Socioeconomic inequalities in children's weight, height and BMI trajectories in Norway

Integrating Genetic Insights, Technological Advancements, Screening, and Personalized Pharmacological Interventions in Childhood Obesity

Childhood obesity is a significant global health challenge with rising prevalence over the past 50 years, affecting both immediate and long-term health outcomes. The increase in prevalence from 0.7% to 5.6% in girls and 0.9% to 7.8% in boys highlights the urgency of addressing this epidemic. By 2025, it is estimated that 206 million children and adolescents aged 5-19 years will be living with obesity. This review explores the complex interplay of genomics and genetics in pediatric obesity, transitioning from monogenic and polygenic obesity to epigenetics, and incorporating advancements in omics technologies. The evolutionary purpose of adiposity, systemic evaluation of hyperphagia, and the role of various genetic factors are discussed. Technological advancements in genotyping offer new insights and interventions. The integration of genetic screening into clinical practice for early identification and personalized treatment strategies is emphasized.

Injury Risk in Elite Young Male Soccer Players: A Review on the Impact of Growth, Maturation, and Workload

ABSTRACT

Ribeiro, N, Martinho, DV, Pereira, JR, Rebelo, A, Monasterio, X, Gonzalo-Skok, O, Valente-dos-Santos, J, and Tavares, F. Injury risk in elite young male soccer players: a review on the impact of growth, maturation, and workload. J Strength Cond Res XX(X): 000-000, 2024-The long-term development of young male soccer players involves a prolonged period of significant adjustments, highlighting the importance of studying the complex interaction between dynamic variables, including workload, and inherent elements like growth and maturity. This analysis examines the intricate connections involving the development, maturity, workload, and susceptibility to injuries among adolescent male soccer players. Significantly, these connections become prominent at the peak height velocity (PHV) period, a crucial moment in maturation. Growth rates vary among individuals, and higher rates have been associated with an increased risk of injury in young soccer players, particularly during periods of rapid growth. Identifying possible risk factors and understanding the complex connections between them is crucial to developing specific methods for reducing the risk of injury. Sharing this valuable information with essential stakeholders is crucial for guaranteeing young athletes' comprehensive growth and maturation process. Furthermore, this review emphasizes the immediate need for long-term studies and thorough injury analyses to comprehend better the dynamic interactions that influence injury patterns in young male soccer players. This review will allow practitioners to better understand the main modifiable and nonmodifiable risk factors for injury and provide essential information focusing on practical strategies, facilitating more informed decision making by all stakeholders. The review aims to clarify these complexities and offer crucial insights that can assist in designing and implementing efficient strategies to reduce the risk of injury, specifically for the challenges faced during PHV and within the broader framework of long-term athletic development in young soccer.

Cognitive ability, education, height and body mass index in relation to risk of schizophrenia and mortality following its diagnosis

This study examines the hypotheses that the traits of higher IQ, longer education and taller height are associated with lower risk of death as compared to traits of low IQ, short education, and short height in men with schizophrenia compared to men without schizophrenia. In total, 937,919 men born 1939-59 and 1983-1997 with information from conscription were followed for incident schizophrenia in Danish registries. Higher levels of cognitive ability, longer education, and taller height were associated with fewer cases of schizophrenia. In a sub-sample of 652,368 men with information on body mass index, underweight was associated with more and overweight and obesity were associated with fewer cases of schizophrenia compared with normal weight. Higher cognitive ability, longer education, and taller height were associated with fewer deaths from both natural and unnatural causes in both men with and without schizophrenia. Underweight was associated with more deaths from natural and unnatural causes, whereas overweight and obesity were associated with more deaths from natural causes and fewer deaths from unnatural causes in both groups of men. Due to interaction, tall height and long educational duration were associated with fewer deaths from natural causes, and obesity was associated with fewer deaths from unnatural causes among men with schizophrenia compared to men without. In conclusion, traits in young adulthood are associated with higher mortality in men with and without schizophrenia, but traits of long educational duration and obesity seem to be especially important for lower mortality in men with schizophrenia.

Associations of Maternal Educational Level, Proximity to Green Space During Pregnancy, and Gestational Diabetes With Body Mass Index From Infancy to Early Adulthood: A Proof-of-Concept Federated Analysis in 18 Birth Cohorts

International sharing of cohort data for research is important and challenging. We explored the feasibility of multicohort federated analyses by examining associations between 3 pregnancy exposures (maternal education, exposure to green vegetation, and gestational diabetes) and offspring body mass index (BMI) from infancy to age 17 years. We used data from 18 cohorts (n = 206,180 mother-child pairs) from the EU Child Cohort Network and derived BMI at ages 0-1, 2-3, 4-7, 8-13, and 14-17 years. Associations were estimated using linear regression via 1-stage individual participant data meta-analysis using DataSHIELD. Associations between lower maternal education and higher child BMI emerged from age 4 and increased with age (difference in BMI z score comparing low with high education, at age 2-3 years = 0.03 (95% confidence interval (CI): 0.00, 0.05), at 4-7 years = 0.16 (95% CI: 0.14, 0.17), and at 8-13 years = 0.24 (95% CI: 0.22, 0.26)). Gestational diabetes was positively associated with BMI from age 8 years (BMI z score difference = 0.18, 95% CI: 0.12, 0.25) but not at younger ages; however, associations attenuated towards the null when restricted to cohorts that measured gestational diabetes via universal screening. Exposure to green vegetation was weakly associated with higher BMI up to age 1 year but not at older ages. Opportunities of cross-cohort federated analyses are discussed.

Maternal education and its influence on child growth and nutritional status during the first two years of life: a systematic review and meta-analysis

Background

The first 1000 days of life are critical for a child's health and development. Impaired growth during this period is linked to increased child morbidity, mortality, and long-term consequences. Undernutrition is the main cause, and addressing it within the first 1000 days of life is vital. Maternal education is consistently identified as a significant predictor of child undernutrition, but its specific impact remains to be determined. This study presents a systematic review and meta-analysis investigating the influence of high versus low maternal education levels on child growth from birth to age two, using population-based cohort studies.

Methods

Databases including PubMed, Scopus, EMBASE, Web of Science, ERIC, and Google Scholar were searched from January 1990 to January 2024 using appropriate search terms. We included population-based cohort studies of healthy children aged two years and under and their mothers, categorizing maternal education levels. Child growth and nutritional outcomes were assessed using various indicators. Two reviewers independently conducted data extraction and assessed study quality. The Newcastle Ottawa scale was utilized for quality assessment. Random-effects models were used for meta-analysis, and heterogeneity was assessed using the Cochrane Q and I2 statistic. Subgroup and sensitivity analyses were performed, and publication bias was evaluated.

Findings

The literature search retrieved 14,295 titles, and after full-text screening of 639 reports, 35 studies were included, covering eight outcomes: weight for age z-score (WAZ), height for age z-score (HAZ), BMI for age z-scores (BMIZ), overweight, underweight, stunting, wasting, and rapid weight gain. In middle-income countries, higher maternal education is significantly associated with elevated WAZ (MD 0.398, 95% CI 0.301-0.496) and HAZ (MD 0.388, 95% CI 0.102-0.673) in children. Similarly, in studies with low-educated population, higher maternal education is significantly linked to increased WAZ (MD 0.186, 95% CI 0.078-0.294) and HAZ (0.200, 95% CI 0.036-0.365). However, in high-income and highly educated population, this association is either absent or reversed. In high-income countries, higher maternal education is associated with a non-significant lower BMI-Z (MD -0.028, 95% CI -0.061 to 0.006). Notably, this inverse association is statistically significant in low-educated populations (MD -0.045, 95% CI -0.079 to -0.011) but not in highly educated populations (MD 0.003, 95% CI -0.093 to 0.098).

Interpretation

Maternal education's association with child growth varies based on country income and education levels. Further research is needed to understand this relationship better.

Funding

This study was a student thesis supported financially by Tehran University of Medical Sciences (TUMS).

Analyzing Children's Weight Growth Variations and Associated Factors in Ethiopia, India, Peru, and Vietnam: Using Fractional Polynomial Mixed-Effects Model

Background

Children's growth is increasingly considered a key mediator of later life outcomes. When examining weight growth, the correlation between repeated observations on the same subject must be regarded as well-modelled. This study aimed to analyze children's weight growth variations and associated factors in Ethiopia, India, Peru, and Vietnam using a fractional polynomial mixed-effects model.

Methods

This study used longitudinal data from the Young Lives Cohort Study conducted from 2002 to 2016 in Ethiopia, India, Peru, and Vietnam. The study included 7,140 children of 1 to 15 years old A fractional polynomial mixed-effects model was used to analyze the data.

Results

Ethiopian, Peruvian, and Vietnamese children had significantly higher average body weights than children in India (1.426, P<0.001; 1.992, P<0.001; 1.334, P<0.001, respectively). Girl children's average body weight was significantly 0.15 times less than that of boys (-0.148; P=0.027). The average weight of rural children was significantly 0.671 times less than that of urban children (0.671, P<0.001). Children from Peru and Vietnam had higher rates of weight change than those from India. However, the rate of weight change was lower in Ethiopian children than in Indian children. Children from urban areas had a significantly higher rate of weight gain than those from rural areas.

Conclusion

Country, sex, residence, parental education, household size, wealth, good drinking water, and reliable power affected children's longitudinal weight growth. Therefore, WHO and the nation's health ministry should monitor children's weight growth status and these associated factors to plan future action.

Changes in dietary habits and BMI z-score after a 6-month non-randomized cluster-controlled trial among 6-12 years old overweight and obese Norwegian children

Background

Effective prevention programs to address the high prevalence of childhood overweight and obesity and the concomitant health consequences have been warranted.

Objective

To improve dietary habits and weight status among Norwegian children with overweight/obesity in the primary care setting.

Design

A 6-month non-randomized cluster-controlled intervention among 137 children, aged 6-12 years, with overweight/obesity and their parents. Intervention and control groups were recruited by public health nurses and followed-up by 12 Healthy Life Centers across Norway. The intervention group received individual family counseling and participated in nutrition courses and physical activity groups. A frequency questionnaire assessing sociodemographic characteristics and dietary habits was completed by the parents. Trained public health nurses measured height and weight using standardized methods to calculate body mass index (BMI) and BMI z-scores.

Results

The intervention resulted in an increased odds of consuming evening meals (OR: 3.42), a decreased availability of salty snacks (β = -0.17), a decreased intake of salty snacks (-0.18), an increased consumption of water (β = 0.20), and a decreased estimated total intake of energy (β = -0.17), carbohydrates (β = -0.17), mono- and disaccharides (β = -0.21), sucrose (β = -0.24), and saturated fatty acids (β = -0.17). The intervention directly predicted lower BMI z-score (β = -0.17), and post-treatment levels of energy (β = -0.65), saturated fat (β = 0.43), and total carbohydrates (β = 0.41) were directly linked to BMI z-score after intervention. Age and sex were indirectly associated with BMI after intervention through energy and saturated fat intake.

Conclusions

The intervention had a beneficial impact on nutrient intake and weight status among children with overweight/obesity. These findings provide support for implementing complex intervention programs tailored to local primary care settings.

Trial registration

Clinicaltrials.gov, NCT02290171. Registered 13. November 2014, https://clinicaltrials.gov/ct2/show/NCT02290171.

Neighborhood deprivation, built environment, and overweight in adolescents in the city of Oslo

BACKGROUND

Even though the social and built environment characteristics of neighborhoods have been studied as potential determinants of social inequalities in obesity among adults, fewer studies have focused on children. Our first aim was to investigate whether there were differences in the food and physical activity environments between different neighborhood deprivation levels in the city of Oslo. We also explored whether there was an association between the prevalence of overweight (including obesity) among adolescents and (i) neighborhood deprivation levels and (ii) food and physical activity environments of the neighborhoods they live in.

METHODS

We conducted a food and physical activity environment mapping (using ArcGIS Pro) in all neighborhoods of Oslo, which were defined by administrative boundaries (sub-districts). The neighborhood deprivation score was calculated based on the percentage of households living in poverty, unemployment in the neighborhood, and residents with low education. A cross-sectional study including 802 seventh graders from 28 primary schools in Oslo residing in 75 out of 97 sub-districts in Oslo was also performed. MANCOVA and partial correlations were ran to compare the built environment distribution between different neighborhood deprivation levels, and multilevel logistic regression analyses were used to explore the effect of neighborhood deprivation and the food and physical activity environments on childhood overweight.

RESULTS

We found that deprived neighborhoods had greater availability of fast food restaurants and fewer indoor recreational facilities compared to low-deprived neighborhoods. Additionally, we observed that the residential neighborhoods of the adolescents with overweight had greater availability of grocery and convenience stores when compared to the residential neighborhoods of the adolescents without overweight. Adolescents living in neighborhoods with high deprivation had a two-fold higher odds (95% CI = 1.1-3.8) to have overweight compared to adolescents living in neighborhoods with low deprivation, regardless of participants' ethnicity and parental education. However, the built environment did not determine the relationship between neighborhood deprivation and overweight in adolescents.

CONCLUSION

The neighborhoods in Oslo with higher deprivation levels had more obesogenic characteristics than the low-deprived neighborhoods. Adolescents living in high-deprived neighborhoods were more likely to have overweight than their counterparts from low-deprived neighborhoods. Thus, preventive measures targeting adolescents from high-deprived neighborhoods should be put in place in order to reduce incidence of overweight.

The Influence of Socioeconomic Factors on the Body Characteristics, Proportion, and Health Behavior of Children Aged 6-12 Years

BACKGROUND

The research aimed to determine how socioeconomic factors influence the body structure and health behaviors of children in a suburban commune.

METHODS

Data from 376 children aged 6.78 to 11.82 years from Jabłonna, Poland, were analyzed. A questionnaire was used to gather information regarding the socioeconomic status and dietary habits of these children, and physical measurements such as height, weight, pelvic width, shoulder width, chest, waist, hip, and arm circumferences, and three skinfolds were taken. Hip index, pelvi-acromial index, Marty's index, BMI (body mass index), WHR (waist-hip ratio), and the sum of three skinfolds were calculated. One-way analysis of variance, Student's t-test, and X2 test with p < 0.05 were used.

RESULTS

The size of the family and the level of education and occupation of the fathers had a significant impact on the body proportions of the children. Children from larger centers with more educated parents were seen to have healthier eating habits and higher levels of physical activity, and their parents were less likely to smoke cigarettes.

CONCLUSIONS

It was concluded that the development environment of the parents, such as their level of education and profession, play a more important role than the size of birthplace.

Mediators of differences by parental education in weight-related outcomes in childhood and adolescence in Norway

Studies exploring mediators of socioeconomic inequalities in excess weight gain in early-life and subsequent overweight/obesity (OW/OB) among youth are limited. Thus, this study examined the mediating role of prenatal and early postnatal factors and child energy balance-related behaviours (EBRB) in the effects of parental education on (i) excess weight gain from birth to 2 years and (ii) OW/OB at 5, 8 and 14 years. The Norwegian Mother, Father and Child Cohort Study was used to include participants at the ages of 2 (n = 59,597), 5 (n = 27,134), 8 (n = 28,285) and 14 (n = 11,278) years. Causal mediation analyses using the inverse odds weighting approach were conducted. Children of low-educated parents had a higher conditional excess weight gain at 2 years compared to children of high-educated parents (total effect, RRTE = 1.06; 95% CI 1.01, 1.10). The joint mediation effects of the prenatal and early postnatal factors explained most of the total effect of low education on conditional excess weight gain at 2 years. Children of low-educated parents had a higher risk of OW/OB at 5, 8 and 14 years compared to children of high-educated parents. The mediators jointly explained 63.7%, 67% and 88.9% of the total effect of parental education on OW/OB among 5, 8 and 14 year-old-children, respectively. Of the total mediated effects at 5, 8 and 14 years, the prenatal and early postnatal mediators explained 59.2%, 61.7% and 73.7%, whereas the child EBRB explained 10.3%, 15.8.0%% and 34.8%. The mediators included were found to have a considerable mediating effect in the associations explored, in particular the prenatal and early postnatal factors. If truly causal, the findings could indicate potential targets for interventions to tackle socioeconomic inequalities in OW/OB from birth to adolescence.

Diet quality of Norwegian children at 3 and 7 years: changes, predictors and longitudinal association with weight

BACKGROUND/OBJECTIVES

Poor diet quality in early life can have long-term health effects, but the evidence is largely from cross-sectional studies. Our objective was to examine diet quality of Norwegian children by applying a-priori diet quality indices, identify early life determinants and examine prospective associations with overweight.

SUBJECTS/METHODS

We included 34,074 preschoolers (3-year-olds) and 18,350 school-aged children (7-years-olds) from the prospective, population-based Norwegian Mother, Father and Child Cohort Study. Diet quality was assessed as (i) adherence to a Mediterranean diet, estimated by the food frequency-based Mediterranean Diet Score (fMDS, score range: 0-6) and (ii) by the diet quality index (DQI, score range: -33% to 100%), reflecting compliance to food-based dietary guidelines. In multivariate analyses we explored perinatal and childhood characteristics as potential determinants of diet quality. We used logistic regression to examine the associations between diet quality at 3 years and BMI status at 8 years, adjusting for relevant confounders and diet quality at 7 years.

RESULTS

One in three children had high MD adherence at 3 and 8 years, and DQI (mean 60%) at 3 and 7 years was strongly correlated (r = 0.48, p < 0.001). Short breastfeeding duration, physical activity and sleep duration and long screentime at 18 months were associated with 2-3% lower DQI at 3 years. At both ages, maternal diet quality was the strongest prospective predictor of DQI (beta = 5%, 95% CI = 4.7, 5.2 and beta = 3.1%, 95% CI = 2.8, 3.4), and screentime was the strongest cross-sectional predictor (beta = -5.2%, 95% CI = -5.9, -4.5 and beta = -4.1%, 95% CI = -5.0, -3.2). High DQI score at 3 years, but not MD adherence, was associated with a lower risk for overweight (including obesity) at 8 years, compared to low DQI (lower tertile) (adjusted OR = 0.77, 95% CI = 0.62, 0.96).

CONCLUSIONS

Our study provides evidences that high diet quality in early childhood may reduce the risk for overweight in later childhood, independent of the current dietary behaviors.

Digit ratio (2D:4D) and body mass index in the BBC Internet Study: prenatal sex steroids and a Trivers-Willard effect on body composition

Digit ratio - a putative measure of prenatal sex steroids - may be related to body mass index (BMI). However, reports of correlations between 2D:4D and BMI have yielded mixed results with some studies showing no relationship while others have reported positive associations in men or women only. This study considers associations between self-reported 2D:4D and BMI in a large online survey (i.e. the BBC Internet Study). At the individual level, there was a weak positive association between 2D:4D and BMI in both sexes with greater effect sizes in women. Body mass index was positively related to age and negatively related to parental income; however, the relationship between 2D:4D and BMI was independent of both variables. At the national level, mean 2D:4D per country showed positive associations with mean national BMI but those correlations were restricted to females. It is concluded that BMI is positively related to low prenatal testosterone and high prenatal oestrogen. Parental income inequality may influence both prenatal sex steroids (through a 'Trivers-Willard' effect) and BMI such that increases in inequality result in reductions in prenatal testosterone and increases in BMI at the individual and national level.