Accuracy of simple clinical and epidemiological definitions of childhood obesity: systematic review and evidence appraisal

Assessment and Management of Patients with Obesity and Hypertension in European Society of Hypertension Excellence Centres. A survey from the ESH Working Group on Diabetes and Metabolic Risk Factors

BACKGROUND

Healthcare providers are faced with an increasing number of patients with obesity and arterial hypertension. Preventing obesity-associated hypertension and appropriately managing patients with established disease are both important. Hence, the aim of our study was to evaluate the clinical care of patients with obesity and hypertension among ESH Excellence Centres (ECs).

METHODS

We conducted a cross-sectional, international 30-item survey through e-mails.

RESULTS

In total, 70 representatives of ECs participated (78% men) with 66% of them practicing medicine for more than 30 years and working in well-equipped clinics. Most were internists (41%) and cardiologists (37%) and 73% reported training on the management of obese patients with hypertension. A majority weigh their patients (77%) and evaluate patients for sleep disorders (93%). However, only 47% spend more than 5min to advise for lifestyle modification in general, 59% for weight loss, 56% for salt intake and 64% for exercise. Finally, a minority of participants ask patients if they like their body (6%) or about previous attempts to lose weight (28%), evaluate 24h urinary sodium excretion rate (22%) and provide written (15%) or personalized (10%) dietary advices. If the patient suffers also from type 2 diabetes mellitus, 66% switch treatment to GLP1 receptor agonists and 60% to SGLT2 inhibitors.

CONCLUSION

Most clinicians in ESH ECs are well educated regarding obesity-associated hypertension, and clinics are sufficiently equipped to manage these patients, as well. However, several deficits were reported regarding efforts to address and implement obesity specific aspects and interventions to improve care in patients with obesity and hypertension.

Obesity and dental caries in childhood: trends in prevalence and socioeconomic inequalities-a multicohort population-wide data linkage study

OBJECTIVES

To quantify levels of coexisting obesity and caries experience in children in Scotland, and any associated socioeconomic inequalities over the years 2011/2012-2017/2018.

DESIGN

A multicohort population-wide data linkage study.

SETTING

Local authority primary schools in Scotland.

PATIENTS

335 361 primary 1 (approximately 5 years old) schoolchildren in Scotland between 2011/2012 and 2017/2018.

MAIN OUTCOME MEASURES

Prevalence and inequalities in coexisting caries and obesity.

RESULTS

The prevalence of coexisting obesity and caries experience was 3.4% (n=11 494 of 335 361) and did not change over the 7 years. Children living in the 20% most deprived areas had more than sixfold greater odds of coexisting obesity and caries experience than children from the 20% least deprived areas (adjusted OR=6.63 (95% CI=6.16 to 7.14; p<0.001)). There was a large persistent socioeconomic gradient across the Scottish Index of Multiple Deprivation groups, with the Slope and Relative Indices of Inequality remaining unchanged over the 7 cohort years.

CONCLUSIONS

Despite improvements in oral health in children in Scotland, the prevalence of coexisting obesity and caries experience has remained static, with large persistent inequalities. These conditions are likely to signal increased risk of chronic conditions including multimorbidity in adulthood and therefore early identification of children most at risk and timely intervention tackling common risk factors should be developed and evaluated.

Interventions to prevent obesity in children aged 5 to 11 years old

BACKGROUND

Prevention of obesity in children is an international public health priority given the prevalence of the condition (and its significant impact on health, development and well-being). Interventions that aim to prevent obesity involve behavioural change strategies that promote healthy eating or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective and numerous new studies have been published over the last five years, since the previous version of this Cochrane review.

OBJECTIVES

To assess the effects of interventions that aim to prevent obesity in children by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search date was February 2023.

SELECTION CRITERIA

Randomised controlled trials in children (mean age 5 years and above but less than 12 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our outcomes were body mass index (BMI), zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome.

MAIN RESULTS

This review includes 172 studies (189,707 participants); 149 studies (160,267 participants) were included in meta-analyses. One hundred forty-six studies were based in high-income countries. The main setting for intervention delivery was schools (111 studies), followed by the community (15 studies), the home (eight studies) and a clinical setting (seven studies); one intervention was conducted by telehealth and 31 studies were conducted in more than one setting. Eighty-six interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over four years. Non-industry funding was declared by 132 studies; 24 studies were funded in part or wholly by industry. Dietary interventions versus control Dietary interventions, compared with control, may have little to no effect on BMI at short-term follow-up (mean difference (MD) 0, 95% confidence interval (CI) -0.10 to 0.10; 5 studies, 2107 participants; low-certainty evidence) and at medium-term follow-up (MD -0.01, 95% CI -0.15 to 0.12; 9 studies, 6815 participants; low-certainty evidence) or zBMI at long-term follow-up (MD -0.05, 95% CI -0.10 to 0.01; 7 studies, 5285 participants; low-certainty evidence). Dietary interventions, compared with control, probably have little to no effect on BMI at long-term follow-up (MD -0.17, 95% CI -0.48 to 0.13; 2 studies, 945 participants; moderate-certainty evidence) and zBMI at short- or medium-term follow-up (MD -0.06, 95% CI -0.13 to 0.01; 8 studies, 3695 participants; MD -0.04, 95% CI -0.10 to 0.02; 9 studies, 7048 participants; moderate-certainty evidence). Five studies (1913 participants; very low-certainty evidence) reported data on serious adverse events: one reported serious adverse events (e.g. allergy, behavioural problems and abdominal discomfort) that may have occurred as a result of the intervention; four reported no effect. Activity interventions versus control Activity interventions, compared with control, may have little to no effect on BMI and zBMI at short-term or long-term follow-up (BMI short-term: MD -0.02, 95% CI -0.17 to 0.13; 14 studies, 4069 participants; zBMI short-term: MD -0.02, 95% CI -0.07 to 0.02; 6 studies, 3580 participants; low-certainty evidence; BMI long-term: MD -0.07, 95% CI -0.24 to 0.10; 8 studies, 8302 participants; zBMI long-term: MD -0.02, 95% CI -0.09 to 0.04; 6 studies, 6940 participants; low-certainty evidence). Activity interventions likely result in a slight reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.18 to -0.05; 16 studies, 21,286 participants; zBMI: MD -0.05, 95% CI -0.09 to -0.02; 13 studies, 20,600 participants; moderate-certainty evidence). Eleven studies (21,278 participants; low-certainty evidence) reported data on serious adverse events; one study reported two minor ankle sprains and one study reported the incident rate of adverse events (e.g. musculoskeletal injuries) that may have occurred as a result of the intervention; nine studies reported no effect. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, may result in a slight reduction in BMI and zBMI at short-term follow-up (BMI: MD -0.11, 95% CI -0.21 to -0.01; 27 studies, 16,066 participants; zBMI: MD -0.03, 95% CI -0.06 to 0.00; 26 studies, 12,784 participants; low-certainty evidence) and likely result in a reduction of BMI and zBMI at medium-term follow-up (BMI: MD -0.11, 95% CI -0.21 to 0.00; 21 studies, 17,547 participants; zBMI: MD -0.05, 95% CI -0.07 to -0.02; 24 studies, 20,998 participants; moderate-certainty evidence). Dietary and activity interventions compared with control may result in little to no difference in BMI and zBMI at long-term follow-up (BMI: MD 0.03, 95% CI -0.11 to 0.16; 16 studies, 22,098 participants; zBMI: MD -0.02, 95% CI -0.06 to 0.01; 22 studies, 23,594 participants; low-certainty evidence). Nineteen studies (27,882 participants; low-certainty evidence) reported data on serious adverse events: four studies reported occurrence of serious adverse events (e.g. injuries, low levels of extreme dieting behaviour); 15 studies reported no effect. Heterogeneity was apparent in the results for all outcomes at the three follow-up times, which could not be explained by the main setting of the interventions (school, home, school and home, other), country income status (high-income versus non-high-income), participants' socioeconomic status (low versus mixed) and duration of the intervention. Most studies excluded children with a mental or physical disability.

AUTHORS' CONCLUSIONS

The body of evidence in this review demonstrates that a range of school-based 'activity' interventions, alone or in combination with dietary interventions, may have a modest beneficial effect on obesity in childhood at short- and medium-term, but not at long-term follow-up. Dietary interventions alone may result in little to no difference. Limited evidence of low quality was identified on the effect of dietary and/or activity interventions on severe adverse events and health inequalities; exploratory analyses of these data suggest no meaningful impact. We identified a dearth of evidence for home and community-based settings (e.g. delivered through local youth groups), for children living with disabilities and indicators of health inequities.

Interventions to prevent obesity in children aged 12 to 18 years old

BACKGROUND

Prevention of obesity in adolescents is an international public health priority. The prevalence of overweight and obesity is over 25% in North and South America, Australia, most of Europe, and the Gulf region. Interventions that aim to prevent obesity involve strategies that promote healthy diets or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective, and numerous new studies have been published over the last five years since the previous version of this Cochrane Review.

OBJECTIVES

To assess the effects of interventions that aim to prevent obesity in adolescents by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search date was February 2023.

SELECTION CRITERIA

Randomised controlled trials in adolescents (mean age 12 years and above but less than 19 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our outcomes were BMI, zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome.

MAIN RESULTS

This review includes 74 studies (83,407 participants); 54 studies (46,358 participants) were included in meta-analyses. Sixty studies were based in high-income countries. The main setting for intervention delivery was schools (57 studies), followed by home (nine studies), the community (five studies) and a primary care setting (three studies). Fifty-one interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over 28 months. Sixty-two studies declared non-industry funding; five were funded in part by industry. Dietary interventions versus control The evidence is very uncertain about the effects of dietary interventions on body mass index (BMI) at short-term follow-up (mean difference (MD) -0.18, 95% confidence interval (CI) -0.41 to 0.06; 3 studies, 605 participants), medium-term follow-up (MD -0.65, 95% CI -1.18 to -0.11; 3 studies, 900 participants), and standardised BMI (zBMI) at long-term follow-up (MD -0.14, 95% CI -0.38 to 0.10; 2 studies, 1089 participants); all very low-certainty evidence. Compared with control, dietary interventions may have little to no effect on BMI at long-term follow-up (MD -0.30, 95% CI -1.67 to 1.07; 1 study, 44 participants); zBMI at short-term (MD -0.06, 95% CI -0.12 to 0.01; 5 studies, 3154 participants); and zBMI at medium-term (MD 0.02, 95% CI -0.17 to 0.21; 1 study, 112 participants) follow-up; all low-certainty evidence. Dietary interventions may have little to no effect on serious adverse events (two studies, 377 participants; low-certainty evidence). Activity interventions versus control Compared with control, activity interventions do not reduce BMI at short-term follow-up (MD -0.64, 95% CI -1.86 to 0.58; 6 studies, 1780 participants; low-certainty evidence) and probably do not reduce zBMI at medium- (MD 0, 95% CI -0.04 to 0.05; 6 studies, 5335 participants) or long-term (MD -0.05, 95% CI -0.12 to 0.02; 1 study, 985 participants) follow-up; both moderate-certainty evidence. Activity interventions do not reduce zBMI at short-term follow-up (MD 0.02, 95% CI -0.01 to 0.05; 7 studies, 4718 participants; high-certainty evidence), but may reduce BMI slightly at medium-term (MD -0.32, 95% CI -0.53 to -0.11; 3 studies, 2143 participants) and long-term (MD -0.28, 95% CI -0.51 to -0.05; 1 study, 985 participants) follow-up; both low-certainty evidence. Seven studies (5428 participants; low-certainty evidence) reported data on serious adverse events: two reported injuries relating to the exercise component of the intervention and five reported no effect of intervention on reported serious adverse events. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, do not reduce BMI at short-term follow-up (MD 0.03, 95% CI -0.07 to 0.13; 11 studies, 3429 participants; high-certainty evidence), and probably do not reduce BMI at medium-term (MD 0.01, 95% CI -0.09 to 0.11; 8 studies, 5612 participants; moderate-certainty evidence) or long-term (MD 0.06, 95% CI -0.04 to 0.16; 6 studies, 8736 participants; moderate-certainty evidence) follow-up. They may have little to no effect on zBMI in the short term, but the evidence is very uncertain (MD -0.09, 95% CI -0.2 to 0.02; 3 studies, 515 participants; very low-certainty evidence), and they may not reduce zBMI at medium-term (MD -0.05, 95% CI -0.1 to 0.01; 6 studies, 3511 participants; low-certainty evidence) or long-term (MD -0.02, 95% CI -0.05 to 0.01; 7 studies, 8430 participants; low-certainty evidence) follow-up. Four studies (2394 participants) reported data on serious adverse events (very low-certainty evidence): one reported an increase in weight concern in a few adolescents and three reported no effect.

AUTHORS' CONCLUSIONS

The evidence demonstrates that dietary interventions may have little to no effect on obesity in adolescents. There is low-certainty evidence that activity interventions may have a small beneficial effect on BMI at medium- and long-term follow-up. Diet plus activity interventions may result in little to no difference. Importantly, this updated review also suggests that interventions to prevent obesity in this age group may result in little to no difference in serious adverse effects. Limitations of the evidence include inconsistent results across studies, lack of methodological rigour in some studies and small sample sizes. Further research is justified to investigate the effects of diet and activity interventions to prevent childhood obesity in community settings, and in young people with disabilities, since very few ongoing studies are likely to address these. Further randomised trials to address the remaining uncertainty about the effects of diet, activity interventions, or both, to prevent childhood obesity in schools (ideally with zBMI as the measured outcome) would need to have larger samples.

The association between body mass index and metabolite response to a liquid mixed meal challenge: a Mendelian randomization study

BACKGROUND

Metabolite abundance is a dynamic trait that varies in response to environmental stimuli and phenotypic traits, such as food consumption and body mass index (BMI, kg/m2).

OBJECTIVES

In this study, we used the Netherlands Epidemiology of Obesity (NEO) study data to identify observational and causal associations between BMI and metabolite response to a liquid meal.

METHODS

A liquid meal challenge was performed, and Nightingale Health metabolite profiles were collected in 5744 NEO participants. Observational and one-sample Mendelian randomization (MR) analysis were conducted to estimate the effect of BMI on metabolites (n = 229) in the fasting, postprandial, and response (or change in abundance) states.

RESULTS

We observed 473 associations with BMI (175 fasting, 188 postprandial, and 110 response) in observational analyses. In MR analyses, we observed 20 metabolite traits (5 fasting, 12 postprandial, and 3 response) to be associated with BMI. MR associations included the glucogenic amino acid alanine, which was inversely associated with BMI in the response state (β: -0.081; SE: 0.023; P = 5.91 × 10-4), suggesting that as alanine increased in postprandial abundance, that increase was attenuated with increasing BMI.

CONCLUSIONS

Overall, this study showed that MR estimates were strongly correlated with observational effect estimates, suggesting that the broad associations seen between BMI and metabolite variation has a causal underpinning. Specific effects in previously unassessed postprandial and response states are detected, and these may likely mark novel life course risk exposures driven by regular nutrition.

Association between Physical Activity and Health Outcomes (High Body Fatness, High Blood Pressure) in Namibian Adolescents and Adult women

Regular physical activity (PA) is known to promote the physical and mental health of children and adolescents and further prevent the development of health problems in adulthood. Information on body composition and PA is crucial for health promotion strategies and for epidemiological studies informing policies. However, there is limited data on the association between body composition and PA in Namibia. This dearth of published data is a significant shortcoming in the development of strategies and policies to promote PA in Namibia. Therefore, this cross-sectional study was conducted to determine the association between PA as a dependent variable and independent variables such as high blood pressure and body fatness as measured by different methods (gold standard deuterium dilution, body mass index, mid upper arm circumference, and waist circumference). The study included 206 healthy adolescent girls aged 13-19 years and 207 young adult females aged 20-40 years from Windhoek, Namibia. PA was measured using the PACE+ questionnaire in adolescents, and the GPAQ questionnaire was used for adults. In adolescents, only 33% of the participants met the recommended guidelines for PA, compared to only 2% for adults. Nevertheless, the study found no statistically significant association between PA and blood pressure indices (p-value < 0.05) among adolescents and adults. However, there was a significant association between PA and high body fatness (p-value < 0.001) and waist circumference (p-value = 0.014) in adolescents. Among adults, PA was significantly related to waist circumference only. In conclusion, failure to meet recommended PA guidelines is strongly associated with abdominal obesity and high body fatness. The knowledge gained from this study may be used by policymakers in the development of strategic policies and interventions aimed at promoting PA as a public priority and improving health outcomes.

Validation of mid-arm circumference for surveillance of obesity in African adolescent girls and adult women

This study aimed to assess the validity of mid-arm circumference (MAC), also known as mid-upper arm circumference (MUAC), for classification of high body fatness in Namibian adolescent girls and women and to test whether classification accuracy of MUAC was higher than the traditional simple proxy for high fatness, the BMI. In 206 adolescent girls aged 13-19 years and 207 adult women aged 20-40 years, we defined obesity conventionally (BMI-for-age Z score ≥ 2·00, adolescents; adults BMI ≥ 30·0 kg/m2) and also defined obesity using published MAC cut-off values. 2H oxide dilution was used to measure total body water (TBW) to define high body fat percentage (≥ 30 % in the adolescents, ≥ 38 % in the adults), and we compared the ability of BMI and MAC to classify high body fatness correctly using sensitivity, specificity and predictive values. In the adolescents, obesity prevalence was 9·2 % (19/206) using BMI-for-age and 63·2 % (131/206) using TBW; sensitivity of BMI-for-age was 14·5 % (95 % CI 9·1, 22·0 %) but was improved significantly using MAC of 22·6 cm (sensitivity 96·9 %; 95 % CI 92·1 %, 99·3 %). In the adults, obesity prevalence was 30·4 % (63/207) using BMI and 57·0 % (118/207) using TBW, and sensitivity of BMI was 52·5 % (95 % CI 43·6, 62·2 %), but using a MAC of 30·6 cm sensitivity was 72·8 % (95 % CI 66·4, 82·6 %). Surveillance of obesity in African adolescent girls and adult women is likely to be improved substantially by use of MAC as an alternative to the BMI-for-age and BMI.

Different criteria for body mass index classification for excess weight screening in children aged six to ten years

OBJECTIVE

To evaluate the agreement between body mass index (BMI) parameters applied to children aged six to ten years in the city of Montes Claros (MG), Brazil with national and international criteria, also calculating their sensitivity and specificity regarding excess weight screening.

METHODS

A sample comprising 4151 children aged six to ten years was assessed, with height and body mass determined for BMI calculation. The obtained values were classified according to cutoff points established by the World Health Organization (WHO), International Obesity Task Force (IOTF), Centers for Disease Control and Prevention (CDC), Conde & Monteiro, and a recent local proposal. The agreement index between the mentioned criteria was calculated and thereafter the sensitivity and specificity.

RESULTS

The local proposal was proven to be highly consistent in most combinations, especially concerning the excess weight criteria of the World Health Organization (WHO) (k=0.895). Regarding excess weight, the local proposal presented sensitivity and specificity values of 0.8680 and 0.9956, respectively, indicating high BMI discrimination power.

CONCLUSIONS

The locally applied BMI parameters for children aged six to ten years represent a valid, highly viable and practical proposal for excess weight screening in this population group, improving professional decision-making in their follow-up.

Prevalence of early childhood obesity in Ireland: Differences over time, between sexes and across child growth criteria

BACKGROUND

Various child growth criteria exist for monitoring overweight and obesity prevalence in young children.

OBJECTIVES

To estimate early overweight and obesity prevalence in Ireland and compare the differences in prevalence across ages, growth criteria and sexes.

METHODS

Longitudinal body mass index data from the nationally representative Growing Up in Ireland infant cohort (n = 11 134) were categorized ('under-/normal weight', 'risk of overweight', 'overweight', 'obesity') using the sex- and age-specific International Obesity Task Force growth reference, World Health Organization growth standard and World Health Organization growth reference criteria. Differences in prevalences between criteria and sexes, and changes in each weight category and criterion across ages (9 months, 3 years, 5 years), were investigated.

RESULTS

Across criteria, 11%-40% of children had overweight or obesity at 9 months, 14%-46% at 3 years and 8%-32% at 5 years of age. Prevalence estimates were highest using the World Health Organization growth reference, followed by International Obesity Task Force estimates. Within each criterion, prevalence decreased significantly over time (p < 0.05). However, when combining both World Health Organization criteria, as recommended for population studies, prevalence increased, due to differences in definitions between them. Significantly more boys than girls had overweight/obesity using either World Health Organization criterion, which was reversed using the International Obesity Task Force growth reference.

CONCLUSIONS

To increase transparency and comparability, studies of childhood obesity need to consider differences in prevalence estimates across growth criteria. Effective prevention, intervention and policy-making are needed to control Ireland's high overweight and obesity prevalence.

The multivariate physical activity signatures associated with body mass index and waist-to-height ratio in 3-5-year-old Norwegian children

The evidence regarding associations between intensity-specific physical activity and adiposity in young children is inconclusive. The aim of this study was to determine the multivariate physical activity intensity signatures associated with body mass index and waist-to-height ratio in children aged 3-5 years. A sample of 1003 Norwegian preschool children (mean age 4.3 years, 51 % boys) from the Active Learning Norwegian Preschool(er)s study provided data on physical activity (ActiGraph GT3X+), body mass index, and waist-to-height ratio during 2019-2020. Multivariate pattern analysis was used to determine associations between the triaxial intensity spectrum (0-99 to ≥15,000 counts per minute) and the outcomes. We found significant associations for physical activity with body mass index and waist-to-height ratio (explained variances = 10.8 and 11.5 %, respectively). For the vertical axis, associations were negative for time spent sedentary (0-99 counts per minute) and positive for time spent in lower intensities (100-2999 counts per minute) for both outcomes, whereas associations for vigorous intensities (≥4000 counts per minute) differed for body mass index (no associations) and waist-to-height ratio (negative associations). Association patterns for body mass index and waist-to-height ratio were rather similar, but the stronger associations with vigorous physical activity intensities for waist-to-height ratio suggest that waist-to-height ratio might better capture adiposity resulting from inactivity than body mass index.

Differences in Classification Standards For the Prevalence of Overweight and Obesity in Children. A Systematic Review and Meta-Analysis

The prevalence of childhood obesity has increased dramatically all over the world in recent years. While obesity in adults can be easily measured using the BMI calculation, determining overweight and obesity in children is more controversial. The aim was to compare the three most used international classification systems (WHO 2007, CDC 2000 and Cole-IOTF) to determine overweight and obesity in infant and adolescent populations. We performed a systematic review in accordance with the PRISMA 2020 guidelines of articles comparing any of the three classification systems. The main findings were that the WHO 2007 criteria show the highest prevalence of overweight and obesity in the child and youth population. The prevalence of childhood overweight and obesity was determined to be higher in boys than in girls in most studies, when analysing the classifications of the WHO 2007, CDC 2000 and Cole-IOTF together. However, there was a higher prevalence of overweight and obesity in girls than in boys when only the CDC 2000 and Cole-IOTF criteria were considered. Both the results of the review and the great heterogeneity found in the meta-analysis show that it is necessary to unify the criteria for the classification of childhood overweight and obesity. International standards are insufficient for working with the current population. A working group should be created to address this issue and agree on the unification of a gold standard, taking into account the geographical region, the ethnic groups and the age groups of the child and youth population and above all, the secular growth.

How Is Context Addressed in Growth Monitoring? A Comparison of the Tanzanian, Indian, and Dutch Manuals

Background

To address malnutrition in all its forms, context should be taken into account in growth-monitoring (GM) practices.

Objectives

The aim was to compare GM manuals of countries with different nutrition problems, and to assess how these manuals are adapted to the different biological, socioeconomic, and cultural contexts.

Methods

GM manuals from Tanzania, India, and the Netherlands were compared with each other, and with the materials for the WHO training course on child growth assessment. First, the aims of GM, growth measurements, interpretation of these measurements, and counseling approaches are compared. Second, contextual determinants of malnutrition are identified using the UNICEF framework for malnutrition as an analytical model.

Results

Our results show that the GM manuals differ in their descriptions of the aim of GM, growth measurements, their interpretation, and counseling approaches. Assessing normal growth and detecting growth problems are among the aims of GM in all of the analyzed countries. In Tanzania and India, the focus is mainly on undernutrition, whereas the Dutch manuals focus on overweight and on underlying pathologies that contribute to poor linear growth. The findings of our analysis of contextual factors within the UNICEF framework show that the Tanzanian protocol is only minimally adapted to the local context. Of the manuals examined in our study, the Indian manual is most focused on the contextual determinants of malnutrition, and stresses the importance of taking customs and beliefs into account. The Dutch protocol, by contrast, emphasizes the importance of the biological environment, including parental height and ethnicity, as determinants of child growth.

Conclusions

The country manuals we analyzed only partly reflect the contexts in which children live. To address malnutrition in all its forms, the GM manuals should take children's biological, socioeconomic, and cultural contexts into account, as this would help health professionals to tailor counseling messages for parents.

Fruit juice and childhood obesity: a review of epidemiologic studies

Childhood obesity is a national epidemic, and many efforts have been made to understand its risk factors. The purpose of this review was to provide an updated account of the observational studies evaluating the relationship between 100% fruit juice intake and obesity in children and adolescents, and to highlight the major risk factors that may impact this relationship. PubMed and Scopus were searched for terms related to fruit juice and childhood obesity, and studies assessing 100% fruit juice intake in participants ≤ 19 years old, with obesity-related outcomes (BMI or adiposity), and published before March 9, 2021 were included. There were 17 prospective cohort and 14 cross-sectional studies included in the analysis. Overall, the evidence does not support a relationship between 100% fruit juice intake and measures of obesity in most children. There is some evidence to suggest a minor positive association in some overweight or very young children, but due to fundamental differences and limitations in methodology, further investigation is required. Significant gaps in literature on this topic exist particularly in regards to randomized clinical trials in children, and in studies in racially diverse populations.

The impact of resistance training on strength and correlates of physical activity in youth

Resistance training (RT) may have a positive impact on specific correlates of physical activity (PA) in inactive and/or obese youth, with strength as a possible underlying mechanism. The aim of this study was to investigate this. Twelve participants (aged 8.9 ± 1.0 years) were assigned to an experimental group (EG) or control group (CG). Pre and post intervention assessments for strength, physical self-perceptions (PSPs), weight status, fundamental movement skills (FMS), and PA levels were completed. The EG participated in a twice-weekly 10-week RT programme. There were significant group x time interactions for FMS (CAMSA total P = 0.016, CAMSA skill score P = 0.036) and stretch stature (P = 0.002) (EG larges changes than the CG). Large effect sizes for the differences in change scores between the EG and CG were evident for CAMSA total score (Hedges' g = 0.830, P = 0.138), CAMSA skill score (Hedges' g = 0.895, P = 0.112) and relative strength (Hedges' g = 0.825, P = 0.140). This study demonstrated that a 10-week RT intervention has a positive effect on strength and FMS, and may also benefit weight status and PSPs. This study supports the development of RT interventions to develop these correlates, and increase PA levels.

Trends in socioeconomic inequalities in underweight and obesity in 5-year-old children, 2011-2018: a population-based, repeated cross-sectional study

OBJECTIVE

To explore trends in prevalence and socioeconomic inequalities in underweight and obesity in 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018.

DESIGN

A population-based, repeated cross-sectional study.

SETTING

Local authority primary schools in Scotland.

PARTICIPANTS

373 189 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018.

METHODOLOGY

Trends in prevalence and inequalities in underweight and obesity were examined across seven school years (2011/2012-2017/2018) for 373 189 5-year-old schoolchildren in Scotland. Body mass index SD scores were calculated, and epidemiological cut-offs relative to the UK 1990 references categorised underweight and obesity. Slope/relative indices of inequality (SII/RII) were calculated for underweight and obesity by school year using the area-based Scottish Index of Multiple Deprivation.

RESULTS

The prevalence of obesity rose slightly overall during the study period (9.8% in 2011/2012; 10.1% in 2017/2018). However, this masked a widening of inequalities, with children from the most deprived areas experiencing a greater risk of obesity in 2017/2018 than in 2011/2012 (risk ratio=1.14, 95% CI 1.04 to 1.25) compared with an unchanged risk in children from the least deprived areas (risk ratio=0.95, 95% CI 0.82 to 1.11). SII and RII indicate widening inequalities for obesity, with RII rising from 1.95 (95% CI 1.71 to 2.22) in 2011/2012 to 2.22 (95% CI 1.93 to 2.56) in 2017/2018. The prevalence of underweight was consistently low (compared with the UK 1990 references) and remained unchanged over the study period (1.2% in 2011/2012; 1.1% in 2017/2018), with no consistent evidence of social patterning over time.

CONCLUSIONS

Inequalities in obesity in schoolchildren in Scotland are large and have widened from 2011, despite only a slight rise in overall prevalence. In contrast there has been little change in underweight prevalence or inequalities during the study period. Extra resources for policy implementation and measures which do not widen inequalities and focus on reaching the most deprived children are required to tackle the high prevalence and growing inequalities in childhood obesity in Scotland.

Use of Anthropometry Versus Ultrasound for the Assessment of Body Fat and Comorbidities in Children With Obesity

OBJECTIVES

We aimed to examine the association between abdominal fat measured by ultrasound and anthropometric indices in children with obesity, and those with normal weight. We also examined the association between anthropometry and fat measures in the prediction of comorbidities in children with obesity.

METHODS

Forty children with body mass index of >95th percentile were included as cases, and a comparable group of 32 healthy average-weight peers were included as controls in this study. All children underwent clinical assessment, anthropometric measures, and evaluation of abdominal subcutaneous fat (SCF) and visceral fat by ultrasound. Fasting blood sugar, serum transaminases, and lipid profile of all the included children were also evaluated.

RESULTS

Children with obesity had a mean age of 8.7 ± 2.9 years (range 3-13). The SCF and intraperitoneal fat (IPF) values correlated well with each other and with anthropometric measurements in children with obesity. Among all the included cases, 90% were metabolically unhealthy, 70% had hypertension, 52.5% had dyslipidemia, and 22.5% had echogenic liver. Anthropometric measures, abdominal SCF and IPF were higher in children with complications. SCF was observed as a good predictor for hepatic echogenicity among the measured ultrasound parameters (P: 0.03, odds ratio 4.6). The best cutoff value for SCF in cases with hepatic echogenicity was 23.2 mm with an overall accuracy of 80%.

CONCLUSIONS

In children with obesity, abdominal SCF and IPF correlated well with anthropometric measures and were higher in children with comorbidities. This finding, however, did not predict comorbidities apart from those with echogenic liver.

Breakfast skipping and overweight/obesity in first grade primary school children: A nationwide register-based study in Iceland

Although several studies have revealed an association between skipping breakfast and overweight (OW) or obesity (OB) in older children and adolescents, less is known about that association in younger children. The purpose of our study was to assess the association between skipping breakfast and OW/OB in children in the first grade. The sample included 4360 children (51.5% boys) aged 5.6 to 7.4 years who participated in the annual health examination in Iceland during 2016 and 2017, completed by 91% of all first graders in Iceland. Binary logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (CIs) was used to assess the association between skipping breakfast and OW/OB. Skipping breakfast was assessed as not eating breakfast on the day of the assessment, whereas OW or OB was based on measured height and weight relative to the International Obesity Task Force reference. The final analyses were adjusted for bedtime, well-being in school, commuting to school and physical activity. 7.2% of the boys (n = 162) and 7.5% of the girls (n = 158) had not eaten breakfast. After multivariable adjustment, a statistically significant association emerged between skipping breakfast and OW/OB in girls (OR 1.66, 95% CI 1.17-2.36) but not in boys (OR 1.02, 95% CI 0.63-1.63). Because the study's results suggest an association between skipping breakfast and OW/OB only in first-grade girls in Iceland, sex-based differences should be further investigated to inform future strategies for preventing OW and OB in young children.

Comparison of International Growth Standards for Assessing Nutritional Status in Cystic Fibrosis: The GreeCF Study

OBJECTIVE

The aim of the study was to compare 3 international growth references and explore their differences in assessing growth in Greek school-aged patients with cystic fibrosis (CF).

METHODS

Sample included 114 patients (50 boys, age 11.5 ± 3.9 years), provided care at Aghia Sofia Children's Hospital, Greece. Anthropometrics and predicted forced expiratory volume in 1 second (FEV1%) were measured. Body mass index (BMI) and height z scores were computed according to the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and International Obesity Task Force (IOTF) references. Agreement between methods was analyzed with kappa statistics, repeated-measures analysis of variance, and Bland-Altman analysis. The relationship between FEV1% and BMI was explored with linear regression.

RESULTS

Mean CDC BMI z score was the lowest (0.06 ± 1.08), followed by WHO (0.17 ± 1.14) and IOTF (0.35 ± 1.05) (P ≤ 0.001 for all). The CDC and WHO growth references highly agreed for most weight status strata and stunting; all other comparisons produced lower agreements. Except for CDC and IOTF BMI z scores, all other comparisons produced wide levels of agreement and proportional bias. CDC reference classified more children as attaining low or normal weight, against WHO or IOTF (P ≤ 0.001 for all). Lowest prevalence of ideal and excess weight was recorded by CDC, compared to all other standards (P ≤ 0.001 for all). All BMI z scores provided moderate associations with FEV1%.

CONCLUSION

Large variations across weight status classification were present when employing 3 growth standards in school-aged patients . Given than BMI z-scores from all references provided comparable associations with pulmonary function, our data indicate that no studied reference is better than others in assessing growth in CF.

Evaluation of a computer-assisted multi-professional intervention to address lifestyle-related risk factors for overweight and obesity in expecting mothers and their infants: protocol for an effectiveness-implementation hybrid study

BACKGROUND

The first 1000 days after conception are a critical period to encourage lifestyle changes to reduce the risk of childhood obesity and early programming of chronic diseases. A healthy lifestyle during pregnancy is also crucial to avoid high post-partum weight retention. Currently, lifestyle changes are not consistently discussed during routine health services in Germany. The objective of this study is to evaluate a novel computer-assisted lifestyle intervention embedded in prenatal visits and infant check-ups. The intervention seeks to reduce lifestyle-related risk factors for overweight and obesity among expecting mothers and their infants.

METHODS

The study is designed as a hybrid effectiveness-implementation trial to simultaneously collect data on the effectiveness and implementation of the lifestyle intervention. The trial will take place in eight regions of the German state Baden-Wuerttemberg. Region were matched using propensity score matching. Expecting mothers (n = 1860) will be recruited before 12 weeks of gestation through gynecological practices and followed for 18 months. During 11 routine prenatal visits and infant check-ups gynecologists, midwives and pediatricians provide lifestyle counseling using Motivational Interviewing techniques. The primary outcome measure is the proportion of expecting mothers with gestational weight gain within the recommended range. To understand the process of implementation (focus group) interviews will be conducted with providers and participants of the lifestyle intervention. Additionally, an analysis of administrative data and documents will be carried out. An economic analysis will provide insights into cost and consequences compared to routine health services.

DISCUSSION

Findings of this study will add to the evidence on lifestyle interventions to reduce risk for overweight and obesity commenced during pregnancy. Insights gained will contribute to the prevention of early programming of chronic disease. Study results regarding implementation fidelity, adoption, reach and cost-effectiveness of the lifestyle intervention will inform decisions about scale up and public funding.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS00013173). Registered 3rd of January 2019, https://www.drks.de.

Built Environment and Childhood Weight Status: A Multi-Level Study Using Population-Based Data in the City of Hannover, Germany

In recent years, built environmental characteristics have been linked to childhood overweight, but the results remain inconsistent across studies. The present study examines associations between several built environmental features and body weight status (BMI) z-score among a large sample of preschool children in the city of Hannover, Germany. Walkability (Index), green space availability, and playground availability related to preschool children's home environments were measured using data from OpenStreetMap (OSM). These built environment characteristics were linked to the data from the 2010-2014 school entry examinations in the Hannover city (n = 22,678), and analysed using multilevel linear regression models to examine associations between the built environment features and the BMI z-score of these children (4-8 years old). No significant associations of built environmental factors on children's BMI were detected, but the effect between green space availability and BMI was modified by the parental educational level. In children with lower compared to higher educated parents, a higher spatial availability of greenspace was significantly associated with reduced body weight. Future research should continue to monitor the disparities in diverse built environment features and how these are related to children's health.

Body composition-derived BMI cut-offs for overweight and obesity in ethnic Indian and Creole urban children of Mauritius

It is increasingly recognised that the use of BMI cut-off points for diagnosing obesity (OB) and proxy measures for body fatness in a given population needs to take into account the potential impact of ethnicity on the BMI–fat % relationship in order to avoid adiposity status misclassification. This relationship was studied here in 377 Mauritian schoolchildren (200 boys and 177 girls, aged 7–13 years) belonging to the two main ethnic groups: Indian (South Asian descent) and Creole (African/Malagasy descent), with body composition assessed using an isotopic ²H dilution technique as reference. The results indicate that for the same BMI, Indians have more body fat (and less lean mass) than Creoles among both boys and girls: linear regression analysis revealed significantly higher body fat % by 4–5 units (P < 0·001) in Indians than in Creoles across a wide range of BMI (11·6–34·2 kg/m²) and body fat % (5–52 %). By applying Deurenberg’s Caucasian-based equation to predict body fat % from WHO-defined BMI thresholds for overweight (OW) and OB, and by recalculating the equivalent BMI values using a Mauritian-specific equation, it is shown that the WHO BMI cut-offs for OB and OW would need to be lowered by 4·6–5·9 units in Indian and 2·0–3·7 units in Creole children in the 7–13-year-old age group. These results have major implications for ethnic-based population research towards improving the early diagnosis of excess adiposity in this multi-ethnic population known to be at high risk for later development of type 2 diabetes and CVD.

Classification Accuracy of Body Mass Index for Excessive Body Fatness in Kuwaiti Adolescent Girls and Young Adult Women

PURPOSE

Adolescent obesity, as defined by BMI, is amongst the highest in the world in Kuwait. This study aimed to determine the extent to which BMI might be underestimating obesity as defined by excessive fatness in Kuwaiti female adolescents and young adults.

METHODS

A total of 400 apparently healthy Kuwaiti female university students (mean age 18.0 years, SD 0.6) were recruited. Excessive fatness was defined as body fat percentage ≥30, measured using the Tanita model TBF-310 Bio-impedance system with the manufacturer's equation. Obesity was defined as recommended by the WHO in adult participants - those aged ≥19.1 years - as BMI≥30 kg/m². In the adolescent participants (age <19.1 years) obesity was defined as recommended by the WHO as a BMI-for-age Z score of ≥2.00. The accuracy of BMI-defined obesity to identify excessively fat individuals was determined by estimating the prevalence of obesity using high BMI and prevalence of excessive fatness, and by calculating sensitivity and specificity and predictive values.

RESULTS

Median BMI was 27.8 kg/m² (range 15.1-51.2) and median body fat percentage was 32.0 (range 5.0-54.0). The prevalence of excessive fatness was 62% (247/400 individuals were excessively fat), while the prevalence of obesity according to BMI was 42% (169/400 individuals were obese according to their BMI). The sensitivity of BMI to identify the excessively fat individuals was moderate (66%) but specificity was high (96%). The positive predictive value of BMI was 96% and the negative predictive value was 64%.

CONCLUSION

BMI-based measures substantially underestimate the prevalence of excessive fatness in Kuwaiti adolescent females. Obesity is even more prevalent, and requires more urgent attention, than is apparent from BMI-based measures used in most research and national surveys. BMI may also be too crude for use as an exposure or outcome variable in many epidemiological studies of Arab adolescent girls and adult women.

Becoming obese in young adulthood: the role of career-family pathways in the transition to adulthood for men and women

BACKGROUND

During the transition to adulthood many young adults become obese for the first time in their lives, yet relatively little research has examined why people in this life phase become obese. This study examines what career and family life-course pathways during the transition to adulthood are related to developing obesity in young adulthood.

METHODS

We use data from the NLSY97, a U.S. nationally representative panel survey conducted by the Bureau of Labor Statistics between 1997 to 2013 (N = 4688), and apply multichannel sequence analysis in order to identify clusters of typical career-family pathways during the transition to adulthood (age 17 to 27), and subsequently investigate whether these pathways are associated with becoming obese at the end of young adulthood (age 28), using logistic regression. We control for obesity at age 17 and family background factors (race, parental education, parental income, and family structure). To take into account the fact that the transition to adulthood has a different meaning for men and for women, we also interact career-family clusters with gender.

RESULTS

For women, pathways characterized by college education, early home leaving, and postponement of family formation decrease the probability of becoming obese. For men, pathways characterized by early marriage increase the probability of becoming obese.

CONCLUSIONS

The results highlight the importance of gender differences in how career and family pathways are related to becoming obese in young adulthood.

Development and validation of a prediction model for fat mass in children and adolescents: meta-analysis using individual participant data

OBJECTIVES

To develop and validate a prediction model for fat mass in children aged 4-15 years using routinely available risk factors of height, weight, and demographic information without the need for more complex forms of assessment.

DESIGN

Individual participant data meta-analysis.

SETTING

Four population based cross sectional studies and a fifth study for external validation, United Kingdom.

PARTICIPANTS

A pooled derivation dataset (four studies) of 2375 children and an external validation dataset of 176 children with complete data on anthropometric measurements and deuterium dilution assessments of fat mass.

MAIN OUTCOME MEASURE

Multivariable linear regression analysis, using backwards selection for inclusion of predictor variables and allowing non-linear relations, was used to develop a prediction model for fat-free mass (and subsequently fat mass by subtracting resulting estimates from weight) based on the four studies. Internal validation and then internal-external cross validation were used to examine overfitting and generalisability of the model's predictive performance within the four development studies; external validation followed using the fifth dataset.

RESULTS

Model derivation was based on a multi-ethnic population of 2375 children (47.8% boys, n=1136) aged 4-15 years. The final model containing predictor variables of height, weight, age, sex, and ethnicity had extremely high predictive ability (optimism adjusted R²: 94.8%, 95% confidence interval 94.4% to 95.2%) with excellent calibration of observed and predicted values. The internal validation showed minimal overfitting and good model generalisability, with excellent calibration and predictive performance. External validation in 176 children aged 11-12 years showed promising generalisability of the model (R²: 90.0%, 95% confidence interval 87.2% to 92.8%) with good calibration of observed and predicted fat mass (slope: 1.02, 95% confidence interval 0.97 to 1.07). The mean difference between observed and predicted fat mass was -1.29 kg (95% confidence interval -1.62 to -0.96 kg).

CONCLUSION

The developed model accurately predicted levels of fat mass in children aged 4-15 years. The prediction model is based on simple anthropometric measures without the need for more complex forms of assessment and could improve the accuracy of assessments for body fatness in children (compared with those provided by body mass index) for effective surveillance, prevention, and management of clinical and public health obesity.

Parental misperception of child's weight and related factors within family norms

PURPOSE

Parental perception of their child's weight may be a crucial factor in parental ability for action with regard to their child's weight problem. This aim of this study was to investigate parental perception of their child's weight status and dietary healthiness, amount of food consumed and physical activity level and its related factors.

METHODS

A cross-sectional survey was conducted among children (Grades 4-6) selected by cluster sampling in two schools. Children were invited to participate in the measurements of anthropometry and their parents were asked to classify their child's weight and health behaviors.

RESULTS

In total, 41.8% of parents misperceived their child's weight, of which 82% underestimated their child's weight, in particular regarding overweight or obesity. As parents of overweight or obese children underestimated their child's weight, around 65% were not concerned with their child's current weight and about becoming overweight in the future. Factor associated with underestimation of overweight children was not having a sibling, while among children with normal weight, the underestimation was associated with boys, lower body mass index (BMI), maternal employment and low household income. Furthermore, parents underestimating their child's weight were more likely to be optimistic about their child's dietary healthiness, food amount taken, and physical activity level than those with correct child's weight estimates.

CONCLUSIONS

Findings show a high proportion of parental misperception of their child's weight status. Family-based weight control interventions will need to incorporate parental misperceptions of the body weight and health behaviors of their children.

Anthropometric and clinical correlates of fat mass in healthy term infants at 6 months of age

BACKGROUND

Body composition in infancy plays a central role in the programming of metabolic diseases. Fat mass (FM) is determined by personal and environmental factors. Anthropometric measurements allow for estimations of FM in many age groups; however, correlations of these measurements with FM in early stages of life are scarcely reported. The aim of this study was to evaluate anthropometric and clinical correlates of FM in healthy term infants at 6 months of age.

METHODS

Healthy term newborns (n = 102) from a prospective cohort. Weight, length, skinfolds (biceps, triceps, subscapular and the sum -SFS-) and waist circumference (WC) were measured at 6 months. Body mass index (BMI) and WC/length ratio were computed. Type of feeding during the first 6 months of age was recorded. Air displacement plethysmography was used to asses FM (percentage -%-) and FM index (FMI) was calculated. Correlations and general linear models were performed to evaluate associations.

RESULTS

Significant correlations were observed between all anthropometric measurements and FM (% and index)(p < 0.001). Exclusive/predominant breastfed infants had higher FM and anthropometric measurements at 6 months. Models that showed the strongest associations with FM (% and index) were SFS + WC + sex + type of feeding.

CONCLUSIONS

Anthropometry showed good correlations with FM at 6 months of age. Skinfolds sum and waist circumference were the strongest anthropometric variables associated to FM. Exclusive/predominant breastfeeding was strongly associated with FM.

Utility of anthropometric indicators to screen for clustered cardiometabolic risk factors in children and adolescents

Background Anthropometric indicators are associated with cardiometabolic risk factors (CMRF), but there is no consensus as to which indicator is the most suitable to screen for clustered CMRF. This study aimed to evaluate the utility of five anthropometric indicators to screen for clustered CMRF in children and adolescents. Methods A cross-sectional study was conducted in 1139 schoolchildren aged 6-17 years from Northeastern Brazil. Body weight, height, waist circumference (WC) and subscapular (SSF) and triceps skinfold thickness (TSF) were measured. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. The following CMRF were evaluated: elevated total cholesterol, low high-density lipoprotein-cholesterol (HDL-C), elevated low-density lipoprotein-cholesterol (LDL-C), high triglyceride concentration, hyperglycemia and high blood pressure. The participants were categorized into no CMRF, 1 CMRF, 2 CMRF and ≥3 CMRF. Receiver operating characteristic (ROC) curves were constructed to assess the accuracy of the anthropometric indicators in predicting CMRF for age group and sex. Results Poor associations were observed between the anthropometric indicators and 1 CMRF (accuracy of 0.49-0.64). The indicators showed moderate associations with 2 CMRF (accuracy of 0.57-0.75) and ≥3 CMRF (accuracy of 0.59-0.79). In general, TSF exhibited the worst performance in predicting CMRF, followed by WHtR. The highest accuracies were observed for BMI, WC and SSF, with no significant difference between these indicators. Conclusions The routine use of BMI, WC and SSF as epidemiological screening tools for clustered CMRF in childhood and adolescence should be encouraged.

Low Diagnostic Accuracy of Body Mass Index-Based and Waist Circumference-Based References of Childhood Overweight and Obesity in Identifying Overfat among Chinese Children and Adolescents

This study aimed to investigate the diagnostic accuracy of body mass index- (BMI-) based and waist circumference- (WC-) based references for childhood overweight and obesity in screening overfat individuals among 2134 Chinese children and adolescents. In this study, overfat status was defined as over 25% body fat for boys and over 30% for girls. Childhood obesity or overweight was defined by four BMI-based references and two WC-based references. All BMI-based references for obesity showed low sensitivity (SE) (0.128–0.473) but high specificity (SP) (0.971–0.998) in detecting overfat individuals in the current population. SE values increased from 0.493 to 0.881 when BMI- and WC-based references for overweight were used to detect overfat individuals. All references for overweight showed high SP rates (0.816–0.966). To improve diagnostic accuracy for childhood obesity, further studies may define a cut-off value for childhood obesity specific for a local population and ethnicity by using health-related overfat data.

Prevalence of obesity among school-age children and adolescents in the Gulf cooperation council (GCC) states: a systematic review

Background

The Gulf Cooperation Council (GCC) countries have among the highest prevalence of adult obesity and type 2 diabetes in the world. This study aimed to estimate the recent prevalence of obesity among school-age children and adolescents in the GCC States.

Methods

The literature search for obesity prevalence data was carried out in July 2017 in Google Scholar, Physical education index, Medline, SCOPUS, WHO, 2007-2017, and updated in November 2018.In addition, 22 experts from the GCC were contacted to check the search results, and to suggest studies or grey literature which had been missed. Eligible studies were assessed for quality by using the Joanna Briggs Institute (JBI) tool for prevalence studies. Conduct of the systematic review followed the Assessment of Multiple Systematic Reviews Tool (AMSTAR) guidance. A narrative synthesis was conducted.

Results

Out of 392 studies identified, 41 full-text reports were screened for eligibility; 11 of which were eligible and so were included, from 3 of the 6 GCC countries (United Arab Emirates, Kuwait, Saudi Arabia). Surveillance seems good in Kuwait in compared to other countries, with one recent national survey of prevalence. Quality of the eligible studies was generally low-moderate according to the JNBI tool: representative samples were rare; participation rates low; power calculations were mentioned by only 3/11 studies and confidence intervals around prevalence estimates provided by only 3/11 eligible studies; none of the studies acknowledged that prevalence estimates were conservative (being based on BMI-for-age). There was generally a very high prevalence of obesity (at least one quarter-one third of study or survey participants obese according to BMI-for-age), prevalence increased with age, and was consistently higher in boys than girls.

Conclusions

The prevalence of obesity among school-age children and adolescents appears to have reached alarming levels in the GCC, but there are a number of major gaps and limitations in obesity surveillance in the GCC states. More national surveys of child and adolescent obesity prevalence are required for the GCC states.

Trial registration

PROSPERO registration number CRD42017073692.

Body mass index vs deuterium dilution method for establishing childhood obesity prevalence, Ghana, Kenya, Mauritius, Morocco, Namibia, Senegal, Tunisia and United Republic of Tanzania

Objective

To compare the World Health Organization (WHO) body mass index (BMI)-for-age definition of obesity against measured body fatness in African children.

Methods

In a prospective multicentre study over 2013 to 2017, we recruited 1516 participants aged 8 to 11 years old from urban areas of eight countries (Ghana, Kenya, Mauritius, Morocco, Namibia, Senegal, Tunisia and United Republic of Tanzania). We measured height and weight and calculated BMI-for-age using WHO standards. We measured body fatness using the deuterium dilution method and defined excessive body fat percentage as > 25% in boys and > 30% in girls. We calculated the sensitivity and specificity of BMI z-score > +2.00 standard deviations (SD) and used receiver operating characteristic analysis and the Youden index to determine the optimal BMI z-score cut-off for classifying excessive fatness.

Findings

The prevalence of excessive fatness was over three times higher than BMI-for-age-defined obesity: 29.1% (95% CI: 26.8 to 31.4; 441 children) versus 8.8% (95% CI: 7.5 to 10.4; 134 children). The sensitivity of BMI z-score > +2.00 SD was low (29.7%, 95% CI: 25.5 to 34.2) and specificity was high (99.7%, 95% CI: 99.2 to 99.9). The receiver operating characteristic analysis found that a BMI z-score +0.58 SD would optimize sensitivity, and at this cut-off the area under the curve was 0.86, sensitivity 71.9% (95% CI: 67.4 to 76.0) and specificity 91.1% (95% CI: 89.2 to 92.7).

Conclusion

While BMI remains a practical tool for obesity surveillance, it underestimates excessive fatness and this should be considered when planning future African responses to the childhood obesity pandemic.

Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight

BACKGROUND

The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions.

OBJECTIVES

To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group.

SEARCH METHODS

In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data.

SELECTION CRITERIA

We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes.

DATA COLLECTION AND ANALYSIS

Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes.

MAIN RESULTS

We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence).

AUTHORS' CONCLUSIONS

Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.

Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight

BACKGROUND

The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions.

OBJECTIVES

To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group.

SEARCH METHODS

In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data.

SELECTION CRITERIA

We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes.

DATA COLLECTION AND ANALYSIS

Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes.

MAIN RESULTS

We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence).

AUTHORS' CONCLUSIONS

Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.

Waist Circumference and Body Mass Index in Children with Chronic Kidney Disease and Metabolic, Cardiovascular, and Renal Outcomes

OBJECTIVE

To describe the prevalence of obesity as estimated by waist circumference (WC) and body mass index (BMI) and compare associations of WC and BMI with indicators of metabolic, cardiovascular, and renal health in children with chronic kidney disease (CKD).

STUDY DESIGN

Cross-sectional analysis stratified by CKD etiology (nonglomerular or glomerular) of 737 subjects. The kappa statistic was used to assess agreement between the 2 measures of obesity. Linear regression models were performed using WC and BMI as separate independent variables. Dependent variables included lipid measures, insulin resistance, blood pressure, left ventricular mass index, proteinuria, and estimated glomerular filtration rate. Associations were scaled to SD and interpreted as the change in dependent variable associated with a 1-SD change in WC or BMI.

RESULTS

There was good agreement (kappa statistic = 0.68) between WC and BMI in identifying obesity. Approximately 10% of subjects had obesity by 1 measure but not the other. BMI was more strongly associated with estimated glomerular filtration rate than WC. BMI was more strongly associated with left ventricular mass index in the nonglomerular CKD group compared with WC, but both had significant associations. The associations between WC and BMI with the remainder of the dependent variables were not significantly different.

CONCLUSIONS

Measurement of WC added limited information to BMI in this cohort. Further longitudinal study is needed to determine how WC and BMI compare in predicting outcomes, particularly for children with CKD identified as having obesity by 1 measure but not the other.

ANTHROPOMETRY AND CLUSTERED CARDIOMETABOLIC RISK FACTORS IN YOUNG PEOPLE: A SYSTEMATIC REVIEW

OBJECTIVE

To conduct a systematic review of the literature on the ability of anthropometric indicators to predict clustered cardiometabolic risk factors (CMRF) in children and adolescents.

DATA SOURCE

Studies published from June 1st, 2011 to May 31st, 2016 in the PubMed, SciELO and LILACS databases were analyzed. The research was based on keywords derived from the terms "anthropometric indicators" AND "cardiometabolic risk factors". Observational studies on the ability of anthropometric indicators as predictors of clustered CMRF in children and adolescents in Portuguese, English and Spanish languages were included. Studies with a specific group of obese patients or with other diseases were not included.

DATA SYNTHESIS

Of the 2,755 articles retrieved, 31 were selected for systematic review. Twenty-eight studies analyzed body mass index (BMI) as a predictor of clustered CMRF. Only 3 of the 25 cross-sectional studies found no association between anthropometric indicators and clustered CMRF. The results of six studies that compared the predictive ability of different anthropometric measures for clustered CMRF were divergent, and it was not possible to define a single indicator as the best predictor of clustered CMRF. Only six articles were cohort studies, and the findings suggested that changes in adiposity during childhood predict alterations in the clustered CMRF in adolescence.

CONCLUSIONS

BMI, waist circumference and waist-to-height ratio were predictors of clustered CMRF in childhood and adolescence and exhibited a similar predictive ability for these outcomes. These findings suggest anthropometric indicators as an interesting screening tool of clustered CMRF at early ages.

Childhood and adolescent obesity definitions as related to BMI, evaluation and management options

In North America, 30% of children are overweight or obese. Child obesity is a precursor to adult health risks. Diagnosis of childhood obesity is difficult. The best measurement is BMI percentile charts. Obesity in children and adolescents can be treated by diet and activity changes. Family involvement in healthy lifestyle changes is best for weight loss and prevention.

Associations of Vigorous-Intensity Physical Activity with Biomarkers in Youth

INTRODUCTION

Physical activity (PA) conveys known cardiometabolic benefits to youth, but the contribution of vigorous-intensity PA (VPA) to these benefits is unknown. Therefore, we sought to determine (a) the associations between VPA and cardiometabolic biomarkers independent of moderate-intensity PA (MPA) and time sedentary and (b) the accelerometer cut point that best represents the threshold for health-promoting VPA in youth.

METHODS

Data from the International Children's Accelerometry Database (ICAD) were analyzed in 2015. The relationship between cardiometabolic biomarkers and four categories of VPA estimated via three sets of cut points were examined using isotemporal substitution quantile regression modeling at the 10th, 25th, 50th, 75th, and 90th percentile of the distribution of each biomarker, separately. Age, sex, accelerometer wear time, sedentary time, and MPA were controlled for while allowing substitution for light-intensity PA. Data from 11,588 youth (4-18 yr) from 11 ICAD studies (collected 1998-2009) were analyzed.

RESULTS

Only 32 of 360 significant associations were observed. Significant, negative relationships were observed for VPA with waist circumference and insulin. Replacing light-intensity PA with VPA (corresponding to at the 25th to 90th percentiles of VPA) was associated with 0.67 (-1.33 to -0.01; P = 0.048) to 7.30 cm (-11.01 to -3.58; P < 0.001) lower waist circumference using Evenson and ICAD cut points (i.e., higher counts per minute). VPA levels were associated with 12.60 (-21.28 to -3.92; P = 0.004) to 27.03 pmol·L (-45.03 to -9.03; P = 0.003) lower insulin levels at the 75th to 90th percentiles using Evenson and ICAD cut points when substituted for light PA.

CONCLUSIONS

Substituting light PA with VPA was inversely associated with waist circumference and insulin. However, VPA was inconsistently related to the remaining biomarkers after controlling for time sedentary and MPA.

Normal-weight obesity and cardiometabolic risk: A 7-year longitudinal study in girls from prepuberty to early adulthood

OBJECTIVE

To study whether normal-weight obesity in childhood is associated with increased cardiometabolic risk in early adulthood.

METHODS

This study assessed data for 236 girls followed from prepuberty to early adulthood. Growth chart data were obtained from birth to 18 years. Body composition was assessed by dual-energy x-ray absorptiometry and cardiometabolic risk by calculating continuous clustered risk score (at ages 11, 14, and 18). The association of body weight status with cardiometabolic risk from childhood to early adulthood was examined.

RESULTS

Subjects with normal-weight obesity were virtually indistinguishable from their normal-weight lean peers in terms of relative body weight and BMI but had significantly higher fat mass (7.1-7.3 kg) and cardiometabolic risk already in childhood, and this difference persisted into early adulthood (P <  0.001 for all).

CONCLUSIONS

Children and adolescents with normal body weight and high body fat percentage may be at increased risk for cardiometabolic morbidity in adulthood. Body fatness may be of utility in clinical practice to effectively identify children and adolescents at risk and to permit recommendation of lifestyle changes that could translate to lower risks of cardiovascular diseases in the future.

Early-Life Obesity Prevention: Critique of Intervention Trials During the First One Thousand Days

PURPOSE OF REVIEW

To critique the evidence from recent and ongoing obesity prevention interventions in the first 1000 days in order to identify evidence gaps and weaknesses, and to make suggestions for more informative future intervention trials.

RECENT FINDINGS

Completed and ongoing intervention trials have had fairly modest effects, have been limited largely to high-income countries, and have used relatively short-term interventions and outcomes. Comparison of the evidence from completed prevention trials with the evidence from systematic reviews of behavioral risk factors shows that some life-course stages have been neglected (pre-conception and toddlerhood), and that interventions have neglected to target some important behavioral risk factors (maternal smoking during pregnancy, infant and child sleep). Finally, while obesity prevention interventions aim to modify body composition, few intervention trials have used body composition measures as outcomes, and this has limited their sensitivity to detect intervention effects. The new WHO Healthy Lifestyles Trajectory (HeLTI) initiative should address some of these weaknesses. Future early obesity prevention trials should be much more ambitious. They should, ideally: extend their interventions over the first 1000 days; have longer-term (childhood) outcomes, and improved outcome measures (body composition measures in addition to proxies for body composition such as the BMI for age); have greater emphasis on maternal smoking and child sleep; be global.

Household food insecurity is associated with abdominal but not general obesity among Iranian children

BACKGROUND

Childhood obesity is increasing all over the world. Food insecurity is mentioned as a possible risk factor; however, previous studies have led to inconsistent results in different societies while data are lacking for the Middle East. We aimed to investigate the relationship between food insecurity and general or abdominal obesity in Iranian children in a cross-sectional study.

METHODS

Anthropometric data including height, weight, and waist circumference were measured by trained nutritionists. General and abdominal obesity were defined based on world health organization (WHO) and Iranian reference curves for age and gender, respectively. Radimer/Cornell food security questionnaire was filled by parents. Data about the physical activity of participants, family socio-economic status, parental obesity and data about perinatal period were also gathered using self-administered questionnaires. Logistic regression was incorporated to investigate the association between food insecurity and obesity in crude and multi-variable adjusted models.

RESULTS

A total of 587 children aged 9.30 ± 1.49 years had complete data for analysis. Food insecurity at household level was significantly associated with abdominal obesity (odds ratio (OR) = 1.54; confidence interval (CI):1.01-2.34, p <0.05) and the relationship remained significant after adjusting for all potential confounding variables (OR = 2.02; CI:1.01-4.03, p <0.05). Food insecurity was associated with general obesity neither in crude analysis and multi-variable adjusted models.

CONCLUSIONS

The slight levels of food insecurity might increase the likelihood of abdominal obesity in Iranian children and macroeconomic policies to improve the food security are necessary. Large-scale prospective studies, particularly in the Middle East, are highly recommended to confirm our results.

Body mass index adjustments to increase the validity of body fatness assessment in UK Black African and South Asian children

Background/Objectives:

Body mass index (BMI) (weight per height²) is the most widely used marker of childhood obesity and total body fatness (BF). However, its validity is limited, especially in children of South Asian and Black African origins. We aimed to quantify BMI adjustments needed for UK children of Black African and South Asian origins so that adjusted BMI related to BF in the same way as for White European children.

Methods:

We used data from four recent UK studies that made deuterium dilution BF measurements in UK children of White European, South Asian and Black African origins. A height-standardized fat mass index (FMI) was derived to represent BF. Linear regression models were then fitted, separately for boys and girls, to quantify ethnic differences in BMI–FMI relationships and to provide ethnic-specific BMI adjustments.

Results:

We restricted analyses to 4–12 year olds, to whom a single consistent FMI (fat mass per height⁵) could be applied. BMI consistently underestimated BF in South Asians, requiring positive BMI adjustments of +1.12 kg m⁻² (95% confidence interval (CI): 0.83, 1.41 kg m⁻²; P<0.0001) for boys and +1.07 kg m⁻² (95% CI: 0.74, 1.39 kg m⁻²; P<0.0001) for girls of all age groups and FMI levels. BMI overestimated BF in Black Africans, requiring negative BMI adjustments for Black African children. However, these were complex because there were statistically significant interactions between Black African ethnicity and FMI (P=0.004 boys; P=0.003 girls) and also between FMI and age group (P<0.0001 for boys and girls). BMI adjustments therefore varied by age group and FMI level (and indirectly BMI); the largest adjustments were in younger children with higher unadjusted BMI and the smallest in older children with lower unadjusted BMI.

Conclusions:

BMI underestimated BF in South Asians and overestimated BF in Black Africans. Ethnic-specific adjustments, increasing BMI in South Asians and reducing BMI in Black Africans, can improve the accuracy of BF assessment in these children.

Childhood obesity classification systems and cardiometabolic risk factors: a comparison of the Italian, World Health Organization and International Obesity Task Force references

BACKGROUND

Body Mass Index Italian reference data are available for clinical and/or epidemiological use, but no study compared the ability of this system to classify overweight and obesity and detect subjects with clustered cardiometabolic risk factors with international standards. Therefore our aim was to assess 1) the agreement among the Italian Society for Pediatric Endocrinology and Diabetology (ISPED), the World Health Organisation (WHO) and the International Obesity Task Force (IOTF) Body Mass Index cut-offs in estimating overweight or obesity in children and adolescents; 2) the ability of each above-mentioned set of cut-points to detect subjects with cardiometabolic risk factors.

METHODS

Data of 6070 Italian subjects aged 5-17 years were collected. Prevalence of normal-weight, overweight and obesity was determined using three classification systems: ISPED, WHO and IOTF. High blood pressure, hypertriglyceridemia, low high density lipoprotein-cholesterol and impaired fasting glucose were considered as cardiometabolic risk factors.

RESULTS

ISPED and IOTF classified more subjects as normal-weight or overweight and less subjects as obese as compared to WHO (p <0.0001) in the whole sample and in groups divided by gender and age. The strength of agreement between the three methods compared to each other was excellent for overweight (including obesity) definition (k > 0.900), while it differed for obesity definition, ranging from the highest agreement between ISPED and IOTF (k 0.875) to the lowest between ISPED and WHO (k 0.664). WHO had the highest sensitivity, while ISPED and IOTF systems had the highest specificity, in identifying obese subjects with clustered cardiometabolic risk factors. Analogous results were found in subjects stratified by gender or age.

CONCLUSIONS

ISPED and IOTF systems performed similarly in assessing overweight and obesity, and were more specific in identifying obese children/adolescents with clustered cardiometabolic risk factors; on the contrary, the WHO system was more sensitive. Given the seriousness of the obesity epidemic, we wonder whether the WHO system should be preferable to the national standards for clinical practice and/or obesity screening.

Simple tests for the diagnosis of childhood obesity: a systematic review and meta-analysis

There is a need to accurately quantify levels of adiposity in order to identify overweight and obesity in children. This systematic review aimed to identify all diagnostic accuracy studies evaluating simple tests for obesity and adiposity, including body mass index (BMI), skin-fold thickness and waist circumference, compared against high-quality reference tests. Twenty-four cohort studies including 25,807 children were included. BMI had good performance when diagnosing obesity: a sensitivity of 81.9% (95% confidence interval [CI]: 73.0 to 93.8) for a specificity of 96.0% (95% CI: 93.8 to 98.1). It was less effective at diagnosing overweight (sensitivity: 76.3%, 95% CI: 70.2 to 82.4; specificity: 92.1% 95% CI: 90.0 to 94.3). When diagnosing obesity, waist circumference had similar performance (sensitivity: 83.8%; specificity: 96.5%). Skin-fold thickness had slightly poorer performance (sensitivity: 72.5%; specificity: 93.7%). Few studies considered any other tests. There was no conclusive evidence that any test was generally superior to the others. BMI is a good simple diagnostic test for identifying childhood adiposity. It identifies most genuinely obese and adipose children while misclassifying only a small number as obese. There was no conclusive evidence that any test should be preferred to BMI, and the extra complexity of skin-fold thickness tests does not appear to improve diagnostic accuracy.

Comparison of body mass index with abdominal obesity for identifying elevated blood pressure in children and adolescents: The SNEC study

Body mass index (BMI) and waist circumference (WC) are two common ways to measure obesity. There is a debate, however, about which of these two measures are more closely associated with elevated blood pressure (BP). The aim of this study is to investigate the prevalence of obesity and whether BMI and WC is better associated with elevated BP in children and adolescents. A representative sample of 8613 Chinese youth aged 7-17 years from seven cities in Northeastern China was selected and measurements of height, weight, WC, BP were taken from 2012 to 2013. The average age of the children was 11.3±2.3years. The prevalence of overweight/obese and abdominal obesity in the subjects was 35% and 44.8%, respectively. We found that both BMI and WC were significantly associated with elevated BP. An increase of 1kgm^-2 in BMI was associated with a 1.10 (1.08-1.12, 95% CI) increased risk of an elevated BP diagnosis in boys, and a 1.14 (1.11-1.16, 95% CI) increased risk in girls. Meanwhile, a 1cm increase in WC correlated with a 1.03 (1.02-1.04, 95% CI) and a 1.05 (1.04-1.06, 95% CI) increased risk of higher BP in boys and girls, respectively. Compared to the normal-weight youth, subjects with elevated BMI (BMI>85th) had higher risk of elevated BP (OR: 2.42, 95% CI: 2.13-2.75) than that of in elevated WC participants (OR: 2.00, 95% CI: 1.77-2.27). Therefore, BMI may associate better with elevated BP than WC in Chinese youth in our Seven Northeastern Cities study.

Barriers for Hispanic Caregivers With Obese Preschool Children

INTRODUCTION

Childhood obesity is a growing epidemic, and the rates are disproportionately higher in minorities. Clinical guidelines have contributed to decreased prevalence overall, but the rates in Hispanic preschoolers have increased.

METHOD

This review of the literature summarizes the perceptions and beliefs of caregivers of Hispanic preschool children regarding weight status and feeding behaviors, as well as the perceived cultural barriers to guideline adherence. A search of the CINAHL, PubMed, Joanna Briggs, and Global Health databases identified studies performed between January 1, 2008, and April 1, 2016. Search terms included Hispanics, guideline adherence, gap, barriers, obesity, overweight, and attitude to obesity.

RESULTS

Fifteen studies met the inclusion criteria, including some about Hispanic caregivers of preschool-aged children. Several cultural perceptions and beliefs were identified.

CONCLUSION

Further study is needed to develop more culturally relevant and sensitive guidelines and to design specific and effective interventions for this population.

Prevalence of overweight and obesity among children and adolescents with intellectual disabilities: a systematic review and meta-analysis

Although there have been numerous studies examining the prevalence of overweight and obesity among children and adolescents with intellectual disabilities, they have not yet been integrated and synthesized through a systematic quantitative review process. The purpose of this systematic review and meta-analysis was to determine: (i) the prevalence of overweight/obesity among children and adolescents with intellectual disabilities; (ii) the sources of heterogeneity in studies reporting the prevalence of overweight/obesity in this population; and (iii) the risk of overweight/obesity in this population compared with their typically developing peers. A systematic literature search was performed and 16 studies, published between 1985 and 2015, met the inclusion criteria. The resulting pooled prevalence estimates for overweight, overweight-obesity and obesity were respectively: (i) 15%, 30%, and 13%, in children; and (ii) 18%, 33%, and 15% in adolescents. Subgroup analyses showed significant variations in the pooled prevalence estimates as a function of geographical region, recruitment setting, additional diagnoses, and norms used to define overweight or obesity. The findings also showed adolescents with intellectual disabilities to be respectively 1.54 and 1.80 times more at risk of overweight-obesity and obesity than typically developing adolescents. Unfortunately, no such comparison is available for children. © 2016 World Obesity.