Impact of the COVID-19 kindergarten closure on overweight and obesity among 3- to 7-year-old children

The prevalence of overweight among 4-year-olds during and after the COVID-19 pandemic was associated with socioeconomic burden

AIM

To assess the prevalence of overweight among Swedish 4 year olds in 2018, 2020 and 2022, taking socioeconomic variables into account.

METHODS

Aggregated regional data on children's body mass index were collected. The socioeconomic Care Need Index (CNI), foreign background, low education, being a single parent, low income and childhood poverty, were assessed. The differences in overweight, including obesity, were tested for Sweden and for regions.

RESULTS

Data were available for 303 843 children, representing 87% of children born in 2014, 2016 and 2018. Overweight or obesity were found in 11 177 (11.4%) of children in 2022, decreasing from 2020 (13.3%, p < 0.001) but at the same level as in 2018. Regional low CNI, low level of foreign background, education and income as well as being a single parent were associated with a higher prevalence of overweight or obesity in all cohorts (p < 0.001). In regions with high levels of childhood poverty, overweight or obesity were more prevalent during (p = 0.009) and after the pandemic (p < 0.001).

CONCLUSION

Three national cohorts demonstrate that the increase in overweight during the COVID-19 pandemic has returned to pre-pandemic levels, but the inequalities in health associated with socioeconomic vulnerability of the regions remained.

Associations between Changes in Body Weight Status and High Blood Pressure among Lithuanian Children and Adolescents during the COVID-19 Pandemic: A Retrospective Cohort Study

(1) Background: High blood pressure (HBP), overweight, and obesity are common, growing public health problems worldwide. The aim of this study was to evaluate associations between changes in body weight status and HBP among Lithuanian children and adolescents during the COVID-19 pandemic. (2) Methods: In this study, we analysed data on blood pressure and anthropometric measurements of 2430 children and adolescents aged 8-18 years, who participated in both the baseline study conducted before the COVID-19 pandemic (from November 2019 to March 2020) and the follow-up study during the COVID-19 pandemic (from November 2021 to April 2022). Multivariate logistic regression analysis was used to estimate the associations between changes in weight status categories and HBP. (3) Results: At baseline, 17.1% of the subjects had overweight, 5.9% had obesity, 5.6% had abdominal obesity, and 23.7% had HBP, whereas at the follow-up, these percentages increased to 20.1%, 8.2%, 6.8%, and 27.4%, respectively. Compared to schoolchildren who maintained normal weight from baseline to the follow-up period, subjects who newly developed overweight/obesity and those who remained with persistent overweight/obesity had increased odds of HBP, with adjusted odds ratios (aORs) of 1.95 (p < 0.001) and 2.58 (p < 0.001), respectively. In subjects who transitioned from overweight/obesity to normal weight, the odds of HBP were slightly increased, with an aOR of 1.14 (p = 0.598), but the change was not statistically significant (p > 0.05). (4) Conclusions: This study observed an increase in the prevalence of overweight, obesity, and HBP among schoolchildren during the COVID-19 pandemic. The study also suggested that changes from normal body weight status at baseline to overweight/obesity during follow-up, especially persistent overweight/obesity, were associated with higher odds of HBP in Lithuanian children and adolescents during the COVID-19 pandemic.

Prevalence of overweight/obesity, and associated factors among adolescents aged 12 ∼ 15 in Shandong Province, China: A cross-sectional study

Overweight/obesity among adolescents in Shandong Province, China, has been rising, posing significant public health challenge. Comprehensive investigation is needed to develop effective interventions. Following the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, a stratified random cluster sampling approach was used from September to October 2023 across 17 cities in Shandong Province. The study included 165 middle schools, surveying 99,638 students aged 12 ∼ 15. After applying exclusion criteria, 97,356 students (97.71% effective rate) completed anthropometric measurements and questionnaires. Overweight/obesity were assessed based on national and international standards. Univariable chi-square test and multivariable logistic regression were used to analyze factors influencing overweight/obesity. In 2023, the overweight/obesity rate among 12 ∼ 15-year-olds in Shandong was 19.75%. Significant factors included sex, age, residence, family income, parental weight status and activity, mother's gestational diabetes history, birth weight, physical activity, sleep, screen time, homework, and diet. Girls, older adolescents, and those with physically active parents or who themselves engaged in over 1.5 h of daily physical activity had lower odds of being overweight/obese. Adequate sleep and frequent consumption of vegetable and fruit were also protective. Higher odds were associated with urban residence, high family income, overweight/obese parents, maternal gestational diabetes, high birth weight, excessive screen time, extensive homework, and frequent fast food consumption. Overweight/obesity in Shandong adolescents is influenced by multiple determinants. Holistic interventions addressing genetic, behavioral, and environmental factors are essential for promoting healthier lifestyles and reducing the prevalence in this demographic.

SARS-CoV-2 Test-to-Stay in Daycare

BACKGROUND AND OBJECTIVES

Test-to-stay concepts apply serial testing of children in daycare after exposure to SARS-CoV-2 without use of quarantine. This study aims to assess the safety of a test-to-stay screening in daycare facilities.

METHODS

714 daycare facilities and approximately 50 000 children ≤6 years in Cologne, Germany participated in a SARS-CoV-2 Pool-polymerase chain reaction (PCR) screening from March 2021 to April 2022. The screening initially comprised post-exposure quarantine and was adapted to a test-to-stay approach during its course. To assess safety of the test-to-stay approach, we explored potential changes in frequencies of infections among children after the adaptation to the test-to-stay approach by applying regression discontinuity in time (RDiT) analyses. To this end, PCR-test data were linked with routinely collected data on reported infections in children and analyzed using ordinary least squares regressions.

RESULTS

219 885 Pool-PCRs and 352 305 Single-PCRs were performed. 6440 (2.93%) Pool-PCRs tested positive, and 17 208 infections in children were reported. We estimated that during a period of 30 weeks, the test-to-stay concept avoided between 7 and 20 days of quarantine per eligible daycare child. RDiT revealed a 26% reduction (Exp. Coef: 0.74, confidence interval 0.52-1.06) in infection frequency among children and indicated no significant increase attributable to the test-to-stay approach. This result was not sensitive to adjustments for 7-day incidence, season, SARS-CoV-2 variant, and socioeconomic status.

CONCLUSIONS

Our analyses provide evidence that suggest safety of the test-to-stay approach compared with quarantine measures. This approach offers a promising option to avoid use of quarantine after exposure to respiratory pathogens in daycare settings.

The Ongoing Impact of COVID-19 on Pediatric Obesity

In the developed world, pediatric obesity (PO) has been a major health concern since the last century, and this condition may lead to detrimental life-long physical and mental comorbidities. Currently, its prevalence has increased in low- and middle-income countries and in many high-income countries. Thus, the provision of effective and tailored care for children and their families has become vital. The social consequences of the COVID-19 pandemic are known everywhere, and among these, it has been argued that the COVID-19 pandemic has had a major impact on PO. Overall, the growth of PO over the last decade has been enhanced by the pandemic. During the COVID-19 pandemic, children, adolescents and young adults gained weight as the pediatric population dealt with sedentary lifestyles and changes in food habits. In this review, we want to highlight the impact that the COVID-19 pandemic had on PO.

Impact of lockdown on the growth of children in China aged 3-6 years during the COVID-19 pandemic

Background

Lockdowns in COVID-19 pandemic led to less physical activity and more intake of unhealthy food in children. The aim of this study was to investigate the negative impact of major lockdowns on the growth of children aged 3-6 years during COVID-19 pandemic period.

Methods

Physical examination results in 2019 to 2022 from 5834 eligible children (2972 males and 2862 females) from Southwestern China who were 3 years old in 2019 were retrospectively collected. Height and weight data points were extracted from the results, and percentiles of height (height%), weight (weight%), and BMI (BMI%), and rates of overweight and obesity were calculated and compared between different years during the pandemic.

Results

After analyzing the 15404 growth data points from 5834 children, a slowly increasing trend of height% from 2019 to 2022 was observed. Weight%, BMI%, overweight rate, obesity rate, and combined overweight and obesity rate had two peaks in 2020 and 2022 when major lockdowns were adopted and a drop in between (year 2021), except for obesity rate which did not drop in 2021. Similar results were shown after stratification by gender.

Conclusion

The lockdowns in COVID-19 pandemic promoted obesity of kindergarten children, but did not show any negative impact on their height growth possibly due to over-nutrition of children during lockdowns. More efforts need to be made to limit the increase of obesity rate in kindergarten children during possible future lockdowns.

Kindergarten dust heavy metal(loid) exposure associates with growth retardation in children

Heavy metal contamination from electronic waste recycling sites is present in dust found in indoor kindergartens located in e-waste recycling areas, and its potential impact on child health is a significant concern. The association between heavy metal(loid)s and the child developmental indicators is still unclear. In 2019 and 2020, we enrolled 325 and 319 children in an e-waste recycling town, respectively. Corresponding 61 and 121 dust samples were collected from roads, houses, and kindergartens in the two years. The median concentrations of metals, including Cr, Ni, Cu, Zn, and Pb exceeded the allowable limits. The highest amount of cumulative enrichment (cEF) was observed in indoor kindergarten dust (cEF = 112.3400), followed by house dust (cEF = 76.6950) and road dust (cEF = 39.7700). Children residing in the e-waste town had below-average height and weight compared to their Chinese peers. Based on linear regression analysis, the daily intake of Cd, V, Mn, and Pb in indoor kindergarten dust was found to be negatively associated with head circumference (HeC) (P < 0.05). Similarly, the daily intake of As, Cd, and Ba in indoor kindergarten dust was found to be negatively associated with chest circumference (ChC) (P < 0.05). In addition, the daily intake of As, Cd, and Ba in indoor kindergarten dust was negatively correlated with body mass index (BMI), as per the results of the study (P < 0.05). Cross-product term analysis revealed a negative correlation between daily intake of heavy metal(loid)s and HeC, ChC, and BMI, with age and sex serving as influencing factors. In conclusion, exposure to heavy metal(loid)s in indoor kindergarten dust increases the risk of growth retardation and developmental delay in children.

Trends of obesity and overweight among children and adolescents in China

BACKGROUND

Recent decades have shown a rapid increase in the prevalence of overweight and obesity among Chinese children based on several national surveys. Restrictions due to the coronavirus disease 2019 outbreak have worsened its epidemiology. This review updates the trends in the prevalence of overweight and obesity among Chinese children and adolescents and analyzes the underlying reasons to provide evidence for better policy making.

METHODS

Studies published in English and Chinese were retrieved from PubMed, Google Scholar, China National Knowledge Infrastructure and Wanfang.

RESULTS

The prevalence of overweight and obesity has been increasing for decades and varies with age, sex and geography but is more pronounced in primary school students. The increase in obesity in boys appeared to be slower, whereas that in girls showed a declining trend. The northern areas of China have persistently maintained the highest levels of obesity with a stable trend in recent years. Meanwhile, the prevalence in eastern regions has dramatically increased. Notably, the overall prevalence of obesity in children has shown a stabilizing trend in recent years. However, the occurrence of obesity-related metabolic diseases increased. The effect of migrants floating into east-coast cities should not be neglected.

CONCLUSIONS

The high prevalence of overweight and obesity among Chinese children and adolescents persists but with varying patterns. Obesity-related metabolic diseases occur more frequently despite a stable trend of obesity. Multiple factors are responsible for the changing prevalence. Thus, comprehensive and flexible policies are needed to effectively manage and prevent the burden of obesity and its related complications.