Dietary Patterns and Childhood Obesity Risk: A Systematic Review

Dietary patterns among European children and their association with adiposity-related outcomes: a multi-country study

BACKGROUND/OBJECTIVE

Children's diets in school-age are inherently unhealthy, with few meeting dietary recommendations. Yet, little is known about similarities and differences on dietary patterns across countries and their association with obesity. We aimed to derive dietary patterns in childhood and explore their association with adiposity-related outcomes in childhood and adolescence.

SUBJCTS/METHODS

This study included data from six European countries (Spain, France, UK, Greece, Lithuania and Norway) during childhood (n = 1597) and adolescence (n = 803). Using a food frequency questionnaire, we derived data-driven dietary patterns through exploratory factor analyses and calculated the Mediterranean KIDMED index. We assessed body mass index z-score (zBMI), fat mass proportion and waist-to-height ratio at both visits. Associations were estimated using generalized linear regressions, adjusted for key-confounders.

RESULTS

"Meat", "Dairy", "Western", "Healthy" and "Sweets and fats" dietary patterns were derived. Norwegian children showed better diet quality, with higher consumption of fruits and vegetables, and highest "Healthy pattern" adherence, and Lithuanian children, the worst, with higher sweets consumption, and highest "Western pattern" adherence. Children with lower intake of healthy foods (vegetables, fruits, fish) tended to have higher adiposity, e.g., children with average or low "Healthy pattern" adherence (vs. high) had higher fat mass proportion in childhood (average: β (95% CI) 1.44 (0.48; 2.39), low: 1.10 (0.09; 2.12)). Low adherence to a "Healthy pattern" (vs. high) was associated with increased adolescent zBMI, and child and adolescent waist-to-height ratio. Low "Dairy pattern" adherence (vs. high), was associated with lower zBMI and fat mass in childhood, but not in adolescence. No significant associations were seen with the KIDMED index.

CONCLUSIONS

Many European children have poor diets and a low adherence to a healthy diet pattern may be of concern for adiposity-related outcomes. Assessment of children's dietary patterns can help tailor dietary advice and provide support for families aiming to prevent future excess weight gain.

Effectiveness of Universal Community Engagement Childhood Obesity Interventions at Improving Weight-Related and Behavioral Outcomes among Children and Adolescents: A Systematic Review and Meta-Analysis

BACKGROUND

Universal community engagement interventions can address childhood obesity.

OBJECTIVES

This review aimed to evaluate the effectiveness of these interventions in improving body mass index (BMI) (primary outcome) as well as dietary choices and activity levels (secondary outcomes) among children and adolescents.

METHODS

Eight electronic databases were searched from inception dates to January 2024. A meta-analysis was conducted using the random-effect model, when appropriate; otherwise, the findings were narratively synthesized. Heterogeneity was determined by the I2 statistics and Cochran's Q chi-squared test. The Cochrane ROB tool and the GRADE approach were used to assess the quality appraisal at the study and outcome levels, respectively.

RESULTS

Twenty-two studies were included in this review. The results showed that these interventions had a limited effect in improving children's standardized BMI (BMI-z) scores post-intervention. A meta-analysis on BMI-z scores showed that the intervention group had a statistically non-significantly lower BMI-z score than the control group (MD = -0.02, 95%CI = [-0.07, 0.03], Z = 0.83, p = 0.40) at immediate post-intervention. It was also reported that universal community engagement interventions had a limited effect in improving children's dietary choices and activity levels. Only the meta-analysis on children's daily sugar-sweetened beverage intake measured using continuous data reported a statistically significant small effect favoring the intervention group (SMD = -0.25, 95%CI = [-0.38, -0.13], Z = 3.98, p < 0.0001) at immediate post-intervention.

CONCLUSIONS

Universal community engagement interventions have the potential to address childhood obesity. Children and adolescents could benefit more from interventions that focus on implementing both environmental and behavioral changes, and interventions that include parental involvement.

Adherence to the Mediterranean diet and changes in body mass index

BACKGROUND

Diet is considered a determinant of weight status, however, more evidence is needed for children. The Mediterranean diet (MedDiet) is one of the healthiest worldwide. This study analyzes the prospective association between adherence to the MedDiet at baseline and changes in standardized body mass index (zBMI) and the incidence of excessive weight.

METHODS

1389 children participated with a follow-up of 15 months. Weight, height, and adherence to the MedDiet were measured (baseline and follow-up).

RESULTS

Multiple logistic regression analysis revealed that a high increase in zBMI was associated with lower odds of eating vegetables once [OR 0.74 (95% CI 0.57-0.98)] or more a day [OR 0.68 (95% CI 0.49-0.95)], nuts 2-3 times/week [OR 0.74 (95% CI 0.56-0.97)] or 2 cups of yogurt or/and cheese daily [OR 0.74 (95% CI 0.55-0.99)]. Not consuming each food item was used as reference. Multiple linear regression analysis showed a negative (β = -0.010, p = 0.040) association between the MedDiet at baseline and changes in zBMI at follow-up, significance disappeared (p = 0.082) after final adjustment for baseline zBMI.

CONCLUSION

Baseline MedDiet was not significantly associated with the incidence of excessive weight at follow-up. The MedDiet was positively associated with changes in zBMI, however the effect size was small.

IMPACT

The present longitudinal study contributes knowledge regarding the adherence to Mediterranean diet as a predictive variable of weight status evolution in children. Higher adherence to the Mediterranean diet at baseline was prospectively and inversely associated with changes in zBMI after 15 months of follow-up. Consuming vegetables, nuts, and yoghurt/cheese according to the recommendations reduces the likelihood of having a high increase in zBMI after 15 months of follow-up.

Lifestyle Interventions in Pediatric Primary Care

Pediatric clinicians should offer guidance on age-appropriate nutrition, physical activity, sleep and screen time for families of children and adolescents with obesity. They should build rapport with families, ask permission before discussing obesity-related health concerns, use preferred terminology, and recommend whole family change. Using principles of shared decision-making, pediatric clinicians and families should set individualized goals for lifestyle changes, prioritizing reducing sugar-sweetened beverage intake, increasing physical activity, and reducing screen time. Families of children and adolescents with obesity should be connected to the highest level of support accessible to and desired by the family, including intensive health behavior and lifestyle treatment programs.

Association between obesity phenotypes and dietary patterns: A two-step cluster analysis based on the China multi-ethnic cohort study

OBJECTIVE

This study aimed to explore obesity phenotypes and investigate their association with dietary patterns.

METHODS

Data were obtained from the baseline survey conducted in the China Multi-Ethnic Cohort Study from July 2018 to August 2019. All participants with a body mass index of at least 24 kg/m2 were enrolled and underwent a questionnaire survey, physical examination, and clinical laboratory tests. A two-step cluster analysis was employed to classify the participants into phenotypes. Dietary information was collected using the food frequency questionnaire, and principal component analysis was conducted to identify distinct dietary patterns.

RESULTS

We analyzed the data of 8757 participants. They were categorized based on demographic characteristics, biochemical indicators, and anthropometric measurements into two distinct clusters identified as metabolically healthy obesity and metabolically unhealthy obesity (MUO). Key predictors included serum uric acid, sex, and diastolic blood pressure. Subgroup analysis by sex identified three distinct clusters within both male and female participants. The MUO group had the highest prevalence of a range of chronic noncommunicable diseases. The analysis uncovered three unique dietary patterns among participants classified as the premium protein, rice-oil-red meat, and oil-salt patterns. Notably, the MUO subgroup demonstrated significantly higher factor scores for both the rice-oil-red meat and oil-salt patterns.

CONCLUSIONS

Obesity phenotypes are closely related to metabolic and demographic characteristics, with serum uric acid being a significant factor in categorizing the metabolic states of obesity. The rice-oil-red meat and oil-salt patterns may be related to the metabolic status of individuals with obesity.

Nutritional Nesting (Nestrition): Shaping the Home Food Environment in the First Pregnancy

OBJECTIVE

To investigate primiparous women's knowledge, attitudes, and practices regarding the physical home food environment (PHFE) and to assess if the first pregnancy provides a teachable opportunity to enhance the PHFE of first-time pregnant couples.

DESIGN

Longitudinal in-depth qualitative study involving questionnaires and individual interviews during and after pregnancy.

PARTICIPANTS

Fifteen primigravida women.

MAIN OUTCOME MEASURES

Knowledge, attitudes, and behaviors concerning PHFE; lifestyle and dietary habits; and interest in guidance regarding healthy PHFE during the first pregnancy and the transition to motherhood.

ANALYSIS

Thematic analysis for qualitative data and descriptive statistics.

RESULTS

Key findings include the significance of health, nutrition, and spousal support in the transition to motherhood. The first pregnancy was recognized as a critical period for establishing a healthy PHFE, while noting the physical and emotional challenges involved. A gap was found in guidance regarding PHFE for first-time pregnant women despite their interest in practical advice.

CONCLUSIONS AND IMPLICATIONS

The first pregnancy presents a significant opportunity to improve PHFE. 'Nestrition' (nutritional nesting), a new health-promotion strategy, incorporates nutrition education to enhance this process. These data support future research encompassing partners and diverse at-risk populations prior to the development of effective nutrition education for PHFE in the first pregnancy.

Food consumption and adherence to dietary guidelines among Jordanian children and adolescents

Background

Early-life food consumption patterns may affect children's health by increasing susceptibility to developing non-communicable chronic diseases (NCDs) in adulthood.

Aims

To evaluate Jordanian children and adolescents' energy and macronutrient intake and how closely they adhere to dietary recommendations.

Methods

This cross-sectional study used data from Jordan's Population-based Food Consumption Survey, a household population-based study conducted in Jordan between 2021 and 2022 (561 children and adolescents 8-19 years). Dietary intake was assessed using the two non-consecutive 24-hour dietary recall methods (24-h DR). The estimated food group and nutrient intakes were compared to nutritional recommendations, including MyPlate dietary guidelines.

Results

The prevalence of overweight/obese individuals based on body mass index (BMI) was 44%, and the average waist-to-height ratio (WHtR) was 24.7%. Compared to MyPlate dietary guidelines, children and adolescents had a higher added sugar intake (57g/day). Also, consuming vegetables, fruits, and dairy fell short of MyPlate dietary guidelines. The total discretionary calorie intake in children and adolescents was approximately one-third of the total energy intake.

Conclusion

The food consumption of Jordanian children and adolescents includes high intakes of discretionary calories, with a low intake of fruits, vegetables, and dairy products. The prevalence of overweight/obesity was elevated compared to international norms.

Are the EAT-Lancet dietary recommendations associated with future cardiometabolic health? - Insights from the Generation XXI cohort from childhood into early adolescence

BACKGROUND

The prospective effect of healthy and planetary diets on cardiometabolic health at young ages remains unclear.

OBJECTIVES

This study aims to investigate the prospective associations between adherence to the EAT-Lancet dietary recommendations at age 7 and the prevalence of obesity and Metabolic Syndrome (MetS) at 7, 10, and 13 y old.

METHODS

Participants are children from the Generation XXI birth cohort who completed 3-d food diaries at age 7, with complete data in variables of interest (n = 3564). Adherence to the EAT-Lancet dietary recommendations was evaluated using the World Index for Sustainability and Health (WISH); a higher score indicates a healthier and environmentally sustainable diet. At 7, 10, and 13 y, anthropometrics (weight, height, and waist circumference), blood pressure, serum-fasting triglycerides, high-density lipoprotein cholesterol, and glucose were measured. Obesity and MetS prevalence were determined by the World Health Organization and the International Diabetes Federation criteria, respectively. Adjusted custom binomial log-linear models were used to calculate prevalence ratios (PR) and the respective 95% confidence intervals (95% CI) (covariates: mother's age, education, prepregnancy body mass index (BMI), gestational diabetes, child's sex, age, Tanner stage, sports practice and total grams of the remaining food).

RESULTS

From 7 to 13 y, obesity decreased from 14.1% to 9.3% and MetS increased from 1.0% to 5.1%. Higher WISH scores at 7 y were associated with a lower prevalence of obesity, measured by both BMI (≥97th percentile: PR = 0.912; 95% CI: 0.839, 0.991; PR = 0.882; 95% CI: 0.79, 0.938, respectively at 10 and 13 y) and waist circumference (≥90th percentile: PR = 0.899; 95% CI: 0.830, 0.974; PR = 0.858; 95% CI: 0.782, 0.942, respectively at 10 and 13 y). For each 10-point increase in the WISH, a reduction of 16% in MetS prevalence at 13 y was observed (PR = 0.837; 95% CI: 0.732, 0.957). No significant effects were found at younger ages.

CONCLUSIONS

Adherence to the EAT-Lancet diet from an early age may help reduce cardiometabolic risk in early adolescence.

Early life factors that affect obesity and the need for complex solutions

The prevalence of obesity increases with age but is apparent even in early life. Early childhood is a critical period for development that is known to influence future health. Even so, the focus on obesity in this phase, and the factors that affect the development of obesity, has only emerged over the past two decades. Furthermore, there is a paucity of iterative work in this area that would move the field forward. Obesity is a complex condition involving the interplay of multiple influences at different levels: the individual and biological level, the sociocultural level, and the environmental and system levels. This Review provides a brief overview of the evidence for these factors with a focus on aspects specific to early life. By spotlighting the complex web of interactions between the broad range of influences, both causal and risk markers, we highlight the complex nature of the condition. Much work in the early life field remains observational and many of the intervention studies are limited by a focus on single influences and a disjointed approach to solutions. Yet the complexity of obesity necessitates coordinated multi-focused solutions and joined-up action across the first 2,000 days from conception, and beyond.

Associations between Meal Patterns and Risk of Overweight/Obesity in Children and Adolescents in Western Countries: A Systematic Review of Longitudinal Studies and Randomised Controlled Trials

Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity-MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO in children/adolescents aged 2-19 years. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 and April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk, with none on MUO risk. Regular consumption of breakfast (n = 3) and family meals (n = 4) and avoiding dining while watching TV (n = 4) may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast; n = 4) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and the use of harmonised definitions regarding the assessment of meal patterns are highly warranted.

Prevalence of childhood obesity in Spain and its relation with socioeconomic status and health behaviors: Population-based cross-sectional study

OBJECTIVES

This study aims to assess the current state of childhood overweight and obesity in Spain, and its relationship with socioeconomic status and health-related behaviors.

METHODS

Population-based cross-sectional observational study, based on the 2017 National Health Survey in minors in Spain. This study included all children surveyed who were aged 1-14 years. Childhood obesity was estimated from the z-score of the body mass index.

RESULTS

The study included 4882 children aged 1-14 years (mean 7.5). The prevalence of obesity was 18.6% (95% confidence interval [CI] 18.5-18.7), while 13.5% (95% CI 13.4-13.6) were overweight. These figures represent over a million children in Spain who are obese and nearly 750,000 who are overweight. A north-south geographic gradient was apparent, with higher prevalence of unhealthy body weight in southern Spain. Factors associated with childhood obesity were low socioeconomic status, poor diet and sedentarism, among others.

CONCLUSIONS

Childhood overweight in Spain is strongly associated with socioeconomic status and other factors such as diet and sedentarism. Multidisciplinary public health interventions are needed to reduce this serious health problem in children.

Relationship between motivations and dietary behaviours within parent-adolescent dyads: Application of actor-partner interdependence models

BACKGROUND

Parents play a substantial role in improving adolescent dietary behaviours.

OBJECTIVES

To examine the interdependent relationships between motivations (autonomous and emotional motivation) and dietary behaviours (fruit and vegetable [F/V] and junk food and sugar-sweetened beverage [JF/SSB] intake) within parent-adolescent dyads.

METHODS

This secondary data analysis was conducted on 1522 parent-adolescent dyads using a cross-sectional Family Life, Activity, Sun, Health, and Eating (FLASHE) study. The ratio of boys to girls among the adolescents was approximately equal, and 74% of the parents were mothers. The adolescents were between 12 and 17 years old, and 85.5% of the parents were between 35 and 59 years old. Parents and adolescents completed an online survey on dietary motivations and behaviours. Actor-partner interdependence models were performed within parent-adolescent dyads.

RESULTS

F/V and JF/SSB intake was influenced by parents' or adolescents' autonomous motivation (actor-only pattern), except among adolescents with obesity. A dyadic pattern was found in the relationship between autonomous motivation and F/V and JF/SSB intake, but only among adolescents with normal weight. No relationship was found between F/V and JF/SSB controlled motivation and F/V or JF/SSB intake among adolescents with overweight or obesity.

CONCLUSIONS

Autonomous motivation had a significant relationship with F/V and JF/SSB intake for both parents and adolescents, but the association varied depending on the adolescents' weight. Personalized programmes that foster autonomous motivation to change dietary behaviours should be provided based on the adolescents' weight status.

Nuts and seeds consumption impact on adolescent obesity: sex-specific associations from 2003 to 2018 National Health and Nutrition Examination Survey

The nutritional benefits and immunological advantages of consuming nuts and seeds are well-established. However, the link between nuts and seeds consumption and the susceptibility of being overweight or obese among adolescents is not clear. This study aims to explore this relationship in adolescents aged 12-19. Using a weighted multiple logistic regression model, we analysed data of the Food Patterns Equivalents Database and the U.S. National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018. We found a significant association between nuts and seeds consumption and a reduced odds of being overweight or obese in females. Specifically, females who habitually consumed nuts and seeds had lower odds of being overweight or obese (OR = 0.55, 95% CI: 0.32-0.94). Additionally, we found an L-shaped relationship between nuts and seeds consumption and appropriate waist-to-height ratio in males. The findings suggest that nuts and seeds consumption may contribute to healthier physical development in adolescents.

Policy, Systems, and Environmental Strategies to Support Healthy Eating Behaviors in Early Childhood: A Scoping Review of Existing Evaluation Tools

BACKGROUND

Policy, systems, and environmental (PSE) change strategies aimed at supporting healthy eating behaviors work to enhance optimal nutrition by making healthy foods more available and accessible in the community. PSE change strategies can complement and strengthen knowledge, skills, and behaviors obtained through individual-level nutrition education.

OBJECTIVE

This scoping review aimed to identify existing literature evaluating early childhood (ie, children younger than age 5 years) PSE change strategies supporting healthy eating behaviors and to describe the evaluation tools used to assess the identified PSE change strategies.

METHODS

Three databases (PubMed, Cumulated Index in Nursing and Allied Health Literature, and Web of Science) were used to systematically search for articles published between 2013 and 2023 written in English and conducted in the United States that evaluated PSE change strategies supporting healthy eating behaviors in young children (ie, children younger than age 5 years). Two study members conducted the review, discussing and reconciling discrepancies until a consensus was reached for interobserver reliability.

RESULTS

Findings from this review identified 48 studies evaluating early childhood PSE change strategies supporting healthy eating behaviors, with 36 studies using 25 PSE-focused evaluation tools to evaluate these strategies. Most tools (80%) assessed PSE change strategies supporting access and availability of healthy food and beverage options in early childhood education settings. Studies did not evaluate child-level outcomes (ie, attitudes, preferences, and behaviors) to showcase improvement of early childhood nutrition. Only 60% of the tools reported evidence of validity or reliability.

CONCLUSIONS

Most of the studies identified in this scoping review were aimed to evaluate healthy eating PSE change strategies focused on improving access to and availability of healthy foods and beverages in early childhood education settings. Future research is needed to develop and validate PSE-focused evaluation tools assessing child-level healthy eating practices and behaviors.

Exploration of the Determinants of Subjective Health and Depression Using Korean Longitudinal Study of Aging Data

Aging is an imperative issue in Korean society, and a healthy life is important for a better quality of life for older adults. Therefore, the purpose of this research was to investigate the determinants of subjective health and depression in middle-aged and elderly Korean individuals. This study used three attributes as the determinants of subjective health and depression, including the curve linear effect of medical expenses and eating-out expenses and the linear impact of regular exercise. We utilized the Korean Longitudinal Study of Aging (KLOSA) to determine the associations between five attributes: subjective health, depression, medical expenses, eating-out expenses, and regular exercise. Research panel data were employed as the data source. The study period was between 2018 and 2020. This research implemented various multiple linear panel regression econometric analysis instruments: ordinary least squares, random effects, and fixed effects. The mean age of survey participants was 72.10 years, and 35 percent of participants were female. The number of observations for data analysis was 7197. The results revealed that medical and eating-out expenses had a curved linear effect on subjective health and depression. Moreover, regular exercise positively affected subjective health and resulted in less depression. These findings may inform policy decisions that promote regular exercise and manage medical and eating-out expenses, thereby enhancing subjective health and mitigating depression.

Adherence to Mediterranean Diet and Health Outcomes in Adolescents: An Umbrella Review

CONTEXT

Proper nutrition represents 1 of the domains of adolescents' well-being. In this context, the Mediterranean diet (MD), as a healthy, traditional, and sustainable dietary pattern, plays a crucial role in promoting adequate growth and preventing chronic noncommunicable diseases.

OBJECTIVE

The currently available evidence on the effects of adherence to the MD (AMD) in association with several physical health outcomes in adolescence is summarized in this review.

DATA SOURCES

Five electronic databases were searched.

STUDY SELECTION

Systematic reviews with or without meta-analysis of observational studies and randomized clinical trials, published in English during 2013-2022, and that assessed the health impact of AMD among adolescents were eligible.

DATA EXTRACTION

Details on study design, methods, population, assessment of dietary patterns, health outcomes, and main results were extracted.

RESULTS

The search yielded 59 references after removal of duplicates. Applying PICOS criteria, 4 systematic reviews and 3 meta-analyses ultimately were included in this review. The AMD was evaluated in association with overweight/obesity and adiposity in 2 studies, musculoskeletal health in another 2, inflammation in 1 study, and cardiometabolic health in 1 study. The seventh review examined all mentioned health outcomes (overweight and obesity, musculoskeletal health, inflammation, and cardiometabolic health) in relation to AMD.

CONCLUSIONS

Overall, this umbrella review showed limited evidence and a lack of consistency about the relation between AMD and health outcomes of interest in adolescence, indicating the need for more studies to better understand it.

SYSTEMIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023428712.

Relationship Between School Food Environment and Eating Behaviors of Primary School Children in Dodoma: A Cross-Sectional Study

This cross-sectional study assesses the relationship between school food environment and eating behaviors of primary school children in Dodoma among 248 primary school children aged 6-13 years. School characteristics information and socio-demographic characteristics were collected. Multilevel modeling was employed to assess the individual-level variance in eating behaviors. Most of the variances in the investigated eating behaviors were at the personal level. Significant associations (p < .05) were between protein-rich food intake and fats and sugar-rich food with the death of either parent. And association between intake of vitamin and mineral-rich foods and the number of people living in household.

Prevalence and associated factors of overweight in Chinese adolescents: A cross-sectional study

Background and Aim

Obesity has been a global public health issue due to the increasing mortality rate and prevalence among children. However, there are scarce studies on obesity prevalence in Hong Kong children. The study aims to identify the risk factors of obesity among primary and secondary school students by assessing the relationship between sociodemographic factors, health-related behaviors, and social relationships.

Methods

Self-administrated surveys were collected from 30 primary schools and 25 secondary schools participating in the "Quality Education Fund Thematic Network on Health Schools" project. Descriptive analysis was conducted to examine the proportions of different characteristics and to compare the disparity between primary and secondary school students with obesity.

Results

A total of 4884 responses were collected. A larger proportion of primary school students with obesity were male (adjusted odds ratio [aOR]: 2.55, 95% confidence interval [CI]: 1.77-3.67, p < 0.001) and actively gamed (aOR: 1.64, 95% CI: 1.07-2.51, p = 0.024). Secondary school students with obesity were male (aOR: 1.61, 95% CI: 1.21-2.13, p = 0.001), had poor self-perceived academic performance (aOR:1.51, 95% CI: 1.10-2.08, p = 0.011) and expressed higher life satisfaction (family) (aOR: 1.13, 95% CI: 1.01-1.26, p = 0.032). There were negative associations found between obesity and physical activity, high consumption of sugary drinks, chocolate or candies, and insufficient consumption of vegetables.

Conclusion

Male sex, physical inactivity, low self-perecived academic performance, and poor dietary behaviors were the risk factors for obesity among primary and secondary school students. The findings highlighted the importance of identifying younger individuals who were at risk of becoming clinically obese. Further studies should explore the effectiveness of various interventions through longitudinal study.

Early Lifestyle Determinants of Adiposity Trajectories from Childhood into Late Adolescence

Objective: The aim of this study was to examine associations of childhood physical activity, sedentary behavior, and dietary intake with adiposity trajectories from childhood to adolescence. Methods: Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) cohort (n = 630) data from 3 time points (8-10, 10-12, and 15-17 years) for 377 Caucasian children with parental obesity were analyzed. Height and weight, physical activity and sedentary behavior (7-day accelerometry), screen time (self-reported), and dietary intake (three 24-hour diet recalls) were measured. Group-based trajectory modeling identified longitudinal trajectories of body-mass index z-scores (zBMIs). Inverse probability of exposure-weighted multinomial logistic regressions examined associations between baseline lifestyles and zBMI trajectory groups. Results: Six trajectory groups were identified: Stable-Low-Normal-Weight (two groups, 5.7% and 33.0%, which were combined), Stable-High-Normal-Weight (24.8%), Stable-Overweight (19.8%), Stable-Obesity (8.8%), and Overweight-Decreasers (7.9%). For every additional portion of fruits and vegetables, the likelihood of being in the group of Overweight-Decreasers increased by 29% (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.09-1.55) compared with the reference group (Stable-Low-Normal-Weight). For every additional hour of sedentary behavior, the likelihood of belonging to the group of Overweight-Decreasers increased 2-fold (OR: 1.99, 95% CI: 1.28-3.21) and Stable-Obesity increased 1.5-fold (OR: 1.56, 95% CI: 1.08-2.23), compared with the reference. Every additional 10 minutes of moderate-to-vigorous physical activity was associated with a lower likelihood of belonging to the Stable-Obesity group (OR: 0.75, 95% CI: 0.61-0.89) and to the group of Overweight-Decreasers (OR: 0.79, 95% CI: 0.64-0.95) compared with the reference. Finally, children were more likely to belong to the Stable-Obesity group with each additional hour/day of screen time (OR: 1.23, 95% CI: 1.01-1.58). Conclusions: Trajectories of zBMIs from childhood to late adolescence were stable, except for one group which decreased from overweight in childhood to normal weight in adolescence. The latter had more favorable baseline dietary intake of fruits and vegetables. ClinicalTrials.org no. NCT03356262.

Egocentric 3D Skeleton Learning in a Deep Neural Network Encodes Obese-like Motion Representations

Obesity is a growing health concern, mainly caused by poor dietary habits. Yet, accurately tracking the diet and food intake of individuals with obesity is challenging. Although 3D motion capture technology is becoming increasingly important in healthcare, its potential for detecting early signs of obesity has not been fully explored. In this research, we used a deep LSTM network trained with individual identity (identity-trained deep LSTM network) to analyze 3D time-series skeleton data from mouse models with diet-induced obesity. First, we analyzed the data from two different viewpoints: allocentric and egocentric. Second, we trained various deep recurrent networks (e.g., RNN, GRU, LSTM) to predict the identity. Lastly, we tested whether these models effectively encode obese-like motion representations by training a support vector classifier with the latent features from the last layer. Our experimental results indicate that the optimal performance is achieved when utilizing an identity-trained deep LSTM network in conjunction with an egocentric viewpoint. This approach suggests a new way to use deep learning to spot health risks in mouse models of obesity and should be useful for detecting early signs of obesity in humans.

Prevalence of obesity and associated sociodemographic and lifestyle factors in Ecuadorian children and adolescents

BACKGROUND

Given the increasing prevalence of obesity in young people in Ecuador, there is a need to understand the factors associated with this condition. The aim of this study was to assess the prevalence of obesity in Ecuadorian children and adolescents aged 5-17 years and identify its associated sociodemographic and lifestyle factors.

METHODS

This cross-sectional study was conducted using data from the Encuesta Nacional de Salud y Nutrición (ENSANUT-2018). The final sample consisted of 11,980 participants who provided full information on the variables of interest.

RESULTS

The prevalence of obesity was 12.7%. A lower odd of having obesity was observed for adolescents; for those with a breadwinner with an educational level in middle/high school or higher; for each additional day with 60 or more minutes of daily moderate-to-vigorous physical activity; and for those with greater daily vegetable consumption (one, two, or three or more servings). Conversely, there were greater odds of obesity in participants from families with medium, poor, and very poor wealth and those from the coast and insular region.

CONCLUSIONS

The high prevalence of obesity in Ecuadorian children and adolescents is a public health concern. Sociodemographic and lifestyle behavior differences in young people with obesity should be considered when developing specific interventions.

IMPACT

As the prevalence of obesity among children and adolescents increases in Latin America, with a particular focus on Ecuador, it becomes crucial to delve into the factors linked to this condition and identify the most successful strategies for its mitigation. The elevated prevalence of obesity among young individuals in Ecuador raises significant public health concerns. To develop targeted interventions, it is crucial to account for sociodemographic variables and lifestyle behaviors that contribute to obesity in this population.

Understanding health behaviors that modify the risk for obesity in ADHD

OBJECTIVE

Research provides support for the associated risk of inadequate sleep duration, limited physical activity, and excessive media use in attention-deficit/hyperactivity disorder (ADHD) and obesity. The present study aims to (1) examine the association between ADHD and overweight or obese status (OW/OB); (2) comprehensively examine sleep duration, physical activity, and media use as potential moderators of OW/OB; and (3) examine the moderating effects of these health behaviors cross-sectionally by comparing medicated youth with ADHD, unmedicated youth with ADHD, and youth without ADHD.

METHODS

Data were acquired from the 2018 and 2019 National Survey of Children's Health, a nationally representative survey of caregivers conducted across the United States. The current study used data for youth 11-17 years old with a final sample size of 26,644. Hours of sleep, physical activity, and media use per day were dichotomized based on national recommendation guidelines for each health behavior (i.e., either meeting or not meeting guidelines).

RESULTS

The OW/OB prevalence rate was 7% greater among unmedicated youth with ADHD than among medicated youth with ADHD. Medicated youth with ADHD and peers without ADHD had similar OW/OB rates. Among medicated youth with ADHD, physical activity, sleep duration, and media use did not contribute to OW/OB risk after controlling for family poverty level. However, among unmedicated youth with ADHD, meeting sleep duration guidelines was linked to a lower OW/OB risk.

CONCLUSION

Overall, findings suggest that clinical providers and parents may wish to prioritize improved sleep duration in the management of OW/OB risk in youth with ADHD.

Oral health and multimorbidity: is diet the chicken or the egg?

Oral health is a critical component of overall health and well-being, not just the absence of disease. The objective of this review paper is to describe relationships among diet, nutrition and oral and systemic diseases that contribute to multimorbidity. Diet- and nutrient-related risk factors for oral diseases include high intakes of free sugars, low intakes of fruits and vegetables and nutrient-poor diets which are similar to diet- and nutrient-related risk factors for systemic diseases. Oral diseases are chronic diseases. Once the disease process is initiated, it persists throughout the lifespan. Pain and tissue loss from oral disease leads to oral dysfunction which contributes to impaired biting, chewing, oral motility and swallowing. Oral dysfunction makes it difficult to eat nutrient-dense whole grains, fruits and vegetables associated with a healthy diet. Early childhood caries (ECC) associated with frequent intake of free sugars is one of the first manifestations of oral disease. The presence of ECC is our 'canary in the coal mine' for diet-related chronic diseases. The dietary sugars causing ECC are not complementary to an Eatwell Guide compliant diet, but rather consistent with a diet high in energy-dense, nutrient-poor foods - typically ultra-processed in nature. This diet generally deteriorates throughout childhood, adolescence and adulthood increasing the risk of diet-related chronic diseases. Recognition of ECC is an opportunity to intervene and disrupt the pathway to multimorbidities. Disruption of this pathway will reduce the risk of multimorbidities and enable individuals to fully engage in society throughout the lifespan.

Farm to Preschool Programs and Its Impact on Children's Dietary Health: Evaluation Through Bronfenbrenner's Socio-Ecological Model

Children's development is shaped by the world around them. According to Bronfenbrenner's theory, children are influenced by direct interactions and the broader environment, which includes family, community, and society. This concept aligns with initiatives like farm-to-preschool programs. These programs forge connections between communities and local food sources, introducing gardening and nutritional education. This approach aligns seamlessly with Bronfenbrenner's theory, creating a multi-layered learning experience and fostering children's healthier eating habits. This review delves into how farm-to-preschool efforts enhance young children's diets through the ecological model evaluation framework, encompassing health, education, economics, and the environment.

What shapes parental feeding decisions over the first 18 months of parenting: Insights into drivers towards commercial and home-prepared foods among different socioeconomic groups in the UK

Infants born into families experiencing socioeconomic disadvantage follow a high-risk trajectory for obesity and poor health in later life. Differences in early childhood food experiences may be contributing to these inequalities. This study aimed to explore the factors that influence parental decisions on when, how and what food to introduce over the first 18 months of their child's life and identify differences according to families' social position. Particular attention was given to social and environmental determinants within and outside the home. This research utilised a longitudinal qualitative methodology, with interviews and photo-elicitation exercises completed by participants when their children were 4-6; 10-12 and 16-18 months of age. Participants were parents (61 mothers; 1 father), distributed across low, medium and high socioeconomic position (SEP). During analysis, observable differences in factors directing parents to home-prepared or commercial foods were identified. Factors that undermined the provision of home-prepared meals included lack of time after returning to work, insufficient support from partners, uncertainty around infant and young child feeding (defined as the introduction and provision of solids) and an implicit trust in the messaging on branded products. These factors directed parents towards commercial foods and were most persistent among families experiencing socioeconomic disadvantage due to barriers accessing formal childcare, less flexible working conditions and fathers being less involved in infant feeding. To facilitate an enabling environment for healthy infant and young child feeding practices and address dietary inequalities, immediate steps that policy makers and healthcare providers can take include: i) changing the eligibility criteria for shared parental leave, ii) aligning claims on commercial infant food labels with international best practices, and iii) improving access to formal childcare.

Eating Habits and Lifestyle Factors Related to Childhood Obesity Among Children Aged 5-6 Years: Cluster Analysis of Panel Survey Data in Korea

BACKGROUND

Childhood obesity has emerged as a major health issue due to the rapid growth in the prevalence of obesity among young children worldwide. Establishing healthy eating habits and lifestyles in early childhood may help children gain appropriate weight and further improve their health outcomes later in life.

OBJECTIVE

This study aims to classify clusters of young children according to their eating habits and identify the features of each cluster as they relate to childhood obesity.

METHODS

A total of 1280 children were selected from the Panel Study on Korean Children. Data on their eating habits (eating speed, mealtime regularity, consistency of food amount, and balanced eating), sleep hours per day, outdoor activity hours per day, and BMI were obtained. We performed a cluster analysis on the children's eating habits using k-means methods. We conducted ANOVA and chi-square analyses to identify differences in the children's BMI, sleep hours, physical activity, and the characteristics of their parents and family by cluster.

RESULTS

At both ages (ages 5 and 6 years), we identified 4 clusters based on the children's eating habits. Cluster 1 was characterized by a fast eating speed (fast eaters); cluster 2 by a slow eating speed (slow eaters); cluster 3 by irregular eating habits (poor eaters); and cluster 4 by a balanced diet, regular mealtimes, and consistent food amounts (healthy eaters). Slow eaters tended to have the lowest BMI (P<.001), and a low proportion had overweight and obesity at the age of 5 years (P=.03) and 1 year later (P=.005). There was a significant difference in sleep time (P=.01) and mother's education level (P=.03) at the age of 5 years. Moreover, there was a significant difference in sleep time (P=.03) and the father's education level (P=.02) at the age of 6 years.

CONCLUSIONS

Efforts to establish healthy eating habits in early childhood may contribute to the prevention of obesity in children. Specifically, providing dietary guidance on a child's eating speed can help prevent childhood obesity. This research suggests that lifestyle modification could be a viable target to decrease the risk of childhood obesity and promote the development of healthy children. Additionally, we propose that future studies examine long-term changes in obesity resulting from lifestyle modifications in children from families with low educational levels.

Western, Healthful, and Low-Preparation Diet Patterns in Preschoolers of the STRONG Kids2 Program

OBJECTIVE

Identify and describe diet patterns of children during early childhood using confirmatory factor analysis (CFA).

DESIGN

Longitudinal data were drawn from the STRONG Kids 2 program.

PARTICIPANTS

Mothers were surveyed about their child's diet at 24 (n = 337), 36 (n = 317), and 48 (n = 289) months old.

VARIABLES MEASURED

The Block Food Frequency Questionnaire for children aged 2-7 years was used to derive diet patterns; 23 food groups were created for analyses.

ANALYSIS

Principal component analysis was used to obtain preliminary factor loadings, and loadings were used to form a priori hypotheses for CFA-derived diet patterns. Independent samples t tests were used to compare food groups, nutrient intakes, and child and family characteristics by CFA pattern scores above vs at/below the median.

RESULTS

Three diet patterns consistently emerged: (1) processed meats, sweets, and fried foods; (2) vegetables, legumes, and starchy vegetables; and (3) grains, nuts/seeds, and condiments (only 24 and 36 months). Patterns were related to differences in added sugars, dietary fiber and potassium intakes, maternal education, and household income.

CONCLUSIONS AND IMPLICATIONS

Opposing healthful vs Western patterns, extant in child and adult literature, were observed across all ages. The third pattern differed between 24/36 and 48 months, representing a potential shift in food choices or offerings as children age.

Association between gut microbiota at 3.5 years of age and body mass index at 5 years: results from two French nationwide birth cohorts

BACKGROUND/OBJECTIVES

The relationship between gut microbiota and changes in body mass index (BMI) or pediatric overweight in early life remains unclear, and information regarding the preterm population is scarce. This study aimed to investigate how the gut microbiota at 3.5 years of age is associated with (1) later BMI at 5 years, and (2) BMI z-score variations between 2 and 5 years in children from two French nationwide birth cohorts.

SUBJECTS/METHODS

Bacterial 16S rRNA gene sequencing was performed to profile the gut microbiota at 3.5 years of age in preterm children (n = 143, EPIPAGE 2 cohort) and late preterm/full-term children (n = 369, ELFE cohort). The predicted abundances of metabolic functions were computed using PICRUSt2. Anthropometric measurements were collected at 2 and 5 years of age during medical examinations or retrieved from children's health records. Statistical analyses included multivariable linear and logistic regressions, random forest variable selection, and MiRKAT.

RESULTS

The Firmicutes to Bacteroidetes (F/B) ratio at 3.5 years was positively associated with the BMI z-score at 5 years. Several genera were positively ([Eubacterium] hallii group, Fusicatenibacter, and [Eubacterium] ventriosum group) or negatively (Eggerthella, Colidextribacter, and Ruminococcaceae CAG-352) associated with the BMI z-scores at 5 years. Some genera were also associated with variations in the BMI z-scores between 2 and 5 years of age. Predicted metabolic functions, including steroid hormone biosynthesis, biotin metabolism, glycosaminoglycan degradation, and amino sugar and nucleotide sugar metabolism, were associated with lower BMI z-scores at 5 years. The unsaturated fatty acids biosynthesis pathway was associated with higher BMI z-scores.

CONCLUSIONS

These findings indicate that the gut microbiota at 3.5 years is associated with later BMI during childhood, independent of preterm or term birth, suggesting that changes in the gut microbiota that may predispose to adult obesity begin in early childhood.

Development and validation of a short dietary questionnaire for assessing obesity-related dietary behaviours in young children

There are few short, validated tools to assess young children's obesity-related dietary behaviours, limiting the rapid screening of dietary behaviours in research and practice-based early obesity prevention. This study aimed to develop and assess the reliability and validity of a caregiver-reported short dietary questionnaire to rapidly assess obesity-related dietary behaviours in children aged 6 months to 5 years. The Early Prevention of Obesity in Childhood Dietary Questionnaire (EPOCH-DQ) was developed using a rigorous process to determine content and structural validity. Three age-appropriate versions were developed for (1) infants, aged 6-12 months, (2) toddlers, aged 1-2.9 years and (3) pre-schoolers, aged 3-5 years. The questionnaire (7-15 items) measures dietary behaviours, including diet risk from non-core food and beverage intake, diet quality from vegetable frequency, bread type and infant feeding practices. Test-retest reliability was assessed from repeated administrations 1 week apart (n = 126). Internal consistency, concurrent validity (against a comparison questionnaire, the InFANT Food Frequency Questionnaire), construct validity and interpretability were assessed (n = 209). Most scores were highly correlated and significantly associated (p < 0.05) for validity (rs: 0.45-0.89, percentage agreement 68%-100%) and reliability (intraclass correlation coefficient: 0.61-0.99) for diet risk, diet quality and feeding practice items. The EPOCH-DQ shows acceptable validity and reliability for screening of obesity-related behaviours of children under 5 years of age. The short length and, thus, low participant burden of the EPOCH-DQ allows for potential applications in various settings. Future testing of the EPOCH-DQ should evaluate culturally and socio-economically diverse populations and establish the predictive validity and sensitivity to detect change.

Nutritional impact of no-added sugar fruit puree consumption at different eating occasions: a modelling study on French children

OBJECTIVE

The recommended level of five fruits and vegetables per day is reached by a minority of French children. No-added sugars fruit puree (NASFP) can be consumed as a complement of fresh fruit to meet the recommendation for fruits and vegetables. The objective was to simulate the nutritional impact of an increase in consumption of NASFP among French children, together with a reduction in sweetened foods.

DESIGN

The study was conducted on French children aged 1-17 years. The simulation consisted in introducing NASFP on four different eating occasions (breakfast, lunch, snack and dinner) to reach one serving and removing the same serving of sweetened foods. Intakes in nutrients to favour, nutrients to limit and prevalence of adequacy to nutritional requirements were compared between observed and simulated diets in the whole sample and in five different age groups.

SETTING

France.

PARTICIPANTS

Children from 1 to 17 years of age in the last available French representative dietary survey (INCA3).

RESULTS

Simulated diets were more nutrient-dense thanks to increases in nutrients to favour from NASFP (especially fibres, iodine, Se, and vitamin A and C) associated with reductions in energy and nutrients to limit (especially free sugars) coming from sweetened foods. Prevalence of adequacy increased from 2 to 14·5 points for fibres and from 4·5 to 12 points for free sugars according to age group and eating occasion.

CONCLUSION

Promoting NASFP in replacement of sweetened products is a promising strategy to improve the nutritional quality of French children's diet through a better adherence to national guidelines.

Antiobesity effect of healthy food crops and functional foods: A systematic review of their mechanisms

Diet is a modifiable risk factor in the prevention and management of obesity, and various foods have the potential to aid in obesity management by modulating different pathways involved in the disease's pathology. We performed a systematic review of literature, using CINAHL, PubMed, and Google Scholar, focusing on the antiobesity potential of foods crops and functional food products, and their mechanisms of action and clinical evidence. Sixty-four articles were identified, of which 41 investigated food crops, while 23 investigated functional products. Food crops, such as cereals, vegetables, fruits, mushrooms, seaweeds, legumes, herbs, spices, and cocoa seeds, have antiobesity effects through mechanisms such as altering the metabolism of glucolipids by inhibiting enzymes like α-amylase and α-glucosidase, stimulating the bioenergetics of thermogenic fat, modulating gut microbiota, and inhibiting lipogenesis and storage. In addition, developed functional teas, beverages, and yoghurt have antiobesity effects through similar or different mechanisms, such as enhancing energy expenditure and satiety, suppressing adipogenesis and lipolysis, improving glucose and lipid metabolism, and altering hormonal secretion. This review reemphasized the significance of food in the control of obesity, and highlights the distinct methods these explored foods exert their antiobesity effects. In conclusion, foods are safe and effective means of combating obesity without the side effects of conventional drugs, which can help inform dietary choices, assist professionals in providing more accurate advice, and also lead to better understanding of food and its effect on overall health of the public. This approach will eradicate global diseases, especially if more underutilized and indigenous food crops are extensively researched.

Longitudinal changes in home food availability and concurrent associations with food and nutrient intake among children at 24-48 months

OBJECTIVES

To describe changes in home food availability during early childhood, including modified, developmentally sensitive obesogenic scores, and to determine whether home food availability is associated with food and nutrient intakes of children concurrently, over time.

DESIGN

Data were drawn from the STRONG Kids 2 longitudinal, birth cohort to achieve the study objectives. Home food availability was assessed with the Home Food Inventory (HFI) and included fifteen food groups (e.g. fruit and vegetables) and three obesogenic scores (one original and two modified). Food and nutrient intakes were measured using the Block FFQ and included twenty-seven food groups and eighteen nutrients (e.g. vitamins A and C, protein). HFI and FFQ were completed by trained researchers or mothers, respectively, at 24, 36 and 48 months. Repeated-measures ANOVA and Spearman's correlations were used to achieve the study objectives.

SETTING

Central Illinois, USA.

PARTICIPANTS

Participants were 468 children at 24, 36 and 48 months of age.

RESULTS

Availability of less nutritious foods and obesogenic foods and beverages increased as children aged, and availability of both nutritious and less nutritious foods were associated with child food and nutrient intake. The three obesogenic scores demonstrated similar, positive associations with the intake of energy, saturated fat, added sugars and kilocalories from sweets.

CONCLUSION

These findings offer novel insight into changes in home food availability and associations with food and nutrient intake during early childhood. Additional attention is needed examining antecedents (e.g. built environments, purchasing behaviours) and consequences (e.g. child diet quality and weight) of home food availability.

Childhood sleep: physical, cognitive, and behavioral consequences and implications

BACKGROUND

Sleep problems in children have been increasingly recognized as a major public health issue. Previous research has extensively studied and presented many risk factors and potential mechanisms for children's sleep problems. In this paper, we aimed to identify and summarize the consequences and implications of child sleep problems.

DATA SOURCES

A comprehensive search for relevant English language full-text, peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed, SCOPUS, and Psych Info published in the past two decades. Both relevant data-based articles and systematic reviews are included.

RESULTS

Many adverse consequences are associated with child sleep deficiency and other sleep problems, including physical outcomes (e.g., obesity), neurocognitive outcomes (e.g., memory and attention, intelligence, academic performance), and emotional and behavioral outcomes (e.g., internalizing/externalizing behaviors, behavioral disorders). Current prevention and intervention approaches to address childhood sleep problems include nutrition, exercise, cognitive-behavioral therapy for insomnia, aromatherapy, acupressure, and mindfulness. These interventions may be particularly important in the context of coronavirus disease 2019. Specific research and policy strategies can target the risk factors of child sleep as well as the efficacy and accessibility of treatments.

CONCLUSIONS

Given the increasing prevalence of child sleep problems, which have been shown to affect children's physical and neurobehavioral wellbeing, understanding the multi-aspect consequences and intervention programs for childhood sleep is important to inform future research direction as well as a public health practice for sleep screening and intervention, thus improving sleep-related child development and health.

Food patterns associated with overweight in 7-11-year old children: machine-learning approach

Longitudinal study, whose objective was to present a better strategy and statistical methods, and demonstrate its use with the data across the 2013-2015 period in schoolchildren aged 7 to 11 years, covered with the same food questionnaire (WebCAAFE) survey in Florianopolis, southern Brazil. Six meals/snacks and 32 foods/beverages yielded 192 possible combinations denominated meal/snack-Specific Food/beverage item (MSFIs). LASSO algorithm (LASSO-logistic regression) was used to determine the MSFIs predictive of overweight/obesity, and then binary (logistic) regression was used to further analyze a subset of these variables. Late breakfast, lunch and dinner were all associated with increased overweight/obesity risk, as was an anticipated lunch. Time-of-day or meal-tagged food/beverage intake result in large number of variables whose predictive patterns regarding weight status can be analyzed by machine learning such as LASSO, which in turn may identify the patterns not amenable to other popular statistical methods such as binary logistic regression.

Associations Between Household Frequency of Cooking Dinner and Ultraprocessed Food Consumption and Dietary Quality Among US Children and Adolescents

Introduction: Dietary quality is poor and intake of ultraprocessed foods (UPFs) is high among children and adolescents in the United States. Low dietary quality and high UPF intake are associated with obesity and higher risk of diet-related chronic diseases. It is unknown whether household cooking behavior is related to improved dietary quality and lower consumption of UPFs among US children and adolescents. Methods: Nationally representative data from the 2007-2010 National Health and Nutrition Examination Survey (n = 6032 children and adolescents ≤19 years of age) were used to examine the relationships between household cooking frequency of evening meals and children's dietary quality and UPF intake using multivariate linear regression models adjusted for sociodemographics. Two 24-hour diet recalls were used to assess UPF intake and dietary quality [Healthy Eating Index-2015 (HEI-2015)]. Food items were categorized according to Nova classification to obtain the UPF percent of total energy intake. Results: A higher household frequency of cooking dinner was associated with lower UPF intake and higher overall dietary quality. Compared to children in households cooking dinner 0-2 times per week, children in households cooking dinner 7 times/week had lower intake of UPFs [β = -6.30, 95% confidence interval (CI) -8.81 to -3.78, p < 0.001] and marginally higher HEI-2015 scores (β = 1.92, 95% CI -0.04 to 3.87, p = 0.054). The trends toward lower UPF intake (p-trend <0.001) and higher HEI-2015 scores (p-trend = 0.001) with increasing cooking frequency were significant. Conclusions: In this nationally representative sample of children and adolescents, more frequent cooking at home was associated with lower intake of UPFs and higher HEI-2015 scores.

Maternal determinants of dietary patterns in infancy and early childhood in the Growing up in New Zealand cohort

Given the importance of diet in early life, assessing children's diet is crucial to guide interventions. Using data from a nationally generalizable New Zealand (NZ) birth cohort we examined children's dietary patterns at 9- (n = 6259), 24- (n = 6292), and 54-months (n = 6131), and their association with maternal sociodemographic and health behaviours. At each time-point, children's dietary patterns were identified using principal components analysis. We then used multivariate linear regression to examine associations between each pattern and maternal variables. At 9-, 24- and 54-months, two dietary patterns were identified, explaining 36.4%, 35.3% and 33.6% of children's intake variability, respectively. Refined high in sugar, salt and fat dietary pattern, at all time-points, was characterized by high positive loadings in white/refined breads and cereals, and items with high sugar, sodium, and fat content. At 24-months, Refined high in sugar, salt and fat also included a high positive loading with protein food groups. Fruit and vegetables dietary pattern, at all time-points, had high positive loadings for fruits and vegetables (with type varying across time-points). Fruit and vegetables also included high loading in whole grain options of breads and cereals at 24-months and the protein food group was part of this dietary pattern at 9- and 54-months. Children's scores on the Refined high in sugar, salt and fat pattern had strong associations with maternal smoking habits, education level, ethnicity, and maternal scores in the "Junk" and "Traditional/White bread" dietary patterns (constructed from an antenatal interview). Children's scores on the Fruit and vegetables pattern had strong associations with the maternal scores in the dietary pattern "Health Conscious". Interventions to improve diet in early life in NZ need to be responsive to ethnicity and suitable for people of all education levels. Interventions that improve maternal health behaviours may also improve children's diet.

The path between breakfast eating habit, sleep duration and physical activity on obesity status: An epidemiological study in schoolchildren

Background: Although the literature suggests that skipping breakfast, insufficient sleep, and reduced physical activity are associated with childhood obesity their co-influence and their in-between interactions on weight status have rarely been studied. Aim: To examine the co-influence of breakfast eating habits, sleep duration, and physical activity on the weight status of children 10-12 years old from several schools of Greece. Methods: A cross-sectional study was conducted on 1688 students in Greece, during 2014-2016. Children's Body Mass Index (BMI) was calculated and classified according to the International Obesity Task Force (IOTF) classification. Logistic regression models and path analysis were used. Results: Overweight/obesity prevalence was higher in boys (32.5% vs. 20.4%; p < 0.001). Average sleep duration decreased the odds of overweight/obesity [OR (95% CI): 0.86 (0.76, 0.97)] independently of the frequency of breakfast habit. Interaction between sleep duration with breakfast habit (p = 0.002) and physical activity (p < 0.001) was observed. Path analysis showed a negative association of BMI with sleep duration (standardized beta = -0.095, p < 0.001). A third-order interaction between breakfast habit, sleep duration, and physical activity revealed that daily breakfast eating along with adequate sleep and moderate/adequate physical activity levels, decreased the odds of over-weight/obesity by 55% [OR 0.45, 95% CI (0.27, 0.72)]. Conclusion: Although sleep duration is inversely associated with weight status independently of breakfast habit, the co-influence of adequate sleep duration with frequent breakfast eating and moderate/adequate physical activity seems to be a profoundly higher associated as a result of synergy against childhood obesity.

Dietary and Nutritional Interventions in Nonalcoholic Fatty Liver Disease in Pediatrics

Nonalcoholic fatty liver disease (NAFLD) is pediatrics' most common chronic liver disease. The incidence is high in children and adolescents with obesity, which is associated with an increased risk of disease progression. Currently, there is no effective drug therapy in pediatrics; therefore, lifestyle interventions remain the first line of treatment. This review aims to present an updated compilation of the scientific evidence for treating this pathology, including lifestyle modifications, such as exercise and dietary changes, highlighting specific nutritional strategies. The bibliographic review was carried out in different databases, including studies within the pediatric population where dietary and/or nutritional interventions were used to treat NAFLD. Main interventions include diets low in carbohydrates, free sugars, fructose, and lipids, in addition to healthy eating patterns and possible nutritional interventions with n-3 polyunsaturated fatty acids (EPA and DHA), amino acids (cysteine, L-carnitine), cysteamine, vitamins, and probiotics (one strain or multi-strain). Lifestyle changes remain the main recommendation for children with NAFLD. Nevertheless, more studies are required to elucidate the effectiveness of specific nutrients and bioactive compounds in this population.

The Association of Maternal Weight Status throughout the Life-Course with the Development of Childhood Obesity: A Secondary Analysis of the Healthy Growth Study Data

Maternal weight-status at various time-points may influence child obesity development, however the most critical time-point remains unidentified. We used data from the Healthy Growth Study, a cross-sectional study of 2666 Greek schoolchildren aged 9-13 years, exploring associations between childhood obesity and maternal weight-status at pre-pregnancy, during pregnancy/gestational weight gain, and at the child's pre-adolescence. Logistic regression analyses examined associations between maternal weight-status being "below" or "above" the recommended cut-off points (WHO BMI thresholds or IOM cut-off points), at the three time-points, individually or combined into weight-status trajectory groups to determine the strongest associations with child obesity in pre-adolescence. Adjusted models found significant associations and the highest odds ratios [95% Confidence Intervals] for mothers affected by obesity before pregnancy (4.16 [2.47, 7.02]), those with excessive gestational weight gain during pregnancy (1.50 [1.08, 2.08]), and those affected by obesity at their child's pre-adolescence (3.3 [2.29, 4.87]). When combining these weight-status groups, mothers who were above-above-below (3.24 [1.10, 9.55]), and above-above-above (3.07 [1.95, 4.85]) the healthy weight recommendation-based thresholds in each time-point, had a three-fold higher likelihood of child obesity, compared to the below-below-below trajectory group. Maternal obesity across all examined time-points was significantly associated with childhood obesity. Effective childhood obesity preventive initiatives should commence at pre-conception, targeting maternal weight throughout the life-course and childhood developmental stages.

Association between Socioeconomic Factors, Food Insecurity, and Dietary Patterns of Adolescents: A Latent Class Analysis

Socioeconomic factors and food insecurity play a fundamental role in the food choices of adolescents, and in addition to influencing access to food, they also have significant effects on dietary patterns. The objectives of this study were to identify the dietary patterns of adolescents through the application of latent class analysis and to evaluate their association with socioeconomic variables and food insecurity. This cross-sectional study was conducted with adolescents aged between 11 and 17 years from public schools. Latent class analysis was used to identify the dietary patterns. Associations between socioeconomic factors, food insecurity and dietary patterns were assessed using multinomial logistic regression (odds ratio (OR); 95% confidence interval (CI)). Among the 1215 participants in the study, four dietary patterns were identified: "Mixed", "Low consumption", "Prudent" and "Diverse". A "Diverse" dietary pattern was associated with a lower economic stratum (OR:2.02; CI:1.26-3.24). There was no association between food insecurity and identified dietary patterns. These results highlight the importance of promoting healthy eating in this age group at all socioeconomic levels, especially the lowest level.

Eating habits: what foods do children between 12 and 36 months consume?

OBJECTIVE

to identify toddlers' eating habits.

METHOD

a cross-sectional study of quantitative analysis, with a sample of 808 toddlers who attended day care centers in the district of Viseu, Portugal, between November 2018 and September 2019. Data were collected using a questionnaire directed at parents.

RESULTS

the prevalence of children who ate six meals a day was 42.8%, and 42.5%, those who ate five meals. It was found that 2.0% of children consumed chocolates, 1.0%, desserts, and 0.4%, carbonated beverages, daily. On average, dairy product (M=5.61; SD=2.62) and meat/fish/egg (M=4.80; SD=3.57) consumption was higher than recommended, while fat (M=0.48; SD=0.40), legume (M=0.49; SD=0.45), vegetable (M=1.18; SD=0.87) and water (M=0 .51; SD=0.29) consumption was lower.

CONCLUSIONS

there was a higher or lower consumption than recommended for some foods, highlighting the need to implement nursing intervention programs aimed at promoting healthy eating habits in toddlers and families.

Parenting Practices Are Associated With Adolescent Food Choices During Independent Eating Occasions

BACKGROUND

Frequency of independent eating occasions (iEOs) has been linked to intake of unhealthy foods and overweight or obesity among adolescents. Parenting practices involving modeling healthy food intake and making healthy foods available have been associated with healthy food intake among adolescents; however, little is known about these associations during iEOs.

OBJECTIVE

To determine whether parenting practices involving structure (monitoring, availability, modeling, and expectations), lack of structure (indulgence), and autonomy support reported by adolescents or parents were associated with adolescent iEO intake of junk foods, sugar-sweetened beverages (SSBs), sugary foods, and fruit and vegetables.

DESIGN

Cross-sectional study measuring parenting practices and adolescent iEO food choices via an online survey and adapted food frequency questionnaire.

PARTICIPANTS/SETTING

Parent/adolescent dyads (n = 622) completed surveys (November-December 2021) using a national Qualtrics panel database. Adolescents were 11 to 14 years of age and had iEOs at least weekly.

MAIN OUTCOME MEASURES

Primary measures included parent- and adolescent-reported frequency of food parenting practices and adolescent-reported iEO intake of junk foods, sugary foods, SSBs, and fruits and vegetables.

STATISTICAL ANALYSES PERFORMED

Multivariable linear regression models were used to examine associations between parenting practices and iEO intake of foods/beverages, adjusting for adolescent's age, sex, race and ethnicity, iEO frequency, parent's education and marital status, and household food security status. Bonferroni multiple comparison corrections were conducted.

RESULTS

More than half of parents were female (66%) and 35 to 64 years of age (58%). Adolescents/parents identified as White/Caucasian (44%/42%), Black/African American (28%/27%), Asian (21%/23%), and Hispanic ethnicity (42%/42%). Positive associations were observed among adolescent-reported and parent-reported autonomy support, monitoring, indulgence and expectations parenting practices, and adolescent-reported daily iEO intake frequencies of junk foods, sugary foods, and fruits and vegetables (P < 0.001).

CONCLUSIONS

Structural and autonomy support parenting practices were positively associated with both healthy and unhealthy iEO food intake by adolescents. Interventions to improve adolescent iEO intake could promote positive practices associated with healthy food consumption.

Factors associated with overweight/obesity of children aged 6-12 years in Indonesia

BACKGROUND

Globally, the prevalence of childhood obesity has increased considerably, including in Indonesia. Obesity results from multifactorial interactions at the personal, familial, and environmental levels. However, little is known about the factors associated with overweight/obesity among children in Indonesia. This study is intended to identify personal, familial, and environmental factors associated with overweight/obesity in children aged 6-12 years in Indonesia.

METHODS

Study design was a secondary data analysis using the Indonesia Family Life Survey in 2014/2015, focusing on 6,090 children aged 6-12 years. The questions covered the child's body mass index and potential personal, familial, and environmental factors. Logistic regression analysis was performed to identify the personal, familial, and environmental factors.

RESULTS

The mean age of participants was 8.9 years (SD = 2.0); 51.0% were boys; 9.4% were overweight; and 8.1% were obese. Overweight and obesity were associated with age [AOR 1.09 (95% CI 1.04-1.14)], having an overweight [AOR 1.93 (95% CI 1.58-2.36)] or obese [AOR 3.36 (95% CI 2.43-4.61)] father compared with a normal father, being of Chinese [AOR 9.51 (95% CI 1.43-79.43)] or Javanese [AOR 1.60 (95% CI 1.16-2.24)] ethnicity compared with Sundanese ethnicity, and residing in an urban area [AOR 1.36 (95% CI 1.10-1.70)]. A lower risk of child overweight/obesity was associated with the father's perception [AOR 0.56 (95% CI 0.38-0.80)] and mother's perception [AOR 0.66 (95% CI 0.43-0.98)] of the child's food consumption as being less than adequate compared with adequate.

CONCLUSIONS

Risk factors in children for overweight/obesity were older age, having an overweight/obese father, membership of certain ethnic groups, and urban residence. The main protective factor was parents' perception that a child's food consumption was less than adequate. Health promotion programs focused on these factors could help control or prevent childhood obesity in Indonesia.

Dietary Patterns, Socio-Demographic Predictors Thereof, and Associations of Dietary Patterns with Stunting and Overweight/Obesity in 1-<10-Year-Old Children in Two Economically Active Provinces in South Africa

A review of the literature showed that there were only a few studies that reported on the dietary patterns of children in South Africa. The aim of the present study was to characterise the dietary patterns of children aged 1-<10 years who were studied during the Provincial Dietary Intake Survey (PDIS) in 2018 and to investigate the socio-demographic predictors thereof, as well as the associations with stunting and overweight/obesity. Dietary pattern analysis was conducted within three age groups, namely 1-<3-year-olds, 3-<6-year-olds, and 6-<10-year-olds using iterated principal factor analysis with varimax rotation and 24 h recall data from the PDIS. The dietary patterns that emerged seem to be far from ideal. Energy-dense, nutrient-poor patterns were included in the top three strongest patterns in all three age groupings that were investigated. Few of the dietary patterns included vegetables other than starchy vegetables, fruit, dairy, quality proteins, and unrefined carbohydrates. There were no associations between any of the dietary patterns and stunting or overweight/obesity in the children. Key predictors of greater adherence to the mostly unhealthy patterns included indicators of a higher socio-economic status in all three age groups, as well as having an obese mother in the 6-<10-year-old group. Key predictors of greater adherence to the mostly healthy patterns were a higher wealth index and having an obese mother in the two younger groups, with no predictors in the 6-<10-year-old group. We conclude that the dietary patterns of children in the Western Cape contain strong elements of the energy-dense, nutrient-poor dietary patterns. Interventions to improve the dietary intake of children should be directed at both poorer and higher income communities.

Can Kindergarten Meals Improve the Daily Intake of Vegetables, Whole Grains, and Nuts among Preschool Children? A Randomized Controlled Evaluation

Surveys have indicated that preschool children do not consume adequate amounts of vegetables, fruits, whole grains, and nuts. This cross-sectional intervention study aimed to investigate whether a meticulously crafted meal plan for children of kindergarten age (5-6 years) could effectively enhance their daily intake of nutritious foods. Ninety-four healthy children from six kindergartens were enrolled in the study and were randomly assigned to a prototype group (PG) and a control group (CG). The PG kindergartens (n = 4) received a prototype 5-day meal plan that included regulated portions of vegetables, fruits, whole grains, and nuts adhering to dietary guidelines. Conversely, the CG kindergartens (n = 2) adhered to their standard meal plan. Participants maintained their usual eating habits outside of kindergarten and during weekends. Using the dietary assessment tool Open Platform for Clinical Nutrition (OPEN), combined with a 7-day dietary record of food consumed inside and outside the kindergarten, the average daily intake of specific food groups was assessed and compared with the Dietary Guidelines for Children. A total of 57 participants completed the study, 40 from the PG and 17 from the CG. Among the PG participants, the average daily intake of vegetables, whole grains, and nuts compared with the guideline recommendations was significantly higher than in the CG. Notably, only meals consumed within the kindergarten setting significantly improved the overall intake, with the outside intake having no significant effect. This study underscores the vital role of a well-designed and precisely executed meal plan in kindergartens in improving children's intake of healthy foods. The findings could help drive positive changes in child nutrition within educational environments.

Gender Differences in Psychosocial Outcomes and Coping Strategies of Patients with Colorectal Cancer: A Systematic Review

(1) Background: Gender is an important factor impacting cancer experience. This review mainly aimed to summarize colorectal cancer (CRC) patients' gender differences in psychosocial outcomes and coping strategies. (2) Methods: Relevant studies were searched for in four electronic databases from 2007 to July 2023. And manual searching was performed on the included studies' reference lists to identify additional eligible studies. (3) Results: A total of 37 eligible articles were included in this review. These studies were conducted in 19 countries, and they targeted CRC patients at various treatment stages. Significant results showed that female patients tended to have more psychological distress, complex social functioning, and less sexual distress and to choose more positive coping strategies than male patients. But there was no gender difference in psychosocial outcomes and/or coping strategies in some studies, which implied that gender similarity also existed. (4) Conclusions: The findings support the fact that there are both gender differences and similarities in CRC patients' psychosocial outcomes and coping strategies. A perspective beyond the simple masculine-feminine binary improved our in-depth understanding of gender tendency. Importantly, taking gender tendency into account is critical for medical staff to provide more personalized support and communication interventions.

Prospective association between an obesogenic dietary pattern in early adolescence and metabolomics derived and traditional cardiometabolic risk scores in adolescents and young adults from the ALSPAC cohort

BACKGROUND

Dietary intake during early life may be a modifying factor for cardiometabolic risk (CMR). Metabolomic profiling may enable more precise identification of CMR in adolescence than traditional CMR scores. We aim to assess and compare the prospective associations between an obesogenic dietary pattern (DP) score at age 13 years with a novel vs. traditional CMR score in adolescence and young adulthood in the Avon Longitudinal Study of Parents and Children (ALSPAC).

METHODS

Study participants were ALSPAC children with diet diary data at age 13. The obesogenic DP z-score, characterized by high energy-density, high % of energy from total fat and free sugars, and low fibre density, was previously derived using reduced rank regression. CMR scores were calculated by combining novel metabolites or traditional risk factors (fat mass index, insulin resistance, mean arterial blood pressure, triacylglycerol, HDL and LDL cholesterol) at age 15 (n = 1808), 17 (n = 1629), and 24 years (n = 1760). Multivariable linear regression models estimated associations of DP z-score with log-transformed CMR z-scores.

RESULTS

Compared to the lowest tertile, the highest DP z-score tertile at age 13 was associated with an increase in the metabolomics CMR z-score at age 15 (β = 0.20, 95% CI 0.09, 0.32, p trend < 0.001) and at age 17 (β = 0.22, 95% CI 0.10, 0.34, p trend < 0.001), and with the traditional CMR z-score at age 15 (β = 0.15, 95% CI 0.05, 0.24, p trend 0.020). There was no evidence of an association at age 17 for the traditional CMR z-score (β = 0.07, 95% CI -0.03, 0.16, p trend 0.137) or for both scores at age 24.

CONCLUSIONS

An obesogenic DP was associated with greater CMR in adolescents. Stronger associations were observed with a novel metabolite CMR score compared to traditional risk factors. There may be benefits from modifying diet during adolescence for CMR health, which should be prioritized for further research in trials.

Comprehensive mandatory policies are needed to fully protect all children from unhealthy food marketing

The World Health Organization (WHO) have released a new guideline, "Policies to protect children from the harmful impact of food marketing" [1] which recommends the development of comprehensive laws to reduce children's exposure to unhealthy food marketing. This new guideline extends previous recommendations [2] to limit the adverse effects of unhealthy food marketing on the health of the world's children. We consider here whether these new recommendations go far enough.

Potential of Nanocellulose as a Dietary Fiber Isolated from Brewer's Spent Grain

Steady growth in beer production is increasing the number of by-products named brewers' spent grain. Such by-products are a source of several components, where cellulose is usually present in high amounts. The aim of this study was to develop a protocol to obtain a mix of cellulose microfibers with an average diameter of 8-12 µm and cellulose nanoplatelets with an average thickness of 100 nm, which has several applications in the food industry. The process comprised one alkaline treatment followed by acid hydrolysis, giving a new mix of micro and nanocellulose. This mix was characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, and laser scanning microscopy corroborating the presence and measurements of the cellulose nanostructure, showing an aspect ratio of up to 500. Finally, we demonstrated that the administration of this new type of nanocellulose allowed us to control the weight of mice (feed intake), showing a significant percentage of weight reduction (4.96%) after 15 days compared with their initial weight, indicating the possibility of using this material as a dietary fiber.

Clustering of diet, physical activity and sedentary behaviour and related physical and mental health outcomes: a systematic review

BACKGROUND

Physical activity (PA), sedentary behaviour (SB) and diet play an important role in the physical and mental health of young people. Understanding how these behaviours cluster, and the impact of clusters on health is important for the development of public health interventions. This review examines the prevalence of clusters of PA, sedentary time, and dietary behaviours, and how clusters relate to physical and mental health indicators among children, adolescents and young adults.

METHODS

Electronic (PubMed, Web of Science and Scopus) and manual searches were conducted for articles that were (i) observational studies including children, adolescents and/or young adults aged 5-24 years, (ii) examined the 'patterning', 'clustering', or 'co-existence' of each of PA, dietary behaviour and SB, and (iii) published in English up to and including July 2022. In addition to information on clustering, data on physical and mental health outcomes were extracted where reported. Included studies were assessed using the Cochrane risk of bias for observational studies. A narrative synthesis was conducted due to high heterogeneity. This review was registered with PROSPERO (CRD42021230976).

RESULTS

Forty-nine cross-sectional studies and four prospective cohort studies from eighteen countries reporting data from 778,415 individual participants were included. A broad range of clusters (n = 172) were found (healthy, unhealthy, and mixed). Mixed clusters were common (n = 98), and clusters of high diet quality, low PA and high SB were more prevalent in girls, while mixed clusters of high PA, high SB and low diet quality were more prevalent in boys. Unhealthy clusters comprising low moderate to vigorous PA, low consumption of fruits and vegetables, and high screen time were prevalent, particularly in those from lower socioeconomic status families. Compared to those with healthy behavioural clusters, those with unhealthy and mixed clusters had a higher adiposity, higher risk of cardiovascular disease, poorer mental health scores, and lower cardiorespiratory fitness.

CONCLUSIONS

PA, SB and diet cluster in healthy, unhealthy and mixed patterns in young people that differ across sociodemographic characteristics. Unhealthy clusters are associated with poorer health outcomes. Intervention strategies targeting un-clustering multiple unhealthy behaviours should be developed and evaluated for their impact on health outcomes.