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Delpino FM, Costa ÂK, César do Nascimento M, Dias Moura HS, Geremias Dos Santos H, Wichmann RM, Porto Chiavegatto Filho AD, Arcêncio RA, Nunes BP. Does machine learning have a high performance to predict obesity among adults and older adults? A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2024; 34:2034-2045. [PMID: 39004592 DOI: 10.1016/j.numecd.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/27/2024] [Accepted: 05/23/2024] [Indexed: 07/16/2024]
Abstract
AIM Machine learning may be a tool with the potential for obesity prediction. This study aims to review the literature on the performance of machine learning models in predicting obesity and to quantify the pooled results through a meta-analysis. DATA SYNTHESIS A systematic review and meta-analysis were conducted, including studies that used machine learning to predict obesity. Searches were conducted in October 2023 across databases including LILACS, Web of Science, Scopus, Embase, and CINAHL. We included studies that utilized classification models and reported results in the Area Under the ROC Curve (AUC) (PROSPERO registration: CRD42022306940), without imposing restrictions on the year of publication. The risk of bias was assessed using an adapted version of the Transparent Reporting of a multivariable prediction model for individual Prognosis or Diagnosis (TRIPOD). Meta-analysis was conducted using MedCalc software. A total of 14 studies were included, with the majority demonstrating satisfactory performance for obesity prediction, with AUCs exceeding 0.70. The random forest algorithm emerged as the top performer in obesity prediction, achieving an AUC of 0.86 (95%CI: 0.76-0.96; I2: 99.8%), closely followed by logistic regression with an AUC of 0.85 (95%CI: 0.75-0.95; I2: 99.6%). The least effective model was gradient boosting, with an AUC of 0.77 (95%CI: 0.71-0.82; I2: 98.1%). CONCLUSION Machine learning models demonstrated satisfactory predictive performance for obesity. However, future research should utilize more comparable data, larger databases, and a broader range of machine learning models.
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Affiliation(s)
- Felipe Mendes Delpino
- Postgraduate Program in Nursing, Federal University of Pelotas. Pelotas, Rio Grande do Sul, Brazil; Postgraduate Program in Public Health Nursing, University of São Paulo, Ribeirão Preto, Brazil.
| | - Ândria Krolow Costa
- Postgraduate Program in Nursing, Federal University of Pelotas. Pelotas, Rio Grande do Sul, Brazil
| | | | | | | | | | | | | | - Bruno Pereira Nunes
- Postgraduate Program in Nursing, Federal University of Pelotas. Pelotas, Rio Grande do Sul, Brazil
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Zhang CY, Zhao W, Pan XP, Huang AQ. Effects of feeding patterns during the first 6 months on weight development of infants ages 0-12 months: a longitudinal study. Sci Rep 2024; 14:17451. [PMID: 39075043 PMCID: PMC11286799 DOI: 10.1038/s41598-024-58164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/26/2024] [Indexed: 07/31/2024] Open
Abstract
The purpose of this study was to investigate the effect of feeding patterns during the first 6 months on weight development of infants ages 0-12 months. Using monitoring data from the Maternal and Child Health Project conducted by the National Center for Women and Children's Health of the Chinese Center for Disease Control and Prevention from September 2015 to June 2019, we categorized feeding patterns during the first 6 months as exclusive breastfeeding, formula feeding, or mixed feeding. We calculated weight-for-age Z scores (WAZ) according to the World Health Organization's (WHO) 2006 Child Growth Standard using WHO Anthro version 3.2.2. A multilevel model was used to analyze the effect of feeding patterns during the first 6 months on the WAZ of infants ages 0-12 months in monitoring regions. Length of follow-up (age of infants) was assigned to level 1, and infants was assigned to level 2. Characteristics of infants, mothers, and families and region of the country were adjusted for in the model. The average weight of infants ages 0-12 months in our study (except the birth weights of boys who were formula fed or mixed fed) was greater than the WHO growth standard. After we adjusted for confounding factors, the multilevel model showed that the WAZ of exclusively breastfed and mixed-fed infants were statistically significantly higher than those of formula-fed infants (coefficients = 0.329 and 0.159, respectively; P < 0.05), and there was a negative interaction between feeding patterns and age (both coefficients = - 0.020; P < 0.05). Infants who were exclusively breastfed were heavier than formula-fed infants from birth until 12 months of age. Mixed-fed infants were heavier than formula-fed infants before 8 months, after which the latter overtook the former. Infants' weight development may be influenced by feeding patterns during the first 6 months. Exclusive breastfeeding during the first 6 months may be beneficial for weight development of infants in infancy.
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Affiliation(s)
- Chun-Ying Zhang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
- Hebei Provincial National Center for Women and Children's Health, Hebei, 050031, China
| | - Wei Zhao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Xiao-Ping Pan
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Ai-Qun Huang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China.
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Palaska E, Antoniou E, Tzitiridou-Chatzopoulou M, Eskitzis P, Orovou E. Correlation between Breastfeeding, Maternal Body Mass Index, and Childhood Obesity. EPIDEMIOLOGIA 2024; 5:411-420. [PMID: 39051210 PMCID: PMC11270408 DOI: 10.3390/epidemiologia5030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/09/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
Breast milk is a unique and highly beneficial source of nutrition for infants. It contains a wide range of nutrients that are specifically tailored to meet the specific needs of a growing infant. On the other hand, obesity is a major health issue that affects people around the world. The aim of this study is to investigate the relationship between breastfeeding and child BMI and the role of maternal BMI, which may influence this relationship. This study revealed that a longer duration of exclusive breastfeeding was associated with a decrease in the prevalence of overweight children. Additionally, the research found that children born to overweight or obese women had a higher probability of being overweight or obese themselves. Considering that mothers with a higher pre-pregnancy body weight are more likely to have children with a higher BMI, it is important that they receive information about the advantages of breastfeeding for a minimum of 6 months for both themselves and their children. Additionally, they should be offered ongoing support, to encourage them to start breastfeeding and continue with it beyond this period.
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Affiliation(s)
- Ermioni Palaska
- Department of Midwifery, University of West Attica, 12243 Athens, Greece; (E.A.); (E.O.)
| | - Evangelia Antoniou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece; (E.A.); (E.O.)
| | | | - Panagiotis Eskitzis
- Department of Midwifery, University of Western Macedonia, 50200 Ptolemaida, Greece; (M.T.-C.); (P.E.)
| | - Eirini Orovou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece; (E.A.); (E.O.)
- Department of Midwifery, University of Western Macedonia, 50200 Ptolemaida, Greece; (M.T.-C.); (P.E.)
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Santibáñez Cárcamo C, Silva Gómez R. [Factors associated with the development of malnutrition due to excess in children]. NUTR HOSP 2024; 41:554-559. [PMID: 37929834 DOI: 10.20960/nh.04861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Introduction Introduction: malnutrition due to excess is a serious public health problem currently affecting 53 % of children and adolescents in Chile. The early identification of associated factors is key in prevention and necessary to guide interventions from early stages of life. Objective: to identify factors associated with the development of malnutrition due to excess in three-year-old children under control at Ancora Family Health. Methods: a case-control study was carried out in three Ancora Family Health Centers located in the communes of La Pintana and Puente Alto; it included 133 children and their mothers. Factors dependent on the child and the mother were analyzed and their importance in the development of malnutrition due to excess was determined. Results: logistic regression showed maternal smoking during pregnancy as a risk factor (OR = 4.065, 95 % CI: 1.119-14.770, p = 0.033) and as protective factors birth weight < 4,000 g (OR = 0.112, 95 % CI: 0.026-0.483, p = 0.003) and weight gain during the first year of life < 6.4 kg in women and < 6.9 kg in men (OR = 0.060, 95 % CI: 0.017-0.210, p = 0.000). Conclusions: the most important risk factor was maternal smoking and the protective factors were birth weight and weight gain in the first year. Health programs and public policies should focus on modifiable factors such as smoking during pregnancy and adequate weight gain in the first year of life.
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Tong Z, Xie Y, Li K, Yuan R, Zhang L. The global burden and risk factors of cardiovascular diseases in adolescent and young adults, 1990-2019. BMC Public Health 2024; 24:1017. [PMID: 38609901 PMCID: PMC11010320 DOI: 10.1186/s12889-024-18445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND To provide details of the burden and the trend of the cardiovascular disease (CVD) and its risk factors in adolescent and young adults. METHODS Age-standardized rates (ASRs) of incidence, mortality and Disability-Adjusted Life Years (DALYs) were used to describe the burden of CVD in adolescents and young adults. Estimated Annual Percentage Changes (EAPCs) of ASRs were used to describe the trend from 1990 to 2019. Risk factors were calculated by Population Attributable Fractions (PAFs). RESULTS In 2019, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of CVD were 129.85 per 100 000 (95% Confidence interval (CI): 102.60, 160.31), 15.12 per 100 000 (95% CI: 13.89, 16.48) and 990.64 per 100 000 (95% CI: 911.06, 1076.46). The highest ASRs were seen in low sociodemographic index (SDI) and low-middle SDI regions. The burden was heavier in male and individuals aged 35-39. From 1990 to 2019, 72 (35.29%) countries showed an increasing trend of ASIR and more than 80% countries showed a downward trend in ASMR and ASDR. Rheumatic heart disease had the highest ASIR and Ischemic Heart Disease was the highest in both ASMR and ASDR. The main attributable risk factor for death and DALYs were high systolic blood pressure, high body-mass index and high LDL cholesterol. CONCLUSIONS The burden of CVD in adolescent and young adults is a significant global health challenge. It is crucial to take into account the disparities in SDI levels among countries, gender and age characteristics of the population, primary types of CVD, and the attributable risk factors when formulating and implementing prevention strategies.
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Affiliation(s)
- Zhuang Tong
- Clinical Big Data Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- Henan Academy of Medical Big Data, Zhengzhou, China
| | - Yingying Xie
- Department of Scientific Management, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Kaixiang Li
- Clinical Big Data Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- Henan Academy of Medical Big Data, Zhengzhou, China
| | - Ruixia Yuan
- Clinical Big Data Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
- Henan Academy of Medical Big Data, Zhengzhou, China.
| | - Liang Zhang
- Department of Cardiovascular Surgery, Rhe First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
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Xu C, Zhang X, Wang Y, Wang Y, Zhou Y, Li F, Hou X, Xia D. Dietary kaempferol exerts anti-obesity effects by inducing the browing of white adipocytes via the AMPK/SIRT1/PGC-1α signaling pathway. Curr Res Food Sci 2024; 8:100728. [PMID: 38577419 PMCID: PMC10990952 DOI: 10.1016/j.crfs.2024.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/01/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
Browning of white adipose tissue is a novel approach for the management of obesity and obesity-related metabolic disorders. Kaempferol (KPF) is a common dietary nutrient found abundantly in many fruits and vegetables and has been shown to have the potential to regulate lipid metabolism. However, the detailed mechanism by which it affects the browning of white adipose tissue remains unclear. In the present study, we sought to determine how KPF induces adipocytes to undergo a browning transformation by establishing a primary adipocyte model and an obese mouse model. Our results showed that KPF-treated mice were rescued from diet-induced obesity, glucose tolerance and insulin resistance, associated with increased expression of adaptive thermogenesis-related proteins. KPF-promoted white adipose browning correlated with the AMPK/SIRT1/PGC-1α pathway, as the use of an AMPK inhibitor in preadipocytes partially reversed the observed browning phenotype of KPF-treated cells. Taken together, these data suggest that KPF promotes browning of white adipose tissue through activation of the AMPK/SIRT1/PGC-1α pathway. This study demonstrates that KPF is a promising natural product for the treatment of obesity by promoting white fat browning.
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Affiliation(s)
- Changyu Xu
- Department of Food Science and Nutrition, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xiaoxi Zhang
- Department of Food Science and Nutrition, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
- Academy of Chinese Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yihuan Wang
- Department of Food Science and Nutrition, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yan Wang
- Department of Food Science and Nutrition, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yixuan Zhou
- Department of Food Science and Nutrition, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Fenfen Li
- Department of Food Science and Nutrition, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xiaoli Hou
- Academy of Chinese Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Daozong Xia
- Department of Food Science and Nutrition, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, China
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Rosberg A, Merisaari H, Lewis JD, Hashempour N, Lukkarinen M, Rasmussen JM, Scheinin NM, Karlsson L, Karlsson H, Tuulari JJ. Associations between maternal pre-pregnancy BMI and infant striatal mean diffusivity. BMC Med 2024; 22:140. [PMID: 38528552 DOI: 10.1186/s12916-024-03340-z] [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: 09/26/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND It is well-established that parental obesity is a strong risk factor for offspring obesity. Further, a converging body of evidence now suggests that maternal weight profiles may affect the developing offspring's brain in a manner that confers future obesity risk. Here, we investigated how pre-pregnancy maternal weight status influences the reward-related striatal areas of the offspring's brain during in utero development. METHODS We used diffusion tensor imaging to quantify the microstructure of the striatal brain regions of interest in neonates (N = 116 [66 males, 50 females], mean gestational weeks at birth [39.88], SD = 1.14; at scan [43.56], SD = 1.05). Linear regression was used to test the associations between maternal pre-pregnancy body mass index (BMI) and infant striatal mean diffusivity. RESULTS High maternal pre-pregnancy BMI was associated with higher mean MD values in the infant's left caudate nucleus. Results remained unchanged after the adjustment for covariates. CONCLUSIONS In utero exposure to maternal adiposity might have a growth-impairing impact on the mean diffusivity of the infant's left caudate nucleus. Considering the involvement of the caudate nucleus in regulating eating behavior and food-related reward processing later in life, this finding calls for further investigations to define the prognostic relevance of early-life caudate nucleus development and weight trajectories of the offspring.
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Affiliation(s)
- Aylin Rosberg
- FinnBrain Birth Cohort Study, Turku Brain and Mind Centre, Department of Clinical Medicine, University of Turku, Turku, Finland.
- Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland.
| | - Harri Merisaari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Centre, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Diagnostic Radiology, Turku University Hospital, Turku, Finland
| | - John D Lewis
- The Hospital for Sick Children (SickKids) Research Institute, Toronto, ON, Canada
| | - Niloofar Hashempour
- FinnBrain Birth Cohort Study, Turku Brain and Mind Centre, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Minna Lukkarinen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Centre, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Noora M Scheinin
- FinnBrain Birth Cohort Study, Turku Brain and Mind Centre, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, University of Turku and Satakunta Wellbeing Services County, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Centre, Department of Clinical Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Centre, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Jetro J Tuulari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Centre, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
- Turku Collegium for Science, Medicine and Technology, University of Turku, Turku, Finland
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Grady A, Jackson J, Wolfenden L, Lum M, Milat A, Bauman A, Hodder R, Yoong SL. Assessing the scalability of evidence-based healthy eating and physical activity interventions in early childhood education and care: A cross-sectional study of end-user perspectives. Aust N Z J Public Health 2024; 48:100122. [PMID: 38198903 DOI: 10.1016/j.anzjph.2023.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/13/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES To describe early childhood education and care (ECEC) services: i) perceptions regarding the scalability of healthy eating and physical activity interventions; and ii) associations between scalability and service characteristics. METHODS A cross-sectional survey was conducted with a randomly selected sample of ECEC services across Australia. The scalability of 12 healthy eating and physical activity interventions was assessed using items based on the Intervention Scalability Assessment Tool. Higher scores represented higher perceived scalability. RESULTS From 453 participants, the highest scoring healthy eating and physical activity interventions were 'providing healthy eating education and activities for children' (M43.05) (out of 50) and 'providing sufficient opportunities for child physical activity' (M41.43). The lowest scoring was 'providing families with lunchbox guidelines' (M38.99) and 'engaging families in activities to increase child physical activity' (M38.36). Services located in rural areas, compared to urban areas, scored the overall scalability of both healthy eating and physical activity interventions significantly lower. CONCLUSIONS Perceptions regarding the scalability of healthy eating and physical activity interventions in the ECEC setting vary according to service characteristics. IMPLICATIONS FOR PUBLIC HEALTH Findings identify where government investment and implementation efforts may be prioritised to facilitate scale-up. An investigation into the barriers and support required for lower-scoring interventions is warranted.
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Affiliation(s)
- Alice Grady
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia; National Centre of Implementation Science, University of Newcastle, NSW, Australia.
| | - Jacklyn Jackson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia; National Centre of Implementation Science, University of Newcastle, NSW, Australia
| | - Melanie Lum
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia; Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, VIC, Australia
| | - Andrew Milat
- Centre for Epidemiology and Evidence, NSW Health, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Rebecca Hodder
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia; National Centre of Implementation Science, University of Newcastle, NSW, Australia
| | - Sze Lin Yoong
- National Centre of Implementation Science, University of Newcastle, NSW, Australia; Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, VIC, Australia
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Androja L, Bavčević T, Jurčev Savičević A, Bavčević D, Ninčević J, Buljan A, Nonković D, Rodrigues V, Karin Ž. Body Mass Index Trends before and during the COVID-19 Pandemic in Primary School Students in Split-Dalmatia County, Croatia: A Retrospective Study. Nutrients 2023; 16:50. [PMID: 38201879 PMCID: PMC10780733 DOI: 10.3390/nu16010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Within the last decade, childhood obesity has become a serious problem, especially during the COVID-19 pandemic. This research paper aimed to examine whether body mass index (BMI) was higher during the pandemic (2020-2022) than in the pre-pandemic period (2012/2013-2019) using trends related to sex, urban-rural area, and physical activity (PA). This study included data from physical examinations of an entire population of primary school children from Split-Dalmatia County (Croatia) over a period of 10 years. There were 103,804 students from the first, fifth, and eighth grades who participated in the analysis. During the pandemic, the BMI of all the students increased, except for eighth-grade girls. Generations of eighth graders have had significantly different BMIs throughout the past decade. We found that first graders were overweight and obese in urban areas, while in rural areas, this problem was experienced by upper grades. Girls were more overweight and obese in the first and eighth grades, but boys experienced this more in the fifth grade. Reduced PA influenced an increase in BMI in both sexes, especially in girls. During the pandemic, this situation became worse. This study could be useful to experts for the creation of new policies for Split-Dalmatia County and surrounding regions that are similar economically and culturally.
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Affiliation(s)
- Luka Androja
- School of Medicine, University of Split, 21000 Split, Croatia; (L.A.)
- Department of Sports Management, Aspira University of Applied Sciences, 21000 Split, Croatia
| | - Tonči Bavčević
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia
| | - Anamarija Jurčev Savičević
- School of Medicine, University of Split, 21000 Split, Croatia; (L.A.)
- Teaching Institute for Public Health of Split-Dalmatia County, 21000 Split, Croatia
- Department of Health Studies, University of Split, 21000 Split, Croatia
| | - Damir Bavčević
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia
| | - Jasna Ninčević
- Teaching Institute for Public Health of Split-Dalmatia County, 21000 Split, Croatia
| | - Anita Buljan
- Teaching Institute for Public Health of Split-Dalmatia County, 21000 Split, Croatia
| | - Diana Nonković
- Teaching Institute for Public Health of Split-Dalmatia County, 21000 Split, Croatia
| | - Vitor Rodrigues
- Faculty of Medicine, University of Coimbra, 3030-222 Coimbra, Portugal
| | - Željka Karin
- School of Medicine, University of Split, 21000 Split, Croatia; (L.A.)
- Teaching Institute for Public Health of Split-Dalmatia County, 21000 Split, Croatia
- Department of Health Studies, University of Split, 21000 Split, Croatia
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Al-Walah MA, Donnelly M, Cunningham C, Heron N. Which behaviour change techniques are associated with interventions that increase physical activity in pre-school children? A systematic review. BMC Public Health 2023; 23:2013. [PMID: 37845721 PMCID: PMC10580560 DOI: 10.1186/s12889-023-16885-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Insufficient physical activity (PA) is a significant risk factor that contributes to several health problems and there is a need to improve our understanding of how to increase PA, particularly among young children. This review (PROSPERO registration: CRD42022328841) investigated the relationship between behaviour change techniques (BCTs) and interventions that increased PA among pre-school children aged < 6 years old. METHODS Systematic searches of six databases were undertaken from inception to July 2022, updated in December 2022, to locate studies that evaluated interventions and reported a positive change in PA levels in children aged < 6 years old. RESULTS A total of 5,304 studies were screened, and 28 studies involving 10,605 subjects aged 2.5 to 5.9 years met the eligibility criteria. Each eligible study (n = 28) was independently appraised by two researchers using the Cochrane risk of bias tool. The BCT Taxonomy v1 and the Template for Intervention Description and Replication (TIDieR) guided the extraction and analysis of data, and this process led to the identification of 27 BCTs. CONCLUSIONS Potentially promising BCTs for increasing PA among young children included 'shaping knowledge,' 'antecedents,' 'goals and planning,' and 'comparison of behaviour.' Future PA interventions that target young children should consider integrating these promising BCTs into their programmes. However, such consideration needs to be tempered by the fact that most of the reviewed studies were deemed to have a high or unclear risk of bias and/or were limited with respect to the populations that they targeted. Further research using rigorous methodologies is required to establish a higher standard that addresses the needs of young children who are expected to have insufficient levels of physical activity.
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Affiliation(s)
- Mosfer A Al-Walah
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK.
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, 21974, Taif, Saudi Arabia.
| | - Michael Donnelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
| | - Conor Cunningham
- School of Health Science, Ulster University, Northern Ireland, UK
| | - Neil Heron
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
- School of Medicine, Keele University, England, UK
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Baranowska A, Sierakowska M, Owczarczuk A, Olejnik BJ, Lankau A, Baranowski P. An Analysis of the Risk Factors for Postural Defects among Early School-Aged Children. J Clin Med 2023; 12:4621. [PMID: 37510735 PMCID: PMC10380383 DOI: 10.3390/jcm12144621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
A considerable number of problems begin in childhood due to lifestyle changes, which include a transition from a previous period of extensive movement to prolonged hours of staying in a sitting position at school. The aim of this study was to examine the occurrence of back and side view postural defects in the study group of school-aged children and identify risk factors associated with the formation of postural abnormalities in the study group. METHODS This study was conducted on a group of 141 children aged 7-10, attending the first to third grades at a primary school in Białystok (northeastern Poland). This study involved measuring the children's height and weight, assessing the children's body posture based on the FITS method (Functional Individual Scoliosis Therapy) by Białek and M'hango (the authors of this study), and administering a diagnostic survey addressed to parents and guardians of the children (n = 104) using a self-designed questionnaire. RESULTS Almost all defects were more prevalent in boys, especially in the case of stature triangles (p = 0.0489) and knee alignment in the sagittal plane (p = 0.038). The age of the subjects differentiated the incidence of defects in the scapulae (p = 0.0037) and shoulder (p = 0.0129) alignment, correlating negatively with age. The risk of postural defects for knees (p = 0.0391) and abdominal arching (p = 0.0240) was significant with a higher BMI. The following lifestyle-related factors were significant: the seat for doing homework (stature triangles p = 0.0253), time spent in front of a computer (positioning of the scapulae in relation to each other p = 0.0233; vertical view of the intergluteal cleft p = 0.0324), and snacking between meals (feet p = 0.0003; shoulder positioning p = 0.0013; stature triangles p = 0.0186; positioning of the scapulae in relation to each other p = 0.0404). CONCLUSIONS The body posture of the examined children was closed with the head pushed forward and drooped, rounded shoulders, hyperlordosis, and pelvic anteversion. Most exhibited various types of abnormalities related to the feet. The recognized risk factors for posture defects are overweight/obesity, the male gender, children who are older, lack of an adjustable work chair, 2 h a day or more spent using the computer, and snacking between meals.
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Affiliation(s)
- Anna Baranowska
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Bialystok, Poland
| | - Matylda Sierakowska
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Bialystok, Poland
| | | | - Beata Janina Olejnik
- Department of Developmental Age Medicine and Pediatric Nursing, Faculty of Health Sciences, Medical University of Bialystok, 15-295 Bialystok, Poland
| | - Agnieszka Lankau
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Bialystok, Poland
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12
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The Influence of Serious Games in the Promotion of Healthy Diet and Physical Activity Health: A Systematic Review. Nutrients 2023; 15:nu15061399. [PMID: 36986129 PMCID: PMC10056209 DOI: 10.3390/nu15061399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
(1) Background: serious games seem to show promising strategies to promote treatment compliance and motivate behavior changes, and some studies have proven to contribute to the literature on serious games. (2) Methods: this systematic review aimed to analyze the effect of serious games in promoting healthy eating behaviors, effectively preventing childhood obesity, and improving physical activity in children. Five electronic bibliographic databases—PubMed, ACM Digital Library, Games for Health Journal, and IEEE Xplore were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria. Peer-reviewed journal articles published between 2003 and 2021 were selected for data extraction. (3) Results: a total of 26 studies were identified, representing 17 games. Half of the studies tested interventions for healthy eating and physical education. Most of the intervention’s games were designed according to specific behavioral change theories, predominantly the social cognitive theory. (4) Conclusions: studies confirmed the potential of serious games for obesity prevention but considering the restrictions encountered, we exhort for novel designs with different theoretical perspectives.
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13
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Guarino M, Matonti L, Chiarelli F, Blasetti A. Primary prevention programs for childhood obesity: are they cost-effective? Ital J Pediatr 2023; 49:28. [PMID: 36864472 PMCID: PMC9983264 DOI: 10.1186/s13052-023-01424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 02/02/2023] [Indexed: 03/04/2023] Open
Abstract
Childhood obesity is increasing all over the world. It is associated with a reduction in quality of life and a relevant burden on society costs. This systematic review deals with the cost-effectiveness analysis (CEA) of primary prevention programs on childhood overweight/obesity, in order to benefit from cost-effective interventions.We screened and evaluated all the studies with a cost-effectiveness analysis on childhood obesity primary prevention program by PUBMED and Google Scholar, using inclusion and exclusion criteria. The quality of the studies was assessed by Drummond's checklist.Ten studies were included. Two of them examined the cost-effectiveness of community-based prevention programs, four focused only on school-based programs while four more studies examined both community-based and school-based programs. The studies were different in terms of study design, target population, health and economic outcomes. Seventy per cent of the works had positive economic results.The majority of the studies showed effective economic outcomes applying primary prevention programs on childhood obesity. It is important to increase homogeneity and consistency among different studies.
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Affiliation(s)
| | - Lorena Matonti
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
| | - Francesco Chiarelli
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
| | - Annalisa Blasetti
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
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14
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Ayenigbara IO. Risk-Reducing Measures for Cancer Prevention. Korean J Fam Med 2023; 44:76-86. [PMID: 36966737 PMCID: PMC10040267 DOI: 10.4082/kjfm.22.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/30/2022] [Indexed: 03/22/2023] Open
Abstract
Cancer, or malignancy, continues to be one of the most serious health problems in the world, leading to death and disability. Unlike in previous years, where new cases of cancer were predominant in developed nations, the number of cases of cancer and the resultant deaths are increasing in low- and middle-income countries. This is partially attributable to the current trend of adopting a Western lifestyle, substantial urbanization, and the rise in infections, such as the human papillomavirus (HPV) and hepatitis B virus (HBV), which together account for over 30% of cancer cases in underdeveloped and developing nations. The deleterious impact of cancer, as cases multiply worldwide, is multi-dimensional. Cancer exerts serious physical, psychological, and monetary burdens, not only on cancer patients but also on their family members, close friends, health care systems, and society at large. Importantly, over half of all cancer types can be prevented globally by mitigating the risk and causative factors as well as prompt adherence to scientifically recommended prevention measures. This review provides various scientifically based and people-centered strategies that every individual could adopt to reduce their risk of developing cancer in the future. It is recommended that, for these cancer prevention strategies to be effective, there should be a strong political will from the governments of individual countries to enact specific laws and implement policies that will significantly reduce sedentary lifestyles and unhealthy eating among the general public. Likewise, HPV and HBV vaccines, as well as cancer screenings, should be made available, affordable, and accessible on a timely basis for those who are eligible to take them. Finally, intensified campaigns and numerous informative and educational programs that promote cancer prevention should be initiated globally.
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Affiliation(s)
- Israel Oluwasegun Ayenigbara
- School and Community Health Education Unit, Department of Health Education, University of Ibadan, Ibadan, Nigeria
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15
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Liu Y, Chen L, Liu L, Zhao SS, You JQ, Zhao XJ, Liu HX, Xu GW, Wen DL. Interplay between dietary intake, gut microbiota, and metabolic profile in obese adolescents: Sex-dependent differential patterns. Clin Nutr 2022; 41:2706-2719. [PMID: 36351362 DOI: 10.1016/j.clnu.2022.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS The interplay among dietary intake, gut microbiota, gut metabolites and circulating metabolites in adolescents is barely known, not to mention sex-dependent pattern. We aimed to explore unique profiles of gut bacterial, gut metabolites and circulating metabolites from both genders of adolescents due to BMI and eating pattern. METHODS Clinical indices, fecal gut microbiota, fecal and plasma metabolites, and diet intake information were collected in case-control sample matched for normal and obesity in girls (normal = 12, obesity = 12) and boys (normal = 20, obesity = 20), respectively. 16S rRNA gene sequencing and untargeted metabolomics was performed to analysis the signature of gut microbiota and metabolites. Unique profiles of girls associated with BMI and eating pattern was revealed by Spearman's correlations analysis, co-occurrence network analysis, Kruskal-Wallis test, and Wilcoxon rank-sum test. RESULTS Gender difference was found between normal and obese adolescents in gut microbiota, fecal metabolites, and plasma metabolites. The Parabacteroides were only decreased in obese girls. And the characteristic of obese girls' and boys' cases in fecal and plasma was xanthine and glutamine, ornithine and LCA, respectively. Soy products intake was negatively associated with Parabacteroides. The predicted model has a higher accuracy based on the combined markers in obesity boys (AUC = 0.97) and girls (AUC = 0.97), respectively. CONCLUSIONS Reduced abundance of Phascolarctobacterium and Parabacteroides, as well as the increased fecal xanthine and ornithine, may provide a novel biomarker signature in obesity girls and boys. Soy products intake was positively and negatively associated with Romboutsia and Parabacteroides abundance, respectively. And the combined markers facilitate the accuracy of predicting obesity in girls and boys in advance.
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Affiliation(s)
- Yang Liu
- Health Sciences Institute, China Medical University, Shenyang 110122, Liaoning Province, PR China; Liaoning Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning Province, PR China
| | - Lei Chen
- Health Sciences Institute, China Medical University, Shenyang 110122, Liaoning Province, PR China; Liaoning Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning Province, PR China; Institute of Life Sciences, China Medical University, Shenyang 110122, Liaoning Province, PR China
| | - Lei Liu
- Health Sciences Institute, China Medical University, Shenyang 110122, Liaoning Province, PR China; Liaoning Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning Province, PR China
| | - Shan-Shan Zhao
- Health Sciences Institute, China Medical University, Shenyang 110122, Liaoning Province, PR China; Liaoning Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning Province, PR China; Institute of Life Sciences, China Medical University, Shenyang 110122, Liaoning Province, PR China
| | - Jun-Qiao You
- Health Sciences Institute, China Medical University, Shenyang 110122, Liaoning Province, PR China; Liaoning Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning Province, PR China
| | - Xin-Jie Zhao
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, The Chinese Academy of Sciences, Dalian 116023, Liaoning Province, PR China.
| | - Hui-Xin Liu
- Health Sciences Institute, China Medical University, Shenyang 110122, Liaoning Province, PR China; Liaoning Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning Province, PR China; Institute of Life Sciences, China Medical University, Shenyang 110122, Liaoning Province, PR China.
| | - Guo-Wang Xu
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, The Chinese Academy of Sciences, Dalian 116023, Liaoning Province, PR China
| | - De-Liang Wen
- Health Sciences Institute, China Medical University, Shenyang 110122, Liaoning Province, PR China; Liaoning Key Laboratory of Obesity and Glucose/Lipid Associated Metabolic Diseases, China Medical University, Shenyang 110122, Liaoning Province, PR China.
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16
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Ray D, Sniehotta F, McColl E, Ells L, O'Neill G, McCabe K. A collaborative approach to develop an intervention to strengthen health visitors' role in prevention of excess weight gain in children. BMC Public Health 2022; 22:1735. [PMID: 36100859 PMCID: PMC9469535 DOI: 10.1186/s12889-022-14092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The high prevalence of childhood obesity is a concern for public health policy and practitioners, leading to a focus on early prevention. UK health visitors (HVs) are well-positioned to prevent excessive weight gain trends in pre-school children but experience barriers to implementing guideline recommended practices. This research engaged with HVs to design an intervention to strengthen their role in prevention of early childhood obesity. METHODS We describe the processes we used to develop a behaviour change intervention and measures to test its feasibility. We conducted a systematic review to identify factors associated with implementation of practices recommended for prevention of early childhood obesity. We carried out interactive workshops with HVs who deliver health visiting services in County Durham, England. Workshop format was informed by the behaviour change wheel framework for developing theory-based interventions and incorporated systematic review evidence. As intended recipients of the intervention, HVs provided their views of what is important and acceptable in the local context. The findings of the workshops were combined in an iterative process to inform the four steps of the Implementation Intervention development framework that was adapted as a practical guide for the development process. RESULTS Theoretical analysis of the workshop findings revealed HVs' capabilities, opportunities and motivations related to prevention of excess weight in 0-2 year olds. Intervention strategies deemed most likely to support implementation (enablement, education, training, modelling, persuasion) were combined to design an interactive training intervention. Measures to test acceptability, feasibility, and fidelity of delivery of the proposed intervention were identified. CONCLUSIONS An interactive training intervention has been designed, informed by theory, evidence, and expert knowledge of HVs, in an area of health promotion that is currently evolving. This research addresses an important evidence-practice gap in prevention of childhood obesity. The use of a systematic approach to the development process, identification of intervention contents and their hypothesised mechanisms of action provides an opportunity for this research to contribute to the body of literature on designing of implementation interventions using a collaborative approach. Future research should be directed to evaluate the acceptability and feasibility of the intervention.
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Affiliation(s)
- Devashish Ray
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK.
| | - Falko Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK
| | - Louisa Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, England
| | - Gill O'Neill
- Department of Public Health, Durham County Council, Durham, England
| | - Karen McCabe
- Department of Public Health, Durham County Council, Durham, England
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17
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Impact of Obesogenic Environments on Sugar-Sweetened Beverage Consumption among Preschoolers: Findings from a Cross-Sectional Survey in Beijing. Nutrients 2022; 14:nu14142860. [PMID: 35889817 PMCID: PMC9321344 DOI: 10.3390/nu14142860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 01/27/2023] Open
Abstract
The excessive consumption of sugar-sweetened beverages (SSBs) has been proven to be critical for obesity among preschoolers. This study aimed to describe the SSB consumption rates among preschoolers in the Dongcheng District of Beijing, China, and to explore the association between obesogenic environmental determinants and consumption. We applied a stratified cluster sampling method and recruited 3057 primary caregivers of preschoolers in June 2019 to participate in the survey. The caregivers reported their children’s consumption rates of six categories of SSBs and their exposure rates to SSB-related obesogenic environments. The associations between them were tested using multivariate logistic regression models. The mean (SD) age of the children was 5.6 (0.6) years and nearly half (48.3%) were girls. About 84.5% of the children had consumed SSBs over the past three months, and sugar-sweetened milk beverages had the highest consumption rate. Higher exposure to advertisements for the corresponding SSB categories in children, higher frequency rates of consuming SSBs and of taking children to fast-food restaurants in caregivers, and lower frequency rates of reading the Nutrition Facts Panels by caregivers were associated with higher SSB consumption rates among children (p < 0.05 in all of the SSB categories investigated, except for the Nutrition Facts Panel reading behaviors for the sports and energy beverages). SSB consumption among preschoolers is of concern, and comprehensive policy actions and education are urgently needed.
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18
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Mazzocchi A, De Cosmi V, Milani GP, Agostoni C. Health and Sustainable Nutritional Choices from Childhood: Dietary Pattern and Social Models. ANNALS OF NUTRITION AND METABOLISM 2022; 78 Suppl 2:21-27. [PMID: 35679841 DOI: 10.1159/000524860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/02/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The role of diet in the pediatric age for optimal development, achievement, and maintenance of a healthy status is well recognized. Increasing attention is nowadays also paid to reducing the burden of human nutrition on the planet's health for present and future generations. SUMMARY Beyond environmental sustainability, the transition to diets rich in animal and processed foods contributes to an overall unhealthy nutritional status leading to an increased prevalence of obesity- and diet-related noncommunicable diseases. Childhood overweight and obesity are a growing public health crisis worldwide. The aim of this narrative review was to summarize evidence of the nutritional status and dietary habits in children and the link with environmental sustainability. KEY MESSAGE Optimizing nutrition in infancy and establishing healthy lifestyles from the preschool years might help to reduce the risk of overweight, and all the disorders related, respecting the sustainability dimension.
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Affiliation(s)
- Alessandra Mazzocchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy,
| | - Valentina De Cosmi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gregorio P Milani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Pediatric Unit, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Pediatric Intermediate Care Unit, Milan, Italy
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19
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Yao Z, Xie Y, Wang L, Yan C, Du H, Hu H, Li Z. A comparative study of indirect calorimetry and prediction equations in overweight and obese Chinese adults. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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20
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Commercial Baby Foods Aimed at Children up to 36 Months: Are They a Matter of Concern? Foods 2022; 11:foods11101424. [PMID: 35626994 PMCID: PMC9140705 DOI: 10.3390/foods11101424] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
Proper nutrition in infancy and early childhood is crucial to ensuring optimal child development, growth, and better health outcomes later in life. The nutrient profile model proposed by WHO/Europe aims to assess the nutritional quality and promotional/marketing aspects of commercial baby foods aimed at children up to 36 months. We used commercial data from 191 baby foods collected between March 2021 and July 2021, from eight supermarket chains in the Lisbon Metropolitan area. According to the model specifications and the NOVA classification system, we assessed the nutritional quality and promotion aspects and the degree of processing, respectively. The presence of at least one sugar-contributing ingredient was found in 34.0% of the products; 13.9% of products listed sugars and 15.0% listed fruit juices or concentrates as an ingredient. The claim “No added sugar” was present in 69.6% of products. Only 35.1% of products comply with all the nutritional requirements of the model. Concerning processing classification, 61.8% of products were ultra-processed, and about 57.0% were indicated for children < 12 months. These findings reinforce the importance of implementing measures to ensure that commercial foods for infants are marketed appropriately and to promote foods with a lower degree of processing.
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21
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Diaz EN, Pineda JA, Le Q, Wright JA, Greaney ML, Lindsay AC. How do Central American Parents in the United States View the Importance of and Obtain Information About Behaviors Associated with the Risk of Early Childhood Obesity? HISPANIC HEALTH CARE INTERNATIONAL 2022; 21:78-88. [PMID: 35435048 DOI: 10.1177/15404153221093735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Data suggest that Latinx preschool-age children are at increased risk of obesity. The fastest-growing Latinx population in the United States originates from El Salvador, Guatemala, and Honduras, also known as the Northern Triangle countries. Purpose: To describe how Central American parents from the Northern Triangle countries perceive the importance of energy balance-related behaviors (EBRBs), their preferred sources to obtain information about EBRBs, and to assess whether these differ by parent's gender and country of the nativity. Methods: Cross-sectional survey. Results: Seventy-four parents with at least one child between 2 and 5 years of age participated in the study. More than half were immigrants from El Salvador, Guatemala, and Honduras and were classified as having low acculturation. Mothers perceived consuming >5 fruits and vegetables daily, limiting sugar-sweetened beverages consumption, and having <2 hours daily screen time as extremely important, whereas fathers perceived these behaviors as being less important. Although a higher proportion of foreign-born than US-born parents perceived most of the assessed EBRBs (4 out of 6) as extremely important, these differences were not significant. Parents reported multiple sources to obtain EBRB-related information. Direct person-to-person interactions were the most commonly preferred sources, with pediatricians being the top source (97.3%), followed by other parents (86.5%), and WIC professionals (74.3%). Pediatricians were the preferred source to obtain information about EBRBs, irrespective of parent's gender and country of the nativity. A higher proportion of US-born than foreign-born parents reported a preference to obtain EBRB-related information from other parents. Conclusions: Findings suggest the significance of understanding how Central American parents perceive the importance of EBRBs and the sources they would prefer to obtain information for their children's EBRBs. Study findings have implications for health education and obesity prevention interventions designed to reach and deliver key evidence-based child health information to Central American parents from the Northern Triangle countries in the United States.
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Affiliation(s)
- Elizabeth N. Diaz
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA
| | - Joanna A. Pineda
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA
| | - Qun Le
- Department of Public Health, University of Massachusetts Lowell, MA, USA
| | - Julie A. Wright
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA
| | - Mary L. Greaney
- Department of Health Studies, University of Rhode Island, Kingston, RI, USA
| | - Ana Cristina Lindsay
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA
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22
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Huo T, Li Q, Cardel MI, Bussing R, Winterstein AG, Lemas DJ, Xu H, Woodard J, Mistry K, Scholle S, Muller KE, Shenkman EA. Enhancing Quality Measurement With Clinical Information: A Use Case of Body Mass Index Change Among Children Taking Second Generation Antipsychotics. Acad Pediatr 2022; 22:S140-S149. [PMID: 35339240 PMCID: PMC9092621 DOI: 10.1016/j.acap.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/02/2021] [Accepted: 11/21/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We sought to examine the extent to which body mass index (BMI) was available in electronic health records for Florida Medicaid recipients aged 5 to 18 years taking Second-Generation Antipsychotics (SGAP). We also sought to illustrate how clinical data can be used to identify children most at-risk for SGAP-induced weight gain, which cannot be done using process-focused measures. METHODS Electronic health record (EHR) data and Medicaid claims were linked from 2013 to 2019. We quantified sociodemographic differences between children with and without pre- and post-BMI values. We developed a linear regression model of post-BMI to examine pre-post changes in BMI among 4 groups: 1) BH/SGAP+ children had behavioral health conditions and were taking SGAP; 2) BH/SGAP- children had behavioral health conditions without taking SGAP; 3) children with asthma; and 4) healthy children. RESULTS Of 363,360 EHR-Medicaid linked children, 18,726 were BH/SGAP+. Roughly 4% of linked children and 8% of BH/SGAP+ children had both pre and post values of BMI required to assess quality of SGAP monitoring. The percentage varied with gender and race-ethnicity. The R2 for the regression model with all predictors was 0.865. Pre-post change in BMI differed significantly (P < .0001) among the groups, with more BMI gain among those taking SGAP, particularly those with higher baseline BMI. CONCLUSION Meeting the 2030 Centers for Medicare and Medicaid Services goal of digital monitoring of quality of care will require continuing expansion of clinical encounter data capture to provide the data needed for digital quality monitoring. Using linked EHR and claims data allows identifying children at higher risk for SGAP-induced weight gain.
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Affiliation(s)
- Tianyao Huo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla.
| | - Qian Li
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla; WW International, Inc (MI Cardel), New York, NY
| | - Regina Bussing
- Department of Psychiatry, College of Medicine, University of Florida (R Bussing), Gainesville, Fla
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida (AG Winterstein), Gainesville, Fla
| | - Dominick J Lemas
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
| | - Hongzhi Xu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
| | - Jennifer Woodard
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
| | - Kamila Mistry
- Agency for Healthcare Research and Quality (K Mistry), Rockville, Md
| | - Sarah Scholle
- National Committee for Quality Assurance (S Scholle), Washington, DC
| | - Keith E Muller
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (T Huo, Q Li, MI Cardel, DJ Lemas, H Xu, J Woodard, KE Muller, and EA Shenkman), Gainesville, Fla
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23
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Choi MJ, Kang H, Choi J. Risk Factors for Obesity in Five-Year-Old Children: Based on Korean National Health Insurance Service (NHIS) Data. CHILDREN 2022; 9:children9030314. [PMID: 35327686 PMCID: PMC8947730 DOI: 10.3390/children9030314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 12/02/2022]
Abstract
This study aimed to identify the risk factors for obesity in five-year-old children using data from the database of the Korean National Health Insurance Service. We identified 26,047 children who underwent the sixth screening (at age 5) from the 2017 National Health Screening Program for Infant and Children and for whom data from the fourth screening (at age 3) database and the mothers’ health screening and eligibility database were available. To identify the risk factors of obesity, odds ratios and 95% confidence intervals were calculated by a hierarchical multiple logistic regression. Female sex, a birth weight of over 4 kg, the “caution/refer” remark during developmental screening at ages three and five, maternal obesity, and a middle-level income were risk factors for obesity in the subjects. Good appetite, high consumption of milk, heavy intake of sweet food at age three, speedy eating, irregular meals and snack times, large single-meal quantities, heavy intake of oily and salty food, and not performing physical exercise at age five were also considered significant risk factors. For early intervention efforts to prevent childhood obesity, modifiable behavioral factors and other obesity risk factors identified in this study could be used to target high-risk children and dietary behaviors.
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Affiliation(s)
- Mi Jin Choi
- Department of Nursing, Chodang University, Muan-gun 58530, Korea;
| | - Hyunju Kang
- College of Nursing, Kangwon National University, Chuncheon-si 24341, Korea
- Correspondence: ; Tel.: +82-33-250-8878
| | - Jimi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea;
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24
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Pinto DAS, Nascimento JXPT, Padilha LL, da Conceição SIO, França AKTDC, Simões VMF, Batista RFL, Barbieri MA, Ribeiro CCC. High sugar content and body mass index: modelling pathways around the first 1000 d of life, BRISA cohort. Public Health Nutr 2021; 24:4997-5005. [PMID: 33517949 PMCID: PMC11082806 DOI: 10.1017/s136898002000525x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Few studies are focused on sugar consumption around the first 1000 d of life. Thus, this work modelled the pathways linking the consumption of sugary drinks in pregnancy and maternal pre-gestational BMI to early child’s exposure to products with high sugar content and to BMI z-score in the second year of life. DESIGN BRISA cohort, São Luís, Brazil was used from the baseline to the follow-up at the second year of life. SETTING A theoretical model was constructed to analyse associations between variables from prenatal period (socio-economic status, age, frequency of sugary drinks consumption during pregnancy and pre-gestational BMI), birth weight, exclusive breast-feeding and two outcomes: higher calories from products with added sugar as a percentage of the total daily energy intake and BMI z-score at follow-up at the first 2 years of life, using structural equation modelling. PARTICIPANTS Data of pregnant women (n 1136) and their offspring. RESULTS Higher pre-gestational BMI (standardised coefficient (SC) = 0·100; P = 0·008) and higher frequency of sugary drinks consumption during pregnancy (SC = 0·134; P < 0·001) resulted in high percentage of daily calories from products with added sugar in the second year of child, although no yet effect was observed on offspring weight at that time. CONCLUSIONS Maternal obesity and sugary drinks consumption in pregnancy increased the risk of early exposure (before to 2 years) and high exposure of child to added sugar, showing perpetuation of the unhealthy dietary behaviours in the first 1000 d of life.
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Affiliation(s)
- Dâmaris Alves Silva Pinto
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão, 155 Barão de Itapary–Centro, São Luís, MA 65020-070, Brasil
| | | | - Luana Lopes Padilha
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão, 155 Barão de Itapary–Centro, São Luís, MA 65020-070, Brasil
| | | | | | - Vanda Maria Ferreira Simões
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão, 155 Barão de Itapary–Centro, São Luís, MA 65020-070, Brasil
| | - Rosângela Fernandes Lucena Batista
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão, 155 Barão de Itapary–Centro, São Luís, MA 65020-070, Brasil
| | - Marco Antônio Barbieri
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Cecilia Claudia Costa Ribeiro
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão, 155 Barão de Itapary–Centro, São Luís, MA 65020-070, Brasil
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25
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Perng W, Cantoral A, Soria-Contreras DC, Betanzos-Robledo L, Kordas K, Liu Y, Mora AM, Corvalan C, Pereira A, Cardoso MA, Chavarro JE, Breton CV, Meeker JD, Harley KG, Eskenazi B, Peterson KE, Tellez-Rojo MM. [Exposición a químicos disruptores endócrinos obesogénicos y obesidad en niños y jóvenes de origen latino o hispano en Estados Unidos y Latinoamérica: una perspectiva del curso de la vida]. Obes Rev 2021; 22 Suppl 5:e13352. [PMID: 34708538 DOI: 10.1111/obr.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Wei Perng
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, EE. UU.,Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, EE. UU
| | - Alejandra Cantoral
- Consejo Nacional de Ciencia y Tecnología, Instituto Nacional de Salud Pública, Ciudad de México, México
| | - Diana C Soria-Contreras
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Ciudad de México, México
| | - Larissa Betanzos-Robledo
- Consejo Nacional de Ciencia y Tecnología, Instituto Nacional de Salud Pública, Ciudad de México, México
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, Búfalo, Nueva York, EE. UU
| | - Yun Liu
- Department of Epidemiology, Brown University, Providence, Rhode Island, EE. UU
| | - Ana M Mora
- Center for Environmental Research and Children's Health, School of Public Health, University of California Berkeley, Berkeley, California, EE. UU.,Instituto Regional de Estudios en Sustancias Tóxicas (IRET), Universidad Nacional de Costa Rica, Heredia, Costa Rica
| | - Camila Corvalan
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Anita Pereira
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Marly Augusto Cardoso
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
| | - Jorge E Chavarro
- Department of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, EE. UU
| | - Carrie V Breton
- Division of Environmental Health, University of Southern California Keck School of Medicine, Los Ángeles, California, EE. UU
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Míchigan, EE. UU
| | - Kim G Harley
- Center for Environmental Research and Children's Health, School of Public Health, University of California Berkeley, Berkeley, California, EE. UU
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health, School of Public Health, University of California Berkeley, Berkeley, California, EE. UU
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Míchigan, EE. UU
| | - Martha Maria Tellez-Rojo
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Ciudad de México, México
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26
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Prevalence of Excessive Weight and Underweight and Its Associated Knowledge and Lifestyle Behaviors among Urban Private School-Going Adolescents in New Delhi. Nutrients 2021; 13:nu13093296. [PMID: 34579174 PMCID: PMC8472350 DOI: 10.3390/nu13093296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022] Open
Abstract
With rapid urbanization and the Indian nutrition transition, Indian adolescents face a high risk of developing an energy imbalance. This study aims to assess the prevalence of excessive weight, underweight, and associated knowledge and lifestyle behaviors among private school-going adolescents in Delhi. A cross-sectional study was conducted in students (6th–7th grades) of eight randomly selected private schools in Delhi, India in 2019. A self-administered survey was used to assess students’ dietary-and-physical-activity-related knowledge and behavior. Anthropometric measurements (height, weight, and waist circumference) were also conducted. Out of 1567 participants, 7.2% were underweight, 61.3% normal, and 31.5% excess in weight. Underweight was associated with significantly more eating whilst studying for exams (relative risk ratio (RRR) 1.7 (1.0–2.9)). Excessive weight was associated with less incorrect knowledge on behaviors causing overweight (RRR 0.7 (0.5–0.9)), more often reading nutritional labels of packed food items (RRR 0.6 (0.4–0.9)), and less frequent vegetable-intake (RRR 0.7 (0.4–0.9)). Underweight students showed more suboptimal knowledge and unhealthy behaviors, whilst students with excessive weight showed more correct knowledge and healthy behaviors. This study highlights the immediate need for effective health-promoting interventions focused on the importance of healthy lifestyle at least in underweight adolescents.
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27
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Whole-blood magnesium and blood lipids are individually and jointly associated with an elevated likelihood of youngsters being overweight or obese: A matched case-control study using the propensity score. Nutrition 2021; 93:111425. [PMID: 34481288 DOI: 10.1016/j.nut.2021.111425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/23/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Youngsters who are overweight or obese (YOO) have become an important global health concern. Some micronutrients may be modifiable influential factors. This study aimed to investigate the individual and joint association of whole-blood magnesium (WBMg) and total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), or high-density lipoprotein cholesterol (HDL-C) in YOO. METHODS This is a propensity score matching-based case-control study. YOO was defined depending on age- and sex-specific body mass index z-score, calculated with SAS macros (%group_standard and %WHO2007) from the World Health Organization website. WBMg, blood lipids, and covariates were carefully measured by trained technicians using a whole-blood, five-element, basic analyzer and atomic absorption spectrometer or automatic biochemical analyzer. Locally weighted scattered plot smoothing and multivariable conditional logistic regression models were applied to estimate the associations of WBMg and blood lipids in YOO. RESULTS WBMg was positively associated with YOO. The adjusted likelihood of YOO significantly increased by 21% (odds ratio: 1.21; 95% confidence interval [CI], 1.10-1.33) with per-interquartile range elevation of WBMg. Compared with the 1st quartile, adjusted odds ratios among youngsters in the 2nd, 3rd, and 4th quartiles of WBMg were 1.11 (95% CI, 0.92-1.35), 1.29 (95% CI, 1.06-1.57), and 1.47 (95% CI, 1.18-1.83), respectively. Furthermore, the relationship between WBMg and YOO was moderated by lipid profiles. Compared with those having lower (< median) WBMg and TC, TG, LDL-C, or higher (≥ median) HDL-C, youngsters with both higher WBMg and TC, TG, LDL-C, or lower HDL-C had higher YOO odds, which averagely increased by 188%, 250%, 339%, and 369%, respectively. CONCLUSIONS WBMg was an independent risk factor of YOO, and the associations were stronger among those with unhealthy blood lipids. Our findings can help to guide clinical and public health policies on the relevance of magnesium nutritional status.
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28
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Gato-Moreno M, Martos-Lirio MF, Leiva-Gea I, Bernal-López MR, Vegas-Toro F, Fernández-Tenreiro MC, López-Siguero JP. Early Nutritional Education in the Prevention of Childhood Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126569. [PMID: 34207231 PMCID: PMC8296335 DOI: 10.3390/ijerph18126569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/14/2022]
Abstract
Early childhood is a critical period for obesity prevention. This randomized controlled study evaluated the effectiveness of an educational intervention preventing obesity in preschool-age children. A nutritional education intervention, with a follow-up session one year later, was conducted with parents of children aged 3 to 4 years of public schools in the province of Málaga. The main outcome variable was the body mass index z-score (zBMI). The prevalence of overweight or obesity was the secondary outcome variable. The sample comprised 261 students (control group = 139). Initial BMI, weight, height-for-age and prevalence of overweight and obesity were similar for both groups. After the first year of the intervention, the zBMI of the intervention group decreased significantly from 0.23 to 0.10 (p = 0.002), and the subgroup of patients with baseline zBMI above the median decreased from 1 to 0.72 (p = 0.001), and in the second year from 1.01 to 0.73 (p = 0.002). The joint prevalence of overweight and obesity increased in the control group (12.2% to 20.1%; p = 0.027), while in the intervention group, there were no significant changes. This preschool educational intervention with parents improved their children’s BMI, especially those with a higher BMI for their age, and favored the prevention of overweight or obesity.
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Affiliation(s)
- Mario Gato-Moreno
- Department of Pediatric Endocrinology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.G.-M.); (M.F.M.-L.); (F.V.-T.); (M.C.F.-T.); (J.P.L.-S.)
| | - María F. Martos-Lirio
- Department of Pediatric Endocrinology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.G.-M.); (M.F.M.-L.); (F.V.-T.); (M.C.F.-T.); (J.P.L.-S.)
| | - Isabel Leiva-Gea
- Department of Pediatric Endocrinology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.G.-M.); (M.F.M.-L.); (F.V.-T.); (M.C.F.-T.); (J.P.L.-S.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- Department of Pharmacology and Pediatrics, Faculty of Medicine, University of Málaga, 29016 Málaga, Spain
- Correspondence:
| | - M. Rosa Bernal-López
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- Department of Internal Medicine, Regional University Hospital of Málaga, 29009 Málaga, Spain
- CIBER Fisiopatologia de la Obesidad y la Nutricion (Ciber Obn), Carlos III Health Institute, 28029 Madrid, Spain
| | | | - María C. Fernández-Tenreiro
- Department of Pediatric Endocrinology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.G.-M.); (M.F.M.-L.); (F.V.-T.); (M.C.F.-T.); (J.P.L.-S.)
| | - Juan P. López-Siguero
- Department of Pediatric Endocrinology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.G.-M.); (M.F.M.-L.); (F.V.-T.); (M.C.F.-T.); (J.P.L.-S.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- Department of Pharmacology and Pediatrics, Faculty of Medicine, University of Málaga, 29016 Málaga, Spain
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29
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Perng W, Cantoral A, Soria-Contreras DC, Betanzos-Robledo L, Kordas K, Liu Y, Mora AM, Corvalan C, Pereira A, Cardoso MA, Chavarro JE, Breton CV, Meeker JD, Harley KG, Eskenazi B, Peterson KE, Tellez-Rojo MM. Exposure to obesogenic endocrine disrupting chemicals and obesity among youth of Latino or Hispanic origin in the United States and Latin America: A lifecourse perspective. Obes Rev 2021; 22 Suppl 3:e13245. [PMID: 33951277 PMCID: PMC8217151 DOI: 10.1111/obr.13245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 01/18/2023]
Abstract
Following a 2019 workshop led by the Center for Global Health Studies at the Fogarty International Center on the topic of childhood obesity prevention and research synergies transpiring from cross-border collaborations, we convened a group of experts in the United States and Latin America to conduct a narrative review of the epidemiological literature on the role of obesogenic endocrine disrupting chemicals (EDCs) in the etiology of childhood obesity among Latino youth in the United States and Latin America. In addition to summarizing and synthesizing results from research on this topic published within the last decade, we place the findings within a lifecourse biobehavioral framework to aid in identification of unique exposure-outcome relationships driven by both biological and behavioral research, identify inconsistencies and deficiencies in current literature, and discuss the role of policy regulations, all with the goal of identifying viable avenues for prevention of early life obesity in Latino/Hispanic populations.
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Affiliation(s)
- Wei Perng
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA.,Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alejandra Cantoral
- National Council of Science and Technology, National Institute of Public Health, Mexico City, Mexico
| | - Diana C Soria-Contreras
- Center for Nutrition and Health Research, National Institute of Public Health, Mexico City, Mexico
| | - Larissa Betanzos-Robledo
- National Council of Science and Technology, National Institute of Public Health, Mexico City, Mexico
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, Buffalo, New York, USA
| | - Yun Liu
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Ana M Mora
- Center for Environmental Research and Children's Health, School of Public Health, University of California Berkeley, Berkeley, California, USA.,Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional de Costa Rica, Heredia, Costa Rica
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Anita Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Marly Augusto Cardoso
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Jorge E Chavarro
- Department of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Carrie V Breton
- Division of Environmental Health, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kim G Harley
- Center for Environmental Research and Children's Health, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Martha Maria Tellez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Mexico City, Mexico
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30
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Jiang X, Zhang Y, Hu W, Liang Y, Zheng L, Zheng J, Wang B, Guo X. Different Effects of Leucine Supplementation and/or Exercise on Systemic Insulin Sensitivity in Mice. Front Endocrinol (Lausanne) 2021; 12:651303. [PMID: 34054726 PMCID: PMC8150005 DOI: 10.3389/fendo.2021.651303] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Obesity-related diseases such as diabetes, hypertension, dyslipidemia, and cardiovascular diseases have increased due to the obesity epidemic. Early intervention for obesity through lifestyle and nutrition plays an important role in preventing obesity-related diseases. Therefore, the purpose of this study is to explore the role of leucine and exercise in adiposity, systemic insulin resistance, and inflammation to provide theoretical and guiding basis for the early prevention and treatment of obesity. Methods C57BL/6J male mice were randomly divided into HFD or LFD-fed mice group. After 9 weeks, glucose tolerance test (GTT) was performed to detect their systemic insulin sensitivity. Starting from week 10, mice were divided into eight groups and treated with moderate exercise or/and 1.5% leucine. At week 13, systemic insulin sensitivity was detected by GTT. At week 14, mice were dissected to analyze adiposity and inflammation. Results In LFD mice, exercise significantly increased systemic insulin sensitivity by increasing GLUT4 expression in the muscle and decreasing adiposity through increasing AMPK phosphorylation in adipose tissue. In HFD mice, the simultaneous intervention of exercise and leucine increases systemic insulin sensitivity by reducing liver and adipose tissue inflammation via decreasing NF-κB p65 phosphorylation, and increasing the expression of adiponectin in adipose tissue. Conclusion There are different mechanisms underlying the effects of exercise and leucine on insulin resistance and inflammation in LFD-fed mice or HFD-fed mice.
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Affiliation(s)
- Xiaofan Jiang
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuwei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Weichao Hu
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuxiu Liang
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liang Zheng
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Juan Zheng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Baozhen Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xin Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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31
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Flores-Barrantes P, Iglesia I, Miguel-Berges ML, Vučinić V, Moreno LA, Rodríguez G. Rapid infant weight gain is associated with excess adiposity at 7-years of age in children from Aragon, Spain. CHILD AND ADOLESCENT OBESITY 2021. [DOI: 10.1080/2574254x.2020.1865122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- P. Flores-Barrantes
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (Ciberobn), Instituto de Salud Carlos III, Madrid, Spain
| | - I. Iglesia
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (Ciberobn), Instituto de Salud Carlos III, Madrid, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Retics ISCIII, Madrid, Spain
| | - M. L. Miguel-Berges
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (Ciberobn), Instituto de Salud Carlos III, Madrid, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - V. Vučinić
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - L. A. Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (Ciberobn), Instituto de Salud Carlos III, Madrid, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - G. Rodríguez
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Retics ISCIII, Madrid, Spain
- Department of Pediatrics, Radiology and Physical Medicine, University of Zaragoza, Zaragoza, Spain
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32
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Ojeda-Rodríguez A, Morell-Azanza L, Martín-Calvo N, Zalba G, Chueca M, Azcona-Sanjulian MC, Marti A. Association between favourable changes in objectively measured physical activity and telomere length after a lifestyle intervention in pediatric patients with abdominal obesity. Appl Physiol Nutr Metab 2020; 46:205-212. [PMID: 32871095 DOI: 10.1139/apnm-2020-0297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The purpose of this study was to assess the effect of physical activity (PA) changes, measured by accelerometry, on telomere length (TL) in pediatric patients with abdominal obesity after a lifestyle intervention. One hundred and twenty-one children (7-16 years old) with abdominal obesity were randomized to the intervention (a moderately hypocaloric Mediterranean diet) or the usual care group (standard pediatric recommendations) for 22 months (a 2 month intensive phase and a subsequent 20 month follow-up). Both groups were encouraged to accumulate an extra 200 min/week of PA. TL was measured by MMqPCR. Data were analyzed in 102 subjects after 2 months and 64 subjects at the first 10 months of follow-up. Light PA level decreased in both groups after 12 months of intervention. At month 2, moderate to vigorous PA (MVPA) increased in the intervention group (+5.4 min/day, p = 0.035) and so did sedentary time in the usual care group (+49.7 min/day, p = 0.010). TL changes were positively associated (p < 0.050) with metabolic equivalents (METs), MVPA level, and number of steps, and were inversely associated with sedentary and light PA levels in the intervention group after the intensive phase. In conclusion, favourable changes in PA levels in the intensive phase of a lifestyle intervention could contribute to TL maintenance in a pediatric population with abdominal obesity. Novelty Changes in physical activity levels had a direct effect on telomere length, a biomarker of cellular aging and oxidative stress. PA advice based on The American College of Sports Medicine included in this intervention is easy to implement in primary care.
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Affiliation(s)
- Ana Ojeda-Rodríguez
- Department of Nutrition, Food Sciences and Physiology, University of Navarra. C/Irunlarrea, 1. 31008 Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA). C/Irunlarrea, 3. 31008 Pamplona, Spain
| | - Lydia Morell-Azanza
- Department of Nutrition, Food Sciences and Physiology, University of Navarra. C/Irunlarrea, 1. 31008 Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA). C/Irunlarrea, 3. 31008 Pamplona, Spain
| | - Nerea Martín-Calvo
- Instituto de Investigación Sanitaria de Navarra (IdiSNA). C/Irunlarrea, 3. 31008 Pamplona, Spain.,Department of Preventive Medicine and Public Health, School of Medicine-Clínica, University of Navarra. C/Irunlarrea, 1. 31008 Pamplona, Spain.,Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III. Av. Monforte de Lemos, 3-5. 28029 Madrid, Spain
| | - Guillermo Zalba
- Instituto de Investigación Sanitaria de Navarra (IdiSNA). C/Irunlarrea, 3. 31008 Pamplona, Spain.,Department of Biochemistry and Genetics, University of Navarra, C/Irunlarrea, 1, 31008, Pamplona, Spain
| | - María Chueca
- Instituto de Investigación Sanitaria de Navarra (IdiSNA). C/Irunlarrea, 3. 31008 Pamplona, Spain.,Pediatric Endocrinology Unit, Department of Pediatrics, Complejo Hospitalario de Navarra, 31008, Pamplona, Spain
| | - Maria Cristina Azcona-Sanjulian
- Instituto de Investigación Sanitaria de Navarra (IdiSNA). C/Irunlarrea, 3. 31008 Pamplona, Spain.,Pediatric Endocrinology Unit, Department of Pediatrics, Clínica Universidad de Navarra. Av. Pío XII, 36. 31008 Pamplona, Spain
| | - Amelia Marti
- Department of Nutrition, Food Sciences and Physiology, University of Navarra. C/Irunlarrea, 1. 31008 Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA). C/Irunlarrea, 3. 31008 Pamplona, Spain.,Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III. Av. Monforte de Lemos, 3-5. 28029 Madrid, Spain
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Binns C, Lee MK, Yun Low W, Baker P, Bulgiba A, Dahlui M, Thuy Duong DT, Guldan G, Hairi N, Hokama T, Kagawa M, Karunathilake I, Abdul Majid H, Maycock B, Nanishi K, Qiu L, Raheem RA, Scott J, Tang L. Guidelines for Complementary Feeding of Infants in the Asia Pacific Region: APACPH Public Health Nutrition Group. Asia Pac J Public Health 2020; 32:179-187. [PMID: 32475150 DOI: 10.1177/1010539520931328] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Good nutrition in the first "1000 days," including breastfeeding and appropriate complementary foods, prepares for a healthy childhood and adult life, also contributes to the prevention of the double burden of malnutrition. Exclusive breastfeeding provides all required nutrients until an infant is around 6 months of age when complementary foods are needed. A literature review was undertaken of complementary foods in the Asia Pacific region. The foods being used at present are often of low nutrient density may provide insufficient amounts of some critical nutrients, and generally the variety is limited. Guidelines for complementary feeding are provided to assist in education and in public health planning.
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Affiliation(s)
- Colin Binns
- Curtin University, Perth, Western Australia, Australia
| | - Mi Kyung Lee
- Murdoch University, Perth, Western Australia, Australia
| | - Wah Yun Low
- University of Malaya, Kuala Lumpur, Malaysia
| | - Philip Baker
- Queensland University of Technology, Brisbane, Queensland, Australia
| | | | | | | | - Georgia Guldan
- University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Noran Hairi
- University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | - Bruce Maycock
- Asia Pacific Academic Consortium of Public Health, Kuala Lumpur, Malaysia
| | | | - Liqian Qiu
- Women's Hospital, Zhejiang University Hangzhou, China
| | | | - Jane Scott
- Curtin University, Perth, Western Australia, Australia
| | - Li Tang
- Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Martins VJB, Filgueiras AR, Almeida VBP, de Moraes RCS, Sawaya AL. Changes in Thyroid and Glycemic Status and Food Intake in Children with Excess Weight Who Were Submitted for a Multi-Component School Intervention for 16 Months. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3825. [PMID: 32481623 PMCID: PMC7312354 DOI: 10.3390/ijerph17113825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/20/2020] [Accepted: 04/01/2020] [Indexed: 12/11/2022]
Abstract
We investigated if children with excess weight who submitted to two types of intervention at school for 16 months showed improvements in thyroid and glycemic function and food intake. Children (8-11 years) with a body mass index-for-age (BMI/A) of ≥1 Z score were divided into two groups: Treatment 1 (n = 73) involved motivation to adopt healthier lifestyle; Treatment 2 (n = 103) involved performing weekly nutritional education, motivational, and physical activities at school. A semi-quantitative food frequency questionnaire was used. The delta BMI/A were similar after 16 months; Treatment 1 showed higher decrease in thyroid-stimulating hormone (TSH; median (range)): -0.45 (-3.19 to 2.17) and 0.06 (-4.57 to 1.63) mIU/L, p = 0.001), FreeT3 (-0.46 (-2.92 to 1.54) and -0.15 (-2.46 to 1.38) pmol/L, p = 0.038), and FreeT4 -1.41 (-6.18 to 3.47) and -0.90 (-4.89 to 2.96) pmol/L, p = 0.018), followed by decrease in energy intake (7304 (6806 to 7840) and 8267 (7739 to 8832) kJ, Ptreatment = 0.439, Ptime <0.001, interaction group-time p < 0.001), macronutrients and sugar. A positive correlation between FreeT3 and BMI/A, and a negative correlation with FreeT4 and insulin were found at baseline (r 0.212, p < 0.01; r -0.155, p < 0.01, respectively) and follow-up (r 0.222, p < 0.01; r -0.221, p < 0.01). The decrease in overall diet and particularly sugar intake was accompanied by a greater reduction in TSH and FreeT3 in Treatment 1, demonstrating the impact of dietary intake on thyroid function.
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Affiliation(s)
- Vinicius J. B. Martins
- Department of Physiology and Pathology, Federal University of Paraíba, Health Sciences Center, Campus I, Cidade Universitária, João Pessoa 58051-900, Brazil
| | - Andrea R. Filgueiras
- Department of Physiology, Federal University of São Paulo, Rua Botucatu, 862, Edifício de Ciências Biomédicas, 2 andar, São Paulo 04023-060, Brazil; (A.R.F.); (V.B.P.A.); (A.L.S.)
| | - Viviane B. P. Almeida
- Department of Physiology, Federal University of São Paulo, Rua Botucatu, 862, Edifício de Ciências Biomédicas, 2 andar, São Paulo 04023-060, Brazil; (A.R.F.); (V.B.P.A.); (A.L.S.)
| | - Rúbia C. S. de Moraes
- Department of Nutrition, Federal University of Paraíba, Health Sciences Center, Campus I, Cidade Universitária, João Pessoa 58051-900, Brazil;
| | - Ana L. Sawaya
- Department of Physiology, Federal University of São Paulo, Rua Botucatu, 862, Edifício de Ciências Biomédicas, 2 andar, São Paulo 04023-060, Brazil; (A.R.F.); (V.B.P.A.); (A.L.S.)
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LMX1B rs10733682 Polymorphism Interacts with Macronutrients, Dietary Patterns on the Risk of Obesity in Han Chinese Girls. Nutrients 2020; 12:nu12051227. [PMID: 32357537 PMCID: PMC7281971 DOI: 10.3390/nu12051227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
Previous studies have found that LMX1B rs10733682 polymorphism is associated with Body Mass Index (BMI) in European and American Indian adults. In this study, the association of rs10733682 polymorphism with obesity-related indicators, and its interaction with macronutrients and dietary patterns (DPs) were explored in Chinese children (n = 798). The rs10733682 polymorphism was genotyped by improved Multiple Ligase Detection Reaction (iMLDR). Four DPs were identified by factor analysis. The AA genotype had a higher incidence of overweight/obesity than GG+GA genotypes (P = 0.010) in girls (n = 398), but no difference in boys. The AA genotype in girls could interact with intake of energy, fat and carbohydrate, causing an increased triglyceride (TG), (P = 0.021, 0.003, 0.002, respectively), and also could interact with energy from protein, causing an elevated BMI (P = 0.023) and waist (P = 0.019). Girls inclining to the HED (high-energy density)-DP were associated with increased TG (P = 0.033), and girls inclining to the VEF (vegetables, eggs, and fishes based)-DP were associated with decreased total cholesterol (TC, P = 0.045) and decreased low density lipoprotein cholesterin (LDL, P = 0.016). The findings indicated that the AA genotype of rs10733682 and the HED-DP are potential risk factors of obesity in Chinese girls.
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Limauro R, Gallo P, Cioffi L, Antignani A, Cioffi V, Calella P, Valerio G. Clinical audit in the pediatric primary care office and overweight prevention in toddlers. BMC Pediatr 2020; 20:163. [PMID: 32290831 PMCID: PMC7158019 DOI: 10.1186/s12887-020-02076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clinical audit is a process by which physicians or other health care professionals perform a regular and systematic review of their clinical practice and amend it, when necessary. An internal audit allows to review the activities carried out by professionals, in order to assess the appropriateness, effectiveness, efficiency and safety of the services provided. Aim of this study was to apply the process of clinical audit to the obesity/overweight care in toddlers. After the correction of the nutritional errors that were considered potentially responsible for the excess weight gain, the effect of the changes of dietary advice on the frequency of overweight/obesity was assessed in a cohort of children aged 24-36 months. METHODS Three Italian primary care pediatricians set up the audit strategy by recognizing the high prevalence of overweight and obesity in the entire cohort of toddlers born in 2005, 2006 and 2007 (Pre-Audit group, age 24-36 months old) under their care. By reviewing their clinical practice, they changed the protocol of weaning and feeding up to 36 months, mainly reducing protein and sugar excess. The change involved the cohorts of toddlers born in the years 2010, 2011 and 2012 (Post-Audit group). RESULTS Change in the approach of pediatricians to children's diet yielded a reduction of the frequency of overweight/obesity in children between 24 and 36 months of life from 26.3% in the Pre-Audit group to 13.9% in the Post-Audit group (p < 0.0001). CONCLUSION Clinical audit revealed high rates of obesity/overweight among toddlers. The practice developed a new strategy for nutritional counseling, which was effective in reducing the frequency of overweight/obesity in young children.
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Affiliation(s)
- Raffaele Limauro
- FIMP (Italian Federation Pediatricians), Naples Section, Pediatric Primary Care Local Health Authority NA 3 Sud, P.co Carelli 23, 80123, Naples, Italy.
| | - Patrizia Gallo
- FIMP (Italian Federation Pediatricians), Naples Section, Pediatric Primary Care Local Health Authority NA 3 Sud, P.co Carelli 23, 80123, Naples, Italy
| | - Luigi Cioffi
- FIMP (Italian Federation Pediatricians), Naples Section, Pediatric Primary Care Local Health Authority NA 3 Sud, P.co Carelli 23, 80123, Naples, Italy
| | - Angelo Antignani
- School of Specialization in Human Nutrition, AOU Federico II, Naples, Italy
| | - Valentina Cioffi
- Master of Science in Biology, Department of Biology, University of Naples Federico II, Naples, Italy
| | - Patrizia Calella
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy
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Fintini D, Cianfarani S, Cofini M, Andreoletti A, Ubertini GM, Cappa M, Manco M. The Bones of Children With Obesity. Front Endocrinol (Lausanne) 2020; 11:200. [PMID: 32390939 PMCID: PMC7193990 DOI: 10.3389/fendo.2020.00200] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/20/2020] [Indexed: 12/11/2022] Open
Abstract
Excess adiposity in childhood may affect bone development, ultimately leading to bone frailty. Previous reports showing an increased rate of extremity fractures in children with obesity support this fear. On the other hand, there is also evidence suggesting that bone mineral content is higher in obese children than in normal weight peers. Both adipocytes and osteoblasts derive from multipotent mesenchymal stem cells (MSCs) and obesity drives the differentiation of MSCs toward adipocytes at the expense of osteoblast differentiation. Furthermore, adipocytes in bone marrow microenvironment release a number of pro-inflammatory and immunomodulatory molecules that up-regulate formation and activation of osteoclasts, thus favoring bone frailty. On the other hand, body adiposity represents a mechanical load, which is beneficial for bone accrual. In this frame, bone quality, and structure result from the balance of inflammatory and mechanical stimuli. Diet, physical activity and the hormonal milieu at puberty play a pivotal role on this balance. In this review, we will address the question whether the bone of obese children and adolescents is unhealthy in comparison with normal-weight peers and discuss mechanisms underlying the differences in bone quality and structure. We anticipate that many biases and confounders affect the clinical studies conducted so far and preclude us from achieving robust conclusions. Sample-size, lack of adequate controls, heterogeneity of study designs are the major drawbacks of the existing reports. Due to the increased body size of children with obesity, dual energy absorptiometry might overestimate bone mineral density in these individuals. Magnetic resonance imaging, peripheral quantitative CT (pQCT) scanning and high-resolution pQCT are promising techniques for the accurate estimate of bone mineral content in obese children. Moreover, no longitudinal study on the risk of incident osteoporosis in early adulthood of children and adolescents with obesity is available. Finally, we will address emerging dietary issues (i.e., the likely benefits for the bone health of polyunsaturated fatty acids and polyphenols) since an healthy diet (i.e., the Mediterranean diet) with balanced intake of certain nutrients associated with physical activity remain the cornerstones for achieving an adequate bone accrual in young individuals regardless of their adiposity degree.
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Affiliation(s)
- Danilo Fintini
- Endocrinology Unit, Pediatric University Department, Bambino Gesù Children's Hospital, Rome, Italy
- *Correspondence: Danilo Fintini
| | - Stefano Cianfarani
- Diabetes and Growth Disorders Unit, Dipartimento Pediatrico Universitario Ospedaliero Bambino Gesù Children's Hospital, Tor Vergata University, Rome, Italy
- Department of Women's and Children's Health, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Marta Cofini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Angela Andreoletti
- Pediatric Resident, Pediatric Clinic, University of Brescia, Brescia, Italy
| | - Grazia Maria Ubertini
- Endocrinology Unit, Pediatric University Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marco Cappa
- Endocrinology Unit, Pediatric University Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Bambino Gesù Children's Hospital, Rome, Italy
- Melania Manco
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Vahid F, Bourbour F, Gholamalizadeh M, Shivappa N, Hébert JR, Babakhani K, Mosavi Jarrahi A, Mirzaei Dahka S, Doaei S. A pro-inflammatory diet increases the likelihood of obesity and overweight in adolescent boys: a case-control study. Diabetol Metab Syndr 2020; 12:29. [PMID: 32292493 PMCID: PMC7140561 DOI: 10.1186/s13098-020-00536-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Obesity and Overweight at an early age can contribute with many chronic diseases such as cancers, diabetes and cardiovascular diseases. Diet-related inflammation is one of the most important underlying mechanisms that may has a key role in obesity and overweight. This paper aimed to compare the dietary inflammatory index (DII®) in normal weight and overweight adolescent boys. METHODS A total of 535 adolescent boys (214 cases were overweight and obese and 321 controls with normal weight) participated in this study from two schools in Tehran, Iran. The student's weight and body composition were measured using a Bio-Impedance Analyzer (BIA) scale. A validated semi-quantitative Food Frequency Questionnaire (FFQ) was used to assess dietary inflammatory index. RESULTS Results obtained from modeling DII® as a continuous variable identified a positive association between DII® and obesity (OR = 1.08, CI 1.01-1.16). After multivariable adjustment, subjects with DII® > 0.02 had at 1.5 times higher odds of obesity and overweight compared to subjects with DII® ≤ 0.02 (OR = 1.52; CI 1.04-2.22). CONCLUSION Our study indicated the importance of dietary-induced inflammation in the obesity and overweight during adolescence. Therefore, advising adolescent to consume diet with lower DII® with more fruits and vegetables, rich sources of fiber, flavonoids, zinc, magnesium and selenium and avoiding the consumption of saturated fatty acids (SFA), trans-fatty acids, and cholesterol may support a healthy weight.
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Affiliation(s)
- Farhad Vahid
- Department of Nutritional Sciences, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Fatemeh Bourbour
- Department of Clinical Nutrition and Dietetics, Research Institute Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Maryam Gholamalizadeh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nitin Shivappa
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC USA
| | - James R. Hébert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC USA
| | - Khatereh Babakhani
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | | | - Saeid Doaei
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research Center of Health and Environment, Guilan University of Medical Sciences, Rasht, Iran
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Elkum N, Alarouj M, Bennakhi A, Shaltout A. The Complex Etiology of Childhood Obesity in Arabs Is Highlighted by a Combination of Biological and Socio-Economic Factors. Front Public Health 2019; 7:72. [PMID: 31001508 PMCID: PMC6455072 DOI: 10.3389/fpubh.2019.00072] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/12/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives: To identify predictors of childhood and adolescent obesity in Kuwaitis with Arab ethnicity. Methods: A cross-sectional sample of 6–18 year-old schoolchildren was randomly selected from 244 public schools across all six governorates in the State of Kuwait. Anthropometric data were measured from 6,574 Arab Kuwaiti schoolchildren, and a structured questionnaire was used to collect information on possible risk factors associated with obesity. Overweight and obesity were defined in accordance with the Center for Disease Control and Prevention criteria. Results: The prevalence of overweight and obesity in children (aged 6–18 years) were 17.7% and 33.7%, respectively. The likelihood of childhood obesity increased with birth weights >4.0 Kg [odds ratio (OR) = 2.3; p < 0.0001], maternal employment (OR = 1.26, p = 0.0006), maternal age at pregnancy >30 years (OR = 1.24; p = 0.0016) and family size of <6 members (OR = 1.16, p = 0.0106). Conclusions: Public health professionals should be aware that advanced maternal age, maternal employment, smaller family size, and high birthweight may predict the risk of obesity in Kuwaiti Arab children and adolescents.
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Affiliation(s)
- Naser Elkum
- Research Department, Sidra Medicine, Doha, Qatar.,Department of Clinical Services, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Monira Alarouj
- Department of Clinical Services, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Abdullah Bennakhi
- Department of Clinical Services, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Azza Shaltout
- Department of Clinical Services, Dasman Diabetes Institute, Kuwait City, Kuwait
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Dendale P, Scherrenberg M, Sivakova O, Frederix I. Prevention: From the cradle to the grave and beyond. Eur J Prev Cardiol 2019; 26:507-511. [DOI: 10.1177/2047487318821772] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Present cardiac prevention mainly focuses on risk reduction later in life, and focuses also mainly on reducing risk factors for coronary heart disease. However, multiple studies have gathered evidence that the development risk of cardiovascular disease starts early in life and that even preconceptional influences play an important role in lifetime risk. Therefore, the importance of well-timed prevention strategies to reduce cardiovascular disease is well established. In this article, we discuss different risk factors for future cardiac disease, and how we can respond to lesser known cardiac risk factors in the different stages of life.
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Affiliation(s)
- Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Belgium
- Mobile Health Unit, Hasselt University, Belgium
| | - Oksana Sivakova
- National Research Center for Preventive Medicine, Russian Federation
| | - Ines Frederix
- Faculty of Medicine and Life Sciences, Antwerp University, Belgium
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41
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Aris IM, Rifas-Shiman SL, Li LJ, Yang S, Belfort MB, Thompson J, Hivert MF, Patel R, Martin RM, Kramer MS, Oken E. Association of Weight for Length vs Body Mass Index During the First 2 Years of Life With Cardiometabolic Risk in Early Adolescence. JAMA Netw Open 2018; 1:e182460. [PMID: 30646168 PMCID: PMC6324504 DOI: 10.1001/jamanetworkopen.2018.2460] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/11/2018] [Indexed: 12/17/2022] Open
Abstract
Importance The American Academy of Pediatrics currently recommends weight for length (WFL) for assessment of weight status in children younger than 2 years but body mass index (BMI) for children older than 2 years. However, the clinical implications of using WFL vs BMI in children younger than 2 years as an indicator of future health outcomes remains understudied. Objective To compare associations of overweight based on WFL vs BMI in children younger than 2 years with cardiometabolic outcomes during early adolescence. Design, Setting, and Participants This prospective study of birth cohorts in the United States (Project Viva) and Belarus (Promotion of Breastfeeding Intervention Trial [PROBIT]) performed from June 1, 1996, to November 31, 2002, included 13 666 children younger than 2 years. Main Exposures Overweight defined as Centers for Disease Control and Prevention (CDC) WFL in the 95th percentile or greater, World Health Organization (WHO) WFL in the 97.7th percentile or greater, or WHO BMI in the 97.7th percentile or greater at 6, 12, 18, or 24 months of age. Main Outcomes and Measures Primary outcomes were fat mass index, insulin resistance, metabolic risk score, and obesity during early adolescence. Secondary outcomes were height and BMI z scores, sum of skinfolds, waist circumference, and systolic blood pressure during early adolescence. Results The study included 919 children (mean [SD] age, 12.9 [0.9] years; 460 [50.1%] male; and 598 [65.1%] white) from Project Viva and 12 747 children (mean [SD] age, 11.5 [0.5] years; 6204 [48.7%] male; and 12 747 [100%] white) from PROBIT. During 6 to 24 months of age, in Project Viva, 206 children (22.4%) were overweight at any of the 4 times points according to the CDC WFL, 160 (17.4%) according to WHO WFL, and 161 (17.5%) according to WHO BMI cut points. In PROBIT, 3715 children (29.1%) were overweight at any of the 4 time points according to the CDC WFL, 3069 (24.1%) according to WHO WFL, and 3125 (24.5%) according to WHO BMI cut points. After maternal and child characteristics were adjusted for, being ever overweight (vs never overweight) during 6 to 24 months of age was associated with higher likelihood of adverse cardiometabolic risk markers during early adolescence, but associations did not differ substantially across WFL and BMI cut points in either cohort. For example, for fat mass index in Project Viva, β = 0.9 (95% CI, 0.5-1.4) for the CDC WFL, β = 1.1 (95% CI, 0.6-1.6) for WHO WFL, and β = 1.4 (95% CI, 0.9-1.9) for WHO BMI. For PROBIT, β = 0.5 (95% CI, 0.4-0.6) for the CDC WFL, β = 0.6 (95% CI, 0.5-0.7) for WHO WFL, and β = 0.6 (95% CI, 0.5-0.6) for WHO BMI. Neither growth metric in infancy was superior over the others based on F statistics (Project Viva: 17.1-17.8; PROBIT: 87.1-88.7). Findings were similar for insulin resistance, metabolic risk score, obesity, and secondary outcomes. Conclusions and Relevance Choice of WFL vs BMI to define overweight during the first 2 years of life may not greatly affect the association with cardiometabolic outcomes during early adolescence. The findings appear to have important implications for investigators seeking to use BMI as a growth metric for epidemiologic research and for practitioners monitoring the weight status of children younger than 2 years.
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Affiliation(s)
- Izzuddin M. Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Ling-Jun Li
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Division of Obstetrics and Gynecology, KK Women’s and Children’s Hospital, Singapore, Singapore
- Obstetrics and Gynecology Academic Clinical Programme, Duke–National University of Singapore Graduate Medical School, Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Seungmi Yang
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine McGill University, Montreal, Quebec, Canada
| | - Mandy B. Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Thompson
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Diabetes Unit, Massachusetts General Hospital, Boston
| | - Rita Patel
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Richard M. Martin
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Michael S. Kramer
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine McGill University, Montreal, Quebec, Canada
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Influence of Physical Activity on Bone Mineral Content and Density in Overweight and Obese Children with Low Adherence to the Mediterranean Dietary Pattern. Nutrients 2018; 10:nu10081075. [PMID: 30103535 PMCID: PMC6116035 DOI: 10.3390/nu10081075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 02/06/2023] Open
Abstract
The objective of the present cross-sectional study was to examine the associations of physical activity and the adherence to the Mediterranean dietary pattern (MDP) with bone mineral content (BMC) and density (BMD) in children with overweight and obesity. A total of 177 (n = 80 girls) children with overweight and obesity aged 8 to 12 years old participated in the study. Both BMC and BMD were assessed by Dual-Energy X-ray absorptiometry. Dietary patterns were assessed by the KIDMED questionnaire and two 24-hour recalls. Physical activity was assessed by accelerometers for 7 consecutive days (24 hours/day). Low adherence to the MDP was observed in 82.4% of participants. Higher physical activity levels (of at least moderate intensity) and lower sedentary time were significantly associated with BMC and BMD in children with low adherence to the MDP (all p < 0.05). No associations were observed between physical activity and BMC and BMD in children with high adherence to the MDP. In conclusion, engaging in moderate to vigorous physical activity and reducing the time spent in sedentary behavior might be particularly beneficial for improving bone health in overweight or obese children with poor adherence to the Mediterranean dietary pattern.
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