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Improved Understanding of Interactions between Risk Factors for Child Obesity May Lead to Better Designed Prevention Policies and Programs in Indonesia

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Department of Nutrition, Faculty of Health Science, Universitas Alma Ata, Yogyakarta 55183, Indonesia
2
Alma Ata Center for Healthy Life and Foods (ACHEAF) Universitas Alma Ata, Yogyakarta 55183, Indonesia
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Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD 21205, USA
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Department of Nutrition, Faculty of Public Health, Hasanuddin University, Makassar 90245, Indonesia
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Central Clinical School, Faculty of Medicine and Health Science, The University of Sydney, Sydney 2050, Australia
6
Global Public Health Nutrition, Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney 2006, Australia
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(1), 175; https://doi.org/10.3390/nu12010175 (registering DOI)
Received: 17 December 2019 / Revised: 23 December 2019 / Accepted: 7 January 2020 / Published: 8 January 2020
(This article belongs to the Section Nutrition and Public Health)
The nutrition transition in low-middle income countries is marked by rising intakes of highly caloric, low nutrient-dense (junk) foods, decreasing intakes of fruits and vegetables, and sedentary behavior. The objective of this study was to explore interactions among fruit-and-vegetable intake, junk food energy intake, sedentary behavior, and obesity in Indonesian children. We conducted this school-based, case-control study in 2013 in Yogyakarta Special Province, Indonesia. The cases were 244 obese children aged 7–12 years having a BMI ≥95th percentile of an age- and sex-specific distribution from the Centers for Disease Control and Prevention. The controls (n = 244) were classroom-matched children with a BMI <85th percentile. Using conditional logistic regression, the relative odds (95% confidence intervals; OR: 95% CI) of obesity given reported frequent fruit-and-vegetable intake (≥3 servings/day), low junk food energy (≤1050 kcal/day) intake and low sedentary behavior (<5 h/day) was 0.46 (0.30–0.69), 0.61 (0.37–0.98), and 0.18 (0.12–0.28), respectively. Effect sizes were dose-responsive and appeared additive. For example, children with low sedentary behavior and frequent fruit-and-vegetable intake were 92% less likely (OR = 0.08; 0.04–0.15) to be obese than children not exceeding either of these thresholds. Similarly, children frequently eating fruits and vegetables and reporting a low junk food energy intake were 70% less likely (OR = 0.30; 0.15–0.59) to be obese. The findings were unchanged after adjusting for child, maternal, and household covariates. Preventive interventions for child obesity need multiple components to improve diets and raise levels of physical activity rather than just addressing one of the three types of assessed behaviors. View Full-Text
Keywords: sedentary behaviors; fruit and vegetable; junk food; school children; Indonesia; obesity sedentary behaviors; fruit and vegetable; junk food; school children; Indonesia; obesity
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Hadi, H.; Nurwanti, E.; Gittelsohn, J.; Arundhana, A.I.; Astiti, D.; West, K.P., Jr.; Dibley, M.J. Improved Understanding of Interactions between Risk Factors for Child Obesity May Lead to Better Designed Prevention Policies and Programs in Indonesia. Nutrients 2020, 12, 175.

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