Energy balance: an overview with emphasis on children

Study of the Reliability of Field Test Methods for Physical Fitness in Children Aged 2-3 Years

Physical fitness measures overall physical health. It is the ability of the body to work effectively and stay healthy during leisure and emergencies. Given the progressive integration of 2–3-year-olds into preschool, physical fitness testing of these children has become increasingly important. We aimed to develop and test the reliability of an appropriate field test method for physical fitness in 2–3-year-olds children. One hundred and three children (44 boys and 59 girls) volunteered for this study. Their height and weight were tested, and the same tester conducted the test twice for handgrip strength, 3 m balance walking, stair climbing, 5 m run, and kicking a ball at one-minute intervals. Pearson correlation coefficient and intraclass correlation coefficient (ICC) were used for reliability testing. The reliability of this field test method for physical fitness was high in the repetitive tests of Chinese 2–3-year-olds for the four items of handgrip strength, 3 m balance walking, stair climbing and 5 m run, and the reliability was moderate for the kicking the ball item. This study indicates that these field-based physical fitness test methods have good reliability and are simple, feasible, safe, and easy to be accepted and understood by 2–3-year-old children; thus, it may be used as a reference for professionals in China and abroad.

Timing of Adiposity Rebound and Determinants of Early Adiposity Rebound in Korean Infants and Children Based on Data from the National Health Insurance Service

Adiposity rebound (AR) is defined as the second rise in the body mass index (BMI) usually occurring in early childhood. This study aimed to investigate the timing of AR and the factors determining early AR (EAR) by tracking BMI patterns using large-scale longitudinal nationwide data (n = 142,668; 73,389 boys and 69,279 girls) over seven time periods (4–6, 9–12, 18–24, 30–36, 42–48, 54–60, and 66–71 months). The average BMI rebound indicating AR was found before the age of 5 years (6th time period, 54–60 months). Interestingly, children experiencing BMI rebound during the 4th to 6th time periods showed a small increase in the proportion of underweight in the 2nd time period, but a dramatically higher proportion of underweight during the corresponding time period, similar to M-shaped patterns. In contrast, overweight or obese children in the above group showed opposite W-shaped patterns. The parameters predicting the risk of EAR are diverse for each time period by sex. Adequate breastfeeding before the age of 1 year, adequate diet, and reduced sugar-sweetened beverage consumption after the age of 1 year were important for reducing EAR. This study presents for the first time, the timing of AR and the major determinants of EAR among Korean infants and children based on large-scale nationwide data.

The effects of motivational interviewing on children's body mass index and fat distributions: A systematic review and meta-analysis

Currently, the effects of motivational interviewing (MI) on children's anthropometric changes remain unclear. This systematic review and meta-analysis examined the effects of MI on children's anthropometric changes (body mass index [BMI], waist circumference [WC], and body fat percentage [BF%]). We also assessed potential moderators of MI on children's BMI changes. This systematic review searched five databases (CINAHL, Cochrane, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2020 to evaluate the effects of MI interventions that had a comparison group on children's anthropometric change as outcomes (BMI, WC, or BF%). Thirty-three articles met the inclusion criteria. We performed random-effects models and exploratory moderation analyses with mixed-effects models. The pooled effect size of MI was -0.18 (p = 0.002) on BMI, -0.65 (p < 0.001) on WC, and -0.44 (p = 0.005) on children's BF%. The relationship between MI and BMI changes was significantly moderated by the types of intervener (Q = 9.71, p = 0.021) and the existence of supplemental intervention activities (Q = 9.21, p = 0.002). Other potential moderators included children's age, weight status, intervention setting, and targeted behaviors (eating and/or physical activity). Our findings support the effectiveness of MI interventions on improving children's anthropometric outcomes (i.e., BMI, WC, and BF%).

Physical activity and health in Chinese children and adolescents: expert consensus statement (2020)

China is experiencing significant public health challenges related to social and demographic transitions and lifestyle transformations following unprecedented economic reforms four decades ago. Of particular public health concern is the fourfold increase in overweight and obesity rates in the nation's youth population, coupled with the low prevalence of adolescents meeting recommended levels of physical activity. Improving the overall health of China's more than 170 million children and adolescents has become a national priority. However, advancing nationwide health initiatives and physical activity promotion in this population has been hampered by the lack of a population-specific and culturally relevant consensus on recommendations for achieving these ends. To address this deficiency and inform policies to achieve Healthy China 2030 goals, a panel of Chinese experts, complemented by international professionals, developed this consensus statement. The consensus was achieved through an iterative process that began with a literature search from electronic databases; in-depth reviews, conducted by a steering committee, of the resulting articles; and panel group evaluations and discussions in the form of email correspondence, conference calls and written communications. Ultimately, the panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6-17, participating in moderate to vigorous physical activities led to multiple positive health outcomes. Our consensus statement also (1) highlights major challenges in promoting physical activity, (2) identifies future research that addresses current knowledge gaps, and (3) provides recommendations for teachers, education experts, parents and policymakers for promoting physical activity among Chinese school-aged children and adolescents. This consensus statement aligns with international efforts to develop global physical activity guidelines to promote physical activity and health and prevent lifestyle-related diseases in children and adolescents. More importantly, it provides a foundation for developing culturally appropriate and effective physical activity interventions, health promotion strategies and policy initiatives to improve the health of Chinese children and adolescents.

Feasibility and Acceptability Findings of an Energy Balance Data Repository of Children, Adolescents, and Young Adults with Cancer

Cancer patients suffer changes in energy balance (EB), the combination of energy intake (nutrition) and energy expenditure (physical activity (PA)), which may influence cancer-related morbidity, mortality, and quality of life. Significant gaps remain in our understanding of the frequency and magnitude of these EB changes. Herein, we report on the feasibility and acceptability of a longitudinal repository of EB outcomes in children, adolescents and young adults (AYA) with cancer along the cancer continuum to fill these gaps. This EB repository includes PA, nutrition, and physical function (PF) parameters. PA data were gathered through activity trackers. Nutritional data were gathered through food diaries and micronutrient labs. PF was assessed with validated objective and patient-reported measures. Feasibility was achieved with >50% enrollment of eligible patients (n = 80, Mage = 18.1 ± 7.5); 26 were children with cancer and 54 were AYAs with cancer. An 88.75% retention rate indicated acceptability. Despite COVID-19 disruptions, >50% of participants provided completed data for PA and micronutrient labs as of April 2020. Food diaries and PF data collection experienced disruptions. Methodological adaptations are in progress to minimize future disruptions. Overall, our findings demonstrate that prospective EB assessments are feasible and acceptable among children and AYAs with cancer.

Body composition during early infancy and developmental progression from 1 to 5 years of age: the Infant Anthropometry and Body Composition (iABC) cohort study among Ethiopian children

Early nutrition and growth have been found to be important early exposures for later development. Studies of crude growth in terms of weight and length/height, however, cannot elucidate how body composition (BC) might mediate associations between nutrition and later development. In this study, we aimed to examine the relation between fat mass (FM) or fat-free mass (FFM) tissues at birth and their accretion during early infancy, and later developmental progression. In a birth cohort from Ethiopia, 455 children who have BC measurement at birth and 416 who have standardised rate of BC growth during infancy were followed up for outcome variable, and were included in the statistical analysis. The study sample was restricted to mothers living in Jimma town who gave birth to a term baby with a birth weight ≥1500 g and no evident congenital anomalies. The relationship between the exposure and outcome variables was examined using linear-mixed regression model. The finding revealed that FFM at birth was positively associated with global developmental progression from 1 to 5 years (β=1·75; 95 % CI 0·11, 3·39) and from 4 to 5 years (β=1·34; 95 % CI 0·23, 2·44) in the adjusted model. Furthermore, the rate of postnatal FFM tissue accretion was positively associated with development at 1 year of age (β=0·50; 95 % CI 0·01, 0·99). Neither fetal nor postnatal FM showed a significant association. In conclusion, fetal, rather than postnatal, FFM tissue accretion was associated with developmental progression. Intervention studies are needed to assess whether nutrition interventions increasing FFM also increase cognitive development.

Excessive homework, inadequate sleep, physical inactivity and screen viewing time are major contributors to high paediatric obesity

Aim

This study examined the relationships between energy balance‐related behaviours (EBRBs) outside school hours and obesity in Chinese primary school students. We also explored the influence of gender on those relationships.

Methods

The study sample was a cross‐sectional cohort of 5032 Chinese children who were enrolled in grades 1–6 in primary schools in five Chinese cities and whose mean ages ranged from seven years and three months to 11.9 years. The children's parents completed a survey on their child's height, weight and EBRBs outside school hours.

Results

The response rate was 97%, and the reported rates of overweight and obesity were 13.6% and 13.8%, respectively. The obesity rates were higher in boys and lower grade children. Most EBRBs varied between boys and girls and with increased grade levels. The amount of time spent on academic‐related activities, screen viewing, outdoor activities and sleep was mostly associated with obesity on weekdays and varied by gender.

Conclusion

Rate of obesity was alarmingly high in the primary school Chinese children in this cohort, especially in younger children. Excessive time spent on academic‐related activities outside school hours, inadequate sleep, physical inactivity and higher levels of screen viewing were major contributors to obesity in these Chinese children.

Increased Body Mass Index during Therapy for Childhood Acute Lymphoblastic Leukemia: A Significant and Underestimated Complication

Objective & Design. We undertook a retrospective review of children diagnosed with acute lymphoblastic leukemia (ALL) and treated with modern COG protocols (n = 80) to determine longitudinal changes in body mass index (BMI) and the prevalence of obesity compared with a healthy reference population. Results. At diagnosis, the majority of patients (77.5%) were in the healthy weight category. During treatment, increases in BMI z-scores were greater for females than males; the prevalence of obesity increased from 10.3% to 44.8% (P < 0.004) for females but remained relatively unchanged for males (9.8% to 13.7%, P = 0.7). Longitudinal analysis using linear mixed-effects identified associations between BMI z-scores and time-dependent interactions with sex (P = 0.0005), disease risk (P < 0.0001), age (P = 0.0001), and BMI z-score (P < 0.0001) at diagnosis and total dose of steroid during maintenance (P = 0.01). Predicted mean BMI z-scores at the end of therapy were greater for females with standard risk ALL irrespective of age at diagnosis and for males younger than 4 years of age at diagnosis with standard risk ALL. Conclusion. Females treated on standard risk protocols and younger males may be at greatest risk of becoming obese during treatment for ALL. These subgroups may benefit from intervention strategies to manage BMI during treatment for ALL.

Eating behavior and BMI in adolescent survivors of brain tumor and acute lymphoblastic leukemia

OBJECTIVES

Elevated body mass index (BMI) has been reported in pediatric cancer survivors. It is unclear whether this is related to altered energy intake (via disordered eating), decreased energy expenditure (via limited exercise), or treatment-related direct/indirect changes. The aims of this study are to describe the occurrence of overweight and obesity, exercise frequency, and the extent of disordered eating patterns in this sample of survivors, and to examine relationships among BMI, eating patterns, exercise frequency, and demographic and disease and treatment-related variables to identify those survivors most at risk for overweight/obesity.

METHODS

This cross-sectional study recruited 98 cancer survivors (50 acute lymphoblastic leukemia [ALL], 48 brain tumor [BT]), aged 12 to 17 years and ≥12 months posttreatment from a large pediatric oncology hospital. Survivors completed health behavior measures assessing disordered eating patterns and physical activity. Clinical variables were obtained through medical record review. Univariate analyses were conducted to make comparisons on health behaviors by diagnosis, gender, treatment history, and BMI category.

RESULTS

Fifty-two percent of ALL survivors and 41.7% of BT survivors were classified as overweight/obese. Overweight/obesity status was associated with higher cognitive restraint (odds ratio = 1.0; 95% confidence interval = 1.0-1.1). Only 12% of ALL survivors and 8.3% of BT survivors met Centers for Disease Control and Prevention guidelines for physical activity. Males reported more physical activity, t(96) = 2.2, P < .05.

CONCLUSIONS

Overweight/obese survivors may attempt to purposefully restrict their food intake and rely less on physiological cues to regulate consumption. Survivors should be screened at follow-up for weight-related concerns.