Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935

Understanding Blame in the Context of Childhood Obesity

This paper explicates blame as a psychological construct in communication processes, with a focus on its underlying structure and its mediating role between message characteristics and the public's issue engagement. Data were collected from Amazon Mechanical Turk (N = 373) via a Web-based experiment, where we manipulated a news story about a child suffering an obesity-related health risk (asthma attack vs. heart attack) with different levels of preventability (high vs. low) and severity (high vs. low). Findings showed that blame should best be conceptualized and operationalized as a latent construct comprising both cognitive and affective components. Blame mediated message effects on social responses related to obesity prevention, including punitive attitudes, policy support, and intentions toward interpersonal communication and civic participatory behaviors.

Metabolic complications of obesity in children and adolescents

The global prevalence of childhood and adolescent obesity, exacerbated by the coronavirus disease 2019 pandemic, affects school-aged children and preschoolers. Early-onset obesity, which carries a high risk of metabolic complications, may contribute to a lower age at the onset of cardiovascular disease. As metabolic diseases such as diabetes, dyslipidemia, and nonalcoholic fatty liver disease observed in adulthood are increasingly recognized in the pediatric population, there is an emphasis on moving disease susceptibility assessments from adulthood to childhood to enable early detection. However, consensus is lacking regarding the definition of metabolic diseases in children. In response, various indicators such as the pediatric simple metabolic syndrome score, continuous metabolic syndrome score, single-point insulin sensitivity estimator, and fatty liver index have been proposed in several studies. These indicators may aid the early detection of metabolic complications associated with pediatric obesity, although further validation studies are needed. Obesity assessments are shifting in perspective from visual obesity to metabolic health and body composition considerations to fill the gap in health impact assessments. Sarcopenic obesity, defined as the muscle- to-fat ratio, has been proposed in pediatric populations and is associated with metabolic health in children and adolescents. The National Health Screening Program for Children in Korea has expanded but still faces limitations in laboratory testing. These tests facilitate timely intervention by identifying groups at a high risk of metabolic complications. Early detection and intervention through comprehensive health screening are critical for mitigating long-term complications of childhood obesity.

Neurodevelopmental Programming of Adiposity: Contributions to Obesity Risk

This review analyzes the published evidence regarding maternal factors that influence the developmental programming of long-term adiposity in humans and animals via the central nervous system (CNS). We describe the physiological outcomes of perinatal underfeeding and overfeeding and explore potential mechanisms that may mediate the impact of such exposures on the development of feeding circuits within the CNS-including the influences of metabolic hormones and epigenetic changes. The perinatal environment, reflective of maternal nutritional status, contributes to the programming of offspring adiposity. The in utero and early postnatal periods represent critically sensitive developmental windows during which the hormonal and metabolic milieu affects the maturation of the hypothalamus. Maternal hyperglycemia is associated with increased transfer of glucose to the fetus driving fetal hyperinsulinemia. Elevated fetal insulin causes increased adiposity and consequently higher fetal circulating leptin concentration. Mechanistic studies in animal models indicate important roles of leptin and insulin in central and peripheral programming of adiposity, and suggest that optimal concentrations of these hormones are critical during early life. Additionally, the environmental milieu during development may be conveyed to progeny through epigenetic marks and these can potentially be vertically transmitted to subsequent generations. Thus, nutritional and metabolic/endocrine signals during perinatal development can have lifelong (and possibly multigenerational) impacts on offspring body weight regulation.

Birth History and Cardiovascular Disease Risk Among Youth With Significant Obesity

Children born prematurely have greater lifetime risk for hypertension. We aimed to determine (1) the association between prematurity and cardiovascular disease (CVD) risk factors among 90 children with obesity and elevated blood pressure and (2) if dietary sodium intake modified these associations. Multivariable regression analysis explored for associations between prematurity (<37 weeks gestation; early gestational age) and low birth weight (<2.5 kg) with hypertension, left ventricular mass index (LVMI), and left ventricular hypertrophy (LVH). Effect modification by dietary sodium intake was also explored. Patients were predominately male (60%), black (78%), adolescents (13.3 years), and with substantial obesity (body mass index: 36.5 kg/m2). Early gestational age/low birth weight was not an independent predictor for hypertension, LVMI, or LVH. There was no effect modification by sodium load. Our results suggest the increased CVD risk conferred by prematurity is less significant at certain cardiometabolic profiles. Promoting heart-healthy lifestyles to prevent pediatric obesity remains of utmost importance to foster cardiovascular health.

Association of High Body Mass Index in Early Life With the Development of Colorectal Cancer

SIGNIFICANCE

This study on the relationship between early life high BMI and the development of CRC reveals the role of high BMI during childhood and adolescence in the occurrence and progression of CRC. It suggests the importance of restoring normal weight or reducing weight in individuals with high BMI early in life for the prevention of colorectal cancer.

From Metabolically Healthy Obesity to Metabolically Unhealthy Obesity Populations: Decreased Bone Turnover Bioactivity

Purpose

A bone turnover marker reflects bone bioactivity. The effects of metabolically healthy compared with metabolically unhealthy obesity phenotypes on bone metabolism are not well understood. The aim of the study was to evaluate differences of bone transformation indexes in these two obesity phenotypes.

Patients and Methods

A total of 419 obese subjects were recruited, 64 with metabolically healthy obesity (MHO) and 351 with metabolically unhealthy obesity (MuHO). BTMs and clinical parameters were measured.

Results

Bone metabolism indexes, including tartrate resistant acid phosphatase (TRACP, p < 0.05), β carboxyl terminal peptide of collagen (β-CTX, p < 0.01), and bone alkaline phosphatase (BAP, p < 0.01), were higher in subjects with MHO than MuHO, but parathyroid hormone (PTH) was lower (p < 0.05). The between-group difference in serum calcium was not significant. Low bone turnover activity was associated with significant hyperglycemia, insulin resistance, and body fat index (p < 0.05). Multivariate logistic regression found that TRACP, β-CTX, and BAP were independently associated with the presence of MHO. Receiver operating characteristic curve analysis found that the maximum area under the curve value for the definition of MHO was (0.8221) and was obtained when sex, age, body mass index (BMI), TRACP, β-CTX and BAP were included simultaneously, resulting in a sensitivity of 81.25% and specificity: 72.3%.

Conclusion

The MHO group had significantly increased circulating TRACP and β-CTX compared with the MuHO group and BAP levels were within the physiological range. Obesity with the metabolically healthy phenotype had slightly increased bone turnover activity that may be an early compensatory response of skeletal metabolism to the increased BMI.

Association between childhood obesity and infertility in later life: a systematic review of cohort studies

BACKGROUND

The global prevalence of childhood obesity has exhibited a troubling surge in recent years. Due to the raised questions regarding its potential correlation with infertility in adulthood, this systematic review has been undertaken to explore the relationships between childhood obesity, and infertility later in life.

METHODS

A comprehensive search was performed in three international databases (PubMed, Web of Science, and Scopus). All cohort (retrospective or prospective), case-cohort, and nested case-control studies until April 2022 which assessed the association of obesity in children and adolescents with male and female infertility indicators in later life were included. The quality of the included studies was assessed by Newcastle-Ottawa quality assessment checklists.

RESULT

Out of the initial 32,501 documents, eleven eligible studies with a total sample size of 498,980 participants were included. Five studies focused on the number of offspring and indicated that obesity, especially in adolescence had an association with later life lower number of children, nulliparity, and childlessness in both men and women. Concerning conceiving problems, two studies showed that obesity before age 12 increased the risk of female fertility problems in the future. Two studies reported that obesity in early life raised the risk of impaired female reproductive system such as menstrual or ovulatory problems. As well as females, a study discovered that obesity in men during their 20s was linked to an elevated risk of low sperm motility and poor sperm morphology. Another study has reported men with higher pre-pubertal BMI had lower sex hormone-binding globulin; however, the same association was not seen between childhood BMI and semen quality.

CONCLUSION

The evidence suggests a positive association between childhood obesity with infertility indicators in later life. Childhood weight reduction strategies are suggested to be implemented in societies in order to reduce infertility rates in later life.

Management of children with obesity at local hospital and impact of COVID-19 pandemic

This study investigated the status of children with obesity before and after the COVID-19 pandemic, and the effects of lifestyle guidance on weight loss among children in Japan. We analysed the data of patients who visited our hospital after check-ups for obesity and evaluated the efficacy of lifestyle guidance. The patients were divided into groups A, B, and C (year 2011, 2019, and 2021, respectively). There were no differences in body weight, obesity index (OI), blood pressure, or alanine transaminase (ALT) levels between the groups; however, aspartate transaminase (AST) level was the highest in Group C. In Group C, only OI increased between the primary and secondary screenings; however, OI and body mass index (BMI) improved during the second screening and more children in the weight loss group followed lifestyle guidance. OI/BMI did not change over the past decade; however, short-term weight gain was significant owing to the COVID-19 pandemic, and simple guidance was effective in reducing weight. Future challenges include identifying methods to achieve long-term weight loss.

Diet and Food and Nutrition Insecurity and Cardiometabolic Disease

Poor nutrition is the leading cause of poor health, health care spending, and lost productivity in the United States and globally, which acts through cardiometabolic diseases as precursors to cardiovascular disease, cancer, and other conditions. There is great interest in how the social determinants of health (the conditions in which people are born, live, work, develop, and age) impact cardiometabolic disease. Food insecurity is an example of a powerful social determinant of health that impacts health outcomes. Nutrition insecurity, a distinct but related concept to food insecurity, is a direct determinant of health. In this article, we provide an overview of how diet in early life relates to cardiometabolic disease and then continue to focus on the concepts of food insecurity and nutrition insecurity. In the discussions herein we make important distinctions between the concepts of food insecurity and nutrition insecurity and provide a review of their concepts, histories, measurement and assessment devices, trends and prevalence, and links to health and health disparities. The discussions here set the stage for future research and practice to directly address the negative consequences of food and nutrition insecurity.

Molecular Biomarkers for Cardiometabolic Disease: Risk Assessment in Young Individuals

Cardiometabolic diseases, including cardiovascular disease and diabetes, are major causes of morbidity and mortality worldwide. Despite progress in prevention and treatment, recent trends show a stalling in the reduction of cardiovascular disease morbidity and mortality, paralleled by increasing rates of cardiometabolic disease risk factors in young adults, underscoring the importance of risk assessments in this population. This review highlights the evidence for molecular biomarkers for early risk assessment in young individuals. We examine the utility of traditional biomarkers in young individuals and discuss novel, nontraditional biomarkers specific to pathways contributing to early cardiometabolic disease risk. Additionally, we explore emerging omic technologies and analytical approaches that could enhance risk assessment for cardiometabolic disease.

Differences in specific abdominal fat depots between metabolically healthy and unhealthy children with overweight/obesity: The role of cardiorespiratory fitness

OBJECTIVES

Fat depots localization has a critical role in the metabolic health status of adults. Nevertheless, whether that is also the case in children remains under-studied. Therefore, the aims of this study were: (i) to examine the differences between metabolically healthy (MHO) and unhealthy (MUO) overweight/obesity phenotypes on specific abdominal fat depots, and (ii) to further explore whether cardiorespiratory fitness plays a major role in the differences between metabolic phenotypes among children with overweight/obesity.

METHODS

A total of 114 children with overweight/obesity (10.6 ± 1.1 years, 62 girls) were included. Children were classified as MHO (n = 68) or MUO. visceral (VAT), abdominal subcutaneous (ASAT), intermuscular abdominal (IMAAT), psoas, hepatic, pancreatic, and lumbar bone marrow adipose tissues were measured by magnetic resonance imaging. Cardiorespiratory fitness was assessed using the 20 m shuttle run test.

RESULTS

MHO children had lower VAT and ASAT contents and psoas fat fraction compared to MUO children (difference = 12.4%-25.8%, all p < 0.035). MUO-unfit had more VAT and ASAT content than those MUO-fit and MHO-fit (difference = 34.8%-45.3%, all p < 0.044). MUO-unfit shows also greater IMAAT fat fraction than those MUO-fit and MHO-fit peers (difference = 16.4%-13.9% respectively, all p ≤ 0.001). In addition, MHO-unfit presented higher IMAAT fat fraction than MHO-fit (difference = 13.4%, p < 0.001). MUO-unfit presented higher psoas fat fraction than MHO-fit (difference = 29.1%, p = 0.008).

CONCLUSIONS

VAT together with ASAT and psoas fat fraction, were lower in MHO than in MUO children. Further, we also observed that being fit, regardless of metabolic phenotype, has a protective role over the specific abdominal fat depots among children with overweight/obesity.

Reference percentiles for tri-ponderal mass index and its association with general and abdominal obesity among Iranian children and adolescents: A report from the SHED LIGHT study

BACKGROUND

The body mass index (BMI) has some limitations in identifying obesity, particularly among children and adolescents.

OBJECTIVES

We sought to determine the reference percentiles of tri-ponderal mass index (TMI) for Iranian population, and its relation to BMI, waist circumference (WC), and waist circumference-to-height ratio (WHtR).

METHODS

Baseline characteristics for 14 641 children and adolescents were applied. The area under the characteristics (AUC) curve and optimal cut-off points for TMI were used to define the accuracy of TMI for discriminating general and central obesity compared to other anthropometric measurements.

RESULTS

TMI levels remained stable from 6 to 18 years with a small range of difference. The highest AUCs for discriminating obesity according to BMI and WHtR ≥0.5 from non-obese subjects were related to TMI (0.980) and TMI (0.912), respectively, and these findings were similar for both sexes. Moreover, the AUC for TMI to discriminate central obesity by WHtR was higher than that for BMI (0.912 vs. 0.833, p < .001), and this difference was similar among sex and age groups. The optimal value of TMI for discriminating general obesity, obesity by WC, and obesity by WHtR were 15.2 (sensitivity 96.2 and specificity 89.8), 15 (sensitivity 86.9 and specificity 79.9), and 13.9 (sensitivity 85.1 and specificity 81.5), respectively.

CONCLUSIONS

TMI discriminated central obesity by WHtR more accurately than obesity by BMI among Iranian children and adolescents irrespective of sex. Besides it remained relatively constant across age- and sex-specific groups providing a single optimal cut-off point for screening obesity during childhood and adolescence.

Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS

BACKGROUND AND AIMS

Elevated body weight in adolescence is associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, weight in midlife or to weight gain is not known. The aim of this study is to assess the risk of midlife coronary atherosclerosis being associated with body weight at age 20, body weight in midlife and body weight change.

METHODS

We used data from 25,181 participants with no previous myocardial infarction or cardiac procedure in the Swedish CArdioPulmonary bioImage Study (SCAPIS, mean age 57 years, 51% women). Data on coronary atherosclerosis, self-reported body weight at age 20 and measured midlife weight were recorded together with potential confounders and mediators. Coronary atherosclerosis was assessed using coronary computed tomography angiography (CCTA) and expressed as segment involvement score (SIS).

RESULTS

The probability of having coronary atherosclerosis was markedly higher with increasing weight at age 20 and with mid-life weight (p < 0.001 for both sexes). However, weight increase from age 20 until mid-life was only modestly associated with coronary atherosclerosis. The association between weight gain and coronary atherosclerosis was mainly seen in men. However, no significant sex difference could be detected when adjusting for the 10-year delay in disease development in women.

CONCLUSIONS

Similar in men and women, weight at age 20 and weight in midlife are strongly related to coronary atherosclerosis while weight increase from age 20 until midlife is only modestly related to coronary atherosclerosis.

The effect of foetal and early childhood growth on metabolic derangements of Sri Lankan children

BACKGROUND

Previous studies have shown that delayed prenatal growth followed by accelerated postnatal growth plays a significant role on the onset of adult metabolic diseases. The present study aimed to identify the effects of intrauterine and later growth on metabolic derangements among children in Colombo, Sri Lanka.

METHODS

A school-based cross-sectional study was conducted among 5-15-year-old children selected using a two-stage probability-proportionate-to-size cluster sampling technique. Birth-weight (BW) was extracted from records (denotes prenatal growth) and body mass index(BMI)-Z score and fat mass(FM) measured to denote the current growth of children. Fasting and random blood glucose, lipid profile and blood pressure(BP) were measured. The sample was stratified by age (5-< 10 and 10-15 years); was further categorized into tertiles of BW and BMI-Z scores. Based on these two parameters, metabolic parameters were evaluated within each age category.

RESULTS

The sample comprised 833(494 boys) healthy school children. Metabolic parameters did not significantly differ by sex or across BW tertiles of each BMI-Z score tertile. However, significant changes in some metabolic parameters were noted across the BMI-Z score tertiles of each BW tertile. Children belonging to the lowest BW and highest BMI-Z score tertiles had worst metabolic profiles, while those in the lowest BW as well as BMI-Z score tertile were protected. Excessive fat deposition seemed to move children to higher BMI-Z score tertiles.

CONCLUSION

Poor prenatal growth is not the sole risk factor for abnormal metabolic profile found in childhood. Those who gain fat, denoted by weight, during early childhood are at a higher risk of developing metabolic abnormalities than those who do not. This favours the accelerated postnatal growth hypothesis.

Did the increase in sitting time due to COVID-19 lead to obesity in adolescents?

INTRODUCTION

Since adolescent with obesity is closely linked with the incidence of cardiovascular disease, it is important to identify the factors that increase the prevalence of adolescent with obesity and prevent it early. This study aimed to examine which of the demographic and lifestyle factors including sitting hours per week for purposes other than study had the greatest influence on Korean adolescents with obesity during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

We used the Korean Youth Risk Behavior Web-based Survey (KYRBWS) data. The primary outcome was the relationship between sitting hours and obesity during and after the COVID-19 pandemic. Multiple logistic regression analysis was performed to examine which of the demographic and lifestyle factors including sitting hours per week for purposes other than study had the greatest influence on Korean adolescents' obesity status.

RESULTS

The prevalence of obesity was significantly higher during the COVID-19 than before the COVID-19 (OR, 1.268, CI:1.232-1.305). There was a significant increase in the OR for sitting hours per week for purposes other than study (OR, 1.021, 95% CI, 1.019-1.024). Compared to low household income, the OR decreased for middle (OR = 0.798, 95% CI:0.77, 0.826) and high-income household students (OR, 0.833, 95% CI: 0.803-0.865).

DISCUSSION/CONCLUSION

The results of this study confirmed the relationship between sit-ting hours and obesity in adolescents during the pandemic. To prevent adolescent with obesity, further studies are needed to focus on the importance of promoting health policy in adolescents to avoid the continuous rising of its prevalence and needed to understand whether the increase in obesity rates during the pandemic is a temporary trend.

Prevalence and trends in obesity and severe obesity in Korean children and adolescents, 2007-2020: A population-based study

BACKGROUND

The age-adjusted prevalence of child and adolescent obesity has been stabilized in the Korean population, although severe obesity has increased with adverse health effects. In this study, we detailed the prevalence of and trends in overweight, obesity, and severe obesity in Korean children and adolescents by age group and sex from a nationally representative sample, using a new, 2017 age- and sex-specific reference for body mass index.

METHODS

We collected Korea National Health and Nutrition Examination Survey data from the years 2007-2020. A total of 23,595 subjects (11,210 females) aged 2-18 years were included in this study. We calculated the recent prevalence of overweight and obesity, including severe obesity, by weighted data from 2019 and 2020.

RESULTS

The prevalence of overweight and obesity (class II and class III obesity) was 23.5% and 14.2% (2.5% and 0.5%), respectively. Males showed a higher prevalence of overweight and obesity. Adolescents aged 13-15 years showed the highest prevalence of severe obesity. A positive linear trend was significant for overweight (p = 0.025), class I obesity (p < 0.001), and class II obesity (p = 0.002) for both sexes and all ages combined. However, the trend of obesity prevalence was different in each subgroup. Comparing pre- and post- COVID-19 pandemic, obesity prevalence seemed to increase, but not significantly.

CONCLUSIONS

Despite previous reports that obesity in children and adolescents has remained stable, we found that the prevalence of overweight, obesity, and severe obesity has increased in Korean children and adolescents. The effects of COVID-19 on this trend require further evaluation.

Adolescent cardiometabolic risk scores: A scoping review

AIMS

Clustering of cardiometabolic risk factors (CMRFs) indicates cardiometabolic risk (CMR), a key driver of cardiovascular disease. Early detection and treatment of CMR are important to decrease this risk. To facilitate the identification of individuals at risk, CMRFs are commonly combined into a CMR Score. This scoping review aims to identify CMRFs and methods used to calculate adolescent CMR Scores.

DATA SYNTHESIS

Systematic searches were executed in Child Development and Adolescent Studies, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, EBSCO CINAHL, Scopus Elsevier, Cochrane CENTRAL, and Nursing and Allied Health. No limits were placed on publication date or geographic location. Studies were included if participants were 10-19 years and the study reported CMRFs in a composite score. Key extracted information included participant characteristics, CMRFs comprising the scores, and methods of score calculation. CMRFs were categorized and data were reported as frequencies. This study identified 170 studies representing 189 CMR Scores. The most common CMRF categories were related to lipids, blood pressure, and adiposity. The most frequent CMRFs were triglyceride z-score, systolic blood pressure z-score, and inverse high-density lipoproteins z-score. Scores were mostly calculated by summing CMRF z-scores without weighting.

CONCLUSIONS

The range of CMRFs and Scores identified in adolescent CMR literature limits their use and interpretation. Published CMR Scores commonly contain two main limitations: (a) use of an internal cohort as the z-score reference population, and (b) Scores relying on adiposity measures. We highlight the need for a standard set of CMRFs and a consensus for a CMR Score for adolescents.

Analysis of the gut microbiome in obese native Tibetan children living at different altitudes: A case-control study

Objective

To explore the relationship between intestinal flora and obesity in Tibetan children at different altitudes.

Methods

Using16S rRNA gene sequencing results and blood lipid metabolism indexes to study the characteristics of the intestinal flora present in faeces and changes in blood lipid metabolism in obese children in Tibet who reside at different altitudes and to study correlations between blood lipid metabolism indicators and the intestinal flora composition.

Results

The results showed the following. (a) The triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) levels in the obesity groups were higher than those in the normal-weight groups, and those in the high-altitude obesity groups were lower than those in the low-altitude obesity groups. (b) The 16S rRNA gene sequencing results showed that altitude affected the composition and relative abundance of the gut microbiota. These parameters were basically the same among the low-altitude groups, while they were significantly lower in the high-altitude groups than in the low-altitude groups. (c) Groups that lived at different altitudes and had different body weights had different dominant bacterial genera. Megamonas was closely related to obesity, and its relative abundance in the low-altitude groups was higher than that in the high-altitude groups. Prevotella was associated with altitude, and its relative abundance in the high-altitude groups was higher than that in the low-altitude groups. In addition, Prevotella elicited changes in the abundance of Escherichia-Shigella. The lower prevalence of obesity and incidence of intestinal inflammation in those living at high altitudes were related to the abundance of Prevotella. (d) There were correlations between the gut microbiota composition and lipid metabolism indicators. The abundance of Romboutsia was positively correlated with TG and LDL-C levels but negatively correlated with high-density lipoprotein cholesterol (HDL-C) levels. The abundance of Akkermansia was negatively correlated with LDL-C levels, and the abundance of Blautia was negatively correlated with body mass index (BMI) and LDL-C levels.

Conclusions

The intestinal flora diversity varied by body weight and altitude, with lower diversity in those at higher altitudes and with lower body weights. Prevotella likely plays a role in suppressing obesity at high altitudes.

Cost-effectiveness of a motivational interviewing obesity intervention versus usual care in pediatric primary care offices

OBJECTIVE

This study aimed to assess the incremental cost-effectiveness ratio (ICER) of a 2-year motivational interviewing (MI) intervention versus usual primary care.

METHODS

A national trial was implemented in the Pediatric Research in Office Settings (PROS) network of the American Academy of Pediatrics to evaluate MI versus usual care for children (2-8 years old; baseline BMI 85th-97th percentiles). Health care use, food costs, provider fees, and training costs were assessed, and sensitivity analyses were conducted. Primary outcome was the ICER, calculated as cost per unit change in BMI percentile for intervention versus usual care.

RESULTS

At 2 years, 72% of enrolled parent/child dyads were retained; 312 children were included in the analysis. Mean BMI percentile point change was -4.9 and -1.8 for the intervention and control, respectively, yielding an incremental reduction of 3.1 BMI percentile points (95% CI: 1.2-5.0). The intervention cost $1051 per dyad ($658 for training DVD development). Incorporating health care and non-health care costs, the intervention ICER was $363 (range from sensitivity analyses: cost saving, $3159) per BMI percentile point decrease per participant over 2 years.

CONCLUSIONS

Training pediatricians, nurse practitioners, and registered dietitians to deliver MI-based interventions for childhood obesity in primary care is clinically effective and acceptably cost-effective. Future work should explore this approach in broader dissemination.

A visualized and scientometric analysis of research trends of weight loss in overweight/obese children and adolescents (1958-2021)

Background

Weight loss is an appropriate approach to reduce the health risks associated with overweight/obese children and adolescents, and the optimal method of weight loss requires further research. This study systematically explores scientific co-operation, disciplinary interaction, hotspots and trends in the field of weight loss in overweight/obese children and adolescents (WLOCA), and provides references for further research.

Methods

Citespace 5.8.R1 (64-bit) was adopted to conduct a comprehensive visualization analysis of the literature on WLOCA from Web of Science Core Collection, including publication, institution, country/region, author, journal, keywords and reference.

Results

2,513 papers were found in the Web of Science Core Collection, and the annual number of papers published has increased significantly since 2003. Cincinnati Children's Hospital is the institution with the largest number of publications, while Washington University plays a pivotal role in the collaboration network. In terms of nations, USA has made greater contributions than the rest in terms of the number of publications and global co-operation research. The most influential authors in this field are Thomas H. Inge, Thomas Reinehr, Todd M. Jenkins, Epstein LH, Ogden CL, etc. The most active journals are "Obesity," "International Journal of Obesity," "Obesity Surgery," "Pediatrics," etc. which are characterized by interdisciplinary interactions. Research hot topics mainly include "assessment of obesity and pathophysiological mechanism," "comprehensive intervention," and "bariatric surgery," and there's a gradual shift from "lifestyle intervention" and "pathophysiological mechanism" to "clinical surgical application." In addition, disciplinary integration and comprehensive research, targeted intervention and treatment, and prospective research are the future research trends.

Conclusion

The overall trend in WLOCA study is positive. The main contribution of this study is to reveal the overall picture of the research in this field with visual maps and detailed data by combining quantitative with qualitative approaches, which can provide valuable references for relevant researchers to quickly understand the status of studies on WLOCA, to seek co-operation, and grasp research hotspots and frontier trends.

Association of Puberty Stage and Weight Status with Cardiometabolic Risk in Children and Adolescents Living on the Texas-Mexico Border

Background: This retrospective cohort study aimed to examine the interaction effect between puberty stage and weight status on individual and clustering of cardiometabolic risk factors (CMRFs) among Mexican American children and adolescents. A total of 333 children and adolescents (aged 8-18 years) enrolled in the Cameron County Hispanic Cohort (CCHC) from 2014 to 2020 were included in the study. Methods: CCHC is a longitudinal, randomly recruited cohort based on the United States Census tracts/blocks of Mexican Americans living on the Texas-Mexico border. Individual CMRFs, including high blood pressure, central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, and insulin resistance (IR) were assessed. Clustering of CMRFs is defined as the presence of three or more individual CMRFs. Puberty stages were assessed using the Tanner criteria. Multivariable logistic regressions were conducted to assess the association of puberty, weight status, and the interaction of the two main exposures with individual and clustering of CMRFs. Results: We observed that weight status had a dominant effect on all CMRF measures. The effect was especially prominent on central obesity and clustering of CMRFs. There were 95.4% of children with central obesity and 98.4% of those with clustering of CMRF were either overweight or obese. Entering puberty was associated with an increased risk of having IR [Tanner stage 2 vs. 1: odds ratio (OR) = 3.25, 95% confidence interval (95% CI) 1.28-8.27; Tanner stage 3 vs. 1: OR = 3.50, 95% CI 1.45-8.46] and hypertriglyceridemia (Tanner stage 2 vs. 1: OR = 2.67, 95% CI 1.11-6.45). However, the effects were not observed among those reaching the end of puberty (Tanner stage 4 and 5). Conclusions: A significant interaction effect between weight status and puberty was not detected on any individual CMRF and in the clustering of CMRFs. Other factors positively associated with individual CMRFs, especially IR, were being female and having a family history of diabetes.

The mortality risk of being overweight in the twentieth century: Evidence from two cohorts of New Zealand men

How have health and social mortality risks changed over time? Evidence from pre-1945 cohorts is sparse, mostly from the United States, and evidence is mixed on long-term changes in the risk of being overweight. We develop a dataset of men entering the NZ army in the two world wars, with objectively measured height and weight, and socioeconomic status in early adulthood. Our sample includes significant numbers of indigenous Māori, providing estimates of weight and mortality risk in an indigenous population. We follow men from war's end until death, with data on more than 12,000 men from each war. Overweight and obesity were important risk factors for mortality, and associated with shorter life expectancy. However, the reduction in life expectancy associated with being overweight declined from 5 to 3 years between the two cohorts, consistent with the hypothesis that being overweight became less risky during the twentieth century.

Body mass index trajectories in childhood and incidence rates of type 2 diabetes and coronary heart disease in adulthood: A cohort study

AIMS

We examined associations between five body mass index (BMI) trajectories from ages 6-15 years and register-based adult-onset type 2 diabetes mellitus (T2D) and coronary heart disease (CHD) with and without adjustment for adult BMI.

METHODS

Child and adult BMI came from two Danish cohorts and 13,205 and 13,438 individuals were included in T2D and CHD analyses, respectively. Trajectories were estimated by latent class modelling. Incidence rate ratios (IRRs) were estimated with Poisson regression.

RESULTS

In models without adult BMI, compared to the lowest trajectory, among men the T2D IRRs were 0.92 (95 %CI:0.77-1.09) for the second lowest trajectory and 1.51 (95 %CI:0.71-3.20) for the highest trajectory. The corresponding IRRs in women were 0.92 (95 %CI:0.74-1.16) and 3.58 (95 %CI:2.30-5.57). In models including adult BMI, compared to the lowest trajectory, T2D IRRs in men were 0.57 (95 %CI:0.47-0.68) for the second lowest trajectory and 0.26 (95 %CI:0.12-0.56) for the highest trajectory. The corresponding IRRs in women were 0.60 (95 %CI:0.48-0.75) and 0.59 (95 %CI:0.36-0.96). The associations were similar in direction, but not statistically significant, for CHD.

CONCLUSIONS

Incidence rates of adult-onset T2D were greater for a high child BMI trajectory than a low child BMI trajectory, but not in models that included adult BMI.

Change of obesity prevalence and lifestyle patterns before and during COVID-19 among Korean adolescents

PURPOSE

Lockdown measure for limiting coronavirus disease 2019 (COVID-19) spread cause an aggravation of the childhood obesity epidemic through lifestyle changes. The aim is to investigate how social restriction might have changed obesity prevalence and lifestyle patterns in Korean adolescents. We also evaluate the most fragile group and most influencing lifestyle parameters on obesity prevalence.

METHODS

To assess the change in weight status and lifestyle, we compared the Korea Youth Risk Behavior Web-based Survey data 2019 (pre-COVID-19, n=57,303) and 2020 (post-COVID-19, n=54,948). Participants from middle schools and high schools, aged 12 to 18 years, voluntarily reported their weight status and lifestyles.

RESULTS

The prevalence of obesity of the total subjects was 11.0% in 2019 and 12.1% in 2020. This prevalence difference varied by sex (males 1.8%, females 0.3%, p<0.001), age group (12-15 year 1.6%, 16-18 year 0.4%, p<0.001), and socioeconomic status. Male aged 12-15 years showed highest increase from 12.5% to 15.2%. Physical activities, fruit intake, consumption of sugar-sweetened beverages, and stress showed all decrease. Only, nonstudy sedentary time marked increased from 3.3±2.3 hr/day to 4.3±2.8 hr/day. Both moderate-intensity and vigorous-intensity physical activity marked decreased especially in male aged 12-15 years, while increased in female aged 16-18 years.

CONCLUSION

Korean adolescents showed increasing obesity prevalence after COVID-19 lockdown, with males aged 12-15 years mainly affected, mainly due to a reduced physical activity and increased sedentary time.

Dental biorhythm is associated with adolescent weight gain

Background

Evidence of a long-period biological rhythm present in mammalian hard tissue relates to species average body mass. Studies have just begun to investigate the role of this biorhythm in human physiology.

Methods

The biorhythm is calculated from naturally exfoliated primary molars for 61 adolescents. We determine if the timing relates to longitudinal measures of their weight, height, lower leg length and body mass collected over 14 months between September 2019 to October 2020. We use univariate and multivariate statistical analyses to isolate and identify relationships with the biorhythm.

Results

Participants with a faster biorhythm typically weigh less each month and gain significantly less weight and mass over 14-months, relative to those with a slower biorhythm. The biorhythm relates to sex differences in weight gain.

Conclusions

We identify a previously unknown factor that associates with the rapid change in body size that accompanies human adolescence. Our findings provide a basis from which to explore novel relationships between the biorhythm and weight-related health risks.

The human body undergoes cyclic changes such as the daily cycle of sleeping and waking, and monthly menstruation. This study calculated one cycle that can be tracked through the growth of children’s milk teeth. The timing of the cycle in different children was compared to changes in body size that occurred when these children were in puberty. A link was seen between the children’s cycle and the weight they gained over 14-months. Adolescents with a faster cycle typically weighed less each month and gained less weight over 14 months compared to those with a slower cycle.

Mahoney et al. calculate the long-term biorhythm of adolescents from primary molar teeth and examine the relationship with weight, height and mass. Faster biorhythms are associated with a lower weight, and reduced weight and mass gain during adolescence.

Effects of Trace Elements on Anthropometric Characteristics of Children: Cobalt and Childhood Body Mass Index

Objectives

There are many reports on the effects of trace elements on human anthropometric characteristics. Among these elements, cobalt has consistently shown an inverse relationship with obesity risk. In the present study, we aimed to investigate the relationship between urinary levels of trace elements, focusing on cobalt, and childhood obesity, as indicated by the body mass index (BMI) in early adolescents, focusing on the participants' gender.

Design

A cross-sectional study was conducted in the Tokyo Teen Cohort study. Based on urinary samples, we obtained the anthropometric characteristics (weight and height) and potential covariates associated with childhood BMI for 1542 children (mean age=12 years; 860 boys and 682 girls).

Methods

Concentrations of urinary cobalt and 17 other trace elements were measured using inductively coupled plasma-mass spectrometry or inductively coupled plasma-atomic emission spectrometry.

Results

Pearson's correlation coefficient revealed an inverse relationship between the log of cobalt concentrations in the urine and the BMI for the boys (r=-0.125, p<0.001) and girls (r=-0.082, p=0.033). Multivariate analysis, adjusted for various covariates, reconfirmed the correlation between urine cobalt and the childhood BMI, only in the boys (beta=-0.14, p<0.001).

Conclusions

Among the 18 elements measured in the children's urine, cobalt may exhibit sufficient potency to decrease the risk of childhood obesity, particularly in boys. Future studies are required to clearly determine the magnitude of the effect and the underlying mechanism(s).

Can adult polygenic scores improve prediction of body mass index in childhood?

BACKGROUND/OBJECTIVES

Modelling genetic pre-disposition may identify children at risk of obesity. However, most polygenic scores (PGSs) have been derived in adults, and lack validation during childhood. This study compared the utility of existing large-scale adult-derived PGSs to predict common anthropometric traits (body mass index (BMI), waist circumference, and body fat) in children and adults, and examined whether childhood BMI prediction could be improved by combining PGSs and non-genetic factors (maternal and earlier child BMI).

SUBJECTS/METHODS

Participants (n = 1365 children, and n = 2094 adults made up of their parents) were drawn from the Longitudinal Study of Australian Children. Children were weighed and measured every two years from 0-1 to 12-13 years, and adults were measured or self-reported measurements were obtained concurrently (average analysed). Participants were genotyped from blood or oral samples, and PGSs were derived based on published genome-wide association studies. We used linear regression to compare the relative utility of these PGSs to predict their respective traits at different ages.

RESULTS

BMI PGSs explained up to 12% of child BMI z-score variance in 10-13 year olds, compared with up to 15% in adults. PGSs for waist circumference and body fat explained less variance (up to 8%). An interaction between BMI PGSs and puberty (p = 0.001-0.002) suggests the effect of some variants may differ across the life course. Individual BMI measures across childhood predicted 10-60% of the variance in BMI at 12-13 years, and maternal BMI and BMI PGS each added 1-9% above this.

CONCLUSION

Adult-derived PGSs for BMI, particularly those derived by modelling between-variant interactions, may be useful for predicting BMI during adolescence with similar accuracy to that obtained in adulthood. The level of precision presented here to predict BMI during childhood may be relevant to public health, but is likely to be less useful for individual clinical purposes.

Intakes of nutrients and food categories in Canadian children and adolescents across levels of sugars intake: cross-sectional analyses of the Canadian Community Health Survey 2015 Public Use Microdata File

Dietary recommendations to reduce sugars consumption may influence choices of sugars-containing foods and affect the intake of key micronutrients. We compared intakes of nutrients and food sources stratified by quintiles of total sugars in Canadian children (2-8 y) and adolescents (9-13 y, 14-18 y) using 24-hour dietary recalls from the 2015 Canadian Community Health Survey-Nutrition. Energy intakes did not differ across quintiles of sugars intake. Those with lower sugars intakes (Q1/Q3) generally had higher protein, fat, sodium, niacin, folate, and zinc and lower vitamin C compared with those with the highest sugars intakes (Q5). Q1 also had lower potassium but higher saturated fat compared with Q5. Further, Q1 generally had higher protein, fats, and niacin compared with Q3, while children in Q3 had higher potassium and riboflavin and older adolescents had higher calcium and fibre. Q5 had highest intakes of multiple sugar-containing food categories (e.g., fruit, confectionary, milks, cakes/pies/pastries), with higher sugars-sweetened beverages in adolescents. Q3 had higher fruit, milks, and fruit juice compared with Q1 and lower sugars/syrups/preserves, confectionary, and fruit juices compared with Q5. Certain nutrient-dense food sources of sugars (fruit, milks) may help increase key nutrients (potassium, calcium, fibre) in older adolescents with low sugars intakes. However, in those with the highest sugars intakes, nutrient-poor foods may displace nutrient-dense foods. Novelty: Canadian children and adolescents with lower sugars intake have better intakes of some nutrients. Energy intakes did not differ across sugars intake. Older adolescents with mean intakes of total sugars had better intakes of some key nutrients (potassium, calcium, fibre).

Exercise dose on hepatic fat and cardiovascular health in adolescents with excess of adiposity

OBJECTIVE

The HEPAFIT study was aimed at examining the impact of a 6-month physical education intervention, considering various levels of exercise intensity, on hepatic fat and cardiometabolic health outcomes in adolescents with excess adiposity.

METHODS

Adolescents (n = 120), 11-17 years with excess adiposity by body fat >30%, were randomly assigned to one of the following 4 groups for 6 months: (1) standard physical education lessons, control (CTRL); (2) high-intensity physical education (HIPE); (3) low-to-moderate intensity physical education (LIPE) and (4) combined HIPE and LIPE (PLUS). The primary outcome was hepatic fat content measured by vibration-controlled transient elastography (controlled attenuation parameter [CAP]). Secondary outcomes were traditional cardiovascular health markers (body composition, serum lipids, aminotransferases and health-related physical fitness components).

RESULTS

Adjusted mixed effects linear models revealed a significant decrease in CAP levels in HIPE (-20.02 dB/m, p < 0.0001) (p = 0.001 vs. CTRL group) and PLUS (-16.25 dB/m, p = 0.005) groups. Body fat decreased in the HIPE (-2.88%, p < 0.001) (p = 0.001 vs. CTRL group) and LIPE (-1.26%, p = 0.022) groups. The physical fitness components were increased in the HIPE and PLUS group relative to the baseline (p < 0.05), and the HIPE group showed a reduction in the total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels (p < 0.05).

CONCLUSIONS

Implementation of a 6-month physical education exercise program, particularly high-intensity or combined high and low-intensity, improves hepatic fat storage and significantly reduces cardiometabolic markers in adolescents with excess of adiposity. Interventions involving supervised physical exercise may help to improve metabolism and fat deposition at the hepatic level, thus preventing the development of non-alcoholic fatty liver disease in adolescents.

Weight changes of children in 1 year during COVID-19 pandemic

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic has changed everyday life. The Korean government urged schools to close as a measure of social distancing, and children and adolescents seemed to gain weight due to home confinement. We aimed to investigate the trends in weight changes in children during the pandemic period.

MATERIALS AND METHODS

This retrospective study included 139 children aged between 6 and 12 years who visited the pediatric endocrine clinic for regular growth follow-up for 1 year during the COVID-19 pandemic. We analyzed changes in the body mass index (BMI), BMI z-score, and proportion of children who were overweight or obese over a period of 1 year.

RESULTS

The BMI and BMI z-scores of the 139 children increased significantly over the year. The increase was maximum during the first three months of the COVID-19 pandemic, with little change between the third and sixth month of the pandemic. The proportion of children who were overweight or obese increased over time, from 24.5% at the COVID-19 pandemic baseline to 38.1% 1 year later (p < 0.001).

CONCLUSIONS

The COVID-19-related lockdown resulted in significant weight gain in Korean children. Changes in BMI showed different trends depending on the degree of school closure. An overall shift from normal weight to overweight or obesity was observed during the pandemic period.

Lifestyle, inadequate environments in childhood and their effects on adult cardiovascular health

OBJECTIVES

To discuss the associations between habits and environment in childhood and cardiovascular effects on adults.

SOURCE OF DATA

Search in PubMed, Scielo and Science databases, cohort or case-control studies, and systematic or scope-based reviewson the causal relationship among exposures in the pediatric age group and cardiovascular effects in adults.

SYNTHESIS OF DATA

The authors identified 41 eligible articles, which demonstrated an impact on cardiovascular health (characterized as surrogate events - structural or functional vascular alterations or left ventricular dysfunction - or clinical events - myocardial infarction, stroke or cardiovascular death) with environmental aspects (intrauterine or economically poor environment, violence, reduced life expectancy and serious infections) and habits (nutrition, physical activity and tobacco exposure). In addition to the direct and independent associations between exposures and outcomes, several traditional cardiovascular risk factors (CVRF) or family histories are also intermediate pathophysiological pathways in the described phenomena.

CONCLUSIONS

There are direct relationships between lifestyle and inadequate environments in childhood and cardiovascular effects, although the observed associations showed divergences in terms of results and interpretation. In spite of these, it is recommended to encourage healthy lifestyles and protection against childhood adverse exposures, as habit formation occurs at this age, and its relationship with CVRF since childhood has already been well established. On the other hand, the format and intensity of the stimulus must respect the social, cultural and psychological aspects of each population, aiming to obtain the best and most lasting result without generating harmful consequences for the individuals.

Insurance Coverage of Pediatric Bariatric Surgery: a Cross-Sectional Analysis of the USA

PURPOSE

Pediatric bariatric surgery is increasingly recognized as a safe and effective option for the management of obesity and obesity-related conditions. However, insurance coverage is a key barrier to accessing these procedures. Criteria are variable and often not evidence-based. In an effort to characterize common patterns in insurance coverage, we report coverage criteria for adolescents relative to adults.

MATERIALS AND METHODS

We surveyed medical policies of the 50 highest market share health insurance providers in the USA. Private insurer coverage criteria included age, Tanner staging, skeletal maturity, body mass index, procedures covered, medical weight management requirements, co-morbidities, and multidisciplinary team criteria. These were then compared to the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines.

RESULTS

Two thirds (n = 33, 66%) of companies provided inclusion criteria for adolescents. All policies covered RYGB (n = 33), most covered sleeve gastrectomy (n = 32, 97.0%). Obstructive sleep apnea (OSA) (n = 32, 97%), hypertension (HTN) (n = 27, 81.8%), and gastroesophageal reflux disease (GERD) (n = 11, 33.3%) were the three most commonly cited co-morbidities used as inclusion criteria. Tanner staging or skeletal maturity were most commonly used (n = 10, 30.3%). Similarly, twenty (60.6%) insurers required medical weight management programs. Multi-disciplinary teams were required by 81.8% of adolescent policies (n = 27) as described by the ASMBS. Seventeen (51.5%) policies defined providers for these teams, and 10 (30.3%) provided other defined criteria.

CONCLUSION

Contrary to ASMBS guidelines, companies commonly require Tanner staging and/or skeletal maturity criteria as well as participation in medical weight management programs. Also, multi-disciplinary team are frequently required but not well defined.

Behavioral mimicry of eating in mice

Nonconscious behavioral mimicry is prevalent in humans and highly social animals who imitate the behaviors of others without awareness. Previous studies indicated people tended to match their amount of eating to that of their eating companions due to behavioral mimicry, however whether such phenomena were existed in rodents is still unknown. Developing a behavioral paradigm would be helpful to better understand the molecular and circuit mechanisms underlying behavioral mimicry. In this study, we examined behavioral mimicry of eating in C57BL/6J mice which had strong sociality and were widely used as animal model in researches. We set up an eating monitoring platform, and this platform could record the data of mice eating behavior in real time. We further examined the behavioral mimicry of eating in mice, and found that the mice observing eating behavior of food-restricted mice would consume more food than control mice, and visual cue with eating behavior was sufficient to increased food consumption in mice. Our study indicated behavioral mimicry of eating was existed in mice and provided a mouse model for future studies on the mechanism of behavioral mimicry of eating.

Instrumental variable analysis using offspring BMI in childhood as an indicator of parental BMI in relation to mortality

Childhood BMI shows associations with adult mortality, but these may be influenced by effects of ill health in childhood on BMI and later mortality. To avoid this, we used offspring childhood BMI as an instrumental variable (IV) for own BMI in relation to mortality and compared it with conventional associations of own childhood BMI and own mortality. We included 36,097 parent-offspring pairs with measured heights and weights from the Copenhagen School Health Records Register and register-based information on death. Hazard ratios (HR) were estimated using adjusted Cox regression models. For all-cause mortality, per zBMI at age 7 the conventional HR = 1.07 (95%CI: 1.04-1.09) in women and 1.02 (95%CI: 0.92-1.14) in men, whereas the IV HR = 1.23 (95%CI: 1.15-1.32) in women and 1.05 (95%CI: 0.94-1.17) in men. Per zBMI at age 13, the conventional HR = 1.11 (95%CI: 1.08-1.15) in women and 1.03 (95%CI: 0.99-1.06) in men, whereas the IV HR = 1.30 (95%CI: 1.19-1.42) in women and 1.15 (95%CI: 1.04-1.29) in men. Only conventional models showed indications of J-shaped associations. Our IV analyses suggest that there is a causal relationship between BMI and mortality that is positive at both high and low BMI values.

The association between obesity and problematic smartphone use among school-age children and adolescents: a cross-sectional study in Shanghai

BACKGROUND

The study aimed to investigate the association between content-based problematic smartphone use and obesity in school-age children and adolescents, including variations in the association by educational stage and sex.

METHODS

Two-stage non-probability sampling was used to recruit 8419 participants from nineteen primary schools, five middle schools, and thirteen high schools in Shanghai in December 2017. Obesity was identified by body mass index (BMI), which was obtained from the school physical examination record, while problematic smartphone use was measured by the Revised Problematic Smartphone Use Classification Scale as the independent variable.

RESULTS

The rates of obesity varied with educational stages, while problematic smartphone use increased with educational stages. Male students reported higher obesity rates (37.1%vs19.4%, P < 0.001) and greater problematic smartphone use scores (25.65 ± 10.37 vs 22.88 ± 8.94, P < 0.001) than female students. Problematic smartphone use for entertainment (smartphone users addicted to entertainment games, music, videos, novels and other applications) was positively associated to obesity status for primary school [odds ratio (OR), 1.030; 95% confidence interval (95% CI), 1.005-1.057] and high school students (OR, 1.031; 95% CI, 1.004-1.059). For female students, problematic smartphone use for entertainment was positively associated with obesity status (OR, 1.046; 95% CI, 1.018-1.075).

CONCLUSIONS

Problematic smartphone use may be associated with obesity in children and adolescents. The association differed based on the educational stage and sex, and the difference possessed dimensional specificity.

Association of dietary intake, physical activity, and sedentary behaviours with overweight and obesity among 282,213 adolescents in 89 low and middle income to high-income countries

BACKGROUND

Adolescent overweight and obesity are well documented in high-income countries (HICs). They are also emerging as a global public health concern in low-and middle-income countries (LMICs), yet there is a lack of reliable, national-level data to inform policies and interventions. This study aimed to estimate the prevalence of overweight and obesity and assess associated lifestyle risk factors amongst school-going adolescents in LMICs as well as HICs.

METHODS

A total of 282,213 samples were drawn from 89 LMICs and HICs in the 'latest Global School-based Student Health Survey' of school children, aged 11-17 years, during 2003 to 2015, in the six World Health Organisation (WHO) regions. The prevalence of adolescent overweight and obesity were estimated using the WHO BMI-for-age growth standards. A multinomial logistic regression model was employed to estimate the adjusted (age and sex) association of food patterns, physical activity, and sedentary behaviours with adolescent overweight and obesity.

RESULTS

The pooled prevalence of overweight and obesity amongst adolescents was 10.12%, and 4.96%, respectively, ranging from 2.40% in Sri Lanka to 29.08% in Niue for overweight and 0.40% in Sri Lanka to 34.66% in the Cook Islands for obesity. Overweight and obesity were associated with unhealthy dietary intake and lifestyles including respectively fast-food intake (adjusted relative risk ratio, RRR = 1.09; 95% CI: 1.05-1.12 and RRR = 1.32; 95% CI: 1.26-1.38), a high level of carbonated soft drinks consumption (RRR = 1.19; 1.12-1.24 and RRR = 1.28; 1.18-1.38), a low level of physical activity (RRR = 1.11; 1.06-1.17 and 1.20; 1.12-1.28), and high level of sedentary behaviours (RRR = 1.33; 1.27-1.39 and RRR = 1.73; 1.63-1.84). Adolescents who consumed vegetables at least two times per day had a lower risk of overweight (22%) and obesity (17%) than those who did not consume vegetables per day.

CONCLUSIONS

Adolescent overweight and obesity represent a global public health problem and can possibly track into adult weight status and morbidity. School-based obesity prevention that promotes environmental and policy changes related to healthy dietary practices and active living are urgently needed to curb the trend.

Non-alcoholic fatty liver disease in children and young adults is associated with increased long-term mortality

BACKGROUND & AIMS

Longitudinal data are scarce regarding the natural history and long-term risk of mortality in children and young adults with biopsy-confirmed non-alcoholic fatty liver disease (NAFLD).

METHODS

This nationwide, matched cohort study included all Swedish children and young adults (≤25 years) with biopsy-confirmed NAFLD (1966-2017; n = 718). NAFLD was confirmed histologically from all liver biopsies submitted to Sweden's 28 pathology departments, and further categorized as simple steatosis or steatohepatitis (NASH). Patients with NAFLD were matched to ≤5 general population controls by age, sex, calendar year and county (n = 3,457). To account for shared genetic and early-life factors, we also matched patients with NAFLD to full-sibling comparators. Using Cox regression, we estimated multivariable-adjusted hazard ratios (aHRs) and 95% CIs.

RESULTS

Over a median of 15.8 years, 59 patients with NAFLD died (5.5/1,000 person-years [PY]) compared to 36 population controls (0.7/1,000 PY; difference = 4.8/1,000 PY; multivariable aHR 5.88; 95% CI 3.77-9.17), corresponding to 1 additional death per 15 patients with NAFLD, followed for 20 years. The 20-year absolute risk of overall mortality was 7.7% among patients with NAFLD, and 1.1% among controls (difference = 6.6%; 95% CI 4.0-9.2). Findings persisted after excluding those who died within the first 6 months (aHR 4.65; 95% CI 2.92-7.42), and after using full-sibling comparators (aHR 11.72; 95% CI 3.18-43.23). Simple steatosis was associated with a 5.26-fold higher adjusted rate of mortality compared to controls (95% CI 3.05-9.07), and this was amplified with NASH (aHR 11.51, 95% CI 4.77-27.79). Most of the excess mortality was from cancer (1.67 vs. 0.07/1,000PY; aHR 15.60; 95% CI 4.97-48.93), liver disease (0.93 vs. 0.04/1,000PY; aHR 16.46; 95% CI 2.75-98.43) and cardiometabolic disease (1.12 vs. 0.14/1,000PY; aHR 4.32, 95% CI 1.73-10.79).

CONCLUSIONS

Swedish children and young adults with biopsy-confirmed NAFLD have significantly higher rates of overall, cancer-, liver- and cardiometabolic-specific mortality compared to matched general population controls.

LAY SUMMARY

Currently, the natural history and long-term risk of mortality in children and young adults with biopsy-confirmed non-alcoholic fatty liver disease (NAFLD) is unknown. This nationwide cohort study compared the risk of all-cause and cause-specific mortality in pediatric and young adult patients in Sweden with biopsy-confirmed NAFLD to matched general population controls. We found that compared to controls, children and young adults with biopsy-confirmed NAFLD and NASH have significantly higher rates of overall, cancer-, liver- and cardiometabolic-specific mortality.

A structured physical activity program in an adolescent population with overweight and obesity: a prospective interventional study

BACKGROUND

Obesity is a significant health problem, with increasing involvement of young population worldwide. The aim of this study was to evaluate the effects of two different types of physical exercise (resistance vs combined aerobic-resistance) on cardiovascular and anthropometric profile of a sample of sedentary adolescents with overweight and obesity.

METHODS

After undergoing clinical, cardiovascular and anthropometric-metabolic evaluation (T0), subjects with overweight and obesity were randomized to a 6-months resistance or combined aerobic-resistance training program. Clinical, cardiovascular and anthropometric-metabolic evaluations were repeated after 6 months of training (T1) and after 3 months of detraining (T2).

RESULTS

Thirty adolescents with overweight/obesity were enrolled; 20 subjects completed training program. A significant improvement in body composition was detected after 6 months, with a reduction of BMI (32.1 [30.5-34.4] vs 31.1 [29.6-33.4] kg/m2, p=0.02) and adipose tissue (45.5 [41.1-49.7] vs 41.6 [37.0-49.2] Kg, p<0.01). A reduction in Diastolic blood pressure (75.5 ± 8.9 vs 68.2 ± 6.4 mmHg, p=0.02) and Pulse Wave Velocity (5.7 [5.1-5.9] vs 5.2 [4.7-5.7] m/s, p=0.04) was also observed. Persistence of the effect on the most important parameters was observed also after detraining period.

CONCLUSIONS

Regular physical exercise induces positive metabolic and cardiovascular effects, with persistence also after brief discontinuation. Novelty bullets. Physical exercise induces positive effect on cardiovascular risk profile. Positive effects persist also after brief discontinuation. Physical exercise reduces early signs of autonomic disfunction.

Pancreatic fat accumulation is associated with decreased β-cell function and deterioration in glucose tolerance in Korean adults

AIMS

This study was designed to investigate the association between pancreatic fat content (PFC) and insulin secretory capacity as well as glucose tolerance in Korean adults.

MATERIALS

A total of 39 participants (mean age 49.9 years, 53% males) without a previous history of diabetes, or those previously diagnosed as having diabetes but with less than 10 years of disease duration and no medication history were included. They were stratified according to the results of the oral glucose tolerance test (OGTT): normal glucose tolerance, prediabetes, and diabetes.

METHODS

All participants underwent the proton magnetic resonance spectroscopy (¹ H-MRS) to assess PFC. Insulin sensitivity and β-cell function were measured by the frequently sampled intravenous glucose tolerance tests (FSIVGTT) and OGTT-derived indices.

RESULTS

As glucose tolerance deteriorated, parameters such as Stumvoll index, oral glucose insulin sensitivity index, homeostatic model assessment (HOMA)-β, insulinogenic index and oral disposition index from the OGTT, and acute insulin response to glucose (AIR) and disposition index (DI) from the FSIVGTT were decreased. PFC increased with deterioration in glucose tolerance (NGT: 12.0%, prediabetes: 23.7%, and diabetes: 31.9%). Correlation analysis indicated that glucose levels at 60 and 120 min during the OGTT were positively correlated with PFC. Also, there was a significant negative correlation between PFC and DI as well as AIR derived from the FSIVGTT.

CONCLUSIONS

PFC evaluated by ¹ H-MRS in Korean adults was higher in those diagnosed with diabetes than those with normal glucose tolerance status. PFC also showed a significant negative correlation with indices reflecting beta cell function.

The Incidence of Adult Obesity is Associated with Parental and Adolescent Histories of Obesity in North Sumatra, Indonesia: A Cross-Sectional Study

Purpose

Obesity that occurs in adulthood is influenced by various factors, not only energy balance, especially concerning the amount of energy consumed, but also heredity. The hereditary factors of obese parents on childhood obesity have been studied, but what about adulthood? This study examines the relationship between a history of obesity in adolescence, and maternal and paternal incidences of adult obesity.

Patients and Methods

This study was a cross-sectional study that included adult men and women aged 20–60 years old. The subjects had no chronic or metabolic disease. This research was conducted from April to November, 2020, in North Sumatra Province, Indonesia. The parameters studied were demographics, daily food intake, anthropometry and a history of obesity in adolescence, and for the participants’ fathers and mothers. The statistical test used was the chi-squared test/Fisher test.

Results

This study included 136 research subjects, 60 male and 76 female; based on the results of the study, 47.8% were found to be obese, but food intake showed a low intake (96.2%). There was a significant relationship between a history of obesity in adolescence and incidences of obesity (≥30 kg/m²) in the mother and father, with significance values of p=0.01, p=0.004, and p=0.001, respectively.

Conclusion

This study found that there was a significant relationship between a history of obesity in adolescence and incidences of adult obesity (≥ 30kg/m²) in parents, but not with the level of food intake per day. The risk of obesity will increase further with a history of obesity in parents and obesity in adolescence, and this can be used to understand and prevent obesity.

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Associations between body mass index and height during childhood and adolescence and the risk of coronary heart disease in adulthood: A systematic review and meta-analysis

Body mass index (BMI) at child and adolescent ages is positively associated with adult coronary heart disease (CHD) whereas height at these ages may be inversely associated with CHD. However, potential effects of age, sex, and socioeconomic status on associations between BMI and CHD are less investigated. We conducted a systematic review and meta-analysis of BMI and height at ages 2-19 years in relation to adult CHD and examined effects of age, sex, socioeconomic status, and other factors. Twenty-two studies on BMI and five on height were included, comprising 5,538,319 individuals and 69,830 CHD events. Random effects meta-analyses were conducted. Child and adolescent BMI were positively associated with CHD (hazard ratio = 1.12; 95% confidence interval [CI] [1.01, 1.25] per standard deviation [SD]), and categorical analyses supported these findings. The associations did not significantly differ by age, sex, or by adjustment for socioeconomic status. Child and adolescent height were inversely associated with CHD (hazard ratio = 0.87; 95% CI [0.81, 0.93] per SD), and categorical analyses agreed. Insufficient studies on height precluded subgroup analyses. Heterogeneity was generally high in all analyses. We found that BMI in youth is positively associated with adult CHD regardless of sex or adjustment for socioeconomic status whereas height is inversely associated with later risk of CHD.

Identification of Adolescents with Adiposities and Elevated Blood Pressure and Implementation of Preventive Measures Warrants the Use of Multiple Clinical Assessment Tools

The burden of abdominal adiposity has increased globally, which is recognized as a key condition for the development of obesity-related disorders among youth, including type 2 diabetes, cardiovascular disease, and hypertension. High blood pressure (BP) and cardiovascular diseases increase the rates of premature mortality and morbidity substantially. Aims: to investigate the relation between abdominal adiposity and elevated BP among adolescent males in Jordan. Methods: Nationally representative sample of male adolescents was selected using multi-cluster sampling technique. Study sample included 1035 adolescent males aged 12 to 17 years. Multiple indicators were used to assess adiposity including waist circumference (WC) and total body fat (TF), truncal fat (TrF), and visceral fat (VF). Systolic blood pressure was measured to assess hypertension. Results: After adjusting for age, smoking status, and physical activity, the odds of having stage two hypertension increased 6, 7, and 8 times for adolescents who were on 90th percentile or above for Trf, VF, and WC, respectively. Conclusion: Elevated BP was significantly associated with total and abdominal adiposity among adolescent males in Jordan. Use of multiple clinical assessment tools is essential to assess abdominal obesity among adolescents.

Effekte von hochintensivem Intervalltraining (HIIT) auf Body-Mass-Index (BMI) und Körperfettanteil von übergewichtigen und adipösen Kindern – eine systematische Übersichtsarbeit

Hintergrund Mehr als 340 Millionen Kinder gelten weltweit als übergewichtig oder adipös, ihre Anzahl nahm in den letzten Jahren – auch durch die Coronapandemie – erheblich zu. Eine alternative Behandlung zur Reduzierung des Übergewichts, die in den Empfehlungen bisher keine große Beachtung findet, stellt das sogenannte hochintensive Intervalltraining (HIIT) dar.

Ziel Darstellung der Wirksamkeit von hochintensivem Intervalltraining auf den BMI und Körperfettanteil übergewichtiger und adipöser Kinder im Alter von 6–13 Jahren.

Methode Die Erstellung der systematischen Übersichtsarbeit orientierte sich an den PRISMA-Guidelines. Für die Literaturrecherche wurden die Datenbanken MEDLINE, Cochrane Library, CINAHL, Embase, Sports Medicine & Education Index und Web of Science nach Studien mit hochintensivem Intervalltraining für übergewichtige und adipöse Kinder durchsucht. Die Bewertung der methodischen Studienqualität erfolgte mittels PEDro-Skala, MINORS und Risk of Bias. Die Berichtsqualität wurde anhand von CONSORT und TREND bewertet.

Ergebnisse Es wurden 6 randomisierte kontrollierte Studien und 2 kontrollierte klinische Studien mit 479 HIIT-Teilnehmenden betrachtet. Diese zeigten, dass hochintensives Intervalltraining positive Auswirkungen auf den BMI und Körperfettanteil übergewichtiger und adipöser Kinder hat.

Schlussfolgerung Hochintensives Intervalltraining ist eine kinderfreundliche und zugleich effektive Alternative zur Behandlung von übergewichtigen und adipösen Kindern. Weitere klinische Studien sind erforderlich, um die Ergebnisse zu bekräftigen.

Sleep duration and anthropometric indices in an Iranian population: the Fasa PERSIAN cohort study

Recent decades have seen a dramatic rise in the prevalence of obesity. While genetic factors can influence obesity, environmental factors and lifestyle may play important roles as well. Sleep can be regarded as one of these factors. This study aimed to examine sleep duration, as a potential risk factor for obesity in an Iranian population. In this cross-sectional study, the Fasa PERSIAN cohort study data was used and 10,136 subjects aged 35-70 were entered. Anthropometrics indices have been measured and the total body fat percentage (BFP) was obtained by Bio-Impedance Analysis. Also, physical activity and dietary intake have been recorded. Sleep duration was obtained and individuals categorized into two groups of "< 8" and "≥ 8" h of sleep. The mean age and sleep duration of the participants were 48.63 ± 9.57 years and 6.92 ± 1.62 h in the total population, respectively. All of the anthropometric indices were significantly higher in the "< 8 h of sleep" group than in the "≥ 8 h of sleep" group. Regarding BFP and fat mass index (FMI) the same results was seen (p-value < 0.05). Body mass index (BMI), Waist and hip circumferences (WC, HC), and waist-to-height ratio (WHtR) were in a significant negative association with night time sleep (p-value < 0.001), while these associations with daytime napping were positive (p-value < 0.001). After multi-variable adjusting, BMI, WC, HC, WHtR, and wrist circumference showed significant negative associations with 24-h sleep duration (p-value < 0.05). This study established the association between nocturnal, daytime napping, 24-h sleep duration and obesity parameters. Daytime napping was positively associated with obesity parameters and short 24-h sleep duration was associated with higher risk of overweight/obesity. These results indicate that insufficient sleep can be a screening indicator for an unhealthy lifestyle and poor health outcomes.

Effect of vitamin D supplementation on microvascular reactivity in obese adolescents: A randomized controlled trial

BACKGROUND AND AIM

Childhood obesity is associated with vitamin D (VD) deficiency and vascular dysfunction. Considering evidence indicates that VD may improve vascular function, this study, for the first time, assessed the effect of VD supplementation on microvascular reactivity in obese adolescents (OA).

METHODS AND RESULTS

This randomized controlled trial included 26 OA, receiving fruit juice with (n = 13) or without VD (4000 IU/d; n = 13) over a 3-month lifestyle program, as well as 23 normal-weight adolescents (controls). The primary outcome was the pre-to-post-program change in microvascular reactivity determined by laser speckle contrast imaging with acetylcholine and sodium nitroprusside iontophoresis. Changes in 25 hydroxyvitamin D (25(OH)D), flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), insulin resistance (HOMA-IR) and inflammatory markers (C-reactive protein [CRP]) were monitored. At inclusion, in comparison to controls, OA exhibited lower total and free 25(OH)D, impaired microvascular responses, and impaired FMD, but similar NMD. After the lifestyle program, total and free 25(OH)D increased in all OA, with a greater increase in those receiving VD supplements. HOMA-IR and CRP decreased in all OA. Neither FMD nor NMD were altered in either group. Endothelium-dependent microvascular reactivity only increased in the VD-supplemented group, reaching values comparable to that of controls. Similar results were found when analyzing only OA with a VD deficiency at baseline.

CONCLUSION

VD supplementation during a lifestyle program attenuated microvascular dysfunction in OA without altering macrovascular function.

REGISTRATION NUMBER FOR CLINICAL TRIAL

NCT02400151.

Pubertal Body Mass Index Change Is Associated With Adult Coronary Atherosclerosis and Acute Coronary Events in Men

[Figure: see text].

Normative misperceptions of unhealthy snacking amongst 11- to 12-year-old secondary school students

Younger adolescents are at an age where they have increasing control of their diet, and where peers become an important social reference for acceptable and normative dietary behaviours. These normative perceptions are often inaccurate and can lead to the development of unhealthy eating practices; although, the role of normative misperceptions of peers' unhealthy snacking behaviours in younger adolescents' personal snacking behaviours is not clear. The current study was a cross-sectional analysis of baseline data from a social norms-based healthy eating intervention sampling two secondary schools in deprived areas of England. Students aged 11-12 years (n = 252) completed self-report measures of their demographic characteristics and personal behaviours, attitudes, intentions, and normative perceptions (descriptive and injunctive norms), relating to unhealthy snacking. Results indicated students overestimated peers' daily unhealthy snacks consumption by approximately 3.2 portions, misperceived peers to have more positive attitudes towards unhealthy snacking and more negative attitudes towards reducing snacking. The greater these misperceptions of peers' behaviours and attitudes, the more likely students were to consume unhealthy snacks and have positive attitudes about unhealthy snacking. Girls had a stronger intention to reduce their snacking behaviours if they had more positive attitudes to reducing snacking behaviours and misperceived peers to also have a positive attitude. In summary, 11- to 12-year-olds misperceive the snacking behaviour and attitudes of their peers, and such normative misperceptions are associated with students' own snacking behaviours and attitudes. Interventions which challenge these misperceptions may assist in reducing the social acceptability of unhealthy snacking and in reducing unhealthy snacking amongst young adolescents.