Child and adolescent obesity: part of a bigger picture

Association between Obesity and Cardiovascular Disease Risk Factors in Different Age Groups of Adolescents: An Analysis of Data from the Korean National Health and Nutritional Examination Survey

We investigated the association between obesity and cardiovascular disease risk factors (CVDRFs) in adolescents. We performed a cross-sectional study using the data from 8149 adolescents, aged 10-18 years, included in the Korean National Health and Nutrition Examination Survey (2011-2020). Using the body mass index, we defined "overweight" (≥85th to <95th percentile) and "obese" (≥95th percentile). We analyzed the associations between obesity and CVDRFs (high blood pressure, abnormal lipid profiles, and high fasting glucose levels) by sex and age groups (early [10-12 years], middle [13-15 years], and late [16-18 years] adolescence). When analyzing all the subjects, being overweight was correlated with high blood pressure and abnormal all-lipid profiles in boys and high triglyceride and low high-density lipoprotein cholesterol levels in girls, while obesity was associated with all CVDRFs in both boys and girls. Analyzing separately in the age subgroups, the correlation between obesity and CVDRFs tended to be shown earlier in boys than in girls, and obesity tended to be associated with CVDRFs earlier than being overweight. The association between obesity and CVDRFs may begin to be shown at different periods of youth, depending on the degree of obesity, CVDRF variables, and sex.

Long-Term Results of Bariatric Surgery in Adolescents with at Least 5 Years of Follow-up: a Systematic Review and Meta-Analysis

OBJECTS

The purpose of this study was to investigate the long-term outcomes of bariatric surgery in adolescents with obesity by including studies with a follow-up of at least 5 years.

METHODS

PubMed, EMBASE, and CENTRAL were systematically searched. Studies that met the criteria were included in the analysis.

RESULT

We identified 29 cohort studies with a total population of 4970. Preoperative age ranged from 12 to 21 years; body mass index (BMI) ranged from 38.9 to 58.5 kg/m². Females were the predominant gender (60.3%). After at least 5-year of follow-up, the pooled BMI decline was 13.09 kg/m² (95%CI 11.75-14.43), with sleeve gastrectomy (SG) was 15.27 kg/m², Roux-en-Y gastric bypass (RYGB) was 12.86 kg/m², and adjustable gastric banding (AGB) was 7.64 kg/m². The combined remission rates of type 2 diabetes mellitus (T2DM), dyslipidemia, hypertension (HTN), obstructive sleep apnea (OSA), and asthma were 90.0%, 76.6%, 80.7%, 80.8%, and 92.5%, (95%CI 83.2-95.6, 62.0-88.9, 71.5-88.8, 36.4-100, and 48.5-100), respectively. Postoperative complications were underreported. Combined with the current study, we found a low level of postoperative complications. Iron and vitamin B12 deficiencies were the main nutritional deficiency complications identified so far.

CONCLUSION

For adolescents with severe obesity, bariatric surgery (especially RYGB and SG) is the independent and effective treatment option. After at least 5 years of follow-up, bariatric surgery in adolescents showed a desirable reduction in BMI and significant remission of T2DM, dyslipidemia, and HTN. Surgical and nutrition-related complications still need to be further explored by more long-term studies.

GLP-1 receptor agonist, liraglutide, protects podocytes from apoptosis in diabetic nephropathy by promoting white fat browning

Glucagon like peptide-1 receptor agonists (GLP-1RAs) belong to the class of incretin drugs. Incretin is a hormone secreted into blood by intestinal cells after food stimulation that induces insulin secretion. Liraglutide is a long-acting GLP-1RA that can reduce blood pressure, blood lipids, and inflammation. Previous studies showed that liraglutide can promote white fat browning and improve renal outcomes in patients with type 2 diabetes mellitus. However, no studies have linked white fat browning to kidney damage. The objective of this study was to investigate the effects of liraglutide-induced white fat browning on podocyte apoptosis in diabetic nephropathy. We also aimed to determine whether podocytes express glucagon like peptide-1 receptor (GLP-1R) and if liraglutide directly affects podocytes via GLP-1R. We assessed fat and renal function in db/db and wild-type mice and the effects of adipocyte conditioned medium on cultured podocytes. Liraglutide (400 mg/kg/d) was subcutaneously injected for 8 weeks. Liraglutide promoted white fat browning in vivo. During adipogenic differentiation of 3T3-L1 cells in vitro, liraglutide also upregulated expression of peroxisome proliferator-activated receptor γ coactivator-1 alpha (PGC1α) and uncoupling protein 1 (UCP1), which can induce white fat browning in vitro. Furthermore, we found that supernatant from 3T3-L1 cells stimulated by liraglutide reduced podocyte apoptosis. The inhibitory effect of liraglutide on apoptosis was eliminated by exogenous TNF-α. Finally, podocytes express GLP-1R. In vivo and in vitro studies showed that the apoptosis of podocytes in diabetic nephropathy may be related to the effect of liraglutide on promoting white lipid browning. Similarly, liraglutide may directly affect podocytes via GLP-1R.

Micronutrient Deficiency in Children and Adolescents with Obesity-A Narrative Review

Childhood obesity represents a serious public health burden. Despite excessive dietary consumption, children with obesity present high rates of micronutrient deficiencies, such as deficiencies in minerals and specific vitamins; micronutrient deficiencies may have a pathogenic role in obesity-related metabolic comorbidities. In this narrative review, we analyzed the main deficiencies associated with obesity, their clinical consequences, and the evidence about a possible supplementation. Iron; vitamins A, B, C, D, and E; folic acid; zinc; and copper deficiencies represent the most common deficient microelements. The relationship between obesity and multiple micronutrient deficiencies remains unclear, and different mechanisms have been proposed. The medical care plan for pediatric obesity should include food choices with high nutritional content as part of a crucial approach to obesity-related complications. Unfortunately, only a few studies are available regarding the efficacy of oral supplementation or weight loss for treating them; thus, continuous nutritional monitoring is necessary.

MaestraNatura Reveals Its Effectiveness in Acquiring Nutritional Knowledge and Skills: Bridging the Gap between Girls and Boys from Primary School

MaestraNatura (MN) is a nutrition education program developed to both enhance awareness about the importance of healthy eating behaviour and skills on food and nutrition in primary school students. The level of knowledge about food and nutritional issues was assessed by a questionnaire administered to 256 students (9–10 years old) attending the last class of primary school and was compared with that of a control group of 98 students frequenting the same schools that received traditional nutrition education based on curricular science lessons and one frontal lesson conducted by an expert nutritionist. The results indicated that students in the MN program showed a higher percentage of correct responses to the questionnaire when compared with the control group (76 ± 15.4 vs. 59 ± 17.7; p < 0.001). Furthermore, the students attending the MN program were requested to organise a weekly menu before (T0) and when finished (T1) the MN program. The results evidenced an overall significant improvement in the score obtained at T1 with respect to those at T0 (p < 0.001), indicating a strong improvement in the ability to translate the theoretical concepts of nutrition guidelines in practice. In addition, the analysis revealed a gender gap between boys and girls, with boys showing a worse score at T0 that was ameliorated after the completion of the program (p < 0.001). Overall, MN program is effective in improving nutrition knowledge amongst 9–10-year-old students. Furthermore, students showed an increased ability to organise a weekly dietary plan after completing the MN program, a result which also bridged gender gaps. Thus, preventive nutrition education strategies specifically addressed to boys and girls, and involving both the school and family, are needed to make children aware of the importance of a healthy lifestyle and to correct inadequate eating habits.

Barriers and Facilitators Related to the Adoption of Policies to Reduce Ultra-Processed Foods Consumption: A Scoping Review

Cost-effective regulatory and fiscal interventions are recommended to address non-communicable diseases. While some countries are advancing regarding these actions, others have found it difficult to approve them.

AIM

to conduct a scoping review to answer the question "What factors have influenced the adoption of food taxes, front-of-pack labeling and restrictions on marketing to children?".

METHODS

A scoping review was developed from four databases. Studies that described and analyzed policy processes were included. Analysis was performed to identify the barriers and enablers mentioned under the guidance of Swinburn et al., Huang et al., Mialon et al., and Kingdon.

RESULTS

168 documents were identified, describing experiences from five regions or groups and 23 countries, which have generated 1584 examples of 52 enablers (689 examples; 43.5%) and 55 barriers (895 examples; 56.5%) that may have influenced policies. The main enablers were related to the government environment and governance and to civil society strategies. Corporate political activity strategies were the main examples of barriers.

CONCLUSIONS

This scoping review consolidated barriers and facilitators related to policies aimed at reducing ultra-processed foods consumption, demonstrating that factors related to the actions of governments and civil society are the main facilitators. On the other hand, as the most interested actor in promoting the consumption of these products, the strategies adopted by the companies that produce these products constitute the main barrier to these policies in all the studied countries and should be overcome.

The energetics of childhood: Current knowledge and insights into human variation, evolution, and health

How organisms capture and ultimately use metabolic energy-a limiting resource of life-has profound implications for understanding evolutionary legacies and current patterns of phenotypic variation, adaptation, and health. Energetics research among humans has a rich history in biological anthropology and beyond. The energetics of childhood, however, remains relatively underexplored. This shortcoming is notable given the accepted importance of childhood in the evolution of the unique human life history pattern as well as the known sensitivity of childhood development to local environments and lived experiences. In this review, I have three objectives: (1) To overview current knowledge regarding how children acquire and use energy, highlighting work among diverse human populations and pointing to recent advances and remaining areas of uncertainty; (2) To discuss key applications of this knowledge for understanding human variation, evolution, and health; (3) To recommend future avenues for research. A growing body of evidence supports a model of trade-offs and constraint in childhood energy expenditure. This model, combined with advancements on topics such as the energetics of immune activity, the brain, and the gut, provides insights into the evolution of extended human subadulthood and the nature of variation in childhood development, lifetime phenotype, and health.

Targeted Lipidomics and Inflammation Response to Six Weeks of Sprint Interval Training in Male Adolescents

Lipids play an important role in coordinating and regulating metabolic and inflammatory processes. Sprint interval training (SIT) is widely used to improve sports performance and health outcomes, but the current understanding of SIT-induced lipid metabolism and the corresponding systemic inflammatory status modification remains controversial and limited, especially in male adolescents. To answer these questions, twelve untrained male adolescents were recruited and underwent 6 weeks of SIT. The pre- and post-training testing included analyses of peak oxygen consumption (VO2peak), biometric data (weight and body composition), serum biochemical parameters (fasting blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triacylglycerol, testosterone, and cortisol), inflammatory markers, and targeted lipidomics. After the 6-week SIT, the serum C-reactive protein (CRP), interleukin (IL)-1β, IL-2, IL-4, IL-10, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β significantly decreased (p < 0.05), whereas IL-6 and IL-10/TNF-α significantly increased (p < 0.05). In addition, the targeted lipidomics revealed changes in 296 lipids, of which 33 changed significantly (p < 0.05, fold change > 1.2 or <1/1.2). The correlation analysis revealed that the changes in the inflammatory markers were closely correlated with the changes in some of the lipids, such as LPC, HexCer, and FFA. In conclusion, the 6-week SIT induced significant changes in the inflammatory markers and circulating lipid composition, offering health benefits to the population.

Is early or late biological maturation trigger obesity? A machine learning modeling research in Turkey boys and girls

Biological maturation status can affect individual differences, sex, height, body fat, and body weight in adolescents and thus may be associated with obesity. The primary aim of this study was to examine the relationship between biological maturation and obesity. Overall, 1,328 adolescents (792 boys and 536 girls) aged 12.00 ± 0.94-12.21 ± 0.99 years, respectively (measured for body mass, body stature, sitting stature). Body weights were deter-mined with Tanita body analysis system and adolescent obesity status was calculated according to the WHO classification. Biological maturation was determined according to the somatic maturation method. Our results showed that boys mature 3.077-fold later than girls. Obesity was an increasing effect on early maturation. It was determined that being obese, overweight and healthy-weight increased the risk of early maturation 9.80, 6.99 and 1.81-fold, respectively. The equation of the model predicting maturation is: Logit (P) = 1/(1 + exp. (- (-31.386 + sex-boy * (1.124) + [chronological age = 10] * (-7.031) + [chronological age = 11] * (-4.338) + [chronological age = 12] * (-1.677) + age * (-2.075) + weight * 0.093 + height * (-0.141) + obesity * (-2.282) + overweight * (-1.944) + healthy weight * (-0.592)))). Logistic regression model predicted maturity with 80.7% [95% CI: 77.2-84.1%] accuracy. In addition, the model had a high sensitivity value (81.7% [76.2-86.6%]), which indicates that the model can successfully distinguish adolescents with early maturation. In conclusion, sex and obesity are independent predictors of maturity, and the risk of early maturation is increased, especially in the case of obesity and in girls.

Loss of Lkb1 in CD11c+ myeloid cells protects mice from diet-induced obesity while enhancing glucose intolerance and IL-17/IFN-γ imbalance

Adipose tissue CD11c⁺ myeloid cell is an independent risk factor associated with obesity and metabolic disorders. However, the underlying molecular basis remains elusive. Here, we demonstrated that liver kinase B1 (Lkb1), a key bioenergetic sensor, is involved in CD11c⁺ cell-mediated immune responses in diet-induced obesity. Loss of Lkb1 in CD11c⁺ cells results in obesity resistance but lower glucose tolerance, which accompanies tissue-specific immune abnormalities. The accumulation and CD80's expression of Lkb1 deficient adipose-tissue specific dendritic cells but not macrophages is restrained. Additionally, the balance of IL-17A and IFN-γ remarkably tips towards the latter in fat T cells and CD11c^- macrophages. Mechanistically, IFN-γ promotes apoptosis of preadipocytes and inhibits their adipogenesis while IL-17A promotes the adipogenesis in vitro, which might account in part for the fat gain resistant phenotype. In summary, these findings reveal that Lkb1 is essential for fat CD11c⁺ dendritic cells responding to HFD exposure and provides new insights into the IL-17A/IFN-γ balance in HFD-induced obesity.

The association of metabolic syndrome status with sensorineural hearing loss in pediatric obese patients

OBJECTIVES

The prevalences of pediatric obesity and its associated comorbidities such as metabolic syndrome (metS) are rising. The aim of this study was to evaluate the association of metS status with sensorineural hearing loss in pediatric obese patients.

METHODS

A two-center observationalprospective study was designed. In this study, 252 consecutive treatment-naive pediatric obese patients aged 5.8-17.8 yr in a tertiary pediatric Endocrinology outpatient clinic were prospectively enrolled. Following standard clinical and biochemical evaluations, the obese patients were diagnosed as having metabolic syndrome (metS) or not according to Internetional Diabetes Federation Criteria. All the patients were evaluated with tympanometry and pure tone audiometry tests after otomicroscopic examination. Comparative analyses of audiometric evaluations were performed between metS+ and metS- subgroups of the obese patients.

RESULTS

The median age of the patients was 12.5 yr (range: 6.0-17.8 yr) and 56.3% of the patients were male. Metabolic syndrome was diagnosed in 82 (32.5%) patients. Age, gender distribution, history of the ventilation tube, and pubertal stage of the metS + patients and metS- counterparts were not statistically different (p > 0.05 for all). Pure tone hearing thresholds at all frequencies (125, 250, 500, 1k, 2k, 4k, 8k) were significantly higher in the metS + group then the metS- group (p˂0.05 for all). The tympanometry results were not statistically different between the two groups (p˃0.05). Abdominal obesity, hypertension, fasting hyperglycemia and dyslipidemia were not associated with increased hearing thresholds in metS + patients (p˃0.05 for all).

CONCLUSION

Metabolic syndrome was associated with increased rates of subclinical hearing loss in our cohort. None of the investigated metS components emerged as a positive association with hearing loss in our cohort. Longitudinal follow-up of our cohort may help probe the causality of the association we found.

Body Composition in Youths Aged 10‒17 Years by Deuterium Oxide Dilution, Air Displacement Plethysmography, and DXA: Validation of the Medical Body Composition Analyzer Bioimpedance Device by a 4-Compartment Model

BACKGROUND

The medical body composition analyzer (mBCA) incorporates advances in multifrequency technology and has been validated using a 4-compartment (4C) model in adults but not in youths aged <18 y.

OBJECTIVES

This study aimed to formulate a 4C model based on 3 reference methods and develop and validate a body composition prediction equation for the mBCA in youths aged 10‒17 y.

METHODS

The body density of 60 female and male youths was measured by air displacement plethysmography, total body water by deuterium oxide dilution, and BMC by DXA. Data from the equation group (n = 30) were used to formulate a 4C model. The all-possible-regressions method was used to select variables. The model was validated in a second cohort (n = 30) in a random split design. The accuracy, precision, and potential bias were evaluated by the Bland and Altman procedure.

RESULTS

Mean age, weight (W), height (H), waist circumference, and z-score of BMI were 13.6 ± 2.3 y, 54.5 ± 15.5 kg, 156 ± 11.9 cm, 75.5 ± 10.9 cm, and 0.70 ± 1.32 z, respectively. The prediction equation was as follows: FFM in kg (FFM_kg) = ([0.2081] ∗ [W] + [0.8814] ∗ [H²_cm/R_Ω] + [0.2055 ∗ Xc_Ω])-15.343; R² = 0.96; standardized root-mean-square error (SRMSE) = 2.18 kg. FFM did not differ between the 4C method (38.9 ± 12.0 kg) and the mBCA (38.4 ± 11.4 kg) (P > 0.05). The relationship between these 2 variables did not deviate from the identity line, was not significantly different from 0, and the slope was not significantly different from 1.0. In the precision prediction model of mBCA, the R² value was 0.98 and SRMSE was 2.1. No significant bias was found when regressing differences between methods and their means (P = 0.08).

CONCLUSIONS

The equation for the mBCA was accurate, precise, had no significant bias, had substantial strength of agreement and could be used in this age group when subjects were preferentially within the constraints of a specified body size.

Barriers and facilitators of childhood obesity prevention policies: A systematic review and meta-synthesis

Objectives

Childhood obesity is one of the worldwide considerable public health challenges and many factors can play a role in its management. Therefore, this article examined the facilitators and barriers of childhood obesity prevention (COP) policies.

Methods

This systematic review of qualitative studies was conducted via a search of the SCOPUS, PubMed, and Google Scholar databases between 1 January 2010 and 11 February 2022 and examined factors that influence the implementation of COP policies at a community approach.

Results

The parents' reluctance to engage in COP activities, lack of sufficient knowledge, and financial problems were the most reported barriers at the individual level. In addition, the beliefs about COP at the sociocultural level and limited funding and resources, time limitations in stakeholders at the implementation level, and lack of policy support at the structural level were the most frequently reported barriers. Further, effective communication between stakeholders and parents and school staff at the sociocultural level and flexibility of the intervention, delivery of healthy food programs in schools, low-cost and appropriate resources, and the availability of appropriate facilities are the most frequently reported facilitators in the structural level.

Conclusion

Individual, sociocultural, and structural level-related barriers and facilitators influence the implementation of COP policies. Most of the barriers and facilitators in this systematic review were related to the structural level.

Nutrient patterns in relation to metabolic health status in overweight and obese adolescents

The association between dietary nutrient patterns (NPs) and metabolic health status has not been investigated in adolescents. This study aimed to evaluate the relationship between NPs and metabolic health status in Iranian adolescents with overweight and obesity. In this cross-sectional study, 203 obese/overweight adolescents were selected using a multistage mass random sampling method. To assess usual dietary intakes, a validated food frequency questionnaire was applied. Data of anthropometric and blood pressure were collected. Insulin, lipid profile, and glucose levels were determined using fasting blood samples. Two approaches [International Diabetes Federation (IDF) and a combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR)] were applied to identify metabolically healthy obese and metabolically unhealthy obese (MUO) adolescents. Participants had a mean age of 13.9 ± 1.61 years and 52.2% of them were girls. Three NPs were identified and labeled as "high minerals and vitamins" (NP1), "high carbohydrate" (NP2) and "high fat and sodium" (NP3). After adjustments for all potential confounders, no significant association was observed between higher adherence to NP1 and NP2 and odds of MUO; however, greater adherence to "high fat and sodium" NP was associated with higher odds of being MUO based on IDF (OR = 3.12; 95% CI 1.19, 8.09) and IDF/HOMA-IR (OR = 2.81; 95% CI 1.02, 7.74) definitions. Stratified analysis revealed that these associations were stronger in boys (versus girls) and obese (versus overweight) adolescents. In conclusion, high adherence to a "high fat and sodium" nutrient pattern was related to elevated chance of being MUO in Iranian adolescents, especially in boys and obese individuals. Therefore, less consumption of trans fatty acids, saturated fatty acids and sodium could be recommended to prevent MUO prevalence especially in boys with obesity.

Did the increase in sitting time due to COVID-19 lead to obesity in adolescents?

INTRODUCTION

Since adolescent with obesity is closely linked with the incidence of cardiovascular disease, it is important to identify the factors that increase the prevalence of adolescent with obesity and prevent it early. This study aimed to examine which of the demographic and lifestyle factors including sitting hours per week for purposes other than study had the greatest influence on Korean adolescents with obesity during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

We used the Korean Youth Risk Behavior Web-based Survey (KYRBWS) data. The primary outcome was the relationship between sitting hours and obesity during and after the COVID-19 pandemic. Multiple logistic regression analysis was performed to examine which of the demographic and lifestyle factors including sitting hours per week for purposes other than study had the greatest influence on Korean adolescents' obesity status.

RESULTS

The prevalence of obesity was significantly higher during the COVID-19 than before the COVID-19 (OR, 1.268, CI:1.232-1.305). There was a significant increase in the OR for sitting hours per week for purposes other than study (OR, 1.021, 95% CI, 1.019-1.024). Compared to low household income, the OR decreased for middle (OR = 0.798, 95% CI:0.77, 0.826) and high-income household students (OR, 0.833, 95% CI: 0.803-0.865).

DISCUSSION/CONCLUSION

The results of this study confirmed the relationship between sit-ting hours and obesity in adolescents during the pandemic. To prevent adolescent with obesity, further studies are needed to focus on the importance of promoting health policy in adolescents to avoid the continuous rising of its prevalence and needed to understand whether the increase in obesity rates during the pandemic is a temporary trend.

Mechanisms and contextual factors related to key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A realist evaluation perspective

BACKGROUND

Reducing health inequalities is a challenge for policymakers and civil society. A multisectoral and multilevel approach is most promising to reduce those inequalities. Previous research showed what key elements of Zwolle Healthy City, an integrated community-based approach aimed at reducing socioeconomic health inequalities, are. To fully understand approaches that are complex and context dependent, questions as 'how does the intervention work' and 'in what context does it work' are just as important as 'what works'. The current study aimed to identify mechanisms and contextual factors associated with the key elements of Zwolle Healthy City, using a realist evaluation perspective.

METHODS

Transcripts of semi-structured interviews with a wide range of local professionals were used (n = 29). Following realist evaluation logic in the analysis of this primary data, context-mechanism-outcome configurations were identified and thereafter discussed with experts (n = 5).

RESULTS

How mechanisms (M) in certain contexts (C) were of influence on the key elements (O) of the Zwolle Healthy City approach are described. For example, how, in the context of the responsible aldermen embracing the approach (C), regular meetings with the aldermen (M) increased support for the approach among involved professionals (O). Or, how, in the context of available financial resources (C), assigning a program manager (M) contributed positively to coordination and communication (O). All 36 context-mechanism-outcome configurations can be found in the repository.

CONCLUSION

This study showed what mechanisms and contextual factors are associated with the key elements of Zwolle Healthy City. By applying realist evaluation logic in the analysis of primary qualitative data we were able to disentangle the complexity of processes of this whole system approach and show this complexity in a structured manner. Also, by describing the context in which the Zwolle Healthy City approach is implemented, we contribute to the transferability of this approach across different contexts.

Body mass index percentiles versus body composition assessments: Challenges for disease risk classifications in children

Background

Identifying at-risk children with optimal specificity and sensitivity to allow for the appropriate intervention strategies to be implemented is crucial to improving the health and well-being of children. We determined relationships of body mass indexes for age and sex percentile (BMI%) classifications to actual body composition using validated and convenient methodologies and compared fat and non-fat mass estimates to normative cut-off reference values to determine guideline reliability. We hypothesized that we would achieve an improved ability to identify at-risk children using simple, non-invasive body composition and index measures.

Methods

Cross-sectional study of a volunteer convenience sample of 1,064 (537 boys) young children comparing Body Fat Percentage (BF%), Fat Mass Index (FMI), Fat-Free Mass Index (FFMI), determined via rapid bioimpedance methods vs. BMI% in children. Comparisons determined among weight classifications and boys vs. girls.

Results

Amongst all subjects BMI% was generally correlated to body composition measures and indexes but nearly one quarter of children in the low-risk classifications (healthy weight or overweight BMI%) had higher BF% and/or lower FFMI than recommended standards. Substantial evidence of higher than expected fatness and or sarcopenia was found relative to risk status. Inaccuracies were more common in girls than boys and girls were found to have consistently higher BF% at any BMI%.

Conclusions

The population studied raises concerns regarding actual risks for children of healthy or overweight categorized BMI% since many had higher than expected BF% and potential sarcopenia. When body composition and FMI and FFMI are used in conjunction with BMI% improved sensitivity, and accuracy of identifying children who may benefit from appropriate interventions results. These additional measures could help guide clinical decision making in settings of disease-risks stratifications and interventions.

Longitudinal effects of school policies on children's eating behaviors and weight status: findings from the childhood obesity study in China megacities

OBJECTIVES

To examine longitudinal effects of school policies on children's weight status and eating behaviors, and study how these effects may vary by children's age, sex, and baseline weight status in China.

METHODS

Data were collected in 2015, 2016, and 2017 in an open cohort of 3298 children aged 6-17, their parents, and schools in five large cities across China (Beijing, Shanghai, Xi'an, Nanjing, and Chengdu). Children's weight, height, and waist circumference were measured, and their eating behaviors were self-reported. The 1691 children with such repeated measures in ≥ two waves were included in longitudinal data analysis with mixed effects models, testing the associations.

RESULTS

Having school vicinity food stall policy was associated with less frequent consumption of fast food (β = -0.14, p < 0.01) and snack (β = -0.84, p < 0.01). More significant associations were found between school policies and unhealthy eating behaviors for girls and children aged 6-11 than their counterparts. Among children without overweight or central obesity at baseline, having school cafeteria food policy was associated with lower risks for overweight and obesity (OR = 0.33, 95% CI: 0.17-0.63) and central obesity (OR = 0.47, 95% CI: 0.26-0.85). This existed for girls, but not for boys. School vicinity food stall policy was associated with lower BMI (β = -0.20, 95% CI: -0.37, -0.03) among all children and in girls (β = -0.28, 95% CI: -0.50, -0.05) without overweight at baseline.

CONCLUSIONS

School policies could reduce children's unhealthy eating behaviors and obesity risk in megacities in China. Children's age, sex, and baseline weight status modify the effects. School policies are important to fight the growing childhood obesity epidemic.

Building capacity for the use of systems science to support local government public health planning: a case study of the VicHealth Local Government Partnership in Victoria, Australia

OBJECTIVE

To present an approach to build capacity for the use of systems science to support local communities in municipal public health and well-being planning.

DESIGN

Case study.

SETTING

Local government authorities participating in the VicHealth Local Government Partnership in Victoria, Australia.

PARTICIPANTS

Local government staff members were trained in community-based system dynamics (CBSD), and group model building (GMB) techniques to mobilise local community efforts. The trained local government facilitation teams then delivered GMB workshops to community stakeholder groups from 13 local government areas (LGA)s.

MAIN OUTCOMES

Training in CBSD was conducted with council facilitation teams in 13 LGAs, followed by the local delivery of GMB workshops 1-3 to community stakeholders. Causal loop diagrams (CLD) representing localised drivers of mental well-being, healthy eating, active living or general health and well-being of children and young people were developed by community stakeholders. Locally tailored action ideas were generated such as well-being classes in school, faster active transport and access to free and low-cost sporting programmes RESULTS: Overall, 111 local government staff participated in CBSD training. Thirteen CLDs were developed, with the stakeholders that included children, young people and community members, who had participated in the GMB workshops across all 13 council sites. Workshop 3 had the highest total number of participants (n=301), followed by workshop 1 (n=287) and workshop 2 (n=171).

CONCLUSIONS

Local facilitation of the CBSD process has developed community informed and locally relevant CLDs that will be used to lead local action to improve the well-being of children and young people. Training employees in CBSD is one approach to increase systems thinking capacity within local government.

Risk Factors, Clinical Consequences, Prevention, and Treatment of Childhood Obesity

Obesity might adversely affect the health and well-being of children and their families. Childhood obesity has crucial implications for health, both during childhood and as they age. It is highly associated with many acute problems and is commonly present during childhood, making visits and hospital admissions polarized in this group of children. The problems that may affect these children can be medical, such as asthma, chronic inflammation, orthopedic abnormalities, liver disease, diabetes mellitus or dyslipidemia. Long-term consequences of cardiovascular risk factors, the persistence of obesity and premature mortality are common among adults who had obesity during their early lives. Additionally, they could also suffer from psychological issues, such as low self-esteem, which puts them at risk of a much more serious psychosocial problem that may lead to depression, as well as a disruption in educational achievements and social relationships. A healthy diet, physical activity, adequate sleep, and limited screen time are all preventive measures that should be implemented at the family and community levels, preferably through well-structured programs. Furthermore, pharmacological management of childhood obesity is limited and only used after non-pharmacological interventions have failed or in the late stages of obesity. However, recent guidelines advocate the early use of medical interventions. Approved pharmacotherapeutic options include orlistat, phentermine/topiramate combination and liraglutide. There are several other options approved primarily for other specific forms of obesity or for other indications, including setmelanotide, metformin, lisdexamfetamine, zonisamide and fluoxetine. Bariatric surgery is a safe and effective option in cases with extreme obesity and comorbidities considering the need for long-term monitoring and support for cases and their families post-surgery. This review aims to discuss and highlight the recent evidence regarding risk factors, clinical consequences, prevention, and treatment of childhood obesity.

Obesity in children and adolescents and the risk of ovarian cancer: A systematic review and dose‒response meta-analysis

OBJECTIVE

The relationship between obesity in children and adolescents and the risk of ovarian cancer remains controversial. The aim of this meta-analysis was to explore the exact shape of this relationship.

METHODS

We conducted dose‒response meta-analyses of cohort and case‒control studies, including published studies derived from searches in the PubMed, Embase, Web of Science and Cochrane Library databases until October 2022. Pooled effect size estimates are expressed as relative risks (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) and were evaluated by fixed-effect models. A nonlinear dose‒response meta-analysis was performed by using a restricted cubic spline model.

RESULTS

After screening 4215 publications, 10 studies were included in the present meta-analysis. Overall analyses revealed statistically significant associations of obesity in children and adolescents with ovarian cancer (adjusted RR = 1.19, 95% CI: 1.11 to 1.28, P < 0.001). Moreover, the association was consistently significant in most subgroup analyses, for example, using geographic stratification, the results remained stable both in the Americas(RR = 1.11; 95% CI: 1.01 to 1.21; P = 0.022) and Europe (RR = 1.46; 95% CI: 1.21 to 1.77; P<0.001). For the dose‒response analyses, the risk of ovarian cancer increased with the degree of obesity, and the trend increased rapidly when body mass index (BMI) was over 25.95 kg/m2.

CONCLUSION

Our findings indicate that obesity in children and adolescents is a risk factor for ovarian cancer, and the risk increases with increasing BMI.

Impacts of gain versus loss frame messages about beverages on boy students, an application of extended parallel process model

Background

Unhealthy diet including consumption of high amounts of sugar-sweetened beverages is a key modifiable risk factor for obesity and NCDs which begin in childhood and adolescence. The study aimed to compare the effect of gain frame vs. loss frame messages on SSBs consumption intention and behavior of high school boy students.

Methods

In this quasi-experimental study, 270 students from three boy’s high schools were selected through a multistage random sampling. Data collection was done through a 15 items self-reported questionnaire before and two months after the intervention. Each of the two intervention groups received one of the two types of gain frame or loss frame designed pamphlets inspired with extended parallel process model. The control group received no pamphlet.

Results

In control, GFM and LFM groups 91, 86 and 89 students participated in the study, respectively. After the intervention, significant differences were observed in perceived efficacy and threat of the GFM group and perceived efficacy, threat and intention in the LFM group compared with before the intervention. The GFM group had higher perceived self-efficacy than the control group and lower perceived severity than the LFM group. Intention to consume SSBs reduced significantly in LFM group, compared with the control group.

Conclusions

A combination of LFM and GFM messages could more effectively lead to nutritional behavior change regarding the consumption of SSBs. Results help to design messages for educational programs and nutritional campaigns.

Vitamin D supplementation combined with aerobic physical exercise restores the cell density in hypothalamic nuclei of rats exposed to monosodium glutamate

BACKGROUND & AIMS

In view of the increase in the prevalence of obesity and metabolic syndrome in childhood and adolescence, this study proposed the early and combined use of treatments to restore brain areas related to satiety. The vitamin D supplementation, aerobic exercise and the combination of these interventions on the structure of arcuate (ARC) and ventromedial (VMH) nuclei of hypothalamus were investigated in monosodium glutamate (MSG)-treated rats.

METHODS

Wistar rats were separated into five groups: Control group (CT); Obese group injected with MSG (OB); Obese group supplemented with vitamin D (OBvd); Obese group submitted to forced swimming training (OBexe) and Obese group treated with vitamin D supplementation and forced swimming training (OBvd + exe).

RESULTS

In the OB group, the visceral fat weight was significantly higher, there was a reduction in the number of glial cells in the ARC nucleus and also in the number of neurons in the ARC and VMH nuclei. Aerobic exercise was able to reduce the visceral fat weight in the OBexe group. The combination of treatments used in the OBvd + exe group reversed the loss of neurons and glial cells produced by MSG in the ARC nucleus. All treated groups exhibited a higher number of neurons in VMH nucleus, but an increase in the glial cells were observed only in the OBexe and OBvd + exe groups.

CONCLUSIONS

The effectiveness of obesity treatment can be favored through the early and combined use of vitamin D supplementation and aerobic exercise, since these therapies are able to restore brain nuclei involved in the control of food intake.

Mothers as advocates for healthier lifestyle behaviour environments for their children: results from INFANT 3.5-year follow-up

BACKGROUND

The amount of time children spend outside of their home environment has increased over the past decades. Therefore, the quality of the health behaviour environments where young children spend time is likely to impact their health behaviour opportunities. The aim of this study was to describe the proportion of mothers who consider it possible to make changes in their local communities to increase opportunities for children to eat healthily, be physically active, and limit screen time exposure, as well as the proportion who have attempted to do so. The characteristics of mothers with differing advocacy beliefs and intentions were explored.

METHODS

Cross-sectional data collected using questionnaires from 307 mothers who participated in the 3.5-year follow-up of the INFANT cluster-randomized controlled trial were used. Frequencies were used to assess the number of mothers who thought it possible to bring about change in their local communities and for the those who had attempted to do so. Binary logistic regression analyses were used to compare sociodemographic characteristics of mothers with differing responses.

RESULTS

Most mothers thought it was possible to bring about change in their local community with regards to providing more opportunities for their child to eat healthily (83.7%), be physically active (90.9%) as well as limit exposure to screen time (63.5%). However, less than 19% and 11% of mothers have thought about or tried to bring about change in their child's childcare centre or local community, respectively. No sociodemographic differences were found between the mothers who thought it was possible to bring about actioning change (p-values > 0.1) or for those that have thought about change (p-values > 0.1).

CONCLUSION

As children are continuously being exposed to obesogenic environments future quantitative and qualitative studies are needed to describe how to promote parental advocacy and engagement, in order to provide children with environments that support healthy lifestyle behaviours.

The Developing Brain: Considering the Multifactorial Effects of Obesity, Physical Activity & Mental Wellbeing in Childhood and Adolescence

Obesity during childhood has been associated with many important physiological and neurological health considerations. Specifically concerning are the associations between youth obesity and declines in mental health, as shown with increasing rates of adolescent depression and anxiety worldwide. The emergence of mental health disorders commonly arises during adolescent development, and approximately half the global population satisfy the criteria for at least one psychiatric disorder in their lifetime, suggesting a need for early intervention. Adolescence is critical time whereby brain structure and functions are not only negatively associated with obesity and declines in mental health, while also coinciding with significant declines in rates of physical activity among individuals in this age group. Physical activity is thus a prime candidate to address the intersection of obesity and mental health crises occurring globally. This review addresses the important considerations between physiological health (obesity, aerobic fitness, physical activity), brain health (structure and function), and mental wellbeing symptomology. Lastly, we pose a theoretical framework which asks important questions regarding the influence of physiological health on the association between brain health and the development of depression and anxiety symptoms in adolescence. Specifically, we hypothesize that obesity is a mediating risk factor on the associations between brain health and psychopathology, whereas physical activity is a mediating protective factor. We conclude with recommendations for promoting physical activity and reducing sedentary time.

Socioeconomic and contextual determinants of the burden of disease attributable to metabolic risks in childhood

We analyze the socioeconomic and political contextual determinants of the burden of disease attributable to three metabolic risks in children: kidney dysfunction, high fasting plasma glucose, and high body-mass index. We use data from 121 countries. We matched data of the Global Burden of Disease project, World Bank and United Nations databases. The burden of disease is measured with the Disability Adjusted Life Years lost. We explore associations with four groups of variables: (i) income level, which measures differences in socioeconomic conditions between countries; (ii) income inequality, which measures within country inequalities in the income distribution; (iii) health care expenditure, which measures the resources allocated to health and healthcare, and (iv) women empowerment, which we measure in terms of both educational and political participation. Our findings point toward the need to act at the root of the underlying factors underpinning the disease burden, namely: reducing between and, particularly, within-country income inequalities, increasing the role of expenditure on health, and ensuring women empowerment and girls education. To our knowledge, this is the first study that have identified the associations of these variables with the burden of disease that is specifically attributable to metabolic risks in childhood.

Craniofacial form differences between obese and nonobese children

INTRODUCTION

Current evidence suggests that obesity is correlated with differences in craniofacial form in children and adolescents. Here, we sought to test this hypothesis by evaluating the craniofacial form of obese and nonobese preorthodontic patients, using 2D cephalometric data combined with cephalometric and geometric morphometric approaches.

METHODS

Height, weight, age, and lateral cephalometric radiographs were gathered from patients aged 7-16 years before beginning orthodontic treatment at the University of British Columbia. Based on their body mass index, 24 obese patients were age, sex, and Angle classification of malocclusion matched with nonobese controls. Cephalometric radiographs were annotated, and coordinates of landmarks were used to obtain linear and angular cephalometric measurements. Geometric morphometric analyses were performed to determine overall craniofacial form differences between cohorts. Dental maturation index scores and cervical vertebral maturation scores were recorded as an indicator of skeletal maturation.

RESULTS

Cephalometric analysis revealed that the maxillary length and gonial angle are the only marginally larger metrics in obese subjects than in control subjects. However, principal component and discriminant analyses (geometric morphometrics) confirmed that the overall craniofacial form of obese patients differs statistically from that of control patients. Obese patients tend to be slightly mandibular prognathic and brachycephalic. Dental maturation index scores were statistically higher in the obese group than in the control group, with no statistical difference in cervical vertebral maturation scores.

CONCLUSIONS

Our data reveals a subtle but significant difference in cranial skeletal morphology between obese and nonobese children and adolescents, suggesting a correlation between craniofacial form and physiological/metabolic phenotypes of subjects. It is likely that with continued growth, these differences may increase. Recording body mass index as part of the orthodontic records for patients may help in supporting the assessment of craniofacial form.

Association Between Birthplace and Time in the United States With Diet Quality in US Adolescents: Findings from the National Health and Nutrition Examination Survey, 2007 to 2018

BACKGROUND

During adolescence, diet quality reaches its lowest point compared to other childhood life stages. Acculturation is associated with decreased diet quality among many groups of US immigrant adults, but research is limited among adolescents.

OBJECTIVES

We investigated the associations between birthplace and length of time living in the United States, 2 proxy measures of acculturation, and diet quality among adolescents (12-19 years old).

METHODS

Data were from the NHANES (2007-2018), which included two 24-hour dietary recalls (n = 6113) to estimate Healthy Eating Index 2015 (HEI-2015) total scores and component scores. Multivariate linear regression and generalized linear models were performed to compare HEI-2015 total scores and component scores between US-born adolescents (n = 5342) and foreign-born adolescents with <5 years (n = 244), 5 to <10 years (n = 201), and ≥10 years (n = 290) of US residency.

RESULTS

Foreign-born adolescents with <5 years (53.3 ± 1.2), 5 to <10 years (51.4 ± 1.5), and ≥10 years of US residency (49.9 ± 0.8) had higher HEI-2015 total scores than US-born adolescents (47.0 ± 0.3; P < 0.0001) and higher component scores for total vegetables, seafood and plant proteins, and added sugars (P values ≤ 0.0001). Foreign-born adolescents with more years of US residency had higher component scores for total fruits, whole fruits, and saturated fats than those with fewer years of US residency. A sensitivity analysis revealed this pattern held for Mexican-American and other Hispanic adolescents.

CONCLUSIONS

Being born outside the United States and living in the United States for less time (among foreign-born adolescents) are associated with higher diet quality. Culturally informed health promotion programs may help to reduce diet-related disparities related to acculturation among adolescents.

Built Environments And Child Health in WalEs and AuStralia (BEACHES): a study protocol

INTRODUCTION

Childhood obesity and physical inactivity are two of the most significant modifiable risk factors for the prevention of non-communicable diseases (NCDs). Yet, a third of children in Wales and Australia are overweight or obese, and only 20% of UK and Australian children are sufficiently active. The purpose of the Built Environments And Child Health in WalEs and AuStralia (BEACHES) study is to identify and understand how complex and interacting factors in the built environment influence modifiable risk factors for NCDs across childhood.

METHODS AND ANALYSIS

This is an observational study using data from five established cohorts from Wales and Australia: (1) Wales Electronic Cohort for Children; (2) Millennium Cohort Study; (3) PLAY Spaces and Environments for Children's Physical Activity study; (4) The ORIGINS Project; and (5) Growing Up in Australia: the Longitudinal Study of Australian Children. The study will incorporate a comprehensive suite of longitudinal quantitative data (surveys, anthropometry, accelerometry, and Geographic Information Systems data) to understand how the built environment influences children's modifiable risk factors for NCDs (body mass index, physical activity, sedentary behaviour and diet).

ETHICS AND DISSEMINATION

This study has received the following approvals: University of Western Australia Human Research Ethics Committee (2020/ET000353), Ramsay Human Research Ethics Committee (under review) and Swansea University Information Governance Review Panel (Project ID: 1001). Findings will be reported to the following: (1) funding bodies, research institutes and hospitals supporting the BEACHES project; (2) parents and children; (3) school management teams; (4) existing and new industry partner networks; (5) federal, state and local governments to inform policy; as well as (6) presented at local, national and international conferences; and (7) disseminated by peer-reviewed publications.

Physical Changes of Preschool Children during COVID-19 School Closures in Fujian, China

The COVID-19 pandemic may constitute an "obesogenic lifestyle" that results in exacerbating childhood obesity. However, studies investigating regional sociodemographic factors including different age groups or sexes in children with obesity are lacking. We aimed to clarify the high obesity prevalence populations of preschool children to provide a regional basis for children's health policy during the COVID-19 school closures. From May to September 2019, a total of 29,518 preschool children were included in a large sample, multicenter cross-sectional study to explore physical status in Fujian Province by stratified cluster random sampling. In October 2019 and October 2020, we also conducted a cross-sectional study exploring physical development including changes in height, weight, and BMI of 1688 preschool children in Fuzhou before and after the COVID-19 school closures. Student' s t-test, Mann-Whitney U test, or chi-square test was used to assess differences in physical development and overweight and obesity rates among preschool children before and after school closures. For regional factors, the weight of urban preschool children of all ages became higher after the outbreak (p (age 3-4) = 0.009; p (age 4-5) < 0.001; p (age 5-6) = 0.002). For sex factors, overweight and obesity in boys had a greater prevalence than in girls before and after the outbreak. In four age groups, overweight and obesity rates in the 5-year-old group (15.5% and 9.9%) were higher than before (11.4% and 6.0%). The weight and BMI of 4- to 5-year-old children also increased faster than before (p < 0.001). The COVID-19 pandemic has promoted the epidemic of childhood obesity. Living in urban/coastal (economically developed) areas, boys, and aged 4-6 years old may be a susceptible population to obesity development after the outbreak.

Evaluation of two social norms nudge interventions to promote healthier food choices in a Canadian grocery store

The objective of this study was to determine the impact of two nudge interventions on customers’ produce purchases at a rural Canadian grocery store. A pre- and post-intervention observational study design was used. Sales data were gathered before and after the staggered implementation of two nudge-based interventions to encourage produce purchases: grocery cart dividers to encourage shoppers to fill one-third of their cart with produce and grocery cart plaques with information about how many fruits and vegetables were typically purchased in the store. The proportion of total sales accounted for by produce was compared between baseline and implementation of the first intervention (Phase 1), between implementation of the first intervention and the addition of the second intervention (Phase 2), and between baseline and post-implementation of both interventions together. There was a 5% relative increase (0.5% absolute increase) in produce spending between baseline and post-implementation of both interventions (10.3% to 10.8%, p < 0.001, 95% CI 0.2%, 0.7%). Intervention phase-specific produce spending showed no significant change in the percentage of produce spending from baseline to Phase 1 of the intervention, and an 8% relative increase (0.8% absolute increase) in the percentage of produce spending from Phase 1 to Phase 2 of the intervention (10.3% to 11.1%, p < 0.001, 95% CI 0.5, 1.1%). Simple, low-cost nudge interventions were effective at increasing the proportion of total grocery spend on produce. This study also demonstrated that partnerships with local businesses can promote healthier food choices in rural communities in Canada.

A Meta-Analysis of the Effects of Different Training Modalities on the Inflammatory Response in Adolescents with Obesity

The aim of this study was to investigate the effect of different training modalities on improving the inflammatory response in adolescents with obesity. For the study methodology, the databases such as China National Knowledge Infrastructure (CNKI), Wanfang Data, Pubmed, Web of Science, and EBSCO were selected for searching. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias (ROB) tool, and statistical analysis was performed by applying RevMan 5.4.1 analysis software. A total of 14 studies with 682 subjects were included. The results of this meta-analysis showed that aerobic training (AT) and aerobic plus resistance training (AT + RT) reduced the levels of IL-6 and CRP in adolescents with obesity. Among them, AT + RT was more effective than other training modalities in reducing IL-6 and CRP in adolescents with obesity. Different training modalities have no effect on the TNF-α level in adolescents with obesity. However, regarding the increase in IL-6, CRP, and TNF-α in adolescents with obesity, resistance training (RT) did not lead to significant differences. In conclusion, long-term regular AT, AT + RT, and HIIT are all helpful in improving the inflammatory state of adolescents with obesity, with AT + RT being the best training modality to combat inflammation in adolescents with obesity.

Lactose-reduced infant formula with corn syrup solids and obesity risk among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

BACKGROUND

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a federal nutrition assistance program supporting low-income families, serves half of United States-born infants, most of whom are issued infant formula by age 2 mo. Obesity prevalence is high among children of low-income households, particularly formula-fed children.

OBJECTIVES

This study was conducted to determine whether glucose-based lactose-reduced infant formula made with corn syrup solids (CSSF) is associated with increased obesity risk compared with non-CSSFs that are lactose based.

DESIGN

WIC administrative data on infant formula issuance and child weights and lengths were collected prospectively in Southern California between 2012 and 2020. Included children stopped breastfeeding by 3 mo, were issued cow's milk-based formula through 12 mo, and were enrolled through the final year of WIC eligibility at age 4 y ( n = 15,246). CSSF issuance was assessed continuously (range 0-13 mo) and dichotomously (any, none). Poisson and linear risk regression with robust SE estimates generated risk ratios (RRs), risk differences, and CIs for child obesity [BMI for age (in kg/m 2) ≥95th percentile].

RESULTS

Any CSSF was issued to 23% of children, and 25% were obese at age 4 y. Children with any CSSF issuance had 10% higher obesity risk (RR: 1.10; 95% CI: 1.02, 1.20) than children with no CSSF issuance at age 2 y. Associations remained significant through age 4 y (RR: 1.07; 95% CI: 1.01,1.14), independent of maternal weight status, total formula issued and breastfeeding duration, and were not modified by child race or sex. Obesity risk increased with additional mo of CSSF exposure, reaching 16% higher risk (RR: 1.16; 95% CI: 1.05, 1.28) at age 2 y for children with 12 mo of CSSF.

CONCLUSIONS

CSSF issuance is associated with increased obesity risk in the first 5 y life in a dose dependent manner, independently of maternal weight status, breastfeeding duration, and total formula issuance.

Integrating High-Intensity Interval Training into a School Setting Improve Body Composition, Cardiorespiratory Fitness and Physical Activity in Children with Obesity: A Randomized Controlled Trial

The aim of this study was to examine the effects of school-based high-intensity interval training (HIIT) on cardiorespiratory fitness and visceral adipose tissue (VAT) in children with obesity. A total of 40 students (11.0 ± 0.6 years; 20 boys) were randomized into an intervention group (IG) and control group (CG). The IG group performed a 12-week HIIT intervention with three sessions per week. Each session included 18 min of training (three sets of eight bouts of 15 s run at 100% maximal aerobic speed (MAS) separated by eight bouts of 15 s recovery run at 50% MAS) in PE class; the CG group were instructed to continue their normal behaviors. All subjects had indices of body mass index (BMI), fat mass (FM), body fat percentage (%BF), fat free mass (FFM), VAT, and maximal oxygen uptake (VO2max) measured at baseline and post-intervention. The cooperation of students was high, and all 40 students were included in the final analysis. A significant group−time interaction was determined in body composition (p < 0.05), with a significant decrease in BM (−3.4 ± 1.4 kg, p = 0.001; η2 = 0.63), BMI (−1.7 ± 0.5, p = 0.001; η2 = 0.58), %BF (−3.3 ± 1.4, p = 0.001; η2 = 0.54), and FM (−3.2 ± 1.4 kg, p = 0.001; η2 = 0.69), and VAT (−22.4 ± 9.8 cm2; p = 0.001; η2 = 0.61) in the IG. Furthermore, VO2max exhibited a significant increase in the IG (4.5 ± 1.6 mL/kg/min, p = 0.001; η2 = 0.84) and CG groups (1.7 ± 1.1 mL/kg/min, p = 0.001; η2 = 0.44). Integrating regular school-based HIIT sessions is a suitable method to improve body composition, cardiorespiratory fitness, and physical activity in students with obesity. Trial Registration: ChiCTR2100048737.

Serious games and eating behaviors: A systematic review of the last 5 years (2018–2022)

Background

Serious game intervention has emerged over the years as a popular strategy for solving the problem of unhealthy eating behavior. This has prompted several scholars to explore its significant impact on eating behaviors, identifying its positive effect on nutritional knowledge and eating behaviors. However, since this research field is yet nascent, an update in knowledge is required to further inform the real-world practice as an alternative intervention for instating healthy eating behavior. Therefore, this current research utilized a systematic review method to reveal the latest state of this concept of a serious game and eating behavior, to identify the position of the literature and shed light on under-researched and emerging areas by recommending future investigations.

Method

To achieve the object of this research, four electronic databases- Science Direct, Web of Science (WoS), APA PsyclNFO, and Emerald- were searched using predefined keywords (search string) relating to the review topic. A total of 15,107 results were retrieved from the databases. After title, abstract, and full-text screening, 15 studies were included following inclusion criteria.

Key findings

The result of this research demonstrated that various designs of serious games comprise an effective intervention for changing eating behavior in both children and adults and addressed the risks of childhood obesity and overweight. The findings also show that the design of the games is co-designed by different specialists such as a nutritionist, psychologist and developer, among others, as either single or multiple players. The effectiveness of the games was attributed to behavior techniques (BT), cognitive theories (CT), and socio-cognitive theories (SCT) of behavior change technique (BCT), incorporating an element of implicit learning in serious games. Feedback and reward were the most reported influencing strategies and self-reporting the evaluation approach.

Conclusion

This research contributed significantly to the body of knowledge in the field of serious games as the most recent review of evidence in the research area. Evidence from 93.33% of the included studies confirmed the effectiveness of serious games in addressing eating behavior. This study concludes that serious games are an effective intervention for improving healthy eating behavior and decreasing unhealthy eating behavior and that various elements of behavior change techniques are essential components of implicit nutritional learning through the games. In addition, it is concluded that the risk of childhood obesity and overweight can be reduced or prevented by leveraging the strength of these games. The need for future research in this field was also pointed out by this study.

Study of the Association between Thiols and Oxidative Stress Markers in Children with Obesity

Obesity has reached epidemic proportions, and the World Health Organization defined childhood overweight and obesity as a noncommunicable disease that represents the most serious public health challenges of the twenty-first century. Oxidative stress, defined as an imbalance between oxidants and antioxidants causing an impairment of the redox signals, is linked to the development of metabolic diseases. In addition, reactive oxygen species generated during metabolic disorder could increase inflammation, causing the development of insulin resistance, diabetes, and cardiovascular disease. We analyze serum levels of cysteine (Cys), cysteinyl-glycine (Cys-Gly), homocysteine (Hcy), and glutathione (GSH), and other markers of oxidative stress, such as thiobarbituric acid reactive substances (T-BARS), 8-isoprostane, and protein carbonyl in our children with obesity. Total antioxidant status was also determined. We found lower GSH and Cys-Gly levels, and higher Hcy and oxidative stress markers levels. We also found a positive correlation between Body Mass Index (BMI), Cys, GSH, and Hcy levels, between insulin and Cys levels, and between BMI and the homeostasis model assessment-estimated insulin resistance (HOMA-IR) with 8-isoprostane levels. Finally, we found a correlation between age and GSH and Cys levels. The deficiency of GSH could be restored by dietary supplementation with GSH precursors, supplying an inexpensive approach to oppose oxidative stress, thus avoiding obesity complications.

Face-to-face physical activity incorporated into dietary intervention for overweight/obesity in children and adolescents: a Bayesian network meta-analysis

BACKGROUND

Adolescent obesity has been reported to have deleterious consequences but is considered a promising modifiable risk factor. We aimed to investigate the optimal intervention for obese and overweight children and adolescents.

METHODS

We searched the Medline (PubMed, 1946-December 2020), PsycINFO (Ovid, 1927-December 2020), Cochrane library (1966-December 2020), Web of Science (1900-December 2020), Embase (1974-December 2020), CINAHL (1937-December 2020), Chinese Biomedical Literature (1978-December 2020), and ClinicalTrials.gov (December 2020) databases. We included randomized controlled trials (RCTs) reporting the association between various interventions and obese/overweight children and adolescents. The quality of the included studies was judged by two independent reviewers using the Cochrane Collaboration Risk of Bias Tool. A Bayesian network meta-analysis was conducted to summarize the comparative effectiveness of interventions based on several outcomes.

RESULTS

We included 118 RCTs comprising 71,064 participants in our analyses. Based on the outcome of the body mass index (BMI), face-to-face physical activity (FTF PA) combined with dietary intervention (DI) (mean difference [MD] = - 0.98; 95% credible interval [CrI] - 1.19, - 0.77), FTF multi-lifestyle intervention (MLI) (MD = - 0.95; 95% CrI - 1.14, - 0.75), and mobile health (MH)-delivered MLI (MD = - 0.87; 95% CrI - 1.63, - 0.09) showed significant benefits over the named control group (NCG). For the outcome of BMI z-score, FTF PA+DI (MD = - 0.10; 95% CrI - 0.15, - 0.04) and MH-delivered PA+DI (MD = - 0.09; 95% CrI - 0.14, - 0.04) were more effective than the NCG. Sensitivity analyses revealed similar findings after exclusion of studies with < 12-month and 24-month outcome assessments for the intervention, which indicated the results were stable.

CONCLUSIONS

Based on limited quality evidence and limited direct evidence, our preliminary findings showed that FTF-PA+DI, FTF-MLI, and MH-delivered MLI improved the health-related parameters in obese adolescents, in comparison with NCG. Owing to the absence of strong, direct evidence of a significant difference between the various interventions for the four outcomes, we can only cautiously suggest that FTF-PA+DI is likely the most effective intervention.

Maternal carbohydrate intake during pregnancy is associated with child peripubertal markers of metabolic health but not adiposity

OBJECTIVE

To examine the associations of trimester-specific maternal prenatal carbohydrate (CHO) intake with offspring adiposity and metabolic health during peripuberty.

DESIGN

Prospective cohort study in which maternal dietary intake was collected via validated FFQ during each trimester. Offspring adiposity and metabolic biomarkers were evaluated at age 8-14 years. We used multivariable linear regression to examine associations between total energy-adjusted maternal CHO intake and offspring BMI z-score, skinfold thickness and metabolic syndrome risk z-score calculated as the average of waist circumference, fasting glucose, fasting C-peptide, TAG:HDL and systolic blood pressure + diastolic blood pressure/2.

SETTING

Mexico City, Mexico.

PARTICIPANTS

237 mother-child pairs in the Early Life Exposure in Mexico to Environmental Toxicants cohort.

RESULTS

We found non-linear associations of maternal CHO intake during pregnancy with offspring metabolic health during peripuberty. After adjusting for maternal age, and child age, sex and pubertal status, children whose mothers were in the fourth v. first quartile of total CHO intake during the third trimester had 0·42 (95 % CI -0·01, 0·08) ng/ml lower C-peptide and 0·10 (95 % CI -0·02, 0·22) units lower C-peptide insulin resistance (CP-IR). We found similar magnitude and direction of association with respect to net CHO intake during the first trimester and offspring C-peptide and CP-IR. Maternal CHO intake during pregnancy was not associated with offspring adiposity.

CONCLUSIONS

In this study of mother-child pairs in Mexico City, children born to women in the highest quartile of CHO intake during pregnancy had lowest C-peptide and CP-IR during peripuberty. Additional research is warranted to replicate and identify mechanisms.

Risk factors for obesity and overweight in Chinese children: a nationwide survey

OBJECTIVE

This study aimed to analyze a comprehensive set of potential risk factors for obesity and overweight among Chinese children with a full range of ages and with wide geographical coverage.

METHODS

In the Prevalence and Risk Factors for Obesity and Diabetes in Youth (PRODY) study (2017-2019), the authors analyzed 193,997 children aged 3 to 18 years from 11 provinces, autonomous regions, and municipalities that are geographically representative of China. All participants underwent physical examinations, and their caregivers completed questionnaires including dietary, lifestyle, familial, and perinatal information of participants. A multilevel multinomial logistic regression model was used to evaluate the potential risk factors.

RESULTS

Among the actionable risk factors that were measured, higher consumption frequencies of animal offal (odds ratios [OR] for an additional time/day = 0.91, 95% CI: 0.88-0.95, same unit for OR below unless specified otherwise), dairy products (0.91, 95% CI: 0.88-0.94), freshwater products (0.94, 95% CI: 0.91-0.96), staple foods (0.94, 95% CI: 0.92-0.96), and coarse food grain (OR for every day vs. rarely = 0.92, 95% CI: 0.86-0.98) were associated with lower relative risk of obesity. However, higher restaurant-eating frequency (OR for >4 times/month vs. rarely = 1.21, 95% CI: 1.15-1.29) and longer screen-viewing duration (OR for >2 hours vs. <30 minutes = 1.16, 95% CI: 1.10-1.22) were associated with higher relative risk of obesity. Increased exercise frequency was associated with the lowest relative risk of obesity (OR for every day vs. rarely = 0.72, 95% CI: 0.68-0.77).

CONCLUSIONS

Changes in lifestyle and diet of Chinese children may help relieve their obesity burden.

Differences in Classification Standards For the Prevalence of Overweight and Obesity in Children. A Systematic Review and Meta-Analysis

The prevalence of childhood obesity has increased dramatically all over the world in recent years. While obesity in adults can be easily measured using the BMI calculation, determining overweight and obesity in children is more controversial. The aim was to compare the three most used international classification systems (WHO 2007, CDC 2000 and Cole-IOTF) to determine overweight and obesity in infant and adolescent populations. We performed a systematic review in accordance with the PRISMA 2020 guidelines of articles comparing any of the three classification systems. The main findings were that the WHO 2007 criteria show the highest prevalence of overweight and obesity in the child and youth population. The prevalence of childhood overweight and obesity was determined to be higher in boys than in girls in most studies, when analysing the classifications of the WHO 2007, CDC 2000 and Cole-IOTF together. However, there was a higher prevalence of overweight and obesity in girls than in boys when only the CDC 2000 and Cole-IOTF criteria were considered. Both the results of the review and the great heterogeneity found in the meta-analysis show that it is necessary to unify the criteria for the classification of childhood overweight and obesity. International standards are insufficient for working with the current population. A working group should be created to address this issue and agree on the unification of a gold standard, taking into account the geographical region, the ethnic groups and the age groups of the child and youth population and above all, the secular growth.

Childhood obesity and adverse cardiometabolic risk in large for gestational age infants and potential early preventive strategies: a narrative review

Accumulating evidence indicates that obesity and cardiometabolic risks become established early in life due to developmental programming and infants born as large for gestational age (LGA) are particularly at risk. This review summarizes the recent literature connecting LGA infants and early childhood obesity and cardiometabolic risk and explores potential preventive interventions in early infancy. With the rising obesity rates in women of childbearing age, the LGA birth rate is about 10%. Recent literature continues to support the higher rates of obesity in LGA infants. However, there is a knowledge gap for their lifetime risk for adverse cardiometabolic outcomes. Potential factors that may modify the risk in early infancy include catch-down early postnatal growth, reduction in body fat growth trajectory, longer breastfeeding duration, and presence of a healthy gut microbiome. The early postnatal period may be a critical window of opportunity for active interventions to mitigate or prevent obesity and potential adverse metabolic consequences in later life. A variety of promising candidate biomarkers for the early identification of metabolic alterations in LGA infants is also discussed. IMPACT: LGA infants are the greatest risk category for future obesity, especially if they experience rapid postnatal growth during infancy. Potential risk modifying secondary prevention strategies in early infancy in LGA infants include catch-down early postnatal growth, reduction in body fat growth trajectory, longer breastfeeding duration, and presence of a healthy gut microbiome. LGA infants may be potential low-hanging fruit targets for early preventive interventions in the fight against childhood obesity.

Early childhood caries, obesity and anthropometric measurements: Is there a relationship?

This brief research report explored the relationship among obesity, anthropometric measurements, and early childhood caries (ECC), in 3–5 years-old children. Three hundred and ninety-one Brazilian preschoolers were given anthropometric examinations for the assessment of general, peripheral, and central adiposity, by the following measures: body mass index (BMI), hip circumference, and waist circumference. Obesity status was determined by BMI according to WHO standards. Parent's age and BMI were assessed by questionnaire, and sucrose exposure was tracked by means of a food diary. For the assessment of ECC, dental examinations were performed according to modified WHO criteria. Also, the presence of dental biofilm in maxillary incisors was detected. A direct association between BMI and ECC was found in the bivariate analysis and the best possibility of logistic regression model showed that hip circumference (HC) values ≥62 centimeters (OR = 1.63; p = 0.033) jointly with the presence of dental biofilm (OR = 2.38; p = 0.000), children's ages ≥37 months (OR = 5.09; p = 0.012), and mothers younger than 35 years (OR = 1.96; p = 0.004) were significantly connected with ECC. In conclusion, peripheral adiposity (represented by HC) in young children was in fact associated with ECC. Thus, hip circumference might be a valuable tool for exploring the relationship between caries and obesity in the early years of life.

LIMIT: LIfestyle and Microbiome InTeraction Early Adiposity Rebound in Children, a Study Protocol

Childhood obesity is a strong predictor of adult obesity with health and economic consequences for individuals and society. Adiposity rebound (AR) is a rise in the Body Mass Index occurring between 3 and 7 years. Early adiposity rebound (EAR) occurs at a median age of 2 years and predisposes to a later onset of obesity. Since obesity has been associated with intestinal dysbiosis, we hypothesize that EAR could be related to early microbiome changes due to maternal/lifestyle changes and environmental exposures, which can increase the unhealthy consequences of childhood obesity. LIMIT is a prospective cohort study that aims at identifying the longitudinal interplay between infant gut microbiome, infant/maternal lifestyle, and environmental variables, in children with EAR vs. AR. Methods. The study evaluated 272 mother-infant pairs, enrolled at an Italian neonatal unit, at different time points (T0, at delivery; T1, 1 month; T2, 6 months; T3, 12 months; T4, 24 months; T5, 36 months after birth). The variables that were collected include maternal/infant anthropometric measurements, lifestyle habits, maternal environmental endocrine disruptor exposure, as well as infant AR. The LIMIT results will provide the basis for early identification of those maternal and infant modifiable factors on which to act for an effective and personalized prevention of childhood obesity.

Oral administration of Blautia wexlerae ameliorates obesity and type 2 diabetes via metabolic remodeling of the gut microbiota

The gut microbiome is an important determinant in various diseases. Here we perform a cross-sectional study of Japanese adults and identify the Blautia genus, especially B. wexlerae, as a commensal bacterium that is inversely correlated with obesity and type 2 diabetes mellitus. Oral administration of B. wexlerae to mice induce metabolic changes and anti-inflammatory effects that decrease both high-fat diet–induced obesity and diabetes. The beneficial effects of B. wexlerae are correlated with unique amino-acid metabolism to produce S-adenosylmethionine, acetylcholine, and l-ornithine and carbohydrate metabolism resulting in the accumulation of amylopectin and production of succinate, lactate, and acetate, with simultaneous modification of the gut bacterial composition. These findings reveal unique regulatory pathways of host and microbial metabolism that may provide novel strategies in preventive and therapeutic approaches for metabolic disorders.

Here, the authors inversely associate Blautia wexlerae with obesity and type 2 diabetes mellitus in humans and further show that administration of B. wexlerae to mice decrease both high-fat diet–induced obesity and diabetes via modulating gut microbial metabolism.

The effect of unhealthy dietary habits on the incidence of dental caries and overweight/obesity among Egyptian school children (A cross-sectional study)

Background

Obesity and dental caries are public health problems in Egypt. Factors such as unhealthy diet, poor oral hygiene, and physical inactivity can play a major role in both problems. This study was carried out to illuminate the mutual unhealthy dietary risk factors associated with the incidence of both health conditions.

Methods

Between 1 October 2020 and 1 July 2021, 369 Egyptian children (5-10 years) were examined. Dental status was assessed using decayed, missing/extracted, and filled tooth indices (dmft, deft, and DMFT) for deciduous, mixed, and permanent dentitions, respectively. Moreover, the lifestyle, food habits, and body mass index (BMI) were recorded.

Results

A total of 342 (93.7%) of the included subjects suffered from caries, and only 27(7.3%) were caries-free. Based on BMI percentiles, 247 (66.9%) of the youngsters were overweight/obese, while 122 (33.1%) had normal weight. The mean dmft was 6.9 (±4.6), deft 4.2 (±3.3), and DMFT 0.1 (±1.7). In the primary dentition, a significant positive correlation was detected between dmft and BMI, legumes, sweetened milk and juice, soft drinks, and desserts, while a significant negative correlation was detected between dmft/deft, meat/poultry/fish, fresh fruits, and vegetables. A significant positive correlation was detected between deft and BMI, sweetened milk and juice, ice cream, candies, and crackers. In the permanent dentition, a significant positive correlation was detected between age, soft drinks, sweetened juice, desserts, and DMFT, while a significant negative correlation was detected with fresh fruits and vegetables. BMI was significantly negatively correlated with a healthy lifestyle, meat/poultry/fish consumption, and fresh fruits and vegetables while positively correlated with legumes, ice cream, soft drinks, granulated sugars, desserts, fast food, and caffeinated drinks.

Conclusion

Overweight/obesity was positively correlated with primary dentition dental caries. Desserts (sweetened snacks) and soft drinks could be the common risk factors associated with high caries and overweight/obesity incidence among Egyptian school children; conversely, consumption of fruits and vegetables could hinder both health conditions. Moreover, sweetened juices were associated with primary and permanent dental caries.

Interactions between Self-Perceived Weight Status and Lifestyle Behaviors and Their Associations with Childhood Obesity: Results from the Childhood Obesity Study in China Mega-Cities

This study investigated the interactions between self-perceived weight status and lifestyle behaviors, and their associations with childhood obesity among school children. Methods: Cross-sectional study data from a nationwide sample of 3258 participants (aged 8-15 years old) during 2015-2017 were used. Self-perceived weight status and lifestyle factors (dietary intake and physical activity) were assessed using self-administered questionnaires. Multivariable mixed-effects models tested the effect of interactions between weight self-perception and behavioral factors on overweight and obesity (ow/ob). Results: Overall ow/ob prevalence based on BMI was 30.9% (38.5% for boys, 23.0% for girls). Based on self-perceived weight status, ow/ob prevalence was 37.7% (35.8% for boys, 39.7% for girls). 41.2% of boys and 25.9% of girls underestimated their actual weight status. The interaction between self-perceived weight status and meat consumption was associated with ow/ob in boys, while the interaction between self-assessed weight status and protein foods and sedentary lifestyle were associated with ow/ob in girls. The attributable proportions of these three factors were 39.8%, 48.2%, and 34.6%, respectively. Conclusions: The self-perceived weight status was different from their actual weight status in children. The interactions between self-perceived weight status and lifestyle behaviors were associated with ow/ob. Health promotion programs that empower children to have appropriate self-awareness of weight status, eating, and physical activity behaviors need to be developed and implemented.

Student Subjective Wellbeing amidst the Covid-19 Pandemic in Iran: Role of Loneliness, Resilience and Parental Involvement

The COVID-19 pandemic and lockdowns potentially severely impact adolescents' mental well-being. This research aims to study students' subjective well-being during the covid-19 pandemic in Iran and investigate the role of loneliness, resilience, and parental involvement. For this study, 629 students (female = 345) were recruited by purposive sampling. Students were assessed on the Student's Subjective Well-Being, Loneliness Scale, Resilience Scale, and Parental Involvement. The results confirm our hypothesis that the relationship between parental involvement and students' subjective well-being is mediated by loneliness. Furthermore, the results indicated a partial mediation of resilience in the relationship between parental involvement and students' subjective well-being. This study theoretically contributes to a better understanding of the factors determining the impact of traumatic events such as a pandemic on adolescents' mental health. The implications of this study indicate interventions that can be carried out to minimize the negative psychological consequences of the pandemic.