The health-related quality of life in normal and obese children

Impact of Underweight, Overweight, and Obesity on Health-Related Quality of Life in Children with Tetralogy of Fallot Variants

Traditional cardiovascular risk factors put patients with congenital heart disease (CHD) at increased risk for cardiovascular morbidity and mortality. The aim of this study was to evaluate whether body mass index (BMI) is associated with health-related quality of life (HRQoL) in patients with variants of Tetralogy of Fallot (TOF). Patients and parents of children with variants of TOF-CHD were asked to fill out the PedsQL 4.0 questionnaire and provide weight and length. Patients were categorized into low, normal, and high BMI percentiles. Other demographic data were obtained from the Swedish national registry for congenital heart disease (SWEDCON). Statistical analyses included non-parametric Mann-Whitney U test, Fisher exact, and Chi-square tests. Eighty-five patients were included. Twelve were overweight or obese, 57 had a normal BMI, and 16 were underweight. There was a significant difference in age and gender between the groups. Comparing overweight/obese children to those with normal BMI, physical and social functioning were impaired, while emotional and school function were comparable between the groups. This applied to both child and parental assessment. When comparing underweight to normal weight children, school functioning assessed by the parent was the only domain significantly different from patients with a normal BMI. Children with variants of TOF and overweight/obesity have lower HRQoL, particularly in physical and social functioning, while underweight children may have impaired school functioning. We suggest that preventive measures aimed at maintaining a normal weight should be taken early in life to reduce long-term cardiovascular risk in the CHD population.

Evaluation of health-related quality of life and its domains in pediatric patients with cancer

BACKGROUND

Health-related quality of life has emerged as a significant component in pediatric oncology research during the last several decades. Measures of health-related quality of life provide a thorough assessment of the child's response to medical therapy, disease course, and adjustment outcomes in the context of pediatric oncology.

METHODS

The aim of the present study was to assess the cancer-specific health-related quality of life in cancer pediatric patients and to evaluate the contribution of its domains and some of the anthropometric, sociodemographic, and treatment-related variables on the overall quality of life, by using the PedsQL™ 3.0 Cancer Module.

RESULTS

The study included 110 cases. The mean value of the PedsQL™ 3.0 Cancer Module score was 49.3 ± 12.0. The lowest mean score of quality of life was for the "procedure anxiety" (8.7 ± 23.9), followed by the "worry" domains (16.6 ± 28.5). Higher "frequency of hospital visits" was associated with increased feeling of pain and treatment anxiety yet decrease in suffering from nausea and vice versa. The longer period of hospital admission for more than half of the recommended treatment period was associated with reduced pain suffering on the expense of increase in feeling of worry as well as communication problems. The perceived physical appearance was better among those patients who spent a treatment period for 3-6 months when compared to those who spent a treatment period less than 3 months or more than 6 months. There was a highly significant association between all the eight-cancer-specific quality-of-life domains except the pain domain- and the overall quality-of-life log scores. Nausea problem followed by worry and cognitive problems was the most effective domains on the overall quality-of-life score.

CONCLUSION

Cancer pediatric patients suffered low quality of life especially for anxiety procedure and worry domains with special consideration for the impact of nausea, worry, and cognitive problems on their perception of quality of life.

Adverse Influences of Nonstrabismic Amblyopia on Quality of Life of Teenagers in China

The aim of this study was to explore the influences of nonstrabismic amblyopia on quality of life in adolescents. Health-related quality of life (HRQoL) scale, a multidimensional construct that indicates a fundamental health outcome, was used to measure physical and psychosocial functioning of the adolescents. Forty teenagers with nonstrabismic amblyopia and 40 control teenagers without nonstrabismic amblyopia were recruited between April 2019 and July 2021. The anthropometric measures, body image, physical activity outcome, and HRQoL scores including physical health, emotional functioning, social functioning, and school functioning were compared between the two groups. The results revealed that teenagers with nonstrabismic amblyopia had less weekly sedentary time (P < 0.001), weekly total steps (P < 0.001), and worse school functioning (P = 0.0211) than control teenagers. No significant difference was found in anthropometric measures and body image between the two groups (P > 0.05). This study implied the needs for teenagers with nonstrabismic amblyopia to enhance physical activities. Teachers and parents are encouraged to pay more attention to teenagers with nonstrabismic amblyopia to improve their school functioning.

Use of person-centred language among scientific research focused on childhood obesity

BACKGROUND

Stigma towards children with obesity can begin as early as 3 years old, leading to increased risk for poorer mental health outcomes and lower quality of life. This includes discriminatory language used by peers and adults, which may be compounded by use within the medical community and in published research.

OBJECTIVES

Our primary objective was to investigate adherence to person-centred language (PCL) in childhood obesity-related medical publications.

METHODS

We searched PubMed for childhood obesity-related articles from 2018 through 2020, from journals frequently publishing childhood-obesity-related research. Articles were randomized and searched for a list of predetermined, stigmatizing terms.

RESULTS

Of the sample of 300 articles, only 21.7% were adherent to PCL guidelines. The most frequent labels found were 'obese' appearing in 70.33% of articles and 'overweight' in 63.7%. Labels such as 'chubby', 'large', and 'fat' were less common, but still appeared in the medical literature.

CONCLUSIONS

A majority of childhood obesity-related articles did not adhere to PCL guidelines. Given the negative effects of stigma among children with obesity, it is imperative to advocate for PCL use within the medical community. Increased stringency by journal editors and publishers may be the next step in this process.

Maternal Emotional States in Relation to Offspring Weight and Health-Related Quality of Life: Tehran Lipid and Glucose Study

BACKGROUND

Maternal characteristics have been known to be associated with parenting practices, which could eventually influence their child's weight and health-related quality of life (HRQoL).

OBJECTIVES

This study aimed to assess the direct and indirect associations of maternal emotional states (depression, anxiety, and stress) with body mass index (BMI) and HRQoL in their children.

METHODS

This study was conducted within the framework of the Tehran lipid and glucose study (TLGS). Participants were the children (n = 231) enrolled in TLGS during 2014 - 2016, who had complete data on maternal emotional states. The body weight and height of children were measured using the standard protocol, and BMI Z-score was determined using Anthroplus. Also, HRQoL in children and emotional states in mothers were assessed using the Iranian version of the pediatric quality of life inventory (PedsQLTM4.0) and the depression, anxiety, and stress scale (DASS-21), respectively. Structural equations modeling (SEM) was used to assess the direct and indirect relations of maternal emotional states with children's BMI Z-score and HRQoL.

RESULTS

Mean age, BMI Z-score, and HRQoL total score in children were 13.8 ± 3.1 years, 0.74 ± 1.5, and 84.7 ± 11.3, respectively. In the mothers, median DASS-21 scores (interquartile ranges) in the three scales of depression, anxiety, and stress were 4 (0 - 10), 6 (2 - 12), and 14 (8 - 20), respectively. Maternal level of education was significantly associated with the DASS-21 score (β = -0.23, 95% CI: -0.37,-0.07). Maternal DASS-21 score was significantly associated with BMI Z-score only in girls (β = 0.25, 95% CI: 0.06, 0.53). Significant determinants of HRQoL in boys were the child's age (β = -0.21, 95% CI: -0.40, -0.01) and maternal education (β = -0.24, 95%CI: -0.44, -0.02) and emotional state (β = -0.24, 95% CI: -0.44, -0.03). The child's age (β = -0.33, 95% CI: -0.53, -0.10) and maternal emotional state (β = -0.31, 95% CI: -0.54, -0.08) were significantly associated with HRQoL in girls.

CONCLUSIONS

The maternal emotional state is an important determinant of HRQoL in children, regardless of their weight status. Further research is recommended to examine the current hypothesized model in rural and suburban populations, taking into consideration more influential factors.

The Determinants of Health-Related Quality of Life in a Sample of Primary School Children: A Cross-Sectional Analysis

Background: Health-related quality of life (HRQoL) in childhood is a multidimensional construct with many sub dimensions of subjective experience, including physical activity (PA), psychological well-being, social interaction, and school performance, that represents a fundamental health outcome to assess a child’s physical and psycho-social functioning. Our study aims to explore the potential predictors of children’s health-related quality of life, using a convenience sample from the Imola Active Break Study (I-MOVE), considering demographic, anthropometric measures, PA level measured by Actigraph accelerometers, parent-reported/self-reported HRQoL, and body image. Methods: A cross-sectional analysis was conducted among 151 primary school children in Italy. HRQoL was assessed using the Italian version 4.0 of the Paediatric Quality of Life (PedsQL) questionnaire. Results: Children who spent more time partaking in moderate PA were associated with a higher total PedsQL score (p < 0.03). Mother’s body mass index (BMI) was the only variable statistically significant associated with the physical health domain of PedsQL. Parent’s proxy-report perception concerning children’s psychosocial health was statistically relevant. The children’s gender, age, and BMI had no association with any of the HRQoL outcomes. Discussion: Parent proxy-report psychosocial health and mother’s BMI should be considered as predictors of HRQoL for the psychosocial and physical domain. PA should be implemented in order to improve the HRQoL of primary school children.

Lifestyle Modification Improves Insulin Resistance and Carotid Intima-Media Thickness in a Metabolically Healthy Obese Prepubescent Population

OBJECTIVES

The aim of this study was to analyze effects of a 12-month lifestyle modification that involved a Mediterranean diet (MedDiet) and physical activity (PA) program in a population of metabolically healthy obese children (MHOCh).

METHODS

We included a population of MHOCh with ≤1 of the following criteria: waist circumference and blood pressure ≥90 percentile, triglycerides >150 mg/dL, high-density lipoprotein-cholesterol (HDL-c) <40 mg/dL, or impaired fasting glucose. After 12 months of intensive lifestyle modification, anthropometric measurements, glycemic and lipid profiles, adherence to the MedDiet, energy intake, PA, body composition, and carotid intima-media thickness (cIMT) were analyzed.

RESULTS

One hundred thirty-one MHOCh (70 boys and 61 girls; P = 0.65, age: 7.9 ± 1.3 years, body mass index [BMI]: 24.7 ± 3.5 kg/m2) were included. After 12 months of intervention, a significant decrease in standard deviation (SD) units of body weight (-0.5 ± 0.1; P < 0.001) and BMI (-0.5 ± 0.1; P < 0.001) were observed in the total population. A significant improvement in adherence to the MedDiet (+2 points) and a significant reduction in protein, fatty acids, total fat, and cholesterol intake in the entire population were observed. All participants did more moderate-vigorous PA, which led to a significant increase in lean and total mass and decrease in total fat. Significant improvements in the glycemic profile (insulin levels [-6.6 μIU/mL, P < 0.001] and HOMA index [-1.2, P < 0.001]) were observed. Participants with pathological cIMT values reduced this cardiovascular predictor to normal values.

CONCLUSIONS

A 12-month lifestyle modification intervention involving weight loss with MedDiet and PA in MHOCh yielded improvements in MedDiet adherence, lipid intake, moderate-vigorous PA, body composition, insulin resistance, and cIMT.

Overweight, obesity, weight-related behaviors, and health-related quality of life among high-school students in Turkey

PURPOSE

The purpose of this study was to assess the prevalence of overweight and obesity, and associated socio-demographic and lifestyle behaviors among a sample of high-school students in Turkey. This study also examined the effect of overweight and obesity on health-related quality of life in students.

METHODS

A cross-sectional survey of 1216 adolescents aged 14-18 years old was conducted from 2018 to 2019 in Turkey, using questionnaire forms and anthropometric measurements. Classification of BMI was based on the WHO reference weight categories. Factors linked to adolescent obesity were identified using the binary logistic regression model and the degree of association was revealed by determining the odds ratio, at a confidence interval (CI) of 95%.

RESULTS

The prevalence of overweight was 26.1%, while that of obese students was 12.8%. Factors associated with being obese included being in the 14-15 age group, being male, having dysfunctional family relationships, spending more than 3 h/day on screen time, and performing physical activity (≥ 60 min) two times or less per week. Obese adolescents reported significantly lower scores in physical and mental health.

CONCLUSIONS

In this study, more than one-third of the students were either overweight or obese. Obesity was associated with screen time, physical activity, and family relationship. Obesity in children had a negative impact on their quality of life. Therefore, increasing physical activity, lowering screen time, and having a healthy parent-adolescent relationship could contribute to reducing the prevalence of obesity in overweight/obese students.

LEVEL OF EVIDENCE

Level V, descriptive (cross-sectional) study.

Trajectories in health recovery in the 12 months following a mild traumatic brain injury in children: findings from the BIONIC Study

INTRODUCTION There is growing consensus that adverse child outcomes may be evident in the early recovery phase following mild traumatic brain injury (TBI). However, controversy remains around the nature of children's longer-term recovery. AIM To examine child cognitive, behavioural and quality-of-life outcomes over 12 months following mild injury, and to identify prognostic factors associated with outcomes. METHODS A prospective sample of 222 children (aged 2-15 years at injury) with mild TBI was assessed using a cognitive testing battery and parent-report questionnaires at ≤ 14 days, 1, 6 and/or 12-months post-injury. RESULTS Parents reported significant improvements in their child's behavioural adjustment between baseline and 6 months (P = 0.003), with further improvements at 12 months following injury (P = 0.001). Cognitive recovery and quality-of-life improvements were more gradual with minimal changes in the first month (P > 0.05), but significant improvements by 12-months post-injury (P = 0.03, P = 0.02, respectively). Time since injury, male gender, living rurally and parent anxiety were associated with extent of recovery beyond the acute period. CONCLUSIONS Children's recovery from mild TBI continues beyond the initial 6 months following injury. Health-care providers need to be vigilant about the varying trajectories in children's recovery from TBI. On-going monitoring of children following injury will enable timely and proactive responses to persistent difficulties, with a view to minimising longer-term adverse consequences.

Increased Obesity Awareness and Adherence to Healthy Lifestyle-Diet Reduce Metabolic Syndrome Risk in Overweight Children

Objective: Obesity is a common epidemic issue in all over the world. In order to prevent obesity it is essential to know about obesity and its detrimental consequences. This study aimed to evaluate children's awareness about obesity and to determine the associations between level of awareness, healthy lifestyle, dietary habits and risk factors for metabolic syndrome.Methods: Two hundred and thirty-six overweight children (119 boys and 117 girls) aged 10-14 years were enrolled to the study. Anthropometric and biochemical measurements were taken and metabolic syndrome (MetS) definition were done according to the International Diabetes Federation (IDF) consensus and divided into two groups as MetS (+) and MetS (-). Obesity awareness scale (OBA) and Adapted Healthy Lifestyle-Diet Index for Turkey (HLD-TR) were performed.Results: Among children, the prevalence of having MetS was found as 26.3%. Obesity awareness and HLD-TR index sores were lower in MetS (+) group than MetS (-) group. Metabolic syndrome related biochemical parameters and anthropometric measurements were associated with obesity awareness level of the children. The binary logistic regression model shows that a one-unit increase in the OBA index score increases the odd of not having MetS for 1.12 times after adjustments for age, gender, body mass index, and HLD-TR index score.Conclusions: Increased awareness about obesity among children will help to reduce the risk of metabolic syndrome, type 2 diabetes and atherosclerotic cardiovascular diseases in the future.

"If my family is happy, then I am happy": Quality-of-life determinants of parents of school-age children

OBJECTIVE

Obesity is a public health concern for children and adults and effective obesity prevention programming is needed urgently. The effectiveness of health-related messaging and interventions is influenced by the way content is framed. HomeStyles is an obesity prevention program, which aims to promote health through the frame of improved quality of life.

METHODS

Thus, focus groups were conducted with English- and Spanish-speaking parents of school-aged children (ages 6-11) to identify key quality-of-life determinants as described by parents.

RESULTS

Parents (n = 158) reported that their quality of life was influenced by family happiness and parent and child health (e.g. adequate sleep, exercise, healthy diet). Many parents expressed that their busy schedules and lack of family time were detrimental to their quality of life. Work-life balance and financial stability were other factors commonly noted to impact quality of life. Spanish-speaking parents also reported being undocumented and feeling a lack of a sense of community negatively influenced their quality of life.

CONCLUSION

Considering parent-defined quality-of-life determinants when framing health-related messaging and developing interventions may increase participant interest and ultimately improve health-related behaviors. Next steps in the HomeStyles project include using parent-reported quality-of-life determinants to guide the development of intervention materials.

Health-related quality-of-life model in adolescents with different body composition

The purpose of the present study was to develop and evaluate a causal model of health-related quality of life (HRQoL) in adolescents with different body composition. The participants were 209 adolescents (107 women and 102 men) ranging from 10 to 15 years of age. A model based on that proposed by Wilson and Cleary (JAMA 273(1):59-65, 1995) was elaborated. The body composition of the participants was analyzed. They were asked to complete a battery of questionnaires composed of the following factors: biological status (BS; included body mass index and weight), symptomatic psychological status (SPS; included the variables of drive for thinness and food concerns), functional status (FS; composed of physical activity, food consumption estimation, and socioeconomic status), and HRQoL, which included the dimensions of psychological well-being, autonomy and relationship with parents, social support and peers, and the academic environment. Structural equation modeling produced a model, which obtained an adequate fit for the prediction of HRQoL (χ²(38) = 51.88, p = .07; NNFI = 0.97, CFI = 0.98, GFI = 0.95, and RMSEA = 0.04). The main outcome demonstrated the indirect effect of BS (0.44) and SPS (- 0.45) as well as a direct effect of FS (0.21) on HRQoL. In addition, a second path was observed, BS has an indirect effect on FS (0.34) and FS on HRQoL (0.21). These results provide empirical support for the evaluated model.Level of evidence: Level V, Descriptive study.

Is obesity associated with decreased health-related quality of life in school-age children?-Results from a survey in Vietnam

Background

Overweight and obesity have short-term and long-term effects on children's physical and mental health. These conditions currently have a tendency to increase among Vietnamese school children.

Aims

This study aimed to assess the quality of life among 8-10 year-old children in Vietnam.

Methods

This cross-sectional study was conducted with a sample of 264 children aged 8-10 years (including 88 obese children and 176 normal-weight ones) at two primary schools in Hanoi, Vietnam, in 2018 and their mothers or fathers participated in this study. The Vietnamese version of the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic score scales were used to collect information from children and their parents about the children's quality-of-life. Mean and standard deviation of PedsQL scores were calculated. Independent t-test was used to compare mean scores between normal-weight and obese children.

Results

Both child self reports and parent-proxy reports revealed that obese children had significantly lower scores for the total scales compared to normal weight children (80.7 versus 84.0; p < 0.05 for proxy reports and 77.6 vs 84.6; p < 0.001 for self reports). Total scale and subscale scores reported by parents were lower compared to those reported by children. Besides, 79% of normal weight children reported having PedsQL total scores in the highest quartile (≥75%), compared to 56.8 % of obese children (p = 0.01). Similarly, these proportions for parent-proxy reports were 79.5% and 65.9%, respectively (p < 0.05). Emotional scores were both found the lowest among the four subscales (71.6 for child self reports and 73.1 for parent-proxy reports).

Recommendations

Interventions aimed to improve quality of life of overweight and obese children in Vietnam should not focus only on diet adjustment and physical exercise but need to address all dimensions of health-related quality of life, especially emotional, social and school functioning.

The impact of multicomponent weight management interventions on quality of life in adolescents affected by overweight or obesity: a meta-analysis of randomized controlled trials

Adolescents affected by overweight or obesity report similar quality of life to adolescents with cancer. While weight management is important for physiological outcomes, it is unclear whether weight management improves quality of life in this age group. This meta-analysis assessed the impact of multicomponent weight management interventions on quality of life in adolescents affected by overweight or obesity. Ovid PsycINFO, Ovid Medline, Ovid Embase, Cochrane Library, Scopus and CINAHL Plus databases were searched up to July 2017. Eight eligible studies were randomized controlled trials of multicomponent weight management interventions for adolescents (10 to 19 years) affected by overweight or obesity, with quality of life and weight measurements. Meta-analyses determined a positive effect on quality of life (mean difference 0.20 [0.11, 0.29]; p < 0.01) and weight (mean difference 0.30 [0.12, 0.47]; p < 0.01) following intervention. There was no correlation between weight loss and improvements in quality of life (R²  = 0.103). Rather than weight loss, intervention factors such as parental involvement, group settings and a focus on psychosocial well-being appeared linked to improvements in quality of life. The reduced quality of life reported by this group may be due to social consequences of obesity, rather than actual weight.