Prevalence of overweight and obesity in European children below the age of 10

Exploring the Influence of a Physical Activity and Healthy Eating Program on Childhood Well-Being: A Comparative Study in Primary School Students

Childhood is a crucial stage of human development in which the lifestyles children adopt can have a significant impact on their well-being throughout their lives. The aim of this study was to analyze and compare the healthy habits and Body Mass Index (BMI) of students from a primary school that participated in a program to promote physical activity and healthy eating one year earlier with other students from two schools that had not participated in this type of program. We analyzed a sample of 287 Spanish students, aged between 8 and 12 years. A survey of healthy habits was completed, and anthropometric data were taken to determine their Body Mass Index (BMI). The questionnaire data indicated that there are some significant differences (p = ≤ 0.05) in the consumption of some unhealthy foods between the evaluated groups. An amount of 11% of the sample was considered obese and 26% were overweight; no significant differences were found between the groups. This study suggests that the healthy habits strategy implemented by a school improves pupils' habits, especially in reducing the consumption of unhealthy foods. Despite the positive effects, the data indicate that these programs fall short of government recommendations, particularly in areas such as physical activity and certain dietary choices.

Translation of the working alliance inventory short revised into Italian using a Delphi procedure and a forward-backward translation

Introduction

Enhancing treatment adherence, especially for chronic diseases, can be achieved through therapeutic alliance, potentially elevating the quality of care. An instrument to evaluate the therapeutic alliance could be beneficial in routine clinical settings, educational environments, and extensive research efforts at national and European levels. In this study, we translated therapist and patient versions of the Working Alliance Inventory Short Revised (WAI-SR) into Italian.

Methodology

An email-based Delphi method was employed for the English-to-Italian translation, incorporating a forward-backward process. The initial translation team comprised two Italian family physicians proficient in English, a linguist, and a psychiatrist. The forward translation was then reviewed by 18 Italian family physicians through a Delphi process and was subjected to a backward translation by two Italian English teachers. A cultural correspondence was subsequently identified to adjust translations within a national and international framework.

Results

All 18 experts fully engaged in the Delphi process, and consensus was achieved by the second Delphi round. A cultural check checked for discrepancies regarding linguistic consistency with other translations and found no difference.

Conclusion

This Italian translation of the WAI-SR is expected to support Italian family physicians aiming to enhance their clinical practice and therapeutic outcomes. It could also be a valuable tool for Italian medical students to foster therapeutic relationships and improve their communication skills.

Household, dietary, and clinical characteristics of childhood caries and overweight progression-A prospective cohort study

BACKGROUND

Childhood caries and obesity are complex chronic diseases with negative health outcomes.

AIM

This study sought a risk profile for childhood caries and overweight.

DESIGN

Children were recruited into a longitudinal prospective cohort study. Caries and overweight characteristics were obtained at baseline, 6, 12, and 18 months. Sequential data modeling steps determined a disease risk profile.

RESULTS

At baseline, 50% of the children (n = 194, 3.0 to 6.9 years) had caries; 24% were overweight, of whom 50% had caries. Correlation analysis separated child characteristics from household circumstances. Principal component modeling separated child snacking from meal-eating patterns, and household smoking from parent education variables. Baseline caries and overweight were not associated, but they grouped together in the modeling of composite features. Forty-five percent of children showed caries progression, 29% overweight progression, and 10% progression of both diseases. The strongest predictors of progression were disease presence, household-based characteristics, and sugary drinks. Children with caries and overweight progression shared multiple child- and household-based features.

CONCLUSION

Individually, caries and overweight were not associated. Children with progression of both conditions shared a profile and multiple risk characteristics suggesting these findings could be useful in assessing the risk for the most extreme cases of caries and overweight.

Early life adversity jointly regulates body-mass index and working memory development

Previous work has proposed that balancing energy expenditure towards body and brain development in an optimal fashion results in a negative relationship between somatic and neurocognitive growth during development. An important issue, largely overlooked so far, is the extent to which this energetic trade-off is influenced by early life environmental factors. In this study, we estimated the association between neurocognitive (measured by working memory ability) and somatic (measured by body-mass index) developmental trajectories, while taking into account multiple dimensions of early life adversity. Results of our initial growth curve model were consistent with this brain-body trade-off in both girls and boys. In a subsequent model, we showed that early life adversity had positive associations with somatic and negative associations with neurocognitive growth trajectories, although the direct negative coupling between them remained consistent. Finally, a multidimensional adversity model, separating the effects of deprivation, threat and unpredictability, revealed that the dimension of deprivation-reflecting lack of access to resources and cognitive stimulation-contributed the most to both somatic and neurocognitive growth patterns. These results suggest that the way individuals balance energy between these two biological constructs during development is partly linked to environmental influences through phenotypic plasticity.

A systematic review of economic evaluations of interventions targeting childhood overweight and obesity

This systematic review critically appraised and synthesized evidence from economic evaluations of interventions targeting childhood excess weight. We conducted systematic searches in 11 databases from inception to April 19, 2023. Studies were eligible if they evaluated interventions targeting children up to 18 years and the study intervention(s) targeted childhood excess weight or sought to improve diet or physical activity, regardless of the type of economic evaluation or the underpinning study design. We synthesized evidence using narrative synthesis methods. One-hundred fifty-one studies met the eligibility criteria and were classified into three groups based on the intervention approach: prevention-only (13 studies), prevention and treatment (100 studies), and treatment-only (38 studies). The predominant setting and study design differed considerably between the three groups of studies. However, compared with usual care, most interventions were deemed cost-effective. The study participants' ages, sex, and socioeconomic status were crucial to intervention cost-effectiveness. Interventions whose effects were projected beyond childhood, such as bariatric surgery, lower protein infant formula, and home-based general practitioner consultations, tended to be cost-effective. However, cost-effectiveness was sensitive to the assumptions underlying the persistence and intensity of such effects. Our findings can inform future recommendations on the conduct of economic evaluations of interventions targeting childhood overweight and obesity, as well as practice and policy recommendations.

Do family characteristics contribute to a socioeconomic gradient in overweight in early childhood? - Single mediation analyses of data from German preschool children

Children's overweight is strongly associated with family socioeconomic position (SEP) and family characteristics (FC). There is limited research on the extent to which FC account for a socioeconomic gradient in childhood overweight. This study examined whether FC explain SEP differences in the prevalence of overweight. The study used baseline data of preschool-aged children from the German 'PReschool INtervention Study'. The sample (n = 872, 48% girls) was recruited at kindergartens in Baden-Württemberg, Germany. Data included children's measured weight status and parents' reports on socioeconomic indicators (e.g., school education, vocational education, income) and FC. Variables represent main determinants of overweight (nutrition: sweets consumption in front of TV, soft drink consumption, regular breakfast, child sets table; physical activity: outdoor sports; parental role model). In single mediation analyses indirect effects of SEP on overweight were analysed (OR[95%CI]). Preschool girls and boys with low parental education had higher odds for overweight than children with high parental education. Among boys, low levels of parental education contributed to the odds of overweight via indirect effects by both factors 'sweets consumption in front of TV' (OR = 1.31[1.05-1.59]) and 'no sports' (OR = 1.14[1.01-1.38]). Among girls, FC measured did not explain SEP differences in overweight. Family nutrition and parental/family physical activity contribute to inequalities in overweight among preschool boys, but not girls. Research is needed to identify FC that explain inequalities in overweight for both.

Early sex-dependent differences in metabolic profiles of overweight and adiposity in young children: a cross-sectional analysis

BACKGROUND

Childhood obesity is a global health concern and can lead to lifetime cardiometabolic disease. New advances in metabolomics can provide biochemical insights into the early development of obesity, so we aimed to characterize serum metabolites associated with overweight and adiposity in early childhood and to stratify associations by sex.

METHODS

Nontargeted metabolite profiling was conducted in the Canadian CHILD birth cohort (discovery cohort) at age 5 years (n = 900) by multisegment injection-capillary electrophoresis-mass spectrometry. Clinical outcome was defined using novel combined measures of overweight (WHO-standardized body mass index ≥ 85th percentile) and/or adiposity (waist circumference ≥ 90th percentile). Associations between circulating metabolites and child overweight/adiposity (binary and continuous outcomes) were determined by multivariable linear and logistic regression, adjusting for covariates and false discovery rate, and by subsequent sex-stratified analysis. Replication was assessed in an independent replication cohort called FAMILY at age 5 years (n = 456).

RESULTS

In the discovery cohort, each standard deviation (SD) increment of branched-chain and aromatic amino acids, glutamic acid, threonine, and oxoproline was associated with 20-28% increased odds of overweight/adiposity, whereas each SD increment of the glutamine/glutamic acid ratio was associated with 20% decreased odds. All associations were significant in females but not in males in sex-stratified analyses, except for oxoproline that was not significant in either subgroup. Similar outcomes were confirmed in the replication cohort, where associations of aromatic amino acids, leucine, glutamic acid, and the glutamine/glutamic acid ratio with childhood overweight/adiposity were independently replicated.

CONCLUSIONS

Our findings show the utility of combining measures of both overweight and adiposity in young children. Childhood overweight/adiposity at age 5 years has a specific serum metabolic phenotype, with the profile being more prominent in females compared to males.

Could interventions on physical activity mitigate genomic liability for obesity? Applying the health disparity framework in genetically informed studies

Polygenic scores (PGS) are now commonly available in longitudinal cohort studies, leading to their integration into epidemiological research. In this work, our aim is to explore how polygenic scores can be used as exposures in causal inference-based methods, specifically mediation analyses. We propose to estimate the extent to which the association of a polygenic score indexing genetic liability to an outcome could be mitigated by a potential intervention on a mediator. To do this this, we use the interventional disparity measure approach, which allows us to compare the adjusted total effect of an exposure on an outcome, with the association that would remain had we intervened on a potentially modifiable mediator. As an example, we analyse data from two UK cohorts, the Millennium Cohort Study (MCS, N = 2575) and the Avon Longitudinal Study of Parents and Children (ALSPAC, N = 3347). In both, the exposure is genetic liability for obesity (indicated by a PGS for BMI), the outcome is late childhood/early adolescent BMI, and the mediator and potential intervention target is physical activity, measured between exposure and outcome. Our results suggest that a potential intervention on child physical activity can mitigate some of the genetic liability for childhood obesity. We propose that including PGSs in a health disparity measure approach, and causal inference-based methods more broadly, is a valuable addition to the study of gene-environment interplay in complex health outcomes.

Nutritional education knowledge of teachers and nutritionists in four European countries

Introduction

Objective: the aim of this study was to examine the perception of professionals from four European countries in charge of teaching Nutrition Education (NE) to children in primary schools or hospitals. Methods: this was achieved through an exploratory study that initiated with two focus groups, one with 5 elementary school teachers and another with 14 nutritionists. From the results of it an online survey was designed and distributed internationally to elementary schools and professional clinics in Spain, Italy, Norway, and Austria. The participants were 75 elementary school teachers and 98 nutritionists. It was measured the level of knowledge of teachers and nutritionists to teach NE, and the level of nutritional knowledge of the children in their respective country. Descriptive statistics were conducted, one-factor ANOVAs to analyze the effect of nationality, and when a significant interaction was found, a post-hoc analysis using Bonferroni adjustment was applied. Results: the results indicated that forty-one percent of the participants considered they have "adequate" theoretical knowledge to teach NE. Only 27 % considered they had "adequate" pedagogical training. A significant effect was found: F(3,168) = 17.37, p < 0.001, η2p = 0.24. Regarding the levels of NE knowledge of children, from lowest to highest, there were Spain, Italy, Austria, and Norway. Also, it was observed that professionals and children from Spain and Italy were more affected with less knowledge and training regarding NE. Conclusions: these results could help governments and educational organizations of the affected countries to take decisions to tackle this problematic.

Ethnic Disparities and Obesity Risk Factors in Pregnant Women: A Retrospective Observational Cohort Study

(1) Background: This article focuses on the prevalence of overweight and obesity in pregnancy in different ethnic groups and assesses the existence of associated comorbidities. (2) Materials and Methods: A retrospective observational cohort study of 16803 pregnant women was carried out between 2012 and 2018 in the health region of Lleida (72% of the total). The relationship between overweight and obesity and different variables was analyzed by calculating the adjusted odds ratio (aOR) and 95% confidence intervals with multivariate logistic regression models. (3) Results: The prevalence of obesity in pregnant women rose from 11.1% in 2012 to 13.4% in 2018, and there was an age-related weight gain. A high incidence of overweight and obesity was recorded in pregnant women from ethnic groups: Maghrebi, sub-Saharan African and Latin America populations presented ORs of 4.08, 3.18 and 1.59, respectively. Hypertension was the variable most affected by body mass index (BMI) > 25 (OR = 3.39) followed by gestational diabetes mellitus (OR = 2.35). Depression was also associated with obesity. (4) Conclusions: The BMI of pregnant women is influenced by individual, ethnic and clinical factors. Mental health conditions such as depression are associated with BMI.

Longitudinal association of childhood physical activity and physical fitness with physical activity in adolescence: insights from the IDEFICS/I.Family study

BACKGROUND

This study aimed to examine associations of early childhood physical fitness and physical activity (PA) with PA during later childhood/early adolescence while accounting for gender differences.

METHODS

We selected data of N = 4329 children from the IDEFICS/I. Family cohort (age 2.4-11.7 years) with data on baseline fitness and accelerometer measurements. At baseline, physical fitness tests were conducted including Flamingo balance, Backsaver sit and reach, Handgrip strength, Standing Long Jump, 40-m sprint and 20-m Shuttle run (to estimate cardio-respiratory fitness levels). PA was measured with Actigraph accelerometers over 3 days at baseline (ActiTrainer or GT1M) and 7 days at follow-up (GT3X). Evenson cutpoints were used to determine moderate-to-vigorous PA (MVPA) time, and children with ≥60mins/day of average MVPA were deemed as having met WHO guidelines at baseline and follow-up. Linear and logistic regressions were performed to examine longitudinal associations between meeting WHO guidelines, MVPA, and physical fitness tests at baseline with meeting WHO guidelines and MVPA at follow-up. Models were conducted on the entire sample, the sex-stratified sample, and stratified by sex and pubertal status at follow-up.

RESULTS

Results showed that meeting WHO guidelines for MVPA at baseline was positively associated with MVPA (Standardized Beta (B) = 0.13, 95%CI:(5.6;11.1)) and meeting WHO guidelines at follow-up for the entire sample (OR = 2.1, 95%CI:(1.5; 3.14), and stratified by males (OR = 2.5, 95%CI:(1.5; 4.1)) and females (OR = 1.8, 95%CI:(1.0; 3.2)). This was also found for both male pre/early pubertal and pubertal groups but only in the female pre/early pubertal group, and not the female pubertal group (MVPA: B = .00, 95%CI:(- 6.1; 5.6), WHO: OR = 0.61, 95%CI:(0.23;1.6)). Models indicated that Standing Long jump, 40-m sprint, Shuttle run and Flamingo balance at baseline were associated with MVPA and meeting the guidelines at follow-up.

CONCLUSIONS

Meeting WHO guidelines and certain fitness tests at baseline were strongly associated with MVPA and meeting WHO guidelines at follow-up, but this association varied with sex and pubertal status. Consequently, these findings underline the importance of ensuring sufficient physical activity in terms of quality and quantity for children at the earliest stages of life.

TRIAL REGISTRATION

ISRCTN62310987.

Disease Activity Is Associated with Obesity in Newly Diagnosed Pediatric Patients with Ulcerative Colitis

Malnutrition and inflammatory bowel disease (IBD) are interrelated conditions. Our aim was to assess the prevalence of malnutrition, to compare anthropometric parameters in the evaluation of nutritional status in pediatric IBD, and to investigate the association between anthropometric parameters and disease activity indices (AI). Pediatric patients with newly diagnosed IBD recorded between 2010 and 2016 in the Hungarian Pediatric IBD Registry were included in this cross-sectional study. Body weight, body mass index (BMI), weight-for-height, and ideal body weight percent (IBW%) were analyzed. Pearson linear and non-linear correlations and polynomial regression analyses were performed to assess correlation between nutritional status and AI. p-values < 0.05 were considered significant. Anthropometric data of 1027 children with IBD (Crohn’s disease (CD): 699; ulcerative colitis (UC): 328; mean age 13.7 years) were analyzed. IBW% identified more obese patients than BMI both in CD (7.02% vs. 2.28%) and UC (12.17% vs. 5.48%). Significant negative correlation was found among anthropometric parameters and AI in CD. In contrast, polynomial regression analysis revealed a U-shaped correlation curve between IBW% and AI in UC. Our findings show that obesity has a bimodal association with disease activity in pediatric UC. Furthermore, IBW% was more useful to identify obese pediatric patients with IBD.

Characteristics of paediatric foot arches according to body mass among primary school students in Wrocław, Poland

Background

The purpose of this study, conducted within the framework of the project entitled ‘Let’s get the kids moving’, was to determine the associations between children’s longitudinal and transverse foot arch and their weight, gender and age.

Method

The pro-health initiative ‘Let’s get the kids moving’ was created by researchers of the Medical University and the Run for Health Foundation. A total of 655 children (51.5% boys) aged 7 to 10 years from primary schools in south-western Poland participated in the study. The mean age of the subjects was 8.7 ± 0.8 years. In all the children, we assessed anthropometric measurements (weight and height) and the longitudinal and transverse arch of the foot under the load of their weight. A two-dimensional foot scanner (Sensor Medica, Italy) was used to examine the plantar part of the children’s feet.

Results

The data collected from the 655 subjects revealed that excessive weight predisposed them to less longitudinal and transverse arching. The foot shape was not differentiated by gender or age.

Conclusions

Screening school-aged children’s footprints can detect abnormalities in the shape of children’s feet early on, which allows for early diagnosis of functional or structural flatfoot in children.

Prevalence of early childhood obesity in Ireland: Differences over time, between sexes and across child growth criteria

BACKGROUND

Various child growth criteria exist for monitoring overweight and obesity prevalence in young children.

OBJECTIVES

To estimate early overweight and obesity prevalence in Ireland and compare the differences in prevalence across ages, growth criteria and sexes.

METHODS

Longitudinal body mass index data from the nationally representative Growing Up in Ireland infant cohort (n = 11 134) were categorized ('under-/normal weight', 'risk of overweight', 'overweight', 'obesity') using the sex- and age-specific International Obesity Task Force growth reference, World Health Organization growth standard and World Health Organization growth reference criteria. Differences in prevalences between criteria and sexes, and changes in each weight category and criterion across ages (9 months, 3 years, 5 years), were investigated.

RESULTS

Across criteria, 11%-40% of children had overweight or obesity at 9 months, 14%-46% at 3 years and 8%-32% at 5 years of age. Prevalence estimates were highest using the World Health Organization growth reference, followed by International Obesity Task Force estimates. Within each criterion, prevalence decreased significantly over time (p < 0.05). However, when combining both World Health Organization criteria, as recommended for population studies, prevalence increased, due to differences in definitions between them. Significantly more boys than girls had overweight/obesity using either World Health Organization criterion, which was reversed using the International Obesity Task Force growth reference.

CONCLUSIONS

To increase transparency and comparability, studies of childhood obesity need to consider differences in prevalence estimates across growth criteria. Effective prevention, intervention and policy-making are needed to control Ireland's high overweight and obesity prevalence.

Mechanical Behavior of Subcutaneous and Visceral Abdominal Adipose Tissue in Patients with Obesity

The mechanical characterization of adipose tissues is important for various medical purposes, including plastic surgery and biomechanical applications, such as computational human body models for the simulation of surgical procedures or injury prediction, for example, in the evaluation of vehicle crashworthiness. In this context, the measurement of human subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) mechanical properties in relation to subject characteristics may be really relevant. The aim of this work was to properly characterize the mechanical response of adipose tissues in patients with obesity. Then, the data were exploited to develop a reliable finite element model of the adipose tissues characterized by a constitutive material model that accounted for nonlinear elasticity and time dependence. Mechanical tests have been performed on both SAT and VAT specimens, which have been harvested from patients with severe obesity during standard laparoscopic sleeve gastrectomy intervention. The experimental campaign included indentation tests, which permitted us to obtain the initial/final indentation stiffnesses for each specimen. Statistical results revealed a higher statistical stiffness in SAT than in VAT, with an initial/final indentation stiffness of 1.65 (SD ± 0.29) N/30.30 (SD ± 20) N compared to 1.29 (SD ± 0.30) N/21.00 (SD ± 16) N. Moreover, the results showed that gender, BMI, and age did not significantly affect the stiffness. The experimental results were used in the identification of the constitutive parameters to be inserted in the constitutive material model. Such constitutive characterization of VAT and SAT mechanics can be the starting point for the future development of more accurate computational models of the human adipose tissue and, in general, of the human body for the optimization of numerous medical and biomechanical procedures and applications.

Body surface area-based kidney length percentiles misdiagnose small kidneys in children with overweight/obesity

BACKGROUND

We evaluated the diagnostic performance of height-, age- and body surface area (BSA)-based kidney length (KL) percentiles in the identification of at least one small kidney (KL < 3^rd) and in the prediction of reduced estimated glomerular filtration rate (eGFR) and/or elevated blood pressure (BP) in children with and without overweight (OW)/obesity(OB).

METHODS

In this cross-sectional study, 744 apparently healthy children (mean age 8.3 years) were recruited in a primary care setting. Clinical data were collected, and serum creatinine and KL were measured. Height-, age- and BSA-based percentiles of KL were calculated and the association of at least one small kidney per subject with reduced eGFR and/or elevated BP was explored by logistic regression.

RESULTS

Two hundred fifty-seven out of seven hundred forty-four (34.5%) subjects were OW/OB and 127 (17.1%) had reduced eGFR or elevated BP. In separate analyses in children with OW/OB, the KL percentiles calculated on the basis of BSA were lower compared with height- and age-based KL percentiles. Consequently, the prevalence of a small kidney was significantly higher when evaluating percentiles of KL based on BSA compared with other percentiles. In logistic regression analysis, a small kidney was significantly associated with reduced eGFR and/or elevated BP only when using height-based KL percentiles. The KL percentiles according to BSA for the ideal weight (iBSA) showed similar performance compared with height-based percentiles. No differences in the diagnostic performance of different percentiles were found in children with normal weight.

CONCLUSIONS

BSA-based percentiles underestimate KL in children with OW/OB. In these subjects, the use of height-based or iBSA-based percentiles should be preferred. A higher resolution version of the Graphical abstract is available as Supplementary information.

Infancy Dietary Patterns, Development, and Health: An Extensive Narrative Review

Correct dietary patterns are important for a child’s health from birth to adulthood. Understanding a child’s health as a state of entire physical, mental, and social well-being is essential. However, reaching adulthood in a complete health proper state is determined by feeding and dietary habits during preconception, pregnancy, or children infancy. Different factors, such as the mother’s lifestyle, culture, or socioeconomic status, are crucial during all these phases. In this review, we aimed to assess the long-term associations between infancy dietary patterns and health and their influence on development and growth. To reach this objective, a consensus critical review was carried out using primary sources such as scientific articles, and secondary bibliographic indexes, databases, and web pages. PubMed, SciELO, and Google Scholar were the tools used to complete this research. We found that high-income countries promote high-calorie foods and, consequently, obesity problems among children are rising. However, undernutrition is a global health issue concerning children in low- and middle-income countries; thus, parental socioeconomic status in early life is essential to children’s health and development, showing that biological, social, and environmental influences are increased risk factors for chronic diseases. This narrative review is aimed to collect evidence for early nutritional intervention and future disease prevention.

Association between maternal and paternal employment and their children's weight status and unhealthy behaviours: does it matter who the working parent is?

Background

The growing number of employed women has been associated with an increase in the prevalence of overweight and obesity in children. We sought to determine whether childhood overweight/obesity in Spain is associated with labour participation of mothers and fathers, and whether the identity of the main caregiver has an influence on child’s weight and unhealthy behaviour.

Methods

We used microdata from the 2010 and 2014 Health Behaviour in School-Aged Children surveys performed in Spain (n = 32,694). Logistic and linear multi-level regression models were applied to assess the association between parental employment and children’s self-reported weight status, accounting for school effects and controlling for socioeconomic factors. Separated binary models were also fitted for consumption of fruit, sweets, screen viewing and sedentarism.

Results

In most cases, the significant associations between children’s weight and their parents’ work status disappeared once the models were adjusted for family wealth and education. However, we found persistent associations for some groups. Girls under 13 years-old living in households where the mother was the only employed parent were more likely to be affected by obesity and to report a higher body mass index value. Children in this type of household were more likely to show unhealthy lifestyles related to diet and leisure time activities.

Conclusions

Parents’ socioeconomic characteristics had a protective effect on their children’s risk of obesity. Unhealthy behaviours were observed in households with a non-working father and a working mother, although the link with obesity was limited to girls. Our results suggest the need for a more equally shared burden of caregiving.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13735-3.

Has the Prevalence of Childhood Obesity in Spain Plateaued? A Systematic Review and Meta-Analysis

The prevalence of excess body weight (overweight plus obesity) in children has risen during the last decades in many countries, but it is unclear whether it has reached a plateau in Spanish children. We performed an updated systematic review and meta-analysis for the prevalence of excess body weight in children from Spain, comparing the trends between 1999 and 2010 and 2011 and 2021. Data were reported in a prior meta-analysis, plus an updated search using the Web of Science, MEDLINE (via PubMed) and EMBASE databases for data from January 2018 until December 2021. Thirteen representative studies were identified (34,813 children aged 2 to 13 years), with sample sizes averaging 2678 (range: 396-16,665). The prevalence of excess body weight in Spanish children aged 2 to 6 years increased from 23.3% (95% CI, 18.5% to 25.5%) during the period 1999-2010 to 39.9% (95% CI, 35.4% to 44.7%) during 2011-2021. In children aged 7 to 13 years, the prevalence of excess body weight increased from 32.3% (95% CI, 29.1-35.6%) during the period 1999-2010 to 35.3% (95% CI, 32.9-37.7%) during 2011-2021. The prevalence of childhood overweight and obesity in Spain has substantially increased in the last decade. New food policies to address the childhood obesity epidemic are urgently required to reverse current trends.

25-Hydroxyvitamin D reference percentiles and the role of their determinants among European children and adolescents

BACKGROUND/OBJECTIVES

To provide age- and sex-specific percentile curves of serum 25-hydroxyvitamin D (25(OH)D) by determinants from 3-<15 year-old European children, and to analyse how modifiable determinants influence 25(OH)D.

SUBJECTS/METHODS

Serum samples were collected from children of eight European countries participating in the multicenter IDEFICS/I.Family cohort studies. Serum 25(OH)D concentrations were analysed in a central lab by a chemiluminescence assay and the values from 2171 children (N = 3606 measurements) were used to estimate percentile curves using the generalized additive model for location, scale and shape. The association of 25(OH)D with time spent outdoors was investigated considering sex, age, country, parental education, BMI z score, UV radiation, and dietary vitamin D in regressions models.

RESULTS

The age- and sex-specific 5th and 95th percentiles of 25(OH)D ranged from 16.5 to 73.3 and 20.8 to 79.3 nmol/l in girls and boys, respectively. A total of 63% had deficient (<50 nmol/l), 33% insufficient (50-<75 nmol/l) and 3% sufficient (≥75 nmol/l) levels. 25(OH)D increased with increasing UV radiation, time spent outdoors, and vitamin D intake and slightly decreased with increasing BMI z score and age. The odds ratio (OR) for a non-deficient 25(OH)D status (reference category: deficient status) by one additional hour spent outdoors was 1.21, 95% CI [1.12-1.31], i.e., children who spent one more hour per day outdoors than other children had a 21% higher chance of a non-deficient than a deficient status.

CONCLUSION

A majority of children suffer from deficient 25(OH)D. UV radiation, outdoor time, and dietary vitamin D are important determinants of 25(OH)D.

Effects of high dairy protein intake and vitamin D supplementation on body composition and cardiometabolic markers in 6-8-y-old children-the D-pro trial

BACKGROUND

Increasing evidence suggests that prevention of lifestyle diseases should begin early. Dairy protein and vitamin D can affect body composition and cardiometabolic markers, yet evidence among well-nourished children is sparse.

OBJECTIVES

We investigated combined and separate effects of high dairy protein intake and vitamin D on body composition and cardiometabolic markers in children.

METHODS

In a 2 × 2-factorial, randomized trial, 200 white, Danish, 6-8-y-old children substituted 260 g/d dairy in their diet with high-protein (HP; 10 g protein/100 g) or normal-protein (NP; 3.5 g protein/100 g) yogurt and received blinded tablets with 20 µg/d vitamin D3 or placebo for 24 wk during winter. We measured body composition (by DXA), blood pressure, and fasting blood glucose, insulin, C-peptide, and lipids.

RESULTS

In total, 184 children (92%) completed the study. Baseline median (25th-75th percentile) dairy protein intake was median: 3.7 (25th-75th percentile: 2.5-5.1) energy percentage (E%) and increased to median: 7.2 (25th-75th percentile: 4.7-8.8) E% and median: 4.2 (25th-75th percentile: 3.1-5.3) E% with HP and NP. Mean ± SD serum 25-hydroxyvitamin D concentration changed from 81 ± 17 to 89 ± 18 nmol/L and 48 ± 13 nmol/L with vitamin D and placebo, respectively. There were no combined effects of dairy protein and vitamin D, except for plasma glucose, with the largest increase in the NP-vitamin D group (Pinteraction = 0.005). There were smaller increases in fat mass index (P = 0.04) with HP than with NP, and the same pattern was seen for insulin, HOMA-IR, and C-peptide (all P = 0.06). LDL cholesterol was reduced with vitamin D compared with placebo (P < 0.05). Fat-free mass and blood pressure were unaffected.

CONCLUSIONS

High compared with normal dairy protein intake hampered an increase in fat mass index. Vitamin D supplementation counteracted the winter decline in 25-hydroxyvitamin D and the increase in LDL cholesterol observed with placebo. This study adds to the sparse evidence on dairy protein in well-nourished children and supports a vitamin D intake of ∼20 µg/d during winter. This trial was registered at clinicaltrials.gov as NCT03956732.

Health Economic Aspects of Childhood Excess Weight: A Structured Review

An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted.

Independent and Combined Association of Lifestyle Behaviours and Physical Fitness with Body Weight Status in Schoolchildren

(1) Background: Lifestyle behaviours and physical fitness play a critical role in the development of childhood obesity. It has been demonstrated in this study that self-reported physical fitness is representative of a healthy lifestyle and thus is associated with a lower incidence of overweight/obesity. The objective of this study was to analyse the independent and combined association of lifestyles (physical activity, screen time, diet and hours of sleep) and self-reported physical fitness with body weight in schoolchildren. (2) Methods: This study performed a descriptive and cross-sectional analysis. The study sample consisted of 864 schoolchildren between 8−9 years old from 26 schools of the province of Cádiz. To measure lifestyles and self-reported physical fitness, questionnaires were administered to both schoolchildren and families. To obtain the body weight status, the children were measured by body mass index (BMI). To verify the influence of lifestyles and self-reported physical fitness on the body weight status of schoolchildren, a combined score of lifestyles and self-reported physical fitness was calculated. (3) Results: Schoolchildren who followed healthier lifestyles and presented good physical fitness had a better body weight status (p < 0.001). Schoolchildren who had less healthful lifestyles and bad physical fitness had a 10.34 times higher risk of being overweight or obese (p = 0.004). (4) Conclusions: It has been shown that there is an independent and combined association between lifestyles and physical fitness on the body weight of the schoolchildren. We have suggested strategies to get children to adopt healthy lifestyles and good physical fitness to maintain a healthy body weight and prevent obesity.

Obesity and immune system impairment: A global problem during the COVID-19 pandemic

BACKGROUND

The production of healthy and nutritious food, in an ecologically sustainable and safe way, has become one of the great ethical issues of our time. The recent G 20 urged the "promotion and work on the social determinants of health to address other critical health issues such as food and nutrition".

OBJECTIVE

The aim of this work is to analyze the current scientific literature regarding the role of obesity in the severe COVID-19 outcomes. In the light of the indications of the G20, the main causes of obesity are examined, and lifestyles are suggested with particular regard to proper nutrition in order to prevent/treat overweight since childhood.

METHODS

Multidisciplinary work, in which the biological and legal perspectives provide a meta-legal analysis of the obesity problem.

RESULTS

Unhealthy habits induce metabolic imbalance and increase in the body weight promoting obesity. This condition is the result of many factors (genetic predisposition, social position and "junk food" consumption) and is associated with a high risk of diseases, among them exacerbations from viral respiratory infections, including the current COVID-19 pandemic.

CONCLUSIONS

The industrial food revolution changed our eating habits, leading to production of too much unhealthy food, absent in ancient diet, thus contributing to the onset of some disorders. The business of food industry should be downsized in favor of morally or ethically fair choices for consumers and for the well-being of society, together with an ethical food distribution, governmental food education programs, and balanced oversight of food production.

Calreticulin and PDIA3, two markers of endoplasmic reticulum stress, are associated with metabolic alterations and insulin resistance in pediatric obesity: A pilot study

Our aim was to evaluate the markers of endoplasmic reticulum (ER) stress among children and adolescents with obesity in relation to metabolic alterations. Calreticulin (CALR) and PDIA3 circulating levels were assessed on 52 pediatric subjects-26 patients with obesity and 26 normal weight controls (4-18 years)-enrolled in a pilot study. Clinical and metabolic evaluations were performed (BMI-SDS, insulin, and glucose at fasting and during an oral glucose tolerance test, lipid profile, blood pressure), and metabolic syndrome was detected. PDIA3 was higher (p < 0.02) and CALR slightly higher in children with obesity than in controls. PDIA3 was related positively to the Tanner stages. Both PDIA3 and CALR were positively associated with insulin resistance, cholesterol, and triglycerides and the number of criteria identifying metabolic syndrome and negatively with fasting and post-challenge insulin sensitivity. Our preliminary findings suggest the existence of a link between ER stress and metabolic changes behind obesity complications even at the pediatric age. CALR and PDIA3 could be early markers of insulin resistance and dyslipidemia-related ER stress useful to stratify patients at high risk of further complications.

Mobile phone-based lifestyle support for families with young children in primary health care (MINISTOP 2.0): Exploring behavioral change determinants for implementation using the COM-B model

Background

Obesity in childhood is a public health concern worldwide and mobile phone-based interventions (mHealth) has shown to facilitate obesity prevention. However, more research is needed on the implementation of digital tools in routine primary care. This study explored behavior change determinants for implementing a health promotion mHealth intervention (MINISTOP 2.0 app) targeting parents of 4-year-olds.

Methods

Secondary data from telephone interviews (n = 15) with child health care nurses working within primary child healthcare in Sweden was analyzed using directed content analysis and the COM-B model.

Results

Barriers for implementation included: limited knowledge about using technology and reservations about how and to what extent parents would use mHealth. Potential facilitators included nurses' openness to learn and try new tools, confidence in their role and engagement in reaching parents as well as beliefs that the app could improve practice by prompting dialogue and being a shared platform. Nurses expressed a strong professional identity and shared understanding of their practice, mechanisms that could potentially inhibit or facilitate implementation.

Conclusions

Findings suggest cautious optimism regarding implementing mobile phone-based tools in child primary healthcare in terms of capability, opportunity and motivation among stakeholders. Implementation strategies such as educational outreach visits and making the intervention testable among stakeholders could further facilitate implementation in this clinical context. However, more research is needed on behavior change determinants in different stages of real-world implementation.

There Is an Inverse Correlation between Basic Motor Skills and Overweight in Schoolchildren Aged 8 to 12

In the last three decades, childhood obesity has become a 21st century epidemic, a product of social development. The purpose of this study was to analyze the repercussions that overweight and obesity have for the basic motor skills of a group of children in primary school, as well as their interrelations. We analyzed a sample of 287 students from Spain, aged between 8 and 12 years. Anthropometric data were taken to determine their Body Mass Index (BMI). A scale of assessment of basic motor skills was used to evaluate their motor skills. The BMI data revealed that 11% of this sample was considered obese, and 26% was overweight. Children showed higher competence in locomotor skills than in object control and turn and rolling skills, for which motor competence levels were lower. Likewise, there was an inverse relationship between BMI and basic motor skills; children with obesity had the lowest levels of motor skills, and there was a significant difference regarding non-obese children (p ≤ 0.05). These results showed that overweight and obese children have lower basic motor skills, which can lead to the abandonment of physical activity and the preference for other activities that reinforce a sedentary lifestyle.

Metabolite profiles and the risk of metabolic syndrome in early childhood: a case-control study

BACKGROUND

Defining the metabolic syndrome (MetS) in children remains challenging. Furthermore, a dichotomous MetS diagnosis can limit the power to study associations. We sought to characterize the serum metabolite signature of the MetS in early childhood using high-throughput metabolomic technologies that allow comprehensive profiling of metabolic status from a biospecimen.

METHODS

In the Family Atherosclerosis Monitoring In earLY life (FAMILY) prospective birth cohort study, we selected 228 cases of MetS and 228 matched controls among children age 5 years. In addition, a continuous MetS risk score was calculated for all 456 participants. Comprehensive metabolite profiling was performed on fasting serum samples using multisegment injection-capillary electrophoresis-mass spectrometry. Multivariable regression models were applied to test metabolite associations with MetS adjusting for covariates of screen time, diet quality, physical activity, night sleep, socioeconomic status, age, and sex.

RESULTS

Compared to controls, thirteen serum metabolites were identified in MetS cases when using multivariable regression models, and using the quantitative MetS score, an additional eight metabolites were identified. These included metabolites associated with gluconeogenesis (glucose (odds ratio (OR) 1.55 [95% CI 1.25-1.93]) and glutamine/glutamate ratio (OR 0.82 [95% CI 0.67-1.00])) and the alanine-glucose cycle (alanine (OR 1.41 [95% CI 1.16-1.73])), amino acids metabolism (tyrosine (OR 1.33 [95% CI 1.10-1.63]), threonine (OR 1.24 [95% CI 1.02-1.51]), monomethylarginine (OR 1.33 [95% CI 1.09-1.64]) and lysine (OR 1.23 [95% CI 1.01-1.50])), tryptophan metabolism (tryptophan (OR 0.78 [95% CI 0.64-0.95])), and fatty acids metabolism (carnitine (OR 1.24 [95% CI 1.02-1.51])). The quantitative MetS risk score was more powerful than the dichotomous outcome in consistently detecting this metabolite signature.

CONCLUSIONS

A distinct metabolite signature of pediatric MetS is detectable in children as young as 5 years old and may improve risk assessment at early stages of development.

Childhood overweight and obesity abatement policies in Europe

Over the past two decades, a concerted effort to combat the rising tide of childhood overweight and obesity has taken shape. The World Health Organization (WHO) Commission on Ending Childhood Obesity (ECHO) provides recommendations for six priority areas of action, including the promotion of healthy food consumption, promotion of physical activity, preconception and pregnancy care, early childhood diet and physical activity, healthy nutrition and physical activity for school-aged children, and community-based weight management. This paper provides a snapshot of policies and measures aligned to these areas of action within the WHO European Region in order to encourage other countries to make similar efforts. Examples are drawn from Portugal (sugar-sweetened beverage tax, integrated nutrition strategy), the United Kingdom (soft drink levy, active commuting programs, urban design principles), Lithuania (prohibition of energy drinks), Norway (industry and government partnerships to promote healthier foods, nutrition education curriculum for schools), Hungary (tax subsidies to promote healthy diets), the European Union (cross-border marketing regulations, preconception and pregnancy care), Slovenia (food marketing restrictions), Spain (marketing restrictions within educational settings), Poland (investing in sports infrastructure), Russia (increasing sports participation), Estonia (redevelopment of the physical education curriculum), Netherlands (preconception and pregnancy care), Croatia (conditions to support breastfeeding), Austria (perinatal and early childhood nutrition), Czechia (life-course strategy), San Marino (nutrition and physical activity for school-aged children), Ukraine (potable water for schools), Ireland and Italy (community-based weight management approaches). Our findings suggest that a large disparity exists among the type and breadth of policies adopted by Member States, with a mix of single-issue policy responses and more cohesive strategies. The role of data, implementation research, and ongoing surveillance of country-level progress related to childhood overweight and obesity policies are discussed as an essential part of the iterative process of policy development. Additional work to systematically gather context-specific information on policy development, implementation, and reach according to ECHO's six areas of action by WHO European Region countries will inform future policy paradigms within the region.

Early-life childhood obesity risk prediction: A Danish register-based cohort study exploring the predictive value of infancy weight gain

BACKGROUND

Information on postnatal weight gain is important for predicting later overweight and obesity, but it is unclear whether inclusion of this postnatal predictor improves the predictive performance of a comprehensive model based on prenatal and birth-related predictors.

OBJECTIVES

To compare performance of prediction models based on predictors available at birth, with and without information on infancy weight gain during the first year when predicting childhood obesity risk.

METHODS

A Danish register-based cohort study including 55.041 term children born between January 2004 and July 2011 with birthweight >2500 g registered in The Children's Database was used to compare model discrimination, reclassification, sensitivity and specificity of two models predicting risk of childhood obesity at school age. Each model consisted of eight predictors available at birth, one additionally including information on weight gain during the first 12 months of life.

RESULTS

The area under the receiving operating characteristic curve increased from 0.785 (95% confidence interval (CI) [0.773-0.798]) to 0.812 (95% CI [0.801-0.824]) after adding weight gain information when predicting childhood obesity. Adding this information correctly classified 30% more children without obesity and 21% with obesity and improved sensitivity from 0.42 to 0.48. Specificity remained unchanged at 0.91.

CONCLUSION

Adding infancy weight gain information improves discrimination, reclassification and sensitivity of a comprehensive prediction model based on predictors available at birth.

Cost effectiveness of a controlled lifestyle intervention for pregnant women with obesity

Background

The Mighty Mums antenatal lifestyle intervention is a person-centered behavioral intervention focusing on nutrition and physical activity for pregnant women with obesity (body mass index [BMI] ≥30). The aim of this study was to evaluate the costs and clinical outcomes of adding the Mighty Mums intervention to standard antenatal care.

Methods

Participants in the intervention group (n = 434) received motivational talks with their midwife and a selection of physical and/or nutritional activities in addition to antenatal care. Control participants (n = 867) from adjacent geographic areas received standard antenatal care. Costs for staff, unit costs for specific activities, and registered costs for specialized antenatal care were analyzed for associations with gestational weight gain and self-reported health. Results are reported for the intention-to-treat (ITT) population and a per protocol (PP) population identified by participation in the intervention. Analyses included bootstrapped linear regressions adjusted for background characteristics that differed significantly between groups.

Results

The average costs were SEK 9727 higher (95% confidence interval [CI]: 6677 to 12,777) among participants in the intervention group than in the control ITT population and SEK 8655 (95% CI 4586 to 12,724) higher than in the PP population. The cost increase per 1 kg reduction in gestational weight gain was SEK 12,369 in the ITT population and SEK 7209 for the PP population.

Conclusion

Participation in the Mighty Mums intervention was associated with higher costs, but also reduced gestational weight gain. The cost per kilogram reduction in gestational weight gain was low, particularly in the PP population. A future decision to implement this behavioral intervention in standard care should take into account society’s willingness to pay per unit reduction in gestational weight gain.

Trial registration

The study is registered at ClinicalTrials.gov, Identifier: NCT03147079.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04098-5.

Interrelationship Between Age, Gender, and Weight Status on Motor Coordination in Italian Children and Early Adolescents Aged 6-13 Years Old

Although numerous evidences reported a negative correlation between motor coordination (MC) and overweight/obesity in children and adolescents, the interrelationship between age, gender, and weight status is still debatable. Hence, the aim of this cross-sectional study was to examine the association between MC and weight status according to age and gender across childhood and early adolescence in a large sample of Italian elementary and middle school students. A number of 1961 Italian school students (1,026 boys, 935 girls) was stratified in three consecutive age groups (6-7, 8-10, and 11-13 years) and four weight status categories (underweight, normal weight, overweight, and obese) according to Cole's body mass index (BMI) cut-off points for children. MC performance was assessed measuring motor quotient (MQ) with the Körperkoordinationstest für Kinder (KTK). Results showed significantly lower MQ levels in children in overweight (OW) and with obesity (OB) in both sexes for all age groups than peers in normal weight (NW), except in 6-7-year-old boys. Girls in OW and with OB had similar MQ levels across all age groups, while younger boys in OW and with OB showed higher MQ levels than older ones (p < 0.05). The 6-7-year-old boys showed better MQ levels than girls peers in NW, OW, and with OB, while 8-10-year-old boys in underweight (UW), NW, and OW; and 11-13-year-old boys only in NW (p < 0.05). No interaction effect was found between age, gender, and weight status on MQ levels. These outcomes showed the negative impact of higher weight status on MC performance according to age and gender, pointing out the importance of planning targeted motor programs that consider these variables to improve MC performance.

Longitudinal Effects of Excessive Weight and Obesity on Academic Performance of Primary School Boys in Different Socio-Economic Statuses: The NW-CHILD Study

Obesity affects millions of children worldwide and can often impact their academic performance. This longitudinal study, conducted over seven years, determines the effects of excessive weight and obesity on the academic performance of primary school boys, taking into account their socio-economic status (SES). The study forms part of a seven-year (2010–2016) longitudinal study, the North-West Child-Health-Integrated-Learning and Development (NW-CHILD) study, which includes a baseline measurement and two follow-up measurements of the 181 participants from varying areas in the North West Province. Two-way frequency tables, repeated measure ANOVA’s and Spearman rank order correlations were used to analyze the data. The Body Mass Index (BMI) of the participants reported an increase from 2010–2016. Nearly all of the school subjects reported small to large correlations between BMI and academic performance (r ≥ 0.1 and r ≥ 0.3), except for Afrikaans in 2013 (r = −0.06). Only two subjects (English and Language as tested with the ANA test) reported medium effects (r ≥ 0.3), whereas the other subjects only reported small effects (r ≥ 0.1). No statistically significant relationships (p ≥ 0.05) were observed between the BMI values and academic subjects, however SES and school subject scores reported several statistically significant relationships, especially regarding Language (English and First Additional Language) and Mathematics (p = 0.02). Overweight and obese primary school boys in the North West Province of South Africa reported a higher academic performance in comparison to boys of a normal weight, even when SES was taken into consideration. Further studies are recommended to verify current findings regarding weight, obesity and academic performance.

Trajectories of objectively measured physical activity and childhood overweight: longitudinal analysis of the IDEFICS/I.Family cohort

BACKGROUND

Since only few longitudinal studies with appropriate study designs investigated the relationship between objectively measured physical activity (PA) and overweight, the degree PA can prevent excess weight gain in children, remains unclear. Moreover, evidence is limited on how childhood overweight determines PA during childhood. Therefore, we analyzed longitudinal trajectories of objectively measured PA and their bi-directional association with weight trajectories of children at 2- and 6-year follow-ups.

METHODS

Longitudinal data of three subsequent measurements from the IDEFICS/I.Family cohort study were used to analyze the bi-directional association between moderate-to-vigorous PA (MVPA) and weight status by means of multilevel regression models. Analyses comprised 3393 (2-year follow-up) and 1899 (6-year follow-up) children aged 2-15.9 years from eight European countries with valid accelerometer data and body mass index (BMI) measurements. For categorized analyses, children's weight status was categorized as normal weight or overweight (cutoff: 90th percentile of BMI) and children's PA as (in-) sufficiently active (cutoffs: 30, 45 and 60 min of MVPA per day).

RESULTS

Children engaging in at least 60 min MVPA daily at baseline and follow-ups had a lower odds of becoming overweight (odds ratio [OR] at 2-year follow-up: 0.546, 95% CI: 0.378, 0.789 and 6-year follow-up: 0.393, 95% CI: 0.242, 0.638), compared to less active children. Similar associations were found for 45 min MVPA daily. On the other side, children who became overweight had the lowest odds to achieve 45 or 60 min MVPA daily (ORs: 0.459 to 0.634), compared to normal weight children.

CONCLUSIONS

Bi-directional associations between MVPA and weight status were observed. In summary, at least 60 min MVPA are still recommended for the prevention of childhood overweight. To prevent excess weight gain, 45 min MVPA per day also showed preventive effects.

Adapting a Parental Support App to Promote Healthy Diet and Physical Activity Behaviors (MINISTOP) for a Multi-Ethnic Setting: A Qualitative Study on the Needs and Preferences of Parents and Nurses within Swedish Child Health Care

Early efforts for prevention of childhood overweight and obesity are needed. In order to adapt an app promoting healthy diet and physical activity behaviors in children (MINISTOP 1.0) for multi-ethnic communities, we explored: (1) needs and concerns among Somali-, Arabic-, and Swedish-speaking parents in terms of supporting healthy diet and activity behaviors in their children; (2) nurses’ perceptions of parental needs and concerns in relation to diet and physical activity behaviors; and (3) how the features and content of the MINISTOP 1.0 app could be refined to better support health behaviors in children, among both parents and nurses. Focus groups with Somali-, Arabic-, and Swedish-speaking parents (n = 15), and individual interviews with nurses (n = 15) were conducted. Parents expressed several challenges in supporting children’s health behaviors, the need for a tailored app, and alternative ways of accessing the content (audio/video). Nurses emphasized the need of supporting parents early, and the value of a shared platform in different languages, to facilitate communication. This study contributes valuable insights about parental needs and relevant adaptations to a parental support app, such as addition of audio/video files for increased accessibility. This adapted app version—MINISTOP 2.0, can be useful for childhood obesity prevention in multi-ethnic communities.

Obesity and thinness prevalence trends in Spanish schoolchildren: are they two convergent epidemics?

BACKGROUND

The objective of this study was to analyse the secular trends in body composition variables and weight status among Spanish schoolchildren from 1992 to 2017, and to examine the persistence in the same weight status category from 2013 to 2017 of the birth cohort in 2007-08.

METHODS

The data for the prevalence/trend analysis were taken from cross-sectional analyses conducted in 1992 (n = 308), 1996 (n = 307), 1998 (n = 275), 2004 (n = 1119), 2010 (n = 912), 2013 (n = 352) and 2017 (n = 275) using similar procedure methods among schoolchildren (aged 4-6 y and 8-11 years) from 22 public schools in the province of Cuenca, Spain. The data for the longitudinal analysis were obtained from cross-sectional analyses of measurements gathered in 2013 and 2017 in the same cohort of children (n = 275) born in 2007 and 2008. Weight, height, body fat percentage (by electronic bioimpedance) and waist circumference were measured by trained personnel. Weight status was defined according to the BMI cut-offs proposed by the International obesity task force (IOTF) criteria.

RESULTS

In schoolchildren, the overall prevalence of thinness increased from 5.9% in 1992 to 14.5% in 2017, P < 0.001. Whereas, the overall prevalence of obesity/overweight remained relatively steady between the same time period (from 25.2% to 26.9%), P = 0.599. In relation to the longitudinal analyses, we observed that 70.9% of schoolchildren in 2017 remained in the same weight status category as in 2013.

CONCLUSIONS

The child obesity epidemic in Spain has remained relatively stable over the last two decades. However, the prevalence of thinness shows a worrying upward trend.

Changes in weight status of 7-year-old children in North Macedonia between 2010 and 2019

Childhood obesity is growing as one of the most important public health issues that affects individual and population health but also puts heavy burden on the health systems. It is frequently associated with immediate adverse consequences, such as psychological problems, and a higher risk of many harmful comorbidities later in life, such as type 2 diabetes, dyslipidemia, non-alcoholic fatty liver disease, hypertension, and coronary heart disease. Comparability of anthropometric data is crucial to track the changes over time. The aim of this paper was to present prevalence of thinness, overweight, and obesity in 7-year-old schoolchildren in North Macedonia in 2010 and 2019, and the changes in their nutritional status during thatperiod. Material and methods: Anthropometric measurements of body height and body weight were performed to the nationally representative sample of 7-year-oldchildren in school years 2010/2011 and 2018/2019. Measurements followed the Childhood Obesity Surveillance Initiative (COSI) protocol and data collecting procedures. In total, 2737 children (1317 girls and 1420 boys) in 2010 and 2059 children (1045 girls and 1014 boys) in 2019 were measured. WHO Growth references were used to determine the growth and nutritional status of children. Results: The average height of children in the observed period has increased by 1.7 cm, weight for 1.2 kg and the BMI for 0.3 kg/m2. As for the weight classification, thinness prevalence is significantly increased for 0.3%. Overweight (including obesity) significantly increased (p=0.0377) from 34.4% (95% CI 32.6%-36.2%) in 2010 to 37.3% (95% CI 35.2%-39.5%) in 2019. Obesity significantly increased (p=0.040) from 16.3% (95% CI 14.9%-17.7%) in 2010 to 18.4% (95% CI 16.7%-20.1%) in 2019. The main driver of that increase was the highly significant (p=0.0004) increase of almost 7% of overweight (including obesity) in girls. Conclusion: There is unfavorable rising trend which indicates deterioration of the situation with childhood obesity in the country. Focused and more comprehensive public health nutrition actions are needed to plateau or reverse the trends. The childhood obesity national monitoring system is well established and should continue to beone of the key public health monitoring systems that provide evidence for actions.  

Dietary Patterns and Weight Status of Primary School Children in Serbia

The purpose of the present cross-sectional study was to examine dietary patterns and the prevalence of underweight, overweight, and obesity among Serbian children. Furthermore, the study analyzed the association between dietary patterns and weight status. A nationally representative sample of 6–9-year-old children (n = 3,067) was evaluated as part of the Fifth Round World Health Organization European Childhood Obesity Surveillance Initiative. The children's height and weight were measured by trained field examiners, while their parents or guardians filled paper versions of the food frequency questionnaire to collect information related to the child's breakfast habits and food and beverage intake. According to the International Obesity Task Force cut-off points, the overall prevalence of overweight (including obesity) and underweight were 28.9 and 8.1%, respectively. The majority of parents reported that their children (84.5%) had breakfast every day, while only 39.5 and 37% of children had daily fruit and vegetable consumption, respectively. The children who do not eat breakfast every day are more likely to be obese (OR = 1.50), while a higher intake frequency of nutrient-poor beverages such as soft drinks increases the risk of being not only overweight (OR = 1.32) but also underweight (OR = 1.39). Regular monitoring and understanding of dietary patterns and weight status is crucial to inform, design, and implement strategies to reduce national and global diet and obesity-related diseases. Urgent actions need to be taken from public policymakers to stop and reverse the increasing trend of overweight (including obesity) among Serbian children.

Status of folate in healthy children in Almeria

The objective of this study is to establish reference values for folic acid in a healthy population of children aged 4-11 years and to examine related epidemiological, dietary and analytical factors. A cross-sectional study of 658 healthy children aged 4-11 years was made. Epidemiological, socioeconomic and dietary variables were analysed, the BMI Z-score was obtained, levels of serum folate and serum vitamin B₁₂ were determined and haematological, iron status and erythropoietic activity parameters were examined. The study data were analysed by non-parametric tests and linear multiple regression. The mean folate value was 8.6 ± 4.6 ng/mL (95% reference interval: 2.8-20 ng/mL). A level < 3 ng/mL (5th percentile) was considered as folate deficiency (4.6% of subjects). No child reported symptoms related to this deficiency. Folate values were significantly lower with age (p < 0.01), low NSE and low parental educational level (p: 0.0001). No relationship was found between folates and the analytical variables. According to multivariate linear regression, the variables significantly associated with serum folate were age, socioeconomic level and vitamin B₁₂.Conclusions: Serum folate levels in healthy school children are described. Age, socioeconomic level and serum vitamin B₁₂ are factors associated with folate status. Specific cut-off values for a paediatric population should be defined. What is Known: • Folic acid is an essential micronutrient for optimal growth and development; its deficit is associated with adverse health effects. • The studies on their status and deficit are not comparable due to a lack of agreement on appropriate indicators and reference values. What is New: • This study reports the levels of serum folate in a large population of healthy schoolchildren, with strict inclusion criteria in a developed country and identifies the associated sociodemographic, dietary and analytical (vitamin B12, iron parameters and erythropoietic activity) factors, avoiding potential confusion.

Polygenic risk for obesity and its interaction with lifestyle and sociodemographic factors in European children and adolescents

BACKGROUND

Childhood obesity is a complex multifaceted condition, which is influenced by genetics, environmental factors, and their interaction. However, these interactions have mainly been studied in twin studies and evidence from population-based cohorts is limited. Here, we analyze the interaction of an obesity-related genome-wide polygenic risk score (PRS) with sociodemographic and lifestyle factors for BMI and waist circumference (WC) in European children and adolescents.

METHODS

The analyses are based on 8609 repeated observations from 3098 participants aged 2-16 years from the IDEFICS/I.Family cohort. A genome-wide polygenic risk score (PRS) was calculated using summary statistics from independent genome-wide association studies of BMI. Associations were estimated using generalized linear mixed models adjusted for sex, age, region of residence, parental education, dietary intake, relatedness, and population stratification.

RESULTS

The PRS was associated with BMI (beta estimate [95% confidence interval (95%-CI)] = 0.33 [0.30, 0.37], r2 = 0.11, p value = 7.9 × 10-81) and WC (beta [95%-CI] = 0.36 [0.32, 0.40], r2 = 0.09, p value = 1.8 × 10-71). We observed significant interactions with demographic and lifestyle factors for BMI as well as WC. Children from Southern Europe showed increased genetic liability to obesity (BMI: beta [95%-CI] = 0.40 [0.34, 0.45]) in comparison to children from central Europe (beta [95%-CI] = 0.29 [0.23, 0.34]), p-interaction = 0.0066). Children of parents with a low level of education showed an increased genetic liability to obesity (BMI: beta [95%-CI] = 0.48 [0.38, 0.59]) in comparison to children of parents with a high level of education (beta [95%-CI] = 0.30 [0.26, 0.34]), p-interaction = 0.0012). Furthermore, the genetic liability to obesity was attenuated by a higher intake of fiber (BMI: beta [95%-CI] interaction = -0.02 [-0.04,-0.01]) and shorter screen times (beta [95%-CI] interaction = 0.02 [0.00, 0.03]).

CONCLUSIONS

Our results highlight that a healthy childhood environment might partly offset a genetic predisposition to obesity during childhood and adolescence.

Prevalence of malnutrition risk and acute malnutrition in pediatric population in a tertiary hospital and their burden on healthcare

BACKGROUND

Malnutrition is related to an increased rate of complications and prolonged hospital stays. Malnutrition risk screening is recommended for all hospital inpatients, but its applicability as part of routine care is not well known.

METHODS

The prevalence of malnutrition risk, measured by the Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), and acute malnutrition were studied 1 day per year in all pediatric inpatient and day wards in 2015 and 2016 and in inpatients and outpatients in 2017 at a university hospital. Nurses carried out the STRONGkids screening and measured the weight and height of each child, recording the information in the hospital database, where it was subsequently extracted along with data on the child's diagnoses, procedures, and the length and costs of hospital stay.

RESULTS

In all, 696/1217 patients (57.2%) were screened. Of inpatients and outpatients, 37/398 (9.3%) and 3/298 (1.0%), respectively, were classified as being at high risk of malnutrition. The corresponding figures for those who were acutely malnourished were 18/260 (6.9%) and 11/264 (4.2%). High risk of malnutrition increased the costs and length of hospital stay (P < .05). Dietetic input was involved during hospital stay in 12/37 (32.4%), 32/173 (18.5%), and 13/188 (6.9%) of inpatients at high, moderate, and low risk, respectively (P < .001). Nutrition risk screening did not detect all patients classified as acutely malnourished.

CONCLUSION

Hospitals need to ensure proper application of nutrition screening, develop a protocol for the care of children at nutrition risk, and monitor the use of this protocol.

Body Fat Mass, Percent Body Fat, Fat-Free Mass, and Skeletal Muscle Mass Reference Curves for Czech Children Aged 6-11 Years

BACKGROUND

Negative lifestyle trends are reflected in overweight and obese children, in which their lack of physical activity results in decreased muscle mass. This study aimed to define age- and sex-specific reference curves for body fat mass (BFM), skeletal muscle mass (SMM), fat-free mass (FFM), and percent body fat (%BF) in Czech children.

METHODS

Body composition was measured by segmental bioelectrical impedance (BIA, InBody 720). The research sample included 2093 children aged 6-11 years (1008 boys and 1085 girls). Only children whose parents provided informed consent were included. Statistical analysis was performed using SPSS v. 22. The statistical analysis was performed separately by age and sex. Anthropometric data were summarized as means and standard deviation. The percentile curves (P3, P10, P25, P50, P75, P90, and P97) of BFM, FFM, %BF, and SMM were calculated using the gamlss package in R 3.4.2 (R Foundation for Statistical Computing, Vienna, Austria).

RESULTS

This study developed age- and gender-specific percentile curves of SMM, FFM, BFM, and %BF for Czech children aged 6-11 years. During childhood, BFM and %BF increased in boys, peaking at approximately 11 years of age. Girls displayed a different pattern of age-related changes in BFM and %BF compared to that in boys. These parameters gradually increased during childhood. This pattern was also observed for SMM and FFM in both sexes.

CONCLUSIONS

The purpose of this study was to serve as a reference to improve methods to evaluate body composition in Czech children and for comparison with studies worldwide.

Prevalence and trends of underweight in European children and adolescents: a systematic review and meta-analysis

PURPOSE

This study aimed at providing prevalence trend estimates of underweight among children and adolescents in Europe from 2000 to 2017.

METHODS

MEDLINE, Web of Science, Scopus and CINAHL were searched from their inception up to March 2020. Moreover, searches were conducted on health institutions' websites to identify studies not published in scientific journals. Underweight was defined according to the body mass index (BMI) cut-offs proposed by the International Obesity Task Force (IOTF) and the World Health Organization (WHO) definition criteria. The Mantel-Haenszel method was used to compute the pooled prevalence estimates whenever there was no evidence of heterogeneity; otherwise, the DerSimonian and Laird random-effects method was used. Subgroup analyses by sex, age range (2-13 and 14-18 years old), study year (2000-2006 and 2007-2017), country and European region were conducted.

RESULTS

A total of 49 studies with data from 323,420 children and adolescents aged 2 to 18 years, from 26 countries were included. From 2000 to 2017, according to the IOTF criteria, the prevalence of underweight showed an increasing trend in Eastern, Northern and Southern Europe, where the underweight prevalence ranged from 9.1 to 12.0%, from 4.1 to 6.8%, and from 5.8 to 6.7%, respectively. In Western Europe, the prevalence of underweight tended to decrease, from 14.0 to 11.8%. No significant differences were found by sex or age range.

CONCLUSION

The prevalence of underweight is considerable (overall, around 8-9%), particularly in Eastern Europe, and follows a slight upward trend during the past decade.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017056924.

Phenome-wide investigation of the causal associations between childhood BMI and adult trait outcomes: a two-sample Mendelian randomization study

Background

Childhood obesity is reported to be associated with the risk of many diseases in adulthood. However, observational studies cannot fully account for confounding factors. We aimed to systematically assess the causal associations between childhood body mass index (BMI) and various adult traits/diseases using two-sample Mendelian randomization (MR).

Methods

After data filtering, 263 adult traits genetically correlated with childhood BMI (P < 0.05) were subjected to MR analyses. Inverse-variance weighted, MR-Egger, weighted median, and weighted mode methods were used to estimate the causal effects. Multivariable MR analysis was performed to test whether the effects of childhood BMI on adult traits are independent from adult BMI.

Results

We identified potential causal effects of childhood obesity on 60 adult traits (27 disease-related traits, 27 lifestyle factors, and 6 other traits). Higher childhood BMI was associated with a reduced overall health rating (β = − 0.10, 95% CI − 0.13 to − 0.07, P = 6.26 × 10⁻¹¹). Specifically, higher childhood BMI was associated with increased odds of coronary artery disease (OR = 1.09, 95% CI 1.06 to 1.11, P = 4.28 × 10⁻¹¹), essential hypertension (OR = 1.12, 95% CI 1.08 to 1.16, P = 1.27 × 10⁻¹¹), type 2 diabetes (OR = 1.36, 95% CI 1.30 to 1.43, P = 1.57 × 10⁻³⁴), and arthrosis (OR = 1.09, 95% CI 1.06 to 1.12, P = 8.80 × 10⁻⁹). However, after accounting for adult BMI, the detrimental effects of childhood BMI on disease-related traits were no longer present (P > 0.05). For dietary habits, different from conventional understanding, we found that higher childhood BMI was associated with low calorie density food intake. However, this association might be specific to the UK Biobank population.

Conclusions

In summary, we provided a phenome-wide view of the effects of childhood BMI on adult traits. Multivariable MR analysis suggested that the associations between childhood BMI and increased risks of diseases in adulthood are likely attributed to individuals remaining obese in later life. Therefore, ensuring that childhood obesity does not persist into later life might be useful for reducing the detrimental effects of childhood obesity on adult diseases.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13073-021-00865-3.

Intake of Fibre-Associated Foods and Texture Preferences in Relation to Weight Status Among 9-12 Years Old Children in 6 European Countries

Plant foods, rich in fibre, can offer textures that children find difficult to orally manipulate, resulting in low preferences but are important for a healthy diet and prevention of overweight in children. Our aim was to investigate preferences for food texture, intake of fibre-associated foods and the relation to BMI. Three hundred thirty European children (9-12 years, 54% female) indicated their texture preferences using the Child-Food-Texture-Preference- Questionnaire (CFTPQ), and their parents responded on fibre-associated food consumption and anthropometric information. BMI was significantly lower for children with higher intake of wholegrain alternatives of common foods; in addition to being significantly influenced by country and the wearing of a dental brace. Overall BMI-for-age-percentiles (BMI_pct) were negatively associated with the consumption of wholegrain cereals, white pasta and wholemeal products and positively associated with the intake of legumes and white biscuits. In males, BMI_pct were negatively associated with wholegrain products and dried fruits, and in females, positively with legume consumption. A few country-related associations were found for BMI_pct and wholegrain biscuits, seeds and nuts and refined products. No overall correlation was found between BMI_pct and the texture preference of soft/hard foods by CFTPQ, except in Austria. We conclude that this study revealed evidence of a connection between fibre-associated foods and children's BMI at a cross-cultural level and that sex is an important determinant of fibre-associated food intake and the development of overweight in childhood.

Prevalence of Overweight, Obesity, Abdominal Obesity, and Obesity-Related Risk Factors in Polish Preschool Children: A Cross-Sectional Study

The aim of this study was to assess the prevalence of overweight, obesity, abdominal obesity (AO), and obesity-related risk factors in children aged 5–6 years from Poland. The study was conducted at 22 randomly selected kindergartens representing each city district. A cross-sectional study of 1172 children aged 5–6 years was conducted using questionnaire forms and physical measurements. The physical measurements included body height, weight, waist circumference (WC), and body fat percentage (BFP). A univariate and multivariate logistic regressions were performed to evaluate the risk factors for excess weight, excess adiposity, and abdominal obesity (AO). The prevalence of excess weight (BMI ≥ 85th percentile) was 11.0%. The prevalence of excess adiposity (BFP ≥ 85th percentile) was 42.3%. Prevalence of AO (WC ≥ 90th percentile) was higher in girls compared to boys (14.9% vs. 10.7%, respectively). Multivariate logistic regression analysis indicated that children whose both parents were obese had significantly higher risk of excess weight, excess adiposity, and AO. Lower education level of fathers was associated with higher risk of excess weight and excess adiposity in children, while a lower level of maternal education was associated with higher risk of AO in children. Screen time over 120 min per day, participating less than once a week in at least 60 min of moderate-to-vigorous physical activity (MVPA) and birth weight over 4000 g were associated with excess weight, excess adiposity and AO. Moreover, cesarean delivery was associated with higher risk of excess weight and excess adiposity, and lower socio-economic status with higher risk of AO. This study revealed that excess adiposity and AO differed by gender. Parental obesity, screen time, MVPA, and birth weight could be significant determinants of excess weight, excess adiposity and AO in Polish preschool children.

A 3-year school-based intervention improved physical fitness and reduced the prevalence of overweight and obesity in Italian prepubertal children

BACKGROUND

Schools constitute the ideal setting in which children's physical activity, physical fitness, and health status can improve. However, intervention protocols and their effectiveness vary considerably. The purpose of the study was to investigate the differences in physical fitness and overweight and obesity prevalence between children attending structured physical education classes held by a specialized teacher (EXP) or traditional classes of equal duration held by an ordinary teacher (TRAD).

METHODS

Anthropometric and fitness parameters were assessed in a convenience sample of 12,519 1^st grade schoolchildren over 3 subsequent school years. Six field-based tests were used to assess physical fitness.

RESULTS

Physical fitness improved more in the EXP group than in the TRAD group, except for flexibility (sit and reach). At the end of the 3^rd year, the EXP children performed better than did the TRAD children (P<0.001) in Léger (girls: +34%, boys: +30%), agility shuttle (girls: -10%, boys: -9%), long jump (girls: +9%, boys: +8%), frontal basketball throw (girls: +11%, boys: +10%), and standing balance (girls: +18%, boys: +28%). The prevalence of obesity and overweight was 5% lower in the EXP than in the TRAD group at the 3-year follow-up.

CONCLUSIONS

The proposed teacher-driven intervention, which was focused on the quality rather than the duration of time spent in the gym during school hours, was effective in improving children's physical fitness. Furthermore, the decrease in the prevalence of obesity and overweight suggests the intervention can improve heavier children's weight status.

A Multimodal Intervention for Prevention of Overweight and Obesity in Schoolchildren. A Protocol Study "PREVIENE-CÁDIZ"

This paper describes the protocol for a study designed to address the high prevalence (40%) of childhood overweight and obesity in the province of Cádiz, Spain, as a reflection of what is happening worldwide. It is widely known that children who suffer from childhood obesity have a higher risk of developing chronic diseases in adulthood. This causes a decrease in the quality of life and an increase in health spending. In this context, it is necessary to intervene promoting healthy lifestyle habits from an early stage. The objective of this project will be to evaluate the effectiveness of a multimodal intervention (individual, school and family) called "PREVIENE-CÁDIZ" [CADIZ-PREVENT]. The intervention will be focused mainly on diet, physical activity, sedentary lifestyle and sleep, to prevent overweight and obesity in schoolchildren from 8 to 9 years old in the province of Cádiz. It will consist of a 10-session education program carried out in the classroom by the teachers. In addition, children will be assigned two workbooks, one to work on in class and the other at home with parents. A workshop aimed at parents will be included to help teach them how to obtain healthier lifestyle habits. The proposed study will involve a quasi-experimental design with a control group.

Association between muscle strength and risk factors for metabolic syndrome in children and adolescents: a systematic review

The aim of this systematic review was to identify and summarize evidence for the association between muscle strength (MS) and metabolic syndrome (MetS), and MS and combinations of risk factors for MetS in children and adolescents. Five databases (Medline/PubMed, EBSCO, Scielo, Scopus, and Web of Knowledge) were searched up to November 2019 with complementary reference list searches. Inclusion criteria were studies that investigated the relationship between MS and MetS or MS and combinations of risk factors for MetS in children and adolescents (≤19 years of age). Risk of bias was assessed using standard procedures. From the total of 15,599 articles initially identified, 13 articles were included, representing 11,641 children and adolescents. Higher MS values were associated with lower risk for MetS or combinations of risk factors for MetS (n=11/13 studies). Of the total of included studies, about 23.1% (03/13) were longitudinal and all included studies were classified as having a moderate risk of bias. This review provides preliminary evidence for a beneficial relationship between MS and MetS among children and adolescents. Additionally, although the body of evidence points to the beneficial relationship between higher MS and lower risk for combination of factors for MetS in children and adolescents, this relationship is inconclusive.