Childhood body-mass index and the risk of coronary heart disease in adulthood

Gut Microbiota Metabolite TMAO and Adolescent Cardiometabolic Health: A Cross-sectional Analysis

Background

Trimethylamine N-oxide (TMAO) is a metabolite derived from gut microbiota that has been associated with cardiovascular and metabolic disease risk in adults. However, its role in assessing cardiometabolic risk in adolescents is unclear.

Objective

This study investigates the association between serum TMAO levels and cardiometabolic health indicators in Brazilian adolescents.

Materials and Methods

This is a multicenter, cross-sectional analysis involving 4446 participants aged 12 to 17 years from four Brazilian cities. Serum TMAO levels were quantified using liquid chromatography-tandem mass spectrometry, and associations with clinical, metabolic, and inflammatory variables were evaluated through multivariate linear regression analyses.

Results

After adjusting for potential confounders, being in the highest tertile of serum TMAO was positively associated with waist circumference [β 1.45; 95% confidence interval (CI) 0.77, 2.14; P < .001], body mass index Z-score (β .19; 95% CI 0.10, 0.27; P < .001), and C-reactive protein (β .24; 95% CI 0.13, 0.34; P < .001). A negative association between the highest tertile of TMAO and fasting plasma glucose was also observed (β -1.22; 95% CI -1.77, -0.66; P < .001).

Conclusion

TMAO may serve as an emerging biomarker for cardiometabolic risk assessment in adolescents.

Association between early age body mass index and the risk of adulthood cardiovascular diseases: a systematic review and meta-analysis

BACKGROUND

Several studies have attempted to demonstrate the associations between body mass index (BMI) in early age and cardiovascular diseases (CVDs). However, their findings were inconsistent and inconclusive, indicating the need for further investigation.

METHODS

We conducted a systematic review and meta-analysis of studies focusing on BMI in early age (age from 2 to 22) in relation to CVDs in adulthood, including coronary artery disease (CHD), ischemic and hemorrhagic stroke, myocardial infarction and heart failure. Fixed-effects and Random-effects models were used to pool the data. Sex, age, adjustment of socioeconomic status and fatal events specific analysis were conducted to examine their effects on the results.

RESULTS

Thirty-eight studies were eligible for inclusion. BMI in early age was positively related to CVD (HR = 1.18, 95% CI: 1.07-1.30), CHD (HR = 1.13, 95% CI: 1.07-1.19), heart failure (HR = 1.16, 95% CI: 1.11-1.20) but not stroke (HR = 0.99, 95% CI: 0.93-1.05). The results remained consistent after stratified by sex, fatal or non-fatal events and adjustment for socioeconomic status. Further age-specific analysis showed that both childhood and early adulthood group showed positive associations on CHD and HF. While estimates in early adulthood for all CVDs were numerically higher than that for childhood. Category analyses showed a positive association between being overweight or obesity and adulthood CVDs, including stroke.

CONCLUSION

We found a positive association between early-age BMI and adulthood cardiovascular diseases except for stroke.

TRIAL REGISTRATION

Systemic review registration https://www.crd.york.ac.uk/Prospero/ , identifier CRD42023403602.

Low-Carbohydrate Diets for the Management of Pediatric Obesity: A Systematic Review and Meta-analysis

CONTEXT

Although low-carbohydrate (LC) diets have been shown to be beneficial for weight loss and improvements in cardiometabolic health in adults with obesity, their efficacy in youth has not yet been established.

OBJECTIVES

A systematic review and meta-analysis was conducted to qualitatively and quantitively synthesize the evidence from clinical trials testing the efficacy of LC diets to improve anthropometric and cardiometabolic-related parameters in children and adolescents with obesity.

DATA SOURCES

Searches in Medline, EMBASE, and Cochrane databases were undertaken for LC interventions with or without control comparisons.

DATA EXTRACTION AND ANALYSIS

Data before and after the LC intervention and control comparisons (if applicable) were extracted from 19 studies, 17 of which were pooled in random-effects meta-analyses.

RESULTS

Children on LC diets (Mean = 30 [IQR: 30-60] g/d), for approximately 3 months (IQR: 3-4 months) significantly reduced their weight (mean change [MC] = -7.09 [95% CI: -9.60, -4.58] kg; P < .001), body mass index (BMI) (MC = -3.01 [-3.71, -2.30] kg/m2; P < .001), and BMI z-score (MC = -0.27 [-0.48, -0.06]; P = .020), on average, with concomitant improvements in different metabolic biomarkers, such as serum triglycerides (MC = -29.16 [-45.06, -13.26] mg/dL; P = .002) and insulin (MC = -7.13 [-9.27, -4.99] µU/mL; P < .001). Evidence from 5 out of 7 controlled trials suggests that LC diets without caloric restriction may lead to similar or greater improvements in anthropometric and lipid-related outcomes relative to caloric-restricted or low-fat diets. However, meta-analyses demonstrated high between-study heterogeneity, indicative of a wide variety of methodologies, including intervention duration and degree of carbohydrate restriction.

CONCLUSION

Overall, this review found that short-term LC diets can be beneficial for weight loss and improving cardiometabolic parameters with or without calorie restriction. However, the limited number of controlled trials and the demonstrable diversity in methods prevent firm conclusions regarding their efficacy relative to traditional approaches, such as energy restriction.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023440835.

Changes in gut microbiota following supplementation with chitosan in adolescents with overweight or obesity: a randomized, double-blind clinical trial

BACKGROUND

Overweight and obesity have been associated with an altered intestinal microbiome. Recent investigations have demonstrated that fiber supplementation, including chitosan, can exert beneficial and protective effects on the composition of gut microbiota in humans diagnosed with overweight/obesity. However, there is still a great deal of heated debate regarding the impact of chitosan supplementation in overweight and obese adolescents. Therefore, the aim of this study is to clarify the effects of chitosan administration on the composition of the gut microbiome in overweight and obese adolescents.

METHODS AND ANALYSIS

Sixty-four overweight and obese adolescents were subjected to supplementation with 3 g of chitosan for 12 weeks. Anthropometric indices and physical activity were measured at the beginning and at the end of the intervention. After DNA extraction and purification, the quantity of bacteria in the patients' stool samples was determined by real-time polymerase chain reaction (PCR). The RCT was registered on the Iranian Registry of Clinical Trials ( www.irct.ir ) website (IRCT20091114002709 N57; registration date: 2021 - 06 - 20).

RESULTS

Individuals who received chitosan supplementation experienced a significant decrease in the BMI z-score (P < 0.001). Administration of chitosan led to notable significant decrease in the Firmicutes (P < 0.001) populations and the ratio of Firmicutes to Bacteroidetes (P < 0.001) as well as a notable increase in the Bacteroidetes (P = 0.008) and Akkermansia (P < 0.001) populations, respectively compare to control group. Mean changes in Lactobacillus populations were marginally significant (P = 0.05). Chitosan administration did not alter the composition in Bifidobacterium populations (P = 0.97).

CONCLUSION

The present study demonstrates beneficial effects of chitosan administration on some bacterial species associated with overweight and obesity in adolescents. Further research is needed to confirm our findings and clarify the impact of this intervention on the Lactobacillus population in the gut.

Effects of two forms of school-based high-intensity interval training on body fat, blood pressure, and cardiorespiratory fitness in adolescents: randomized control trial with eight-week follow-up-the PEER-HEART study

Introduction

This study examined the effects of 8-week interventions based on two variants of typical exercises, namely, high-intensity interval training (HIIT) and high-intensity plyometric training (HIPT), on body fat (BF%), blood pressure, and cardiorespiratory fitness (CRF). In addition, the sustainability of the effects after another 8 weeks was assessed.

Methods

The project was designed as a randomized controlled trial with eight groups of participants (two variants, two sexes, and two groups (experimental and control)) and was conducted in a school physical education (PE) program. The outcomes analyzed were the BF%, systolic (SBP), diastolic blood pressure (DBP), and CRF expressed in terms of maximum oxygen uptake (VO2max). A total of 307 healthy adolescents participated in this study and were randomly assigned into the two groups. During the 8 weeks, the participants completed two exercise sessions each week with progressively increasing volumes. For the first 2 weeks, the sessions involved four rounds of 20 s of intense effort followed by 10 s of rest; this increased to six rounds during weeks 3-4 and eight rounds during weeks 5-8. The HIPT program was based on plyometric exercises, whereas the HIIT was based on bodyweight resistance exercises.

Results

Multidimensional analysis of variance (ANOVA) indicated a statistically significant second-order interaction (time × variant × group: Ʌ = 0.943, F = 2.20, p < 0.027, η2 pG = 0.057, d = 0.25), confirming the changes in the BF%, SBP, DBP, and VO2max dependent on the type of intervention and group assignment. The ANOVA results revealed significant main and interaction effects for BF%, SBP, and DBP, with time and the HIIT variant as the main contributors (BF%: F = 3.911, p = 0.023, η2 pG = 0.001, d = 0.04 vs. F = 9.900, p < 0.001, η2 pG = 0.001, d = 0.03; SBP: F = 31.801, p < 0.001, η2 pG = 0.012, d = 0.16 vs. F = 8.939, p = 0.003, η 2 pG = 0.026, d = 0.16; DBP: F = 3.470, p = 0.033, η2 pG = 0.002, d = 0.06 vs. F = 4.982, p = 0.026, η2 pG = 0.014, d = 0.12). The second-order interaction for VO2max (time × sex × group: F = 6.960, p = 0.001, η2 pG = 0.003, d = 0.05) indicated that the improvements over time were not related to the training variant. Although these effects were small (low eta values), post hoc tests (all comparisons in post-intervention, p > 0.05) showed that both the HIIT and HIPT groups exhibited beneficial changes compared to controls; however, no statistically significant differences were observed between the experimental and control groups. Furthermore, the observed improvements were maintained through the 8-week follow-up period, as demonstrated by no significant changes between the post-intervention and follow-up measurements (p > 0.05). Discriminant analysis showed that BF% and SBP were the key variables for the two exercise variants in men, with HIPT yielding greater reductions in SBP and HIIT resulting in more pronounced decreases in BF%.

Discussion

In conclusion, both HIIT and HIPT interventions effectively improved health-related parameters, providing valuable enrichment to the PE lessons in schools. These benefits were also sustained for at least 8 weeks post-intervention.

Trajectory of Early Life Adiposity Among South Asian Children

Importance

Measures of childhood adiposity merit investigation, particularly in individuals of South Asian descent.

Objective

To investigate prenatal and childhood factors associated with the trajectory of adiposity in South Asian children, and the cumulative contribution of modifiable factors, such as diet and physical activity, on this trajectory.

Design, Setting, and Participants

This cohort study was a prospective analysis of the South Asian Birth Cohort (START; 2011-2015) for discovery; and the Family Atherosclerosis Monitoring In Early Life (FAMILY; 2002-2009) in Ontario, Canada, and the Born in Bradford (BiB; 2008-2009) cohort in Bradford, UK, for validation. Mother-child pairs included 903 South Asian individuals (START), 675 White European individuals (FAMILY), and 1593 individuals (BiB), of which 52% were South Asian. Analysis was conducted from March 2020 to September 2024.

Exposure

Maternal, infancy, and early childhood exposures.

Main Outcomes and Measures

Adiposity, assessed by the sum of subscapular and triceps skinfold thicknesses (SSF) from birth to 3 years, aggregated to a single measure as total area under the growth curve (AUC for SSF); multivariable linear regression models to identify determinants of AUC for SSF; and a cumulative score to assess joint contribution of modifiable risk factors to AUC for SSF.

Results

START included 903 children (456 female [50.5%]; mean [SD] maternal age, 30.2 [4.0] years; maternal mean [SD] prepregnancy body mass index [BMI], 23.8 [4.50]). Maternal sum of skinfold thicknesses (β = 0.80 [95% CI, 0.30-1.30] per 10 mm), gestational weight gain (β = 0.38 [95% CI, 0.02-0.74] per 5 kg), a health-conscious diet score (β = -0.68 [95% CI, -1.26 to -0.10] per 1 SD), and infant breastfeeding for the first year (β = -1.68 [95% CI, -2.94 to -0.42), as well as physical activity (β = -0.33 [95% CI, -0.57 to -0.09] per 30-min/d) and screen time (β = 0.49 [95% CI, 0.18-0.81] per 30-min/d) were each independently associated with AUC for SSF. These 6 early-life modifiable factors combined into a single score had a direct, graded association between number of factors and AUC for SSF (P for trend < .001). In the validation cohorts, maternal BMI, breastfeeding, and child physical activity were replicated and showed a similar graded association with AUC for SSF (P for trend < .001) when combined.

Conclusions and Relevance

In this cohort study of South Asian children, 6 modifiable factors were associated with lower adiposity and combined into a single score. This score may be useful in clinical and public health settings to help mitigate childhood obesity in South Asian individuals and beyond.

Excess cardiometabolic risk in children and adolescents initiating antipsychotic treatment compared to young adults: results from a nationwide cohort study

Antipsychotic treatment is associated with cardiometabolic risks that may be especially detrimental to children and adolescents. In this Danish population-based cohort study, we included individuals with psychiatric diagnoses who initiated antipsychotics in 2000-2021 at age 6-31 years. We assessed the risk of cardiometabolic adverse events up to 10 years following incident exposure to antipsychotics, compared to age- and sex-matched unexposed individuals with psychiatric diagnoses. Cox regression models were used to calculate hazard ratios (HRs) after adjustment using high-dimensional propensity scores, including age, sex, calendar time, hospital diagnoses, and prescription drug use. HRs were compared between incident exposure in youths (6-17 years) and young adults (18-31 years), and between incident exposure in children (6-11 years) and adolescents (12-17 years). The total cohort consisted of 335,093 individuals, including 36,092 subjects exposed to antipsychotics (children and adolescents: 8,547, mean follow-up: 6.8±3.2 years; young adults: 27,545, mean follow-up: 6.5±3.4 years) and 299,001 age-, sex- and calendar-matched unexposed subjects. The incidence rate of cardiometabolic events was higher for young adults initiating antipsychotics than for children and adolescents (23.2 vs. 14.1 events/1,000 person-years). However, the adjusted excess risk of cardiometabolic events was significantly higher in exposed compared to unexposed children and adolescents (HR=1.87, 95% CI: 1.71-2.05) than in exposed compared to unexposed young adults (HR=1.46, 95% CI: 1.40-1.51) (p<0.001). The excess risk of cardiometabolic events was even higher when antipsychotic treatment was initiated before age 12 years (HR=2.44; 95% CI: 1.99-2.98) than at age 12-17 years (HR=1.69, 95% CI: 1.52-1.87) (p=0.012). Concerning specific cardiometabolic outcomes, there was an effect of age at antipsychotic initiation on the risks of metabolic syndrome (p=0.011) and obesity (p<0.001), that were higher among children and adolescents than young adults. Thus, initiation of antipsychotic treatment before age 18 years is associated with an excess risk of cardiometabolic events compared to age- and sex-matched youths with psychiatric disorders but unexposed to antipsychotics. The excess cardiometabolic risk is significantly higher than that of individuals who start antipsychotic treatment in early adulthood, and significantly higher for treatment onset in childhood compared to adolescence. On the basis of these findings, recommendations are provided about the use of antipsychotics in children and adolescents.

Associations of early life body size and pubertal timing with breast density and postmenopausal breast cancer risk: A mediation analysis

PURPOSE

Whether breast density mediates associations between early life body size and pubertal timing with postmenopausal breast cancer is underexplored.

METHODS

We studied 33,939 Danish women attending the Capital Mammography Screening Program at ages 50-69 years. Early life anthropometry and pubertal timing information came from the Copenhagen School Health Records Register. Postmenopausal breast cancer information came from the Danish Breast Cancer Group database (n = 833). Breast density (BI-RADS) was categorized as low (n = 25,464; 75 %) or high. Risk ratios (RR) and hazard ratios (HR) were estimated using generalized linear regression and Cox proportional hazards analyses. Counterfactual mediation analyses were conducted.

RESULTS

Evidence was limited for associations between birthweight and pubertal timing with breast density or breast cancer. Childhood BMI was inversely associated with high breast density (age 13y, RR=0.77 [0.72-0.81] for a z-score of 0.6 versus 0) and breast cancer (HR=0.90 [0.83-0.96] per z-score). Breast density mediated 37 % (17-170 %) of this association. Although childhood height was associated with breast density and breast cancer, there were few indications of mediation by breast density.

CONCLUSIONS

Breast density may partially explain the inverse association between childhood BMI and postmenopausal breast cancer, but not the positive association between childhood height and postmenopausal breast cancer.

Reframing interventions for optimal child nutrition and childhood obesity: the importance of considering psychological factors

This review aims to emphasise the impact of poor nutrition on children's health and psychological well-being, urging those involved in childhood obesity or nutrition services to broaden their intervention approach. Poor nutrition and childhood obesity affect physical and psychological health. The stress of living with obesity further impacts quality of life, well-being and self-esteem. Children living with obesity may experience adverse childhood events and stress, and young people are able to recall the impact of psychosocial issues such as experiencing stigma and discrimination. Food is often a coping mechanism for managing negative emotions, perpetuating cycles of emotional coping and unhealthy eating behaviours. UK guidelines recommend family-based, multi-component weight management interventions for children living with obesity. Interventions mainly target health behaviours and utilise behaviour change techniques attempting to directly improve diet and physical activity as behavioural outcomes. Whilst these interventions may show some improvements in psychological well-being, there is limited consideration or understanding of the underlying mechanisms of action which indirectly influence engagement and the sustainability of the behaviour change. Lack of attention and inclusion of psychosocial variables in intervention implementation may help explain the variable effectiveness reported across childhood obesity interventions. In conclusion, enhancing the effectiveness of childhood obesity interventions requires a broader approach that fully incorporates psychosocial factors. Those responsible for commissioning, designing and implementing these interventions should adopt a holistic approach that addresses psychological and emotional needs while incorporating underlying mechanisms of action. This shift in focus could result in more sustainable and comprehensive treatment for childhood obesity.

Genetic contributions to body mass index over adolescence and its associations with adult weight gain: a 25-year follow-up study of Finnish twins

INTRODUCTION

High body mass index (BMI) in adolescence is a strong predictor of adult obesity. However, the nature of this association is unclear. We investigated how adolescent BMI is associated with adult weight change using longitudinal data from ages 11.5 to 37 years and examined the genetic factors behind these associations.

DATA AND METHODS

The study cohort consisted of 1400 Finnish twin individuals (40% males) with 494 complete twin pairs who reported their body mass index (BMI) at five ages: 11.5, 14, 17.5, 24, and 37 years. BMI trajectories (defined as BMI changes (i.e., slope) and BMI at baseline age (i.e., intercept)) were calculated in adulthood (from 17.5 to 37 years of age) using linear mixed-effects models. Polygenic Risk Scores of BMI (PRSBMI) and genetic twin models were utilised to analyse the role of genetic factors underlying BMI trajectories and their associations with BMI at 11.5 and 14 years of age.

RESULTS

Mean BMI increased in adulthood (4.06 kg/m2 in men and 3.39 kg/m2 in women). The BMI changes correlated with BMI at the baseline age of 17.5 years (i.e. intercept) (r = 0.24 in men and r = 0.35 in women) as well as with BMI in adolescence (11.5 and 14 years of age). Genetic factors contributed to the BMI changes during adulthood (correlation with PRSBMI r = 0.25 in men and r = 0.27 in women; heritability estimates 0.63 and 0.64 respectively) as well as to their correlations with BMI at the baseline age (rA = 0.5 in men and 0.54 in women) and BMI during adolescence (at 11.5 and 14 years of age) (rA = 0.63-0.64).

CONCLUSION

We found that genetic factors play a role in BMI change in adulthood, and part of this genetic component overlaps with the genetics of BMI in adolescence. Genetic predisposition to high BMI in adolescence is also related to adult weight gain.

An Active Learning Model for Promoting Healthy Cooking and Dietary Strategies Among South Asian Children: A Proof-of-Concept Study

Background/Objectives: South Asian children living in Canada have a higher prevalence of cardiovascular disease risk factors compared to their non-South Asian counterparts, and poor dietary habits may contribute to this health disparity. Methods: This study uses a pre-post intervention design to examine the impact of a family-focused, "hands-on" cooking workshop on improving three cooking and dietary strategies: (1) using healthy cooking techniques, (2) practicing portion control, and (3) making healthy substitutions. We recruited 70 South Asian parent-child dyads (n = 140) across four elementary schools in Surrey, British Columbia. The 90 min workshop includes a didactic segment on healthy food preparation and dietary strategies, followed by an interactive cooking session where participants make a healthier version of a traditional Punjabi dish. Results: Among the three dietary strategies measured, both children and parents increased their frequency of using healthy cooking techniques (child p = 0.02; parent p < 0.001) and practicing portion control (child p < 0.001; parent p = 0.02). No changes were reported by either group for making healthy substitutions. Conclusions: Findings suggest that educational approaches that engage the family as a unit and encourage active participation are associated with improvements in cooking and dietary strategies in the South Asian community.

Feasibility of engaging parents attending an adult weight management programme with child weight management support: a mixed methods study

OBJECTIVE

To explore whether parents' attendance at a commercial adult weight management programme (WMP) offers an opportunity to identify and signpost families to child weight management support, if appropriate to a child's weight status.

DESIGN

Mixed methods study including a cross-sectional online survey and semistructured telephone interviews.

SETTING AND PARTICIPANTS

Parents attending Slimming World (UK-based adult commercial WMP), with one or more children aged 5-11 years, were invited to take part. There were 396 survey and 18 telephone interview participants.

RESULTS

Most parents (78%) attending the adult WMP and worried about their child's weight were receptive to being offered support for their child. Nearly all (98%) of these parents were happy for the adult WMP to signpost to this support. Nearly half of parents (47%, n=122/262) not worried about their child's weight were still interested in a child height and weight check. The preferred intervention format and delivery possibilities differed among parents, with 'no-one size fits all', while recognising that change takes time, and weekly sessions may be too frequent. Parents were clear that the focus of support should be on healthy lifestyle not weight. Many parents felt a parent 'peer support' group would be helpful.

CONCLUSIONS

Parents actively addressing their own weight, through an adult WMP, are receptive to being offered and signposted to support for their child, where they have concerns about their child's weight. These findings support a new referral pathway into child weight management services, through parents attending an adult WMP.

Impact of Early Childhood Malnutrition on Cardiometabolic Risk Factors in Young Adults from Marginalized Areas of Chiapas, Mexico

The presence of malnutrition in early life is a determining factor in the onset of metabolic alterations and chronic diseases in adults. Therefore, the objective of this study was to determine the impact of malnutrition in early childhood with the presence of cardiometabolic risk factors in adulthood in marginalized populations from Chiapas, Mexico. The present investigation was based on a prospective cohort study that began in 2002, with young adults aged 18 to 25 years belonging to De Los Bosques region in Chiapas, Mexico. Sociodemographic, anthropometric, clinical and biochemical data were obtained in adulthood. Binary logistic regression models with 95% confidence intervals were fitted to assess the association between nutritional status in childhood (≤5 years of age) and cardiometabolic risk in adulthood. Individuals with overweight/obesity in childhood were more likely to have overweight/obesity (OR = 2.65, 95% CI: 1.09-6.45), high waist circumference (3.78, 95% CI: 1.55-9.24), high waist to height ratio (OR = 5.38, CI 95%: 1.60-18.10), elevated total cholesterol (OR = 3.95, 95% CI: 1.36-11.43) and metabolic syndrome (OR = 4.71, 95% CI: 1.49-14.90) in adulthood. In conclusion, malnutrition presented in early childhood increased the probability of developing cardiometabolic alterations in young adults from southern Mexico.

Relationships between perceived physical literacy and mental health in tertiary education students: a scoping review

BACKGROUND/OBJECTIVE

Physical literacy (PL) is "the motivation, confidence, physical competence, knowledge, and understanding to value and take responsibility for engagement in physical activities for life". Recent evidence has shown that PL was associated with mental wellbeing in different populations, yet a comprehensive review examining the association between PL and mental health among tertiary education students was lacking. The aims of this scoping review were to rapidly map relevant evidence on the relationships between perceived PL and mental health in higher education students and to determine the feasibility and value of conducting a full systematic review in this research area.

METHODS

All primary studies (observational and experimental) examining the associations between PL and mental health in college/university/undergraduate students were included. Seven electronic databases, namely PubMed, Academic Search Premier, CINAHL, ERIC, PsycINFO, Medline, and SPORTDiscus, were searched from their inceptions through 30 September 2024. A narrative approach was adopted to synthesize results relevant to the study aims categorized based on mental health outcomes.

RESULTS

Seven observational studies (n = 34,824) were included. Results showed that PL was positively correlated with better mental wellbeing, including greater quality of life, better subjective wellbeing, higher levels of life satisfaction, improved resilience, and greater compliance with sleep guideline, and negatively associated with psychological distress (depression, anxiety, and stress) among university students. During the COVID-19 pandemic, PL was also shown to buffer university students' psychological distress, declines in quality of life and life satisfaction, as well as impaired sleep in the population.

CONCLUSION

Despite emerging research efforts to decipher the relationships between perceived PL and mental health in tertiary institution settings, further high-quality experimental studies are imperatively needed to guarantee the relevance of rigorous systemic reviews in the realm of university students' mental health.

Association Between Physical Fitness and Cardiovascular Health in Chilean Schoolchildren from the Metropolitan Region

Background: Cardiovascular diseases increasingly impact youth, with early development of risk factors such as obesity, hypertension, and inadequate nutrient intake. Proper nutrient intake and physical fitness are vital for reducing these risks, especially in pediatric populations. This study explores the connection between physical fitness, metabolic risk, and nutrient status among 1656 Chilean schoolchildren from diverse socio-economic backgrounds. Methods: Anthropometric measures included weight, height, skinfold thickness, waist circumference, and blood pressure. Physical fitness was assessed via handgrip strength, standing long jump, and a six-minute walk test. Nutrient intake was also evaluated, and a composite metabolic risk score was calculated based on waist circumference, skinfolds, and blood pressure. Results: Boys consistently outperformed girls in physical fitness tests, including grip strength and horizontal jump, with differences becoming more pronounced in higher grades and Tanner stages. Girls exhibited higher subcutaneous fat levels and obesity prevalence during later grades, highlighting gender-specific patterns in body composition. Better physical fitness was associated with lower waist circumference, skinfold thickness, and metabolic risk scores. A moderate correlation between aerobic fitness (distance/height) and blood pressure (r = 0.27, p = 0.01) was observed. Z-Score MR analysis revealed that students in the lowest fitness tertile exhibited significantly higher cardiovascular risk profiles compared to their fitter peers. Conclusions: Physical fitness plays a critical role in reducing cardiovascular risk in children. The findings underscore the importance of promoting gender- and age-specific interventions that include both aerobic and strength-based physical activities. Comprehensive school programs focusing on nutrition and physical activity are essential to mitigating cardiovascular risk and promoting long-term health outcomes. Future longitudinal studies are recommended to establish causal relationships and evaluate the impact of targeted interventions.

2-Fold More Cardiovascular Disease Events Decades Before Type 2 Diabetes Diagnosis: A Nationwide Registry Study

BACKGROUND

The risk of cardiovascular disease (CVD) is increased in individuals with type 2 diabetes mellitus (T2DM), but it remains uncertain how long an elevated CVD occurrence precedes diabetes diagnosis.

OBJECTIVES

The aim of this study was to investigate CVD occurrence 30 years before, and 5 years after, T2DM diagnosis compared with matched comparisons.

METHODS

This combined case-control and cohort study included all individuals diagnosed with T2DM in Denmark between 2010 and 2015, as well as general population comparisons matched by age and sex. CVD was defined as myocardial infarction or ischemic stroke. Conditional logistic regression was used to compute ORs for CVD prevalence in the 30-year period before T2DM diagnosis. Cox proportional hazards regression models were used to compute HRs for 5-year CVD incidence after T2DM diagnosis.

RESULTS

The study included 127,092 individuals with T2DM and 381,023 matched comparisons. In the 30-year period before T2DM diagnosis, 14,179 (11.2%) T2DM individuals and 17,871 (4.7%) comparisons experienced CVD. CVD prevalence was higher in those with T2DM than the comparisons in the entire period before T2DM diagnosis, with ORs ranging from 2.18 (95% CI: 1.91-2.48) in the earliest period (25-30 years before diagnosis) to 2.96 (95% CI: 2.85-3.08) in the latest period (<5 years before diagnosis). After T2DM diagnosis, 5-year CVD incidence was similarly increased in T2DM individuals vs comparisons (HR: 2.20; 95% CI: 2.12-2.27).

CONCLUSIONS

Individuals with T2DM had 2-fold more CVD events than matched comparisons starting 3 decades before T2DM diagnosis. This indicates that comprehensive preventive strategies may be initiated much earlier in individuals at risk of T2DM.

Lifestyle Factors Associated With Childhood Obesity in South Asian Expatriates of Dubai: A Cross-Sectional Study

Background Obesity, a chronic disease caused by excessive fat deposits, increases the risk of various health conditions. Childhood obesity is a growing global concern, affecting millions of children. There is a paucity of research on the determinants of childhood obesity in the expatriate population of Dubai. This study aimed to explore modifiable key lifestyle factors contributing to childhood obesity in Dubai's South Asian expatriates. Methodology Based on prior research, we decided to evaluate the role of three most commonly associated lifestyle factors: physical activity, fast food consumption, and daily screen time. The hypothesis was that higher screen time and fast food intake would positively correlate with body mass index (BMI), while physical activity would show a negative correlation. The study applied a non-probability convenience sampling method and included 208 South Asian children aged 5-17 who visited a Dubai clinic between January and March 2024 and who did not have any serious physical or mental health illness requiring long-term medication or any genetic disorder. Results Results showed that one-third of the children had a BMI of ≥85 percentile with no significant gender differences. Age was positively correlated with BMI percentile. Higher daily screen time is significantly associated with a higher prevalence of overweight and obesity as per the Centers for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF), and World Health Organization (WHO) classifications. The frequent intake of fast food is associated with a higher prevalence of overweight and obesity only as per the IOTF classification. Physical activity, however, was not significantly different between the two groups. Conclusion We concluded that children who have a BMI of ≥85 percentile tend to have significantly higher daily screen time. The association between frequent fast food consumption and higher BMI was significant only under the IOTF criteria. Larger multicentric studies are needed to further validate these associations and to look for causal relationships. Nevertheless, this study underscores modifiable risk factors for childhood obesity, suggesting that small lifestyle changes could mitigate this epidemic.

Predictors in Youth of Adult Cardiovascular Events

BACKGROUND AND OBJECTIVES

Childhood risk factors are associated with cardiovascular events in adulthood. We compared the utility of a risk model based solely on nonlaboratory risk factors in adolescence versus a model that additionally included lipids to predict cardiovascular events in adulthood.

METHODS

The study comprised 11 550 participants from 7 longitudinal cohort studies in the United States, Australia, and Finland with risk factor measurements in adolescence and followed into adulthood. The adolescent risk factors were defined by using clinical standards including overweight or obesity, elevated blood pressure, smoking, and borderline high or high levels of total cholesterol and triglycerides. The main outcomes were medically adjudicated fatal or nonfatal cardiovascular disease events occurring after age 25.

RESULTS

Of 11 550 participants (55.1% female, mean age 50.0 ± 7.7 years), 513 (4.4%) had confirmed cardiovascular events. In a multivariable model (hazard ratio [95% confidence interval]), elevated blood pressure (1.25 [1.03-1.52]), overweight (1.76 [1.42-2.18]), obesity (2.19 [1.62-2.98]), smoking (1.63 [1.37-1.95]), and high total cholesterol (1.79 [1.39-2.31]) were predictors of cardiovascular events (P < .05). The addition of lipids (total cholesterol and triglycerides) into the nonlaboratory model (age, sex, blood pressure, BMI, and smoking) did not improve discrimination in predicting cardiovascular events (C-statistics for the lipid model 0.75 [SD 0.07] and nonlaboratory model 0.75 [0.07], P = .82).

CONCLUSIONS

Nonlaboratory-based risk factors and lipids measured in adolescence independently predicted adult cardiovascular events. The addition of lipid measurements to nonlaboratory risk factors did not improve the prediction of cardiovascular events.

Early-Life Risk Factors for Carotid Intima-Media Thickness and Carotid Stiffness in Adolescence

Importance

Atherogenesis starts during childhood, making childhood and adolescence an important window of opportunity to prevent atherosclerotic cardiovascular disease later in life.

Objective

To identify early-life risk factors for preclinical atherosclerosis in adolescence.

Design, Setting, and Participants

This cohort study is part of the ongoing Wheezing Illness Study in Leidsche Rijn (WHISTLER) prospective birth cohort study, which includes 3005 healthy newborns born between December 2001 and December 2012 in the Leidsche Rijn area of Utrecht, the Netherlands. Eligible participants included those from the WHISTLER cohort who visited the clinic between March 2019 and October 2020 for adolescent follow-up. This study's analyses were performed in January 2024.

Exposures

Early-life growth was assessed at birth to 6 months, 5 years, and 12 to 16 years. Abdominal ultrasonography determined abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) depth. Blood pressure (BP) percentiles and body mass index (BMI) z scores were used.

Main Outcomes and Measures

Carotid ultrasonography was performed at age 12 to 16 years to assess carotid intima-media thickness (cIMT) and the distensibility coefficient (DC), established measures of preclinical atherosclerosis. Multivariable linear regression models were used to identify early-life risk factors for cIMT and DC in adolescence.

Results

In total, 232 adolescents (median [IQR] age, 14.9 [13.7-15.8] years; 121 female [52.2%]) were included. More postnatal weight gain (B = 12.34; 95% CI, 2.39 to 22.39), higher systolic BP at 5 years (B = 0.52; 95% CI, 0.02 to 1.01), more VAT at 5 years (B = 3.48; 95% CI, 1.55 to 5.40), and a larger change in VAT between 5 and 12 to 16 years (B = 3.13; 95% CI, 1.87 to 4.39) were associated with a higher cIMT in adolescence. A higher BMI (B = -2.70, 95% CI,-4.59 to -0.80) and VAT at 5 years (B = -0.56; 95% CI, -0.87 to -0.25), as well as a larger change in BMI between 5 and 12 to 16 years (B = -3.63; 95% CI, -5.66 to -1.60) were associated with a higher carotid stiffness in adolescence. On the contrary, a larger change in SAT between 5 and 12 to 16 years (B = 0.37; 95% CI, 0.16 to 0.58) was associated with a higher carotid DC in adolescence.

Conclusions and Relevance

In this cohort study of 232 participants, early-life growth parameters, and particularly abdominal VAT development, were associated with a higher cIMT and carotid stiffness in adolescence. These findings suggest that assessment of adipose tissue development during childhood can aid characterization of lifetime risk trajectories and tailoring of cardiovascular prevention and risk management strategies.

Evaluating an acceptance-based lifestyle modification program to address cardiovascular disease risk among adolescent girls with overweight and obesity: Protocol for a randomized controlled trial

BACKGROUND

Behavioral weight loss interventions achieve only limited weight loss in adolescent samples and weight regain is common. This limited intervention success may be attributed, in part, to adolescents' lack of self-regulation skills essential for lifestyle modification and use of a one-size fits-all approach to produce weight loss in boys and girls. Interventions which teach self-regulation skills, such as Acceptance-Based Therapy (ABT), and are tailored to meet gender-specific concerns, are critical to help adolescents adapt to pervasive biological and environmental influences toward weight gain.

OBJECTIVE

This trial tests the effect of an ABT intervention on cardiometabolic health, health-related behaviors, and psychological factors among adolescent girls with overweight or obesity (OW/OB).

METHODS

Girls 14-19 years (N = 148; ≥ 40% racial/ethnic minorities) with OW/OB (BMI: ≥ 85th percentile) will be enrolled in the study. Participants will be randomized to one of two 6-month interventions, consisting of either 18 sessions of ABT or 9 sessions of a health education control, an augmented version of standard care for adolescent OW/OB, both led by bachelor's level interventionists.

RESULTS

Recruitment is taking place in Philadelphia, USA, from January 2024 to January 2028. Cardiometabolic health markers (adiposity; blood pressure; blood lipids), health-related behaviors (dietary intake; physical activity; sleep), and psychological factors (quality of life; depression; disordered eating; psychological flexibility) will be measured at baseline, mid-treatment, post-treatment, 6-month follow-up, and 12-month follow-up.

CONCLUSIONS

This study will provide valuable information on a novel intervention tailored to the needs of adolescent girls with OW/OB to address self-regulation and cardiometabolic health.

Bariatric surgery and diabetes: Current challenges and perspectives

Diabetes mellitus (DM) and obesity have become public issues of global concern. Bariatric surgery for the treatment of obesity combined with type 2 DM has been shown to be a safe and effective approach; however, there are limited studies that have systematically addressed the challenges of surgical treatment of obesity combined with DM. In this review, we summarize and answer the most pressing questions in the field of surgical treatment of obesity-associated DM. I believe that our insights will be of great help to clinicians in their daily practice.

Characteristics of stachyose-induced effects on gut microbiota and microbial metabolites in vitro associated with obesity in children

Childhood obesity presents a serious health concern associated with gut microbiota alterations. Dietary interventions targeting the gut microbiota have emerged as promising strategies for managing obesity in children. This study aimed to elucidate the impact of stachyose (STS) supplementation on the gut microbiota composition and metabolic processes in obese children. Fecal samples were collected from 40 obese children (20 boys and 20 girls) aged between 6 and 15 and in vitro fermentation was conducted with or without the addition of STS, respectively, followed by 16S rRNA amplicon sequencing and analysis of short-chain fatty acids (SCFAs) and gases. Notably, our results revealed that STS supplementation led to significant alterations in gut microbiota composition, including an increase in the abundance of beneficial bacteria such as Bifidobacterium and Faecalibacterium, and a decrease in harmful bacteria including Escherichia-Shigella, Parabacteroides, Eggerthella, and Flavonifractor. Moreover, STS supplementation resulted in changes in SCFAs production, with significant increases in acetate levels and reductions in propionate and propionate, while simultaneously reducing the generation of gases such as H2S, H2, and NH3. The Area Under the Curve (AUC)-Random Forest algorithm and PICRUSt 2 were employed to identify valuable biomarkers and predict associations between the gut microbiota, metabolites, and metabolic pathways. The results not only contribute to the elucidation of STS's modulatory effects on gut microbiota but also underscore its potential in shaping metabolic activities within the gastrointestinal environment. Furthermore, our study underscores the significance of personalized nutrition interventions, particularly utilizing STS supplementation, in the management of childhood obesity through targeted modulation of gut microbial ecology and metabolic function.

Childhood Adiposity and Risk of Major Clinical Heart Diseases in Adulthood: A Mendelian Randomization Study

BACKGROUND

The causal relationship between childhood adiposity and adult risk of heart diseases has not been clearly demonstrated. This study aims to ascertain whether genetically predicted childhood body mass index (BMI) and childhood obesity are causally associated with adult coronary heart disease, myocardial infarction, heart failure, atrial fibrillation, hypertrophic cardiomyopathy, and pulmonary heart disease.

METHODS AND RESULTS

To investigate the causative relationships and underlying mechanisms between childhood adiposity and adult heart diseases, 3 main methods of Mendelian randomization were used: 2-sample Mendelian randomization, multivariable Mendelian randomization with controlling for several cardiometabolic risk variables, and mediation analysis. Every 1-SD rise in genetically predicted childhood body mass index was associated with 24% (odds ratio [OR], 1.24 [95% CI, 1.12-1.37]), 28% (OR, 1.28 [95% CI, 1.14-1.42]), 28% (OR, 1.28 [95% CI, 1.14-1.42]), and 27% (OR, 1.27 [95% CI, 1.04-1.49]) higher risk of coronary heart disease, myocardial infarction, heart failure, and atrial fibrillation, respectively. Every 1-unit increase in log-odds in childhood obesity was associated with 11% (OR, 1.11 [95% CI, 1.06-1.16]), 14% (OR, 1.14 [95% CI, 1.04-1.23]), 10% (OR, 1.10 [95% CI, 1.03-1.18]), and 20% (OR, 1.20 [95% CI, 1.08-1.32]) higher risk of coronary heart disease, myocardial infarction, heart failure, and atrial fibrillation, respectively. The link between childhood adiposity and adult heart diseases was found to be mediated by high-density lipoprotein cholesterol, triglyceride, hypertension, and type 2 diabetes.

CONCLUSIONS

Our findings support the causal relationships between childhood adiposity and risk of adult coronary heart disease, myocardial infarction, heart failure, and atrial fibrillation. Blood lipids, hypertension, and type 2 diabetes are factors that mediate the aforementioned associations.

The Prevention of Childhood Obesity Is a Priority: The Preliminary Results of the "EpPOI: Education to Prevent Childhood Obesity" Project

BACKGROUND

The increase in childhood obesity rates represents a serious public health problem. The project "EpPOI: Education to prevent childhood obesity" is aimed at a multidisciplinary approach to raise awareness of the importance of preventing childhood obesity through lifestyle education.

METHODS

Two actions by experts were performed: an intervention with children in schools and a meeting for both parents and school staff. Participants completed a questionnaire structured as a Likert scale.

RESULTS

The sample size was 96 people, and awareness of the childhood obesity problem as well as the need for obesity prevention was high among respondents. We also found great interest among participants in having more information on pediatric nutrition and physical activity, with a positive correlation with age. Furthermore, the multivariate regression model configured interest in having more information on nutrition and physical activity as an independent and statistically significant predictor of awareness of childhood obesity as a current issue.

CONCLUSIONS

The results highlight the need to act on childhood obesity through lifestyle prevention strategies early in life.

Cardiovascular disease in adults with a history of out-of-home care during childhood: a systematic review and meta-analysis of prospective cohort studies

Background

While individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected adverse health problems in adulthood, their risk of cardiovascular disease is uncertain. Our aim was to explore this association by pooling published and unpublished results from prospective cohort studies.

Methods

We used two approaches to identifying relevant data on childhood care and adult cardiovascular disease (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the objective of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews on childhood out-of-home care and other adult health outcomes. Included studies were required to satisfy three criteria: a cohort study in which the assessment of care was made prospectively pre-adulthood (in the avoidance of recall bias); data on an unexposed comparator group were available (for the computation of relative risk); and a diagnosis of adult cardiovascular disease events (coronary heart disease, stroke, or their combination) had been made (as opposed to risk factors only). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality.

Findings

Twelve studies (2 published, 10 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Five of the nine studies were judged to be of higher methodological quality. Relative to the unexposed, individuals with a care placement during childhood had a 51% greater risk of cardiovascular disease in adulthood (summary rate ratio after age- and sex-adjustment [95% confidence interval]: 1.51 [1.22, 1.86]; range of study-specific estimates: 1.07 to 2.06; I 2  = 69%, p = 0.001). This association was attenuated but persisted after adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.29 [1.11, 1.51]).

Interpretation

Our findings show that individuals with experience of out-of-home care in childhood have a moderately raised risk of cardiovascular disease in adulthood.

Funding

Medical Research Council; National Institute on Aging; Wellcome Trust.

Global Prevalence of Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analysis

Importance

Overweight and obesity in childhood and adolescence is a global health issue associated with adverse outcomes throughout the life course.

Objective

To estimate worldwide prevalence of overweight and obesity in children and adolescents from 2000 to 2023 and to assess potential risk factors for and comorbidities of obesity.

Data Sources

MEDLINE, Web of Science, Embase, and Cochrane.

Study Selection

The inclusion criteria were: (1) studies provided adequate information, (2) diagnosis based on body mass index cutoffs proposed by accepted references, (3) studies performed on general population between January 2000 and March 2023, (4) participants were younger than 18 years.

Data Extraction and Synthesis

The current study was performed in accordance with the Meta-analysis of Observational Studies in Epidemiology guidelines. DerSimonian-Laird random-effects model with Free-Tukey double arcsine transformation was used for data analysis. Sensitivity analysis, meta-regression, and subgroup analysis of obesity among children and adolescents were conducted.

Main Outcomes and Measures

Prevalence of overweight and obesity among children and adolescents assessed by World Health Organization, International Obesity Task Force, the US Centers for Disease Control and Prevention, or other national references.

Results

A total of 2033 studies from 154 different countries or regions involving 45 890 555 individuals were included. The overall prevalence of obesity in children and adolescents was 8.5% (95% CI 8.2-8.8). We found that the prevalence varied across countries, ranging from 0.4% (Vanuatu) to 28.4% (Puerto Rico). Higher prevalence of obesity among children and adolescents was reported in countries with Human Development Index scores of 0.8 or greater and high-income countries or regions. Compared to 2000 to 2011, a 1.5-fold increase in the prevalence of obesity was observed in 2012 to 2023. Substantial differences in rates of obesity were noted when stratified by 11 risk factors. Children and adolescents with obesity had a high risk of depression and hypertension. The pooled estimates of overweight and excess weight in children and adolescents were 14.8% (95% CI 14.5-15.1) and 22.2% (95% CI 21.6-22.8), respectively.

Conclusions and Relevance

This study's findings indicated 1 of 5 children or adolescents experienced excess weight and that rates of excess weight varied by regional income and Human Development Index. Excess weight among children and adolescents was associated with a mix of inherent, behavioral, environmental, and sociocultural influences that need the attention and committed intervention of primary care professionals, clinicians, health authorities, and the general public.

Eight-year diet and physical activity intervention affects serum metabolites during childhood and adolescence: A nonrandomized controlled trial

Long-term lifestyle interventions in childhood and adolescence can significantly improve cardiometabolic health, but the underlying molecular mechanisms remain poorly understood. To address this knowledge gap, we conducted an 8-year diet and physical activity intervention in a general population of children. The research revealed that the intervention influenced 80 serum metabolites over two years, with 17 metabolites continuing to be affected after eight years. The intervention primarily impacted fatty amides, including palmitic amide, linoleamide, oleamide, and others, as well as unsaturated fatty acids, acylcarnitines, phospholipids, sterols, gut microbiota-derived metabolites, amino acids, and purine metabolites. Particularly noteworthy were the pronounced changes in serum fatty amides. These serum metabolite alterations could represent molecular mechanisms responsible for the observed benefits of long-term lifestyle interventions on cardiometabolic and overall health since childhood. Understanding these metabolic changes may provide valuable insights into the prevention of cardiometabolic and other non-communicable diseases since childhood.

The Application of Mendelian Randomization in Cardiovascular Disease Risk Prediction: Current Status and Future Prospects

Cardiovascular disease (CVD), a leading cause of death and disability worldwide, and is associated with a wide range of risk factors, and genetically associated conditions. While many CVDs are preventable and early detection alongside treatment can significantly mitigate complication risks, current prediction models for CVDs need enhancements for better accuracy. Mendelian randomization (MR) offers a novel approach for estimating the causal relationship between exposure and outcome by using genetic variation in quasi-experimental data. This method minimizes the impact of confounding variables by leveraging the random allocation of genes during gamete formation, thereby facilitating the integration of new predictors into risk prediction models to refine the accuracy of prediction. In this review, we delve into the theory behind MR, as well as the strengths, applications, and limitations behind this emerging technology. A particular focus will be placed on MR application to CVD, and integration into CVD prediction frameworks. We conclude by discussing the inclusion of various populations and by offering insights into potential areas for future research and refinement.

What is the disease burden from childhood and adolescent obesity?: a narrative review

The prevalence of childhood and adolescent obesity has increased and exacerbated during the coronavirus disease 2019 pandemic, both in Korea and globally. Childhood and adolescent obesity poses significant risks for premature morbidity and mortality. The development of serious comorbidities depends not only on the duration of obesity but also on the age of onset. Obesity in children and adolescents affects almost all organ systems, including the endocrine, cardiovascular, gastrointestinal, reproductive, nervous, and immune systems. Obesity in children and adolescents affects growth, cognitive function, and psychosocial interactions during development, in addition to aggravating known adult comorbidities such as type 2 diabetes mellitus, hypertension, dyslipidemia, nonalcoholic fatty liver disease, obstructive sleep apnea, and cancer. Childhood and adolescent obesity are highly associated with increased cardiometabolic risk factors and prevalence of metabolic syndrome. The risk of cardiovascular and metabolic diseases in later life can be considerably decreased by even a small weight loss before the onset of puberty. Childhood and adolescent obesity is a disease that requires treatment and is associated with many comorbidities and disease burdens. Therefore, early detection and therapeutic intervention are crucial.

Comparative physiological effects of antipsychotic drugs in children and young people: a network meta-analysis

BACKGROUND

The degree of physiological responses to individual antipsychotic drugs is unclear in children and adolescents. With network meta-analysis, we aimed to investigate the effects of various antipsychotic medications on physiological variables in children and adolescents with neuropsychiatric and neurodevelopmental conditions.

METHODS

For this network meta-analysis, we searched Medline, EMBASE, PsycINFO, Web of Science, and Scopus from database inception until Dec 22, 2023, and included randomised controlled trials comparing antipsychotics with placebo in children or adolescents younger than 18 years with any neuropsychiatric and neurodevelopmental condition. Primary outcomes were mean change from baseline to end of acute treatment in bodyweight, BMI, fasting glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, prolactin, heart rate, systolic blood pressure (SBP), and QT interval corrected for heart rate (QTc) for patients receiving either active treatment or placebo. For multigroup trials reporting several doses, we calculated a summary value for each physiological variable for all doses. After transitivity assessment, we fitted frequentist random-effects network meta-analyses for all comparisons in the network. A Kilim plot was used to summarise the results for all treatments and outcomes, providing information regarding the strength of the statistical evidence of treatment effects, using p values. Network heterogeneity was assessed with τ, risk of bias of individual trials was assessed with the Cochrane Collaboration's Tool for Assessing Risk of Bias, and the credibility of findings from each network meta-analysis was assessed with the Confidence in Network Meta-Analysis (CINEMA) app. This study is registered on PROSPERO (CRD42021274393).

FINDINGS

Of 6676 studies screened, 47 randomised controlled trials were included, which included 6500 children (mean age 13·29 years, SD 2·14) who received treatment for a median of 7 weeks (IQR 6-8) with either placebo (n=2134) or one of aripiprazole, asenapine, blonanserin, clozapine, haloperidol, lurasidone, molindone, olanzapine, paliperidone, pimozide, quetiapine, risperidone, or ziprasidone (n=4366). Mean differences for bodyweight change gain compared with placebo ranged from -2·00 kg (95% CI -3·61 to -0·39) with molindone to 5·60 kg (0·27 to 10·94) with haloperidol; BMI -0·70 kg/m2 (-1·21 to -0·19) with molindone to 2·03 kg/m2 (0·51 to 3·55) with quetiapine; total cholesterol -0·04 mmol/L (-0·39 to 0·31) with blonanserin to 0·35 mmol/L (0·17 to 0·53) with quetiapine; LDL cholesterol -0·12 mmol/L (-0·31 to 0·07) with risperidone or paliperidone to 0·17 mmol/L (-0·06 to 0·40) with olanzapine; HDL cholesterol 0·05 mmol/L (-0·19 to 0·30) with quetiapine to 0·48 mmol/L (0·18 to 0·78) with risperidone or paliperidone; triglycerides -0·03 mmol/L (-0·12 to 0·06) with lurasidone to 0·29 mmol/L (0·14 to 0·44) with olanzapine; fasting glucose from -0·09 mmol/L (-1·45 to 1·28) with blonanserin to 0·74 mmol/L (0·04 to 1·43) with quetiapine; prolactin from -2·83 ng/mL (-8·42 to 2·75) with aripiprazole to 26·40 ng/mL (21·13 to 31·67) with risperidone or paliperidone; heart rate from -0·20 bpm (-8·11 to 7·71) with ziprasidone to 12·42 bpm (3·83 to 21·01) with quetiapine; SBP from -3·40 mm Hg (-6·25 to -0·55) with ziprasidone to 10·04 mm Hg (5·56 to 14·51) with quetiapine; QTc from -0·61 ms (-1·47 to 0·26) with pimozide to 0·30 ms (-0·05 to 0·65) with ziprasidone.

INTERPRETATION

Children and adolescents show varied but clinically significant physiological responses to individual antipsychotic drugs. Treatment guidelines for children and adolescents with a range of neuropsychiatric and neurodevelopmental conditions should be updated to reflect each antipsychotic drug's distinct profile for associated metabolic changes, alterations in prolactin, and haemodynamic alterations.

FUNDING

UK Academy of Medical Sciences, Brain and Behaviour Research Foundation, UK National Institute of Health Research, Maudsley Charity, the Wellcome Trust, Medical Research Council, National Institute of Health and Care Research Biomedical Centre at King's College London and South London and Maudsley NHS Foundation Trust, the Italian Ministry of University and Research, the Italian National Recovery and Resilience Plan, and Swiss National Science Foundation.

Association between protein-to-energy ratio and overweight/obesity in children and adolescents in the United States: a cross-sectional study based on NHANES

Background

The dietary protein proportion may be crucial in triggering overweight and obesity among children and adolescents.

Methods

Cross-sectional data from 4,336 children and adolescents who participated in the National Health and Nutrition Survey (NHANES) between 2011 and March 2020 were analyzed. Multivariate logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI). Restricted cubic splines assessed the nonlinear relationships between dietary protein intake and the prevalence of overweight and obesity.

Results

Adjusted logistic regression models showed that each 1% increase in dietary protein proportion was associated with a 4% higher risk of overweight and obesity (OR = 1.04, 95% CI: 1.01-1.07). A nonlinear relationship was noted in children aged 6-11 years (P < 0.05), as demonstrated by restricted cubic spline analysis. After dividing dietary protein intake into quartiles, the highest quartile had an adjusted OR of 2.07 (95% CI: 1.35, 3.16, P = 0.001) compared to the lowest, among children aged 6-11 years.

Conclusion

Dietary protein intake is positively linked to overweight and obesity in American children, irrespective of individual characteristics and total energy consumption.

Body weight in childhood, adolescence, and young adulthood in relation to later risk of disabilities and early retirement among Danish female nurses

BACKGROUND

Obesity is now the most common health problem in the younger population in Western societies and obesity rates are higher in lower socioeconomic status (SES) groups. We investigated whether overweight in childhood, independently of overweight in adulthood, influenced adult employment status and later risk of having disabilities. Using data from the Danish Female Nurse Cohort study, we examined associations between overweight in childhood/adolescence, and young adulthood and disabilities and early retirement in later adulthood (>44 years) and whether it was influenced by menopausal age (

RESULTS

Our results showed that overweight in childhood, adolescence and young adulthood was associated with an increased risk of disabilities and early retirement. Especially childhood overweight that did not persist into adulthood was associated with an increased risk of disabilities (OR = 1.82, 95% CI = 1.26-2.63) and early retirement (OR = 2.05, 95% CI = 1.38-3.03) in the postmenopausal group. A similar increased risk for disabilities (OR = 1.76, 95% CI = 1.26-2.47) was seen for adolescent overweight that did not persist into adulthood.

CONCLUSION

The results show that in a well-educated population of women, overweight in childhood and/or adolescence had adverse socioeconomic consequences for later risk of disabilities and early retirement irrespective of weight status in adulthood.

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MESH Headings

• Humans
• Female
• Denmark/epidemiology
• Adolescent
• Retirement/statistics & numerical data
• Adult
• Risk Factors
• Persons with Disabilities/statistics & numerical data
• Child
• Nurses/statistics & numerical data
• Young Adult
• Body Mass Index
• Middle Aged
• Pediatric Obesity/epidemiology
• Overweight/epidemiology
• Socioeconomic Factors
• Employment/statistics & numerical data
• Body Weight/physiology
• Cohort Studies

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Affiliation(s)

Hanna Kruse Reiband The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.
Rikke Tannenberg Klemmensen The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
Susanne Rosthøj The Danish Cancer Institute, Research Centre, Copenhagen, Denmark Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Thorkild I A Sørensen Center for Childhood Health, Copenhagen, Denmark Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark NNF Centre for Basic Metabolic Health, University of Copenhagen, Copenhagen, Denmark
Berit Lilienthal Heitmann The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark Department of Public Health, Section for general Practise, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark

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Maternal folic acid supplementation during pregnancy in association with childhood overweight or obesity

OBJECTIVE

This study aimed to examine associations of maternal folic acid supplementation (FAS) during pregnancy with childhood overweight or obesity (OWO) or adiposity.

METHODS

In a population-based cohort of 1479 children, maternal FAS during pregnancy was assessed retrospectively by questionnaires. BMI and body fat percentages were measured at a mean age of 6.4 years. Pertinent factors were accounted for in data analyses.

RESULTS

Maternal FAS during pregnancy was negatively associated with OWO (adjusted odds ratio: 0.70; 95% CI: 0.50 to 0.99). There were inverse associations of maternal FAS during pregnancy with BMI z score (β: -0.22; 95% CI: -0.39 to -0.05), whole body fat percentage (β: -1.28; 95% CI: -2.27 to -0.30), trunk fat percentage (β: -1.41; 95% CI: -2.78 to -0.04), and limb fat percentage (β: -1.31; 95% CI: -2.32 to -0.30). Stratified analyses found inverse associations of FAS during pregnancy with OWO, BMI z score, and body fat percentages predominantly among children without breastfeeding and whose parents had a below-tertiary educational level.

CONCLUSIONS

This study provides novel evidence that maternal FAS during pregnancy was significantly associated with a decreased risk of childhood OWO and adiposity, particularly among children with no breastfeeding and lower parental educational level.

Prevalence of Childhood Obesity in Indian Expatriate Children in Dubai: A Cross-Sectional Analytical Study

Background Childhood obesity is one of the most prevalent nutritional disorders affecting children across the world, which further leads to diabetes, hypertension, coronary artery disease, and fatty liver disease in adulthood. The magnitude of this problem among Indian expatriates in the United Arab Emirates (UAE) has not been investigated before. This study delves into the prevalence of childhood obesity among this demographic and also provides a comparative analysis of the prevalence of obesity in UAE citizens and children in India. Methodology This is a cross-sectional study that investigates the prevalence of obesity in 3,698 students of a single Indian school in the UAE. Anonymous anthropometric data of these children of age range four to 18 years were analyzed. The International Obesity Task Force (IOTF), World Health Organization (WHO), and Centers for Disease Control (CDC) reference methods were used to calculate the prevalence of overweight, obesity, and extreme obesity. Results According to CDC guidelines, the prevalence of body mass index (BMI) ≥ 85th percentile, ≥ 95th percentile, and ≥ 99th percentile stands at 32.74%, 13.68%, and 5.1%, respectively. Children particularly boys aged more than 10 years are at a higher risk of being overweight, obese, and extremely obese (p = < 0.05). In children aged 10 years or less, as the age increases, they tend to have a higher BMI percentile and this is particularly prominent in boys (Pearson correlation coefficient 0.227). Conversely, in those over the age of 10 years, the BMI percentile decreases with age, particularly noticeable in girls, albeit without statistical significance. Conclusion Approximately one-third of school-aged Indian expatriates in the UAE are overweight, obese, or extremely obese. Our study, when contrasted with earlier studies, reveals that Emirati teenagers exhibit a higher prevalence of overweight and obesity compared to their Indian counterparts in the UAE. Similarly, the prevalence of childhood obesity among Indian expatriates in the UAE surpasses that among children residing in India.

Association between being large for gestational age and cardiovascular metabolic health in children conceived from assisted reproductive technology: a prospective cohort study

BACKGROUND

To the best of our knowledge, no study has investigated the potential joint effect of large for gestational age (LGA) and assisted reproductive technology (ART) on the long-term health of children.

METHODS

This was a prospective cohort study that recruited children whose parents had received ART treatment in the Center for Reproductive Medicine, Shandong Provincial Hospital, affiliated to Shandong University, between January 2006 and December 2017. Linear mixed model was used to compare the main outcomes. The mediation model was used to evaluate the intermediary effect of body mass index (BMI).

RESULTS

4138 (29.5%) children born LGA and 9910 (70.5%) children born appropriate for gestational age (AGA) were included in the present study. The offspring ranged from 0.4 to 9.9 years. LGAs conceived through ART were shown to have higher BMI, blood pressure, fasting blood glucose, fasting insulin, and homeostatic model assessment of insulin resistance values, even after controlling for all covariates. The odds of overweight and insulin resistance are also higher in LGA subjects. After adjusting for all covariates, LGAs conceived through ART had BMI and BMI z-scores that were 0.48 kg/m2 and 0.34 units greater than those of AGAs, respectively. The effect of LGA on BMI was identified as early as infancy and remained consistently significant throughout pre-puberty.

CONCLUSIONS

Compared to AGA, LGA children conceived from ART were associated with increased cardiovascular-metabolic events, which appeared as early as infancy and with no recovery by pre-puberty.

Prevalence of Cardiovascular Disease and Risk Factors Among Former National Football League Players

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death worldwide, but prevalence estimates in former professional athletes are limited.

OBJECTIVES

HUDDLE (Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms) aimed to raise awareness and estimate the prevalence of CVD and associated risk factors among members of the National Football League (NFL) Alumni Association and their families through education and screening events.

METHODS

HUDDLE was a multicity, cross-sectional study of NFL alumni and family members aged 50 years and older. Subjects reported their health history and participated in CVD education and screening (blood pressure, electrocardiogram, and transthoracic echocardiogram [TTE] assessments). Phone follow-up by investigators occurred 30 days postscreening to review results and recommendations. This analysis focuses on former NFL athletes.

RESULTS

Of 498 participants screened, 57.2% (N = 285) were former NFL players, the majority of whom were African American (67.6%). The prevalence of hypertension among NFL alumni was estimated to be 89.8%, though only 37.5% reported a history of hypertension. Of 285 evaluable participants, 61.8% had structural cardiac abnormalities by TTE. Multivariable analysis showed that hypertension was a significant predictor of clinically relevant structural abnormalities on TTE.

CONCLUSIONS

HUDDLE identified a large discrepancy between participant self-awareness and actual prevalence of CVD and risk factors, highlighting a significant opportunity for population health interventions. Structural cardiac abnormalities were observed in most participants and were independently predicted by hypertension, affirming the role of TTE for CVD screening in this population aged older than 50 years. (Heart Health: Understanding and Diagnosing Disease by Leveraging Echocardiograms [HUDDLE]; NCT05009589).

Child-to-adult body size change and risk of type 2 diabetes and cardiovascular disease

AIMS/HYPOTHESIS

Childhood overweight increases the risk of type 2 diabetes and cardiovascular disease in adulthood. However, the impact of childhood leanness on adult obesity and disease risk has been overlooked. We examined the independent and combined influences of child and adult body size on the risk of type 2 diabetes and cardiovascular disease.

METHODS

Data from the UK Biobank on 364,695 individuals of European ancestry and free of type 2 diabetes and cardiovascular disease were divided into nine categories based on their self-reported body size at age 10 and measured BMI in adulthood. After a median follow-up of 12.8 years, 33,460 individuals had developed type 2 diabetes and/or cardiovascular disease. We used Cox regression models to assess the associations of body size categories with disease incidence.

RESULTS

Individuals with low body size in childhood and high body size in adulthood had the highest risk of type 2 diabetes (HR 4.73; 95% CI 4.50, 4.99), compared to those with average body size in both childhood and adulthood. This was significantly higher than the risk in those with high body size in both childhood and adulthood (HR 4.05; 95% CI 3.84, 4.26). By contrast, cardiovascular disease risk was determined by adult body size, irrespective of childhood body size.

CONCLUSIONS/INTERPRETATION

Low body size in childhood exacerbates the risk of type 2 diabetes associated with adult obesity but not the risk of cardiovascular disease. Thus, promoting healthy weight management from childhood to adulthood, among lean children, is crucial.

Early hybrid cardiac rehabilitation in congenital heart disease: the QUALIREHAB trial

BACKGROUND AND AIMS

Cardiopulmonary fitness in congenital heart disease (CHD) decreases faster than in the general population resulting in impaired health-related quality of life (HRQoL). As the standard of care seems insufficient to encourage and maintain fitness, an early hybrid cardiac rehabilitation programme could improve HRQoL in CHD.

METHODS

The QUALIREHAB multicentre, randomized, controlled trial evaluated and implemented a 12-week centre- and home-based hybrid cardiac rehabilitation programme, including multidisciplinary care and physical activity sessions. Adolescent and young adult CHD patients with impaired cardiopulmonary fitness were randomly assigned to either the intervention (i.e. cardiac rehabilitation) or the standard of care. The primary outcome was the change in HRQoL from baseline to 12-month follow-up in an intention-to-treat analysis. The secondary outcomes were the change in cardiovascular parameters, cardiopulmonary fitness, and mental health.

RESULTS

The expected number of 142 patients was enroled in the study (mean age 17.4 ± 3.4 years, 52% female). Patients assigned to the intervention had a significant positive change in HRQoL total score [mean difference 3.8; 95% confidence interval (CI) 0.2; 7.3; P = .038; effect size 0.34], body mass index [mean difference -0.7 kg/m2 (95% CI -1.3; -0.1); P = .022; effect size 0.41], level of physical activity [mean difference 2.5 (95% CI 0.1; 5); P = .044; effect size 0.39], and disease knowledge [mean difference 2.7 (95% CI 0.8; 4.6); P = .007; effect size 0.51]. The per-protocol analysis confirmed these results with a higher magnitude of differences. Acceptability, safety, and short-time effect of the intervention were good to excellent.

CONCLUSIONS

This early hybrid cardiac rehabilitation programme improved HRQoL, body mass index, physical activity, and disease knowledge, in youth with CHD, opening up the possibility for the QUALIREHAB programme to be rolled out to the adult population of CHD and non-congenital cardiac disease.

Hypertension in Athletes: Clinical Implications and Management Strategies

Hypertension is a leading cardiovascular risk factor in athletes. Sport-specific behaviors including nonsteroidal anti-inflammatory use, stimulant use, and unhealthy diets may promote hypertension among athletes. Strength-trained athletes may be more susceptible to hypertension than endurance-trained athletes, although this may, in part, be due to body size differences and the more potent antihypertensive effects of aerobic exercise. With confirmed hypertension, young athletes require secondary hypertension evaluation while older athletes require full cardiovascular risk stratification. Calcium channel blockers and renin-angiotensin-system inhibitors are often preferred pharmacotherapy agents. Further selection of antihypertensives must include consideration of potential side effects and legality in specific sports.

Effects of school nurse-led health education to reduce malnutrition among primary school children in Bangladesh: Cluster nonrandomized controlled trial

Background

Malnutrition is a major health concern among children especially in low and middle-income countries. However, there are limited studies on school health in Bangladesh. This study aimed to reduce malnutrition among primary school children in Bangladesh by increasing awareness and knowledge through school nurse-led health education.

Methods and Materials

A prospective, open-label, parallel-group (1:1), cluster nonrandomized controlled trial on primary school children conducted in rural Bangladesh. The study lasted 13 months between September 2021 and September 2022. Four schools were selected and assigned to the intervention and control groups (CGs). Next, school nurses provided evidence-based health education to the children in the intervention group (IG) for 9 months to improve awareness and knowledge of malnutrition. Data were collected at baseline, midline, and endline.

Results

Overall, 604 children were enrolled at the baseline; among them, 455 (CG, n = 220; IG, n = 235) completed the study. Changes in the malnutrition rate-the primary outcome-were not significant (P = 0.225). However, after adjusting the endline data with baseline and sociodemographic data, the children's body mass index improved significantly in the IG than in the CG (P < 0.05). Changes in eating behavior, and awareness and knowledge of malnutrition-the secondary outcomes-significantly differed between the groups (P < 0.001).

Conclusion

The school nurse-led health education program significantly improved primary school children's awareness and knowledge of malnutrition. This study revealed the effectiveness of school nurses in reducing malnutrition among children, which may decrease future morbidity and mortality rates in children.

Early Infant Feeding Practices and Associations with Growth in Childhood

Early infant growth trajectories have been linked to obesity risk. The aim of this study was to examine early infant feeding practices in association with anthropometric measures and risk of overweight/obesity in childhood. A total of 2492 children from Upstate KIDS, a population-based longitudinal cohort, were included for the analysis. Parents reported breastfeeding and complementary food introduction from 4 to 12 months on questionnaires. Weight and height were reported at 2-3 years of age and during later follow-up at 7-9 years of age. Age and sex z-scores were calculated. Linear mixed models were conducted, adjusting for maternal and child sociodemographic factors. Approximately 54% of infants were formula-fed at <5 months of age. Compared to those formula-fed, BMI- (adjusted B, -0.23; 95% CI: -0.42, -0.05) and weight-for-age z-scores (adjusted B, -0.16; -0.28, -0.03) were lower for those exclusively breastfed. Infants breastfed for ≥12 months had a lower risk of being overweight (aRR, 0.33; 0.18, 0.59) at 2-3 years, relative to formula-fed infants. Compared to introduction at <5 months, the introduction of fruits and vegetables between 5 and 8 months was associated with lower risk of obesity at 7-9 years (aRR, 0.45; 0.22, 0.93). The type and duration of breastfeeding and delayed introduction of certain complementary foods was associated with lower childhood BMI.

Clustered Cardiometabolic Risk and the "Fat but Fit Paradox" in Adolescents: Cross-Sectional Study

The "fat but fit paradox" states that people who are fit have a lower cluster cardiometabolic risk (CCMR), even if they are overweight or obese. Therefore, the objective was to investigate the CCMR between four categories based on the "fat but fit paradox" variable, in different fitness categories-cardiorespiratory fitness, muscular fitness, and physical fitness-in adolescents. Body composition, cardiorespiratory fitness, muscle fitness, blood samples, and blood pressure were assessed in 230 adolescents, and cardiometabolic risk and three different "fat but fit paradox" variables were calculated. Participants with a higher CRF exhibited a lower CCMR within their body mass index (BMI) category (p < 0.05). Participants with a high BMI and high muscular fitness showed a lower CCMR than participants with a low muscular fitness and a similar BMI, or low BMI and low muscular fitness (p < 0.05). When both variables, CRF and muscular fitness, were combined, their effectabove CCMR increased (p < 0.05). Across all fitness categories, the fat and unfit group, whether considered individually or combined, exhibited the highest risk of CCMR (p < 0.05). This study confirms the "fat but fit paradox" in different physical fitness categories, showing the importance of both CRF and muscular fitness as predictors of CCMR, with the combination of both variables showing a greater agreement.

Associations of overweight and obesity with cardiometabolic risk factor clusters among Korean adolescents

This study investigated the association between overweight, obesity, and cardiometabolic risk factor clusters in Korean adolescents. We included 2182 participants (1161 boys and 1021 girls) aged 12-18 years from the Korea National Health and Nutrition Examination Survey (2016-2021). Cardiometabolic risk factors include hypertension, high low-density lipoprotein cholesterol (LDL-C) level, low high-density lipoprotein cholesterol (HDL-C) level, hypertriglyceridemia, high fasting plasma glucose level, elevated alanine aminotransferase level, and hyperuricemia. The average age was 15.1 ± 0.1 years in both boys and girls. The proportion of subjects with ≥ 1, ≥ 2, and ≥ 3 cardiometabolic risk factors was 76.5%, 49.8%, and 22.7% in obese adolescents, and 60.5%, 24.0%, and 9.1%, in overweight adolescents, respectively. Compared to adolescents with underweight/normal weight, the odds ratios (ORs) and 95% confidence intervals for the clustering of cardiometabolic risk factors were at 2.76 (1.74-4.38) for ≥ 1; 3.75 (2.11-6.66) for ≥ 2; and 4.75 (1.70-13.25) for ≥ 3 factors in obese adolescents and 1.88 (1.26-2.81) for ≥ 1 factor in overweight adolescents. Overweight and obese adolescents exhibited high cardiometabolic risk clustering. Prevention and management of overweight/obesity in Korean adolescents are emerging to mitigate health risk associated with this condition.

Improvements in cardiorespiratory fitness, muscle strength and body composition to modest weight loss are similar in those with adult- versus childhood-onset obesity

Adults who have had obesity from childhood are at greater risk of obesity-related comorbidities compared to those who only develop obesity in adulthood. The main way of mitigating these risks in obesity is with weight loss, which has been shown to positively affect the cardiorespiratory fitness (CRF) and body composition of adults. However, it is unclear whether the response of these outcomes to weight loss may be influenced by age of obesity onset. The objective of our study was to investigate how age of obesity onset mitigates the responsiveness of CRF, muscle strength and body composition to modest weight loss. Measurements were conducted at baseline and 12 weeks. In total, 37 participants (childhood-onset = 19, adult-onset = 18) lost 3.7% ± 0.4% through aerobic exercise and diet. The YMCA cycle ergometer test (YMCA) and the 20-m shuttle run test (20MSR) were used to estimate CRF (mL kg-1  min-1 ) and a handgrip dynamometer was used to estimate muscle strength. Total body composition was assessed by dual-energy x-ray absorptiometry (DEXA). Overall, CRF and body composition improved (time effect: p < 0.05) after 12 weeks. There was no group-by-time interaction for YMCA, 20MSR, muscle strength and body composition variables. Therefore, the present study suggests that individuals with childhood-onset obesity and adult-onset obesity can improve their CRF and body composition similarly after mild weight loss.

Impact of preconception and antenatal supplementation with myo-inositol, probiotics, and micronutrients on offspring BMI and weight gain over the first 2 years

BACKGROUND

Nutritional intervention preconception and throughout pregnancy has been proposed as an approach to promoting healthy postnatal weight gain in the offspring but few randomised trials have examined this.

METHODS

Measurements of weight and length were obtained at multiple time points from birth to 2 years among 576 offspring of women randomised to receive preconception and antenatally either a supplement containing myo-inositol, probiotics, and additional micronutrients (intervention) or a standard micronutrient supplement (control). We examined the influence on age- and sex-standardised BMI at 2 years (WHO standards, adjusting for study site, sex, maternal parity, smoking and pre-pregnancy BMI, and gestational age), together with the change in weight, length, BMI from birth, and weight gain trajectories using latent class growth analysis.

RESULTS

At 2 years, there was a trend towards lower mean BMI among intervention offspring (adjusted mean difference [aMD] - 0.14 SD [95% CI 0.30, 0.02], p = 0.09), and fewer had a BMI > 95th percentile (i.e. > 1.65 SD, 9.2% vs 18.0%, adjusted risk ratio [aRR] 0.51 [95% CI 0.31, 0.82], p = 0.006). Longitudinal data revealed that intervention offspring had a 24% reduced risk of experiencing rapid weight gain > 0.67 SD in the first year of life (21.9% vs 31.1%, aRR 0.76 [95% CI 0.58, 1.00], p = 0.047). The risk was likewise decreased for sustained weight gain > 1.34 SD in the first 2 years of life (7.7% vs 17.1%, aRR 0.55 [95% CI 0.34, 0.88], p = 0.014). From five weight gain trajectories identified, there were more intervention offspring in the "normal" weight gain trajectory characterised by stable weight SDS around 0 SD from birth to 2 years (38.8% vs 30.1%, RR 1.29 [95% CI 1.03, 1.62], p = 0.029).

CONCLUSIONS

Supplementation with myo-inositol, probiotics, and additional micronutrients preconception and in pregnancy reduced the incidence of rapid weight gain and obesity at 2 years among offspring. Previous reports suggest these effects will likely translate to health benefits, but longer-term follow-up is needed to evaluate this.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02509988 (Universal Trial Number U1111-1171-8056). Registered on 16 July 2015.

Cardiovascular Disease Events in Adults with a History of State Care in Childhood: Pooling of Unpublished Results from 9 Cohort Studies

Background

Individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected physical and mental health problems in adulthood, however, their risk of cardiovascular disease (CVD) is uncertain. Accordingly, we pooled published and unpublished results from cohort studies of childhood care and adult CVD.

Methods

We used two approaches to identifying relevant data on childhood care and adult CVD (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the aim of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews of the impact of childhood state care on related adult health outcomes. All included studies were required to have prospective measurement of state care in childhood and a follow-up of CVD events in adulthood as the primary outcome (incident coronary heart disease and/or stroke). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality.

Findings

Thirteen studies (2 published, 11 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Relative to the unexposed, individuals with a care placement during childhood had a 50% greater risk of CVD in adulthood (summary rate ratio after basic adjustment [95% confidence interval]: 1.50 [1.22, 1.84]); range of study-specific estimates: 1.28 to 2.06; I2 = 69%, p = 0.001). This association was attenuated but persisted after multivariable adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.28 [1.10, 1.50]). There was a suggestion of a stronger state care-CVD association in women.

Interpretation

Our findings show that individuals with experience of state care in childhood have a moderately raised risk of CVD in adulthood. For timely prevention, clinicians and policy makers should be aware that people with a care history may need additional attention in risk factor management.

The impact of age-specific childhood body-mass index on adult cardiometabolic traits: a Mendelian randomization study

Objective

To evaluate the causal relationship between childhood body-mass index (BMI) at different ages and adult cardiometabolic traits.

Methods

We retrieved genetic instrument variables (IVs) for exposures (standardized BMI at newborn, infant, toddler and late childhood), cardiometabolic traits and potential confounders or mediators (adult BMI, SHBG, testosterone and age at menarche) from the corresponding genome-wide association analysis. We performed univariate and multivariable Mendelian randomization (MR) to dissect associations between age-specific childhood BMI and adult cardiometabolic outcomes. Odds ratio was used to present the direction of the causal association.

Results

In univariate MR, higher newborn BMI was causally associated with reduced risk for type 2 diabetes in women. Late childhood BMI was associated with increased risk for female diabetes and coronary artery disease (CAD), myocardial infarction (MI), and chronic kidney disease (CKD) in general population. Among these associations, only association between late childhood BMI with MI remained significant after adjusting for adult male BMI and sex hormones, (OR = 1.120, 95% CI 1.023-1.226, p = 0.014). Besides, in multivariable MR, we found evidence for causal association between newborn BMI with reduced risk for CAD (OR = 0.862, 95% CI 0.751-0.989, p = 0.034) and MI (OR = 0.864, 95% CI 0.752-0.991, p = 0.037) in men. No obvious impact of infant or toddler BMI was identified on the above-mentioned diseases. For continuous cardiometabolic traits, in all age epochs except infant, higher BMI was associated with increased level of fasting glucose in women.

Conclusion

BMI at birth and late childhood exerts different impact on adult cardiometabolic diseases, while BMI at infant and toddler ages is not causally associated with these outcomes. The effect of childhood BMI may be influenced by sex disparities.

Birth Weight, Childhood and Young Adult Overweight, and the Risk of Coronary Heart Disease in Men

BACKGROUND

Low birth weight is a known risk factor for adult coronary heart disease (CHD), but the additional effect of weight development during childhood and early adult life has not been studied.

METHODS

We included 35 659 men born 1945 to 1961 from the population-based BMI Epidemiology Study Gothenburg, with data available on birthweight, BMI in childhood (8 years), and BMI in young adulthood (20 years). Information on CHD diagnoses was retrieved from national registers. We used Cox proportional hazards regression to estimate hazard ratios and 95% CIs for the risk of early and late CHD (before and after 58.4 years of age, respectively).

RESULTS

During follow-up, a total of 3380 cases of CHD (fatal and nonfatal) were registered. Birth weight was inversely associated with the risk of both early (hazard ratio, 0.88 per SD increase [95% CI, 0.84-0.92]) and late (hazard ratio, 0.94 per SD increase [95% CI, 0.90-0.98]) CHD, independently of BMI at 8 years and BMI change during puberty. In a model including birth weight (below or above the median) together with overweight at 8 and 20 years, only birth weight and young adult overweight, but not overweight in childhood, were significantly associated with the risk of CHD. A birth weight below the median, followed by overweight at 20 years of age was associated with a more than doubled risk of early CHD (hazard ratio, 2.29 [95% CI, 1.86-2.81]), compared with the reference (birth weight above the median and normal weight at 20 years of age). This excess risk was even more pronounced for a birthweight below 2.5 kg.

CONCLUSIONS

We demonstrate that low birth weight and young adult overweight are important developmental markers of risk for adult CHD. These findings motivate a life course perspective for prevention and risk assessment of adult CHD.

Normal pediatric values of carotid artery intima-media thickness measured by B-mode ultrasound and radiofrequency echo tracking respecting the consensus: a systematic review

BACKGROUND

Carotid artery intima-media thickness (IMT) is a sub-clinical radiologic marker of atherosclerosis in children. It is associated with adult-onset vascular disease.

OBJECTIVE

To determine normal pediatric values of IMT from results observed in the literature.

METHODS

Our systematic review was conducted according to PRISMA guidelines. We reviewed 2298 English articles from inception to February 2023. Inclusion criteria included studies evaluating B-mode and radiofrequency (RF)-based IMT measurements based on the American Heart Association, the Association for European Pediatric Cardiology, the Mannheim Consensus, and the American Society of Echocardiography recommendations. A meta-analysis of aggregate data was conducted to obtain the confidence interval (CI) for IMT, using a 95% confidence level.

RESULTS

We obtained 88 B-mode-based IMT measurement studies with 6184 children and six radiofrequency echo-tracking-based studies with 766 children. Mean IMT in the pediatric population was 0.43 mm, 95% [CI] 0,42 to 0.44, using the B-mode technique, and 0.41 mm, 95% [CI] 0.36 to 0.45 using the radiofrequency technique. No significant relationship was detected between IMT and age (p value = 0.83). Finally, no significant effect of sex on IMT was found (p value = 0.82 for B-mode and p value = 0.62 for RF).

CONCLUSION

Based on the studies selected in this literature review, we were unable to conclude that there was a significant difference between the average IMT of boys and girls. No relationship was demonstrated between age and IMT. IMT is technique-specific, and normal values should be interpreted according to recommendations of recognized consensus to counteract the current heterogeneity in literature.

CLINICAL RELEVANCE STATEMENT

Technique and children-specific Intima media thickness measurements help clinicians and scientists to assess the risk of atherosclerosis in children.

KEY POINTS

• Intima-media thickness (IMT) does not correlate with age in children without risk factors. • According to current literature, there is no difference in IMT between healthy boys and girls. • There is heterogeneity, even with studies abiding by the official consensus.