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ABSTRACT: Little research has been done on the long-term longitudinal associations between markers of sedentary behaviour and health risks. We hypothesised that television (TV) viewing in early to mid-adulthood predicts an adverse cardiometabolic risk factor profile in middle age independently of participation in physical activity.
We used prospective data from 5,972 (2,947 men) participants of the 1958 British Birth Cohort study. TV viewing and exercise frequency were obtained at age 23 years. Daily TV viewing and weekly moderate to vigorous physical activity were assessed at age 44 years, as well as HbA(1c), triacylglycerol, total and HDL-cholesterol, systolic and diastolic blood pressure, and waist circumference. We used generalised linear models and multiple linear regression to examine the associations between TV viewing at age 23 years and the cardiometabolic risk markers (including a clustered cardiometabolic risk score) at 44 years, while adjusting for sex, exercise participation and TV viewing at age 44 years, and other potential confounders.
In the multivariable models, TV viewing frequency at age 23 years showed positive associations with C-reactive protein (generalised linear model change 12.6%, 95% CI 3.5, 22.8; p = 0.005), fibrinogen (change 1.8%, 95% CI 0.3, 3.3; p = 0.020), waist circumference (coefficient 1.17, 95% CI 0.32, 2.01; p = 0.004), systolic (coefficient 1.44, 95% CI 0.33, 2.54; p = 0.019) and diastolic (coefficient 0.75, 95% CI -0.01, 1.51; p = 0.053) blood pressure, and clustered cardiometabolic risk score (men only, coefficient 0.06, 95% CI 0.01, 0.11; p = 0.038). Adjustments for baseline (age 23 years) BMI attenuated these associations towards null.
TV viewing habits in early adulthood are associated with adverse cardiometabolic profiles in early middle adulthood that are independent of TV viewing habits and physical activity in middle age, but not independent of BMI in early adulthood.
Diabetologia 11/2011; 55(2):311-20. · 6.81 Impact Factor
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ABSTRACT: We assessed temporal trends in diabetes prevalence and key diabetes risk factors (obesity, physical activity, smoking) over 5 years in a nationally representative sample.
Participants were drawn from the Scottish Health Surveys, which recruited two separate, nationally representative samples in 2003 (n = 7229, aged 50.5 ± 17.2 years) and 2008 (n = 6313, aged 51.8 ± 17.6 years). Prevalent diabetes was assessed from a self-reported physician's diagnosis, and high diabetes risk or undiagnosed cases were defined from HbA(1c) ≥ 6.0% (≥ 42 mmol/mol) to < 6.5% (< 47.5 mmol/mol) and ≥ 6.5% (≥ 47.5 mmol/mol), respectively.
Over 5 years there was an increased prevalence of diabetes (5.2 vs. 9.4% in 2003 and 2008, respectively) and in the prevalence of high diabetes risk (2.9 vs. 12.4%). These differences were accentuated in participants aged 65 years and above; for diabetes, there was a prevalence of 12 and 17.3% in 2003 and 2008, respectively, and, for high risk, the prevalence was 7.8 and 24.7%, respectively. There was also an increase in diabetes risk factors, including obesity and lack of physical activity, although these factors did not explain the diabetes trend.
These results suggest nearly a doubling in the prevalence of diabetes over 5 years in Scotland.
Diabetic Medicine 05/2011; 28(5):595-8. · 2.90 Impact Factor
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ABSTRACT: Few studies have examined both the relative magnitude of association and the discriminative capability of multiple indicators of obesity with cardiovascular disease (CVD) mortality risk. We conducted an individual-participant meta-analysis of nine cohort studies of men and women drawn from the British general population resulting in sample of 82 864 individuals. Body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were measured directly. There were 6641 deaths (1998 CVD) during a mean of 8.1 years of follow-up. After adjustment, a one SD higher in WHR and WC was related to a higher risk of CVD mortality (hazard ratio [95% CI]): 1.15 (1.05-1.25) and 1.15 (1.04-1.27), respectively. The risk of CVD mortality also increased linearly across quintiles of both these abdominal obesity markers with a 66% increased risk in the highest quintile of WHR. In age- and sex-adjusted models only, BMI was related to CVD mortality but not in any other analyses. No major differences were revealed in the discrimination capabilities of models with BMI, WC or WHR for cardiovascular or total mortality outcomes. In conclusion, measures of abdominal adiposity, but not BMI, were related to an increased risk of CVD mortality. No difference was observed in discrimination capacities between adiposity markers.
Obesity Reviews 04/2011; 12(9):680-7. · 7.04 Impact Factor
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ABSTRACT: We examined whether small amounts of low-intensity physical activity were associated with reduced risk of developing type 2 diabetes in a national sample of people aged 50 years and over.
The sample comprised 7,466 individuals (55.9% women) free from self-reported doctor-diagnosed diabetes and was prospectively followed for a mean of 45.3 months. Baseline self-reported physical activity was categorised as physical inactivity, low- and vigorous/moderate-intensity physical activity at least once a week. Cox proportional hazard regression was used to model the association between baseline physical activity and incident type 2 diabetes.
Vigorous/moderate-intensity physical activity at least once a week was associated with reduced risk of type 2 diabetes (HR 0.64, 95% CI 0.43-0.95, p = 0.026) but low-intensity physical activity at least once a week was not (HR 0.87, 95% CI 0.58-1.30, p = 0.497) after adjustment for all covariates. However, age-stratified analysis showed that low-intensity physical activity at least once a week was associated with reduced risk of type 2 diabetes for those aged 70 years and over (HR 0.53, 95% CI 0.28-1.02, p = 0.059), but not for those aged 50 to 59 years (HR 1.09, 95% CI 0.52-2.29, p = 0.828) or those aged 60 to 69 years (HR 1.15, 95% CI 0.55-2.41, p = 0.715) after adjustment for all covariates.
Compared with physical inactivity, any type of physical activity was associated with reduced risk of type 2 diabetes in adults aged 70 years and over, while in adults aged 50 to 69 years, physical activity needed to be vigorous/moderate in intensity to be associated with reduced risk of type 2 diabetes.
Diabetologia 05/2010; 53(9):1877-85. · 6.81 Impact Factor
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ABSTRACT: The aim was to examine the 1995-2007 childhood and adolescent obesity trends and project prevalence to 2015 by age group and social class.
Participants were children aged 2-10 and adolescents aged 11-18 years from general population households in England studied using repeated cross-sectional surveys. Obesity was computed using international standards. Prevalence projections to 2015 were based on extrapolation of linear and non-linear trends.
Obesity prevalence increased from 1995 to 2007 from 3.1% to 6.9% among boys, and 5.2% to 7.4% among girls. There are signs of a levelling off trend past 2004/5. Assuming a linear trend, the 2015 projected obesity prevalence is 10.1% (95% CI 7.5 to 12.6) in boys and 8.9% (5.8 to 12.1) in girls, and 8.0% (4.5, 11.5) in male and 9.7% (6.0, 13.3) in female adolescents. Projected prevalence in manual social classes is markedly higher than in non-manual classes [boys: 10.7% (6.6 to 14.9) vs 7.9% (3.7 to 12.1); girls: 11.2% (7.0 to 15.3) vs 5.4% (1.3 to 9.4); male adolescents: 10.0% (5.2 to 14.8) vs 6.7% (3.4 to 10.0); female adolescents: 10.4% (5.0 to 15.8) vs 8.3% (4.3 to 12.4)].
If the trends in young obesity continue, the percentage and numbers of obese young people in England will increase considerably by 2015 and the existing obesity gap between manual and non-manual classes will widen further. This highlights the need for public health action to reverse recent trends and narrow social inequalities in health.
Journal of epidemiology and community health 02/2010; 64(2):167-74. · 3.04 Impact Factor
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ABSTRACT: Previous data indicate a rapidly increasing prevalence of obesity and overweight among English children and an emerging socioeconomic gradient in prevalence. The main aim of this study was to update the prevalence trends among school-age children and assess the changing socioeconomic gradient.
A series of nationally representative household-based health surveys conducted between 1997 and 2007 in England.
15 271 white children (7880 boys) aged 5 to 10 years with measured height and weight.
Height and weight were directly measured by trained fieldworkers. Overweight (including obesity) and obesity prevalence were calculated using the international body mass index cut-offs. Socioeconomic position (SEP) score was a composite score based on income and social class. Multiple linear regression assessed the prevalence odds with time point (1997/8, 2000/1, 2002/3, 2004/5, 2006/7) as the main exposure. Linear interaction terms of time by SEP were also tested for.
There are signs that the overweight and obesity trend has levelled off from 2002/3 to 2006/7. The odds ratio (OR) for overweight in 2006/7 compared with 2002/3 was 0.99 (95% CI 0.88-1.11) and for obesity OR = 1.06 (0.86-1.29). The socioeconomic gradient has increased in recent years, particularly in 2006/7. Compared to 1997/8, the 2006/7 age and sex-adjusted OR for overweight was 1.88 (1.52 to 2.33) in low-SEP, 1.25 (1.04 to 1.50) in middle-SEP, and 1.13 (0.86 to 1.48) in high-SEP children.
Childhood obesity and overweight prevalence among school-age children in England has stabilized in recent years, but children from lower socio-economic strata have not benefited from this trend. There is an urgent need to reduce socio-economic disparities in childhood overweight and obesity.
International journal of obesity (2005) 11/2009; 34(1):41-7. · 4.34 Impact Factor
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ABSTRACT: To examine temporal trends in participation in sport and exercise activities in England between 1997 and 2006 while taking into account wider societal changes.
A series of annual cross-sectional surveys.
Nationally representative samples of men (n = 27 217) and women (n = 33 721) aged >or=16 years.
Any (more than once every 4 weeks) and regular (more than once a week) participation in overall sport and exercise and a number of sport and exercise groupings (eg cycling, swimming, gym and fitness club-based activities (G/FC), racquet sports). Time point (1997/98, 2003/04, 2006) was the main dependent variable.
Age-standardised overall regular participation changed from 40.8% in 1997/98 to 41.2% in 2006 for men (multivariable-adjusted participation OR = 1.11 in 2006, 95% CI 1.03 to 1.19, p<0.001) and from 31.2% to 33.9% for women (1.21, 1.13 to 1.29, p<0.001). Regular G/FC increased from 17.0% to 19.2% for men (1.19, 1.09 to 1.30) and from 15.9% to 18.7% for women (1.23, 1.14 to 1.33) and regular running increased from 2.4% to 4.0% for women only (1.84, 1.56 to 2.18). Overall increases were apparent only in older adults (>or=45 years) (1.25, 1.16 to 1.35, p<0.001). Young men (16-29 years) had reduced ORs for cycling (0.72, 0.58 to 0.88, p = 0.008), dancing (0.60, 0.45 to 0.82, p = 0.001), running (0.78, 0.64 to 0.94, p<0.001) and racquet sports (0.60, 0.42 to 0.86, p = 0.003). In men, increases were pronounced only among men from non-manual social classes, higher income households and white ethnic backgrounds.
Sports and exercise participation in England has changed between 1997 and 2006 as the result of increases among middle-aged and older adults and decreases among young men. There are no signs that the participation gap between less and more advantaged population groups is narrowing.
British journal of sports medicine 11/2008; 42(11):901-8. · 2.55 Impact Factor
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ABSTRACT: To examine the childhood overweight and obesity prevalence trends between 1974 and 2003 and to assess whether these trends relate to parental social class and household income.
A school based and a general population health survey: the National Study of Health and Growth in 1974, 1984, and 1994, and the Health Survey for England, yearly from 1996 to 2003. Participants were 14,587 white boys and 14,014 white girls aged 5-10 years. Overweight and obesity prevalence were calculated using UK specific as well as international body mass index (kg/m2) cut-offs. Socioeconomic status was measured using the Registrar General's social class; household income (1997 onwards only) was adjusted for household size.
The prevalence of obesity (UK specific definition) in boys increased from 1.2% in 1984 to 3.4% in 1996-97 and 6.0% in 2002-03. In girls, obesity increased from 1.8% in 1984 to 4.5% in 1996-97 and 6.6% in 2002-03. Obesity prevalence has been increasing at accelerating rates in the more recent years. Children from manual social classes had marginally higher odds (OR 1.14, 95% CI 0.98 to 1.33) and children from higher income households had lower odds (OR 0.74, 95% CI 0.61 to 0.89) to be obese than their peers from non-manual class, and lower income households, respectively.
Childhood obesity is increasing rapidly into the 2000s in England and these increases are more marked among children from lower socioeconomic strata. There is an urgent need for action to prevent further increase in obesity among children.
Archives of Disease in Childhood 11/2005; 90(10):999-1004. · 2.88 Impact Factor
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ABSTRACT: To determine the levels and patterns of physical activity in a sample of obese (> or =99th percentile body mass index (BMI)) and nonobese (<99th percentile BMI) children.
Cross-sectional study.
Children were recruited from schools in Bristol and from the childhood obesity clinic, Bristol Royal Hospital for Children. Children were instructed in the use of the accelerometer either while at school or in the clinic, and wore the instrument while carrying out their normal daily activities for 7 days.
A total of 133 children (mean age 10.5+/-0.8 y). In all 11 (16.9%) of the 65 girls and 14 (20.6%) of the 68 boys were classified as obese (above the 99th percentile for BMI and corresponding to projected adult BMI of 30).
Objectively measured physical activity volume, intensity and pattern.
Obese children were significantly less physically active overall than their nonobese counterparts (31,844+/-13,200 vs 41,844+/-10,430 counts/h; 95% confidence interval 4407 to 15592; P=0.001). Similarly the obese children spent less time in physical activity of moderate or greater intensity than the nonobese children (9.9+/-3.9 vs 12.9+/-4.2 min/h; 95% confidence interval 1.15 to 4.80; P=0.002). Hourly patterns of activity indicated a tendency in obese children to be less active than nonobese children at times when activity was more likely to be determined by free choice, particularly outside of school time.
Obese children demonstrated patterns of physical activity that may have contributed to and are likely to sustain their obesity. Minute-by-minute accelerometry is a valuable tool to investigate physical activity patterns in obese children. It can identify periods when intervention to increase activity may be most appropriate and provide an evidence base for specific exercise prescription in primary and secondary care.
International Journal of Obesity 10/2005; 29(9):1070-6. · 4.69 Impact Factor
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ABSTRACT: Objectives The aim of this study was to examine the association between objectively measured secondhand smoke (SHS) exposure and incident cardiovascular disease (CVD) death and assess the extent to which this association can be explained through novel circulating markers of inflammation and hemostasis. Background Existing evidence suggests there is an association between SHS and CVD risk, although the mechanisms remain poorly understood. Methods In a prospective study of 13,443 participants living in England and Scotland (age 53.5 +/- 12.6 years, 52.3% women), we measured salivary cotinine (an objective marker of SHS exposure) and novel CVD biomarkers (C-reactive protein, fibrinogen) at baseline. Results Of the sample, 20.8% had high SHS exposure on the basis of elevated levels of salivary cotinine (range 0.71 to 14.99 ng/ml). During a mean follow-up of 8 years, there were 1,221 all-cause deaths and 364 CVD deaths. High SHS was associated with all-cause (age-adjusted hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 1.02 to 1.53) and CVD death (age-adjusted HR: 1.21, 95% CI: 0.85 to 1.73). High SHS was also associated with elevated CRP, which explained 48% of the association between SHS and CVD death. The excess risk of CVD associated with active smoking was exaggerated in relation to self report (age-adjusted HR: 3.27, 95% CI: 2.48 to 4.31) compared with objective assessment (age-adjusted HR: 2.44, 95% CI: 1.75 to 3.40). Conclusions Among a large representative sample of British adults we observed elevated levels of low-grade inflammation in otherwise healthy participants exposed to high SHS, and this partly explained their elevated risk of CVD death.
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G. O'Donovan,
A.J. Blazevich,
C Boreham,
A R Cooper,
H. Crank,
U Ekelund,
K R Fox,
P. Gately,
B. Giles-Corti,
J.M.R. Gill,
M Hamer,
I. McDermott,
M Murphy,
N. Mutrie,
J J Reilly,
J.M. Saxton, E. Stamatakis
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ABSTRACT: Our understanding of the relationship between physical activity and health is constantly evolving. Therefore, the British Association of Sport and Exercise Sciences convened a panel of experts to review the literature and produce guidelines that health professionals might use. In the ABC of Physical Activity for Health, A is for All healthy adults, B is for Beginners, and C is for Conditioned individuals. All healthy adults aged 18-65 years should aim to take part in at least 150 min of moderate-intensity aerobic activity each week, or at least 75 min of vigorous-intensity aerobic activity per week, or equivalent combinations of moderate- and vigorous-intensity activities. Moderate-intensity activities are those in which heart rate and breathing are raised, but it is possible to speak comfortably. Vigorous-intensity activities are those in which heart rate is higher, breathing is heavier, and conversation is harder. Aerobic activities should be undertaken in bouts of at least 10 min and, ideally, should be performed on five or more days a week. All healthy adults should also perform muscle-strengthening activities on two or more days a week. Weight training, circuit classes, yoga, and other muscle-strengthening activities offer additional health benefits and may help older adults to maintain physical independence. Beginners should work steadily towards meeting the physical activity levels recommended for all healthy adults. Even small increases in activity will bring some health benefits in the early stages and it is important to set achievable goals that provide success, build confidence, and increase motivation. For example, a beginner might be asked to walk an extra 10 min every other day for several weeks to slowly reach the recommended levels of activity for all healthy adults. It is also critical that beginners find activities they enjoy and gain support in becoming more active from family and friends. Conditioned individuals who have met the physical activity levels recommended for all healthy adults for at least 6 months may obtain additional health benefits by engaging in 300 min or more of moderate-intensity aerobic activity per week, or 150 min or more of vigorous-intensity aerobic activity each week, or equivalent combinations of moderate- and vigorous-intensity aerobic activities. Adults who find it difficult to maintain a normal weight and adults with increased risk of cardiovascular disease or type 2 diabetes may in particular benefit from going beyond the levels of activity recommended for all healthy adults and gradually progressing towards meeting the recommendations for conditioned individuals. Physical activity is beneficial to health with or without weight loss, but adults who find it difficult to maintain a normal weight should probably be encouraged to reduce energy intake and minimize time spent in sedentary behaviours to prevent further weight gain. Children and young people aged 5-16 years should accumulate at least 60 min of moderate-to-vigorous-intensity aerobic activity per day, including vigorous-intensity aerobic activities that improve bone density and muscle strength.
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ABSTRACT: Objectives: Sedentary behaviour and physical activity may be an independent risk factor for psychological distress in adolescents, although there is no existing information in children. We examined the cross-sectional association between psychological distress, television and screen entertainment (TVSE) time, and physical activity levels among a representative sample of children aged 4-12 yrs from the 2003 Scottish Health Survey.
Methods: Participants were 1,486 boys and girls (mean age 8.5± 2.3 yrs). Parents’ answered on behalf of children who were required to be present. The parents completed the Strengths and Difficulties questionnaire (SDQ) and information on TVSE time, physical activity and dietary intake of their children.
Results: An abnormally high SDQ total difficulties score (20 – 40) was found in 4.2% of the sample. Approximately 25% of children were exposed to TVSE at least 3hr/day. In general linear models, TVSE time per week and physical activity levels were independently associated with SDQ total difficulties score after adjustment for age, gender, area deprivation level, single parent status, medical conditions, and various dietary intake indicators. There was also an additive interaction effect showing that the combination of high TVSE time and low physical activity was associated with the greatest SDQ score. Higher TVSE exposure (>2.7 hrs/d) alone resulted in a 24% increase in SDQ score in comparison with lower TVSE exposure (<1.6 hrs/d), although when combined with low physical activity this resulted in a 46% increase.
Conclusion: Higher levels of TVSE and low physical activity levels interact to increase psychological distress in young children.
Hamer, M. and Stamatakis, E. and Mishra, G. (2009) Psychological distress, TV viewing and physical activity in children aged 4-12 yrs. Pediatrics, 123 (5). pp. 1263-1268. ISSN 00314005.
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ABSTRACT: Objective: To examine temporal trends in participation in sport and exercise activities (SPEX) in England between 1997 and 2006 while taking into account wider societal changes.
Design: A series of annual cross-sectional surveys. Setting & participants: Nationally-representative samples of men (N=27,217) and women (N=33,721) aged ≥16 yrs.
Main outcome measurements: Any (≥once/four weeks) and regular (≥once/week) participation in overall SPEX, and a number of SPEX groupings (e.g. cycling, swimming, gym and fitness club-based activities (G/FC), racket sports) . Time point (1997/98, 2003/04, 2006) was the main dependent variable.
Results: Age-standardised overall regular participation changed from 40.8% in 1997/98 to 41.2% in 2006 in men (multivariable-adjusted participation odds in 2006:OR 1.11, 95%CIs: 1.03-1.19, p<0.001) and from 31.2% to 33.9% in women (1.21, 1.13-1.29, p<0.001). Regular G/FC increased from 17.0% to 19.2% in men (1.19, 1.09-1.30) and from 15.9% to 18.7% in women (1.23, 1.14-1.33), regular running increased from 2.4% to 4.0% in women only (1.84, 1.56-2.18). Overall increases were apparent only in older adults (≥45 years) (1.25, 1.16-1.35, p<0.001). Young men (16-29 yrs) had reduced odds for cycling (0.72, 0.58-0.88, p=0.008), dancing (0.60, 0.45-0.82, p=0.001), running (0.78, 0.64-0.94, p<0.001) and racket sports (0.60, 0.42-0.86, p=0.003). In men increases were pronounced only among men from nonmanual social classes, higher income households and white ethnic backgrounds.
Conclusions: SPEX participation in England has changed between 1997 and 2006 as the result of increases among middle-aged and older adults and decreases among young males. There are no signs that the participation gap between less and more advantaged population groups is narrowing.
Stamatakis, E. and Chaudhury, M. (2008) Temporal trends in adults' sports participation patterns in England between 1997 and 2006: the Health Survey for England. British Journal of Sports Medicine, 42 (11). pp. 901-908. ISSN 03063674.
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ABSTRACT: Objectives: Physical activity is an established risk factor for chronic disease but very little is known about its temporal trends in England. Such information is crucial for planning public health interventions.
Methods: We explored temporal trends in occupational activity, walking, domestic activity, and sports using Health Survey for England data in 95,342 adults aged 16 and over. Data were collected annually in 1991–4, 1997–9, and 2003–04. Multivariate logistic regression and multiple linear regression models assessed trends in physical activity for dichotomous and continuous outcomes, respectively. Analyses were adjusted for age and social class.
Results: Physical activity levels at work declined over time but there was a consistent and significant upward trend in regular sports participation among all age groups. Changes in questions in 1997 and 1999 confounded trends in walking and heavy domestic activity and total physical activity. Between 1999 and 2004 (when physical activity questions remained unchanged), there were significant increases in average time spent in all activity types and the percentage of adults meeting the current physical activity recommendations. These short-term increases were more marked among adults aged 35 to 64.
Conclusion: The common perception that overall physical activity levels are declining may be over-simplistic as despite the decreases in occupational physical activity, there is a clear upward trend in sports participation. Changes in the measuring methodology over time preclude the presentation of a clear picture of the total temporal trends in physical activity in England.
Stamatakis, E. and Ekelund, U. and Wareham, N. (2007) Temporal trends in physical activity in England: the Health Survey for England 1991 to 2004. Preventive Medicine, 45 (6). pp. 416-423. ISSN 00917435.
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ABSTRACT: Aims: To examine the childhood overweight and obesity prevalence trends between 1974 and 2003 and to assess whether these trends relate to parental social class and household income.
Methods: A school based and a general population health survey: the National Study of Health and Growth in 1974, 1984, and 1994, and the Health Survey for England, yearly from 1996 to 2003. Participants were 14 587 white boys and 14 014 white girls aged 5–10 years. Overweight and obesity prevalence were calculated using UK specific as well as international body mass index (kg/m2) cut-offs. Socioeconomic status was measured using the Registrar General’s social class; household income (1997 onwards only) was adjusted for household size.
Results: The prevalence of obesity (UK specific definition) in boys increased from 1.2% in 1984 to 3.4% in 1996–97 and 6.0% in 2002–03. In girls, obesity increased from 1.8% in 1984 to 4.5% in 1996–97 and 6.6% in 2002–03. Obesity prevalence has been increasing at accelerating rates in the more recent years. Children from manual social classes had marginally higher odds (OR 1.14, 95% CI 0.98 to 1.33) and children from higher income households had lower odds (OR 0.74, 95% CI 0.61 to 0.89) to be obese than their peers from non-manual class, and lower income households, respectively.
Conclusion: Childhood obesity is increasing rapidly into the 2000s in England and these increases are more marked among children from lower socioeconomic strata. There is an urgent need for action to prevent further increase in obesity among children.
Stamatakis, E. and Primatesta, P. and Chinn, S. and Rona, R. and Falascheti, E. (2005) Overweight and obesity trends from 1974 to 2003 in English children: what is the role of socio-economic factors? Archives of Disease in Childhood, 90 (10). pp. 999-1004. ISSN 00039888.
