title: Relationship between weight status and health-related quality of life in Chinese primary school children in Guangzhou: a cross-sectional study.
abstract: BACKGROUND
  To investigate the association between weight status and health-related quality of life (HRQOL) among pupils in Guangzhou, China.
  
  
  METHODS
  The study comprised 5781 children aged 8-12 years from 29 schools. Height and weight were objectively measured using standardized methods, and BMI z-score derived using the age and sex specific WHO reference 2007 for 5-19 years. Weight status was classified as underweight (<-2SD), healthy weight (between -2SD and 1SD), overweight/obesity (>1SD). HRQOL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0.
  
  
  RESULTS
  After controlling for gender, age, school type, parental education, and family income, HRQOL scores were significantly lower in overweight/obese compared with healthy weight children only in the social functioning domain (β = -1.93, p = 0.001). Compared with healthy weight children, underweight children had significantly lower total (β = -1.47, p = 0.05) and physical summary scores (β = -2.18, p = 0.02). Subgroup analysis for gender indicated that compared to healthy weight, total (β = -1.96, p = 0.02), psychosocial (β = -2.40, p = 0.01), social functioning (β = -3.36, p = 0.001), and school functioning (β = -2.19, p = 0.03) scores were lower in overweight/obese girls, but not boys. On the other hand, being underweight was associated with lower physical functioning (β = -2.27, p = 0.047) in girls, and lower social functioning (β = -3.63, p = 0.01) in boys. The associations were mainly observed in children aged 10 and over, but were not significant in younger children. Children from private schools had generally lower HRQOL compared to those in public schools, but the associations with weight status were similar in both groups.
  
  
  CONCLUSIONS
  The relationship between overweight/obesity and HRQOL in children in China is not as prominent as that seen in children in western or high-income countries. However, there appears to be gender and age differences, with more of an impact of overweight on HRQOL in girls and older children compared with boys and younger children. Underweight is also associated with lower HRQOL. Future intervention to prevent both obesity and undernutrition may have a positive impact on the HRQOL in children in China.
authors.affiliation: Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Lin
authors.affiliation: Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China.
authors.forename: Weijia
authors.initials: W
authors.lastname: Liu
authors.affiliation: Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China.
authors.forename: Zhongshan
authors.initials: Z
authors.lastname: Guo
authors.affiliation: Faculty of School Health, Guangzhou Centre for Disease Control and Prevention, Guangzhou, China.
authors.forename: Lihua
authors.initials: L
authors.lastname: Xiong
authors.affiliation: Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
authors.forename: Bai
authors.initials: B
authors.lastname: Li
authors.affiliation: Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
authors.forename: K K
authors.initials: KK
authors.lastname: Cheng
authors.affiliation: Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. P.ADAB@bham.ac.uk.
authors.forename: Peymane
authors.initials: P
authors.lastname: Adab
authors.affiliation: Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
authors.forename: Miranda
authors.initials: M
authors.lastname: Pallan
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002662:Child Health Services; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D063766:Pediatric Obesity / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D011788:Quality of Life; D012572:School Health Services; D012574:Schools
keywords: Children; Health-related quality of life; Weight status