To investigate the association of folic acid (FA) supplementation with birth weight, the risk of small for gestational age (SGA) and low birth weight (LBW) in singleton and twin pregnancy.

A population-based cross-sectional survey.

Twenty counties and ten districts in Shaanxi Province of northwestern China, 2013.

28 174 pregnant women with their infants, covering 27 818 single live births and 356 twin live births.

The prevalence of FA supplementation in singletons and twins was 63·9 and 66·3 %. The mean birth weight was 3267 (sd 459·1) g, 2525 (sd 534·0) g and 2494 (sd 539·5) g; the prevalence of SGA was 14·3, 51·4 and 53·4 %; the prevalence of LBW was 3·4, 42·4 and 46·6 % among singleton, twin A and twin B, respectively. Compared with non-users, women with FA supplementation were (β 17·3, 95 % CI 6·1, 28·4; β 166·3, 95 % CI 69·1, 263·5) associated with increased birth weight, lower risk of SGA (OR 0·85, 95 % CI 0·80, 0·92; OR 0·45, 95 % CI 0·30, 0·68) and LBW (OR 0·82, 95 % CI 0·71, 0·95; OR 0·50, 95 % CI 0·33, 0·75) in singletons and twins, and more prominent effects in twins. Moreover, there were significant interactions between FA supplementation and plurality on birth weight, SGA and LBW.

The present study suggests the association of periconceptional 0·4 mg/d FA supplementation with increased birth weight and reduced risk of SGA and LBW in both singletons and twins, and this association may be more prominent in twins.

To examine the hypothesis that the association between vitamin D deficiency and depressive symptoms is dependent upon total cholesterol level in a representative national sample of the South Korean population.

This was a population-based cross-sectional study.

The Fifth Korean National Health and Nutrition Examination Survey (KNHANES V, 2010–2012).

We included 7198 adults aged 20–88 years.

The incidence of depressive symptoms in individuals with vitamin D deficiency (serum 25-hydroxyvitamin D<20 ng/ml) was 1·54-fold (95 % CI 1·20, 1·98) greater than in individuals without vitamin D deficiency (serum 25-hydroxyvitamin D ≥20 ng/ml). The relationship was stronger in individuals with normal-to-borderline serum total cholesterol (serum total cholesterol<240 mg/dl; OR=1·60; 95 % CI 1·23, 2·08) and non-significant in individuals with high serum total cholesterol (OR=0·97; 95 % CI 0·52, 1·81) after adjustment for confounding variables (age, sex, BMI, alcohol consumption, smoking status, regular exercise, income level, education level, marital status, changes in body weight, perceived body shape, season of examination date and cholesterol profiles).

The association between vitamin D deficiency and depressive symptoms was weakened by high serum total cholesterol status. These findings suggest that both vitamin D and total cholesterol are important targets for the prevention and treatment of depression.

To investigate the reciprocal relationship between unhealthy eating behaviours and depressive symptoms from childhood to adolescence.

Unhealthy eating behaviours were measured by the frequencies of eating foods with excess salt, sugar or fat in the past week. Depressive symptoms in the past two weeks were measured using a seven-item scale. Hierarchical linear growth models were used to analyse longitudinal associations between unhealthy eating behaviours and depressive symptoms. Time-fixed variables (sex, parents’ education level and household monthly income) and time-varying variables (parents’ marital status, family activities, body weight, vegetable or fruit consumption, exercising and smoking) were controlled for.

The Child and Adolescent Behaviors in Long-Term Evolution study, which commenced in 2001 and has annual follow-up.

Students (n 2630) followed from 2nd grade (8 years old in 2002) to 11th grade.

The frequency of unhealthy eating behaviours in the previous year and the difference between the frequency in the previous and successive year were positively associated with the initiation and growth rate of depressive symptoms. Depressive symptoms in the previous year and the difference in depressive symptoms between the previous and successive year were positively associated with the initial state and growth rate of unhealthy eating behaviours.

Our results suggest a reciprocal relationship between depressive symptoms and unhealthy eating behaviours. This relationship should be considered when developing programmes targeting depressive symptoms and unhealthy diet in children and adolescents.

The current study aimed to evaluate the association of major dietary patterns with anxiety in middle-aged adults in eastern China.

Dietary intake was assessed using a semi-quantitative FFQ. Binary logistic regression analysis was used to estimate OR and 95 % CI for anxiety according to quartiles of each dietary pattern score.

Evidence regarding the relationship between dietary patterns and anxiety in the Chinese population is scarce.

The study participants were 1360 Chinese adults aged 45–59 years, who participated in a health survey at the time of periodic check-up in the city of Linyi, Shandong Province, China.

Four major dietary patterns were identified by factor analysis: traditional Chinese, western, grains–vegetables and high-salt diets. After adjusting for potential confounders, participants in the highest quartile of the western pattern had greater odds for anxiety, compared with those in the lowest quartile (OR 1·35, 95 % CI 1·000, 3·086, P < 0·05). In contrast, participants in the highest quartile of the grains–vegetables pattern had lower odds for anxiety than did those in the lowest quartile (OR 0·78, 95 % CI 0·574, 1·000, P < 0·05). Moreover, no significant associations were observed between the traditional Chinese and high-salt patterns and the risk of anxiety.

Our findings indicate that the western pattern is associated with an increased risk, and the grains–vegetables pattern is associated with a decreased risk of anxiety.

To assess the validity of a 148-item quantitative FFQ (QFFQ) that was developed for the Barbados National Cancer Study (BNCS) to determine dietary intake over 12 months and examine the dietary risk factors.

A cross-sectional validation study of the QFFQ against 4 d food diaries. Spearman’s rank correlations (ρ), intra-class correlation coefficients (ICC) and weighted κ were computed as measures of concordance, adjusting for daily variations in the food diaries. Cross-classification tables and Bland–Altman plots were created for further assessment.

BNCS is a case–control study of environmental risk factors for breast and prostate cancer in a predominantly African-origin population in Barbados.

Fifty-four individuals (21 years and older) were recruited among controls in the BNCS who were frequency-matched on sex and age group to breast and prostate cancer cases.

Similar mean daily energy intake was derived from the food diary (8201 kJ (1960 kcal)) and QFFQ (7774 kJ (1858 kcal)). Rho for energy and macronutrients ranged from 0·66 (energy) to 0·17 (dietary fibre). The percentage of energy from carbohydrates and protein showed the highest and lowest ICC among macronutrients (0·63 and 0·27, respectively). The highest weighted κ was observed for energy (0·45). When the nutrient intake was divided into quartiles, approximately 34 % of the observations were in the same quartile.

This investigation supports the validity of the QFFQ as a method for assessing long-term dietary intake except for dietary fibre, folate, vitamins A, E and B12. The instrument will be a useful tool in the analysis of diet–cancer associations in the BNCS.

To study the association between organic food consumption and lifestyle, socio-demographics and dietary habits.

Cohort participants completed detailed questionnaires about organic food consumption, diet and lifestyle between 1999 and 2002. Polytomous logistic regression models were used to estimate the association between organic food consumption, and lifestyle, socio-demographics, and dietary habits.

This cross-sectional study uses data from the Danish Diet, Cancer and Health cohort.

A total of 43 209 men and women aged between 54 and 73 years were included in the study.

Overall, 15 % reported never consuming organic food, 39 % had low organic food consumption, 37 % had medium organic food consumption and 10 % had high organic food consumption. The relative risk of consuming organic food versus never consuming organic food was highest among women, persons with BMI < 25 kg/m2, persons with low alcohol intake, persons participating in sports, persons who did not smoke or were former smokers, and among persons who adhered to the Danish national dietary guidelines. Associations were more distinct with higher levels of organic food consumption.

Based on a historical cohort of Danish adults, organic food consumption was associated with a generally healthy lifestyle, more favourable socio-demographics and dietary habits. These findings have to be considered in the adjustment strategy for future studies linking organic food consumption with health outcomes.

We aimed to examine missing data in FFQ and to assess the effects on estimating dietary intake by comparing between multiple imputation and zero imputation.

We used data from the Okazaki Japan Multi-Institutional Collaborative Cohort (J-MICC) study. A self-administered questionnaire including an FFQ was implemented at baseline (FFQ1) and 5-year follow-up (FFQ2). Missing values in FFQ2 were replaced by corresponding FFQ1 values, multiple imputation and zero imputation.

A methodological sub-study of the Okazaki J-MICC study.

Of a total of 7585 men and women aged 35–79 years at baseline, we analysed data for 5120 participants who answered all items in FFQ1 and at least 50% of items in FFQ2.

Among 5120 participants, the proportion of missing data was 3·7%. The increasing number of missing food items in FFQ2 varied with personal characteristics. Missing food items not eaten often in FFQ2 were likely to represent zero intake in FFQ1. Most food items showed that the observed proportion of zero intake was likely to be similar to the probability that the missing value is zero intake. Compared with FFQ1 values, multiple imputation had smaller differences of total energy and nutrient estimates, except for alcohol, than zero imputation.

Our results indicate that missing values due to zero intake, namely missing not at random, in FFQ can be predicted reasonably well from observed data. Multiple imputation performed better than zero imputation for most nutrients and may be applied to FFQ data when missing is low.

To identify factors associated with food purchasing decisions and expenditure of South African supermarket shoppers across income levels.

Intercept surveys were conducted, grocery receipts collated and expenditure coded into categories, with each category calculated as percentage of the total expenditure. In-supermarket food quality audit and shelf space measurements of foods such as fruits and vegetables (F&V) (healthy foods), snacks and sugar-sweetened beverages (SSB) (unhealthy foods) were also assessed. Shoppers and supermarkets were classified by high-, middle- and low-income socio-economic areas (SEA) of residential area and location, respectively. Shoppers were also classified as “out-shoppers” (persons shopping outside their residential SEA) and “in-shoppers” (persons shopping in their residential SEA). Data were analysed using descriptive analysis and ANOVA.

Supermarkets located in different SEA in urban Cape Town.

Three hundred ninety-five shoppers from eleven purposively selected supermarkets.

Shelf space ratio of total healthy foods v. unhealthy foods in all the supermarkets was low, with supermarkets located in high SEA having the lowest ratio but better quality of fresh F&V. The share expenditure on SSB and snacks was higher than F&V in all SEA. Food secure shoppers spent more on food, but food items purchased frequently did not differ from the food insecure shoppers. Socio-economic status and food security were associated with greater expenditure on food items in supermarkets but not with overall healthier food purchases.

Urban supermarket shoppers in South Africa spent substantially more on unhealthy food items, which were also allocated greater shelf space, compared with healthier foods.

To evaluate the performance of an FFQ for estimating dietary contributions of NOVA groups to individuals’ diets with a specific focus on ultra-processed foods (UPF) compared with a single 24-h dietary recall (24HR).

All consumed foods and beverages assess with both a 109-item FFQ and a single 24HR were classified into one of four NOVA groups: natural or minimally processed foods (MPF), processed culinary ingredients (PCI), processed foods (PF) and UPF. The contributions of each NOVA group to daily intakes of energy, protein, fat, saturated fat, carbohydrate, fibre and Na were expressed as crude intake, energy-adjusted intake and percentage intake. Mean differences, correlation coefficients and joint classification were calculated for intakes of energy and nutrients from each NOVA group between the FFQ and the 24HR.

The Korea National Health and Nutrition Examination Survey 2016.

Adults aged 19–64 years (n 3189).

The smallest group-mean differences between the two methods were observed in UPF (2–40 %). The greatest average Pearson’s correlation coefficients between the FFQ and 24HR were shown in dietary contributions of UPF (r = 0·22–0·25 for MPF; r = 0·02–0·05 for PCI; r = 0·11–0·18 for PF; r = 0·26–0·30 for UPF). The greatest agreement in quartile classification between the FFQ and the 24HR was observed in dietary contributions of UPF (70·0–71·5 % for MPF; 64·2–68·8 % for PCI; 66·9–69·2 % for PF; 71·8–73·9 % for UPF).

The use of the FFQ for estimating absolute intake of UPF may not be encouraged in its current form, but it still may be used for relative comparisons such as quantile categorisation.

To estimate the prevalence of malnutrition (undernutrition and excess BMI) among children under the age of 5 years and women of reproductive age in Bolivia considering three socioeconomic indicators: wealth, education and ethnicity.

We used the 2008 nationally representative Bolivian Demographic and Health Survey (DHS). Malnutrition’s prevalence was estimated by wealth, ethnicity and educational level. Wealth index was measured based on the DHS methodology and nutritional status by using WHO standards and indicators. Education level (EL) was categorized by years of formal education.

Bolivia.

In total, 5·903 children <5 years, 3·345 adolescent women (15–19 years) and 12·297 women (20–49 years) with available information on anthropometric measurements·

A disproportionate prevalence of malnutrition was observed among different wealth groups: lower wealth tertiles show the higher prevalence of stunting (>30 %) and anaemia (>40 %) in all ages· The prevalence of overweight and obesity tends to rise with age from childhood (10·02–11·60) to adolescence (27·9–31·03), reaching highest levels in women of reproductive age (56·02–57·76). According to wealth tertiles, higher prevalence of overweight and obesity was found in children of high tertile (12·23), adolescent women of low (32·56) and adult women of medium tertile (63·08).

The present study shows that currently Bolivia is in a transitional stage, faces not only the problem of undernutrition but also those of overnutrition, showing strong inequalities according to socioeconomic and education status. This study calls for state-specific policies keeping in view of the nature of inequality in malnutrition in the country and its differential characteristics across wealth status.

The present study aimed to develop and validate a questionnaire assessing social support for healthy eating in a French-Canadian population.

A twenty-one-item questionnaire was developed. For each item, participants were asked to rate the frequency, in the past month, with which the actions described had been done by family and friends in two different environments: (i) at home and (ii) outside of home. The content was evaluated by an expert panel. A validation study sample was recruited and completed the questionnaire twice. Exploratory factor analysis was performed on items to assess the number of subscales. Internal consistency reliability was assessed using Cronbach’s ɑ. Test–retest reliability was evaluated with intraclass correlations between scores of the two completions.

Online survey.

Men and women from the Québec City area (n 150).

The content validity assessment led to a few changes, resulting in a twenty-two-item questionnaire. Exploratory factor analysis revealed a two-factor structure for both environments, resulting in four subscales: supportive actions at home; non-supportive actions at home; supportive actions outside of home; and non-supportive actions outside of home. Two items were removed from the questionnaire due to low loadings. The four subscales were found to be reliable (Cronbach’s ɑ=0·82–0·94; test–retest intraclass correlation=0·51–0·70).

The Social Support for Healthy Eating Questionnaire was developed for a French-Canadian population and demonstrated good psychometric properties. This questionnaire will be useful to explore the role of social support and its interactions with other factors in predicting eating behaviours.

To evaluate compliance with the World Health Organization's International Code of Marketing of Breast-milk Substitutes in primary care, after the introduction of strict local infant feeding guidelines.

An audit form was sent to all community-based health professionals with an infant feeding remit. Walking tours were conducted in a random sample of community care facilities.

Greater Glasgow Primary Care Division.

(1) Primary-care staff with an infant feeding remit; (2) community health-care facilities.

Contact with manufacturers of breast-milk substitutes (BMS) and BMS company personnel, free samples or incentives, and advertising of BMS.

Contact with company personnel was minimal, usually unsolicited and was mainly to provide product information. Free samples of BMS or feeding equipment were rare but childcare or parenting literature was more prevalent. Staff voiced concerns about the lack of relevant information for bottle-feeding mothers and the need to support the mother's feeding choice. One-third of facilities were still displaying materials non-compliant with the Code, with the most common materials being weight conversion charts and posters.

Contact between personnel from primary care and BMS companies was minimal and generally unsolicited. The presence of materials from BMS companies in health-care premises was more common. Due to the high level of bottle-feeding in Glasgow, primary-care staff stated a need for information about BMS.

Schools offer an ideal setting for childhood obesity interventions due to their access to children and adolescents. This review aimed to systematically review the impact of school-based intervention for the treatment of childhood obesity.

Eight databases were searched from inception till 30 May 2020. A revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to evaluate the risk of bias and overall evidence. Meta-analysis and meta-regression were performed on Stata software using the random effects model. Overall effect was evaluated using Hedges’ g, and heterogeneity was assessed using Cochran’s Q and I2.

Cluster randomised controlled trials (cluster-RCT) delivered in school.

Children and adolescents (6–18 years of age) with overweight and obesity.

Twelve cluster-RCT from seven countries with 1755 participants were included in the meta-analysis. School-based interventions for the treatment of childhood obesity reduced BMI and BMI z-scores with a medium effect (g = 0·52). Subgroup analyses showed greater effectiveness of brief school-based interventions and the interventions conducted in lower-middle to upper-middle economies. Meta-regression assessed the heterogeneity and the final model, with covariates of the type of economies and trial duration, accounted for 41·2 % of the variability. The overall quality of evidence was rated low because of the high risk of bias and inconsistency.

School-based interventions are a possible approach to provide universal healthcare for the treatment of childhood obesity, and further well-designed cluster-RCT with longer follow-up are needed. This study is registered with PROSPERO (CRD42020160735).

To describe changes in total and central adiposity and body fat distribution in children over a 5-year period by investigating variations in BMI, waist circumference (WC), waist-to-height ratio (WHtR) and skinfold thicknesses (SFT).

A school-based sample of children from 2nd to 5th grades of elementary schools participated in two cross-sectional studies in 2002 (n 2936) and 2007 (n 1232).

Public and private schools of Florianopolis, Brazil.

Schoolchildren aged 7–10 years had their weight, height, WC and SFT measured according to standard procedures. Body fat distribution was assessed by triceps, subscapular, suprailiac and medial calf skinfold measurements. Changes in BMI, WC, WHtR and SFT were analysed, adjusting for type of school and monthly family income.

Adjusted mean differences between 2002 and 2007 for BMI and WC were always positive and of similar magnitude between boys and girls. However, a statistically significant increase was observed only for BMI (raw and Z-score values) in boys. WHtR remained stable in both sexes. Adjusted median values for SFT also increased in boys and girls, except for triceps skinfold. BMI, WC and SFT tended to increase across age classes in both sexes. The relative change observed for the median central skinfolds (subscapular and suprailiac) was greater than that of peripheral skinfolds (triceps and medial calf).

The subcutaneous adipose tissue (SFT) appeared to increase at a faster rate than total adiposity (BMI). The increase in central SFT indicates that the relative change is due primarily to a rise in central adiposity.

To describe national disparities in retail food environments by neighbourhood composition (race/ethnicity and socio-economic status) across time and space.

We examined built food environments (retail outlets) between 1990 and 2014 for census tracts in the contiguous USA (n 71 547). We measured retail food environment as counts of all food stores, all unhealthy food sources (including fast food, convenience stores, bakeries and ice cream) and healthy food stores (including supermarkets, fruit and vegetable markets) from National Establishment Time Series business data. Changes in food environment were mapped to display spatial patterns. Multi-level Poisson models, clustered by tract, estimated time trends in counts of food stores with a land area offset and independent variables population density, racial composition (categorised as predominantly one race/ethnicity (>60 %) or mixed), and inflation-adjusted income tertile.

The contiguous USA between 1990 and 2014.

All census tracts (n 71 547).

All food stores and unhealthy food sources increased, while the subcategory healthy food remained relatively stable. In models adjusting for population density, predominantly non-Hispanic Black, Hispanic, Asian and mixed tracts had significantly more destinations of all food categories than predominantly non-Hispanic White tracts. This disparity increased over time, predominantly driven by larger increases in unhealthy food sources for tracts which were not predominantly non-Hispanic White. Income and food store access were inversely related, although disparities narrowed over time.

Our findings illustrate a national food landscape with both persistent and shifting spatial patterns in the availability of establishments across neighbourhoods with different racial/ethnic and socio-economic compositions.

To characterise clusters of individuals based on adherence to dietary recommendations and to determine whether changes in Healthy Eating Index (HEI) scores in response to a personalised nutrition (PN) intervention varied between clusters.

Food4Me study participants were clustered according to whether their baseline dietary intakes met European dietary recommendations. Changes in HEI scores between baseline and month 6 were compared between clusters and stratified by whether individuals received generalised or PN advice.

Pan-European, Internet-based, 6-month randomised controlled trial.

Adults aged 18–79 years (n 1480).

Individuals in cluster 1 (C1) met all recommended intakes except for red meat, those in cluster 2 (C2) met two recommendations, and those in cluster 3 (C3) and cluster 4 (C4) met one recommendation each. C1 had higher intakes of white fish, beans and lentils and low-fat dairy products and lower percentage energy intake from SFA (P<0·05). C2 consumed less chips and pizza and fried foods than C3 and C4 (P<0·05). C1 were lighter, had lower BMI and waist circumference than C3 and were more physically active than C4 (P<0·05). More individuals in C4 were smokers and wanted to lose weight than in C1 (P<0·05). Individuals who received PN advice in C4 reported greater improvements in HEI compared with C3 and C1 (P<0·05).

The cluster where the fewest recommendations were met (C4) reported greater improvements in HEI following a 6-month trial of PN whereas there was no difference between clusters for those randomised to the Control, non-personalised dietary intervention.

The objective of the current study was to determine if patients of a large health care system in Detroit who self-identify as food insecure live further away from healthy grocery stores compared with food secure patients. Second, we explored whether food insecurity and distance to healthy grocery stores are related to ecological measures of vehicle availability in the area of residence.

A secondary data analysis that uses baseline data from a pilot intervention/feasibility study.

Detroit, Michigan, USA.

Patients of Henry Ford Health System were screened for food insecurity to determine eligibility for a pilot intervention/feasibility study (i.e. Henry’s Groceries for Health), conducted through a collaboration with Gleaners Community Foodbank of Southeastern Michigan. Only patients residing in Detroit city limits (including Highland Park and Hamtramck) were included in the secondary analysis. Of the 1,100 patients included in the analysis, 336 (31 %) were food insecure.

After accounting for socio-demographic factors associated with food insecurity, we did not find evidence that food insecure patients lived further away from healthier grocery stores, nor was this modified by ecological measures of vehicle access. However, some neighbourhoods were identified as having a significantly higher risk of food insecurity.

Food insecure patients in Detroit are perhaps limited by social and political determinants and not their immediate neighbourhood geography or physical access to healthy grocery stores. Future research should explore the complexity in linkages between household socio-economic factors, socio-cultural dynamics and the neighbourhood food environment.

To examine awareness and recall of healthy eating public education campaigns in five countries.

Data were cross-sectional and collected as part of the 2018 International Food Policy Study. Respondents were asked whether they had seen government healthy eating campaigns in the past year; if yes (awareness), they were asked to describe the campaign. Open-ended descriptions were coded to indicate recall of specific campaigns. Logistic models regressed awareness of healthy eating campaigns on participant country, age, sex, ethnicity, education, income adequacy and BMI. Analyses were also stratified by country.

Online surveys.

Participants were Nielsen panelists aged ≥18 years in Australia, Canada, Mexico, UK and the USA (n 22 463).

Odds of campaign awareness were higher in Mexico (50·9 %) than UK (18·2 %), Australia (17·9 %), the USA (13·0 %) and Canada (10·2 %) (P < 0·001). Awareness was also higher in UK and Australia v. Canada and the USA, and the USA v. Canada (P < 0·001). Overall, awareness was higher among males v. females and respondents with medium or high v. low education (P < 0·001 for all). Similar results were found in stratified models, although no sex difference was observed in Australia or UK (P > 0·05), and age was associated with campaign awareness in UK (P < 0·001). Common keywords in all countries included sugar/sugary drinks, fruits and vegetables, and physical activity. The top five campaigns recalled were Chécate, mídete, muévete (Mexico), PrevenIMSS (Mexico), Change4Life (UK), LiveLighter® (Australia), and Actívate, Vive Mejor (Mexico).

In Mexico, UK and Australia, comprehensive campaigns to promote healthy lifestyles appear to have achieved broad, population-level reach.

International definitions of childhood obesity based on body mass index (BMI) are intended to be used for international comparisons of obesity prevalence. In general, they are not appropriate to be used in clinical practice. The objective of this study is to compare international-ecological vs. national-clinical reference data of obesity in Spain, as well as to describe trends.

Cross-sectional study from a representative national random sample of Spanish children and youth conducted between 1998 and 2000. Prevalence estimates of obesity in a national random sample of Spanish children and youth are presented in this paper, defined by age- and sex-specific BMI national reference standards for the 85th percentile (overweight) and 95th percentile (obesity), as well as by Cole et al. criteria. The study protocol included personal data, data on education and socio-economic status for the family and anthropometric measurements.

Population-based study set in Spain.

A random sample of 3534 individuals, aged 2–24 years.

Prevalence of obesity using national reference data was higher (15.3%) than using international data (5.8%), but overweight rates were similar. Agreement observed for both definitions was low for obesity but higher for overweight. Obesity trends among children and adolescents in Spain show increasing patterns in boys but not in girls.

Results indicate the need to standardise the definitions of obesity and overweight in childhood and recommend the use of overweight due to the greater degree of agreement observed among the different methods used. The IOTF reference method underestimates obesity rates in Spanish schoolchildren.