine whether a learner was overweight or obese. Z-scores of less than -2 standard deviation (SD) for height-for-age and weight-for-age were calculated to determine the prevalence of stunting and underweight, while the Z-scores for wasting was determined using BMI-for-age, under the 5th percentile from an international reference population. The Statistica-computer programme (Statsoft, 2011) and AntroPlus software (version 1.0.2) in SAS (Statistical Analysis System) were used to analyse the data. Data were descriptively analysed by using percentages, means (), minimum and maximum values and standard deviations (SD). Two-way frequency tables were used to analyse the incidence for overweight, obesity, stunting, wasting and underweight. Pearson Chi Square analysis p≤0,05 was used to determine statistical significance of differences in stunting, wasting and underweight between school types, race and genders. Practical significance of differences was determined using effect sizes (d≥0,1 which indicates a small effect, d≥0,3 indicating a medium effect and d≥0,5 indicating a large effect). Tukey’s Post Hoc tests were used to determine the significance of differences between the groups and genders. The results revealed an incidence of 11,6% of overweight and obesity in the group (N=816) of Grade 1-learners. Overweight in the group was 7,8% and overweight was more prevalent in 7 year old learners with 10,5%, compared to 6 year old learners with 6,3%. Obesity (3,8%) showed a lower incidence compared to overweight, were 2,5% learners at 6 years and 0,7% learners at 7 years were obese. The boys showed the highest prevalence for severe obesity at 6 and 7 years (2,4%). White learners showed the highest prevalence for overweight, obesity and severe obesity at 6 and 7 years. The group of Grade 1-learners furthermore showed lower percentages of stunting (4,3%), wasting (7,4%) and underweight (4,3%) compared to overweight and obesity incidences. A higher prevalence of wasting and underweight were found among the boys (8,4%; 6,0%) compared to the girls (6,3%; 2,5%), although the difference was only significant for underweight (p=0,02), while stunting was similar among girls (4,5%) and boys (4,1%; p>0,05). Black learners showed the highest incidence for underweight (5,5%; p<0,01), while small percentages of underweight were found in the white learners. Only the black learners showed stunting (p<0,01), while wasting occurred in black (n=39) and white (n=15) learners. Quintile 1-3 schools had the highest prevalence of underweight (5,1% – 8,2%) and stunting (3,9% – 10,7%), which was significantly higher than in Quintile 4 and 5 schools (p<0,01), and agreed with higher prevalences found in rural areas in other South African studies. Knowledge about the body composition profiles of young school beginners is important since extremes such as obesity, stunting and wasting play an important role in the further development and health of children. The results of this study make a valuable contribution to knowledge that can be used in this regard for preventative purposes. / Thesis (MSc (Kinderkinetics))--North-West University, Potchefstroom Campus, 2013.

This diploma thesis is based on the fifth round of the Childhood Obesity Surveillance Initiative (COSI). This study is lead by World Health Organisation and on this study cooperate European countries including the Czech republic. In the Czech republic the study lead by Institute of Endocrinology in collaboration with practical paediatricians since the year 2008. The fifth round of this study took place in the Czech republic in 2019. We collected anthropometric data and characteristic of family and school enviroment from 2289 children 6,5-7,99 years old. Prevalence of underweight according to cut offs of WHO was 2,88% (2,74-3,02), according to National Anthropological Survey (NAS) was 2,27% (1,84- 2,7) and according to International Obesity Task Force was 1,35% (1,13-1,57). Prevalence of underweight was compared with prevalence of underweight in the last rounds of this study and with prevalence of overweight and obesity. Decrease of prevalence of underweight (WHO) in comparsion with last round of COSI study (2016) was significant in boys. We found non- significant increase in underweight prevalence in girls. A mild non-significant decrease of underweight in all children.. Prevalence of overweight and obesity according to cut offs of WHO was 22,24% (22,16-22,32), according to NAS was 18,92%...

Infants and young children in the Northwest province of Nigeria are susceptible to malnutrition. Inappropriate and inadequate breastfeeding and complementary feeding result in stunting, underweight, and wasting. The purpose of this cross-sectional study was to examine current feeding practices of infants not older than 2 years and their nutritional status in Northwest Nigeria. The theory of planned behavior was adopted in this research. With a total sample size of 3,861, multiple linear regression was adopted as a predictive analysis to delineate the correlation between two or more independent variables and one continuous dependent variable. Also, adopted was an independent t test to demonstrate the statistical difference between the mean of the dependent variable and that of the independent variable. The coefficient of determination (R2) indicated that the change in underweight associated with exclusive breastfeeding (EBF) was 8.1%. The overall regression model was significant, F(18, 879) = 4.29, p < .05, adj. R2 = .06 predicted underweight in infants under 6 months of age. The coefficient of determination (R2) indicated that the changes in underweight associated with age appropriate complementary (CP) feeding was 8.0%. The overall regression model was significant, F(18, 2,944) = 14.29, p < .05, adj. R2 = .08. The model predicted underweight in infants 624 months of age. The results from this study can be used in the reinforcement of EBF and age appropriate CP guidelines and policies by the extension of paid leave, implementing flexibility in working hours, and private space to breastfeed.

Introduction: Millions of children worldwide die before they reach their fifth birthday. Approximately 50% of all deaths in children are associated with malnutrition. Although remarkable improvements have been seen in the past few decades, child malnutrition remains a major public health problem in Ethiopia. Malnutrition has been linked to various morbidities and as the underlying cause of 57% of mortality in the country. It is caused by complex and multidimensional biological, social economic, and environmental factors. There are scarce literatures examining the environmental factors, such as access to water and sanitation, on the likelihood of child malnutrition as measured by stunting, wasting, and underweight in Ethiopia, which the current study sought to investigate. Aim: The primary aim of this study was to examine the relationship between households’ access to water and sanitation facilities and the likelihood that a child will become stunted or wasted or underweight. Methods: The study utilized a nationally representative data from 2011 Ethiopia Demographic and Health Survey. The sample size was 9,611 children aged 0-59 months. A weighted descriptive statistical analysis was performed to examine the frequency distribution of the study’s primary independent variables (sanitation and water), dependent variables (childhood stunting, wasting, and underweight), and all other variables included in the study. Weighted bivariate analysis was conducted using logistic regression to quantify association between stunting, wasting, and being underweight and different independent variables. Weighted multivariate logistic regression analysis was performed to control for potential confounders while examining the relationship between the primary independent and dependent variables. Odds ratios, 95% confidence limits, and p-value were calculated. We considered three sets of potential confounders: child’s (child’s gender, child’s age, and child’s size at birth diarrheal disease, fever), maternal (maternal education) and household characteristics (maternal BMI, place of residence, wealth index, stool disposal, time to get water). Only variables that showed significant association (p-value Main results: Approximately 44%, 10%, and 29% of the children under-five years of age were stunted, wasted, and underweight, respectively. About 54% of the study population used unimproved source of drinking water and about 82% used unimproved sanitation facility. Our bivariate logistic analysis revealed that children in households with unimproved source of drinking water had higher odds of stunting compared to children in households with improved drinking water source (OR: 1.2; 95% CL 1.02-1.34). Adjustment for child’s characteristics yielded AOR: 1.2; 95% CL 1.0-1.4. Addition of maternal characteristics attenuated this association (AOR: 1.1; 95% CL 1.0-1.3 1.0; 95% CL 0.8-1.2). Finally, inclusion of household characteristics showed stunting was not associated with unimproved source of drinking water (AOR: 1.0; 95% 0.8-1.2). The bivariate analysis revealed household access to unimproved source of drinking water was not significantly associated with wasting (OR: 1.0; 95% CL 0.8-1.3) and underweight (OR: 1.2; 95% CL 1.0-1.4). Adjustment of child, maternal, and household characteristic showed an inverse association between source of drinking water and wasting (AOR: 0.7; 95% CL 0.6-0.9). In the bivariate analysis, access to unimproved sanitation was significantly associated with stunting (OR: 1.3; 95% CL 1.02-1.74) and underweight (OR: 1.5; 95% CL 1.1-2.1). Compared to children living in homes with access to improved sanitation facility, children in household with unimproved sanitation facility had 1.4 increased odds of being stunted (95% CL 1.1-1.9) after adjustment for child’s characteristics. Adjustment of child, maternal, and household characteristics attenuated this association (AOR: 1.1; 95% CL 0.8-1.5). Children in household with unimproved sanitation facility had higher odds of being underweight after adjusting for child characteristics (AOR: 1.6; 95% CL 1.2-2.2). Addition of maternal characteristic reduced the association (AOR: 1.5; 95% CL 1.1-2.0). Finally, the addition of household characteristics further attenuated this association (AOR: 1.4; 95% CL 1.1-1.9). Children from households with improved water but unimproved sanitation had higher odds of wasting and being underweight compared to children living in household with both services: AORs adjusted for child’s characteristics were 2.3 (95% CL 1.3-4.3) for wasting and 2.4 (95% CL 1.6-3.6) for underweight; when maternal characteristics were included, AORs were 2.2 (95% CL 1.2-4.1) and 2.1 (95% 1.4-3.3) for wasting and underweight, correspondingly; finally, when household characteristics were included AORs were 2.0 (95% CL 1.1-3.9) and 1.9 (95% CL 1.2-3.0), respectively. Conclusion: Our results suggest that household access to unimproved source of drinking water and sanitation increase the likelihood of malnutrition. Therefore, initiatives to increase access to improved sources of drinking water and sanitation facilities along with nutritional intervention could help alleviate the high burden of malnutrition in Ethiopia.

Background and objectives: The current and projected burden of cardiometabolic diseases in Asia is high, with a notable and rapidly increasing prevalence of associated risk factors among children in this region. Comprehensive evidence on cardiometabolic disease risk factors among children in Asia is required to ensure well-informed strategies to address the future burden of disease in this region. This thesis aims to increase the current understanding of cardiometabolic disease risk factors among children in Asia. Methods: Using previously collected data on 6903 children and 17 656 adults participating in the South East Asia Community Observatory health and demographic surveillance system (SEACO HDSS) in Malaysia, the characterisation, prevalence and sociodemographic determinants of key child risk factors were examined. Furthermore, a feasibility study building upon the SEACO framework (N = 203) was designed and implemented to explore the possibility of increasing the range of cardiometabolic measures obtained from children through the collection and analysis of biological samples from individuals in the HDSS. Results: There was a high burden of cardiometabolic disease risk factors among both adults and children in this population. Among children, prevalence estimates for the four key risk factors (overweight, obesity, underweight and stunting) differed considerably depending upon the anthropometric reference used to classify these measures, but were notable regardless of reference. Nutritional and household environmental indices, including child underweight and household sanitation facilities, were strongly associated with stunting risk in this population. Furthermore, children with parents who were obese or centrally obese had an approximately twofold increased risk of being obese. There was no clear evidence of association between measures of socioeconomic position and cardiometabolic disease risk factors among children. Finally, effective procedures were established for the collection, analysis and storage of biological samples from children and their family members in the HDSS, with implications for potential scale-up to facilitate more detailed characterisation of cardiometabolic disease risk. Conclusions: This work indicates a high burden of cardiometabolic disease risk factors among children in this population, identifies modifiable sociodemographic influences on these risk factors, highlights opportunities to more comprehensively characterise child cardiometabolic disease risk in this population, and hence informs future directions for research and strategies to address the growing burden of risk factors among children in this region.