Secular trends in the prevalence of childhood overweight and obesity across Australian states: A meta-analysis

Trends in Well-Being Among Youth in Australia, 2017-2022

Importance

Little is known about temporal trends in children's well-being and how the COVID-19 pandemic may have influenced the well-being of young Australians. Certain demographic groups may be more vulnerable to experiencing declines in well-being.

Objective

To examine well-being trends over 6 consecutive years among South Australian students and explore the influence of sociodemographic characteristics.

Design, Setting, and Participants

Longitudinal analyses of annual (2017 to 2022) cross-sectional data of students in grades 4 through 9 (n = 40 392 to 56 897 per year) attending South Australian government schools from the Well-being and Engagement Collection (WEC) census.

Exposures

Calendar year (2017-2022) and sociodemographic characteristics (sex, school grade, parental education, language spoken at home, residential region) from school enrollment records.

Main Outcomes and Measures

Students self-reported life satisfaction, optimism, happiness, cognitive engagement, emotional regulation, perseverance, worry, and sadness.

Results

Over 6 years (2017 to 2022), a total of 119 033 students (mean [SD] age, 12.1 y; 51.4% male) participated in this study. Most well-being measures declined over time, with consistent worsening of well-being from 2020 onward. For example, compared with 2017, sadness was 0.26 (95% CI, 0.25-0.27) points higher in 2020 (standardized mean difference [SMD], 0.27) and remained elevated by more than 0.26 points (SMD, 0.27) in 2021 and 2022. At almost every time point, greatest well-being was reported by students of male sex (except cognitive engagement and perseverance), in earlier school grades, with highest parental education, speaking a language other than English at home, and residing in outer regional and remote settings (for satisfaction, optimism, and emotional regulation). Sociodemographic differences in well-being were generally consistent over time; however, sex differences widened from 2020 for all indicators except cognitive engagement and perseverance. For example, between 2017 and 2022, sadness increased by 0.27 (95% CI, 0.25-0.29) more points among females than males (SMD, 0.28).

Conclusions and Relevance

In this longitudinal analysis of annual census data, there were downward trends in students' well-being, especially since 2020. The largest sociodemographic disparities were observed for students of female sex, those in later school grades, and those with lowest parental education. Urgent and equitable support for the well-being of all young people, particularly those facing disparity, is imperative.

Associations of anthropometric cardiometabolic risk factors and leg fat accumulation in children and adolescents from Poland

OBJECTIVES

To analyze the correlation between anthropometric cardiometabolic risk factors with calf adiposity in 4-16-year-olds from Poland.

METHODS

Three thousand seventy-six persons (1568 girls and 1508 boys) were examined. Analyzed characteristics included body height, waist, hips and neck circumferences, body weight, six skinfolds. The following were calculated: body mass index (BMI), waist-to-hips ratio (WHR), the sum of all skinfolds, and the sum of skinfolds on the waist area.

RESULTS

The relationship between the calf skinfold and the rest of the characteristics was estimated using multiple regression. There was a negative relationship between calf adiposity and fat tissue accumulated around the waist and the BMI (in some groups). This suggests that participants with greater calf adiposity had lower waist adiposity and BMI than those with less fat tissue on the lower limb.

CONCLUSION

Persons with higher calf adiposity may have a lower cardiometabolic risk. This observation is significant because cardiovascular risk factors can persist from childhood into adulthood. Additionally, cardiovascular issues have numerous medical consequences but also socio-economic ones, thus they can affect individuals and be a burden on public health.

The Effects of Breastfeeding for Four Months on Thinness, Overweight, and Obesity in Children Aged 3 to 6 Years: A Retrospective Cohort Study from National Physical Fitness Surveillance of Jiangsu Province, China

Objective: To explore the effects of breastfeeding during the first four months of life on thinness, overweight, and obesity and to analyze the influential factors in children aged three to six years in eastern China. Methods: This study was designed as a retrospective cohort study, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed. A total of 8053 subjects were included in this secondary analysis of data from the 2015 “Physical Fitness Surveillance data of Jiangsu, China”. The subjects were classified into three groups on the basis of feeding patterns: breastfeeding, mixed feeding, and formula feeding. The International Obesity Task Force (IOTF) definitions of BMI were used to define thinness, overweight, and obesity. Multivariate logistic regression models and subgroup analysis were used to assess the association between feeding patterns and childhood thinness, overweight, obesity, and overweight/obesity, adjusted for potential confounders (sex, age grade, area, region/economy, gestational age, birthweight, childbearing age, mother’s education, and caretaker). Results: The prevalence of breastfeeding was 63.8%, and the prevalence of thinness, overweight, obesity, and overweight/obesity reached 2.7%, 11.2%, 4.7%, and 15.9%, respectively. Breastfeeding participants had a lower risk of overweight and overweight/obesity with adjusted ORs of 0.652 (95% CI: 0.533, 0.797; p < 0.001) and 0.721 (95% CI: 0.602, 0.862; p < 0.001), respectively; however, there was no difference in thinness and obesity (both p > 0.05) compared with formula feeding. There was no statistical difference between mixed and formula feeding, in terms of thinness, overweight, obesity, or overweight/obesity (all p > 0.05). Subgroup analysis showed that breastfeeding for three years, preterm, and a childbearing age of 25−29 years had higher adjusted ORs for thinness, and in 5−6 years, urban areas, southern/developed economy regions, post-mature, childbearing age ≥ 25 years, and other caretakers had higher and invalid breastfeeding-adjusted ORs (all p > 0.05 except overweight in the urban grade) for both overweight and overweight/obesity. Conclusions: Breastfeeding during the first four months was not associated with the thinness of children aged 3−6 years in eastern China, and the protective effect of breastfeeding against overweight or overweight/obesity could be confirmed. However, the effects of breastfeeding on thinness, overweight, and obesity may change or become invalid in some subgroups, suggesting that there may be potential interactions between feeding patterns and influential factors.

Pharmacological Management of Obesity: A Century of Expert Opinions in Cecil Textbook of Medicine

BACKGROUND

Innovations in drug therapy for obesity have had a limited impact on the body mass index, prevalence of medical complications, quality of life, and work potential of a substantial majority of affected persons.

STUDY QUESTION

What are the milestones of the changes in the expert approach to the pharmacological management of obesity in the past century?

STUDY DESIGN

To determine the changes in the experts' approach to the management of obesity, as presented in a widely used textbook in the United States.

DATA SOURCES

The primary sources were chapters describing the management of obesity in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. Secondary sources were publications retrieved from Medline that clarified technical issues related to the development, regulatory approval, and use of the drugs mentioned in the Cecil Textbook of Medicine.

RESULTS

Pharmacological interventions aimed at increasing caloric expenditures through thermogenesis were recommended from 1927 through 1943. Thyroid extracts were prescribed even in the absence of demonstrated hypothyroidism or decreased basal metabolic rate throughout this period. Dinitrophenol was mentioned in 1937, but was banned soon thereafter. Appetite suppression with amphetamine was considered useful from 1943 through 1988, after which the drug was replaced with other centrally acting molecules, such as fenfluramine in 1988, sibutramine in 2000, and rimonabant in 2008, which were in turn withdrawn because of major adverse effects. In the past decade, obesity has been treated with the appetite suppressants phentermine-topiramate, bupropion-naltrexone, lorcaserin, and liraglutide, and with orlistat, a drug promoting fat malabsorption. The change in weight produced by these drugs is generally modest and transient.

CONCLUSIONS

The pharmacological management of obesity has remained frustratingly inefficient. The reasons for the relative lack of success may reside in the ever-growing access to dense, palatable, and relatively inexpensive food, coupled with the decrease in energy expenditure created by a sedentary lifestyle.

Changes in the adiposity level and prevalence of overweight/obesity among children from Kraków (Poland) within the last decade (from 2010 to 2020)

The aim of this study was to assess the changes in the prevalence of overweight, obesity and high adiposity in children and adolescents from Krakow (Poland), between the years 2010 and 2020. Two cross-sectional series of anthropometric measurements were carried out in 2010 and 2020. Analysed characteristics included: body height and weight, BMI (Body Mass Index), body adiposity (%BF). The subjects were categorised according to their BMI (underweight, normal weight, overweight, obesity), as well as %BF (low, normal, high body fat).The research was conducted in randomly selected primary schools in Krakow (Poland). Studied cohorts (8-15 years of age), which represented four of the traditional residential districts: Śródmieście, Podgórze, Krowodrza and Nowa Huta. Among the girls, there was a negative secular trend regarding the prevalence of underweight and obesity. On the other hand, there also was a positive trend concerning the prevalence of overweight and low and high body fat. In boys, there was a negative secular trend regarding the prevalence of underweight and low adiposity. There was also a generally positive secular trend regarding the prevalence of overweight, obesity as well as high adiposity in boys. The findings of this study are particularly significant because detailed knowledge of the prevalence of overweight/obesity in childhood and adolescence is crucial for the future health of entire populations. Further studies should also take into account the levels of physical fitness and activity of the examined population.

Prevalence of childhood obesity in Brazil: systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of childhood obesity in Brazil by means of a systematic review of representative studies.

SOURCES

We searched for population-based studies that assessed obesity in Brazilian children aged < 10 years in MEDLINE, EMBASE, Scopus and other sources up to September, 2019. Paired researchers selected studies, extracted data and assessed the quality of these studies. Meta-analysis of prevalence and confidence interval (95% CI) was calculated, weighted by the population sizes using Freeman-Tukey double-arccosine transformation. Heterogeneity (I²) and publication bias were investigated by meta-regression and Egger's test, respectively.

SUMMARY OF THE FINDINGS

53 studies were included (n = 122,395), which were held from 1986 to 2015 and limited mainly due to inadequate response rates. Prevalence of obesity in the three-decade period was of 8.2% ([95% CI]: 8.1-8.4%, I² = 98.5%). Higher prevalence was observed in boys (9.7% [9.4-9.9%], I² = 97.4%) than girls (7.3% [7.1-7.5%], I² = 96.1%). Prevalence increased according to the decade (1990: 6.5% [6.0-7.0 %], I² = 96.8%; 2000: 7.9% [7.7-8.0 %], I² = 98.8%; 2010: 12.0% [11.5-12.6 %], I² = 95.8%), and Brazilian region (Northeast: 6.4% [6.2-6.7%], I² = 98.1%; North: 6.7% [6.3-7.2%], I² = 98.8%; Southeast:10.6% [10.2-11.0%], I² = 98.2%; South: 10.1 [9.7-10.4%], I² = 97.7%). Heterogeneity was affected by age and region (p < 0.05) and publication bias was discarded (p = 0.746).

CONCLUSION

For every 100 Brazilian children, over eight had obesity in the three-decade period and 12 in each 100 had childhood obesity in more recent estimates. Higher prevalence occurred in boys, recent decades and more developed Brazilian regions.

Impact of Dietary Trajectories on Obesity and Dental Caries in Preschool Children: Findings from the Healthy Smiles Healthy Kids Study

This study examines the impact of longitudinal dietary trajectories on obesity and early childhood caries (ECC) in preschool children in Australia. Mother–infant dyads from the Healthy Smiles Healthy Kids study were interviewed at 4 and 8 months, and 1, 2, and 3 years of age. Children underwent anthropometric and oral health assessments between 3 and 4 years of age. Multivariable logistic regression and negative binomial regression analysis were performed for the prevalence of overweight and obesity, and the number of tooth surfaces with dental caries, respectively. The intake of core, discretionary, and sugary foods showed distinct quadratic (n = 3) trajectories with age. The prevalence of overweight or obesity was 10% (n = 72) and that of early childhood caries (ECC) was 33% (mean decayed, missing, and filled tooth surfaces (dmfs) score: 1.96). Children with the highest trajectories of discretionary foods intake were more likely to be overweight or obese (adjusted OR: 2.51, 95 %CI: 1.16–5.42). Continued breastfeeding beyond 12 months was associated with higher dmfs scores (adjusted IRR: 2.17, 95 %CI: 1.27–3.73). Highest socioeconomic disadvantage was the most significant determinant for overweight or obesity (adjusted OR: 2.86, 95 %CI: 1.11–7.34) and ECC (adjusted IRR: 2.71, 95 %CI: 1.48–4.97). Targeted health promotion interventions should be designed to prevent the incidence of two highly prevalent conditions in preschool children.

Secular Trends of Underweight, Overweight, and Obesity in Children and Adolescents from Ukraine

Overweight and obesity, as well as underweight in children and adolescents, pose a significant public health issue. This study aimed to investigate the secular trend of the incidence of underweight, overweight, and obesity in children from Ukraine in 2013/2014 and 2018/2019. The studies were conducted in randomly selected primary and secondary schools in Ukraine. In total, 13,447 children (6468 boys and 6979 girls) participated in the study in 2013/2014 and 18,144 children (8717 boys and 9427 girls) participated in 2018/2019. Measurements of body weight and height were performed in triplicate. Underweight, overweight, and obesity were diagnosed according to the standards of the World Health Organization (WHO). In the group of girls, a significant difference between 2013/2014 and 2018/2019 measurements was found only among 7-year-olds. The percentage of girls at this age exceeding the body mass index (BMI) norm was lower in the 2018/2019 study. In boys, a significant difference was also found in 7-year-olds, and, as in girls, a lower share of overweight and obesity was found in 2018/2019. But for the ages of 12, 13, and 15, the significant differences had a different character-more overweight or obese boys were found in the 2018/2019 study. The proportion of underweight children was similar for the majority of age groups in both genders and did not differ in a statistically significant way.

Effectiveness and promising behavior change techniques of interventions targeting energy balance related behaviors in children from lower socioeconomic environments: A systematic review

This systematic review aims to summarize the evidence regarding the effectiveness of interventions targeting energy balance-related behaviors in children from lower socioeconomic environments and the applied behavior change techniques. The literature search was conducted in Cochrane, Embase, Psycinfo and Pubmed. Articles had to be published between January 2000 and September 2019. Studies were included that i) targeted dietary behavior, physical activity and/or sedentary behavior; ii) had a controlled trial design; iii) included children aged 9–12 years old; iv) focused on lower socioeconomic environments; and v) took place in upper-middle or high income countries. Two independent researchers extracted data, identified behavior change techniques using the Behavior Change Technique Taxonomy v1, and performed a methodological quality assessment using the quality assessment tool of the Effective Public Health Practice Project. We included 24 studies, of which one received a high and three a moderate quality rating. Demonstration, practice and providing instructions on how to perform a behavior were the most commonly applied behavior change techniques. Seven studies reported significant beneficial intervention effects: five on physical activity, one on physical activity and sedentary behavior and one on dietary behavior. When comparing effective versus non-effective interventions, and comparing our review to previous reviews focusing on children from the general population, similar behavior change techniques were applied. More high quality research is needed to evaluate the effectiveness of interventions and their behavior change techniques targeting children of low socioeconomic environments.

PROSPERO registration number: CRD42016052599

Predictors of Early Introduction of Core and Discretionary Foods in Australian Infants-Results from HSHK Birth Cohort Study

Early introduction of complementary foods can have a detrimental impact on children's long-term health. This study examined the timing and determinants of early introduction of core and discretionary foods among infants in Sydney, Australia. Mothers (n = 1035) from an ongoing population-based birth cohort study were interviewed at 8, 17, 34 and 52 weeks postpartum. The outcome was 'age at which particular core and discretionary food items were first introduced'. Multivariable logistic regression models were used to investigate family and infant-related determinants of early introduction of core (<17 weeks of age) and discretionary foods (<52 weeks of age). Of the 934 mother-infant dyads interviewed, 12% (n = 113) of infants were introduced core foods before 17 weeks of age (median: 22). Mothers working part-time (adjusted odds ratio (OR): 3.42, 95% confidence interval (CI): 1.54-7.62) and those exclusively formula-feeding their babies at four-weeks postpartum (adjusted OR 3.26, 95% CI: 1.99-5.33) were most likely to introduce core foods early. Ninety-five percent (n = 858) of infants were introduced discretionary foods before 52 weeks of age (median: 28). Low socio-economic status was significantly associated with early introduction of discretionary foods (adjusted OR: 3.72, 95% CI: 1.17-11.78). Compliance with infant feeding guidelines related to core foods was better; however, discretionary foods were introduced early in most infants.

Change in overweight and obesity over a decade according to sociodemographic factors in Brazilian adolescents

The aims were to examine changes in the prevalence of overweight and obesity among students from 2001 to 2011, and to verify if these changes differ according to age group, area of residence, and family income. We analyzed two cross-sectional surveys conducted in 2001 and 2011 with brazilian adolescents. Sociodemographic and anthropometric characteristics were self-reported using a questionnaire. Multinomial logistic regression was used to analyze changes in overweight and obesity between the two surveys. The nutritional status was the outcome of the present study and the surveys (2001 and 2011) were the exposure. The odds of being overweight and obese were higher among boys and girls in urban areas in the 2011 survey compared to the 2001. Boys and girls with higher income were also more likely to present overweight and obesity in the second survey compared to the first. An increase of overweight and obesity was observed over a decade. We suggest that future interventions consider the area of residence and the family income to strengthen the effectiveness of actions developed to prevent and control these indicators among adolescents.

Prevalence of underweight in children and adolescents (aged 3-18 years) from Kraków (Poland) in 1983 and 2010

OBJECTIVE

To estimate the changes in the prevalence of underweight among girls and boys living in Kraków that occurred between 1983 and 2010.

DESIGN

The study was based on two cross-sectional surveys conducted in 1983 and 2010. The prevalence of underweight was estimated based on the International Obesity Task Force (IOTF) and Centers for Disease Control and Prevention (CDC) cut-off points.

SETTING

The study was conducted in Kraków, Poland.

PARTICIPANTS

Children aged 3-18 years (n 5245).

RESULTS

Between 1983 and 2010 the prevalence of underweight decreased in both sexes. Using the IOTF criteria, the prevalence of underweight decreased from 10·5 to 10·3 % in girls and from 8·9 to 7·5 % in boys, but it was still higher in girls than in boys. According to the CDC criteria, this prevalence decreased from 5·1 to 4·4 % and from 5·9 to 4·6 %, respectively, and was slightly lower in girls. According to the IOTF criteria, underweight prevalence increased slightly during childhood in both sexes while according to the CDC criteria it decreased in boys and did not change in girls. Among juveniles and adolescents, it decreased regardless of the method used.

CONCLUSIONS

The frequency of underweight in the population of children and adolescents from Kraków changed slightly in 1983 and 2010 despite economic and social changes. Depending on the cut-off points used, not only the magnitude but also the direction of changes between series could be different. In order to aid global monitoring, the prevalence of underweight as well as overweight should always be evaluated by several methods.

Life on holidays: differences in activity composition between school and holiday periods in Australian children

BACKGROUND

Recently, a small number of studies have suggested that gains in fitness and reductions in body fat achieved during the school term are reversed or stagnate during the holiday period. This may be associated with changed activity patterns. The aim of this study was to compare 24-h activity compositions between school and holiday periods in Australian children.

METHODS

The participants in this study were 366 children (53% female, 13.4 ± 2.3 years) who were a subgroup of the 2007 Australian National Children's Nutrition and Physical Activity Survey. Each child recalled use of time on at least one school day, one weekend day and one holiday using the Multimedia Activity Recall for Children and Adults. Composite "in-term" and "holiday" use-of-time profiles were generated by weighting school days by 5, and weekends by 2 where data were available. Difference between holiday and in-term time use was assessed using a compositional multivariate linear model for repeated measures. Subsequent models tested for interaction between time of measurement and socio-economic status or body mass index.

RESULTS

Time use was significantly different between holidays and in-term days (F = 103, p < 0.0001). On holidays, children accumulated 140 min less School-related time, compensated by sleeping 40 min longer, 58 min more Screen Time, and 35 min more Domestic/Social time. Children spent 10 min less in vigorous physical activity, and although sitting time was 33 min/day less during holidays, estimated total daily energy expenditure (TDEE) was 5.4% lower. Differences between holiday and in-term activity compositions did not vary by parental education (F = 1.2, p = 0.25), postcode-level socio-economic status (F = 0.9, p = 0.56) or weight status (F = 1.7, p = 0.07).

CONCLUSIONS

In this subsample of a nationally representative survey of Australian children, holidays were characterised by longer sleep and higher TV and videogame time, lower vigorous activity and lower TDEE. Uncompensated by dietary adjustments, these differences would result in an accumulation of about 650 g of fat over a six-week holiday period. Holiday activity patterns may be a promising focus for obesity prevention efforts.

The Influence of Home and School Environments on Children's Diet and Physical Activity, and Body Mass Index: A Structural Equation Modelling Approach

Introduction The home and school environments play important roles in influencing children's health behaviours. However, their simultaneous influence on childhood obesity has not yet been examined. We explore the relationship of the home and school environments with childhood obesity, to determine whether this relationship is mediated by children's fruit and vegetable intake and physical behaviours. Methods This study uses baseline data from 9 to 11 year old children, their parents and school principals (matched data n = 2466) from the Obesity Prevention and Lifestyle Project. Child-reported behaviours, parent-reported home environment and principal-reported school environment data were collected via questionnaires. Trained researchers measured children's height and weight, and Body Mass Index (BMI, kg/m²) was calculated. Structural equation modelling was used to assess the relationship of the home and school environments with children's fruit and vegetable intake, physical activity behaviours, and children's BMI. Result The home diet environment was positively associated with child diet (β = 0.18, p < 0.001). The home physical activity environment had the largest inverse association with BMI (β = - 0.11, p < 0.001), indirectly through child physical activity (β = 0.28 ,p < 0.001). Schools' healthy eating policy implementation was significantly associated with child diet (β = 0.52, p < 0.05), but physical activity policy was not associated with child activity (β = - 0.007, p > 0.05). The school environment was not associated with child BMI. Discussion The home environment had a stronger association with healthier child behaviours, compared to the school environment. These findings suggest that future childhood obesity interventions targeting healthier home environments and supporting parents can promote healthier child eating and physical activity behaviours.

Environmental risk factors and nonpharmacological and nonsurgical interventions for obesity: An umbrella review of meta-analyses of cohort studies and randomized controlled trials

BACKGROUND

Multiple environmental factors have been implicated in obesity, and multiple interventions, besides drugs and surgery, have been assessed in obese patients. Results are scattered across many studies and meta-analyses, and they often mix obese and overweight individuals.

MATERIALS AND METHODS

PubMed and Cochrane Database of Systematic Reviews were searched through 21 January 2017 for meta-analyses of cohort studies assessing environmental risk factors for obesity, and randomized controlled trials investigating nonpharmacological and nonsurgical therapeutic interventions for obesity. We excluded data on overweight participants. Evidence from observational studies was graded according to criteria that included the statistical significance of the random-effects summary estimate and of the largest study in a meta-analysis, the number of obesity cases, heterogeneity between studies, 95% prediction intervals, small-study effects and excess significance. The evidence of intervention studies for obesity was assessed with the GRADE framework.

RESULTS

Fifty-four articles met eligibility criteria, including 26 meta-analyses of environmental risk factors (166 studies) and 46 meta-analyses of nondrug, nonsurgical interventions (206 trials). In adults, the only risk factor with convincing evidence was depression, and childhood obesity, adolescent obesity, childhood abuse and short sleep duration had highly suggestive evidence. Infancy weight gain during the first year of life, depression and low maternal education had convincing evidence for association with paediatric obesity. All interventions had low or very-low-quality evidence with one exception of moderate-quality evidence for one comparison (no differences in efficacy between brief lifestyle primary care interventions and other interventions for paediatric obesity). Summary effect sizes were mostly small across compared interventions (maximum 5.1 kg in adults and 1.78 kg in children) and even these estimates may be inflated.

CONCLUSIONS

Depression, obesity in earlier age groups, short sleep duration, childhood abuse and low maternal education have the strongest support among proposed risk factors for obesity. Furthermore, there is no high-quality evidence to recommend treating obesity with a specific nonpharmacological and nonsurgical intervention among many available, and whatever benefits in terms of magnitude of weight loss appear small.

The great leap backward: changes in the jumping performance of Australian children aged 11-12-years between 1985 and 2015

Previous data have indicated relative stability over time of paediatric jumping performance, but few data exist since the early 2000s. This study quantified the 30-year secular changes in jumping performance of Australian children aged 11-12-years using data from the Australian Schools Health and Fitness Survey (1985, n = 1967) and Growing Up in Australia's Child Health CheckPoint (2015, n = 1765). Both cohorts measured jumping performance (standing long jump distance), anthropometric and demographic data. Secular changes in jumping performance means and quantiles were examined using multivariable linear and quantile regression. Between 1985 and 2015, jumping performance declined by 16.4 cm or by 11.2% (standardised change 0.66 SD, 95%CI 0.60 to 0.73). Adjustment for body mass reduced the effect by 32%, although the decline remained (absolute change - 11.1 cm, 95%CI -12.5 to -9.7; percent change 7.7%, 95%CI 6.7 to 8.6; standardised change 0.51 SD, 95%CI 0.44 to 0.57). This decline was evident across all quantiles. The jumping performance of Australian children aged 11-12-years has declined between 1985 and 2015, with body mass changes accounting for only part of the decline. Efforts should continue to promote paediatric muscular fitness, reduce adiposity, and aim to reverse this decline in jumping performance.

Intergenerational and early life influences on the well-being of Australian Aboriginal and Torres Strait Islander children: overview and selected findings from Footprints in Time, the Longitudinal Study of Indigenous Children

Footprints in Time: The Longitudinal Study of Indigenous Children (LSIC) is a national study of 1759 Australian Aboriginal and Torres Strait Islander children living across urban, regional and remote areas of Australia. The study is in its 11th wave of annual data collection, having collected extensive data on topics including birth and early life influences, parental health and well-being, identity, cultural engagement, language use, housing, racism, school engagement and academic achievement, and social and emotional well-being. The current paper reviews a selection of major findings from Footprints in Time relating to the developmental origins of health and disease for Australian Aboriginal and Torres Strait Islander peoples. Opportunities for new researchers to conduct further research utilizing the LSIC data set are also presented.

Physical activity and screen-based recreation: Prevalences and trends over time among adolescents and barriers to recommended engagement

Adolescence is a critical time for disengagement from physical activity making young people a priority group for interventions. To determine whether existing initiatives are working in this population segment and help inform future programs, the present study sought to (i) examine prevalences and trends in physical activity and screen-based recreation among Australian adolescents and (ii) identify the barriers to adolescents meeting recommended guidelines. Two cross-sectional representative samples of Western Australian secondary school students aged 12 to 17years were surveyed in 2009-2010 (n=1505) and 2012-2013 (n=1406). Around a quarter (24%) of boys and just 9% of girls reported engaging in the recommended 60min of physical activity per day in 2012-2013. A minority (13% of boys, 17% of girls) adhered to guidelines for time spent engaging in screen-based recreation (≤2h of electronic media use for entertainment). These findings were comparable to 2009-2010 prevalence levels. Multivariable logistic regression analyses conducted on data from the most recent wave found individual-level barriers to be significantly associated with lower odds of meeting physical activity guidelines in both boys (Adj. OR=0.52, 95% CI=0.38, 0.72) and girls (Adj. OR=0.41, 95% CI=0.25, 0.66). The consistently high proportion of adolescents not meeting physical activity recommendations over time suggests that current efforts to increase physical activity may be failing to have an impact on population-level trends in compliance. While initiatives to improve the built environment may reduce barriers at the environmental level, these initiatives risk having little impact on physical activity if individual level barriers remain unaddressed.

Secular trends in height, weight and body mass index of primary school children in Turkey between 1993 and 2016

BACKGROUND

The aim of the study was to analyze the secular trends in height, weight and body mass index (BMI) of children in a Turkish primary school in a 23-year time interval.

METHODS

The height, weight and BMI of 1099 children between 7 and 15 years old were measured. Data were compared to those of children of the same ages from previous measurements carried out in 1993 (867 children) and in 2003 (1214 children) in the same school. The changes in weight, height and BMI were determined and analyzed statistically.

RESULTS

Weight increments between 7.7 and 16.2 kg/23 years and height increments between 1.1 and 8.3 cm/23 years were observed in boys. For girls, weight increments between 6.5 and 13.4 kg/23 years and height increments between 1.3 and 7.2 cm/23 years were indicated. Usually, there were significant height increments between 1993 and 2016 in both genders. However, there were no significant differences in height between 2003 and 2016 for all age groups. Furthermore, there were significant differences in BMI measurements in all age and gender groups between 1993 and 2016.

CONCLUSIONS

The secular ascending trend in height seems to stop between 2003 and 2016; however, increments in weight and mean BMI tend to continue in Turkish primary school children and adolescents.

Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: A meta-analysis

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is emerging as a public health issue worldwide and is highly prevalent in patients with type 2 diabetes mellitus (T2DM). However, there was a great disparity across studies in the estimated prevalence of NAFLD in T2DM patients. This meta-analysis, therefore, aimed to estimate the pooled prevalence of NAFLD in T2DM patients.

METHODS

Electronic databases of PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure, and Wanfang were searched using MeSH terms to identify relevant studies. Eligibility assessment and data extraction were conducted independently by 2 investigators and a meta-analysis was performed to synthesize the data. Heterogeneity was evaluated using the Cochran Q test and quantified using the I statistic. Publication bias was assessed using both the Begg and Egger tests. Subgroup analyses were performed to identify the possible sources of heterogeneity.

RESULTS

Twenty-four studies involving 35,599 T2DM patients were included in this meta-analysis, of which 20,264 were identified with NAFLD. A high degree of heterogeneity (I = 99.0%, P < .001) was observed among the eligible studies, with the reported prevalence ranging from 29.6% to 87.1%. The pooled prevalence of NAFLD in T2DM patients, by a random-effects model, was 59.67% (95% confidence interval: 54.31-64.92%). Sensitivity was low and both the Begg test and Egger test showed low possibility of publication bias. Subgroup analyses indicated that the prevalence of NAFLD in T2DM patients differed by gender, obesity, hypertension, dyslipidemia, coronary heart disease, and chronic kidney disease.

CONCLUSIONS

The high pooled prevalence of NAFLD in T2DM patients found in this study significantly underscores the need for early assessment of NAFLD and the importance of strengthening the management of NAFLD in T2DM patients.