Избыточный вес у детей 3-12 лет: причины, эффекты, профилактика. Часть 3. Окружающая среда и двигательная сфера

Аннотация

Введение. Избыточный вес демонстрирует катастрофическое распространение по всем экономически развитым странам мира, несмотря на всемирные усилия по его профилактике. Целью работы был анализ предикторов избыточного веса, последствий его формирования и подходов к профилактике у детей.

Материалы и методы. Для анализа современного состояния изучения избыточного веса у детей 3-12 лет были использованы материалы из 168 зарубежных источников литературы из международной базы данных PubMed. Критерием включения источника в рассмотрение были репрезентативные выборки и наличие количественных данных по детям в возрастном интервале от 3 до 12 лет, характеризующих тот или иной аспект проблемы избыточного веса. Поиск информации проводился по следующим направлениям: «дети дошкольного и младшего школьного возраста», «избыточный вес и/или ожирение», «рацион питания», «экранное время», «сидячий образ жизни», «качество сна», «физическая (мышечная) работоспособность», «двигательная подготовленность», «физическая (двигательная) активность», «влияние окружающей среды».

Результаты и обсуждение. В Сообщении 3 систематизированы сведения о роли экранного времени, нарушения сна, среды обитания ребенка, включая пищевые ландшафты, социально-экономического статуса семьи, а также о связи двигательной сферы с избыточным весом, включая занятия спортом, изменения физической подготовленности, использование двигательной активности в профилактике избыточного веса. На основании анализа узловых факторов, ведущих к формированию избыточного веса, предложены направления профилактической работы с детьми, для предотвращения избыточного веса и метаболического синдрома.

Заключение. Проведенный анализ публикаций по проблеме избыточного веса у детей и весомых факторов, вызывающих нарушения метаболизма, позволяет наметить направления профилактической работы, учитывающие современное состояние исследований. Эта комплексная работа должна вестись одновременно в нескольких направлениях и на разных уровнях: индивидуальном, семейном, школьном, и на уровне общества и государства.

Благодарности. Исследование выполнено в рамках государственного задания № 073-00070-25-03 ФГБУН «Институт развития, здоровья и адаптации ребенка» Министерства просвещения России.

Финансирование. Исследование финансировалось в рамках государственного задания № 073-00070-25-03 ФГБУН «Институт развития, здоровья и адаптации ребенка» Министерства просвещения России.

 

Литература

Аршавский И.А. Очерки по возрастной физиологии. М.: Медицина. 1967. с 389.

Макеева А.Г. Влияние специального обучения на формирование навыков правильного питания у младших подростков - школьников // Вопросы школьной и университетской медицины и здоровья, 2021, № 4, с. 44-45.

Парфентьева О.И., Сонькин В.Д. Нелинейная зависимость показателей моторного развития от ИМТ у мальчиков-школьников 7-12 лет //Вестник Московского университета. Серия 23. Антропология, 2023. №. 1. С. 49-61. https://doi.org/10.32521/2074-8132.2023.1.049-061

Рекомендации ВОЗ по вопросам физической активности и малоподвижного образа жизни. Женева: Всемирная организация здравоохранения; 2021 г. Лицензия: CC BY-NC-SA 3.0 IGO.

Alviola P.A., Nayga Jr R.M., Thomsen M.R., Danforth D., Smartt J. The effect of fast-food restaurants on childhood obesity: a school level analysis. Econ. Hum. Biol., 2014, 12, рр. 110-119. https://doi.org/10.1016/j.ehb.2013.03.001

Bai Y., Chen S., Laurson K.R., Kim Y., Saint-Maurice P.F., et al. The Associations of Youth Physical Activity and Screen Time with Fatness and Fitness: The 2012 NHANES National Youth Fitness Survey. PLoS One, 2016, 11 (1), e0148038. https://doi.org/10.1371/journal.pone.0148038

Bakour C., Mansuri F., Johns-Rejano C., Crozier M., Wilson R., et al. Association between screen time and obesity in US adolescents: A cross-sectional analysis using National Survey of Children's Health 2016-2017. PLoS One, 2022, 17 (12), e0278490. https://doi.org/10.1371/journal.pone.0278490

Barnett T.A., Ghenadenik A.E., Van Hulst A., Contreras G., Kestens Y., et al. Neighborhood built environment typologies and adiposity in children and adolescents. Int. J. Obes. (Lond.), 2022, 46 (3), рр. 588-596. https://doi.org/10.1038/s41366-021-01010-1

Battaglia G., Giustino V., Tabacchi G., Lanza M., Schena F., et al. Interrelationship Between Age, Gender, and Weight Status on Motor Coordination in Italian Children and Early Adolescents Aged 6-13 Years Old. Front. Pediatr., 2021, 9, 738294. https://doi.org/10.3389/fped.2021.738294

Bi C., Yang J., Sun J., Song Y., Wu X., et al. Benefits of normal body mass index on physical fitness: A cross-sectional study among children and adolescents in Xinjiang Uyghur Autonomous Region, China. PLoS One, 2019, 14 (8), e0220863. https://doi.org/10.1371/journal.pone.0220863

Biehl A., Hovengen R., Grøholt E.K., Hjelmesæth J., Strand B.H., et al. Adiposity among children in Norway by urbanity and maternal education: a nationally representative study. BMC Public Health, 2013, 13, р. 842. https://doi.org/10.1186/1471-2458-13-842

Blaes A., Baquet G., Fabre C., Van Praagh E., Berthoin S. Is there any relationship between physical activity level and patterns, and physical performance in children? Int. J. Behav. Nutr. Phys. Act., 2011, 8, р. 122. https://doi.org/10.1186/1479-5868-8-122

Chaput J.P., Leduc G., Boyer C., Bélanger P., LeBlanc A.G., et al. Electronic screens in children's bedrooms and adiposity, physical activity and sleep: do the number and type of electronic devices matter? Can. J. Public Health, 2014, 105 (4), e273-9. https://doi.org/10.17269/cjph.105.4511

Chaput J.P., Tremblay M.S., Katzmarzyk P.T., Fogelholm M., Hu G., et al. Sleep patterns and sugar-sweetened beverage consumption among children from around the world. Public Health Nutr., 2018, 21 (13), рр. 2385-2393. https://doi.org/10.1017/S1368980018000976

Cheng J., East P., Blanco E., Sim E.K., Castillo M., et al. Obesity leads to declines in motor skills across childhood. Child Care Health Dev., 2016, 42 (3), рр. 343-350. https://doi.org/10.1111/cch.12336

Comeras-Chueca C., Villalba-Heredia L., Perez-Lasierra J.L., Marín-Puyalto J., Lozano-Berges G., et al. Active Video Games Improve Muscular Fitness and Motor Skills in Children with Overweight or Obesity. Int. J. Environ. Res. Public Health, 2022, 19 (5), р. 2642. https://doi.org/10.3390/ijerph19052642

de Jong E., Visscher T.L., HiraSing R.A., Heymans M.W., Seidell J.C., et al. Association between TV viewing, computer use and overweight, determinants and competing activities of screen time in 4- to 13-year-old children. Int. J. Obes. (Lond.), 2013, 37 (1), рр. 47-53. https://doi.org/10.1038/ijo.2011.244

den Uil A.R., Janssen M., Busch V., Kat I.T., Scholte R.H.J. The relationships between children's motor competence, physical activity, perceived motor competence, physical fitness and weight status in relation to age. PLoS One, 2023, 18 (4), e0278438. https://doi.org/10.1371/journal.pone.0278438

Drenowatz C., Eisenmann J.C., Pfeiffer K.A., Welk G., Heelan K., et al. Influence of socio-economic status on habitual physical activity and sedentary behavior in 8- to 11-year old children. BMC Public Health, 2010, 10, р. 214. https://doi.org/10.1186/1471-2458-10-214

Drenowatz C., Steiner R.P., Brandstetter S., Klenk J., Wabitsch M., et al. Organized sports, overweight, and physical fitness in primary school children in Germany. J. Obes., 2013, 2013, р. 935245. https://doi.org/10.1155/2013/935245

Fairclough S.J., Dumuid D., Mackintosh K.A., Stone G., Dagger R., et al. Adiposity, fitness, health-related quality of life and the reallocation of time between children's school day activity behaviours: A compositional data analysis. Prev. Med. Rep., 2018, 11, рр. 254-261. https://doi.org/10.1016/j.pmedr.2018.07.011

Fiechtner L., Tung J.Y., Orav E.J., Taveras E.M., Gillman M.W., et al. Proximity to supermarkets associated with higher body mass index among overweight and obese preschool-age children. Prev. Med., 2013, 56 (3-4), рр. 218-221. https://doi.org/10.1016/j.ypmed.2012.12.020

Galvez M.P., Hong L.U., Choi E., Liao L., Godbold J., et al. Childhood obesity and neighborhood food-store availability in an inner-city community. Acad. Pediatr., 2009, 9 (5), рр. 339-343. https://doi.org/10.1016/j.acap.2009.07.005

Gao Z., Pope Z., Lee J.E., Stodden D., Roncesvalles N., et al. Impact of exergaming on young children's school day energy expenditure and moderate-to-vigorous physical activity levels. J. Sport Health Sci., 2017, 6 (1), рр. 11-16. https://doi.org/10.1016/j.jshs.2016.11.008

Graf D.L., Pratt L.V., Hester C.N., Short K.R. Playing active video games increases energy expenditure in children. Pediatrics, 2009, 124 (2), рр. 534-540. https://doi.org/10.1542/peds.2008-2851

Gülü M., Yagin F.H., Gocer I., Yapici H., Ayyildiz E., et al. Exploring obesity, physical activity, and digital game addiction levels among adolescents: A study on machine learning-based prediction of digital game addiction. Front. Psychol., 2023, 14, 1097145. https://doi.org/10.3389/fpsyg.2023.1097145

Hager E.R., Cockerham A., O'Reilly N., Harrington D., Harding J., et al. Food swamps and food deserts in Baltimore City, MD, USA: associations with dietary behaviours among urban adolescent girls. Public Health Nutr., 2017, 20 (14), рр. 2598-2607. https://doi.org/10.1017/S1368980017001003

Hesketh K., Wake M., Graham M., Waters E.. Stability of television viewing and electronic game/computer use in a prospective cohort study of Australian children: relationship with body mass index. Int. J. Behav. Nutr. Phys. Act., 2007, 4, р. 60. https://doi.org/10.1186/1479-5868-4-60

Hjorth M.F., Chaput J.P., Ritz C., Dalskov S.M, Andersen R., et al. Fatness predicts decreased physical activity and increased sedentary time, but not vice versa: support from a longitudinal study in 8- to 11-year-old children. Int. J. Obes. (Lond.), 2014, 38 (7), рр. 959-965. https://doi.org/10.1038/ijo.2013.229

Hubbard K., Economos C.D., Bakun P., Boulos R., Chui K., et al. Disparities in moderate-to-vigorous physical activity among girls and overweight and obese schoolchildren during school- and out-of-school time. Int. J. Behav. Nutr. Phys. Act., 2016, 13, р. 39. https://doi.org/10.1186/s12966-016-0358-x

Jabbour G., Lambert M., O'Loughlin J., Tremblay A., Mathieu M.E. Mechanical efficiency during a cycling test is not lower in children with excess body weight and low aerobic fitness. Obesity (Silver Spring), 2013, 21 (1), рр. 107-114. https://doi.org/10.1002/oby.20241

Jakubec L., Gába A., Dygrýn J., Rubín L., Šimůnek A., et al. Is adherence to the 24-hour movement guidelines associated with a reduced risk of adiposity among children and adolescents? BMC Public Health, 2020, 20 (1), р. 1119. https://doi.org/10.1186/s12889-020-09213-3

Jansen W., Mackenbach J.P., Joosten-van Zwanenburg E., Brug J. Weight status, energy-balance behaviours and intentions in 9-12-year-old inner-city children. J. Hum. Nutr. Diet., 2010, 23 (1), рр. 85-96. https://doi.org/10.1111/j.1365-277X.2009.01027.x

Kasović M., Štefan L., Petrić V., Štemberger V., Blažević I. Functional endurance capacity is associated with multiple other physical fitness components in 7-14-year-olds: a cross-sectional study. BMC Public Health, 2021, 21 (1), р. 669. https://doi.org/10.1186/s12889-021-10702-2

Key J., Ball H., Ambikapathi R., De Marchis E., Saville N., et al. The effects of food environment on obesity in children: a systematic review. Children (Basel), 2023, 10 (1), р. 98. https://doi.org/10.3390/children10010098

Kobel S., Wartha O., Dreyhaupt J., Kettner S., Steinacker J.M. Cross-sectional associations of objectively assessed sleep duration with physical activity, BMI and television viewing in German primary school children. BMC Pediatr, 2019, 19 (1), р. 54. https://doi.org/10.1186/s12887-019-1429-3

Laguna M., Ruiz J.R., Lara M.T., Aznar S. Recommended levels of physical activity to avoid adiposity in Spanish children. Pediatr. Obes. 2013, 8 (1), pp. 62-69. https://doi.org/10.1111/j.2047-6310.2012.00086.x

Larsen M.N., Nielsen C.M., Ørntoft C.Ø., Randers M.B., Manniche V., et al. Physical Fitness and Body Composition in 8-10-Year-Old Danish Children Are Associated With Sports Club Participation. J. Strength Cond. Res., 2017, 31 (12), рр. 3425-3434. https://doi.org/10.1519/JSC.0000000000001952

Lätt E., Mäestu J., Ortega F.B., Rääsk T., Jürimäe T., et al. Vigorous physical activity rather than sedentary behaviour predicts overweight and obesity in pubertal boys: a 2-year follow-up study. Scand. J. Public Health, 2015, 43 (3), рр. 276-282. https://doi.org/10.1177/1403494815569867

Learmonth Y.C., Hebert J.J., Fairchild T.J., Møller N.C., Klakk H., et al. Physical education and leisure-time sport reduce overweight and obesity: a number needed to treat analysis. Int. J. Obes. (Lond.), 2019, 43 (10), рр. 2076-2084. https://doi.org/10.1038/s41366-018-0300-1

Lee H. The role of local food availability in explaining obesity risk among young school-aged children. Soc. Sci. Med., 2012, 74 (8), рр. 1193-1203. https://doi.org/10.1016/j.socscimed.2011.12.036

Li M.H., Rudd J., Chow J.Y., Sit C.H.P., Wong S.H.S., et al. A Randomized Controlled Trial of a Blended Physical Literacy Intervention to Support Physical Activity and Health of Primary School Children. Sports Med. Open, 2022, 8 (1), р. 55. https://doi.org/10.1186/s40798-022-00448-5

Liao Y., Chang S.H., Miyashita M., Stensel D., Chen J.F., et al. Associations between health-related physical fitness and obesity in Taiwanese youth. J. Sports Sci., 2013, 31 (16), рр. 1797-804. https://doi.org/10.1080/02640414.2013.803588

Lopes V.P., Malina R.M., Maia J.A.R., Rodrigues L.P. Body mass index and motor coordination: Non-linear relationships in children 6-10 years. Child Care Health Dev., 2018, 44 (3), рр. 443-451. https://doi.org/10.1111/cch.12557

Lopes V.P., Stodden D.F., Rodrigues L.P. Weight status is associated with cross-sectional trajectories of motor co-ordination across childhood. Child Care Health Dev., 2014, 40 (6), рр. 891-899. https://doi.org/10.1111/cch.12127

Lupo C., De Pasquale P., Boccia G., Ungureanu A.N., Moisè P., et al. The Most Active Child Is Not Always the Fittest: Physical Activity and Fitness Are Weakly Correlated. Sports (Basel), 2022, 11 (1), р. 3. https://doi.org/10.3390/sports11010003

Ma F.F., Luo D.M. Relationships between physical activity, fundamental motor skills, and body mass index in preschool children. Front. Public Health, 2023, 11, 1094168. https://doi.org/10.3389/fpubh.2023.1094168

Ma L., Ding Y., Chiu D.T., Wu Y., Wang Z., et al. A longitudinal study of sleep, weight status, and weight-related behaviors: Childhood Obesity Study in China Mega-cities. Pediatr. Res., 2021, 90 (5), рр. 971-979. https://doi.org/10.1038/s41390-021-01365-1

Marmeleira J., Veiga G., Cansado H., Raimundo A. Relationship between motor proficiency and body composition in 6- to 10-year-old children. J. Paediatr. Child Health, 2017, 53 (4), рр. 348-353. https://doi.org/10.1111/jpc.13446

Marques A., Minderico C., Martins S., Palmeira A., Ekelund U., et al. Cross-sectional and prospective associations between moderate to vigorous physical activity and sedentary time with adiposity in children. Int. J. Obes. (Lond.), 2016, 40 (1), рр. 28-33. https://doi.org/10.1038/ijo.2015.168

Matarma T., Lagström H., Hurme S., Tammelin T.H., Kulmala J., et al. Motor skills in association with physical activity, sedentary time, body fat, and day care attendance in 5-6-year-old children-The STEPS Study. Scand. J. Med. Sci. Sports, 2018, 28 (12), рр. 2668-2676. https://doi.org/10.1111/sms.13264

Nogueira H., Costeira E., Pereira M.M., Costa D., Gama A., Machado-Rodrigues A., et al. The environment contribution to gender differences in childhood obesity and organized sports engagement. Am. J. Hum. Biol., 2020, 32 (2), e23322. https://doi.org/10.1002/ajhb.23322

Ostojic S.M., Stojanovic M.D., Stojanovic V., Maric J., Njaradi N. Correlation between fitness and fatness in 6-14-year old Serbian school children. J. Health Popul. Nutr., 2011, 29 (1), рр. 53-60. https://doi.org/10.3329/jhpn.v29i1.7566

Riso E.M., Kull M., Mooses K., Hannus A., Jürimäe J. Objectively measured physical activity levels and sedentary time in 7-9-year-old Estonian schoolchildren: independent associations with body composition parameters. BMC Public Health, 2016, 16, р. 346. https://doi.org/10.1186/s12889-016-3000-6

Riso E.M., Toplaan L., Viira P., Vaiksaar S., Jürimäe J. Physical fitness and physical activity of 6-7-year-old children according to weight status and sports participation. PLoS One, 2019, 14 (6), e0218901. https://doi.org/10.1371/journal.pone.0218901

Roberto D.M.T., Pereira L.J., Vieira F.G.K., Di Pietro P.F., de Assis M.A.A., et al. Association between Sleep Timing, Being Overweight and Meal and Snack Consumption in Children and Adolescents in Southern Brazil. Int. J. Environ. Res. Public Health, 2023, 20 (18), р. 6791. https://doi.org/10.3390/ijerph20186791

Rose D., Bodor J.N., Rice J.C., Swalm C.M., Hutchinson P.L. The importance of a multi-dimensional approach for studying the links between food access and consumption. J. Nutr., 2010, 140 (6), рр. 1170-1174. https://doi.org/10.3945/jn.109.113159

Sagbo H., Kpodji P. Dietary diversity and associated factors among school-aged children and adolescents in Lokossa district of southern Benin: a cross-sectional study. BMJ Open, 2023, 13 (10), e066309. https://doi.org/10.1136/bmjopen-2022-066309

Sahota P., Rudolf M.C., Dixey R., Hill A.J., Barth J.H., et al. Randomised controlled trial of primary school based intervention to reduce risk factors for obesity. BMJ, 2001, 323 (7320), рр. 1029-32. https://doi.org/10.1136/bmj.323.7320.1029

Santos D.A., Magalhães J.P., Júdice P.B., Correia I.R., Minderico C.S., et al. Fitness Mediates Activity and Sedentary Patterns Associations with Adiposity in Youth. Med. Sci. Sports Exerc., 2019, 51 (2), рр. 323-329. https://doi.org/10.1249/MSS.0000000000001785

Shih Y.H., Wu H.C., Pan W.H., Chang H.Y. The Association Between Frequent Sugar-Sweetened Beverage Intake and Sleep Duration in School Children: A Cross-Sectional Study. Front. Nutr., 2022, 9, р. 847704. https://doi.org/10.3389/fnut.2022.847704

Sigmund E., El Ansari W., Sigmundová D. Does school-based physical activity decrease overweight and obesity in children aged 6-9 years? A two-year non-randomized longitudinal intervention study in the Czech Republic. BMC Public Health, 2012, 12, р. 570. https://doi.org/10.1186/1471-2458-12-570

Sigmund E., Sigmundová D. The Relationship between Obesity and Physical Activity of Children in the Spotlight of Their Parents' Excessive Body Weight. Int. J. Environ. Res. Public Health, 2020, 17 (23),  pp. 8737. https://doi.org/10.3390/ijerph17238737

Silva D.A.S., Lang J.J., Barnes J.D., Tomkinson G.R., Tremblay M.S. Cardiorespiratory fitness in children: Evidence for criterion-referenced cut-points. PLoS One, 2018, 13 (8), e0201048. https://doi.org/10.1371/journal.pone.0201048

Skrede T., Aadland E., Anderssen S.A., Resaland G.K., Ekelund U. Bi-directional prospective associations between sedentary time, physical activity and adiposity in 10-year old Norwegian children. J. Sports Sci., 2021, 39 (15), рр. 1772-1779. https://doi.org/10.1080/02640414.2021.1898114

Söğüt M., Clemente F.M., Clark C.C.T., Nikolaidis P.T., Rosemann T., Knechtle B. Variations in Central Adiposity, Cardiovascular Fitness, and Objectively Measured Physical Activity According to Weight Status in Children (9-11 Years). Front. Physiol., 2019, 10, р. 936. https://doi.org/10.3389/fphys.2019.00936

Stigman S., Rintala P., Kukkonen-Harjula K., Kujala U., Rinne M., et al. Eight-year-old children with high cardiorespiratory fitness have lower overall and abdominal fatness. Int. J. Pediatr. Obes., 2009, 4 (2), рр. 98-105. https://doi.org/10.1080/17477160802221101

Thivel D., Isacco L., Aucouturier J., Pereira B., Lazaar N., et al. Bedtime and sleep timing but not sleep duration are associated with eating habits in primary school children. J. Dev. Behav. Pediatr., 2015, 36 (3), рр. 158-165. https://doi.org/10.1097/DBP.0000000000000131

Thumann B.F., Buck C., De Henauw S., Hadjigeorgiou C., Hebestreit A., et al. Cross-sectional associations between objectively measured sleep characteristics and body mass index in European children and adolescents. Sleep Med., 2021, 84, рр. 32-39. https://doi.org/10.1016/j.sleep.2021.05.004

Trost S.G., Rosenkranz R.R., Dzewaltowski D. Physical activity levels among children attending after-school programs. Med. Sci. Sports Exerc., 2008, 40 (4), рр. 622-629. https://doi.org/10.1249/MSS.0b013e318161eaa5

Vizcaíno M.V., Aguilar S.F, Gutiérrez F.R., Martínez S.M, López S.M, et al. Assessment of an after-school physical activity program to prevent obesity among 9- to 10-year-old children: a cluster randomized trial. Int. J. Obes. (Lond.), 2008, 32 (1), рр. 12-22. https://doi.org/10.1038/sj.ijo.0803738

Wake M., Hesketh K., Waters E. Television, computer use and body mass index in Australian primary school children. J. Paediatr. Child Health, 2003, 39 (2), рр. 130-134. https://doi.org/10.1046/j.1440-1754.2003.00104.x

Webster E.K., Sur I., Stevens A., Robinson L.E. Associations between body composition and fundamental motor skill competency in children. BMC Pediatr., 2021, 21 (1), р. 444. https://doi.org/10.1186/s12887-021-02912-9

Widener M.J., Shannon J. When are food deserts? Integrating time into research on food accessibility. Health & Place, 2014, 30, р. 1. https://doi.org/10.1016/j.healthplace.2014.07.011.

Wilkie H.J., Standage M., Gillison F.B., Cumming S.P., Katzmarzyk P.T. Multiple lifestyle behaviours and overweight and obesity among children aged 9-11 years: results from the UK site of the International Study of Childhood Obesity, Lifestyle and the Environment. BMJ Open, 2016, 6 (2), e010677. https://doi.org/10.1136/bmjopen-2015-010677

Wisnieski L., Dalimonte-Merckling D., Robbins L.B. Cardiorespiratory Fitness as a Mediator of the Association between Physical Activity and Overweight and Obesity in Adolescent Girls. Child Obes., 2019, 15 (5), рр. 338-345. https://doi.org/10.1089/chi.2018.0360

Wolnicka K., Taraszewska A.M., Jaczewska-Schuetz J., Jarosz M. Factors within the family environment such as parents' dietary habits and fruit and vegetable availability have the greatest influence on fruit and vegetable consumption by Polish children. Public Health Nutr., 2015, 18 (15), рр. 2705-2711. https://doi.org/10.1017/S1368980015000695

Wood C., Gladwell V., Barton J. A repeated measures experiment of school playing environment to increase physical activity and enhance self-esteem in UK school children. PLoS One, 2014, 9 (9), e108701. https://doi.org/10.1371/journal.pone.0108701

Wood C., Hall K. Physical education or playtime: which is more effective at promoting physical activity in primary school children? BMC Res. Notes, 2015, 8, р. 12. https://doi.org/10.1186/s13104-015-0979-1

Yan R., Gong E., Li X., Zheng L., Liao W., et al. Impact of Obesogenic Environments on Sugar-Sweetened Beverage Consumption among Preschoolers: Findings from a Cross-Sectional Survey in Beijing. Nutrients, 2022, 14 (14), р. 2860. https://doi.org/10.3390/nu14142860