Table of Contents
Foreword: Nutrition, Physical Activity And The Risk Of Obesity During Childhood
- Pp. i-iii (3)Marie Françoise Rolland-Cachera
Chapter 1: Secular Changes of Somatic Growth, Puberty and Obesity
- Pp. 3-4 (2)Petr Sedlak, Jana Vignerová and Jana Pařízková
Chapter 1b: Height, Weight, Puberty and AdiposityBody Mass Index, Weight-for-Length/Height and Obesity
- Pp. 25-55 (31)Jana VignerováView Abstract
Objective Means of Monitoring Children’s Physical Activity and Health-Related Recommendations for Its Implementation
- Pp. 79-124 (46)Erik Sigmund and Dagmar SigmundováView Abstract
Metabolic and Hormonal Characteristics Related to Energy Balance and Adiposity During Growth
- Pp. 125-149 (25)Lidka LisáView Abstract
Physical Activity, Fitness and Adiposity During Growth and their Secular Changes in Different Environment
- Pp. 150-230 (81)Jana PařízkováView Abstract
Conclusions, Perspectives and Recommendations
- Pp. 335-338 (4)Jana Pařízková
NUTRITION, PHYSICAL ACTIVITY AND THE
RISK OF OBESITY DURING CHILDHOOD
Since several decades, childhood overweight steeply increased, but after around the year
2000, a plateau or even a decline in prevalence rates has been reported in many industrialized
countries (Rokholm et al., 2010). However, the problem remains important, since the
prevalence of childhood obesity is still high in many countries.
While prevalence of childhood obesity was increasing, energy intake was decreasing,
particularly due to decreasing fat intake (Rolland-Cachera 2002; Gibson 2010; Alexy et al.
2002). This paradoxical situation can be explained by decreasing physical activity and
increasing sedentary lifestyle (Butte et al. 2007). Indeed, exercise has beneficial effects
limiting the development of obesity and improving fitness in children (Kellou et al. 2014;
Decreased energy intake is reported in all age groups, but the hypothesis of decreasing
physical activity to account for by decreasing energy intake is less convincing in very young
children. Other factors may explain the rising trend of obesity. The role of environmental
factors in early life in predicting later health has generated substantial interest in recent years
(Hanley et al. 2010).
The early adiposity rebound recorded in most obese subjects (Rolland-Cachera et al. 2006)
suggests that factors promoting body fat development have operated in the first years of life.
Particularly, early nutrition can exert long-lasting influence on health. Birth weight, growth
velocity, adiposity rebound and body mass index trajectories seem to be highly sensitive to
the nutritional conditions present during pregnancy and in the first years of life. Early
inadequate nutrient balance in early life may account for by the paradox of increasing obesity
and decreasing energy intake. The low protein-high fat diet recorded in many young children,
which contrasts with the low protein-high fat composition of human milk, may favour the
development of obesity (Rolland-Cachera et al. 2006; Michaelsen and Greer 2014; Rolland-
Cachera et al. 2013). High protein intake can promote overweight via increasing Insulin like
growth factors 1 and dietary fat restrictions can decrease energy density, thus programming
adaptive metabolism to prevent underweight and increasing the susceptibility to develop later
overweight and metabolic diseases (Rolland-Cachera et al. 2013). A “mismatch” between
early restrictions and later positive energy balance due to increasing fat intake and low energy
expenditure due to sedentary lifestyle could be particularly harmful.
In conclusion, nutrient balance of the diet varies according to the age of the child. In spite of
official recommendations that dietary fat should not be restricted in young children, fat intake
is often low in early life and increases with age. It should be high in early childhood and
decrease with age. The high protein low fat diet recorded in early life, and low physical
activity in children may have contributed to the obesity epidemic. The consequences of
inadequate nutrition at different ages, and the rising sedentary lifestyle in children stress the
importance of providing nutritional intakes adapted to the child’s metabolic needs at the
various stages of growth and of promoting physical activity which contributes to an optimal
energy balance and improves health and fitness.
Marie Françoise Rolland-Cachera
Knight of the National Order of the Legion of Honour, France
Alexy, U., Sichert-Hellert, W., Kersting, M. (2002). Fifteen-year time trends in energy and
macronutrient intake in German children and adolescents: results of the DONALD study. Br. J. Nutr.,
[http://dx.doi.org/10.1079/BJN/2002572] [PMID: 12067430]
Butte, N.F., Christiansen, E., Sørensen, T.I. (2007). Energy imbalance underlying the development of
childhood obesity. Obesity (Silver Spring), 15(12), 3056-3066. [Silver Spring].
[http://dx.doi.org/10.1038/oby.2007.364] [PMID: 18198315]
Gibson, S. (2010). Trends in energy and sugar intakes and body mass index between 1983 and 1997
among children in Great Britain. J. Hum. Nutr. Diet., 23(4), 371-381.
[http://dx.doi.org/10.1111/j.1365-277X.2010.01059.x] [PMID: 20337846]
Hanley, B., Dijane, J., Fewtrell, M., Grynberg, A., Hummel, S., Junien, C., Koletzko, B., Lewis, S.,
Renz, H., Symonds, M., Gros, M., Harthoorn, L., Mace, K., Samuels, F., van Der Beek, E.M. (2010).
Metabolic imprinting, programming and epigenetics - a review of present priorities and future
opportunities. Br. J. Nutr., 104 (Suppl. 1), S1-S25.
[http://dx.doi.org/10.1017/S0007114510003338] [PMID: 20929595]
Kellou, N., Sandalinas, F., Copin, N., Simon, C. (2014). Prevention of unhealthy weight in children by
promoting physical activity using a socio-ecological approach: What can we learn from intervention
studies? Diabetes Metab., pii: S1262-3636(14)00029-9 [Epub ahead of print].
[http://dx.doi.org/10.1016/j.diabet.2014.01.002] [PMID: 24698814]
Michaelsen, K.F., Greer, F.R. (2014). Protein needs early in life and long-term health. Am. J. Clin. Nutr.,
[http://dx.doi.org/10.3945/ajcn.113.072603] [PMID: 24452233]
Parizkova, J. (2008). Impact of education on food behaviour, body composition and physical fitness in
children. Br. J. Nutr., 99 (Suppl. 1), S26-S32.
[http://dx.doi.org/10.1017/S0007114508892483] [PMID: 18257949]
Rokholm, B., Baker, J.L., Sørensen, T.I. (2010). The levelling off of the obesity epidemic since the year
1999--a review of evidence and perspectives. Obes. Rev., 11(12), 835-846.
[http://dx.doi.org/10.1111/j.1467-789X.2010.00810.x] [PMID: 20973911]
Optimal health and a high level of fitness have been long recognized as a key to the future of
any human population. Concern for the development of future generations has been a central
theme in all civilizations, not only in those well developed, but also in primitive ones.
However, even under positive conditions of problems can appear: provision of a favourable
environment with an ample diet, adequate education and health care is no guarantee that
appropriate level of physical fitness, health status and its prognosis in children and
adolescents will be achieved.
The increasing level of economic conditions and the improvement of nutrition have been
contributing not only to an accelerated growth and development, but also to disproportional
development of body composition, which concern the whole population. This has manifested
especially by an increasing ratio of adipose tissue in the organism, which has affected all age
categories including the preschool one; often without more apparent changes of total body
weight and body mass index - BMI (“hidden obesity”). Nutritional intake, both from the point
of view of energy content as well as the composition of the diet (especially the ratio of
saturated fats and simple sugars) has not corresponded to the actual needs of the organism -
mainly from the point of view of reduced energy expenditure resulting from the impact of
physical inactivity (WHO 2010a,b,c). This concerns already children of early age, who are
characterized by highest level of spontaneous physical activity, and therefore reduced
possibility to move, play and exercise is mostly unnatural at this age. This mostly continues
during following years and has undesirable results.
Secular trend of increasing adiposity along with the reduction of functional capacity and
motor abilities was found since youngest age, and runs parallel with increased health risks
which have started to appear already during this period of growth. With regard to health
problems resulting from a generally enhanced adiposity and increasing prevalence of obesity,
this situation is harmful at any age including school age and adolescence, especially when
considering possible delayed health effects in adult and advanced age. Introduction of an
appropriate régime of not only nutrition, but also of physical activity is indispensable, starting
with the very beginning of life. In this respect, an approach based on proper evaluation of the
individual including genetic factors should be also implemented as all humans are special
from all points of view – also as nutritional and motor individualities (Pařízková 1998, 2008,
More recently also the interrelationships between nutrition - its energy content and
composition on the one hand, and energy expenditure resulting from physical activity level on
the other one have been considered and analyzed in greater extent and detail. However, the effect of physical activity (PA) as a significant metabolic, nutritional, hormonal, psychological
etc stimulus has not always been - as has been much more the effect of others like diet
– more exactly defined, assessed and analyzed with regard to its character, intensity,
frequency and regularity along satifactorily long periods of human growth, and also with
special regard to not only genetic, but also epigenetic factors influencing the organism since
early life. The last mentioned factor – the composition of early diet concerning e.g. proteins –
was mentioned above.
This monograph is aimed, among others, to contribute to this problem and with an effort for a
more complex approach. However, it has been too difficult to summarize more aspects in
their mutual relationships, and also according to the present state of art, as this fragmented
research is a permanently developing story. Too many new studies and reviews have been
appearing during recent years until present which have not been homogenously aimed and
planned, executed, elaborated and interpreted, followed up in comparable groups with regard
to age span, gender, degree of sexual maturation, dietary intake, social and cultural status and
many others – so consented conclusions could have been hardly achieved. But hopefully,
some of the presented information could at least partly contribute to further developement of
this important topic.
Obesity Management Centre
Institute of Endocrinology
Prague, Czech Republic
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WHO Europe. (2010b). Part of a WHO/EC Project on monitoring progress on improving nutrition and
physical activity and preventing obesity in the European Union.
World Health Organization. (2010c). (http://www.euro.who.int/en/health-topics/noncommunicablediseases/obesity/publications/2010/ report-of-the-workshop-on-the-integration-of-data-on-physicalactivity-
Food and health in Europe: a new basis for action. WHO/Europe.
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World Health Organization. Obesity and overweight, Fact Sheet No 311, Updated March 2013.
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Pařízková, J. (2008). Impact of education on food behaviour, body composition and physical fitness in
children. Br. J. Nutr., 99 (Suppl 1), S26-32. Review.
[http://dx.doi.org/10.1017/S0007114508892483] [PMID: 18257949]
Pařízková, J. (2010). Nutrition, Physical Activity and Health in Early Life. (2nd ed.). Boca Raton- London
– New York: CRC Press Taylor and Francis Group.
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Adv. Nutr., 2(2), 177S-81S. Epub Mar 10.
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Pařízková, J. (2014). Fatness and fitness related to exercise in normal and obese children and
adolescents. J. King Saud Univ. – Sci., 26, 245-253.
List of Contributors
Obesity Management Centre, Institute of Endocrinology