Publications by authors named "Marta Buoncristiano"

39 Publications

Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017.

Obes Facts 2021 Nov 5:1-17. Epub 2021 Nov 5.

Observatory of Nutrition and Study of Obesity, Spanish Agency for Food Safety & Nutrition, Ministry of Health, Madrid, Spain.

Introduction: Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child's weight status. The purpose of this study was to measure parental perceptions of their child's weight status and to identify predictors of potential parental misperceptions.

Methods: We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children's weight status as "underweight," "normal weight," "a little overweight," or "extremely overweight." We categorized children's (6-9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child's weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1.

Results: Overall, 64.1% of parents categorized their child's weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child's weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child's weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28-1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26-1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98-1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99-1.24). Overall, parents' BMI was not strongly associated with the underestimation of children's weight status, but there was a stronger association in some countries.

Discussion/conclusion: Our study supplements the current literature on factors that influence parental perceptions of their child's weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents' knowledge and perceptions, as well as the sociocultural contexts in which children and families live.
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http://dx.doi.org/10.1159/000517586DOI Listing
November 2021

Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI).

Obes Rev 2021 Nov 4;22 Suppl 6:e13215. Epub 2021 Nov 4.

Department of Epidemiology and Public Health Sciensano, Brussels, Belgium.

Establishment of the WHO European Childhood Obesity Surveillance Initiative (COSI) has resulted in a surveillance system which provides regular, reliable, timely, and accurate data on children's weight status-through standardized measurement of bodyweight and height-in the WHO European Region. Additional data on dietary intake, physical activity, sedentary behavior, family background, and school environments are collected in several countries. In total, 45 countries in the European Region have participated in COSI. The first five data collection rounds, between 2007 and 2021, yielded measured anthropometric data on over 1.3 million children. In COSI, data are collected according to a common protocol, using standardized instruments and procedures. The systematic collection and analysis of these data enables intercountry comparisons and reveals differences in the prevalence of childhood thinness, overweight, normal weight, and obesity between and within populations. Furthermore, it facilitates investigation of the relationship between overweight, obesity, and potential risk or protective factors and improves the understanding of the development of overweight and obesity in European primary-school children in order to support appropriate and effective policy responses.
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http://dx.doi.org/10.1111/obr.13215DOI Listing
November 2021

Waist circumference and waist-to-height ratio in 7-year-old children-WHO Childhood Obesity Surveillance Initiative.

Obes Rev 2021 Nov 17;22 Suppl 6:e13208. Epub 2021 Aug 17.

World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation.

Childhood obesity is a serious global health problem. Waist circumference (WC) and waist-to-height ratio (WHtR) reflect body fat distribution in children. The objectives of this study were to assess WC and WHtR in 7-year-old children and to determine body mass index (BMI), WC, and WHtR differences in children from 10 selected countries across Europe (Bulgaria, Czechia, Greece, Ireland, Latvia, Lithuania, North Macedonia, Norway, Spain, and Sweden) participating in the World Health Organization (WHO) Europe Childhood Obesity Surveillance Initiative (COSI). The 50th and 90th percentile of WC (according to COSI and "Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS" (IDEFICS) cutoff values) and WHtR above 0.5 were used as measures of abdominal obesity in a unique sample of 38,975 children aged 7.00-7.99 years. Southern European countries, including Greece and Spain, showed significantly higher BMI, WC, and WHtRin both genders (p < 0.0001) than Eastern and Northern Europe. The highest values for WC were observed in Greece (60.8 ± 7.36 cm boys; 60.3 ± 7.48 cm girls), North Macedonia (60.4 ± 7.91 cm boys; 59.0 ± 8.01 cm girls), and Spain (59.7 ± 6.96 cm boys; 58.9 ± 6.77 cm girls). WC and WHtRin may add an information about the occurrence of central obesity in children.
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http://dx.doi.org/10.1111/obr.13208DOI Listing
November 2021

Mobilizing governments and society to combat obesity: Reflections on how data from the WHO European Childhood Obesity Surveillance Initiative are helping to drive policy progress.

Obes Rev 2021 Nov 10;22 Suppl 6:e13217. Epub 2021 Aug 10.

World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation.

To meet the need for regular and reliable data on the prevalence of overweight and obesity among children in Europe, the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established in 2007. The resulting robust surveillance system has improved understanding of the public health challenge of childhood overweight and obesity in the WHO European Region. For the past decade, data from COSI have helped to inform and drive policy action on nutrition and physical activity in the region. This paper describes illustrative examples of how COSI data have fed into national and international policy, but the real scope of COSI's impact is likely to be much broader. In some countries, there are signs that policy responses to COSI data have helped halt the rise in childhood obesity. As the countries of the WHO European Region commit to pursuing United Action for Better Health in Europe in WHO's new European Programme of Work, COSI provides an excellent example of such united action in practice. Further collaborative action will be key to tackling this major public health challenge which affects children throughout the region.
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http://dx.doi.org/10.1111/obr.13217DOI Listing
November 2021

Childhood overweight and obesity in Europe: Changes from 2007 to 2017.

Obes Rev 2021 Nov 10;22 Suppl 6:e13226. Epub 2021 Aug 10.

World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation.

The Childhood Obesity Surveillance Initiative (COSI) routinely measures height and weight of primary school children aged 6-9 years and calculates overweight and obesity prevalence within the World Health Organization (WHO) European Region using a standard methodology. This study examines the trends in the prevalence of overweight and obesity from the first round of COSI carried out in 2007/2008 to the latest of 2015/2017 in 11 European countries in which data were collected for at least three rounds. In total 303,155 children were measured. In general, the prevalence of overweight and obesity among boys and girls decreased in countries with high prevalence (Southern Europe) and remained stable or slightly increased in Northern European and Eastern European countries included in the analysis. Among boys, the highest decrease in overweight (including obesity) was observed in Portugal (from 40.5% in 2007/2008 to 28.4 in 2015/2017) and in Greece for obesity (from 30.5% in 2009/2010 to 21.7% in 2015/2017). Lithuania recorded the strongest increase in the proportion of boys with overweight (from 24.8% to 28.5%) and obesity (from 9.4% to 12.2%). The trends were similar for boys and girls in most countries. Several countries in Europe have successfully implemented policies and interventions to counteract the increase of overweight and obesity, but there is still much to be done.
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http://dx.doi.org/10.1111/obr.13226DOI Listing
November 2021

Thinness, overweight, and obesity in 6- to 9-year-old children from 36 countries: The World Health Organization European Childhood Obesity Surveillance Initiative-COSI 2015-2017.

Obes Rev 2021 Nov 7;22 Suppl 6:e13214. Epub 2021 Jul 7.

Center for Health Ecology, Institute of Public Health, Podgorica, Montenegro.

In 2015-2017, the fourth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 36 countries. National representative samples of children aged 6-9 (203,323) were measured by trained staff, with similar equipment and using a standardized protocol. This paper assesses the children's body weight status and compares the burden of childhood overweight, obesity, and thinness in Northern, Eastern, and Southern Europe and Central Asia. The results show great geographic variability in height, weight, and body mass index. On average, the children of Northern Europe were the tallest, those of Southern Europe the heaviest, and the children living in Central Asia the lightest and the shortest. Overall, 28.7% of boys and 26.5% of girls were overweight (including obesity) and 2.5% and 1.9%, respectively, were thin according to the WHO definitions. The prevalence of obesity varied from 1.8% of boys and 1.1% of girls in Tajikistan to 21.5% and 19.2%, respectively, in Cyprus, and tended to be higher for boys than for girls. Levels of thinness, stunting, and underweight were relatively low, except in Eastern Europe (for thinness) and in Central Asia. Despite the efforts to halt it, unhealthy weight status is still an important problem in the WHO European Region.
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http://dx.doi.org/10.1111/obr.13214DOI Listing
November 2021

Socioeconomic disparities in physical activity, sedentary behavior and sleep patterns among 6- to 9-year-old children from 24 countries in the WHO European region.

Obes Rev 2021 Nov 7;22 Suppl 6:e13209. Epub 2021 Jul 7.

Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Country Office for Tajikistan, Dushanbe, Tajikistan.

Physical activity, sedentary behavior, and sleep are important predictors of children's health. This paper aimed to investigate socioeconomic disparities in physical activity, sedentary behavior, and sleep across the WHO European region. This cross-sectional study used data on 124,700 children aged 6 to 9 years from 24 countries participating in the WHO European Childhood Obesity Surveillance Initiative between 2015 and 2017. Socioeconomic status (SES) was measured through parental education, parental employment status, and family perceived wealth. Overall, results showed different patterns in socioeconomic disparities in children's movement behaviors across countries. In general, high SES children were more likely to use motorized transportation. Low SES children were less likely to participate in sports clubs and more likely to have more than 2 h/day of screen time. Children with low parental education had a 2.24 [95% CI 1.94-2.58] times higher risk of practising sports for less than 2 h/week. In the pooled analysis, SES was not significantly related to active play. The relationship between SES and sleep varied by the SES indicator used. Importantly, results showed that low SES is not always associated with a higher prevalence of "less healthy" behaviors. There is a great diversity in SES patterns across countries which supports the need for country-specific, targeted public health interventions.
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http://dx.doi.org/10.1111/obr.13209DOI Listing
November 2021

Urban and rural differences in frequency of fruit, vegetable, and soft drink consumption among 6-9-year-old children from 19 countries from the WHO European region.

Obes Rev 2021 Nov 7;22 Suppl 6:e13207. Epub 2021 Jul 7.

Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic.

In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban-rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6-9 years from 19 countries participating in the fourth round (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food-frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30-80% and 30-90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR-range: 1.1-2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population-based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.
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http://dx.doi.org/10.1111/obr.13207DOI Listing
November 2021

Socioeconomic differences in food habits among 6- to 9-year-old children from 23 countries-WHO European Childhood Obesity Surveillance Initiative (COSI 2015/2017).

Obes Rev 2021 Nov 7;22 Suppl 6:e13211. Epub 2021 Jul 7.

World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation.

Background: Socioeconomic differences in children's food habits are a key public health concern. In order to inform policy makers, cross-country surveillance studies of dietary patterns across socioeconomic groups are required. The purpose of this study was to examine associations between socioeconomic status (SES) and children's food habits.

Methods: The study was based on nationally representative data from children aged 6-9 years (n = 129,164) in 23 countries in the World Health Organization (WHO) European Region. Multivariate multilevel analyses were used to explore associations between children's food habits (consumption of fruit, vegetables, and sugar-containing soft drinks) and parental education, perceived family wealth and parental employment status.

Results: Overall, the present study suggests that unhealthy food habits are associated with lower SES, particularly as assessed by parental education and family perceived wealth, but not parental employment status. We found cross-national and regional variation in associations between SES and food habits and differences in the extent to which the respective indicators of SES were related to children's diet.

Conclusion: Socioeconomic differences in children's food habits exist in the majority of European and Asian countries examined in this study. The results are of relevance when addressing strategies, policy actions, and interventions targeting social inequalities in children's diets.
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http://dx.doi.org/10.1111/obr.13211DOI Listing
November 2021

Socioeconomic inequalities in overweight and obesity among 6- to 9-year-old children in 24 countries from the World Health Organization European region.

Obes Rev 2021 Nov 28;22 Suppl 6:e13213. Epub 2021 Jun 28.

Center for Health Ecology, Institute of Public Health, Podgorica, Montenegro.

Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6-9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.
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http://dx.doi.org/10.1111/obr.13213DOI Listing
November 2021

The Italian Obstetric Surveillance System: Implementation of a bundle of population-based initiatives to reduce haemorrhagic maternal deaths.

PLoS One 2021 23;16(4):e0250373. Epub 2021 Apr 23.

National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy.

In this before and after cross-sectional analysis, the authors aim to assess the impact of the bundle of research and training initiatives implemented between 2013 and 2018, and coordinated by the Italian Obstetric Surveillance System (ItOSS) to reduce obstetric haemorrhagic emergencies in five selected Italian Regions. To this purpose, the haemorrhagic Maternal Mortality Ratios (MMR) per 100,000 live births were estimated before and after implementing the bundle, through the ItOSS's vital statistic linkage procedures and incident reporting and Confidential Enquiries. The research and training bundle was offered to all health professionals involved in pregnancy and birth care in the selected regions, representing 40% of national live births, and participating in the ItOSS audit cycle since its institution. The haemorrhagic MMR significantly decreased from 2.49/100,000 live births [95% CI 1.75 to 3.43] in the years 2007-2013 prior to the bundle implementation, to 0.77/100,000 live births [95% CI 0.31 to 1.58] in the years 2014-2018 after its implementation. According to the study results, the bundle of population-based initiatives might have contributed to reducing the haemorrhagic MMR in the participating regions, thus improving the quality of care of the major obstetric haemorrhage.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250373PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064507PMC
September 2021

Regional and sociodemographic determinants of the prevalence of overweight and obesity in children aged 7-9 years in Croatia.

Acta Clin Croat 2020 Jun;59(2):303-311

1Health Promotion Division, Croatian Institute of Public Health, Zagreb, Croatia; 2Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia; 3European Office for Prevention and Control of Noncommunicable Diseases, World Health Organization, Moscow, Russia.

The aim of this study was to determine the prevalence and analyze the determinants of overweight and obesity among Croatian schoolchildren aged 7-9 years in relation to sociodemographic factors. This study used data that were gathered as part of the WHO Europe Childhood Obesity Surveillance Initiative in 2015/2016. The sample for the study was nationally representative. Anthropometric measurements of 5591 children, 2811 boys and 2780 girls, were collected during 8 weeks using standardized equipment. Studied variables included child's anthropometric measurements and demographics, maternal education and employment status. The results showed a 35.9% prevalence of overweight and obesity in Croatian 7-9-year-old children. Overweight and obesity were more frequent in boys in comparison to girls, especially among boys from the Adriatic region (42.1%). The risk of overweight and obesity was increased in boys living in the Adriatic region (ORadj=1.33; 95% CI 1.03-1.71) and in girls with high-school educated mothers (ORadj=1.36; 95% CI 1.11-1.66). Girls with unemployed mothers had a lower risk of overweight and obesity (ORadj=0.73; 95% CI 0.58-0.92). The observed prevalence of childhood overweight and obesity warrants national and local time-bound targets for reduction of childhood obesity, accompanied by detailed action plans and monitoring mechanisms.
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http://dx.doi.org/10.20471/acc.2020.59.02.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808219PMC
June 2020

Physical Activity, Screen Time, and Sleep Duration of Children Aged 6-9 Years in 25 Countries: An Analysis within the WHO European Childhood Obesity Surveillance Initiative (COSI) 2015-2017.

Obes Facts 2021 22;14(1):32-44. Epub 2020 Dec 22.

National Institute of Health Dr Ricardo Jorge I.P., Lisbon, Portugal.

Background: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing.

Objectives: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI).

Method: The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration.

Results: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9-11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7-98.3% actively playing for >1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night.

Conclusions: The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children.
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http://dx.doi.org/10.1159/000511263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983588PMC
July 2021

A Snapshot of European Children's Eating Habits: Results from the Fourth Round of the WHO European Childhood Obesity Surveillance Initiative (COSI).

Nutrients 2020 Aug 17;12(8). Epub 2020 Aug 17.

Department for Organization of Health Services to Children, Mothers, Adolescents and Family Planning, Ministry of Health and Social Protection of Population, 734025 Dushanbe, Tajikistan.

Consuming a healthy diet in childhood helps to protect against malnutrition and noncommunicable diseases (NCDs). This cross-sectional study described the diets of 132,489 children aged six to nine years from 23 countries participating in round four (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents or caregivers were asked to complete a questionnaire that contained indicators of energy-balance-related behaviors (including diet). For each country, we calculated the percentage of children who consumed breakfast, fruit, vegetables, sweet snacks or soft drinks "every day", "most days (four to six days per week)", "some days (one to three days per week)", or "never or less than once a week". We reported these results stratified by country, sex, and region. On a daily basis, most children (78.5%) consumed breakfast, fewer than half (42.5%) consumed fruit, fewer than a quarter (22.6%) consumed fresh vegetables, and around one in ten consumed sweet snacks or soft drinks (10.3% and 9.4%, respectively); however, there were large between-country differences. This paper highlights an urgent need to create healthier food and drink environments, reinforce health systems to promote healthy diets, and continue to support child nutrition and obesity surveillance.
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http://dx.doi.org/10.3390/nu12082481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468747PMC
August 2020

Women undergoing peripartum hysterectomy due to obstetric hemorrhage: A prospective population-based study.

Acta Obstet Gynecol Scand 2020 02 26;99(2):274-282. Epub 2019 Sep 26.

National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Italian National Institute of Health, Rome, Italy.

Introduction: Peripartum hysterectomy is usually undertaken in cases of life-threatening obstetric hemorrhage to prevent the death of the mother. Near-miss events are still under-researched and inappropriate care continues to be a critical issue, even in countries with advanced obstetric surveillance systems. The aim of the present study was to estimate the prevalence, associated factors, management and intraoperative and postoperative complications of peripartum hysterectomy due to obstetric hemorrhage.

Material And Methods: A prospective population-based study has been conducted in six Italian regions covering 49% of births in Italy. The study population comprised all women aged 11-59 years undergoing peripartum hysterectomy, from September 2014 to August 2016, due to obstetric hemorrhage within 7 days of delivery. In each maternity unit a trained reference person reported incident cases using electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period.

Results: The overall peripartum hysterectomy prevalence was 1.09 per 1000 maternities, with a large variability among regions, ranging from 0.52 to 1.60. Previous cesarean section (relative risk [RR] 4.97, 95% CI 4.13-5.96), assisted reproductive technology (RR 5.99, 95% CI 4.42-8.11) multiple pregnancy (RR 5.03, 95% CI 3.57-7.09) and maternal age ≥35 years (RR 2.69, 95% CI 2.25-3.21) were the main associated factors for hysterectomy. The most common causes of peripartum hysterectomy were uterine atony (45.1%) and abnormally invasive placentation (40.2%). Intensive care unit admission was reported in 49.9% of cases, 16.8% of women suffered severe morbidity and 5 women died.

Conclusions: The rate of peripartum hysterectomy in Italy was three times higher compared with the UK, the Netherlands and the Nordic countries. The wide difference may be associated with women's characteristics, such as age at delivery and previous cesarean section, and with different management options leading to peripartum hysterectomy.
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http://dx.doi.org/10.1111/aogs.13727DOI Listing
February 2020

Decline of childhood overweight and obesity in Italy from 2008 to 2016: results from 5 rounds of the population-based surveillance system.

BMC Public Health 2019 May 21;19(1):618. Epub 2019 May 21.

National Centre for Disease Prevention and Health Promotion, National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy.

Background: Given the effects of childhood obesity on future health, and the lack of information of its prevalence in Italy, a national surveillance system was implemented in 2007. It is OKkio alla SALUTE, part of the WHO/Europe Childhood Obesity Surveillance Initiative (COSI). This study reports the 2008-2016 trends by sex, area of residence and socio-demographic characteristics in the prevalence of overweight and obesity in primary school children (8-9 years).

Methods: In each round of the surveillance held in 2008, 2010, 2012, 2014 and 2016, a nationally representative sample of about 45,000 children, was weighed and measured with standard equipment and methods by trained personnel. Children were classified as normal weight, overweight or obese using World Obesity Federation (WOF) (formerly the International Obesity Task Force (IOTF)) and WHO cut-offs. Children's sex, area of residence and mothers' education and citizenship, were obtained using self-reported questionnaires and were assessed using multivariate logistic regression models.

Results: Between 2008 and 2016, the overall prevalence of obesity dropped from 12.0 to 9.3% (WOF-IOTF) and from 21.2 to 17.0% (WHO), while the overall prevalence of overweight (including obesity) from 35.2 to 30.6% (WOF-IOTF) and from 44.4 to 39.4% (WHO). Reduction in the prevalence of overweight and obesity was greater in boys (- 14.5%, p for trend< 0.001; and - 24.7%, p = 0.001) compared to girls (- 11.1%, p < 0.001; and - 19.2%, p = 0.034). Decreasing trends were observed in overweight prevalences within children resident in the center and in the south. Decreasing trends in obesity prevalences were observed among boys resident in the north and in the south, and among girls resident in the center. Decreasing trends were observed in overweight prevalences within socio-demographic characteristics, except among children with low educated and foreign mothers; and in obesity prevalences for children with medium educated mothers, and girls with Italian mothers.

Conclusions: From 2008 to 2016 a decrease of childhood overweight and obesity was observed in Italy. However, as these prevalences are still among the highest in Europe, there is need to continue their monitoring and implement more interventions to promote healthy lifestyles. More effort should be focused on children belonging to low social classes.
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http://dx.doi.org/10.1186/s12889-019-6946-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528349PMC
May 2019

Prevalence of Severe Obesity among Primary School Children in 21 European Countries.

Obes Facts 2019 26;12(2):244-258. Epub 2019 Apr 26.

Department of Nutrition and Dietetics, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece.

Background: The World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established more than 10 years ago to estimate prevalence and monitor changes in overweight and obesity in children aged 6-9 years. Since then, there have been five rounds of data collection in more than 40 countries involving more than half a million children. To date, no comparative studies with data on severe childhood obesity from European countries have been published.

Objectives: The aim of this work was to present the prevalence of severe obesity in school-aged children from 21 countries participating in COSI.

Method: The data are from cross-sectional studies in 21 European WHO member states that took part in the first three COSI rounds of data collection (2007/2008, 2009/2010, 2012/2013). School-aged children were measured using standardized instruments and methodology. Children were classified as severely obese using the definitions provided by WHO and the International Obesity Task Force (IOTF). Analyses overtime, by child's age and mother's educational level, were performed in a select group of countries.

Results: A total of 636,933 children were included in the analysis (323,648 boys and 313,285 girls). The prevalence of severe obesity varied greatly among countries, with higher values in Southern Europe. According to the WHO definition, severe obesity ranged from 1.0% in Swedish and Moldovan children (95% CI 0.7-1.3 and 0.7-1.5, respectively) to 5.5% (95% CI 4.9-6.1) in Maltese children. The prevalence was generally higher among boys compared to girls. The IOTF cut-offs lead to lower estimates, but confirm the differences among countries, and were more similar for both boys and girls. In many countries 1 in 4 obese children were severely obese. Applying the estimates of prevalence based on the WHO definition to the whole population of children aged 6-9 years in each country, around 398,000 children would be expected to be severely obese in the 21 European countries. The trend between 2007 and 2013 and the analysis by child's age did not show a clear pattern. Severe obesity was more common among children whose mother's educational level was lower.

Conclusions: Severe obesity is a serious public health issue which affects a large number of children in Europe. Because of the impact on educational, health, social care, and economic systems, obesity needs to be addressed via a range of approaches from early prevention of overweight and obesity to treatment of those who need it.
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http://dx.doi.org/10.1159/000500436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547273PMC
February 2020

Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative - COSI 2015/2017.

Obes Facts 2019 26;12(2):226-243. Epub 2019 Apr 26.

NCD Office, WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation.

Background: In Europe, although the prevalence of childhood obesity seems to be plateauing in some countries, progress on tackling this important public health issue remains slow and inconsistent. Breastfeeding has been described as a protective factor, and the more exclusively and the longer children are breastfed, the greater their protection from obesity. Birth weight has been shown to have a positive association with later risk for obesity.

Objectives: It was the aim of this paper to investigate the association of early-life factors, namely breastfeeding, exclusive breastfeeding and birth weight, with obesity among children.

Method: Data from 22 participating countries in the WHO European COSI study (round 4: 2015/2017) were collected using cross-sectional, nationally representative samples of 6- to 9-year-olds (n = 100,583). The children's standardized weight and height measurements followed a common WHO protocol. Information on the children's birth weight and breastfeeding practice and duration was collected through a family record form. A multivariate multilevel logistic regression analysis regarding breastfeeding practice (both general and exclusive) and characteristics at birth was performed.

Results: The highest prevalence rates of obesity were observed in Spain (17.7%), Malta (17.2%) and Italy (16.8%). A wide between-country disparity in breastfeeding prevalence was found. Tajikistan had the highest percentage of children that were breastfed for ≥6 months (94.4%) and exclusively breastfed for ≥6 months (73.3%). In France, Ireland and Malta, only around 1 in 4 children was breastfed for ≥6 months. Italy and Malta showed the highest prevalence of obesity among children who have never been breastfed (21.2%), followed by Spain (21.0%). The pooled analysis showed that, compared to children who were breastfed for at least 6 months, the odds of being obese were higher among children never breastfed or breastfed for a shorter period, both in case of general (adjusted odds ratio [adjOR] [95% CI] 1.22 [1.16-1.28] and 1.12 [1.07-1.16], respectively) and exclusive breastfeeding (adjOR [95% CI] 1.25 [1.17-1.36] and 1.05 [0.99-1.12], respectively). Higher birth weight was associated with a higher risk of being overweight, which was reported in 11 out of the 22 countries. Bulgaria, Croatia, France, Italy, Poland and Romania showed that children who were preterm at birth had higher odds of being obese, compared to children who were full-term babies.

Conclusion: The present work confirms the beneficial effect of breastfeeding against obesity, which was highly increased if children had never been breastfed or had been breastfed for a shorter period. Nevertheless, adoption of exclusive breastfeeding is below global recommendations and far from the target endorsed by the WHO Member States at the World Health Assembly Global Targets for Nutrition of increasing the prevalence of exclusive breastfeeding in the first 6 months up to at least 50% by 2025.
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http://dx.doi.org/10.1159/000500425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547266PMC
February 2020

Clustering of Multiple Energy Balance-Related Behaviors in School Children and its Association with Overweight and Obesity-WHO European Childhood Obesity Surveillance Initiative (COSI 2015⁻2017).

Nutrients 2019 Feb 27;11(3). Epub 2019 Feb 27.

Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO European Office for Prevention and Control of Noncommunicable Diseases, 125009 Moscow, Russia.

It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children ( = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and weight status varied per group. In South Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated with higher risk of overweight/obesity when compared with the cluster 'Physically active and healthy diet'. Few or no associations were observed in North Europe and West-Central Asia, respectively. These findings support the hypothesis that unfavorable weight status is associated with a particular combination of energy balance-related behavior patterns, but only in some groups of countries.
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http://dx.doi.org/10.3390/nu11030511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471416PMC
February 2019

Breastfeeding Prevalence at Time of Vaccination: Results of a Pilot Study in 6 Italian Regions.

J Hum Lact 2019 Nov 18;35(4):774-781. Epub 2019 Jan 18.

National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy.

Background: In Italy, there is no widespread standardized national monitoring system for breastfeeding practices.

Research Aims: To estimate breastfeeding indicators according to World Health Organization recommendations and associated socioeconomic factors, highlighting the potential and limitations of vaccination centers as sources of data.

Methods: A cross-sectional study was conducted in the vaccination centers of 13 Local Health Districts in Italy. Data on breastfeeding practices were collected via structured questionnaires between February and November, 2015, from 14,191 mothers recruited during vaccination appointments for the 1st, 2nd and 3rd doses against Diphtheria, Tetanus, and Pertussis, and for the 1st dose against Measles, Mumps, and Rubella. Crude breastfeeding rates and direct age standardized rates were compared. Logistic regression models were used to explore socio-demographic characteristics associated with breastfeeding indicators.

Results: Overall, 14,191 mothers were recruited, with a response rate higher than 94%. Exclusive breastfeeding rates among children aged 2-3 months and 4-5 months were 44.4% and 25.8%, respectively; breastfeeding rates among children aged 11-12 and 13-15 months were 34.2% and 24.9%; 10.4% never breastfed. Strong geographical and socioeconomic differences were found. Some differences also emerged between crude and standardized rates.

Conclusions: We conclude that a survey system in vaccination centers is practicable and its use could produce, with standardized methodology, representative regional and national breastfeeding estimates that could monitor progress towards present and future targets.
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http://dx.doi.org/10.1177/0890334418823539DOI Listing
November 2019

In response to "missed opportunities and potentially misleading results in maternal mortality study".

Acta Obstet Gynecol Scand 2019 01 2;98(1):128-129. Epub 2018 Nov 2.

Statistics Service, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy.

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http://dx.doi.org/10.1111/aogs.13476DOI Listing
January 2019

Maternal mortality in Italy: Results and perspectives of record-linkage analysis.

Acta Obstet Gynecol Scand 2018 Nov 20;97(11):1317-1324. Epub 2018 Jul 20.

Statistics Service, Italian National Institute of Health-Istituto Superiore di Sanità, Rome, Italy.

Introduction: Accurate estimates and reliable classification of maternal deaths are imperative steps in the chain of actions targeted at reducing avoidable maternal mortality. The aims of this study were to estimate the maternal mortality ratio (MMR) in 10 Italian regions covering 77% of total national births and to identify the most suitable approach to classify the causes of death.

Material And Methods: Deaths during and within 1 year after pregnancy have been identified through linkage between death registry and hospital discharge database. Regional and national data sources from 2006 to 2012 were used. The MMR has been estimated and deaths were classified as direct or indirect and according to their primary causes.

Results: A total of 277 maternal deaths within 42 days after pregnancy were identified: 149 direct, 102 indirect causes and 26 unclassified-resulting in a MMR of 9.18 per 100 000 live births. The under-reporting rate of official MMR figures in the participating regions is 60.3%. Hemorrhage (MMR 1.92), hypertensive disorders of pregnancy and cardiac diseases (MMR 1.06) were the leading causes of deaths occurring within 42 days after pregnancy, whereas malignancy (39%) and violent deaths (17%) were the most frequent of the 543 late maternal deaths.

Conclusions: Record-linkage is an efficient and reliable method to estimate maternal mortality and to identify causes of maternal deaths. Both the indirect/direct and the classification by primary cause have a role in countries where direct deaths exceed indirect maternal mortality. Building upon linkage data, confidential enquiries further increase the likelihood of reducing maternal mortality.
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http://dx.doi.org/10.1111/aogs.13415DOI Listing
November 2018

Do Italian pregnant women use periconceptional folate supplementation?

Ann Ist Super Sanita 2017 Apr-Jun;53(2):118-124

Centro Nazionale di Prevenzione delle Malattie e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy.

Introduction: Deficiency of folic acid (FA) has been identified as a risk factor for neural tube defects (NTDs) as well as other congenital anomalies. Thus, periconceptional folate supplementation is recommended for all women planning to get pregnant.

Methods: We conducted a KAP (knowledge, attitude, practice) survey to investigate the use of FA and its appropriateness. The survey included a sample of 562 women who delivered in the Lazio region between 2013 and 2014. Two logistic regression analyses were performed to evaluate the association between the characteristics of participating women and both the information received on FA intake and its use.

Results: The prevalence of periconceptional FA assumption was 19.4% although 82.2% of the interviewed women had planned their pregnancies.

Conclusions: It shows that more periconceptional counseling is needed to increase women's awareness on the opportunity of FA supplementation.
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http://dx.doi.org/10.4415/ANN_17_02_07DOI Listing
April 2018

[OKkio alla SALUTE 2014: hours of sleep in Italian 8-9-year-old children].

Epidemiol Prev 2016 Mar-Apr;40(2):145

Centro nazionale di epidemiologia, sorveglianza e promozione della salute, Istituto superiore di sanità, Roma.

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http://dx.doi.org/10.19191/EP16.2.P145.071DOI Listing
January 2018

Do generic correction algorithms produce reliable estimates?

Lancet 2016 Apr 28;387(10030):1815-6. Epub 2016 Apr 28.

National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanità, Italian National Institute of Health, Rome, Italy.

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http://dx.doi.org/10.1016/S0140-6736(16)30319-1DOI Listing
April 2016

[Maternal perception of their children's weight and lifestyles].

Epidemiol Prev 2016 Jan-Feb;40(1):74

Centro nazionale di epidemiologia, sorveglianza e promozione della salute, Istituto superiore di sanità, Roma.

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http://dx.doi.org/10.19191/EP16.1.P074.017DOI Listing
September 2017

Dietary habits among children aged 8-9 years in Italy.

Ann Ist Super Sanita 2015 ;51(4):371-81

Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy.

Objective: To describe dietary habits and related geographic and socio-demographic characteristics among children aged 8-9 years in Italy.

Materials And Methods: Data from the 2012 national nutritional surveillance system collected from children, parents and teachers, have been linked to determine the children's eating habits. Logistic regression analyses were used to investigate the association between incorrect dietary habits and their potential predictors.

Results: Of the 46 307 children, 8.6% skipped breakfast, 48.8% did not eat vegetables and 28.7% did not eat fruit daily, 64.8% ate an abundant mid-morning snack, 41.4% drank sugary beverages and 12.5% drank carbonated beverages at least once a day. Three or more incorrect habits were found in 43.9% of the children. Incorrect dietary habits were more common among children with lower socio-economic conditions, who were resident in the South of the country and who spent more time watching TV.

Conclusion: In Italy, unhealthy dietary habits are common among children. The deficiencies identified may well be a harbinger of future public health problems.
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http://dx.doi.org/10.4415/ANN_15_04_20DOI Listing
February 2017

[Dietary behaviour of children attending primary school in Italy found by the surveillance system "OKkio alla salute"].

Epidemiol Prev 2015 Sep-Dec;39(5-6):380-5

Centro nazionale di epidemiologia, sorveglianza e promozione della salute, Istituto superiore di sanità, Roma.

Objectives: to describe the dietary behaviour of children attending primary school and the school activities which promote healthy dietary habits.

Design Of The Study: surveillance system with biannual prevalence studies.

Setting And Participants: the fourth round of data collection of the surveillance system OKkio alla SALUTE took place in 2014, promoted and financed by the Ministry of Health and coordinated by the National Institute of Health in collaborations with all regions. 2,408 schools, 48,426 children and 50,638 parents participated. Stratified cluster sampling (with third grade classes as units) was used; information was collected using questionnaires completed by children, parents, teachers and head-teachers.

Outcome Measures: consumption of breakfast, mid-morning snack, fruit and vegetables, sweetened and gassy drinks; school initiatives to promote healthy dietary habits.

Results: 31% of children have an adequate breakfast and 8% skip this meal; 52% consume an energy-dense mid-morning snack; 25% do not eat fruit and vegetables daily; 41% drink sweetened/gassy beverages daily. The unhealthy dietary habits are more common among children who have less educated parents or live in the South (more deprived area of the Country). Data show an improvement in the period 2008-2014, except in the consumption of fruit and vegetables. 74% of the schools include nutritional education in the curriculum, 66% have started initiatives of healthy dietary habits and 55% distribute healthy food; 35% involve parents in their initiatives. In the schools of the South nutritional education and involvement of parents are more frequent, while the distribution of healthy food and refectories are less common.

Conclusions: the high frequency of unhealthy dietary behaviour and their geographic and social inequalities show that there is a great potential for improvement. Schools are very involved in initiatives of promotion, but they need more support from the institutions and involvement of the families.
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June 2017
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