Obesity leads to declines in motor skills across childhood

Immunoneuroendocrine, Stress, Metabolic, and Behavioural Responses in High-Fat Diet-Induced Obesity

Obesity has reached global epidemic proportions, and even though its effects are well-documented, studying the interactions among all influencing factors is crucial for a better understanding of its physiopathology. In a high-fat-diet-induced obesity animal model using C57BL/6J mice, behavioural responses were assessed through a battery of tests, while stress biomarkers and systemic inflammatory cytokines were measured using an Enzyme-Linked ImmunoSorbent Assay and a Bio-Plex Multiplex System. The peritoneal macrophage microbicide capacity was analysed via flow cytometry, and crown-like structures (CLSs) in white adipose tissue (WAT) were evaluated through staining techniques. Results indicated that obese mice exhibited increased body weight, hyperglycaemia, and hyperlipidaemia after 18 weeks on a high-fat diet, as well as worse physical conditions, poorer coordination and balance, and anxiety-like behaviour. Differences in corticosterone and noradrenaline concentrations were also found in obese animals, revealing a stress response and noradrenergic dysregulation, along with a weakened innate immune response characterized by a lower microbicide capacity, and the presence of an underlying inflammation evidenced by more CLSs in WAT. Altogether, these findings indicate that obesity deteriorates the entire stress, inflammatory, metabolic, sensorimotor and anxiety-like behavioural axis. This demonstrates that jointly evaluating all these aspects allows for a deeper and better exploration of this disease and its associated comorbidities, emphasizing the need for individualized and context-specific strategies for its management.

Allostatic Load in Childhood, Adolescence, and Young Adulthood: Are Assumptions of Measurement Invariance Warranted?

OVERVIEW

Allostatic load represents the cumulative toll of chronic mobilization of the body's stress response systems, as indexed by biomarkers. Higher levels of stress and disadvantage predict higher levels of allostatic load, which, in turn, predict poorer physical and mental health outcomes. To maximize the efficacy of prevention efforts, screening for stress- and disadvantage-associated health conditions must occur before middle age-that is, during childhood, adolescence, and young adulthood. However, this requires that models of allostatic load display properties of measurement invariance across age groups. Because most research on allostatic load has featured older adults, it is unclear if these requirements can be met.

METHODS

To address this question, we fit a series of exploratory and confirmatory analytic models to data on eight biomarkers using a nationally representative sample of N = 4260 children, adolescents, and young adults drawn from the National Health and Nutrition Examination Survey dataset.

RESULTS

Exploratory and confirmatory models indicated that, consistent with allostatic load theory, a unidimensional model was a good fit to the data. However, this model did not display properties of measurement invariance; post-hoc analyses suggested that the biomarkers included in the final confirmatory model were most strongly intercorrelated among young adults and most weakly intercorrelated among adolescents.

CONCLUSIONS

These results underscore the importance of testing assumptions about measurement invariance in allostatic load before drawing substantive conclusions about stress, disadvantage, and health by directly comparing levels of allostatic load across different stages of development, while underscoring the need to expand investigations of measurement invariance to samples of longitudinal data.

Biocultural correlates of gross motor coordination in prepubescent children: A cross-sectional study

AIM

This study aimed to explore the association of gross motor coordination (GMC) with a matrix of biocultural factors in prepubescent children, taking into account weight status, somatic maturation, sociodemographic variables, and type of school.

METHODS

One hundred twenty-nine prepubescent children, of both sexes, aged between 8.00 and 8.99, were assessed for GMC (Körperkoordinationstest Für Kinder - KTK), weight status, biological maturation (predicted mature stature), sex, mother's education level and type of school. Binary logistic regression was used to examine the relationship between higher values of KTK and associated biocultural factors.

RESULTS

Normoponderal children are more likely to attain better total KTK scores than those with overweight or obesity (OR: 2.942; LC 95%: 1.189, 7.280). In addition, children who are more advanced in terms of biological maturation exhibited significantly lower odds of being in the high KTK category than their less advanced peers (OR: 0.670; LC 95%: 0.474,0.946). Sex, mother's education level and the type of school are not associated with higher performance on KTK.

CONCLUSION

Weight status and biological maturation are associated with motor competence in prepubescent children. Future studies should consider additional correlates to better understand the complex interactions between biological, psychosocial and behavioral factors in the prediction of motor competence.

Motor Competence and Body Mass Index in the Preschool Years: A Pooled Cross-Sectional Analysis of 5545 Children from Eight Countries

BACKGROUND AND OBJECTIVE

One in five preschool children are overweight/obese, and increased weight status over time increases the risks of poorer future health. Motor skill competence may be a protective factor, giving children the ability to participate in health-enhancing physical activity. Yet, we do not know when the relationship between motor competence and weight status first emerges or whether it is evident across the body mass index (BMI) spectrum. This study examined the association between motor skill competence and BMI in a multi-country sample of 5545 preschoolers (54.36 ± 9.15 months of age; 50.5% boys) from eight countries.

METHODS

Quantile regression analyses were used to explore the associations between motor skill competence (assessed using the Test of Gross Motor Development, Second/Third Edition) and quantiles of BMI (15th; 50th; 85th; and 97th percentiles), adjusted for sex, age in months, and country.

RESULTS

Negative associations of locomotor skills, ball skills, and overall motor skill competence with BMI percentiles (p < 0.005) were seen, which became stronger at the higher end of the BMI distribution (97th percentile). Regardless of sex, for each raw score point increase in locomotor skills, ball skills, and overall motor skill competence scores, BMI is reduced by 8.9%, 6.8%, and 5.1%, respectively, for those preschoolers at the 97th BMI percentile onwards.

CONCLUSIONS

Public health policies should position motor skill competence as critical for children's obesity prevention from early childhood onwards. Robust longitudinal and experimental designs are encouraged to explore a possible causal pathway between motor skill competence and BMI from early childhood.

Poor Motor Competence Affects Functional Capacities and Healthcare in Children and Adolescents with Obesity

BACKGROUND

From a young age, children learn different motor skills known as fundamental motor skills. The acquisition of these skills is crucial for the future development of context-tailored actions that could improve adherence to physical activity (PA) practice. Motor competence and function deficits have been associated with pediatric obesity. We reviewed the literature data regarding motor competence in pediatrics and impaired motor performance in children and adolescents with obesity.

METHODS

We assessed the abstracts of the available literature (n = 110) and reviewed the full texts of potentially relevant articles (n = 65) that were analyzed to provide a critical discussion.

RESULTS

Children and adolescents with obesity show impaired motor performance, executive functions, postural control, and motor coordination. Children's age represents a crucial point in the development of motor skills. Early interventions are crucial to preventing declines in motor proficiency and impacting children's PA and overall fitness levels.

CONCLUSIONS

To involve children, the PA protocol must be fun and tailored in consideration of several aspects, such as clinical picture, level of physical fitness, and motor skills. A supervised adapted exercise program is useful to personalized PA programs from an early pediatric age.

Childhood Obesity: An Updated Review

BACKGROUND

Childhood obesity is an important and serious public health problem worldwide.

OBJECTIVE

This article aims to familiarize physicians with the evaluation, management, and prevention of childhood.

METHODS

A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article.

RESULTS

Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition.

CONCLUSION

Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.

Physical function in children and adolescents pre- and 1-year post-liver transplant

BACKGROUND

Several studies describe poorer motor developmental motor outcomes post-liver transplant (LT) in younger children. Limited studies examine physical function in older children and adolescents pre- and post-LT.

METHODS

Retrospective review of standard of care physical function outcome measures pre- and 1-year post-LT in children ≥6 years at LT. Measures include: 6-minute walk test (6MWT), grip strength, Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) components, Physical Activity Questionnaire (PAQ), and Paediatric Quality of Life Multidimensional Fatigue Scale. Association of medical variables with outcomes was explored.

RESULTS

The study cohort included 23 (8 male, median (interquartile range) age 11.67 (8.25, 13.92) years at LT) participants. Top two primary diagnoses included biliary atresia (30.4%) and fulminant hepatic failure (21.7%). At 1-year post-LT, over one-third (36%) were overweight or obese. Compared with healthy norms, children had significantly lower pre-LT PAQ scores (p = .002), pre- and post-6MWT scores (p < .001) and post-LT BOT-2 strength and agility scores (p < .001). Pre-LT, lower balance scores were associated with abdominal distention/ascites (p = .009) and splenomegaly (p = .017). Lower pre-LT platelet count correlated with poorer balance (r = .532, p = .017) and lower strength and agility scores (r = .446, p = .043). Significant moderate inverse correlations were found between weight/body mass index z-scores and BOT-2 components. Post-LT children continue to demonstrate decreased levels of motor proficiency and functional capacity but report less fatigue and increased physical activity.

CONCLUSIONS

Older children and adolescents undergoing LT are at risk of decreased physical function, highlighting the need for pre- and post-LT rehabilitation to optimize long term outcomes.

Validation of remote assessment of preschool children's anthropometrics and motor skills

Introduction

Remotely delivered treatment and research procedures were rapidly adopted in response to the COVID-19 pandemic. However, it is unclear if these measures are valid. The purpose of this study was to compare the validity of anthropometry and motor skill proficiency measurements collected in a remote-setting to in-person setting among a sample of children ages 3-4 years.

Methods

Child anthropometry and motor skill performance were measured in-person by trained assessors and by parents at home with remote supervision via videoconference by trained assessors. The following measures from the National Institutes of Health Toolbox were collected: anthropometry (height and weight), manual dexterity/manipulation (9-hole pegboard), motor coordination and agility (supine timed up and go), lower body strength (standing long jump), and postural stability (one-leg standing balance). Differences in expert and parent-based measurements were assessed using Bland-Altman plots, paired samples t-tests, and Pearson correlations.

Results

A total of n = 14 children completed the assessments. No significant differences were observed between measurement locations for weight and motor skills (p > .05). Remote measurement of height (M = 101.1 cm, SD = 5.40) was significantly greater than in-person measurements (M = 98.2 cm, SD = 5.16); p < .0001.

Discussion

Remote measurements of motor skills and weight are valid assessments for researchers and clinicians to utilize in young children. Remote assessment with guidance offers comparable and valid estimates as in-person assessment, potentially offering a solution to resource-constricted barriers in research and access to care. There is an opportunity for researchers to fine-tune remote height and individual-level assessment strategies.

The double burden of malnutrition and gross motor development in infants: A cross-sectional study

OBJECTIVE

The objective of the present work was to study the relationship between the double burden of malnutrition and gross motor development in infants.

METHOD

ology: Sample included 5900 infants under 24 months of age, participants of the ENSANUT-ECU study. To evaluate nutritional status, we calculated z-scores for body mass index/age (BAZ) and height/age (HAZ). Six gross motor milestones were considered: sitting without-support, crawling, standing and walking with-support, standing and walking without-support. Data was analysed using logistic regression models in R.

RESULTS

Independently form age, sex and other socio-economic factors, the probability of achieving three gross motor milestones was significantly lower among chronically undernourished infants compared to their peers: sitting without-support, crawling, and walking without-support. Compared to no malnourished infants the probability of sitting without-support at six months was 10% lower for chronically undernourished infants (0.70, 95%CI [0.64-0.75]; 0.60, 95%CI [0.52-0.67]; respectively). The probability of crawling at eight months and walking without-support at 12 months were also significantly lower among chronically undernourished infants (0.62, 95%CI [0.58-0.67]); 0.25, 95%CI [0.20-0.30]; respectively) in comparison to no malnourished infants (0.67, 95%CI [0.63-0.72]); 0.29, 95%CI [0.25-0.34]; respectively). Obesity/overweight was not associated with the achievement of gross motor milestones, except for sitting without-support. Chronically undernourished infants with low or high BMI/age were generally delayed in the achievement of gross motor milestones than their peers.

CONCLUSIONS

Chronic undernutrition is related to delayed gross motor development. Public health measures are needed to be implemented to prevent the double burden of malnutrition and its detrimental effects on infant development.

Global hotspots and trends in research on preschool children's motor development from 2012 to 2022: a bibliometric analysis

Background

Motor development plays an important role in human development throughout the lifespans, from conception to death, and has received increasing scholarly attention in recent years. However, valuable comprehensive reviews and literature analysis on this topic are still lacking. Here, this bibliometric study aimed to identify global motor development research hotspots and trends on preschool children's motor development from 2012 to 2022.

Methods

CiteSpace 6.1.R4 was used to visualize and analyze general bibliometric characteristics, research hotspots, and trends through a review of 2,583 articles on the motor development of preschool children, which were published from 2012 to 2022 and included in the Web of Science Core Collection.

Results

Research on motor development in preschool children has been carried out into a phase of rapid development. The top five frequently occurring keywords were physical activity (n = 489), performance (n = 319), intervention (n = 222), health (n = 196), and executive function (n = 165); The top five keywords in terms of centrality are academic achievement (0.22), low birth weight (0.16), association (0.14), brain (0.13), and cerebral palsy (0.13). Thirteen keyword clusters were produced from the log-likelihood ratio (Q = 0.74, S = 0.88), and five research topics has been received focused attention in recent years. The keywords with the strongest citation bursts in the last 5 years are developing country (S = 5.92), school-aged children (S = 5.86), middle-income country (S = 3.46), efficacy (S = 5.41), readiness (S = 3.21), motor proficiency (S = 3.6), and screen time (S = 3.3), indicating newly emerging research trends.

Conclusion

The results indicated that interventions involving fundamental movement skills, cognitive function, 24-h movement behaviors, neurodevelopmental disorders, and health-related fitness were hot topics in the field of motor development over the last decade. Emerging research trends generally center on school readiness, socioeconomic status, motor proficiency, and screen time.

Allometric Association between Six-Minute Walk Distance and Both Body Size and Shape in Young Obese Girls

Background: The 6-min walk test (6MWT) provides information regarding functional capacity, response to therapy and prognosis in a variety of chronic cardiovascular disorders. Variability in body size and composition, particularly in obese people, confounds the six-minute covered distance (6MWD). The aim of the present study was to adopt allometric models to identify the most appropriate body size/shape; i.e., body mass (BM), body height (BH), body mass index (BMI) and estimated fat-free mass (FFM); associated with the 6MWD in 190 young girls with obesity. Methods: Nonlinear allometric modeling was used to calculate common body size exponents for BM, BH, BMI and FFM. In a validation sample of 35 age-matched obese girls, these allometric exponents were used prospectively. Results: The point estimates for the size exponents (95% confidence interval) from the separate allometric models were: BM 0.23 (0.19–0.27), BH 0.91 (0.78–1.03), BMI 0.33 (0.23–0.44) and FFM 0.28 (0.24–0.33). The presence of significant residual size correlations for 6MWD/BH−0.91 indicates that the influence of body size was not correctly partitioned out. In the validation group, the correlations between 6MWD BM−b and BM, 6MWD BMI−b and BMI, and 6MWD FFM−b and FFM using the established exponents were not statistically different from zero (r = 0.01), implying that participants in the allometric investigation were not penalized based on their BM, BMI, or FFM. Conclusion: We conclude that BM, BMI, BH and FFM, as indicators of body size/shape, are the most valid allometric denominators for the scaling of 6MWD in a group of young girls with obesity.

Correlation between body mass index and motor proficiency in Egyptian children: a cross-sectional study

Background

Obesity in children is a frequent and serious problem that can impede motor ability performance, necessitating extra attention and early intervention efforts. The purpose of this study was to determine the relation between body mass index (BMI) and motor proficiency in Egyptian children. Two-hundred normal healthy children from both sexes (6 to 8 years old) were enrolled. BMI was defined by dividing weight in kilograms by height in meters squared (kg/m²), and motor proficiency was evaluated by Bruininks-Oseretsky Test 2 of Motor Proficiency Short Form (BOT-2 SF). Participants were classified into four categories based on the Centers for Disease Control and Prevention (CDC) cutoff points including underweight, normal, overweight, and obese.

Results

Between-group analysis demonstrated a significant difference between groups where (χ² (3) = 131.50, P = 0.0001), with the obese group showing the worst motor ability, with mean differences at 95% confidence intervals of 7.44 for underweight, 81.14 for overweight, and 108.92 for obese children. The correlation coefficients of BOT-2 SF and BMI show a significant negative correlation (R = −0.723, P = 0.0001). Regression analysis revealed that BMI can significantly predict the BOT-2 SF (F = 216.94, P = 0.0001).

Conclusion

Excess body weight in the period of early childhood in Egyptians has a deleterious effect on motor skill performance; also, children who were normal weight or underweight had higher motor skills than those who were overweight or obese.

Associations of fundamental motor skill competence, isometric plank, and modified pull-ups in 5-year old children: An observational analysis of 2012 NHANES NYFS

There are purported relationships between fundamental motor skills (FMS), health-related physical fitness, physical activity, and obesity among children. The purpose of this observational, secondary data analysis was to further examine these associations in children from the 2012 National Youth Fitness Survey (NYFS). 121 five-year old children (51% female) from the NYFS database completed the Test of Gross Motor Development, 2nd edition (TGMD-2), muscular fitness measures of plank and modified pull-ups, and weight status based on body mass index (BMI) percentile. Significant positive correlations were identified between TGMD-2 scores and both pull-ups and plank. Linear regression models, controlling for sex, weight status, and Hispanic ethnicity also identified both modified pull-ups completed and plank time as significant predictors of TGMD-2 total raw score. No demographic factors were significant factors in any of the models. This secondary data analysis identified associations between FMS and health-related physical fitness (i.e., muscular fitness), with both modified pull-ups and plank performance, in five-year old children. Results underscored the importance of different facets of health-related physical fitness contributing significantly to FMS performance and the need for more work related to physical fitness in preschool-age children.

Sex differences on the relation among gross motor competence, cognition, and academic achievement in children

An association between gross motor competence (GMC) and academic achievement (AA) has been described, but the potential mechanisms behind this association are still unknown. It is not known either whether these mechanisms are similar for boys and girls. The aim of this study was to analyse whether the association between GMC and AA is mediated by executive functions (EFs), and to investigate whether this mediation differs by sex. This cross-sectional study involved 451 children aged 8 to 10 (234 girls; mean age 9.95 ± 0.59). The Movement Assessment Battery for Children-Second Edition (MABC-2), NIH Toolbox, and grades in language and mathematics were used to test GMC, EFs, and AA, respectively. Multifactorial structural equation model (SEM) was used to evaluate a possible relation between variables, controlling for confounders. The differences by sex were examined using a multi-group SEM approach. The results showed that EFs acted as a full mediator of the relationship between GMC and AA in boys (β = 0.14, p = 0.012) but not in girls (β = 0.10, p = 0.326). These results show that the benefit of GMC on AA is mediated by EFs in boys but not in girls. Nevertheless, these conclusions should be carefully considered due to the cross-sectional nature of the study.

Factors Associated with Motor Competence in Preschoolers from a Brazilian Urban Area

Background

Preschool is a crucial period for developing motor skills.

Objective

This study evaluated factors associated with motor competence in preschoolers from a Brazilian urban area.

Methods

A total of 211 preschoolers (51.2% girls and 48.8% boys) were evaluated. Body mass index was calculated; the Brazilian Economic Research Criterion, the Mini-Mental Scale (MMC) and the Early Childhood Environment Rating Scale®, Revised (ECERS-R™) were applied; the Habitual Physical Activity time was recorded; the Test of Gross Motor Development (TGMD-2) was performed. Univariate analysis was performed using simple linear regression for the independent variables, considering the motor test subscales as dependent variables. Variables with p < 0.20 in the univariate analysis were considered for the multiple linear regression model and were entered into the stepwise method.

Results

The independent variables remaining in the Standard Score Locomotor model were BMI, presence of park at school, and MMC (R2 = 0.16). The independent variables remaining in the Standard Object Control score were MMC and gender (R2 = 0.03). The variables associated with the highest scores of Gross Motor Quotient were MMC, body mass index, and presence of a park at school, respectively (R2 = 0.11).

Conclusion

Male eutrophic preschoolers who are physically active and attend schools with parks or courtyards in a Brazilian urban area have the highest scores for global cognitive function and motor competence.

Relationship between Asymmetry Indices, Anthropometric Parameters, and Physical Fitness in Obese and Non-Obese High School Students

Impaired balance is associated with an increased risk of lower extremity injuries. The purpose of this study was to investigate the relationship between age, anthropometric measurement, and asymmetry index (AI) in an adolescent high school population. Twenty-six male students (15 ± 1.0 years) were randomly selected. Body composition, measurements of vertical jump height using a countermovement jump test (CMJ), and dynamic single stance balance using the Y-balance test (YBT), were collected over 4 weeks. Hierarchical multiple linear regression analyses were used as dimension reduction techniques in four different blocks to determine valid predictors for AIs. In the first regression analysis, controlling for age, body mass, height, and body mass index (BMI), the regression coefficient (B = 0.383, 95% confidence interval [CI] [0.088, 0.679], p < 0.05) associated with body fat indicated that with each additional unit of body fat, the YBT AI increased by 0.383 units. In the second regression analysis, controlling for age, body mass, and BMI, the regression coefficients associated with height (B = -1.692, 95% CI [-3.115, -0.269], p < 0.05] and body fat percentage (B = 0.529, 95% CI [0.075, 0.983], p < 0.05) indicated that with each additional unit of height or body fat percentage, the CMJ AI decreased by 1.692 units and increased by 0.529 units. Grouping participants based on body fat percentage had a significant effect on the AIs (p < 0.05) of the CMJ and YBT. The AI of the CMJ was 15% higher, and that of the YBT was 7% higher in non-obese students than obese students. These findings contribute to the knowledge of the local community and the emerging body of literature on motor skills and competence related to weight in this population.

Association between executive functions and gross motor skills in overweight/obese and eutrophic preschoolers: cross-sectional study

BACKGROUND

Preschool age (3-5 years old) is a crucial period for children to acquire gross motor skills and develop executive functions (EFs). However, the association between the qualitative gross motor skills and EFs remains unknown in preschoolers, especially among overweight and obese children.

METHODS

This was a cross-sectional, exploratory, and quantitative study carried out on 49 preschool children, divided into two subgroups according to their body mass index (overweight/obese: 24; eutrophic [normal weight]: 25). The mean age was 4.59 years. More than half of the sample were boys (55%) and most of the mothers had completed high school (67%) and were class C socioeconomic level (63%). Gross motor skills were assessed using the Test of Gross Motor Development-2, while EFs were evaluated using Semantic verbal fluency (SVF), Tower of Hanoi (TH), Day/Night Stroop, and Delayed Gratification tests. Multiple linear regression models adjusted for sex, age, maternal education, socioeconomic status, quality of the home environment, and quality of the school environment using the stepwise method were executed, considering the cognitive tasks as independent variables and gross motor skills as dependent variable.

RESULTS

The overweight/obese preschoolers showed worse locomotor skills than their eutrophic peers and below average gross motor quotient (GMQ). Overweight/obese girls performed worse in OC skills than boys with excess weight. SVF (number of errors) and TH (rule breaks) explained 57.8% of the variance in object control (OC) skills and 40.5% of the variance in GMQ (p < .05) in the overweight/obese children. Surprisingly, there was no significant association between any of the EF tasks and gross motor skills in the eutrophic children.

CONCLUSION

A relationship between EF tasks (number of errors in SVF and rule breaks in TH) and gross motor skills (OC and GMQ) was demonstrated in the overweight/obese preschoolers, indicating that worse cognitive flexibility, working memory, planning, and problem solving are associated with worse gross motor skills in this population when compared to eutrophic children.

Is body fat mass associated with worse gross motor skills in preschoolers? An exploratory study

We compared the motor competence between overweight/obese and eutrophic preschoolers with similar physical activity levels, age, socioeconomic status, maternal education, quality of the home environment and quality of the school environment. We also investigated to what extent excess body fat mass explains gross motor skills in preschoolers. A cross-sectional quantitative and exploratory study was conducted with 48 preschoolers assigned into eutrophic and overweight/obese groups. Overweight/obese preschoolers had worse Locomotor subtest standard scores than the eutrophic ones (p = 0.01), but similar Object Control subtest and Gross Motor Quotient scores (p > 0.05). Excess body fat mass explained 12% of the low Locomotor subtest standard scores in preschoolers (R2 = 0.12; p = 0.007). Excess body fat mass was associated with worse locomotor skills when the model was adjusted for physical activity levels, age, socioeconomic status, maternal education, quality of the home environment and quality of the school environment. Thus, excess body fat mass partly explains lower locomotor skills in preschoolers.

Effects of Active Video Games on Health-Related Physical Fitness and Motor Competence in Children and Adolescents With Overweight or Obesity: Systematic Review and Meta-Analysis

Background

Childhood obesity is one of the most important public health problems. Active video games (AVGs) have been proposed as an attractive alternative to increase energy expenditure and are being investigated to determine their effectiveness against childhood obesity.

Objective

The aim of this study is to summarize the existing research and draw conclusions about the effects of AVGs on health-related physical fitness and motor competence in children and adolescents with overweight and obesity.

Methods

The search strategy was applied to PubMed, MEDLINE, Web of Science, and SPORTDiscus, including randomized and nonrandomized controlled trials investigating the effects of AVG programs on health-related physical fitness and motor competence in children and adolescents with overweight and obesity. To measure the risk of bias in randomized and nonrandomized controlled trials, 2 different quality assessment tools were used. In total, 15 articles met the inclusion criteria, and the variables of interest were BMI, body fat percentage, cardiorespiratory fitness (CRF), waist circumference, fat-free mass, muscular fitness, and motor competence. A meta-analysis was performed.

Results

Positive effects were found for BMI and body fat percentage, favoring the AVG group compared with a control group with no intervention (mean difference −0.209; 95% CI −0.388 to −0.031 vs mean difference −0.879; 95% CI −1.138 to −0.602). Positive effects seem to be observed for CRF. The effects of AVG interventions on muscular fitness, fat-free mass, waist circumference, and motor competence are unclear.

Conclusions

AVG programs showed positive effects on BMI, body fat percentage, and CRF. AVG could be a good strategy to combat childhood obesity.

Associations between body composition and fundamental motor skill competency in children

Background

Evidence supports an inverse relationship between weight status and motor competence, but most work utilizes body mass index as the proxy for weight status. Body mass index fails to account for essential components of body composition, which may be critical for motor performance. The purpose of this investigation was to examine the relationship between fundamental motor skills competency and body composition (i.e., fat mass, fat percentage, and fatfree mass) as measured by bio-electrical impedance analysis and body mass index in children.

Methods

Two hundred forty-four children from the Southeastern portion of the United States participated in this project (6.05 ± 2.01 years, 53.3% male). Fundamental motor skills were measured using the Test of Gross Motor Development – 2nd edition and body composition was assessed with the Tanita SC-331S Body Composition Analyzer (bio-electrical impedance analysis). Body mass index was calculated using CDC normative growth charts.

Results

Bio-electrical impedance analysis measures accounted for 23.1%, F(3, 241) = 24.10, p < .001 and 2.7%, F(3, 241) = 2.22, p = .086 variance in locomotor and object control subscales, respectively; body mass index accounted for 8.4% (locomotor) and 0.1% (object control) variance. For the Test of Gross Motor Development -2nd edition total score, bio-electrical impedance analysis measures accounted for 24.4% F(3, 241) = 25.90, p < .001 compared to body mass index which accounted for 7.9% F(1, 244) = 20.86, p < .001 of the variance. Only fat free mass (p < .001) was a significant predictor for locomotor skills and total models for the Test of Gross Motor Development – 2nd edition; BMI was also a significant predictor (p < .001) in both the locomotor and total models.

Conclusions

Different components of body composition (i.e., fat free mass) were associated with different aspects of fundamental motor skills competency. Excess body fat may be a morphological constraint to proficient locomotor performance when transporting the body through space. In contrast, body composition did not significantly predict object manipulation performance. More work is needed to understand the causality and directionality of this relationship; however, bio-electrical impedance analysis accounts for more variance in fundamental motor skills performance than body mass index in a field-based setting.

Exploring the Importance of Motor Competence for Behavioral and Health Outcomes in Youth

In this study, we investigated the relationship between motor competence (MC) and behavioral and health outcomes in youth through its relationship to physical activity (PA) and body composition (in terms of body fat). To date, it is unclear whether these variables reciprocally influence each other over time. We assessed whether and how MC, PA and body composition influence each other across adolescence. In a longitudinal study with 14 months of follow-up, we recruited 166 adolescents aged 12-13 years. We recorded participants' self-reported PA and body fat percentage and assessed their MC using the Körperkoordinationstest für Kinder (KTK). We used linear mixed models and mediation analyses with crude and adjusted (age, sex, time point) models to examine associations among the selected variables across time. MC showed a bidirectional relationship with both PA (p < .001) and body fat (p < .001) in both crude and adjusted models. In addition, MC was a potential mediator (Sobel test = -3.18, p < .001) in the relation between body fat (as predictor) and PA (as outcome) in crude models, but no mediating effect was found in adjusted models. Thus, this study provided longitudinal evidence that MC and PA, as well as MC and body composition, can reciprocally influence each other across adolescence. We recommend the development of MC as a crucial strategy to increase PA engagement and to prevent obesity in youth.

Resolving early obesity leads to a cardiometabolic profile within normal ranges at 23 years old in a two-decade prospective follow-up study

Obesity is the most important predisposing factor for cardiovascular disease and type-2 diabetes. We explored the relationship between the age at onset of obesity and selected cardiometabolic parameters in young adults. Longitudinal study of n = 1,039 participants (48% males) in their early twenties. BMI was measured at birth, 1–5–10–12–14–16–23 years. BMI trajectories were interpolated. Five groups were identified: never obese (never-OB); early childhood obesity transitioning to non-obesity before adolescence (former-OB); obesity starting in preadolescence transitioning to non-obesity as adolescents (transient-OB); obesity from adolescence into early adulthood (recent-onset-OB); participants who were obese in early childhood and remained obese into adulthood (persistent-OB). Waist circumference (WC), blood pressure, lipids, glucose, and insulin were measured at 23 years. HOMA-IR and the Metabolic Syndrome Risk Z-Score were estimated. In the sample, 47% were obese during at least one time-point. Mean obesity duration was 20.7 years, 8.5 years, 6.2 years, and 3.3 years in persistent-OBs, recent-onset-OBs, former-OBs, and transient-OBs, respectively. The cardiometabolic profile was more adverse in recent-onset-OBs (12%) and persistent-OBs (15%) compared to never-OB participants (53%). Although former-OBs (15%) and transient-OBs (4%) had higher WC values than never-OBs, no differences were seen in other biomarkers. Both persistent and recent-onset obesity led to a cardiometabolic profile of risk in early adulthood, as suggested by values of WC, HOMA-IR, and hs-CRP above normal limits and HDL-chol values below normal limits. Participants who had obesity in early childhood or preadolescence but transitioned to a non-obesity status had a cardiometabolic profile similar to participants who were never obese and within normal limits. Obesity leads to risky values in a number of cardiometabolic biomarkers in young adulthood independent of age at obesity onset. Likewise, overcoming obesity during the pediatric age leads to a cardiometabolic profile within normal ranges at 23 years of age.

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

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

Actual and Perceived Motor Competence in Relation to Body Mass Index in Primary School-Aged Children: A Systematic Review

Unhealthy-weight status may represent a precursor of poor actual (AMC) (i.e., process- and product-oriented) and perceived (PMC) motor competence. AMC and PMC represent key elements favoring long-term commitment in sports and day-to-day life physical activity. In fact, the development of AMC and PMC during the primary school years could help to counteract weight-related negative effects (i.e., overweight or obesity) that are responsible for sedentary or unhealthy behavior across the life span. Therefore, this review aimed to provide a synopsis of the current research investigating the relation of AMC and PMC with weight status and in the context of potential gender differences. Systematic research in five electronic databases (PubMed, Web of Science, EMBASE, CINAHL, Scopus) was conducted from April 2021 to May 2021 in compliance with PRISMA guidelines. Studies were included if they involved obese or overweight youth (6–10 years) with no physical or cognitive impairment and used a longitudinal or a cross-sectional assessment of motor competence and perceived motor competence outcomes. After the selection process and after duplicates were removed, the final sample included 27 studies. Most of the studies reported that AMC and PMC are negatively associated with weight status, with male and females differing from each other in overall and subtest (locomotor, object control, and stability skills) AMC scores. However, according to a risk of bias assessment, the level of evidence linked to the association of AMC (process and product) and PMC with weight status (BMI) remained uncertain and lacking, respectively. Further high-quality studies are warranted to improve the understanding of AMC and PMC in relation to weight status, which appears to be differently expressed by gender in primary school years. Regardless, based on the current quantitative data, the emerging inverse association between AMC/PMC and weight status implies that it would be best to limit sedentary behavior by including daily lessons in physical education to limit unfavorable conditions (i.e., obesity and overweight) during the school years.

What Is New in Pediatric Bone Health

BACKGROUND

This review paper aims to report on the last 5 years of relevant research on pediatric bone health in regard to nutrition and obesity, ethnic disparities, common orthopaedic conditions, trauma, spine, and sports medicine.

METHODS

A search of the PubMed database was completed using the following terms: bone health, Vitamin D, pediatric, adolescent, sports medicine, fractures, spine, scoliosis, race, ethnicity, obesity, Slipped Capital Femoral Epiphysis, Osteogenesis Imperfecta, Duchenne's Muscular Dystrophy, neuromuscular, and cancer. Resultant papers were reviewed by study authors and determined to be of quality and relevance for description in this review. Papers from January 1, 2015 to August 31, 2020 were included.

RESULTS

A total of 85 papers were selected for review. General results include 7 key findings. (1) Obesity inhibits pediatric bone health with leptin playing a major role in the process. (2) Socioeconomic and demographic disparities have shown to have a direct influence on bone health. (3) Vitamin D deficiency has been linked to an increased fracture risk and severity in children. (4) Formal vitamin D monitoring can aid with patient compliance with treatment. (5) Patients with chronic medical conditions are impacted by low vitamin D and need ongoing monitoring of their bone health to decrease their fracture risk. (6) Vitamin D deficiency in pediatrics has been correlated to low back pain, spondylolysis, and adolescent idiopathic scoliosis. Osteopenic patients with AIS have an increased risk of curve progression requiring surgery. Before spine fusion, preoperative screening for vitamin D deficiency may reduce complications of fractures, insufficient tissue repair, loosening hardware, and postoperative back pain. (7) Increasing youth sports participation has resulted in increased bone health related injuries. However, improved understanding of Relative Energy Deficiency in Sport effects on bone health has recently occurred.

CONCLUSIONS

Increasing awareness of bone health issues in children will improve their recognition and treatment. Further research is needed on diagnosis, treatment, outcomes, and most importantly prevention of pediatric bone health diseases.

Through the Looking Glass: A Systematic Review of Longitudinal Evidence, Providing New Insight for Motor Competence and Health

Introduction

In 2008, a conceptual model explaining the role of motor competence (MC) in children’s physical activity (PA), weight status, perceived MC and health-related fitness was published.

Objective

The purpose of the current review was to systematically compile mediation, longitudinal and experimental evidence in support of this conceptual model.

Methods

This systematic review (registered with PROSPERO on 28 April 2020) was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Separate searches were undertaken for each pathway of interest (final search 8 November 2019) using CINAHL Complete, ERIC, Medline (OVID), PsycINFO, Web of Science Core Collection, Scopus and SportDiscus. Potential articles were initially identified through abstract and title checking (N = 585) then screened further and combined into one review (n = 152), with 43 articles identified for extraction. Studies needed to be original and peer reviewed, include typically developing children and adolescents first assessed between 2 and 18 years and objective assessment of gross MC and at least one other variable (i.e., PA, weight status, perceived MC, health-related fitness). PA included sport participation, but sport-specific samples were excluded. Longitudinal or experimental designs and cross-sectional mediated models were sought. Strength of evidence was calculated for each pathway in both directions for each domain (i.e., skill composite, object control and locomotor/coordination/stability) by dividing the proportion of studies indicating a significantly positive pathway in the hypothesised direction by the total associations examined for that pathway. Classifications were no association (0–33%), indeterminate/inconsistent (34–59%), or a positive ‘+’ or negative ‘ − ’ association (≥ 60%). The latter category was classified as strong evidence (i.e., ++or −−) when four or more studies found an association. If the total number of studies in a domain of interest was three or fewer, this was considered insufficient evidence to make a determination.

Results

There was strong evidence in both directions for a negative association between MC and weight status. There was strong positive evidence for a pathway from MC to fitness and indeterminate evidence for the reverse. There was indeterminate evidence for a pathway from MC to PA and no evidence for the reverse pathway. There was insufficient evidence for the MC to perceived MC pathway. There was strong positive evidence for the fitness-mediated MC/PA pathway in both directions. There was indeterminate evidence for the perceived MC-mediated pathway from PA to MC and no evidence for the reverse.

Conclusion

Bidirectional longitudinal associations of MC with weight status are consistent with the model authored by Stodden et al. (Quest 2008;60(2):290–306, 2008). However, to test the whole model, the field needs robust longitudinal studies across childhood and adolescence that include all variables in the model, have multiple time points and account for potential confounding factors. Furthermore, experimental studies that examine change in MC relative to change in the other constructs are needed.

Trial Registrations

PROSPERO ID# CRD42020155799.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01516-8.

High BMI and Low Muscular Fitness Predict Low Motor Competence in School-Aged Children Living in Low-Resourced Areas

Childhood obesity is a relatively new problem for Sub-Saharan developing countries. Especially in children with a low socioeconomic background, the link between motor competence, muscular fitness, and body mass index (BMI) remains poorly investigated. Due to the interrelatedness of BMI and physical fitness, the aim of this study is to determine the predictive value of these factors in relation to low motor competence in school-aged children living in low-resourced areas. Motor competence and physical fitness were assessed in 1037 school-aged Ghanaian and South African children using the Performance and Fitness test battery (PERF-FIT). “Low motor competence” was predicted using odds ratios calculated from backward logistic regression analyses. Low motor competence was less prevalent in Ghanaian children (3.7–11.1%) compared to the South African children (21.9–24.2%). Increased BMI and decreased muscular fitness predicted low motor competence in both Ghanaian and South African children. For example, the chance for a Ghanaian child to have low static balance increased by 22.8% (OR = 1.228, p < 0.001) with a 1-point increase in BMI, whereas this decreased by 30.0% (OR = 0.970, p < 0.001) with a 10-cm increase on the standing long jump. In the case of the South African children, if their BMI increased by 1 point, the chance for those children of having low static balance increased by 7.9%, and if their SLJ performance decreased by 10 cm, their chance of low performance increased by 13%. Clearly, motor competence is associated with both BMI and muscular fitness. Policy makers can use this information to counteract the establishment of childhood obesity by promoting weight control through physical activity and stimulating motor competence at school.

Helping Children with Obesity "Move Well" To Move More: An Applied Clinical Review

ABSTRACT

Children with obesity experience musculoskeletal pain and reduced physical function and well-being, which collectively impact their fitness, strength, motor skills, and even their ability to undertake simple tasks, like walking and climbing stairs. Disrupting obesity-related disability may be critical to increasing children's physical activity. Thus, barriers to movement should be considered by health practitioners to improve the efficacy of prescribed physical activity. This applied clinical review highlights key subjective and objective findings from a hypothetical case scenario, linking those findings to the research evidence, before exploring strategies to enhance movement and increase physical activity.

Socio-Cultural and Somatic Factors Associated with Children's Motor Competence

The purpose of this study was to assess the effect of somatic and socio-cultural factors on children's motor competence (MC). MC was assessed through the standing long jump (SLJ), distance throw of a tennis ball (TTB), and 20 m dash (20 m) in 181 children (84 girls) with a mean age of 6.10(0.47) years. The effect of socio-economic status, house/living space, educational practices, the child's interaction with peers and siblings, and the sum of five skinfolds (SS) were analysed via structural equation modelling (SEM) in each motor skill. The SEM models displayed a good fit to the data. In addition, standardized direct effects are significant on different outcome variables, except for brotherhood relationship (BR) and peer relationship in TTB, and 20 m dash and BR in standing long jump (SLJ). SS are negatively related to all motor skills.

Influences of persistent overweight on perceptual-motor proficiency of primary school children: the North-West CHILD longitudinal study : Persistent overweight and perceptual-motor proficiency in children

BACKGROUND

Overweight can be a precursor of poor motor execution, negatively impacting the overall development of school-aged children on various levels. This study determined the long-term influences of overweight on perceptual-motor proficiency (PMP) of primary school children in the North-West Province of South Africa.

METHODS

The study, which included 381 participants, formed part of the NW-CHILD longitudinal study from Grade 1 (6.86 years, ± 0.39) in 2010 to Grade 7 (12.9 years, ± 0.38) in 2016. Socioeconomic categories, called quintiles, were used to compare high and low socioeconomic status groups. Overweight was identified when BMI values fell above the 85th percentile, using age- and gender-specific cut-off points. The group was categorised into 4 BMI groups (never overweight, persistent overweight, overweight-to-normal and normal-to-overweight). The Bruininks Oseretsky Test of Motor Proficiency-2 (BOT-2) Short Form and selected composites measuring strength, balance, and running speed and agility were used to assess PMP.

RESULTS

A repeated measures ANOVA analysis indicated specific PMP differences between different BMI groups, but not total motor proficiency (BOT-2 Short Form total) differences. Practical significant group differences (Cohen's d-values) were found in running speed and agility, strength, balance and the BOT-2 total, over seven primary school years. The persistent overweight group showed the poorest performance over time, but also showed deteriorating skills and a gradual widening in perceptual-motor skills performance, compared to the other groups. BMI-related differences in perceptual-motor coordination were also more pronounced in older age groups.

CONCLUSIONS

Persistent overweight negatively impacts specific motor-proficiency components, while improving weight status can counter these effects, which highlights the importance of timeous intervention to combat obesity at a young age.

The importance of body weight status on motor competence development: From preschool to middle childhood

We evaluated the association between weight status and motor competence from preschool age (3‐5 years of age) until middle childhood (7‐9 years of age). Longitudinal study with three to five‐year‐old preschool children (n = 1155) enrolled in public and private preschools in Recife, Brazil. Children were followed twice (2010, 2012, and 2014) for four years. Köperkoordinationstest für kinder (KTK) assessed the children's motor competence (KTK Motor Quotient). Weight status (underweight, normal weight, overweight, and obesity) was classified according to the children's sex and age. Preschool children with normal weight exhibited higher motor competence at 5‐7 years of age compared to preschool children with overweight (+3.73 MQ, P = .03) and obesity (+5.09 MQ, P < .01). Preschool children with normal weight presented higher motor competence at 7‐9 years of age compared to their peers with overweight (+6.00 MQ, P = .03) and obesity (+5.88 MQ, P = .01). Children with normal weight at 5‐7 years of age presented higher motor competence at 7‐9 years of age compared to their peers with overweight (+3.33 MQ, P = .02) and obesity (+4.00 MQ, P = .02). Independent of the childhood phase and extension of the period evaluated (2‐ or 4‐year period), children who had excessive weight (overweight or obesity) and changed their weight status to underweight or normal weight presented similar motor competence compared to children who continued underweight or normal weight. Weight status already at preschool age is an important predictor of the children's motor competence until middle childhood. Interventions improving the children's weight status, already at preschool age, might impact their motor competence development positively.

How Important is Motor Competence for Healthy Weight Status across Adolescence?

Background: Although evidence supports that motor competence is negatively associated with adiposity levels in children, less is known about how motor competence and weight status relate in adolescence. Adolescence is a critical period to study this relationship because the associations between these elements are expected to strengthen over developmental time. The aim of this study was to analyze the relationship between motor competence and weight status across adolescence. Methods: A longitudinal study (2-year follow-up) was conducted with 122 participants (59.8% girls) aged 12-13 years at baseline. They were assessed annually at three time points. Body fatness, motor competence, physical activity, and musculoskeletal fitness levels were determined through skinfold thickness, Körperkoordinationstest für Kinder (KTK), Physical Activity Questionnaire for Older Children (PAQ-C), and sit-up tests. Generalized Estimating Equation (GEE) models were conducted adjusting for potential confounders (age, gender, anthropometry, physical activity, and fitness). Results: Motor competence and body fat showed moderate-to-high negative correlations (r = -0.65 to -0.69, p < 0.001) across time. Furthermore, motor competence significantly predicted body fat over time (B = -0.05, p = 0.05), even after adjusting for potential confounders. Conclusions: There is a lot of emphasis in the literature on increasing physical activity to maintain a healthy weight status or to prevent unhealthy weight gain, but this study has highlighted the role of motor competence on these aspects across the critical period of adolescence. Therefore, it seems plausible to recommend initiatives that foster the development of motor competence in early adolescence with the aim to prevent obesity.

Effects of School-Based Exercise Program on Obesity and Physical Fitness of Urban Youth: A Quasi-Experiment

(1) Purpose: The purpose of this study was to evaluate if an after-school intervention program could prevent obesity and promote the physical fitness of urban sedentary school children. (2) Methods: A 16-week after-school physical fitness program was provided to 36 middle school students (7th, 8th, and 9th graders) recruited from a middle school for three days a week. They were high-risk youth showing poor health status (level 4 or 5) in the regular physical fitness evaluation conducted. Their body mass index (BMI), cardiovascular endurance, muscular strength and endurance, quickness, and flexibility were evaluated. (3) Results: A paired sample t-test was used (α = 0.05). There were statistical differences ((x ± s), p < 0.05) between the pre-Progressive Aerobic Cardiovascular Endurance Run (PACER) (13.36 ± 4.98 (# of laps)) and post-PACER (18.64 ± 6.31 (# of laps)) (p < 0.001), between the pre-sit-up (18.06 ± 7.22 (# of sit-ups)) and post-sit-up (24.89 ± 7.52 (# of sit-ups)) (p < 0.001), and between the pre-Trunk Flexion (2.64 ± 3.49 ((cm))) and post-Trunk Flexion (5.97 ± 2.78 ((cm)) (p < 0.001). There was no statistical difference between the pre-50m-Run (10.74 ± 1.30 ((sec))) and post-50m-Run results (10.69 ± 1.25 (sec)) (p = 0.063) or between the pre-BMI (24.84 ± 3.97 (kg/m2)) and post-BMI (24.76 ± 3.61 (kg/m2)) (p = 0.458). Overall, the physical fitness measures improved, whereas BMI did not change after 16 weeks. (4) Conclusion: Sixteen weeks of the school-based Health-related Physical Fitness (HrPF) program can be effective in improving overall physical fitness levels of adolescents, although additional treatments would be required to change BMI, which showed no improvement in the present study. It is concluded that in order for adolescents to maintain and promote physical fitness and health, participation in a school-based HrPF program is recommended for at least 30 min a day, three days a week. In addition, schools should provide high-risk youth with easy access to physical activities that are similar to the objectives of the physical education curriculum. In order to promote the health of school-age children, each school should establish and operate school-based systematic intervention programs.

Clinical Assessment and Treatment of Early-Onset Severe Obesity

PURPOSE OF REVIEW

This review describes clinical management of early-onset severe obesity, defined here as severe obesity in children ≤ 5 years old. It summarizes current information regarding (1) assessment, specifically growth, genetics, cardiometabolic risk, health behaviors, developmental considerations, and psychosocial factors, and (2) treatment, focusing on lifestyle modification including parent training and a brief summary of pharmacotherapy.

RECENT FINDINGS

Prevalence of severe obesity in young children has remained stable yet most of these children will become adults with obesity. Interventions that address multiple health domains, such as eating habits, physical activity, and parenting skills, are necessary for addressing early-onset severe obesity. Research into pharmacotherapy remains limited but may provide future strategies for management. Early-onset severe obesity significantly influences children's long-term health and management should focus on intervention to promote BMI reduction. Further research into effective strategies is necessary to address the needs of this high-risk population.

Effects of Overweight/Obesity on Motor Performance in Children: A Systematic Review

Childhood obesity is a serious public health problem. Childhood obesity and overweight are associated with the appearance of coordination deficit disorder and can cause impaired motor performance. We searched online databases for all related articles using comprehensive international databases from the Medline PubMed Institute, Web of Science, ScienceDirect, SCOPUS, and PsycINFO up to December 20, 2020. Overall, 33 studies were included in this systematic review. The present review demonstrated that children with higher percentage of body fat had lower levels of moderate to vigorous physical activity, as well as decreased levels of gross motor coordination, as shown by tests for neuromuscular performance. These results corroborate the hypothesis that overweight and obesity in children and adolescents are associated, not only with insufficient performance during gross motor coordination activities, but also with a greater risk to physical health.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/prospero/], identifier [CRD42020182935].

Delayed motor skills associated with pediatric obesity

OBJECTIVE

To review the literature regarding associations between developmental motor delay (DMD) and pediatric obesity. We hope to identify potential interventions that can improve motor coordination at an early age, thereby minimizing the deterring factors of physical activity down the road.

DESIGN

An integrative review was undertaken using search combinations to best identify potential publications. Manuscripts were reviewed, summarized, and discussed in detail. An experienced clinician in pediatric obesity reviewed the final searches for substantive content.

CRITERIA

Inclusion criteria include English language studies or publications, children ≤18 years old, publication/study relates to DMD and pediatric obesity. Excluded publications regarded topics of pediatric obesity that have been extensively studied such as maternal and family histories of obesity, isolated nutritional or physical interventions to improve obesity without discussion of DMD.

RESULTS

21 publications were included for review. Papers fell into three main categories regarding the association between pediatric obesity and DMD: 1) Motor function - negative association with motor function and obesity 2) Motor Development - lower levels of motor function are associated with decreased levels of exercise, and 3) Role of Intervention - specific physical activity intervention showed improvements in motor function.

CONCLUSIONS

Motor function deficits appear to be associated with obesity. However, it is not well understood if children with obesity have delayed motor skills as a consequence of their weight or if the DMD is a risk factor for the development of obesity; existing studies do not provide an answer.

Six-minute walk distance equation in children and adolescents with obesity

AIM

To develop a 6-minute walk-distance (6MWD) reference equation for children and adolescents with obesity, and to assess its determinant factors.

METHODS

A cross-sectional study using mixed linear and multiple regression models was conducted in 497 children (235 girls and 262 boys) aged 6-18 years with a body mass index (BMI) greater than 97th percentile. Anthropometrics and a 6-minute walk test (6MWT) were performed.

RESULTS

Mean 6MWD was 547 ± 86 m for girls and 575 ± 96 m for boys, which averaged ~80% of a reference normal-weight population matched for age and ethnicity. Age, weight and BMI were positively correlated with 6MWD whereas waist and hip circumferences (WC and HC, respectively) were negatively correlated with 6MWD for both genders. The combination of age, height, BMI and HC explained 69% of the 6MWD variability in the equation for the whole population. Moreover, the combination of age, height, HC as well as the combination of age, height, BMI and WC explained 67% and 75% of the variability in the girls' and boys' equations, respectively.

CONCLUSION

This 6MWD reference equation, which was influenced by abdominal obesity markers in a gender-specific way, extends and enhances scientific knowledge and provides useful predictive tools for the care of obese children.

Promoting healthy weight for all young children: a mixed methods study of child and family health nurses' perceptions of barriers and how to overcome them

BACKGROUND

Childhood obesity is a global health concern. Early intervention to help parents adopt best practice for infant feeding and physical activity is critical for maintaining healthy weight. Australian governments provide universal free primary healthcare from child and family health nurses (CFHNs) to support families with children aged up to five years and to provide evidence-based advice to parents. This paper aims to examine factors influencing the child obesity prevention practices of CFHNs and to identify opportunities to support them in promoting healthy infant growth.

METHODS

This mixed methods study used a survey (n = 90) and semi-structured interviews (n = 20) with CFHNs working in two local health districts in Sydney, Australia. Survey data were analysed descriptively; interview transcripts were coded and analysed iteratively. Survey and interview questions examined how CFHNs addressed healthy infant feeding practices, healthy eating, active play and limiting sedentary behaviour during routine consultations; factors influencing such practices; and how CFHNs could be best supported.

RESULTS

CFHNs frequently advised parents on breastfeeding, introducing solid foods, and techniques for settling infants. They spent less time providing advice on evidence-based formula feeding practices or encouraging physical activity in young children. Although nurses frequently weighed and measured children, they did not always use growth charts to identify those at risk of becoming overweight or obese. Nurses identified several barriers to promoting healthy weight gain in infants and young children, including limited parental recognition of overweight in their children or motivation to change diet or lifestyle; socioeconomic factors (such as the cost of healthy food); and beliefs and attitudes about infant weight and the importance of breastfeeding and physical activity amongst parents and family members.

CONCLUSIONS

CFHNs require further education and support for their role in promoting optimal child growth and development, especially training in behaviour change techniques to increase parents' understanding of healthy infant weight gain. Parent information resources should be accessible and address cultural diversity. Resources should highlight the health effects of childhood overweight and obesity and emphasise the benefits of breastfeeding, appropriate formula feeding, suitable first foods, responsiveness to infant feeding cues, active play and limiting screen time.

Fracture risk factors among children living in New Zealand

Factures are common during childhood. There are limited data available regarding relationships between bone fracture history and calcium intake, sugar sweetened beverages (SSBs) intake, vitamin D status, physical activity (PA), ethnicity, and body composition in New Zealand (NZ) children. Identifying groups of NZ children at risk of fracture and associated predictors may help to improve bone quality during childhood and decrease the risk of fractures throughout life. The aim of this study was to investigate fracture history and associated risk factors in New Zealand children. Children aged 8-12 years were recruited. Capillary blood spots collected from a finger prick were as analyzed for 25(OH)D concentrations. Bioelectrical impedance analysis (InBody720, Seoul, Korea) was used to measure body fat percentage (%BF). Information about fracture history, siblings' history of fractures, family osteoporosis history, PA, ethnicity, and intake of calcium containing foods, and SSBs was collected using questionnaires. Children (n = 647, 354 girls), mean ± SD age 9.8 ± 0.7 years were recruited from six Auckland primary schools. NZ European (n = 252) (NZE) and South Asian (n = 68) children reported the lowest (20.2 %) and highest (44.1 %) fracture incidence, respectively. NZE compared to South Asian children, had higher 25(OH)D concentrations (74.6 ± 19.8 vs. 48.4 ± 19.3 nmol/L, P < 0.001), higher total calcium intake (764.0 ± 394.4 vs. 592.7 ± 266.3 mg/d, P < 0.018), and lower %BF (19.5 ± 6.6 vs. 23.4 ± 8.4, P < 0.003). Māori children had the next highest fracture rate (32.5 %). This group had adequate 25(OH)D (64.2 ± 18.9 nmol/L), but high %BF (23.9 %) and most participated in vigorous PA. After stratifying by sex, binary logistic regression analysis revealed the main determinants of fracture history for boys were high %BF, low 25(OH)D, low calcium intake, high SSBs consumption, siblings' fracture history, family osteoporosis history, and being South Asian; and in girls, high SSBs consumption, siblings' fracture history, and family osteoporosis history. We found South Asian ethnicity was a significant risk factor for boys. Some children were at high risk of vitamin D deficiency and for whom supplementation may be necessary in winter. Good nutrition (especially good sources of calcium and reducing SSBs intakes) should be recommended to children during growth and development to reduce their risk of fractures.

Gesundheit und Fitness von deutschen Schulkindern

Hintergrund

Übergewicht und Bewegungsmangel stellen bei Kindern ein Risiko für kardiovaskuläre Erkrankungen dar. Das Ziel der Studie war, den kardiovaskulären Gesundheitsstatus und die Fitness deutscher Grund- und Gesamtschülerinnen und -schüler sowie mögliche Einflussfaktoren zu erfassen.

Methodik

In einer prospektiven Querschnittsstudie wurden 357 Kinder (9,6 ± 1,7 Jahre) auf kardiovaskuläre Risikofaktoren untersucht. Die Pulswellengeschwindigkeit (PWV) als Maß für die arterielle Gefäßelastizität sowie die Fahrradergometrie zur Einschätzung der Fitness wurden bestimmt.

Ergebnisse

24 % der Kinder waren übergewichtig (Body-Mass-Index, BMI >90. Perzentile) oder adipös (BMI >97. Perzentile). Nahezu alle diese Kinder litten an einer viszeralen Adipositas (99 %). Bei Kindern mit Übergewicht/Adipositas war häufiger eine geringere Gefäßelastizität nachweisbar (PWV „standard deviation score“, SDS 0,8 ± 1,0 vs. 0,2 ± 0,9 bei Kindern ohne Übergewicht, p < 0,001; PWV-Werte >95. Perzentile 24 % vs. 3 %). Das Vorliegen von Übergewicht/Adipositas, Grundschulalter, höherer Blutdruck und niedrigeres „High Density Lipoprotein“(HDL)-Cholesterin waren unabhängige Prädiktoren für geringere Gefäßelastizität. Zudem zeigten Kinder mit Übergewicht/Adipositas einen höheren systolischen Blutdruck, ein nachteiligeres Fettstoffwechselprofil, höhere Harnsäure- und Glutamat-Pyruvat-Transaminase(GPT)-Werte sowie schlechtere körperliche Fitness und einen höheren Medienkonsum. Es bestand eine signifikante Assoziation von BMI und glomerulärer Filtrationsrate.

Diskussion

Das mit erhöhtem BMI und reduzierter Fitness einhergehende kardiovaskuläre Risiko wird durch weitere Risikofaktoren für die Entwicklung eines metabolischen Syndroms verstärkt. Zusätzlich finden sich Hinweise, dass bereits strukturelle Veränderungen an den Gefäßen vorliegen. Unsere Daten legen eine umfassende Beurteilung des individuellen kardiovaskulären Risikos bei Kindern mit Übergewicht nahe und unterstreichen die Notwendigkeit, Präventionsmaßnahmen früh in den Alltag von Kindern zu implementieren, um die kardiovaskuläre Morbidität im Erwachsenenalter zu verringern.

Classes of developmental trajectories of body mass index: Differences in motor competence and cardiorespiratory fitness

The purpose was to identify classes of different developmental trajectories of BMI and testing them for differences in motor competence (MC) and cardiorespiratory fitness (CRF), in children and adolescents (4 to 13 years of age). This was a 5 years' longitudinal study with six cohorts. One hundred and forty-seven children (69 girls) divided into six cohorts participated. At baseline, the youngest and the oldest cohorts had 4 and 11 years of age, respectively. Height and weight were assessed, and BMI was calculated. MC was assessed with KTK and TGMD-2, and CRF was assessed with one-mile run/walk. Developmental trajectories of BMI were identified using latent class linear-mixed modelling. Latent class membership was explained according to covariates of MC and CRF. Two meaningful classes were identified. Class 1 (78.92% of the participants) showed lower initial BMI and a lower slope compared to class 2 (21.08% of the participants) (all ps < 0.001). Class membership only predicted trajectories in motor coordination, with children in class 1 having a better development.In conclusion, this study identified two meaningful trajectories for children based on their BMI development across five time points. In line with previous research, children with slower increasing BMI showed better motor coordination improvements.

Benefits of Activity-Based Interventions Among Female Adolescents Who Are Overweight and Obese

PURPOSE

The purpose of this study was to compare the effects of 2 activity-based motor interventions among female adolescents who are overweight and obese.

METHODS

This study was conducted in a low-income community of Cape Town, South Africa. The study involved 52 participants classified as overweight and obese. Participants were randomly assigned to task-oriented functional training or Wii Fit intervention. Both interventions were 45 minutes of active training once a week for 14 weeks. Outcome measures included aerobic fitness, motor coordination, and self-efficacy. Data were collected before and after the interventions.

RESULTS

Participants in both groups demonstrated significant improvement in aerobic fitness and motor coordination but not self-efficacy. However, no between-group differences were observed on any of the outcomes.

CONCLUSIONS

Activity-based interventions may improve aerobic fitness and motor coordination in female adolescents who are overweight and obese and may also help prevent declines in physical fitness and coordination in this population.

Relationships between adiposity and postural control in girls during balance tasks of varying difficulty

OBJECTIVE

This study aimed to examine associations between postural control and body composition in 8-10-year-old girls.

METHODS

An observational cross-sectional study was conducted in 47 girls who were healthy-weight/overweight/obese [body mass index (BMI) percentile]. Girls participated in six postural control conditions of varying difficulty (standing with malleoli touching, tandem stance leading with dominant and non-dominant foot, repeated with eyes open and closed). Postural control outcomes included Centre of Pressure (COP) sway area, COP principal and minor axis length and COP maximum velocity. Data were analysed using linear mixed modelling.

RESULTS

BMI percentile was positively associated with COP sway area (p=0.034) and principal axis (p=0.030) during tandem stance non-dominant foot leading with eyes closed and COP principal axis during tandem stance dominant foot leading with eyes open (p=0.045). BMI percentile significantly interacted with postural control conditions of varying difficulty to predict postural control outcomes (p≤0.035), notable for tandem stance positions [all four COP sway outcomes in tandem stance non-dominant foot leading eyes closed; tandem stance dominant foot leading with eyes open and closed (two COP sway outcomes each)].

CONCLUSIONS

Girls with greater adiposity may have impairments in postural control, but only during more challenging postural control conditions. In contrast, BMI has little role to play in girls' postural control in easier postural control conditions (standing with feet together). These findings may suggest potential functional or safety considerations when girls with overweight/obesity are performing demanding postural control tasks (such as during sport or physical activity).

Testing the Motor Competence and Health-Related Variable Conceptual Model: A Path Analysis

The purpose of this study was to empirically test a comprehensive conceptual model linking gross motor skills, school day physical activity and health-related variables in a sample of sixth graders. Participants were a convenience sample of 84 sixth grade students (Mean age = 11.6 ± 0.6 years). Gross motor skills were assessed using the Test of Gross Motor Development-3rd Edition (TGMD-3), school day physical activity was assessed using pedometers, health-related fitness was assessed using Progressive Aerobic Cardiovascular Endurance Run (PACER) laps, perceived competence assessed using a validated questionnaire and the health-related outcome was assessed using Body Mass Index (BMI). The relationship between school day step counts and TGMD-3 scores was mediated through both perceived competence and PACER laps (p = 0.015) and the direct path coefficient between TGMD-3 scores and BMI was statistically significant (b = -0.22 kg/m², p < 0.001). Overall there was good model fit with all indices meeting acceptable criteria (χ² = 3.7, p = 0.293; Root Mean Square Error of Approximation (RMSEA) = 0.062, 90% Confidence Interval (C.I.): 0.00-0.23; Comparative Fit Index (CFI) = 0.98; Tucker-Lewis Index (TLI) = 0.96; Standardized Root Mean Square Residual (SRMR) = 0.052). The comprehensive conceptual model explaining the inter-relationships among motor competence and health-related variables was empirically validated with the relationship between physical activity and gross motor skills mediated through both perceived competence and cardiorespiratory endurance in a sample of sixth graders.

Joint Relationship Between Physical Activity, Weight Status, and Motor Skills in Children Aged 3 to 10 Years

While the relationships between physical activity (PA), obesity, and motor skills have been independently examined by previous research, this study explored both independent and combined relationships between children's PA, weight status, and motor skills within a multiple regression analysis. We measured height and weight and calculated body mass index (BMI) z scores for 96 children (3-10 years of age). We measured motor skills using the Movement Assessment Battery for Children-2nd edition (MABC-2), and we measured PA levels through accelerometry. Children with more time in moderate and moderate-to-vigorous PA had higher Total motor skill scores on the MABC-2. Further, children with higher moderate PA levels had higher Balance scores and those with moderate-to-vigorous PA demonstrated higher Aiming and Catching scores. Among children with healthier BMIs, more time spent in PA, regardless of intensity, was related to higher Aiming and Catching scores. Among children with BMI scores suggestive of overweight/obesity, both moderate and moderate-to-vigorous PA were positively related to Balance scores. In conclusion, while BMI z scores were not directly related to motor skills, PA levels were positively related to motor skills, and weight status mediated the relationship between PA and specific components of motor skills.

Motor performance, body fatness and environmental factors in preschool children

The first aim of this study was to investigate the relationship between motor performance and body fatness among 3- to 5-year-old children. The second aim was to assess whether this relationship works similarly for boys and girls. We also investigated whether socioeconomic status (SES) and geographical area when children are aged 3 years old predicts the motor performance of 4 and 5-yr-old children. Motor performance was assessed through the Preschool Test Battery, while body fatness was estimated through body mass index (BMI). SES and geographical area were assessed via parent proxy-report questionnaires. BMI was negatively associated with standing long jump. The association of BMI and motor performance was not statistically different for boys and girls. Children from low SES performed better than high SES peers in tennis ball throw for distance. Rural children were better performers than urban peers in standing long jump. Rural area at baseline was also predictor of standing long jump and tennis ball throw for distance at time 1 and 2. In conclusion, BMI had a negative association with standing long jump and the relationship of BMI with all motor tests was similar for boys and girls. SES and rural area were predictors of motor performance.

Fundamental movement skills and balance of children with Down syndrome

BACKGROUND

Conclusive evidence supports the importance of fundamental movement skills (FMS) proficiency in promoting physical activity and countering obesity. In children with Down Syndrome (DS), FMS development is delayed, which has been suggested to be associated with balance deficits. This study therefore examined the relationship between FMS proficiency and balance ability in children with DS, with the aim of contributing evidence to programmes that address FMS delay.

METHODS

Participants consisted of 20 children with DS (7.1 ± 2.9 years old) and an age-matched control group of children with typical development (7.25 ± 2.5 years). In the first part of the study, FMS (i.e. locomotor and object control) proficiency of the children was tested using the Test of Gross Motor Development-2. Balance ability was assessed using a force platform to measure centre of pressure average velocity (AV; mm/sec), path length (mm), medio-lateral standard deviation (mm) and antero-posterior standard deviation (mm). In the second part of the study, children with DS participated in 5 weeks of FMS training. FMS proficiency and balance ability were tested post-training and compared to pre-training scores. Verbal and visuo-spatial short-term memory capacities were measured at pre-training to verify the role of working memory in skill learning.

RESULTS

FMS proficiency was associated with centre of pressure parameters in children with DS but not in children with typical development. After controlling for age, AV was found to predict significant variance in locomotor (R²  = 0.61, P < 0.001) and object control (R²  = 0.69, P < 0.001) scores. FMS proficiency and mastery improved after FMS training, as did AV, path length and antero-posterior standard deviation (all P < 0.05). Verbal and visuo-spatial short-term memory did not interact with the effects of training.

CONCLUSIONS

Children with DS who have better balance ability tend to have more proficient FMS. Skill-specific training improved not only FMS sub-skills but static balance stability as well. Working memory did not play a role in the changes caused by skills training. Future research should examine the causal relationship between balance and FMS.

Differences in bone mineral density between normal-weight children and children with overweight and obesity: a systematic review and meta-analysis

OBJECTIVE

This study examines the differences in bone mineral density between normal-weight children and children with overweight or obesity.

METHODS

A systematic review and meta-analysis of observational studies (published up to 22 June 2016) on the differences in bone mineral density between normal-weight children and overweight and obese children was performed. Results were pooled when possible and mean differences (MDs) were calculated between normal-weight and overweight and normal-weight and obese children for bone content and density measures at different body sites.

RESULTS

Twenty-seven studies, with a total of 5,958 children, were included. There was moderate and high quality of evidence that overweight (MD 213 g; 95% confidence interval [CI] 166, 261) and obese children (MD 329 g; 95%CI [229, 430]) have a significantly higher whole body bone mineral content than normal-weight children. Similar results were found for whole body bone mineral density. Sensitivity analysis showed that the association was stronger in girls.

CONCLUSIONS

Overweight and obese children have a significantly higher bone mineral density compared with normal-weight children. Because there was only one study included with a longitudinal design, the long-term impact of childhood overweight and obesity on bone health at adulthood is not clear.