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Cao B, Shao X, Xiao Y, McIntyre RS, Teopiz KM, Li R, Fan L, Chen H. Potential biopsychosocial factors mediating/moderating the relationship between depressive symptoms and body size among children and adolescents: A systematic review. Obes Rev 2024; 25:e13645. [PMID: 37814428 DOI: 10.1111/obr.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/29/2023] [Accepted: 09/09/2023] [Indexed: 10/11/2023]
Abstract
The prevalence of depression and obesity in the pediatric population has increased along with multiple adverse health outcomes in later life. However, the mechanisms underlying the bidirectional relationship between obesity and depression have not yet been clarified. We aim to systematically summarize the literature reporting on mediational or moderational biopsychosocial factors in the relationship between depression and body size among children and adolescents. Four electronic databases (PubMed, Web of Science, PsycINFO, and PsychArticles) were systematically searched from inception until December 23, 2021, and subsequently updated until June 9, 2023. The study protocol was registered with PROSPERO (CRD42022301475). A total of 36 unique records reporting 152,513 children and adolescents meeting the inclusion criteria were identified. The results indicate that disparate psychological variables (e.g., body image, victimization and bullying, eating disorders, and sleep problems) may mediate the bidirectional relationship between depressive symptoms and body size. Moreover, the mediational/moderational effect of biological factors has not been well established. The moderational effect of social factors was inconsistently reported. Future research should aim to identify and characterize factors that may impact the bidirectional relationship between depression and obesity to inform prevention intervention strategies for affected children and adolescents.
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Affiliation(s)
- Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, PR China
- National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, PR China
| | - Xiaoli Shao
- The First Affiliated Hospital of Xi'an Medical University, Xi'an, PR China
| | - Yefei Xiao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, PR China
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, Ontario, Canada
- Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
| | - Kayla M Teopiz
- Canadian Rapid Treatment Center of Excellence, Mississauga, Ontario, Canada
| | - Ruonan Li
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, PR China
| | - Linlin Fan
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, PR China
| | - Hong Chen
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, PR China
- National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, PR China
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Do Weightbearing Restrictions Cause Excess Weight Gain in Children With LEGG-Calvé-Perthes Disease? J Pediatr Orthop 2023; 43:31-36. [PMID: 36084623 DOI: 10.1097/bpo.0000000000002264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Restricted weight bearing is commonly prescribed in Legg-Calvé-Perthes Disease (LCPD), raising concerns of causing overweight or obesity. This study utilizes prospectively collected data to address the following questions: (1) does body mass index (BMI) Z-score increase over the course of LCPD follow-up; (2) is having a BMI category of normal, overweight, or obese at baseline associated with BMI Z-score changes over the course of follow-up; and (3) is the duration of weight bearing restrictions (no restrictions, <3, 3 to <6, 6 to 9, or >9 mo) associated with BMI Z-score changes. METHODS Data of 130 children aged 5 to 12 years with unilateral early-stage LCPD were extracted from an international database. Nation-specific BMI Z-scores and percentile-based weight categories were determined, and the duration of follow-up and weight bearing restrictions were calculated. Longitudinal changes in BMI Z-scores were evaluated for the 3 study questions using mixed effects linear regression models with surgery as a covariate. Sensitivity analyses were used to determine the influence of socio-cultural background (USA vs. India) for each study question. RESULTS During the 35.5±15.9 months of follow-up, no statistically significant increase in BMI Z-scores was observed across the entire cohort, or following stratification by baseline weight categories or the duration of the weight bearing restriction. Sensitivity analyses indicated that patients in the USA had no change in their BMI Z-score. When stratified by weight categories, the normal weight of US children had a small increase in their BMI Z-score (0.005 per mo, 95% confidence interval: 0.0002, 0.009), but this was not seen in other BMI categories. The cohort of Indian children had a small but significant decrease in their BMI Z-score (-0.005/mo, 95% CI: -0.009, -0.0002). After stratification by weight categories, a small decrease of the BMI Z-score was observed only in the Indian overweight children (-0.016 per mo, 95% CI: -0.027, -0.005) and no other BMI category. CONCLUSIONS Weightbearing restrictions over the course of follow-up for our cohort of children with early-stage LCPD were not associated with clinically meaningful increases of BMI Z-scores. Weight gain is multi-factorial and probably not caused by weight bearing restrictions alone. LEVEL OF EVIDENCE III Diagnostic Study.
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Davis SL, Soistmann HC. Child's perceived stress: A concept analysis. J Pediatr Nurs 2022; 67:15-26. [PMID: 35882112 PMCID: PMC10167593 DOI: 10.1016/j.pedn.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
PROBLEM Child's perceived stress is a term used widely in literature, yet it is poorly defined. Perceived stress in childhood has been linked to negative health outcomes throughout the lifespan. Therefore, the ability of researchers and healthcare providers to conceptualize child's perceived stress and form accurate measures of the concept is of utmost importance. ELIGIBILITY CRITERIA Following the eight steps identified by Walker and Avant, a literature review was conducted to identify studies that measured perceived stress in school-age children over the last 10 years. SAMPLE Of 914 records identified, 136 were screened, and 16 met inclusion criteria. RESULTS Child's perceived stress is best defined as any actual or imagined threat, personal and specific to childhood, which overwhelms the child and leads to changes in emotional, psychological, developmental, and/or physiological domains. CONCLUSIONS While the concept of child's perceived stress is understood similarly throughout studies, there is notable variation in the way child's perceived stress is measured. Because of the specificity of perceived stress to childhood, and the wide range of what may be perceived as stressful by the child, the child is the best reporter of child's perceived stress. IMPLICATIONS Researchers and clinicians must use child self-report tools to measure the concept of child's perceived stress. Opportunities exist for healthcare workers to intervene, educate, and help children and families recognize and manage child's perceived stress. This concept analysis includes many resources that practitioners may use to help alleviate stress in children.
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Affiliation(s)
- Sara L Davis
- University of South Alabama College of Nursing, 5721 Dr. N., Mobile, AL 36608, USA.
| | - Heather C Soistmann
- Penn State Health Children's Hospital, 500 University Dr, Hershey, PA 17033, USA.
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The Association between Obesity and Depression among Children and the Role of Family: A Systematic Review. CHILDREN 2022; 9:children9081244. [PMID: 36010134 PMCID: PMC9406476 DOI: 10.3390/children9081244] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
Abstract
One of the most critical factors that affects or leads to obesity is depression. However, another point of view is that obesity leads to depression. This systematic review estimates evidence arising from observational and systematic studies concerning the association between obesity and depression in children and adolescents. Moreover, the role of the family environment is investigated in this review. A systematic literature search was performed for research conducted between 2014 and 2021 on PubMed. The basic inclusion criteria were the language, study issue and type, and age of the participants. Studies that examined non-healthy populations, or were not related, or with no access were excluded. Titles and abstracts were screened independently, and full-text manuscripts meeting inclusion criteria were extracted. Finally, twenty-seven studies were retained. Most of them highlighted a positive association between obesity and depression. However, it is not clear whether obesity leads to depression or vice versa. Our review also revealed that the role of the family in this association has not been well studied and understood, since only one study addressed the issue. The evidence from our review emphasizes major public health issues; therefore, appropriate health policies should be developed. Moreover, additional research is required to fully understand the role of the family environment in the association between depression and obesity in childhood.
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Ma L, Liu X, Yan N, Gan Y, Wu Y, Li Y, Chu M, Chiu DT, Ma L. Associations Between Different Cortisol Measures and Adiposity in Children: A Systematic Review and Meta-Analysis. Front Nutr 2022; 9:879256. [PMID: 35811977 PMCID: PMC9260431 DOI: 10.3389/fnut.2022.879256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022] Open
Abstract
This study examined associations between hair, salivary, serum, and urinary cortisol concentration with adiposity-related indicators in children, and explored their potential effects modification by age, sex, cortisol measurement method, and country developmental context. We systematically searched PubMed, Web of Science, and Embase for studies examining at least one of the four aforementioned cortisol with objectively measured adiposity-related outcomes in children. Meta-analyses of cross-sectional studies revealed that hair cortisol concentration was associated with fat mass index (FMI)-standard deviation score (SDS)/FMI z-score (pooled-β = 0.04, 95% CI: 0.01, 0.08) and BMI/BMI z-score (pooled-β = 0.15, 95% CI: 0.06, 0.25), and these associations were significant among children aged ≤ 12 years (pooled-β = 0.15, 95% CI: 0.05, 0.26) and >12 years (pooled-β = 0.13, 95% CI: 0.04, 0.22), children from developed countries (pooled β = 0.12, 95% CI: 0.03, 0.21) and developing countries (pooled-β = 0.193, 95% CI: 0.188, 0.198), and in studies extracting cortisol via LC-MS/MS (pooled-β = 0.18, 95% CI: 0.06, 0.29) but not ELISA (pooled-β = 0.08, 95% CI: −0.06, 0.22). Meta-analyses of both cohort and cross-sectional studies revealed non-significant associations of morning salivary cortisol concentration and total daily cortisol output with BMI/BMI z-score. Serum cortisol concentration was not associated with BMI or waist circumference. Meta-analysis of urinary cortisol concentration and adiposity was hindered by insufficient data. These findings further corroborate understanding of chronic stress’ physiological contribution to increased pediatric obesity risk.
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Affiliation(s)
- Lu Ma
- School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Xi Liu
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Na Yan
- School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Yiqun Gan
- Beijing Key Laboratory of Behavior and Mental Health, School of Psychological and Cognitive Sciences, Peking University, Beijing, China
| | - Yue Wu
- Department of Cardiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an, China
- Key Laboratory of Molecular Cardiology, Xi’an, China
| | - Ying Li
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Meng Chu
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Dorothy T. Chiu
- Community Health Sciences Division, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
- *Correspondence: Dorothy T. Chiu,
| | - Le Ma
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- Le Ma,
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Christaki EV, Pervanidou P, Papassotiriou I, Bastaki D, Valavani E, Mantzou A, Giannakakis G, Boschiero D, Chrousos GP. Stress, Inflammation and Metabolic Biomarkers Are Associated with Body Composition Measures in Lean, Overweight, and Obese Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020291. [PMID: 35205011 PMCID: PMC8870192 DOI: 10.3390/children9020291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022]
Abstract
The aim of this study was to examine the associations between multiple indices of stress, inflammation and metabolism vs. body composition parameters in 121 (43 boys, 78 girls) children and adolescents, aged 5–15 y. Subjects were divided into two groups: normal weight (N) (N = 40, BMI z-score = −0.1923 ± 0.6), and overweight/obese (OB) (N = 81, BMI z-score = 2.1947 ± 1.4). All subjects completed the State-Trait Anxiety Inventory for Children (STAIC) and Children’s Depression Inventory, and underwent cortisol measurements in hair, diurnal series of saliva, and morning serum. Circulating concentrations of high sensitivity C-reactive protein (hsCRP) and other inflammation biomarkers were also obtained. Body composition analysis was performed with a clinically validated, advanced bioimpedance apparatus (BIA), while heart rate variability (HRV) was measured as a stress biomarker by photoplethysmography (PPG). The OB group had a higher STAIC-state score, waist-to-hip ratio, skeletal muscle mass, and total and abdominal fat mass, and a lower percent fat-free mass (FFM) and bone density than the N group. HRV did not differ between the groups. In the entire population, percent fat mass correlated strongly with circulating hsCRP (r = 0.397, p = 0.001), ferritin, and other inflammatory biomarkers, as well as with indices of insulin resistance. A strong correlation between serum hsCRP and hair cortisol was also observed (r = 0.777, p < 0.001), suggesting interrelation of chronic stress and inflammation. Thus, body fat accumulation in children and adolescents was associated with an elevation in clinical and laboratory biomarkers of stress, inflammation, and insulin resistance. BIA-ACC and PPG can be utilized as a direct screening tool for assessing overweight- and obesity -related health risks in children and adolescents.
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Affiliation(s)
- Eirini V. Christaki
- Childhood Obesity Clinic, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (P.P.); (A.M.); (G.P.C.)
- Correspondence:
| | - Panagiota Pervanidou
- Childhood Obesity Clinic, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (P.P.); (A.M.); (G.P.C.)
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (D.B.); (E.V.)
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Despoina Bastaki
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (D.B.); (E.V.)
| | - Eleni Valavani
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (D.B.); (E.V.)
| | - Aimilia Mantzou
- Childhood Obesity Clinic, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (P.P.); (A.M.); (G.P.C.)
| | - Giorgos Giannakakis
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology Hellas (FORTH), 70013 Heraklion, Greece;
- Institute of AgriFood and Life Sciences, University Research Centre, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | | | - George P. Chrousos
- Childhood Obesity Clinic, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (P.P.); (A.M.); (G.P.C.)
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece; (D.B.); (E.V.)
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair on Adolescent Health Care, 11527 Athens, Greece
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Lewis-de los Angeles WW, Liu RT. History of Depression, Elevated Body Mass Index, and Waist-to-Height Ratio in Preadolescent Children. Psychosom Med 2021; 83:1075-1081. [PMID: 34267084 PMCID: PMC8578339 DOI: 10.1097/psy.0000000000000982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether a history of depression or self-injurious thoughts and behaviors predict elevated body mass index (BMI) and elevated waist-to-height ratio in preadolescents. METHODS Baseline data were evaluated from a large, nationally representative cohort study of 9- and 10-year-old children (unweighted n = 11,875), the Adolescent Brain and Cognitive Development study. RESULTS In the weighted sample, 10.6% of children had a history of depression, 7.0% had engaged in nonsuicidal self-injury, 13.1% had experienced suicidal ideation in their lifetime, and 1.1% had a history of attempted suicide. Among the children, 34.1% had an elevated BMI in the overweight or obese range and 31.9% had a waist-to-height ratio >0.5. In multivariate analyses, history of depression was associated with elevated BMI and waist-to-height ratio. Furthermore, interactions with sex were found; girls with a history of depression were more likely to have an elevated BMI (odds ratio = 1.47, 95% confidence interval = 1.24-1.74) and elevated waist-to-height ratio (odds ratio = 1.48, 95% confidence interval = 1.18-1.86) than girls without a history of depression, but no differences were observed between boys with and without a history of depression. Self-injurious thoughts and behaviors were not associated with elevated BMI or elevated waist-to-height. CONCLUSIONS In this study, 9- and 10-year-old girls with a history of depression were more likely to have an elevated BMI and elevated waist-to-height ratio than girls with no history of depression. These results provide important clinical context in caring for preadolescents with a history of depression.
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Affiliation(s)
- William W. Lewis-de los Angeles
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pediatrics, Emma Pendleton Bradley Hospital, Riverside, Rhode Island
| | - Richard T. Liu
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Abstract
BACKGROUND There are multiple issues that arise when researchers focus on and only report "statistical significance" of study findings. An important element that is often not included in reports is a discussion of clinical relevance. OBJECTIVES The authors address issues related to significance, the use of effect sizes, confidence or credible intervals, and the inclusion of clinical relevance in reports of research findings. METHODS Measures of magnitude, precision, and relevance such as effect sizes, confidence intervals (CIs), and clinically relevant effects are described in detail. In addition, recommendations for reporting and evaluating effect sizes and CIs are included. Example scenarios are presented to illustrate the interplay of statistical significance and clinical relevance. RESULTS There are several issues that may arise when significance is the focus of clinical research reporting. One issue is the lack of attention to nonsignificant findings in published works although findings show clinical relevance. Another issue is that significance is interpreted as clinical relevance. As well, clinically relevant results from small-sample studies are often not considered for publication, and thus, findings might not be available for meta-analysis. DISCUSSION Findings in research reports should address effect sizes and clinical relevance and significance. Failure to publish clinically relevant effects and CIs may preclude the inclusion of clinically relevant studies in systematic reviews and meta-analyses, thereby limiting the advancement of evidence-based practice. Several accessible resources for researchers to generate, report, and evaluate measures of magnitude, precision, and relevance are included in this article.
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Christian BJ. Translational research - Promoting quality of life in children through health screening and improved management of chronic conditions. J Pediatr Nurs 2019; 44:123-126. [PMID: 30581067 DOI: 10.1016/j.pedn.2018.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Becky J Christian
- School of Nursing, The University of Louisville, Louisville, KY, USA.
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