Project

Overweight in pacific adolescents

Goal: The Melanesian and Polynesian populations living in New Caledonia have a high prevalence of overweight and obesity. However, little is known about the factors associated with this heightened risk of overweight in these Pacific populations. Previous studies have examined the Pacific islanders separately because they often lived in very different areas. However, New Caledonia today has a highly diverse population: high and low income, rural and urban, and a range of ethnic groups with substantial cultural differences. We think that New Caledonia can be considered as 'open laboratory', with all the diversity of the Pacific region living on one island.

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Christophe Serra-Mallol
added 2 research items
Objectives: In recent decades, food cultures of the Pacific populations have undergone a sharp transition, particularly caused by the fact that trade exchanges with western countries facilitate access to a wide range of processed foods. This already has a major incidence on chronic diseases in the next decades since today 35% of 11-16 years old New Caledonian adolescents are overweight or obese. The aim of this qualitative study is to understand what could the “eating well” be defined in the family context and more largely to know current food practices and representations in families according to their communities (Melanesian, Polynesian and European). Methods : 30 families (including 30 parents and 30 adolescents) from rural and urban areas were interviewed (face to face); Socio-economic status of families and ethnicity were considered. Body composition of children was measured individually. Results : Food practices and “eating well” were related to food availability in the family (i.e.: having a garden at home and be involved in family farming), socio-economic status and ethnicity. In addition, access to nutritional information of food and the role of food socialisation between parents and children impacted food practices and representations (what is “eating well”, “good food”). Overweight and obesity affected 30% in adolescents. Conclusions: This qualitative study shows the importance and the structure of the food culture in families living in rural and tribal areas. This is expected to play a key role to fight against NCD’s in the Pacific region. The positive perception of “traditional and local food” as “organic food” may help government authorities address a clear message to reach a sustainable food system. In addition, educational food programs, with a special focus on youth, are strongly recommended.
In recent decades, the food cultures of the Pacific populations have undergone a profound transition, particularly because the increasing trade exchanges with Western countries have facilitated access to a wide range of processed foods. Essentially, a new normative model of eating is now taking the place of the traditional models. The aims of this qualitative study were to explore what ‘eating well’, ‘good food’ and ‘bad food’ now mean in the New Caledonian family context and, more broadly, to categorise the current food practices and representations in adolescents’ families. A double qualitative methodology was applied: 59 face-to-face interviews with 30 parents and 29 adolescents in both rural and urban areas and 15 collective structured discussions with middle-school classes (11- to 16-year-olds) of almost 25 students each. The main results showed various normative frames for nutrition, food quantities, local provenance, and personal taste. Food practices were related to food availability (having a home garden or involvement in family farming), socioeconomic status and community. In addition, access to nutritional information, temporal and financial constraints mostly in the urban area, and the role of food socialisation between parents and children had an impact on food practices and perceptions. The permanence of food cultures, mainly observed in families in rural areas, and the social inequalities in urban areas regarding food availability are highlighted. The positive perception of ‘local food’ as ‘cultural’, ‘organic’ and ‘healthy’ may help policymakers communicate clear messages to reach a sustainable food system.
Stephane Frayon
added a research item
Background A high prevalence of overweight and obesity has been found in adolescents of New Caledonia and other Pacific Island Countries and Territories. Although Westernization may contribute to the weight gain in populations of Oceanian, Non-European, Non-Asian ancestry (ONENA), little is known about the sociodemographic and lifestyle factors associated with overweight in the Melanesian and Polynesian adolescents of New Caledonia. Methods In this cross-sectional study, a pluri-ethnic sample of New Caledonian adolescents (N = 954; age M = 13.2 years) completed a survey to estimate sleep duration, screen time, and dietary pattern using a food frequency questionnaire. Demographic data (gender, ethnicity, socioeconomic status: SES, area of residence) were collected, and anthropometric measures were used to compute weight status. Findings We found a higher risk for being overweight in Melanesian (OR = 1.67) and Polynesian (OR = 5.40) adolescents compared with European adolescents, even after controlling for age, SES, area of residence, dietary pattern, sleep duration and screen time. We also found that low SES (OR = 3.43) and sleep duration (OR = 0.65 per hour) were independently associated with overweight status in the European but not in ONENA adolescents. Interpretation In this study, the main contribution to being overweight was ethnic background, i.e. being Melanesian or Polynesian. The hypothesis of a genetic influence thus seems attractive and merits further analyses. Funding This project was funded by the University of New Caledonia and the Fondation Nestlé France.
Stephane Frayon
added a research item
Background: Food consumption, sleep duration and overweight were assessed in rural and urban Melanesian adolescents. Methods: A cross-sectional survey of 312 rural and 104 urban adolescents (11-16 years old) was conducted. Food intakes were assessed by a 26-item food frequency questionnaire and then categorised into the number of serves from each of the three recommended Pacific food groups (energy foods, protective foods, bodybuilding foods), with two additional categories for foods and drinks to be avoided i.e., processed foods and sugary drinks. Number of food serves were compared with the guidelines of 50% serves from energy foods, 35% serves from protective foods and 15% serves from bodybuilding foods. Sleep duration as hours per day was self-reported and body mass index (BMI) was calculated from measured weight and height. Results: Approximately 17.9% of rural and 26.9% of urban adolescents met the guidelines for energy foods; 61.5% rural and 69.2% urban met the serves for protective foods and 88.5% and 94.2% met the serves for bodybuilding foods. Less than 6.4% rural and 1.9% urban adolescents avoided processed foods but 61.5% rural and 56.7% urban avoided sugary beverages. Sleep duration for school days was below the international recommendations and did not significantly differ between rural and urban groups: respectively, 8.16 ± 1.10 and 8.31 ± 1.29 h. Overweight/obesity percentage was 38.1% for rural and 31.7% for urban adolescents. Conclusions: Although traditional foods, including protective food, are still part of the adolescents' diet, low consumption of the energy food group and high consumption of processed food occurs regardless of location. As poor eating habits and insufficient sleep may contribute to overweight/obesity, educational nutrition programs should target these lifestyle variables.
Stephane Frayon
added a research item
Objectives: The first aim was to examine New Caledonian adolescents' views of what constitutes an overweight or underweight person. The second aim was to assess whether an environment with a high prevalence of overweight is associated with different norms of overweight or underweight in this population. Methods: The Stunkard Figure Rating Scale was used for a sample of 699 pluriethnic adolescents in New Caledonia. Body mass index (BMI) was assessed for each participant and weight status was determined. The factors associated with higher figure ratings were determined by linear regression modeling. Results: Multilinear regression analysis indicated that gender (being male) and BMI were associated with higher rating scores to designate overweight. Moreover, higher BMI z-scores were associated with higher underweight figure ratings. Ethnicity, area of residence, age, and socioeconomic status were not associated with higher ratings of body image. Conclusions: These findings show that an environment with a high prevalence of overweight does not necessarily shift adolescent "norms," contrary to visual normalization theory. These results should be taken into account in educational overweight prevention programs.
Stephane Frayon
added a research item
Objective Energy drinks are very popular among teenagers but may cause health problems. Energy drink consumption is partly associated with energy drink perception, but little is known about this in the Pacific Island Countries and Territories. The aim of this cross-sectional study was to identify the relationships between energy drink consumption, energy drink perception, weight status and sociodemographic characteristics in a school-going sample of Pacific adolescents. Design A cross-sectional study carried out in the schools during school hours between July 2015 and April 2016. Setting Sociodemographic characteristics, weight status, energy drink perception, and quantity of energy drinks consumed were obtained. Chi-square tests of independence, independent t tests, multivariate logistic regressions and multiple linear regressions were used. Subjects A representative sample of 678 New Caledonian adolescents (11–16 years). Results We found that one third of New Caledonian adolescents consume energy drinks. Boys are more likely to drink them than girls and Polynesians drink significantly more than European and Melanesian adolescents. Higher energy drink consumption in the New Caledonian adolescents is associated with good or neutral perceptions of the energy drink impact on health. Moreover, sex (being male) significantly influences the total energy drink consumption per week. Energy drink consumers have a tendency toward better perceptions of energy drinks than non-consumers. Conclusions Nutritional education targeting energy drink consumers should take these results into account by providing (community-based) educational programs, especially for adolescents from low socioeconomic backgrounds, boys, or those living in rural areas.
Stephane Frayon
added a research item
This cross-sectional study assessed sugar-sweetened beverage (SSB) consumption and its associations with the sociodemographic and physical characteristics, behavior and knowledge of New Caledonian adolescents. The survey data of 447 adolescents from ages 11 to 16 years were collected in five secondary public schools of New Caledonia between July 2015 and April 2016. These data included measured height and weight, SSB consumption, sociodemographic characteristics, body weight perception, physical activity, and knowledge (sugar quantity/SSB unit; energy expenditure required to eliminate a unit) and opinions about the SSB‒weight gain relationship. Ninety percent of these adolescents declared regularly drinking SSBs. Quantities were associated with living environment (1.94 L·week−1 in urban environment vs. 4.49 L·week−1 in rural environment, p = 0.001), ethnic community (4.77 L·week−1 in Melanesians vs. 2.46 L·week−1 in Caucasians, p < 0.001) and knowledge about energy expenditure (6.22 L·week−1 in unknowledgeable adolescents vs. 4.26 L·week−1 in adolescents who underestimated, 3.73 L·week−1 in adolescents who overestimated, and 3.64 L·week−1 in adolescents who correctly responded on the energy expenditure required to eliminate an SSB unit, p = 0.033). To conclude, community-based health promotion strategies should (1) focus on the physical effort needed to negate SSB consumption rather than the nutritional energy from SSB units and (2) highlight how to achieve sustainable lifestyles and provide tools for greater understanding and positive action.
Stephane Frayon
added a research item
Introduction: Waist-to-height ratio (WHtR) is a simple anthropometric proxy for central body fat; it is easy to use from a health education perspective. A WHtR value >0.5 has been proposed as a first level indicator of health risk. The first aim of this study was to compare WHtR with values based on body mass index (BMI) in their prediction of the percentage of body fat (%BF) in a multi-ethnic population of adolescents from New-Caledonia (age 11-16year). Secondly, to see whether WHtR >0.5 could be used to detect overfat subjects whose BMI was in the normal range. Materials and methods: Body fat percentage (%BF, based on skinfold measurements), BMI and WHtR were calculated for New Caledonian adolescents from different ethnic backgrounds. The relationship between %BF, BMI and WHtR was determined using quadratic models and from linear regression equations. The sensitivity and specificity of WHtR for detecting overfat adolescents (%BF >25% in boys and >30% in girls) were assessed and compared with those from the BMI-based classification. Results: WHtR showed better correlation with %BF than BMI-based measurements. WHtR >0.5 was also more accurate than BMI in detecting overfat adolescents. Moreover, using this boundary value, 8% of adolescents in the normal BMI range were shown to be over-fat. Conclusions: WHtR is a good anthropometric proxy to detect overfat adolescents. Detecting overfat adolescents within the normal BMI range is particularly important for preventing non communicable diseases. We therefore recommend using WHtR for health education programs in the Pacific area and more generally.
Stephane Frayon
added a research item
We evaluated anthropometric characteristics and physical fitness in 556 Melanesian adolescents from rural and urban New Caledonia to build health education programs focused on physical activity. In 2013, body weight, height, skinfold thickness, lean body mass (LBM), percentage fat body mass (%FBM), physical fitness (power, agility, speed, maximal aerobic speed [MAS], estimated VO2max), and self-reported physical activity were assessed. Rural adolescents were significantly shorter and faster, had lower weight, %FBM, LBM, and power output and similar MAS and VO2max, and were more active than urban adolescents. Rural girls were significantly shorter, had higher MAS and VO2max, and were faster and significantly more active than urban girls while similar %BFM was observed in both groups of girls. Rural boys showed significantly lower height, weight, %FBM, and power and were significantly faster and more active than urban boys. In conclusion, rural Melanesian adolescents are more active, with good physical fitness (especially boys), although high %FBM was noted (especially in girls).
Stephane Frayon
added 2 research items
Objective(s): The prevalence of adolescent obesity is high among the various ethnic groups native to the Pacific region (European, Melanesian and Polynesian). An important factor of weight gain or loss is body size satisfaction; however, little is known about adolescent body self-perception in the Pacific region. Design: Body dissatisfaction was evaluated using the Stunkard Figure Rating Scale in a sample of 699 adolescents from rural and urban areas of New Caledonia. The socio-demographic factors associated with higher body dissatisfaction were determined by multiple linear regression modeling. Results: Our results showed a high rate of body dissatisfaction (over 70%) in the adolescents. Body dissatisfaction was strongly related to the body mass index z-score. Melanesians boys had higher body dissatisfaction scores when they felt 'too thin' while Melanesian girls showed lower body dissatisfaction when they felt 'too fat.'. Conclusion: These results showed that social pressure for thinness or musculature may be different among adolescents living in New Caledonia. These results should be taken into account in education overweight prevention programs.
Stephane Frayon
added a research item
We examined the accuracy of self-reported weight and height in New Caledonian school-going adolescents. Self-reported and measured height and weight data were collected from 665 adolescents of New Caledonia and were then compared. Multivariable logistic regressions identified the factors associated with inaccurate self-reports. Sensitivity and specificity of self-reported body mass index values to detect overweight or obesity were evaluated. Self-reported weight was significantly lower than measured weight (boys, -3.56 kg; girls, -3.13 kg). Similar results were found for height (boys, -2.51 cm; girls, -3.23 cm). Multiple regression analyses indicated that the difference between self-reported and measured height was significantly associated with ethnicity and pubertal status. Inaccurate self-reported weight was associated with socioeconomic status, place of residence, body-size perception and weight status. Screening accuracy of self-reported body mass index was low, particularly in the Melanesian subgroup. These findings should be considered when overweight is estimated in the Melanesian adolescent population at individual scale.
Stephane Frayon
added a research item
Background: Body mass index is the most often used indicator of obesity but does not distinguish between lean and fat mass. Adiposity at the same body mass index differs across ethnic groups. Objectives: The twofold aim of this study was to determine whether body mass index (BMI)-based references are correlated with body fat percentage (%BF) in a pluri-ethnic population of Pacific Islanders and to assess the diagnostic accuracy of these references by using the percentage of body fat as the gold standard. Methods: Height and weight were obtained, and triceps and subscapular skinfold thicknesses were measured in a sample of 796 adolescents (11-16 years) from the three main ethnic groups in New Caledonia: Melanesian, European and Polynesian. %BF was derived from the Slaughter equations, and BMI z score was calculated by using various international and national references. Results: Melanesian teens had lower %BF compared with their European counterparts for the same BMI z score. Whatever the BMI-based reference used to detect overfatness (%BF >25% for boys and >30% for girls), sensitivity was higher in Melanesian adolescents, while specificity was higher in their European counterparts. Diagnostic accuracy was better in Melanesian compared with European adolescents. Conclusions: This study shows that Melanesian adolescents have lower %BF than their European counterparts for the same BMI z score. Therefore, the diagnostic accuracy of BMI to detect overfatness is related to ethnicity. Whatever the BMI-based reference, sensitivity was higher in the Melanesian group, while specificity was higher in the European group.
Paul Zongo
added 2 research items
ABSTRACT: This study assessed the anthropometric and physiological characteristics of elite Melanesian futsal players in order to determine the best performance predictors. Physiological parameters of performance were measured in 14 Melanesian (MEL-G, 24.4±4.4 yrs) and 8 Caucasian (NMEL-G, 22.9±4.9) elite futsal players, using tests of jump-and-reach (CMJ), agility (T-Test), repeated sprint ability (RSA), RSA with change-of-direction (RSA-COD), sprints with 5 m, 10 m, 15 m, and 30 m lap times, and aerobic fitness with the 30-15 intermittent fitness test (30-15 IFT). The anthropometric data revealed significantly lower height for MEL-G compared with NMEL-G: 1.73±0.05 and 1.80±0.08 m, respectively; P=0.05. The CMJ was significantly higher for MEL-G than NMEL-G: 50.4±5.9 and 45.2±4.3 cm, respectively; P=0.05. T-Test times were significantly lower for MEL-G than NMEL-G: 10.47±0.58 and 11.01±0.64 seconds, respectively; P=0.05. MEL-G height was significantly related to CMJ (r=0.706, P=0.01), CMJpeakP (r=0.709, P=0.01) and T-Test (r=0.589, P=0.02). No significant between- group differences were observed for sprint tests or 30-15 IFT, including heart rate and estimated VO2max. Between groups, the percentage decrement (%Dec) in RSA-COD was significantly lower in MEL-G than NMEL-G (P=0.05), although no significant difference was noted between RSA and RSA-COD. Within groups, no significant difference was observed between %Dec in RSA or RSA-COD; P=0.697. This study presents specific anthropometric (significantly lower height) and physiological (significantly greater agility) reference values in Melanesians, which, taken together, might help coaches and physical fitness trainers to optimize elite futsal training and talent identification in Oceania.
Stephane Frayon
added a research item
Objectives: New Caledonia is a multi-ethnic French territory in the Pacific, characterized by communities with widely varying nutritional habits. Little is currently known about adolescent food behaviors and habits and their association with overweight. This study therefore determined the sociodemographic factors and food behaviors associated with overweight and underweight in this population, as well as the factors associated with skipping breakfast. Methods: A cross-sectional survey was conducted among New Caledonian adolescents using a self-administered questionnaire; anthropometric measurements were also taken. Weight status was determined using international cutoffs, and the factors associated with overweight and underweight were identified with multiple logistic regression analysis. The factors associated with breakfast skipping were also determined. Results: Skipping breakfast, being Melanesian, living in a rural area and having low economic status were positively associated with overweight in these adolescents. Skipping breakfast was relatively infrequent, reported by 18% and 13% of the males and females, respectively. Logistic regression models found that the main factors associated with breakfast consumption habits were gender, weight status and ethnicity. Conclusions: Several factors are associated with overweight status in New Caledonian adolescents. Breakfast education should be improved for adolescents living in rural areas and from low socioeconomic status.
Stephane Frayon
added a research item
Background Adolescent obesity is prevalent in Pacific region ethnic groups (European, Melanesian and Polynesian) living in both urban and rural areas. Although body perception is an important factor of weight gain or loss, little is known about the body self-perceptions of Pacific region adolescents. This study therefore evaluated adolescent perceptions of body weight according to ethnicity (European, Melanesian or Polynesian), socioeconomic status (low, intermediate or high) and living area (rural or urban) in New Caledonia. Methods Sociodemographic and anthropomorphic data from 737 adolescents (351 boys and 386 girls) with ages ranging from 11 to 16 years were collected and analysed. The International Obesity Task Force (IOTF) standards were used to define weight status as normal-weight, underweight or overweight/obese. Weight perception was assessed from detailed questionnaires, with adolescents rating their own weight with the following descriptors: ‘about the right weight’, ‘too heavy’, or ‘too light’. Results Results showed that only 8.5% of normal-weight adolescents (7% boys and 10% girls) identifying themselves as ‘too heavy’. Normal-weight Melanesian adolescents were less likely than their European counterparts to assess themselves as too heavy (OR = 0.357). However, half the overweight/obese adolescents underestimated their weight status (53% boys and 48% girls). Weight misperception was associated with ethnicity, socioeconomic status and living area, with gender-specific differences. Conclusions The results of this study suggest that these sociodemographic factors should be taken into account when designing public health policies and health education school programmes in New Caledonia and, more broadly, the Pacific region.
Stephane Frayon
added a project goal
The Melanesian and Polynesian populations living in New Caledonia have a high prevalence of overweight and obesity. However, little is known about the factors associated with this heightened risk of overweight in these Pacific populations. Previous studies have examined the Pacific islanders separately because they often lived in very different areas. However, New Caledonia today has a highly diverse population: high and low income, rural and urban, and a range of ethnic groups with substantial cultural differences. We think that New Caledonia can be considered as 'open laboratory', with all the diversity of the Pacific region living on one island.