Childhood obesity: the impact on long-term risk of metabolic and CVD is not necessarily inevitable

Life-course trajectories of body mass index and cardiovascular disease risks and health outcomes in adulthood: Systematic review and meta-analysis

OBJECTIVE

This systematic review aimed to assess the effect of life course body mass index (BMI) trajectories (childhood to adulthood) on cardiovascular disease (CVD) risk factors and outcomes.

METHODS

Prospective or retrospective cohort studies were identified that assessed the association of BMI trajectories with CVD risks and outcomes from databases published in English. The pooled effect sizes were estimated using a random-effects model.

FINDINGS

Seventeen eligible studies were included in this systematic review. The results revealed that a persistently overweight trajectory from childhood to adulthood was associated with a higher risk of hypertension (RR: 2.49; 95% CI: 1.9, 3.28) and type 2 diabetes (RR: 4.62; 95% CI: 2.36, 9.04) compared with a trajectory characterized by a normal BMI throughout both childhood and adulthood. Similarly, the risk of hypertension (RR: 2.38; 95% CI: 1.70, 3.33) and type 2 diabetes (RR: 3.66; 95% CI: 2.57, 5.19) was higher in those with normal-to-overweight trajectory compared with participants with a stable normal weight trajectory.

CONCLUSION

The findings suggest that lifetime BMI trajectories may be influential on health outcomes, and preventive strategies should be designed accordingly. Implementing appropriate preventive strategies at all life stages may reduce CVD risks and adverse outcomes later in life.

Promoting hEalthy Diet and Active Lifestyle (PEDAL): a protocol for the development and feasibility study of a multicomponent intervention among primary school children in Singapore

BACKGROUND

Setting healthy lifestyle habits during the formative years of childhood is critical as habits can track to adulthood and help prevent obesity and chronic disease risks in later life. While multicomponent interventions have been shown to be effective in changing the lifestyle behaviours of children, there is a limited understanding of the feasibility of such interventions in primary schools in Singapore. A multiphase mixed method study was conducted to develop and examine the feasibility of a theory-based multicomponent school-based intervention-Promoting hEatlthy Eating and Active Lifestyle (PEDAL).

METHODS

Underpinned by Kincaid's ideation model, the PEDAL intervention was developed to increase fruit and vegetable consumption and decrease sedentary behaviours among children. This study consists of three phases. Phase 1 details the development of PEDAL, which consists of four components: (A) a series of interactive health education lessons, (B) actionable home activities to support habit formation, (C) parental/guardian engagement, and (D) optimising the school environment. In Phase 2, components A and B of PEDAL were implemented in two public, co-educational primary schools among Primary 5 students (aged 10-12 years) in Singapore. Data was collected quantitatively using questionnaires and qualitatively using focus group discussions (FGDs) with students and teachers. The feasibility dimensions of components A and B, including recruitment capability, data collection, social validity, and practicality were examined, and ideation on healthy eating and physical activity was explored. In Phase 3, the full PEDAL intervention was pilot-tested in two other public, co-education primary schools with the same target population, using a concurrent mixed method quasi-experimental study design. Feasibility dimensions and potential effectiveness of the intervention will be assessed.

DISCUSSION

This study will provide insights into the feasibility of PEDAL and inform its refinement. Findings from the pilot test will guide the planning of a larger-scale definitive trial.

TRIAL REGISTRATION

Registered with ISRCTN registry (ISRCTN16114046) on 16 October 2022.

Obesogenic sleep patterns among Chinese preschool children: A latent profile and transition analysis of the association sleep patterns and obesity risk

OBJECTIVE

This paper utilized a person-centered approach to examine whether sleep patterns on school and free days are associated with obesity risk in preschool children aged 3-6 years.

METHODS

The cross-sectional analysis included 204 children from the Wuhan Healthy Start Project with valid sleep data in at least four consecutive days gathered via Actigraph GT3X+. Based on three domains of sleep duration, sleep onset, and sleep offset, we used latent profile analysis to identify distinct sleep patterns on school and free days separately. Additionally, we conducted latent transition analysis to explore the probabilities of sleep patterns transitions between school and free days. The multivariate logistic regression model investigated the associations of sleep patterns with overweight/obesity (OWO) (BMI ≥ age- and sex-specific 85th percentile) and abdominal obesity (AO) (WC ≥ age- and sex-specific 75th percentile).

RESULTS

Two sleep patterns were identified for school days: "EL-sc" (early-to-sleep/longer-duration) (n = 119; 58.3%) and "LS-sc" (late-to-sleep/shorter-duration) (n = 85; 41.7%). Similarly, "LES-fr" (late-to-sleep/early-to-wake/shorter-duration) (n = 118; 57.8%) and "ELL-fr" (early-to-sleep/late-to-wake/longer-duration) (n = 86; 42.2%) patterns were identified for free days. LTA categorized the participants into four distinct transition groups, i.e., "EL-sc→ELL-fr" (32.9%), "EL-sc→LES-fr" (24.0%), "LS-sc→LES-fr" (33.8%), and "LS-sc→ELL-fr" (9.3%). Compared with the "ELsc→ELL-fr", the "LS-sc→LES-fr" had a higher risk of OWO (AOR 4.76; 95% CI: 1.39-20.33) and AO (AOR, 2.78; 95% CI, 1.21-6.62), respectively. Neither "EL-sc→LES-fr" (AOR, 1.11; 95% CI, 0.14-6.67) nor "LS-sc→ELL-fr" (AOR, 0.74; 95% CI, 0.03-6.14) was significantly associated with OWO. Likewise, no significant association was observed for "EL-sc→LES-fr" (AOR, 0.96; 95% CI, 0.35-2.62) and "LS-sc→ELL-fr" (AOR, 0.56; 95% CI, 0.11-2.18) with AO.

CONCLUSIONS

"LS-sc→LES-fr" pattern is significantly associated with an increased risk of general and abdominal obesity, indicating its obesogenic nature. Furthermore, although not statistically associated with obesity outcomes, "LS-sc→ELL-fr" and "EL-sc→LES-fr" patterns exhibit a semi-obesogenic characteristic. In addition, we identified a concerning trend that preschool children are at risk of transitioning to and persisting in sleep patterns characterized by delayed and shorter sleep. These findings underscore the importance of implementing interventions and strategies to address sleep patterns as a crucial step to minimize the risk of obesity.

Efficacy of a smartphone application-based intervention for encouraging children's healthy eating in Denmark

The growing rates of childhood obesity constitute a public health challenge worldwide. Therefore it is important to identify effective and widely applicable interventions to prevent it. This study aims to explore children's experience of using a newly developed smartphone application (app) designed to promote healthy eating and evaluate its efficacy on encouraging healthy eating. First, two focus groups were conducted to explore children's experience of using the app. Then, a quasi-experimental design was used to evaluate the app's efficacy. The children were asked to use the app for three months. Afterwards, the effect of the intervention was evaluated. 118 children aged 9 to 13 years (M=10.9, Sd=1.1) participated in the study. The children's experience of using the app was relatively positive, and they found the app easy to use. A significant increase in fruit (η2=.10) and vegetable preferences (η2=.37) and fruit intake (η2=.06) was found in the experimental group. No effects were found for vegetable intake, selfefficacy for healthy eating, or peer norms for healthy and unhealthy eating (p>0.05). The smartphone app-based intervention could potentially serve as an attractive and low-cost intervention to reach a wide population of children for the promotion of healthy eating and prevention of childhood obesity.

Effects of Bariatric Surgery in Early- and Adult-Onset Obesity in the Prospective Controlled Swedish Obese Subjects Study

OBJECTIVE

Bariatric surgery is an effective treatment for obesity, but it is unknown if outcomes differ between adults with early- versus adult-onset obesity. We investigated how obesity status at 20 years of age affects outcomes after bariatric surgery later in life.

RESEARCH DESIGN AND METHODS

The Swedish Obese Subjects study is a prospective matched study performed at 25 surgical departments and 480 primary health care centers. Participants aged 37-60 years with BMI ≥34 kg/m² (men) or ≥38 kg/m² (women) were recruited between 1987 and 2001; 2,007 participants received bariatric surgery and 2,040 usual care. Self-reported body weight at 20 years of age was used to stratify patients into subgroups with normal BMI (<25 kg/m²), overweight (BMI 25-29.9 kg/m²), or obesity (BMI ≥30 kg/m²). Body weight, energy intake, and type 2 diabetes status were examined over 10 years, and incidence of cardiovascular and microvascular disease was determined over up to 26 years using data from health registers.

RESULTS

There were small but statistically significant differences in reduction of body weight among the subgroups after bariatric surgery (interaction P = 0.032), with the largest reductions among those with obesity aged 20 years. Bariatric surgery increased type 2 diabetes remission (odds ratios 4.51, 4.90, and 5.58 in subgroups with normal BMI, overweight, or obesity at 20 years of age, respectively; interaction P = 0.951), reduced type 2 diabetes incidence (odds ratios 0.15, 0.13, and 0.15, respectively; interaction P = 0.972), and reduced microvascular complications independent of obesity status at 20 years of age (interaction P = 0.650). The association between bariatric surgery and cardiovascular disease was similar in the subgroups (interaction P = 0.674). Surgical complications were similar in the subgroups.

CONCLUSIONS

The treatment benefits of bariatric surgery in adults are similar regardless of obesity status at 20 years of age.

Active children are less adipose and insulin resistant in early adolescence; evidence from the Mysore Parthenon Cohort

Background

The aim of this study was to determine whether physical activity volume and intensity in mid-childhood and early adolescence were associated with cardiometabolic risk factors at 13.5 years.

Methods

Participants were recruited from the Mysore Parthenon observational birth cohort. At ages 6–10 and 11–13 years, volume and intensity of physical activity were assessed using AM7164 or GT1M actigraph accelerometers worn for ≥4 days, and expressed as mean counts per day and percentage time spent in light, moderate and vigorous physical activity according to criteria defined by Evenson et al. At 13.5 years, fasting blood samples were collected; lipids, glucose and insulin concentrations were measured and insulin resistance (HOMA) was calculated. Systolic and diastolic blood pressure were measured at the left arm using a Dinamap (Criticon). Anthropometry and bio-impedance analysis were used to assess body size and composition. Metabolic and anthropometric measures were combined to produce a metabolic syndrome risk score.

Results

At 6–10 years, boys and girls respectively spent a median (IQR) of 1.1 (0.5, 2.0) % and 0.8 (0.4, 1.3) % of recorded time vigorously active. At 11–13 years, boys and girls respectively spent a median (IQR) of 0.8 (0.4, 1.7) % and 0.3 (0.1, 0.6) % of time vigorously active. All of the physical activity parameters were positively correlated between the 6–10 year and the 11–13 year measurements indicating that physical activity tracked from childhood to early adolescence. There were no associations between physical activity at 6–10 years and individual 13.5 year risk factors but % time vigorously active was inversely associated with metabolic syndrome score (B = −0.40, 95% CI −0.75, 0.05). Volume of physical activity at 11–13 years was inversely associated with 13.5 year HOMA and fat percentage and vigorous physical activity was associated with HOMA, fat percentage, sum of skinfolds, waist circumference and total: HDL cholesterol ratio. Vigorous physical activity was inversely associated with metabolic syndrome score (B = −0.51, 95% CI −0.94, −0.08).

Conclusions

Volume and intensity of physical activity in early adolescence were negatively associated with metabolic and anthropometric risk factors. Interventions that aim to increase adolescent physical activity, especially vigorous, may prevent cardiometabolic disease in later life.

Teacher Perceptions and Preferences for 5 School Breakfast Program Models

OBJECTIVE

Identify differences in teacher perceptions of benefits, challenges, and preferences to different School Breakfast Program (SBP) service models.

DESIGN

A cross-sectional study design was used and an electronic survey was distributed to teachers throughout the state of Utah.

SETTING

Kindergarten through 12th-grade schools throughout Utah.

PARTICIPANTS

A convenience sample of 369 kindergarten through 12th-grade teachers in Utah.

VARIABLES MEASURED

Demographics, benefits and challenges, and teacher preference for SBP models in Utah.

ANALYSIS

Frequencies and multiple comparison analysis tests were performed. A level of significance of <.001 was chosen to protect for multiple comparisons.

RESULTS

Traditional breakfast was the most preferred model, with a mean score of 2.8; Breakfast in the Classroom was the least preferred model by teachers, with a mean of -1.3 (scale used = -5 to 0 to 5). Children not going hungry was the greatest benefit (95.4%; n = 352) to SBP and food waste was the greatest challenge (45.8%; n = 168).

CONCLUSIONS AND IMPLICATIONS

Teachers prefer traditional SBP model over BIC and other nontraditional models. Increased awareness and education regarding benefits and challenges of SBP models may increase teacher preference for nontraditional SBP models, especially BIC.

Anthropometric indicators as predictors of total body fat and cardiometabolic risk factors in Chilean children at 4, 7 and 10 years of age

BACKGROUND/OBJECTIVE

To compare the association between anthropometric indicators of global and central obesity as predictors of total body fat (TBF) and cardiometabolic risk factors in children.

SUBJECTS/METHODS

A total of 1044 children were evaluated at 4 years (n=320), 7 years (n=1044) and 10 years (n=483). The following anthropometric indices were determined: body mass index (BMI) for age (BAZ, WHO), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). To estimate TBF we used validated predictive equations. We measured blood sample concentrations of glucose, insulin, triglycerides, total cholesterol, Low-density lipoprotein (LDL) and High-density lipoprotein (HDL), adiponectin, C-reactive protein (CRP) and Insulin-like growth factor-1 (IGF-1).

RESULTS

Adiposity and cardiometabolic markers, particularly those related to glucose metabolism increased from 4 years to 10 years. BAZ and WC were highly correlated to body fat at all ages (all r>0.8) but at 10 years WC was more strongly correlated than BAZ (r=0.94 WC vs r=0.88 BAZ, P<0.05); conversely, WHtR was significantly associated with body fat from 7 years (r=0.85) and 10 years (r=0.88). WHR was unrelated all over the period studied at all ages. Anthropometrical adiposity indicators became associated to cardiometabolic markers only from 7 years on with associations being slightly higher at 10 years, particularly for adiponectin and lipid markers. At all ages, BAZ, WC and WHtR performed similarly as cardiometabolic markers (P<0.05) while WHR was a slightly weaker marker.

CONCLUSIONS

Relationship between anthropometrical indicators of adiposity and cardiometabolic markers becomes stronger from 7 years onwards; BAZ, WC and WHtR perform similarly as markers of cardiometabolic risk at least until 10 years of age.

Development and Feasibility of a Childhood Obesity Prevention Program for Rural Families: Application of the Social Cognitive Theory

BACKGROUND

Effective childhood obesity prevention programs for preschool children are limited in number and focus on changes in the child care environment rather than the home environment.

PURPOSE

The purpose of this project was to develop and test the feasibility of a home environment obesity prevention program that incorporates mindful eating strategies and Social Cognitive Theory (SCT) constructs. Home Sweet Home is specifically designed for rural parents and grandparents of preschool-age children.

METHODS

HSH was developed using community-based participatory research practices and constructs from the SCT. Three community-based education sessions were delivered. Pre- and post-intervention data were collected from 47 grandparents and mothers.F.

RESULTS

Three of the four selected behavioral outcomes improved between pre- and post-intervention. The number of hours engaged in sedentary behaviors and intake of "red light" foods decreased while three of four mindful eating scores increased. Graduates of the program were able to decrease the number of "red light" foods available in their homes.

DISCUSSION

Improvements in mindful eating and several key behaviors were observed after a three week mindful eating/home environment intervention.

TRANSLATION TO HEALTH EDUCATION PRACTICE

Health educators should incorporate mindful eating strategies and use the SCT when designing childhood obesity prevention programs.

Singaporean Mothers' Perception of Their Three-year-old Child's Weight Status: A Cross-Sectional Study

OBJECTIVE

Inaccurate parental perception of their child's weight status is commonly reported in Western countries. It is unclear whether similar misperception exists in Asian populations. This study aimed to evaluate the ability of Singaporean mothers to accurately describe their three-year-old child's weight status verbally and visually.

METHODS

At three years post-delivery, weight and height of the children were measured. Body mass index (BMI) was calculated and converted into actual weight status using International Obesity Task Force criteria. The mothers were blinded to their child's measurements and asked to verbally and visually describe what they perceived was their child's actual weight status. Agreement between actual and described weight status was assessed using Cohen's Kappa statistic (κ).

RESULTS

Of 1237 recruited participants, 66.4% (n = 821) with complete data on mothers' verbal and visual perceptions and children's anthropometric measurements were analysed. Nearly thirty percent of the mothers were unable to describe their child's weight status accurately. In verbal description, 17.9% under-estimated and 11.8% over-estimated their child's weight status. In visual description, 10.4% under-estimated and 19.6% over-estimated their child's weight status. Many mothers of underweight children over-estimated (verbal 51.6%; visual 88.8%), and many mothers of overweight and obese children under-estimated (verbal 82.6%; visual 73.9%), their child's weight status. In contrast, significantly fewer mothers of normal-weight children were inaccurate (verbal 16.8%; visual 8.8%). Birth order (p<0.001), maternal (p = 0.004) and child's weight status (p<0.001) were associated with consistently inaccurate verbal and visual descriptions.

CONCLUSIONS

Singaporean mothers, especially those of underweight and overweight children, may not be able to perceive their young child's weight status accurately. To facilitate prevention of childhood obesity, educating parents and caregivers about their child's weight status is needed.

Sedentary Behavior in Preschoolers: How Many Days of Accelerometer Monitoring Is Needed?

The reliability of accelerometry for measuring sedentary behavior in preschoolers has not been determined, thus we determined how many days of accelerometry monitoring are necessary to reliably estimate daily time spent in sedentary behavior in preschoolers. In total, 191 and 150 preschoolers (three to five years) wore ActiGraph accelerometers (15-s epoch) during the in-school (≥4 days) and the total-day (≥6 days) period respectively. Accelerometry data were summarized as time spent in sedentary behavior (min/h) using three different cutpoints developed for preschool-age children (<37.5, <200, and <373 counts/15 s). The intraclass correlations (ICCs) and Spearman-Brown prophecy formula were used to estimate the reliability of accelerometer for measuring sedentary behavior. Across different cutpoints, the ICCs ranged from 0.81 to 0.92 for in-school sedentary behavior, and from 0.75 to 0.81 for total-day sedentary behavior, respectively. To achieve an ICC of ≥0.8, two to four days or six to nine days of monitoring were needed for in-school sedentary behavior and total-day sedentary behavior, respectively. These findings provide important guidance for future research on sedentary behavior in preschool children using accelerometry. Understanding the reliability of accelerometry will facilitate the conduct of research designed to inform policies and practices aimed at reducing sedentary behavior in preschool children.

Impact of aerobic exercise on sleep and motor skills in children with autism spectrum disorders - a pilot study

BACKGROUND

Prevalence rates of autism spectrum disorder (ASD) have increased dramatically in the last two decades. In addition to the core symptoms such as impaired communication, difficulties in social interaction, and restricted and stereotypical patterns of behavior and interests, poor sleep and motor skill (MS) deficits have also been observed in children with ASD. On the other hand, there is evidence that aerobic exercise training (AET) has a positive impact on sleep, and that specific training improves MSs. Accordingly, the aim of the present pilot study was to investigate to what extent a combination of AET and MS training (MST) would improve sleep and physical performance in a small sample of children with ASD.

METHODS

Ten children with ASD (mean age: 10 years) took part in the study. After a thorough medical examination and psychiatric assessment, children participated in thrice-weekly 60-minute sessions of AET and MST lasting for 3 consecutive weeks. Sleep was assessed both objectively (sleep-encephalography [sleep-EEG]) and subjectively (parents' questionnaire). MSs were assessed via standardized test batteries. Parents completed sleep and mood logs, and ratings of mood.

RESULTS

Mild-to-moderate insomnia was reported in 70% of children. Compared to nights without previous AET and MS, on nights following AET and MS, sleep efficiency increased (d=1.07), sleep onset latency shortened (d=0.38), and wake time after sleep onset decreased for 63% of the sample (d=1.09), as assessed via sleep-EEG. Mood in the morning, as rated by parents, improved after three weeks (d=0.90), as did MSs (ball playing, balance exercise: ds>0.6).

CONCLUSION

The pattern of results of this pilot study suggests that regular AET and MST impact positively on sleep, MSs, and mood among children with ASD.