Journal of Obesity

Journal of Obesity / 2013 / Article

Research Article | Open Access

Volume 2013 |Article ID 395671 |

Paolo Rosati, Stefania Triunfo, Giovanni Scambia, "Child Nutritional Status: A Representative Survey in a Metropolitan School", Journal of Obesity, vol. 2013, Article ID 395671, 4 pages, 2013.

Child Nutritional Status: A Representative Survey in a Metropolitan School

Academic Editor: Francesco Saverio Papadia
Received07 Sep 2012
Revised05 Jan 2013
Accepted05 Jan 2013
Published28 Jan 2013


Objective. To assess the prevalence of obesity, overweight, and thinness among children in an Italian school. Methods. Five hundred ninety-five children (289 males and 306 females) were enrolled, aged between 6 and 19 years old, in Italian school in Rome. Body mass index (BMI) was calculated according to International Obesity Task Force (IOFT) cut-off points. By age criterion all participants have been classified in age classes. Results. A normal BMI was recorded in 73.6% of all cases. Obesity, overweight, and thinness prevalence was 5.9%, 9.6%, and 10.9%, respectively, without statistical differences in both genders, except the prevalence of overweight that resulted statistically significant (13.1% males versus 6.2% females, ). Differences in the age groups have been found. About 23.4% of children between 7 to 11 years were defined obese and about 42.3% between 6 to 8 years thin grade 2, respectively. Conclusion. The study reports the low prevalence of overweight and obesity, in contrast to the unexpected thinness prevalence. The identification of specific age groups with abnormal nutritional status could be the first step to address future epidemiological investigations in order to plan strategic approach in selected age periods.

1. Introduction

The prevalence of abnormal nutritional status has increased in children and adolescents since 1980 in both developed and developing countries [1], alerting the public health system for the possible risks in terms of cardiovascular, metabolic, and psychiatric diseases [25] and economic impact for additional costs to prevent or manage the illness [6].

Obesity, overweight, and thinness are variously distributed in the world, in preschool and school children and in both genders over the years. World Health Organization (WHO) estimated that the prevalence of children <5 years of age with a BMI > 2 SD (equivalent to the 98th percentile) increased from 4.2% in 1990 to 6.7% in 2010 and is expected to reach 9.1% in 2020, higher in developed (11.7%) rather than developing countries (6.1%) [7]. In USA the obesity prevalence has increased from 7% in 1980 to nearly 20% in 2008 in children aged 6–11 years and from 5% to 18% over the same period in adolescents aged 12–19 years, respectively [8]. In European countries and regions wide variations in overweight and obesity prevalence estimates among primary-school children have been reported, suggesting the presence of a north-south gradient with the highest level of overweight found in southern European countries [911].

Surprisingly, after the global alert for overweight and obesity in infants, children, and adolescents, an opposite extreme on the same spectrum of malnutrition status has drawn attention in the developed countries, especially. Considering the malnutrition as “undernutrition,” the first difficult relieved was its classification, appeared unsatisfactory because of the lack of suitable cut-offs for international use [12]. The reference levels proposed by Cole et al. should helped to provide internationally comparable prevalence rates of thinness in children and adolescents [13]. Actually, however, paucity of data about the thinness in childhood has been recorded [14, 15], frequently associated to anorexia nervosa identified as the third most common chronic condition of adolescence [16].

The aim of the present study, defined as pilot study, was to assess the obesity, overweight, and thinness prevalence in specific age groups in an Italian scholastic population and to plan subsequent surveys in order to precise the target age groups, susceptible of health educational programs.

2. Methods

A cross-sectional 2009-2010 school-year survey among children and adolescents, aged between 6 and 19 years, in Rome was performed. The school was chosen both for the interest to participate in the screening program and for the definition of “Italian scholastic population type” by authors. From an initial sample of 623 students, a final study population of 595 subjects (95.5%) has been enrolled: 15 students (2.4%) were absent for illness or personal reasons and 13 (2.1%) refused to participate, respectively. All parents provided an informed written consent for children in the absence of majority.

Height and weight were evaluated with standardized protocols and calibrated equipment during a physical examination in the appropriate nursing school. Decimal age was calculated from the data of birth considering the date of measurement. Weight was measured with an electronic SECA bathroom scale previously calibrated to ±0.1 kg. Children were weighed without shoes, jumpers, or sweatshirts and weight recorded to the last 0.1 kg. Height was measured to the nearest 0.1 cm using a Holtain’s stadiometer.

BMI was calculated as weight in kilograms divided by height in meters squared (kg/m2). BMI classes were calculated according to the IOFT, identifying these criteria as the most stringent of all the current definitions of childhood obesity [13, 17]. According to WHO that recognizes “thinness” as low BMI for age in adults and adolescents, we used the same definition and not “underweight.” BMI values below 18.5 were distributed into two grades: grade 1 thinness (BMI between the 17 and <18.5 cut-offs, from the 3rd to the 16th centile) and grade 2 thinness (BMI between the 16 and the 17 cut-offs, from the 0.6th to the 3rd centile) [18]. In consideration of absence of cases, cut-offs values < 16, used for grade 3 thinness, were not considered. The data obtained were divided into groups according to age and sex.

Statistical analysis was performed using a chi-square test. value     was considered significant.

3. Results

The sample of 595 children included 306 girls (51.4%) and 289 boys (48.6%), as reported in Table 1. Four hundred thirty-eight children (73.6%) had a normal BMI between the 88th and 16th percentile, and 92 (15.5%) were overweight (57 cases, 9.6%) or obese (35 cases, 5.9%), respectively. The prevalence of thinness was 10.9% (65 cases): grade 1 was detected in 29 cases (4.9%) and grade 2 in 36 (6%), respectively. Prevalence of obesity and thinness grades 1 and 2 were not different significantly in males and females (6.2% versus 5.6%, 4.8% versus 4.9%, and 5.6% versus 6.5%, resp.). The prevalence of overweight was statistically significant between genders (13.1% males versus 6.2% females, ).

Thinness grade 2Thinness grade 1OverweightObesity
Age (years) . (total)Girls .Boys .GirlsBoysGirlsBoysGirlsBoysGirlsBoys
.% .% .% .% .% .% .% .%



Total casesTotal casesTotal casesTotal cases

. 366,1% . 294,9% . 579.6% . 355.9%

In relation to the childhood age, the overweight was higher in females between 9 and 13 years (18%) than in males, with an almost equal distribution in all age groups. The highest value in obesity prevalence was found in the 7–11 years age group. In these age groups, 23.4% of children were considered obese, without differences between both genders. Severe thinness was recorded in age groups between 6 and 8 years (42.3%), without difference between genders.

4. Discussion

Our study demonstrates that the abnormal nutritional status in children and adolescents represents a considerably larger public health problem, not only for the increase of overweight and obesity prevalence, but also the thinness condition in selected age groups.

Previous studies have shown the prevalence in all countries, the trends over the years, and the impact of both immediate and long-term effects on health and well-being, increasing the risk of cardiovascular and metabolic diseases in adulthood [8, 1927]. Much has been written about its genetic, nutritional and obstetric risk factors [23, 26, 28, 29]. Profound insights into the biological regulation of appetite, food intake, and weight gain have been gained by identifying and characterizing the rare genetic mutations in individuals and families with extreme obesity, especially [30]. Attention has been given to maternal weight gain in pregnancy, concluding that increased adiposity at birth may predispose to increased risk of obesity and highlight the importance of the impact that women avoid gaining excessive weight in pregnancy [29]. Preventive and treatment strategies have been proposed, recognizing that the childhood malnutrition is not an issue for the education sector alone, but it needs to be tackled at a multisectorial level, identifying the particularly important role of local governments, nongovernment organizations, and the media [31].

In relation to the assessment of nutritional status in Italian children recent studies founded that the excess weight concerns one child out of four, in association to significant differences in the prevalence of overweight and obesity in relation to geographical distribution (Northern, Central and Southern Italy) [32]. Recently, an important survey performed by Italian Ministry of Health has achieved that 23.6% of all Italian children are overweight, while 12.6% obese at 8 years old [33]. However, in the most studies an accurate distribution of all scholastic population by age is not given. Although our study population is lower than previously described (595 versus 2610 cases), the strength of this study is the distribution of all students from 6 to 19 years old by age in order to identify all specific age groups requiring an appropriate health program.

In consideration of the age distribution of our study population, identifyed as another strength of our investigation, we can detected the prevalence of thinness, commonly neglected for the greater impact of obesity and overweight on well-being. Surprisingly, in developing countries the undernutrition is growing, in females particularly. Obviously, we evaluated our results considering the different growth rate in both genders. Adjustments for growth time are important, as recommended by WHO [18], because female overweight is strongly associated with early growth, while the same time is related to low BMI in male gender [34]. Trend of early maturation is recognized recently [17], and evidence is reported in terms of prevalence of thinness in male group and overweight in female group, respectively [34].

In conclusion, nutritional status should be considered in specific age groups and, if confirmed in future and larger studies, the high degrees of malnutrition condition (obesity and thinness) are relieved in target age groups. If our initial findings will be confirmed on a larger population, therapeutic approach to specific age groups can be planned in order to achieve long-lasting benefits.


“Convitto Nazionale” School in Rome, Italy, is acknowledged.


  1. C. L. Ogden and M. D. Carroll, “Prevalence of obesity among children and adolescents: United States, trends 1963–1965 through 2007-2008,” Health E-Stat, 2010, View at: Google Scholar
  2. M. K. Serdula, D. Ivery, R. J. Coates, D. S. Freedman, D. F. Williamson, and T. Byers, “Do obese children become obese adults? A review of the literature,” Preventive Medicine, vol. 22, no. 2, pp. 167–177, 1993. View at: Publisher Site | Google Scholar
  3. N. Halfon, P. A. Verhoef, and A. A. Kuo, “Childhood antecedents to adult cardiovascular disease,” Pediatrics in Review, vol. 33, no. 2, pp. 51–60, 2012. View at: Google Scholar
  4. L. J. Lloyd, S. C. Langley-Evans, and S. McMullen, “Childhood obesity and risk of the adult metabolic syndrome: a systematic review,” International Journal of Obesity, vol. 36, no. 1, pp. 1–11, 2010. View at: Publisher Site | Google Scholar
  5. M. A. Kalarchian and M. D. Marcus, “Psychiatric comorbidity of childhood obesity,” International Review of Psychiatry, vol. 24, no. 3, pp. 241–246, 2012. View at: Google Scholar
  6. J. John, S. B. Wolfenstetter, and C. M. Wenig, “An economic perspective on childhood obesity: recent findings on cost of illness and cost effectiveness of interventions,” Nutrition, vol. 28, no. 9, pp. 829–839, 2012. View at: Google Scholar
  7. M. de Onis, M. Blössner, and E. Borghi, “Global prevalence and trends of overweight and obesity among preschool children,” American Journal of Clinical Nutrition, vol. 92, no. 5, pp. 1257–1264, 2010. View at: Publisher Site | Google Scholar
  8. Centre for Disease Control Prevention (CDC), “Obesity prevalence among low-income, preschool-aged children: United States, 1998–2008,” Morbidity and Mortality Weekly Report, vol. 58, no. 28, pp. 769–773, 2009. View at: Google Scholar
  9. T. M. Wijnhoven, J. M. van Raaij, A. Spinelli et al., “WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6–9-year-old children,” Pediatric Obesity, 2012. View at: Publisher Site | Google Scholar
  10. E. Bergström and H. K. Blomquist, “Is the prevalence of overweight and obesity declining among 4-year-old Swedish children?” Acta Paediatrica, vol. 98, no. 12, pp. 1956–1958, 2009. View at: Publisher Site | Google Scholar
  11. E. Sundblom, M. Petzold, F. Rasmussen, E. Callmer, and L. Lissner, “Childhood overweight and obesity prevalences levelling off in Stockholm but socioeconomic differences persist,” International Journal of Obesity, vol. 32, no. 10, pp. 1525–1530, 2008. View at: Publisher Site | Google Scholar
  12. B. A. Woodruff and A. Duffield, “Anthropometric assessment of nutritional status in adolescent populations in humanitarian emergencies,” European Journal of Clinical Nutrition, vol. 56, no. 11, pp. 1108–1118, 2002. View at: Publisher Site | Google Scholar
  13. T. J. Cole, K. M. Flegal, D. Nicholls, and A. A. Jackson, “Body mass index cut offs to define thinness in children and adolescents: international survey,” British Medical Journal, vol. 335, no. 7612, pp. 194–201, 2007. View at: Publisher Site | Google Scholar
  14. M. Golan and S. Crow, “Parents are key players in the prevention and treatment of weight-related problems,” Nutrition Reviews, vol. 62, no. 1, pp. 39–50, 2004. View at: Publisher Site | Google Scholar
  15. A. S. Wolf, “The overweight and underweight girl: from findings to prevention,” Zentralblatt fur Gynakologie, vol. 124, no. 3, pp. 146–152, 2002. View at: Publisher Site | Google Scholar
  16. M. L. Portela de Santana, H. da Costa Ribeiro Junior, M. M. Giral, and R. M. Raich, “Epidemiology and risk factors of eating disorder in adolescence: a review,” Nutrición Hospitalaria, vol. 27, no. 2, pp. 391–401, 2012. View at: Google Scholar
  17. T. J. Cole, “Secular trends in growth,” The Proceedings of The Nutrition Society, vol. 59, no. 2, pp. 317–324, 2000. View at: Google Scholar
  18. WHO Expert Committee on Physical Status, Physical Status: The Use and Interpretation of Anthropometry, Technical Report Series no. 854, World Health Organization, Geneva, Switzerland, 1995.
  19. K. M. Flegal, M. D. Carroll, C. L. Ogden, and L. R. Curtin, “Prevalence and trends in obesity among US adults, 1999–2008,” Journal of the American Medical Association, vol. 303, no. 3, pp. 235–241, 2010. View at: Publisher Site | Google Scholar
  20. B. M. Popkin, “Recent dynamics suggest selected countries catching up to US obesity,” The American Journal of Clinical Nutrition, vol. 91, no. 1, pp. 284S–288S, 2010. View at: Publisher Site | Google Scholar
  21. A. Berghöfer, T. Pischon, T. Reinhold, C. M. Apovian, A. M. Sharma, and S. N. Willich, “Obesity prevalence from a European perspective: a systematic review,” BMC Public Health, vol. 8, article 200, 2008. View at: Publisher Site | Google Scholar
  22. A. R. El-Ghannam, “The global problems of child malnutrition and mortality in different world regions,” Journal of Health and Social Policy, vol. 16, no. 4, pp. 1–26, 2003. View at: Publisher Site | Google Scholar
  23. A. M. Toschke, S. Rückinger, T. Reinehr, and R. von Kries, “Growth around puberty as predictor of adult obesity,” European Journal of Clinical Nutrition, vol. 62, no. 12, pp. 1405–1411, 2008. View at: Publisher Site | Google Scholar
  24. F. X. Pi-Sunyer, “Health implications of obesity,” The American Journal of Clinical Nutrition, vol. 53, pp. 15955–16035, 1991. View at: Google Scholar
  25. G. S. Berenson, S. R. Srinivasan, W. Bao, W. P. Newman, R. E. Tracy, and W. A. Wattigney, “Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults,” The New England Journal of Medicine, vol. 338, no. 23, pp. 1650–1656, 1998. View at: Publisher Site | Google Scholar
  26. M. H. Park, C. Falconer, R. M. Viner, and S. Kinra, “The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review,” Obesity Reviews, vol. 13, no. 11, pp. 985–1000, 2012. View at: Google Scholar
  27. S. J. Olshansky, D. J. Passaro, R. C. Hershow et al., “A potential decline in life expectancy in the United States in the 21st century,” The New England Journal of Medicine, vol. 352, no. 11, pp. 1138–1145, 2005. View at: Publisher Site | Google Scholar
  28. T. Lobstein, “Maternal and child obesity: some policy challenges,” The Proceedings of the Nutrition Society, vol. 70, no. 4, pp. 506–513, 2011. View at: Google Scholar
  29. D. B. Ehrenthal, K. Maiden, A. Rao et al., “Independent relation of maternal prenatal factors to early childhood obesity in the offspring,” Obstetrics and Gynecology, vol. 121, no. 1, pp. 115–121, 2013. View at: Google Scholar
  30. S. Ramachandrappa and I. S. Farooqi, “Genetic approaches to understanding human obesity,” The Journal of Clinical Investigation, vol. 121, no. 6, pp. 2080–2086, 2011. View at: Publisher Site | Google Scholar
  31. C. D. Summerbell, H. J. Moore, C. Vögele et al., “ToyBox-study group. Evidence-based recommendations for the development of obesity prevention programs targeted at preschool children,” Obesity Reviews, vol. 13, Supplement 1, pp. 129–132, 2012. View at: Google Scholar
  32. F. Turchetta, G. Gatto, R. Saulle, F. Romano, A. Boccia, and G. La Torre, “Systematic review and meta-analysis of the prevalence of overweight and obesity among school-age children in Italy,” Epidemiologia and Prevenzione, vol. 36, no. 3-4, pp. 188–195, 2012. View at: Google Scholar
  33. A. Spinelli, A. Lamberti, M. Buoncristiano, P. Nardone, and G. Baglio, “Gruppo OKkio alla SALUTE 2010. Overweight and obesity among children. 1 out of 4 is overweight, 1 out of 9 is obese,” Epidemiologia and Prevenzione, vol. 35, no. 5-6, supplement 2, pp. 82–83, 2011. View at: Google Scholar
  34. Y. Wang, “Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls,” Pediatrics, vol. 110, no. 5, pp. 903–910, 2002. View at: Publisher Site | Google Scholar

Copyright © 2013 Paolo Rosati et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

More related articles

 PDF Download Citation Citation
 Download other formatsMore
 Order printed copiesOrder

Related articles

We are committed to sharing findings related to COVID-19 as quickly as possible. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. Review articles are excluded from this waiver policy. Sign up here as a reviewer to help fast-track new submissions.