|Year : 2014 | Volume
| Issue : 1 | Page : 14-19
Body fat percentage and its correlation with dietary pattern, physical activity and life-style factors in school going children of Mumbai, India
Jagmeet Madan, Neha Gosavi, Paarmi Vora, Princee Kalra
Department of Food and Nutrition, SVT College of Home Science, SNDT Women's University, Juhu, Mumbai, Maharashtra, India
|Date of Submission||26-Sep-2013|
|Date of Decision||30-Oct-2013|
|Date of Acceptance||09-Nov-2013|
|Date of Web Publication||30-Dec-2013|
Department of Food and Nutrition, SVT College of Home Science, SNDT Women's University, Juhu, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Nutritional status of Indian children is a double-edged sword, reflecting dual burden of malnutrition. The standard norm of body mass index (BMI) percentiles may not reflect adiposity in children at both ends of the spectrum of malnutrition. The aim of the following study was to estimate body fat percentage of school-going children of different socio-economic strata and to compare it with BMI percentiles in an effort to identify the lean obese in malnourished children. An attempt was also made to correlate body fat percentage with dietary intake pattern and life-style factors including levels of physical activity, breakfast-eating patterns, frequency of eating out and sleep patterns. Materials and Methods: The sample comprised of 764 school-going children aged 10-17 years from private and government schools of Mumbai with a majority in the age group of 10 to 15 years. Results: The results indicate a high prevalence of underweight in government and private school children (82.7% and 55% respectively) based on BMI percentiles. A high percentage of government school and private school children (69.1% and 39.4%, respectively) were also classified in the category of very less body fat. The mean BMI was 18.97±3.79 and 16.09±2.9, respectively and the mean body fat percentage was 17.43±9.79 and 11.29±7.0 respectively in private and government school children There was an increase in the percentage of children who were overweight and obese in private schools (from 4.9% to 22.9%) and in government schools (from none to 4.3%) when they were classified based on body fat percentage. A number of children in underweight and normal categories of BMI did show high body fat percentage. Body fat was positively correlated to poor quality of eating and lifestyle factors including quantum of refined flour bakery products (P=0.001), eating out frequency (P=0.001), less duration of sleep (P=0.001), increased TV-viewing (P=0.013); it was negatively correlated to frequency and quantity of salad consumption (P=0.001), regular breakfast-consumption pattern (P=0.001) and increased level of physical activity (P=0.001). Conclusion: The study gives an insight in body fat percentage of Indian children and its relationship to dietary pattern and life-style factors.
Keywords: Body composition, dietary pattern, life-style factors, school going children
|How to cite this article:|
Madan J, Gosavi N, Vora P, Kalra P. Body fat percentage and its correlation with dietary pattern, physical activity and life-style factors in school going children of Mumbai, India. J Obes Metab Res 2014;1:14-9
|How to cite this URL:|
Madan J, Gosavi N, Vora P, Kalra P. Body fat percentage and its correlation with dietary pattern, physical activity and life-style factors in school going children of Mumbai, India. J Obes Metab Res [serial online] 2014 [cited 2019 Feb 15];1:14-9. Available from: http://www.jomrjournal.org/text.asp?2014/1/1/14/123862
| Introduction|| |
Rapidly changing dietary practices and a sedentary life-style have led to the increasing prevalence of childhood obesity (5-19 year) in developing countries recently: 41.8% in Mexico, 22.1% in Brazil, 22.0% in India and 19.3% in Argentina. Moreover, secular trends indicate increasing prevalence rates in these countries: 4.1-13.9% in Brazil during 1974-1997, 12.2-15.6% in Thailand during 1991-1993 and 9.8-11.7% in India during 2006-2009.  A multi-centric study (n = 38,296 children 8-18 years from schools located in 5 cities in India) reported prevalence of overweight and obesity as 14.4% and 2.8% International Obesity Task Force (IOTF cut-offs); 14.5% and 4.8% (CDC cut offs); 18.5% and 5.3% (WHO cut offs). It was higher in14-18 years children (21.1% and 12.3%). On extrapolating this data to urban Indian population, more than 15 million children would be overweight and 4 million abdominally obese in India.  Another multicentric study with a total of 20243 children (2-17 years) from five geographical zones was conducted in 11 affluent urban schools of India. The overall prevalence of overweight and obesity was 18.2% by the IOTF classification and 23.9% by the WHO standards. The prevalence of overweight and obesity was higher in boys than girls.  There are concerns about the validity of body mass index (BMI) as an accurate measure of absolute body fat mass. BMI is a measure of excess weight relative to height than excess body fat and may be a less sensitive indicator of fatness among children.  Its sensitivity and specificity increases by changing BMI cut-off to a lower value.  The prediction of percentage body fat by BMI is relatively poor in both stunted and non-stunted groups of children.  Asian populations have a higher body fat percentage at a lower BMI compared with Caucasians. It has been reported that for the same BMI the body fat percentage was 3-5% points higher.  Thus, there is a felt need to understand the body composition of Indian children to identify the percentage of lean obese and correlate it to dietary pattern and life-style factors. Therefore, the objectives of the present study were to estimate body fat percentage in school going children from different socio-economic strata of Mumbai, to correlate estimated body fat percentage with its possible determinants such as dietary pattern, physical activity and life-style related factors.
| Materials and Methods|| |
A total of 764 children (10-18 years) were randomly selected from Government Schools (run by the state government) and private schools (run by private managements without state aid) from Mumbai city. The sample comprised of 352 children from government schools and 411 from private schools (boys and girls) using stratified random sampling. Weight was recorded using digital weighing scale. Height, waist circumference, hip circumference and mid upper arm circumference was recorded using the standard non stretchable measuring tape to the nearest 0.1 cm. The body fat percentage was analysed using TANITA body fat analyser (Model TBF-300A III, TBF-300/310) (Tanita Corporation of America, Inc. Illinois, USA). Body fat measurement was taken in the morning where subject is normally hydrated, with clean foot pads and with cotton uniforms. Measurements were avoided after recent food intake, exercise and consumption of caffeinated drink which affects hydration levels. All measures were taken using standardized techniques. CDC BMI Percentiles were used to categorize children in underweight (<5 th Percentile), normal weight (>5 th to 85 th Percentile), overweight (>85 th to 95 th Percentile) and obesity (>95 th Percentile). Body fat percentage was analysed based on classification of Gallagher et al. in 2000. 
The research tools included standardised and pretested food frequency questionnaire, standardised physical activity and life-style questionnaire. This included general information including gender, ethnicity and food habits. Information regarding dietary habits such as meal frequency, consumption of breakfast, milk and milk products, fruits and vegetables, salads, non-vegetarian food, fast food, fried and sweet foods and frequency of eating out were recorded. Information regarding the physical activity of the students was taken keeping into consideration the participation in any sport or any other physical activity. Information was also obtained regarding sedentary activities like television (TV) viewing, computer games and leisure activities. Mode of transport (walking, cycling) used for travelling also contributed to the physical activity of the student. Subjects who reported participating in sports activity 3 or more times a week for at least 30 min were classified as "active" (meeting the recommended level). Those who were not engaged in any physical activity were categorised as "inactive". In addition, subjects were asked the average numbers sleeping hours each day. The responses for sleep time were subsequently grouped into 4 levels: <6 h, 6-8 h, >8-10 h. The data was statistically analysed using SPSS version 17 (IBM SPSS Statistics, USA, SPSS Statistics Version 10.0.2, March 2009), Chi-square test, ANOVA, Pearson's correlation.
| Results|| |
The sample comprised of 764 school going children (10-18 years) with the majority in the range of 10-15 years. The fee structure and funding to the schools stratified the children into higher socio-economic strata (Private School) and lower socio-economic strata (Government School). The baseline characteristics [Table 1] show that the sample was evenly distributed in the two schools and sex wise. A high percentage of children from both private (55%) and government (82.7%) were underweight. The percentage of overweight and obesity in Private and government school children was 4.9% and 0% based on BMI and 22.9% and 4.3% respectively based on body fat percentage. The mean anthropometric characteristics of mean height, weight, BMI, Body fat percentage, waist circumference and mid upper arm circumference (MUAC) are appended in [Table 2]. The data clearly indicates that children from government schools were malnourished when compared to private school children with low mean height, weight, BMI, body fat, waist circumference and MUAC.
The mean body fat percentage in boys and girls [Table 3], [Figure 1] and [Figure 2] shows a surge at puberty both in boys and girls which tends to go lower in boys at a later stage when compared to girls where it continues to increase with age. These findings are in line with recent studies. According to a study on body composition by dual-energy X-ray absorptiometry conducted on 888 apparently healthy children from affluent area schools and colleges in Pune city, India showed that the median total body fat percentage increased little (4%) from 5 to 18 years of age in boys compared with that in girls (19%). The total body fat percentage percentiles showed plateau after 13 years of age in boys, whereas a steady increase was seen until 18 years in girls. 
Comparison of BMI with body fat percentage [Table 4] in both groups reveal that 7-16% children categorised as underweight and normal based on BMI were classified as overweight and obese based on body fat classification. This led to an increase in the percentage of children in overweight and obese category based on body fat classification in both the groups (Private school (22.9 vs. 4.9) and government school (4.3 vs. none). In contrary to our observation which was based on bioelectrical impedance a recent cross-sectional study included 1640 apparently healthy school children (825 boys; 815 girls) aged 7-17 years. Total body fat was measured by dual energy X-rays absorptiometry. The percentage body fat was highly correlated with BMI in both boys and girls (all boys: r=0.76, P<0.0001; all girls r=0.81, P<0.0001). It was observed from 9 years onwards, girls had significantly higher percentage body fat than boys. 
|Figure 1. Mean body fat percentage (boys) in private and government school children|
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|Figure 2. Mean body fat percentage (girls) in private and government school children|
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|Table 4: Classification of BMI of school going children as per BF percentage|
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The baseline dietary and life-style characteristics of the children [Table 5] reveal that consumption of vegetables and fruits was much lower in government school children. A high percentage of children from these schools also skipped breakfast (35.8%) and ate out once a week or once in 15 days (71%). A majority of children (60-80%) in both groups were physically active and almost 18-20% of the children slept <6 h.
There was a significant positive correlation observed between the body fat percentage and dietary pattern [Table 6]. A significant negative correlation was observed between the quantum of salad consumption with BMI (P=0.014) and body fat % (P=0.31) in government school children. The mean body fat percentage of children consuming higher quantity of salad was lower in both schools [Table 7], however it was observed to be statistically significant in government school children [Table 6]. The other dietary factors which showed a significant positive correlation [Table 6] with BMI and Body Fat percentage in government school children include high intake of a local bakery products (khari) (BMI and BF% P=0.001) and frequency of eating out (BMI P<0.05: BF% P=0.001). The mean body fat percentage of children skipping breakfast (13.97±7.70) was observed to be higher when compared to the breakfast consumers (10.99±6.06) in government school children.
|Table 6: Correlation of dietary determinants with BMI and BF percentage of school going children|
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|Table 7: Mean BF percentage and quantity of salad consumption in school going children|
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Life-style factor [Table 8], which showed a significant negative correlation with BMI and Body fat percentage in government school children was participation in sports activity (BMI and BF% P=0.001). Significant positive correlation was observed between increased TV viewing (BMI P=0.001: BF% P<0.02) and computer time (BMI P=0.003: BF% P=0.001), <6 h of sleep [Table 9] (BMI P=0.002: BF% P=0.001) with BMI and body fat percentage in government school going children.
|Table 8: Correlation of lifestyle determinants with BMI and BF percentage of school going children|
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| Discussion|| |
This study attempts to give an insight in the body composition and dual burden of malnutrition in Indian children. The percentage prevalence of overweight and obesity observed in the present study based on BMI is an underestimation in both groups. This is evident from the increase in the percentage of overweight and obese when children were classified based on body fat percentage. This clearly indicates the presence of inflammatory state of the body in children who may be categorised as normal or underweight based on BMI. The increasing evidence of lean obesity adds on to the inflammatory state of the body at a younger age thereby increasing predisposition to non-communicable diseases. A high percentage of under nutrition observed in private and government school children is a cause of concern. The implications of the same can be observed in lower values of height, weight, waist circumference and MUAC especially in children from government school. The dietary pattern of these children also reveals skipping breakfast, consumption of refined sugar and saturated fat based bakery products, high eating out frequency and very low intake of vegetables and fruits which has a cumulative effect on the quality of diet. A study conducted in 13- to 25-year-old Asian Indian adolescents and young adults reported an average total fat intake of 84-29 g/d in males and 72-21 g/d in females,  nearly 4 times the recommended dietary allowance for Asian Indians (20-22 g/d)  and nearly at par with the intake in adolescents in North America.  Furthermore, approximately 1.8 cans of cola per week (540 ml/weak) per person consumption was noticed (one can [300 ml] contains 132 kcal and 33-40 g sugar) in Asian Indian adolescents in this study. These data indicate a rapid shift in dietary patterns, from traditional high-carbohydrate meals to heterogeneous calorie-dense westernised foods. , Research indicates that quality of food intake is an important determinant of body composition. Poor quality of food intake on a cumulative basis relates to accumulation of higher body fat. This is clearly depicted with significant correlation between quantity of salad consumption and lower mean body fat percentage. A higher dependence on local bakery refined flour and poor quality fat based products such as khari, biscuits in lower socio-economic strata has shown a positive correlation with high body fat percentage as observed in government school children.
The undesirable life-style factors observed in children like skipping of breakfast, decreased physical activity, increased computer usage and TV viewing and less sleep hours was positively correlated to a higher mean body fat levels. The undesirable life-style pattern was observed in both private and government school children thereby highlighting the adverse effects of urbanization on the dietary pattern at both ends of the spectrum of socio-economic strata.
There are limited Indian studies that have seen associations of body composition with dietary pattern and life-style factors. A recent study carried out by Rebecca Kuriyan et al. (2011) on 3737 Urban South Indian children aged 10-16 years revealed that lack of sleep, eating in front of TV and overdependence on fast foods contributed to higher waist circumference in adolescent children.  A study in 598 urban Indian children aged 6-16 year in Bangalore (South India) suggested that the adjusted odds of being overweight for children who viewed TV for at least 90 min/d was 19.6 (CI=5.5-69.4; P<0.001), when compared with children who viewed TV for no more than 45 min/d.  Furthermore, a considerable proportion of a child's daily energy intake is consumed while watching TV, especially on weekends.  The additional determinants of unhealthy eating pattern include daily allowance of pocket money to buy lunch and snacks in higher socio-economic strata, heavy dependence on fast foods available in the school cafeteria, relatively inactive life-style of affluent children due to individual private vehicles and easily available domestic help.
Thus, the study concludes that there was a marked shift in children from underweight and normal category to overweight and obese category in both SES when body fat percentage was used as criteria for classification. Body fat percentage was significantly correlated to quality of eating including quantum of salad consumption, refined flour products and bakery products. Children with regular breakfast consumption had lower mean body fat percentage. A positive correlation of body fat percentage was observed with increased eating out frequency, T.V. viewing, computer usage, lesser sleep duration and lower physical activity levels.
Thus there is a felt need to enhance the quality of eating of children from high and low socio-economic strata by imparting nutrition education and working out practical action plans based on locally available food resources to make the implementation cost effective. This is an important need of the hour and a challenge for nutritionist across the country. In addition multiple stake holders including school management, teachers, parents, media, NGOs, Social networking groups and celebrities have to join hands to encourage healthy life-style practices and be a role model for our younger generation. This concerted effort will go a long way to curb the striking rate of non-communicable diseases at an early age.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]