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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 4  |  Page : 190-200

Prevalence of obesity in Iranian children: Systematic review and meta-analysis


1 Traditional and Complementary Medicine Research Center, Addiction Institute; Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
2 Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
3 Department of Medical-Surgical, Faculty of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
4 Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran

Date of Submission08-Jan-2019
Date of Decision18-Mar-2019
Date of Acceptance08-Apr-2019
Date of Web Publication18-Nov-2019

Correspondence Address:
Dr. Ali Hasanpour Dehkordi
Department of Medical-Surgical, Faculty of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord
Iran
Dr. Leila Jouybari
Nursing Research Center, Golestan University of Medical Sciences, Gorgan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJMS.INJMS_2_19

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  Abstract 


Background of the Study: Childhood obesity, in addition to the likelihood of its continuation in adulthood, is associated with an increase in mortality and various diseases. Purpose of the Study: This meta-analytic study aimed at determining the prevalence of obesity among Iranian children. Methodology: Two researchers independently searched national and international databases using MeSH, Scopus, PubMed, Science Direct, Web of Science, Springer, Magiran, Iranmedex, SID, Medlib, and the Google Scholar search engine. The heterogeneity between studies was evaluated using the I2 index. Data were analyzed using STATA software. This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Among 93 studies with a sample size of 3,845,768, the prevalence of obesity in Iranian children was 7% (girls 8% and boys 10%), and the prevalence of overweight was 12% (girls 17% and boys 15%). The incidence rate of obesity in children was 13% based on US centers for disease control and prevention (CDC) 2000 reference, 11% on international obesity task force (IOTF) reference, 9% on World Health Organization reference, 9% on Iranian reference, 5% on CDC reference, and 3% on national center for health statistics (NCHS) reference. Meta-regression diagram also showed that the prevalence of obesity in children was not dependent on sample size. However, the prevalence of obesity declined during the years 1999–2016, which was statistically significant. Conclusion: The prevalence of obesity in Iranian children was less than of their overweight. On the other hand, the prevalence of childhood obesity in girls was lower than that of boys, and the prevalence of child overweight among girls was higher than that of boys.

Keywords: Children, Iran, meta-analysis, obesity, prevalence, overweight


How to cite this article:
Fakhri M, Sarokhani D, Sarokhani M, Dehkordi AH, Jouybari L. Prevalence of obesity in Iranian children: Systematic review and meta-analysis. Indian J Med Spec 2019;10:190-200

How to cite this URL:
Fakhri M, Sarokhani D, Sarokhani M, Dehkordi AH, Jouybari L. Prevalence of obesity in Iranian children: Systematic review and meta-analysis. Indian J Med Spec [serial online] 2019 [cited 2019 Dec 14];10:190-200. Available from: http://www.ijms.in/text.asp?2019/10/4/190/271222




  Introduction Top


The World Health Organization (WHO) has identified obesity as a global issue and[1] referred to it as the most serious global health issue that affects the quality of life and ends up in physical, mental, and psychological disorders.[2],[3] The prevalence of childhood obesity has dramatically increased throughout the world over the past decades. Obesity in adolescence is mostly rooted in childhood.[4] According to international definitions, at least 10% of children worldwide are overweight or obese.[5] In other words, about 22 million children worldwide have excess weight.[6] In 2010, overweight/obesity led to the death of 3.4 million people, a loss of 3.9% of the length of their lives, and 3.8% of disability.[7] It has been estimated that up to one-third of the population of children in developed countries is overweight.[8] The prevalence of obesity in Canadian children in the age range of 7–13 years ranged from 5% to 15% between 1981 and 1996.[9] From 2011to 2012, 32.2% of the US children were overweight and 17.3% were obese. In addition, 5.9% of children with obesity had Grade 2 and 2.1% had Grade 3 of obesity criteria. Although these rates were not significantly different from those of 2009–2010, all obesity classes have increased over the past 14 years.[10] Obesity in Iran is a serious problem and is linked to the pandemic of obesity in the world.[11] Lifestyle changes in many developing countries including Iran have been accompanied by aftermaths such as weight gain and obesity and now, childhood obesity has become a global epidemic with domestic, psychological, and economic complications.[12],[13],[14],[15],[16] Obesity is associated with an increase in adult mortality and is also accompanied with childhood problems such as insulin resistance, type 2 diabetes, dyslipidemia, polycystic ovary syndrome, pulmonary disorders, orthopedic ailments, psychiatric problems, chronic cardiovascular diseases, and hypertension.[17] Obesity in children is also accompanied by depression, confusion, low self-esteem, and frustration.[18] The importance of obesity in childhood and adolescence is not only due to early physical and psychological complications, but also because of the increase in adulthood obesity, the increased incidence of diseases and mortality, and also heavy economic burdens on the society.[17] Given the risks in health issues and the significant rise in obesity, it has become a major global health challenge. Obesity has not only increased, but it has not been controlled over the past 33 years. Therefore, international collaboration is needed to help tackle this problem.[19],[20],[21] It is also necessary to have information about the prevalence of obesity among children because it can lead to the identification of subgroups at risk to take preventive measures.[22] Prevention of obesity is very important because effective treatments for this condition are limited. Food management and increased physical activity should be encouraged, promoted, and prioritized to protect children.[4],[12],[23],[24],[25],[26],[27],[28],[29] Over the past few years, many studies have been published on the prevalence of obesity in Iranian children, which have reported different outcomes. This study aimed to determine the prevalence of obesity among Iranian children through a systematic review and meta-analysis.


  Literature Review Top


Protocol of study

We registered the study protocol on the PROSPERO site (ID: 128049, Date: 09/03/2019).

Purpose of the study

This study aimed at determining the prevalence of obesity in Iranian children through meta-analysis.

The design of the study

This research was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses study of reporting system.[30]

Methodology

All articles on the prevalence of obesity in Iranian children have been studied. Two researchers independently used the keywords “Prevalence, Obesity, Overweight, children, Meta-analysis, and Iran” and their combinations and scrutinized the national and international databases including Scopus, PubMed, Science Direct, Web of Science, Springer, Magiran, Iranmedex, SID, Medlib, and the Google Scholar search engine. For generalization of the research step, internal and external keywords were used for general keywords and in external databases, the combination of keywords was used with the “AND” and “OR” operators. The search step was unrestricted and updated by November 2017. In order to complete the search process, manual search was also performed through reviewing the sources of the articles found.

Research outcomes

The inclusion criteria included articles that reported the prevalence of obesity among Iranian children. Exclusion criteria involved studies that had nonrandom sampling, studies that did not have sufficient data and information, studies with inaccessible full texts, studies that did not have the required quality, studies that were not of childhood age range, and studies that were conducted outside Iran. The language of the articles was Persian and English, but in the search phase, no time and language restrictions were applied.

Quality appraisal

The researchers examined the quality of articles using the STROBE checklist,[31] a well-known international standard checklist for qualitative evaluation of articles. This checklist consists of 22 different sections and covers different parts of a report including sampling, variable measurement, statistical analysis, confounding modifications, validity, and reliability of used tools and study objectives. The score range for this checklist is between 0 and 44, and articles scoring <15.5 were excluded from the study.

Data abstraction

Studies that conformed to the required criteria were finally analyzed. To reduce the reporting bias and error in data collection, two researchers independently extracted data from articles. The researchers listed a checklist including the name of the author, study title, age, the prevalence of obesity (in general, the girl and the boy), the prevalence of weight gain (in general, the girl and the boy), the prevalence of weight loss, the year and place of the study, the total number, and the number of girls and boys.

Synthesis

The variance of each study was calculated according to the binomial distribution. Studies were combined according to the sample number and variance. Regarding the heterogeneity of the studies, the random effects model was used. In order to evaluate the studies, Cochran method and I2 index were utilized. The I2 <25% indicates a low heterogeneity, I2 between 25% and 75% indicates a moderate heterogeneity, and I2 >75% indicates a high heterogeneity. The heterogeneity in our study was 99.2%, which was categorized as high heterogeneity. To investigate the relationship between the prevalence of obesity and the quantitative variables of years, and the number of samples, the meta-regression model was used. Data were analyzed using STATA version 11 (KitelyTech's industry leading custom software development services, Chicago). The significance level of the tests was considered to be P < 0.05.


  Results Top


While conducting the study, 93 articles had entered the meta-analysis process, which were in the period from 1998 to 2017.[12],[13],[14],[15] The total number of participants in the study was 3,845,768. As the selected studies had high heterogeneity, the random effects model was used. The meta-analysis of the prevalence of obesity in Iranian children resulted from the combination of the results of studies presented in [Flowchart 1] and [Table 1]. The properties of the studies are listed in [Table 1].[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53],[54],[55],[56],[57],[58],[59],[60],[61],[62],[63],[64],[65],[66],[67],[68],[69],[70],[71],[72],[73],[74],[75],[76],[77],[78],[79],[80],[81],[82],[83],[84],[85],[86],[87],[88],[89],[90],[91],[92],[93],[94],[95],[96],[97],[98],[99],[100],[101],[102],[103],[104],[105],[106],[107],[108],[109],[110],[111],[112],[113],[114],[115],[116],[117],[118],[119],[120],[121],[122]

Table 1: The information on the articles included in the systematic review and meta-analysis

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The prevalence of obesity in Iranian children was 7% (girls 8% and boys 10%) [Figure 1], of which, the weight gain was 12% (girls 17% and boys 15%), and the incidence of weight reduction was 13% [Table 2].
Figure 1: The prevalence and 95% confidence intervals of obesity among Iranian children based on the authors' name and years of research drawing on the random effects model. The middle point of each section reveals the prevalence of obesity in children in each study. The lozenge shows the prevalence of obesity in Iranian children for all studies

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Table 2: The results of meta-analysis on the prevalence of obesity in Iranian children

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As shown in [Figure 2], there was no significant relationship between the prevalence of obesity in Iranian children and the number of research samples (P = 0.116). However, there was a significant relationship between the prevalence of obesity and the year of study (P = 0.039) [Figure 3].
Figure 2: The relationship between the prevalence of obesity in Iranian children and the number of research samples using the meta-regression model

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Figure 3: The relationship between the prevalence of obesity in Iranian children and the year of research using the meta-regression model

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  Discussion Top


Overall, 144 articles with the sample size of 377,858 people (134,588 males and 164,858 females) were included in the study. The prevalence of obesity in populations above the age of 18 in Iran was estimated as 21.7% (95% confidence interval [CI]: 18.5%–25%) and in population below 18, it was 6.1% (95% CI: 6.8%–5.4%).[123] Regarding 93 studies with 3,845,768 people, the prevalence of obesity among Iranian children was 7% (girls 8% and boys 10%), and the prevalence of weight gain was 12% (girls 17% and boys 15%). The results of this study indicated that the prevalence of childhood obesity in boys was higher than that of girls. In a study regarding 23 provinces in Iran in the years 2003–2004, the prevalence of weight gain and obesity in schoolchildren was 9.8% and 4.4%, respectively.[124] The findings of these studies indicated that the prevalence of weight gain was higher than that of obesity in children, which was quite consistent with the current study. In a study conducted in Canada by Veugelers and Fitzgerald, the prevalence of obesity was 9% in girls and 10.9% in boys.[125] In another study in Greece in 2007, the incidence rate of obesity was 48.9% in girls and 51.1% in boys (aged 8–10 years old).[126] In their study, which was similar to this research, the prevalence of childhood obesity was higher in boys than girls. However, in a study in Sweden in 2006, the prevalence of obesity was 5% for girls and 10% for boys (10%),[127] which was inconsistent with the current study's findings.

In the analysis, the prevalence of childhood obesity on the basis of different references was examined. It was found that the prevalence of obesity in children was 13% based on CDC 2000 reference, 11% on IOTF reference, 9% on WHO reference, 9% on Iranian reference, 5% on CDC reference, and 3% on NCHS reference. These results indicated that, according to the CDC 2000 reference, the prevalence of obesity in children was the highest, and based on the NCHS reference, the prevalence of obesity in children was the lowest. In China, the incidence rate of obesity in children under 6 years of age was 3.2%, 3.5%, and 6.8%, using the WHO, IOTF, and CDC guidelines, respectively. The corresponding values for children aged 6–9 years were 10%, 6.3%, and 10.4%, respectively.[128] In Sweden in 2006, the prevalence of obesity was 3.4% and that of weight gain was 22% for 10-year-old children using the WHO reference.[127] In Iran, Prevalences of overweight, obesity, hypertension and abdominal obesity were 21.92, 5.28, 13.16 and 25.31% respectively. The highest prevalence of obesity and abdominal obesity reported in District 3, which is north of Tehran and the lowest was related to boys from region 19 of southern Tehran.[38] According to the WHO criteria, the prevalence of obesity in Iranian children was about three times as much as Swedish children. In the analysis adjusting for children's age groups, the children were divided into two groups of 6 and over 6 years old. It was found that the prevalence of obesity was 8% for children under the age of 6 years and 7% for children aged 6 years and above. It can be said that the prevalence of obesity in Iranian children less than 6 years old was higher than that of children over the age of 6 years. According to the results of a study in Korea in 2005, the prevalence of obesity and weight gain on 54,324 children under the age of 6 years was 6.3% and 10%, and on 32,673 children aged 7–12 years was 8.6% and 12.3%, respectively.[129] The findings of that study were not consistent with the results of the current study. In another study conducted by Armstrong et al. in Scotland on 32,200 children aged 6–8 years, it was found that the prevalence of obesity in children was 8.55%; 8.1% in girls and 9% in boys.[130]

In [Figure 2], the size of a large circle shows sample numbers. No significant relationship was observed between the prevalence of obesity in Iranian children and the number of research samples (P = 0.116). This means that the prevalence of obesity in Iranian children will not increase with increasing number of samples. According to [Figure 3], there is a significant relationship between the prevalence of obesity in Iranian children and the years of study (P = 0.039). Thus, during the years studied, the incidence of obesity in Iranian children declined in the period between 2008 and 2017. There was no difference between the prevalence of obesity in urban and rural communities of Iran and in both regions, the prevalence of obesity was 9%, which may have resulted in the same results due to the unmatched number of studies in each of these two groups. The results of a review study on 144 children show that, in 2010, nearly 43 million infants were overweight or obese.[7] In the USA, during 1999–2000, 16% of children were overweight and 31% of them were at the risk of becoming overweight or were actually overweight. This signified an increase of almost 30% since 1960 and a rise of 45% since the last completed studies in the years 1996–1988.[131] A study on 6 to 11-year-old American children showed that the prevalence of obesity ranged from 4.2% in 1970 to 18.8% in 2004.[132] As for girls living in California, 21.7% were overweight.[133] In Sicily, the prevalence of weight gain in children aged 11 years was 40% and in 15 year olds, it was 25%.[134] According to a study by Martin et al., in Sorocaba in 2010, the prevalence of weight gain and obesity in children aged 7–11 years was 13.1% and 9%, respectively.[135] In another report from the USA, Figueroa-Colon et al. reported the prevalence of obesity among young girls under the age of 5 years as 23%, 10% for White girls aged 5–11 years, 47% for Black girls, and 27% for Whites.[136] The findings of a study by Veugelers and Fitzgerald in Canada in 2003 showed that the prevalence of obesity and weight gain in children aged 10–11 years was 9.9% and 32.9%, respectively.[35] In a study by Valean et al., in Romania, the prevalence of obesity and weight gain in children aged 10 years was 13.31% and 15.95%, respectively.[137] It could be said that the prevalence of obesity among Iranian children was lower than those of many European countries.

Limitations of the study

The limitations of this study included the lack of access to the full texts of some studies and the uneven distribution of studies among urban and rural areas.


  Conclusion Top


Given the high prevalence of obesity and the economic, social, and socioeconomic consequences that ensue the society and families, governments should opt for scientific and educational approaches in devising plans to control and alleviate this phenomenon. Fast foods should be limited or removed from the daily diet. Health-care providers should check the child's risk of obesity and other health problems. Moreover, for children under the age of 2 years, body mass index should be monitored regularly, and electronic health record programs and anthropometric criteria should be devised for children's health control programs.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
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