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Davis BÁ, O'Dwyer C, Keating A, Sharry J, Murphy E, Doran A, Nearchou F, Carr A. The healthy habits questionnaire (HHQ): Validation of a measure designed to assess problematic influential behaviours amongst families of children living with obesity or a risk of developing obesity. Clin Child Psychol Psychiatry 2024:13591045241286223. [PMID: 39344963 DOI: 10.1177/13591045241286223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
The 48-item Healthy Habits Questionnaire (HHQ-48) was developed to (1) monitor positive changes in family lifestyles following engagement in the Parents Plus Healthy Families (PP-HF) parent training programme and (2) be utilised as a standalone measure in clinical settings to identify and track problematic influential behaviours amongst families of children in weight-management services. This study aimed to develop and validate a brief version of the HHQ-48. The scale was administered to a cross-sectional community sample (n = 480), and on two occasions to a control sample (n = 50) and an experimental sample (n = 40) from a randomised controlled trial (RCT) of the PP-HF programme to assess test-retest reliability and sensitivity to change respectively. Exploratory and confirmatory factor analysis showed that a 23-item, 4-factor version of the HHQ (i.e., the HHQ-23) best fit the data. The scale and factor subscales had good internal consistency and test-retest reliability. They also had good concurrent and construct validity shown by significant correlations with another scale that assessed lifestyle issues, and scales that assessed parenting satisfaction, family functioning, and children's strengths and difficulties. The HHQ-23 was sensitive to change following parents completing the PP-HF programme. The HHQ-23 may, therefore, be used to monitor positive changes in family lifestyles following engagement in the PP-HF parent training programme. The HHQ-23 also shows promising potential as a standalone screening measure or as part of a larger battery of screening assessments in paediatric weight-management services.
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Affiliation(s)
- Bríd Áine Davis
- UCD School of Psychology, University College Dublin, Ireland
| | - Claire O'Dwyer
- UCD School of Psychology, University College Dublin, Ireland
| | | | - John Sharry
- Parents Plus Charity, The Mater Hospital, Ireland
| | - Eddie Murphy
- Primary Care Psychology, Health Service Executive, St. Fintan's Campus, Ireland
| | - Alan Doran
- Child and Family Centre, Health Service Executive, Our Lady's Hospital Campus, Ireland
| | - Finiki Nearchou
- UCD School of Psychology, University College Dublin, Ireland
| | - Alan Carr
- UCD School of Psychology, University College Dublin, Ireland
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Chen Y, Zhang L, Wang M, Lu B, Shen T, Gu R, Jin X, Wang H. Insights from Multiple Stakeholders Regarding Adolescent Obesity in China: An Exploratory Qualitative Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241273183. [PMID: 39183631 PMCID: PMC11348365 DOI: 10.1177/00469580241273183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 08/27/2024]
Abstract
With a significant increase in the obesity epidemic in China, addressing adolescent obesity should be highlighted as a priority. The current qualitative study aims to explore the perspectives of key stakeholders regarding adolescent obesity, providing guidance for developing effective obesity interventions for Chinese adolescents. A total of 12 focus group discussions were convened with a range of representative stakeholders including adolescents (n = 37), parents (n = 28), and school staff (n = 21) from sample schools. Semi-structured topic guides were used for data collection. All data were transcribed verbatim and analyzed thematically. From multiple stakeholder perspectives, we finally identified 3 overarching themes (Understanding adolescent obesity, Key healthy lifestyles, and Barriers to obesity prevention practices) and 8 sub-themes. While participants had mixed perceptions of status and prevalence of adolescent obesity, all acknowledged the serious health consequences associated with it. As significant modifiable risk factors, unhealthy diet and physical activity were identified to be prevalent among Chinese teenagers and lead to excessive weight gain. However, a variety of individual, environmental and sociocultural factors hindered the implementation of healthy lifestyles, affecting adolescent obesity prevention and control. Given adolescent obesity is a complex, multifactorial and multilevel public issue, comprehensive lifestyle interventions are recommended that synergistically engage multiple stakeholders across key communities to fight the ongoing obesity epidemic.
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Affiliation(s)
- Ying Chen
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li Zhang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Meng Wang
- Hangzhou Centre for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Bian Lu
- Xiaoshan District Centre for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Ting Shen
- Xihu District Centre for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Renjun Gu
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaoyuan Jin
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongmei Wang
- Department of Social Medicine of School of Public Health and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Jabeen A, Afzal MS, Pathan SA. A Review of the Role of Built Environment and Temperature in the Development of Childhood Obesity. Cureus 2023; 15:e49657. [PMID: 38161805 PMCID: PMC10756253 DOI: 10.7759/cureus.49657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
The burden of obesity is rising globally and is studied widely, yet the evidence for the association of environmental factors (both built and natural) with childhood obesity remains inconsistent. A relation with temperature as a proxy for natural environmental factors for obesity has not been reviewed previously. The purpose of this review was to assimilate updated evidence on environmental factors of childhood obesity. Three databases, MEDLINE (Medical Literature Analysis and Retrieval System Online), Web of Science, and Cochrane, were searched for articles related to the effect of built environment and temperature on childhood obesity in 6-12-year-olds published in the last five years. Twelve studies were identified: four longitudinal and eight cross-sectional. The studies were appraised using the National Institute of Health Quality (NIH) Assessment Tool. A review of included studies showed that built environmental features like higher residential and population density, higher intersection density, more playgrounds, and all park features like the presence or availability of parks, high number of parks, proximity to parks, and an increased park land area, showed a protective association against childhood obesity while land use mix showed a promoting association for the development of childhood obesity. Inconclusive evidence was observed for other built environmental features. The search strategy did not retrieve any literature published in the past five years studying the association between temperature and the development of childhood obesity. Standardization of definitions of exposure and outcome measures is recommended. Further research studying the relationship between environmental temperature and the development of childhood obesity is recommended.
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Affiliation(s)
- Atika Jabeen
- Public Health, London School of Hygiene & Tropical Medicine, University of London, London, GBR
- Emergency Department, Hamad Medical Corporation, Doha, QAT
| | | | - Sameer A Pathan
- Emergency Department, Hamad Medical Corporation, Doha, QAT
- Emergency Medicine, Blizard Institute, Queen Mary University of London, London, GBR
- Emergency Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, AUS
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Davey F, McGowan V, Birch J, Kuhn I, Lahiri A, Gkiouleka A, Arora A, Sowden S, Bambra C, Ford J. Levelling up health: A practical, evidence-based framework for reducing health inequalities. PUBLIC HEALTH IN PRACTICE 2022; 4:100322. [PMID: 36164497 PMCID: PMC9494865 DOI: 10.1016/j.puhip.2022.100322] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022] Open
Abstract
There are substantial inequalities in health across society which have been exacerbated by the COVID-19 pandemic. The UK government have committed to a programme of levelling-up to address geographical inequalities. Here we undertake rapid review of the evidence base on interventions to reduce such health inequalities and developed a practical, evidence-based framework to 'level up' health across the country. This paper overviews a rapid review undertaken to develop a framework of guiding principles to guide policy. To that end and based on an initial theory, we searched one electrotonic database (MEDLINE) from 2007 to July 2021 to identify published umbrella reviews and undertook an internet search to identify relevant systematic reviews, primary studies, and grey literature. Titles and abstracts were screened according to the eligibility criteria. Key themes were extracted from the included studies and synthesised into an overarching framework of guiding principles in consultation with an expert panel. Included studies were cross checked with the initial theoretical domains and further searching undertaken to fill any gaps. We identified 16 published umbrella reviews (covering 667 individual studies), 19 grey literature publications, and 15 key systematic reviews or primary studies. Based on these studies, we develop a framework applicable at national, regional and local level which consisted of five principles - 1) healthy-by-default and easy to use initiatives; 2) long-term, multi-sector action; 3) locally designed focus; 4) targeting disadvantaged communities; and 5) matching of resources to need. Decision-makers working on policies to level up health should be guided by these five principles.
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Affiliation(s)
- Fiona Davey
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Vic McGowan
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - Jack Birch
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Isla Kuhn
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Anwesha Lahiri
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Anna Gkiouleka
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Ananya Arora
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Sarah Sowden
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - Clare Bambra
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - John Ford
- Cambridge Public Health, University of Cambridge, United Kingdom
- NIHR School for Public Health Research, United Kingdom
- NIHR Applied Research Collaboration East of England, United Kingdom
- Corresponding author. Cambridge Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom.
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Tufford AR, Diou C, Lucassen DA, Ioakimidis I, O'Malley G, Alagialoglou L, Charmandari E, Doyle G, Filis K, Kassari P, Kechadi T, Kilintzis V, Kok E, Lekka I, Maglaveras N, Pagkalos I, Papapanagiotou V, Sarafis I, Shahid A, van ’t Veer P, Delopoulos A, Mars M. Toward Systems Models for Obesity Prevention: A Big Role for Big Data. Curr Dev Nutr 2022; 6:nzac123. [PMID: 36157849 PMCID: PMC9492244 DOI: 10.1093/cdn/nzac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/24/2022] [Accepted: 07/28/2022] [Indexed: 11/14/2022] Open
Abstract
The relation among the various causal factors of obesity is not well understood, and there remains a lack of viable data to advance integrated, systems models of its etiology. The collection of big data has begun to allow the exploration of causal associations between behavior, built environment, and obesity-relevant health outcomes. Here, the traditional epidemiologic and emerging big data approaches used in obesity research are compared, describing the research questions, needs, and outcomes of 3 broad research domains: eating behavior, social food environments, and the built environment. Taking tangible steps at the intersection of these domains, the recent European Union project "BigO: Big data against childhood obesity" used a mobile health tool to link objective measurements of health, physical activity, and the built environment. BigO provided learning on the limitations of big data, such as privacy concerns, study sampling, and the balancing of epidemiologic domain expertise with the required technical expertise. Adopting big data approaches will facilitate the exploitation of data concerning obesity-relevant behaviors of a greater variety, which are also processed at speed, facilitated by mobile-based data collection and monitoring systems, citizen science, and artificial intelligence. These approaches will allow the field to expand from causal inference to more complex, systems-level predictive models, stimulating ambitious and effective policy interventions.
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Affiliation(s)
- Adele R Tufford
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Christos Diou
- Department of Informatics and Telematics, Harokopio University of Athens, Athens, Greece
| | - Desiree A Lucassen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Ioannis Ioakimidis
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Grace O'Malley
- W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
- Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland University for Medicine and Health Sciences, Dublin, Ireland
| | - Leonidas Alagialoglou
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children's Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Gerardine Doyle
- College of Business, University College Dublin, Dublin, Ireland
- Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
| | | | - Penio Kassari
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children's Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Tahar Kechadi
- CeADAR: Ireland's Centre for Applied AI, University College Dublin, Dublin 4, Ireland
| | - Vassilis Kilintzis
- Lab of Computing, Medical Informatics, and Biomedical Imaging Technologies, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Esther Kok
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Irini Lekka
- Lab of Computing, Medical Informatics, and Biomedical Imaging Technologies, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nicos Maglaveras
- Lab of Computing, Medical Informatics, and Biomedical Imaging Technologies, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Pagkalos
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Vasileios Papapanagiotou
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Sarafis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Arsalan Shahid
- CeADAR: Ireland's Centre for Applied AI, University College Dublin, Dublin 4, Ireland
| | - Pieter van ’t Veer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Anastasios Delopoulos
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Monica Mars
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
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Day RE, Bridge G, Austin K, Ensaff H, Christian MS. Parents' awareness and perceptions of the Change4Life 100 cal snack campaign, and perceived impact on snack consumption by children under 11 years. BMC Public Health 2022; 22:1012. [PMID: 35590265 PMCID: PMC9118772 DOI: 10.1186/s12889-022-12789-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Childhood obesity is a pertinent public health problem in the UK. Consumption of free sugars has been associated with the development of obesity. In 2018, the Change 4Life (C4L) 100 cal snack campaign was launched with the slogan ‘100 calorie snacks, two a day max’, aiming to encourage parents to choose lower sugar, fat and calorie snacks for their children. This study aimed to examine how the campaign has been perceived by parents. Methods An online survey was developed to explore parent awareness, perceptions and understanding of the C4L 100 cal snack campaign. Respondents were recruited via Leeds City Council, posters displayed at primary schools and children’s centres across Leeds and via social media. Paper surveys were also shared with voluntarily led playgroups. Survey data was analysed using descriptive statistics. Thematic analysis was performed on open text responses. Results Three hundred forty-two 342 respondents completed the survey. Just over half of the respondents had come across the campaign, most seeing the leaflet or a television advert. Over two-thirds of respondents ‘agreed’ or ‘strongly agreed’ that the campaign caught their attention. A similar proportion ‘agreed’ or ‘strongly agreed’ that the campaign informed them about 100 cal snacks and just over a half thought it was memorable. Most respondents used positive language to describe the campaign, but there was no clear consensus of a perceived positive impact on healthier snack purchasing, nor preparing more 100 cal snacks at home. Respondents provided examples of how the campaign could be improved to positively impact eating behaviours: better publicity and information delivery; healthier snack examples made more visible; improved nutritional labelling and access to healthier products in supermarkets (availability, promotion, display, choice). Conclusions The C4L 100 cal snack campaign was perceived positively by parents and carers, with many agreeing that the campaign was informative and memorable. However, there was no agreement in terms of the parents reporting an impact of the campaign on behaviour change and healthier snack habits. Future social marketing campaigns could be improved through more formal pilot testing to assess the understanding and acceptance of the campaign amongst the target audience. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12789-7.
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Affiliation(s)
- Rhiannon E Day
- School of Clinical and Applied Sciences, Leeds Beckett University, CL615A, City Campus, Leeds, LS1 3HE, UK
| | | | - Kate Austin
- School of Clinical and Applied Sciences, Leeds Beckett University, CL615A, City Campus, Leeds, LS1 3HE, UK
| | - Hannah Ensaff
- Nutritional Sciences and Epidemiology, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Meaghan S Christian
- Department of Nutrition, Dietetics & Food, Monash University, Be Active Sleep Eat (BASE) Facility, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
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Aceves-Martins M, López-Cruz L, García-Botello M, Gutierrez-Gómez YY, Moreno-García CF. Interventions to Prevent Obesity in Mexican Children and Adolescents: Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:563-586. [PMID: 34725762 PMCID: PMC9072495 DOI: 10.1007/s11121-021-01316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 10/26/2022]
Abstract
The prevalence of overweight and obesity has been rising among Mexican children and adolescents in the last decades. To systematically review obesity prevention interventions delivered to Mexican children and adolescents. Thirteen databases and one search engine were searched for evidence from 1995 to 2021. Searches were done in English and Spanish to capture relevant information. Studies with experimental designs, delivered in any setting (e.g., schools or clinics) or digital domains (e.g., social media campaigns) targeting Mexican children or adolescents (≤ 18 years) and reporting weight outcomes, were included in this review. In addition, the risk of bias was appraised with the Effective Public Health Practice Project Quality Assessment Tool. Twenty-nine studies with 19,136 participants (3-17 years old) were included. The prevalence of overweight and obesity at baseline ranged from 21 to 69%. Most of the studies (89.6%) were delivered in school settings. The duration ranged from 2 days to 3 school years, and the number of sessions also varied from 2 to 200 sessions at different intensities. Overall, anthropometric changes varied across studies. Thus, the efficacy of the included studies is heterogeneous and inconclusive among studies. Current evidence is heterogeneous and inconclusive about the efficacy of interventions to prevent obesity in Mexican children and adolescents. Interventions should not be limited to educational activities and should include different components, such as multi-settings delivery, family inclusion, and longer-term implementations. Mixed-method evaluations (including robust quantitative and qualitative approaches) could provide a deeper understanding of the effectiveness and best practices.
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Affiliation(s)
- Magaly Aceves-Martins
- The Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Lizet López-Cruz
- Universidad Europea del Atlántico, Parque Científico Y Tecnológico de Cantabria, C/Isabel Torres 21, 39011, Santander, Spain
| | - Marcela García-Botello
- Universidad de Monterrey, Zona Valle Poniente, Av. Ignacio Morones Prieto 4500, 66238, San Pedro Garza García, N.L, Mexico
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Aceves-Martins M, López-Cruz L, García-Botello M, Gutierrez-Gómez YY, Moreno-García CF. Interventions to Treat Obesity in Mexican Children and Adolescents: Systematic Review and Meta-Analysis. Nutr Rev 2022; 80:544-560. [PMID: 34339511 PMCID: PMC8829677 DOI: 10.1093/nutrit/nuab041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Prevalence of overweight and obesity has been rising in the past 3 decades among Mexican children and adolescents. OBJECTIVE To systematically review experimental studies evaluating interventions to treat obesity in Mexican children and adolescents (≤18 years old). DATA SOURCES For this study, 13 databases and 1 search engine were searched. DATA ANALYSIS A total of 29 studies met the inclusion criteria. Overall, 2302 participants (age range, 8-16 years) from 11 states in Mexico were included. Most of the studies (n = 17 of 29) were provided in a clinical setting. A random-effect meta-analysis of 4 randomized controlled trials was conducted and a significant effect was found on body mass index reduction that favored the intervention group (-1.52; 95%CI, -2.15 to -0.89) for short-term (≤6 mo) interventions. CONCLUSIONS A multicomponent, multidisciplinary, and individualized intervention that includes dietary modifications, physical activity practice, behavioral strategies, and active parental involvement might help treat childhood obesity in Mexico. However, long-term results need to be produced to identify effectiveness pointers that might help establish an integrated, long-lasting care model to treat obesity.
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Affiliation(s)
| | - Lizet López-Cruz
- Universidad Europea del Atlantico, Parque Científico y Tecnologico de Cantabria, Santander, Spain
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Welch V, Dewidar O, Tanjong Ghogomu E, Abdisalam S, Al Ameer A, Barbeau VI, Brand K, Kebedom K, Benkhalti M, Kristjansson E, Madani MT, Antequera Martín AM, Mathew CM, McGowan J, McLeod W, Park HA, Petkovic J, Riddle A, Tugwell P, Petticrew M, Trawin J, Wells GA. How effects on health equity are assessed in systematic reviews of interventions. Cochrane Database Syst Rev 2022; 1:MR000028. [PMID: 35040487 PMCID: PMC8764740 DOI: 10.1002/14651858.mr000028.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity factors is cited by decision-makers as a limitation to their ability to inform policy and program decisions. OBJECTIVES: To explore what methods systematic reviewers use to consider health equity in systematic reviews of effectiveness. SEARCH METHODS We searched the following databases up to 26 February 2021: MEDLINE, PsycINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Hein Index to Foreign Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on 10 June 10 2021. We contacted authors and searched the reference lists of included studies to identify additional potentially relevant studies. SELECTION CRITERIA We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. We define health inequalities as unfair and avoidable differences across socially stratifying factors that limit opportunities for health. We operationalised this by assessing studies which evaluated differences in health across any component of the PROGRESS-Plus acronym, which stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital. "Plus" stands for other factors associated with discrimination, exclusion, marginalisation or vulnerability such as personal characteristics (e.g. age, disability), relationships that limit opportunities for health (e.g. children in a household with parents who smoke) or environmental situations which provide limited control of opportunities for health (e.g. school food environment). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using a pre-tested form. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews. MAIN RESULTS: In total, 48,814 studies were identified and the titles and abstracts were screened in duplicate. In this updated review, we identified an additional 124 methodological studies published in the 10 years since the first version of this review, which included 34 studies. Thus, 158 methodological studies met our criteria for inclusion. The methods used by these studies focused on evidence relevant to populations experiencing health inequity (108 out of 158 studies), assess subgroup analysis across PROGRESS-Plus (26 out of 158 studies), assess analysis of a gradient in effect across PROGRESS-Plus (2 out of 158 studies) or use a combination of subgroup analysis and focused approaches (20 out of 158 studies). The most common PROGRESS-Plus factors assessed were age (43 studies), socioeconomic status in 35 studies, low- and middle-income countries in 24 studies, gender or sex in 22 studies, race or ethnicity in 17 studies, and four studies assessed multiple factors across which health inequity may exist. Only 16 studies provided a definition of health inequity. Five methodological approaches to consider health equity in systematic reviews of effectiveness were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (140 of 158 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (50 studies); 3) analytic approaches which assessed differential effects across one or more PROGRESS-Plus factors (16 studies); 4) applicability assessment (25 studies) and 5) stakeholder engagement (28 studies), which is a new finding in this update and examines the appraisal of whether relevant stakeholders with lived experience of health inequity were included in the design of systematic reviews or design and delivery of interventions. Reporting for both approaches (analytic and applicability) lacked transparency and was insufficiently detailed to enable the assessment of credibility. AUTHORS' CONCLUSIONS There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to consider health equity in systematic reviews of effectiveness.
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Affiliation(s)
- Vivian Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | | | | | | | - Kevin Brand
- Telfer School of Management, University of Ottawa, Ottawa, Canada
| | | | | | | | | | | | | | - Jessie McGowan
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - Alison Riddle
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Marmora, Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mark Petticrew
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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10
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Forde K, Costello L, Devine A, Sambell R, Wallace R. A multifaceted approach increased staff confidence to develop outside of school hours care as a health promoting setting. BMC Public Health 2021; 21:2286. [PMID: 34911511 PMCID: PMC8672543 DOI: 10.1186/s12889-021-12360-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Outside-of-school-hours-care (OSHC) services are well positioned to influence the health behaviours of 489, 800 Australian children, and are an important setting for health promotion given the current rates of childhood overweight and obesity and associated health risks. OSHC Professionals are ideally placed to become positive influencers in this setting, although they may require training and support to confidently perform this role. This study piloted a multifaceted intervention strategy to increase OSHC Professional's confidence and competencies, to support a health promoting OSHC environment with a nutrition and physical activity focus. METHODS A mixed methods approach was used. Nineteen OSHC Professionals participated in the study, including a face-to-face workshop, supported by a closed Facebook group and website. Role adequacy (self-confidence) and legitimacy (professional responsibility) were measured pre and post workshop and evaluated using non-parametric statistics. Facebook interactions were monitored, and four participants undertook qualitative exit interviews to discuss their experiences with the intervention. RESULTS Pre-workshop 68% of participants had not received any OSHC-specific health promotion training. Post-workshop significant improvements in confidence about menu planning, accessing nutrition information, activities and recipes was observed (P < 0.05 for all). A significant improvement was observed in role support and role related training (P < 0.05). A high level of support and interaction was observed between participants on Facebook and the website was reported a useful repository of information. CONCLUSIONS Health promotion training, combined with positive social connections, shared learning experiences, and a website improved OSHC Professionals confidence and capacity to provide a health promoting OSHC environment. Health promotion professional development for OSHC professionals should be mandated as a minimum requirement, and such learning opportunities should be scaffolded with support available through social media interactions and website access.
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Affiliation(s)
- Karen Forde
- School of Medical & Health Science, Edith Cowan University, Joondalup, Australia
- Telethon Kids Institute, Nedlands, Australia
| | - Leesa Costello
- School of Medical & Health Science, Edith Cowan University, Joondalup, Australia
| | - Amanda Devine
- School of Medical & Health Science, Edith Cowan University, Joondalup, Australia
| | - Ros Sambell
- School of Medical & Health Science, Edith Cowan University, Joondalup, Australia
| | - Ruth Wallace
- School of Medical & Health Science, Edith Cowan University, Joondalup, Australia.
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11
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The effects of a one year school-based comprehensive lifestyle intervention among Chinese kids against obesity (CLICK-obesity) in Nanjing, China. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Johnson VR, Acholonu NO, Dolan AC, Krishnan A, Wang EHC, Stanford FC. Racial Disparities in Obesity Treatment Among Children and Adolescents. Curr Obes Rep 2021; 10:342-350. [PMID: 33988825 PMCID: PMC8120762 DOI: 10.1007/s13679-021-00442-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW With the growing obesity epidemic among children and adolescents, the evaluation of disease origin to slow disease progression is necessary. Racial disparities which are evident amid prevalence and treatment must be studied to counteract disease propagation. RECENT FINDINGS Disparities are pronounced among Black and Hispanic pediatric patients prior to conception and birth due to genetic composition and fetal environment. Postnatal environment and psychosocial influences can further increase a child/adolescent's propensity to increased weight. Current treatment options including nutrition, physical activity, behavior modification, pharmacotherapy, and surgery are underutilized in communities of color due to limited access to care and cost. Data is limited to demonstrate disparities among treatment of obesity in children and adolescents. The reviewed studies show the role of race on disease treatment. Increased research efforts, especially in pharmacotherapy and metabolic and bariatric surgery (MBS), will help combat obesity in pediatric communities of color.
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Affiliation(s)
- Veronica R Johnson
- Department of Internal Medicine, Northwestern Medicine, 259 E. Erie Street, Suite 2150, Chicago, IL, 60611, USA.
| | - Nonyerem O Acholonu
- Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, USA
| | - Ana C Dolan
- University of Massachusetts Amherst, Amherst, MA, USA
| | | | | | - Fatima Cody Stanford
- Departments of Medicine, Neuroendocrine Unit and Pediatrics, Pediatric Endocrinology, Boston, MA, USA
- Nutrition Obesity Research Center at Harvard, MGH Weight Center, Massachusetts General Hospital, 50 Staniford Street, 4th Floor, Boston, MA, 02114, USA
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13
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Habib-Mourad C, Ghandour LA, Maliha C, Dagher M, Kharroubi S, Hwalla N. Impact of a Three-Year Obesity Prevention Study on Healthy Behaviors and BMI among Lebanese Schoolchildren: Findings from Ajyal Salima Program. Nutrients 2020; 12:E2687. [PMID: 32899135 PMCID: PMC7551295 DOI: 10.3390/nu12092687] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022] Open
Abstract
Most school-based obesity prevention programs in low- to middle-income countries are of short duration, and few undertake follow-up analyses after the termination of the project. The aims of the current study are to investigate (1) the long-term effects of a school-based intervention program when implemented over two years on body mass index (BMI), healthy dietary behaviors, and physical activity (PA); and (2) whether the effects are sustained after one-year washout. The study is a cluster-randomized trial; 36 public and private schools were randomized into either intervention or control groups. Students (8-12 years) completed pre-and post-assessment anthropometric measurements and questionnaires about their eating and physical activity habits. Students in the intervention groups received the program components for two consecutive years. Multiple logistic regression models were used to examine the effect of the intervention on BMI and healthy behaviors. Students in the intervention groups were less likely to be overweight at washout, only in public schools. The number of children reporting change in dietary behaviors significantly increased in intervention groups, with a sustained effect only in public schools. Policies aiming at securing a positive nutrition environment in schools, and adoption of nutrition programs, are needed for achieving sustained behavior and prompting BMI changes in children.
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Affiliation(s)
- Carla Habib-Mourad
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Lilian A. Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon;
| | - Carla Maliha
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Michèle Dagher
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon; (C.H.-M.); (C.M.); (M.D.); (S.K.)
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14
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Anselma M, Chinapaw MJM, Kornet-van der Aa DA, Altenburg TM. Effectiveness and promising behavior change techniques of interventions targeting energy balance related behaviors in children from lower socioeconomic environments: A systematic review. PLoS One 2020; 15:e0237969. [PMID: 32870928 PMCID: PMC7462275 DOI: 10.1371/journal.pone.0237969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/06/2020] [Indexed: 01/22/2023] Open
Abstract
This systematic review aims to summarize the evidence regarding the effectiveness of interventions targeting energy balance-related behaviors in children from lower socioeconomic environments and the applied behavior change techniques. The literature search was conducted in Cochrane, Embase, Psycinfo and Pubmed. Articles had to be published between January 2000 and September 2019. Studies were included that i) targeted dietary behavior, physical activity and/or sedentary behavior; ii) had a controlled trial design; iii) included children aged 9–12 years old; iv) focused on lower socioeconomic environments; and v) took place in upper-middle or high income countries. Two independent researchers extracted data, identified behavior change techniques using the Behavior Change Technique Taxonomy v1, and performed a methodological quality assessment using the quality assessment tool of the Effective Public Health Practice Project. We included 24 studies, of which one received a high and three a moderate quality rating. Demonstration, practice and providing instructions on how to perform a behavior were the most commonly applied behavior change techniques. Seven studies reported significant beneficial intervention effects: five on physical activity, one on physical activity and sedentary behavior and one on dietary behavior. When comparing effective versus non-effective interventions, and comparing our review to previous reviews focusing on children from the general population, similar behavior change techniques were applied. More high quality research is needed to evaluate the effectiveness of interventions and their behavior change techniques targeting children of low socioeconomic environments. PROSPERO registration number: CRD42016052599
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Affiliation(s)
- Manou Anselma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Mai J. M. Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniëlle A. Kornet-van der Aa
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Teatske M. Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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15
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Rotevatn TA, Melendez-Torres GJ, Overgaard C, Peven K, Hyldgaard Nilsen J, Bøggild H, Høstgaard AMB. Understanding rapid infant weight gain prevention: a systematic review of quantitative and qualitative evidence. Eur J Public Health 2020; 30:703-712. [PMID: 31410463 PMCID: PMC7445039 DOI: 10.1093/eurpub/ckz140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Rapid infant weight gain (RIWG) is strongly related to childhood overweight and obesity, and prevention of RIWG is an approach to early years obesity prevention. This systematic review aimed to explore effectiveness, deliverers' and recipients' experiences of involvement, and key intervention components and processes of such prevention activities. METHODS Key databases and websites were searched systematically for quantitative and qualitative studies covering intervention effectiveness, experiences with intervention involvement or process outcomes. After duplicate screening and quality assessment, papers were analyzed through narrative synthesis, thematic synthesis and intervention component analysis. RESULTS Seven quantitative and seven qualitative studies were eligible for inclusion. Most intervention studies reported small, but significant results on infant weight gain. More significant results were measured on weight gain during the first compared with the second year of life. A weak evidence base made elaboration of the relationship between intervention effectiveness and content challenging. Home-delivered interventions may be more relevant for parents. Contextual factors, such as social norms, beliefs and professional identity should be considered during intervention development. Stakeholder involvement can be key to increase intervention acceptability and feasibility. CONCLUSIONS The field of RIWG prevention is new and evolving, but more research is needed before further conclusions about intervention effectiveness and intervention content can be drawn. Future interventions should take parents, health professionals and other contextual needs into account to improve chances of success. More research on long-term effects on overweight and obesity is needed.
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Affiliation(s)
- Torill A Rotevatn
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - G J Melendez-Torres
- DECIPHer, Cardiff School of Social Sciences, Cardiff University, Cardiff, Wales, UK
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Kimberly Peven
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Jane Hyldgaard Nilsen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Anna Marie Balling Høstgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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16
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Liu Z, Li Q, Maddison R, Ni Mhurchu C, Jiang Y, Wei DM, Cheng L, Cheng Y, Wang D, Wang HJ. A School-Based Comprehensive Intervention for Childhood Obesity in China: A Cluster Randomized Controlled Trial. Child Obes 2020; 15:105-115. [PMID: 30565955 DOI: 10.1089/chi.2018.0251] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A comprehensive approach involving both environmental and individual strategies offers opportunities to strengthen school-based interventions for childhood obesity. OBJECTIVES To evaluate a theory-based comprehensive intervention implemented within primary schools for childhood obesity in China. METHODS A 1-year, cluster randomized controlled trial was conducted in twelve primary schools (7-11 years old) in Beijing, China. Environmental and individual factors were improved in the intervention group (6 schools, 930 children) to promote knowledge and behaviors related to energy balance. The control group (6 schools, 959 children) did not receive any intervention. The primary outcome was body mass index (BMI) and its Z-score at 12 months. Generalized linear mixed models were used controlling for the cluster effect of school. RESULTS No significant differences were found between groups on BMI (0.07 kg/m2 [95% confidence interval (CI) -0.16 to 0.31, p = 0.54]) and its Z-score (0.02 [95% CI: -0.08 to 0.11, p = 0.73]) at 12 months. Self-reported knowledge, daily consumption of sugar-sweetened beverage, and frequency of moderate to vigorous physical activity improved at 12 months. CONCLUSIONS The intervention did not mitigate excess weight gain, but did improve children's knowledge and several behaviors related to energy balance.
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Affiliation(s)
- Zheng Liu
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Qin Li
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Ralph Maddison
- 2 Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Cliona Ni Mhurchu
- 3 National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- 3 National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Dong-Mei Wei
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Lan Cheng
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Yu Cheng
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Di Wang
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Hai-Jun Wang
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
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17
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Islami F, Goding Sauer A, Gapstur SM, Jemal A. Proportion of Cancer Cases Attributable to Excess Body Weight by US State, 2011-2015. JAMA Oncol 2019; 5:384-392. [PMID: 30589925 DOI: 10.1001/jamaoncol.2018.5639] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Excess body weight (EBW) is an established cause of cancer. Despite variations in the prevalence of EBW among US states, there is little information on the EBW-related cancer burden by state; this information would be useful for setting priorities for cancer-control initiatives. Objective To calculate the population attributable fraction (PAF) of incident cancer cases attributable to EBW among adults 30 years or older in 2011 to 2015 in all 50 states and the District of Columbia. Design, Setting, and Participants State-level, self-reported body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) data from the Behavioral Risk Factor Surveillance System were adjusted by sex, age, race/ethnicity, and education using objectively measured BMI values from the National Health and Nutrition Examination Survey. Age- and sex-specific cancer incidence data by state were obtained from the US Cancer Statistics database. All analyses were performed between February 15, 2018, and July 17, 2018. Main Outcomes and Measures Sex-, age-, and state-specific adjusted prevalence estimates for 4 high BMI categories and corresponding relative risks from large-scale pooled analyses or meta-analyses were used to compute the PAFs for each US state for esophageal adenocarcinoma, multiple myeloma, and cancers of the gastric cardia, colorectum, liver, gallbladder, pancreas, female breast, corpus uteri, ovary, kidney and renal pelvis, and thyroid. Results Each year, an estimated 37 670 cancer cases in men (4.7% of all cancer cases excluding nonmelanoma skin cancers) and 74 690 cancer cases in women (9.6%) 30 years or older in the United States were attributable to EBW from 2011 to 2015. In both men and women, there was at least a 1.5-fold difference in the proportions of cancers attributable to EBW between states with the highest and lowest PAFs. Among men, the PAF ranged from 3.9% (95% CI, 3.6%-4.3%) in Montana to 6.0% (95% CI, 5.6%-6.4%) in Texas. The PAF for women was approximately twice as high as for men, ranging from 7.1% (95% CI, 6.7%-7.6%) in Hawaii to 11.4% (95% CI, 10.7%-12.2%) in the District of Columbia. The largest PAFs were found mostly in southern and midwestern states, as well as Alaska and the District of Columbia. Conclusions and Relevance The proportion of cancers attributable to EBW varies among states, but EBW accounts for at least 1 in 17 of all incident cancers in each state. Broad implementation of known community- and individual-level interventions is needed to reduce access to and marketing of unhealthy foods (eg, through a tax on sugary drinks) and to promote and increase access to healthy foods and physical activity, as well as preventive care.
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Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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18
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Kerr JA, Loughman A, Knox A, Koplin JJ, Allen KJ, Wake M. Nutrition-related interventions targeting childhood overweight and obesity: A narrative review. Obes Rev 2019; 20 Suppl 1:45-60. [PMID: 31419049 DOI: 10.1111/obr.12768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 11/27/2022]
Abstract
Systematic reviews of nutritional interventions indicate limited efficacy in reducing childhood obesity, but their blanket conclusions could obscure promising components. This narrative review sought more detail on effective components within nutrition-related interventions involving children aged 2 to 11 years. In May 2016, the World Health Organization (WHO) searched the Cochrane Library and PubMed for relevant reviews. From 36 reviews, we screened 182 nutrition-related randomized trials for inclusion. We then reviewed those that reported at least 1 statistically significant (P < 0.05) treatment benefit on body weight and/or composition outcomes at their longest follow-up assessment. Fourteen trials met inclusion criteria (median n = 554; mean intervention duration = 10.8 mo; follow-up = 4.4 mo). "Effective" approaches included environmental changes such as school water fountain installations and cafeteria menu changes and possibly less sustainable strategies such as health education lessons. However, effect sizes even of these selected significant treatment benefits were modest-significant body mass index z-score effects range from -0.1 to -0.2. Each trial was associated with very small improvements in body composition. Because this is a "best-case" scenario (reflecting our design), trialists should rigorously test these strategies alone and possibly together; be open to novel strategies; and ensure that each strategy is culturally relevant and self-sustainable.
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Affiliation(s)
- Jessica A Kerr
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Amy Loughman
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia.,Food & Mood Centre, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, VIC, Geelong, Australia
| | - Andrew Knox
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Katrina J Allen
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Department of Paediatrics and The Liggins Institute, University of Auckland, Auckland, New Zealand
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19
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Gray HL, Buro AW, Barrera Ikan J, Wang W, Stern M. School-level factors associated with obesity: A systematic review of longitudinal studies. Obes Rev 2019; 20:1016-1032. [PMID: 31013544 DOI: 10.1111/obr.12852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/16/2019] [Accepted: 02/25/2019] [Indexed: 01/27/2023]
Abstract
Although school has been an important intervention venue for obesity prevention, the role of school-level factors in obesity development or prevention has not been well-documented. This study aimed to systematically examine the current evidence on school-level factors associated with obesity outcomes in longitudinal studies. The literature search was performed in PubMed, EMBASE, CINHAL, and PsycINFO. Peer-reviewed articles using longitudinal study designs and published in English from 1991 to 2018 were eligible. Twelve articles met eligibility criteria for final systematic review. Nine studies reported significant long-term associations between school-level factors and obesity outcomes. Higher parental education, longer minutes of recess, meeting recommended recess and physical education time, higher socio-economic status, suburban compared with rural area, higher parental involvement in school, and healthful school food environment were significantly associated with lower rates of obesity or obesity trajectory. However, due to the small number of studies and heterogeneity of measures and variables used in their analytic models, the overall level of evidence from this review suggests the importance of further, systematic study. Empirically rigorous research is needed to identify additional aspects of the school context and environment that may contribute to the risk of obesity throughout the life course.
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Affiliation(s)
- Heewon L Gray
- College of Public Health, University of South Florida, Tampa, Florida
| | - Acadia W Buro
- College of Public Health, University of South Florida, Tampa, Florida
| | | | - Wei Wang
- College of Public Health, University of South Florida, Tampa, Florida.,Centre for Addiction and Mental Health, Ontario, Canada
| | - Marilyn Stern
- Department of Child & Family Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida
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20
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Knai C, Petticrew M, Mays N, Capewell S, Cassidy R, Cummins S, Eastmure E, Fafard P, Hawkins B, Jensen JD, Katikireddi SV, Mwatsama M, Orford J, Weishaar H. Systems Thinking as a Framework for Analyzing Commercial Determinants of Health. Milbank Q 2018; 96:472-498. [PMID: 30277610 PMCID: PMC6131339 DOI: 10.1111/1468-0009.12339] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Policy Points: Worldwide, more than 70% of all deaths are attributable to noncommunicable diseases (NCDs), nearly half of which are premature and apply to individuals of working age. Although such deaths are largely preventable, effective solutions continue to elude the public health community. One reason is the considerable influence of the “commercial determinants of health”: NCDs are the product of a system that includes powerful corporate actors, who are often involved in public health policymaking. This article shows how a complex systems perspective may be used to analyze the commercial determinants of NCDs, and it explains how this can help with (1) conceptualizing the problem of NCDs and (2) developing effective policy interventions.
Context The high burden of noncommunicable diseases (NCDs) is politically salient and eminently preventable. However, effective solutions largely continue to elude the public health community. Two pressing issues heighten this challenge: the first is the public health community's narrow approach to addressing NCDs, and the second is the involvement of corporate actors in policymaking. While NCDs are often conceptualized in terms of individual‐level risk factors, we argue that they should be reframed as products of a complex system. This article explores the value of a systems approach to understanding NCDs as an emergent property of a complex system, with a focus on commercial actors. Methods Drawing on Donella Meadows's systems thinking framework, this article examines how a systems perspective may be used to analyze the commercial determinants of NCDs and, specifically, how unhealthy commodity industries influence public health policy. Findings Unhealthy commodity industries actively design and shape the NCD policy system, intervene at different levels of the system to gain agency over policy and politics, and legitimize their presence in public health policy decisions. Conclusions It should be possible to apply the principles of systems thinking to other complex public health issues, not just NCDs. Such an approach should be tested and refined for other complex public health challenges.
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Affiliation(s)
- Cécile Knai
- London School of Hygiene and Tropical Medicine
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21
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Saelens BE, Glanz K, Frank LD, Couch SC, Zhou C, Colburn T, Sallis JF. Two-Year Changes in Child Weight Status, Diet, and Activity by Neighborhood Nutrition and Physical Activity Environment. Obesity (Silver Spring) 2018; 26:1338-1346. [PMID: 30138547 PMCID: PMC6108436 DOI: 10.1002/oby.22247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/27/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to examine 2-year changes in weight status and behaviors among children living in neighborhoods differing on nutrition and activity environments. METHODS A prospective observational study, the Neighborhood Impact on Kids study, was conducted in King County, Washington, and San Diego County, California. Children 6 to 12 years old and a parent or caregiver completed Time 1 (n = 681) and Time 2 (n = 618) assessments. Children lived in neighborhoods characterized as "high/favorable" or "low/unfavorable" in nutrition and activity environments, respectively (four neighborhood types). Child BMI z score and overweight or obesity status were primary outcomes, with diet and activity behaviors as behavioral outcomes. RESULTS After adjusting for sociodemographics and Time 1 values, children living in two of the three less environmentally supportive neighborhoods had significantly less favorable BMI z score changes (+0.11, 95% CI: 0.01-0.21; + 0.12, 95% CI: 0.03-0.21), and all three less supportive neighborhoods had higher overweight or obesity (relative risks, 1.41-1.49; 95% CI: 1.13-1.80) compared with children in the most environmentally supportive neighborhoods. Changes in daily energy intake and sedentary behavior by neighborhood type were consistent with observed weight status changes, with unexpected findings for physical activity. CONCLUSIONS More walkable and recreation-supportive environments with better nutrition access were associated with better child weight outcomes and related behavior changes.
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Affiliation(s)
- Brian E. Saelens
- Seattle Children’s Research Institute, Seattle, Washington
- University of Washington, Department of Pediatrics, Seattle, Washington
| | - Karen Glanz
- Emory University; now at University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania
| | - Lawrence D. Frank
- University of British Columbia, School of Community and Regional Planning, Vancouver, British Columbia
| | - Sarah C. Couch
- University of Cincinnati, Department of Rehabilitation, Exercise, and Nutrition Sciences, Cincinnati, Ohio
| | - Chuan Zhou
- Seattle Children’s Research Institute, Seattle, Washington
- University of Washington, Department of Pediatrics, Seattle, Washington
| | - Trina Colburn
- Seattle Children’s Research Institute, Seattle, Washington
| | - James F. Sallis
- San Diego State University; now at University of California - San Diego, Department of Family Medicine and Public Health
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22
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Valerio G, Maffeis C, Saggese G, Ambruzzi MA, Balsamo A, Bellone S, Bergamini M, Bernasconi S, Bona G, Calcaterra V, Canali T, Caroli M, Chiarelli F, Corciulo N, Crinò A, Di Bonito P, Di Pietrantonio V, Di Pietro M, Di Sessa A, Diamanti A, Doria M, Fintini D, Franceschi R, Franzese A, Giussani M, Grugni G, Iafusco D, Iughetti L, Lamborghini A, Licenziati MR, Limauro R, Maltoni G, Manco M, Reggiani LM, Marcovecchio L, Marsciani A, del Giudice EM, Morandi A, Morino G, Moro B, Nobili V, Perrone L, Picca M, Pietrobelli A, Privitera F, Purromuto S, Ragusa L, Ricotti R, Santamaria F, Sartori C, Stilli S, Street ME, Tanas R, Trifiró G, Umano GR, Vania A, Verduci E, Zito E. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr 2018; 44:88. [PMID: 30064525 PMCID: PMC6069785 DOI: 10.1186/s13052-018-0525-6] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/07/2018] [Indexed: 01/06/2023] Open
Abstract
The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.
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Affiliation(s)
- Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, via Medina 40, 80133 Naples, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Giuseppe Saggese
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | | | - Antonio Balsamo
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Simonetta Bellone
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Sergio Bernasconi
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Parma, Italy
| | - Gianni Bona
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Valeria Calcaterra
- Pediatrics Unit, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Margherita Caroli
- Italian Society for Obesity (SIO), Francavilla Fontana (Brindisi), Italy
| | | | - Nicola Corciulo
- Pediatric Unit, Hospital of Gallipoli, Gallipoli (Lecce), Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie”, Pozzuoli Hospital, Naples, Italy
| | | | - Mario Di Pietro
- Pediatric and Neonatal Unit, “G. Mazzini”Hospital, Teramo, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonella Diamanti
- Artificial Nutrition Unit Bambino Gesù, Children’s Hospital, IRCCS, Rome, Italy
| | - Mattia Doria
- Italian Federation of Pediatricians (FIMP), Venice, Italy
| | - Danilo Fintini
- Endocrinology and Diabetology Unit Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | | | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Giulio Maltoni
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Children’s Hospital Bambino Gesù, Rome, Italy
| | | | | | | | - Emanuele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - Giuseppe Morino
- Nutrition Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | | | - Valerio Nobili
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
- Hepatometabolic Unit, Bambino Gesù Children’s Hospital, IRCSS, Rome, Italy
| | - Laura Perrone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | | | | | | | | | - Roberta Ricotti
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Francesca Santamaria
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | - Chiara Sartori
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Maria Elisabeth Street
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rita Tanas
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
| | | | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Vania
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Elvira Verduci
- Deparment of Pediatrics, San Paolo Hospital, University of Milan, Milan, Italy
| | - Eugenio Zito
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
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23
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Weisman A, Fazli GS, Johns A, Booth GL. Evolving Trends in the Epidemiology, Risk Factors, and Prevention of Type 2 Diabetes: A Review. Can J Cardiol 2018; 34:552-564. [PMID: 29731019 DOI: 10.1016/j.cjca.2018.03.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 02/07/2023] Open
Abstract
Currently, the global prevalence of diabetes is 8.8%. This figure is expected to increase worldwide, with the largest changes projected to occur in low- and middle-income countries. The aging of the world's population and substantial increases in obesity have contributed to the rise in diabetes. Global shifts in lifestyles have led to the adoption of unhealthy behaviours such as physical inactivity and poorer-quality diets. Correspondingly, diabetes is a rapidly-increasing problem in higher- as well as lower-income countries. In Canada, the prevalence of diabetes increased approximately 70% in the past decade. Although diabetes-related mortality rates have decreased in Canada, the number of people affected by diabetes has continued to grow because of a surge in the number of new diabetes cases. Non-European ethnic groups and individuals of lower socioeconomic status have been disproportionately affected by diabetes and its risk factors. Clinical trials have proven efficacy in reducing the onset of diabetes in high-risk populations through diet and physical activity interventions. However, these findings have not been broadly implemented into the Canadian health care context. In this article we review the evolving epidemiology of type 2 diabetes, with regard to trends in occurrence rates and prevalence; the role of risk factors including those related to ethnicity, obesity, diet, physical activity, socioeconomic status, prediabetes, and pregnancy; and the identification of critical windows for lifestyle intervention. Identifying high-risk populations and addressing the upstream determinants and risk factors of diabetes might prove to be effective diabetes prevention strategies to curb the current diabetes epidemic.
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Affiliation(s)
- Alanna Weisman
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ghazal S Fazli
- The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashley Johns
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Gillian L Booth
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
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24
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Matwiejczyk L, Mehta K, Scott J, Tonkin E, Coveney J. Characteristics of Effective Interventions Promoting Healthy Eating for Pre-Schoolers in Childcare Settings: An Umbrella Review. Nutrients 2018; 10:nu10030293. [PMID: 29494537 PMCID: PMC5872711 DOI: 10.3390/nu10030293] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/18/2018] [Accepted: 02/25/2018] [Indexed: 12/13/2022] Open
Abstract
Early Childhood Education and Care (ECEC) settings have a pivotal role in shaping children’s dietary food habits by providing the contextual environment within which they develop these behaviours. This study examines systematic reviews for (1) the effectiveness of interventions to promote healthy eating in children aged 2–5 years attending centre-based childcare; (2) intervention characteristics which are associated with promoting healthy eating and; (3) recommendations for child-health policies and practices. An Umbrella review of systematic reviews was undertaken using a standardized search strategy in ten databases. Twelve systematic reviews were examined using validated critical appraisal and data extraction tools. Children’s dietary food intake and food choices were significantly influenced. Interventions to prevent obesity did not significantly change children’s anthropometric measures or had mixed results. Evidence was more convincing if interventions were multi-component, addressed physical activity and diet, targeted individual-level and environmental-level determinants and engaged parents. Positive outcomes were mostly facilitated by researchers/external experts and these results were not replicated when implemented in centres by ECEC providers without this support. The translation of expert-led interventions into practice warrants further exploration of implementation drivers and barriers. Based on the evidence reviewed, recommendations are made to inform child-health directed practices and policies.
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Affiliation(s)
- Louisa Matwiejczyk
- College Nursing and Health Sciences, Flinders University, Adelaide, SA 5000, Australia.
| | - Kaye Mehta
- College Nursing and Health Sciences, Flinders University, Adelaide, SA 5000, Australia.
| | - Jane Scott
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Emma Tonkin
- College Nursing and Health Sciences, Flinders University, Adelaide, SA 5000, Australia.
| | - John Coveney
- College Nursing and Health Sciences, Flinders University, Adelaide, SA 5000, Australia.
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25
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Islami F, Goding Sauer A, Miller KD, Siegel RL, Fedewa SA, Jacobs EJ, McCullough ML, Patel AV, Ma J, Soerjomataram I, Flanders WD, Brawley OW, Gapstur SM, Jemal A. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin 2018; 68:31-54. [PMID: 29160902 DOI: 10.3322/caac.21440] [Citation(s) in RCA: 882] [Impact Index Per Article: 147.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 12/12/2022] Open
Abstract
Contemporary information on the fraction of cancers that potentially could be prevented is useful for priority setting in cancer prevention and control. Herein, the authors estimate the proportion and number of invasive cancer cases and deaths, overall (excluding nonmelanoma skin cancers) and for 26 cancer types, in adults aged 30 years and older in the United States in 2014, that were attributable to major, potentially modifiable exposures (cigarette smoking; secondhand smoke; excess body weight; alcohol intake; consumption of red and processed meat; low consumption of fruits/vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and 6 cancer-associated infections). The numbers of cancer cases were obtained from the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute; the numbers of deaths were obtained from the CDC; risk factor prevalence estimates were obtained from nationally representative surveys; and associated relative risks of cancer were obtained from published, large-scale pooled analyses or meta-analyses. In the United States in 2014, an estimated 42.0% of all incident cancers (659,640 of 1570,975 cancers, excluding nonmelanoma skin cancers) and 45.1% of cancer deaths (265,150 of 587,521 deaths) were attributable to evaluated risk factors. Cigarette smoking accounted for the highest proportion of cancer cases (19.0%; 298,970 cases) and deaths (28.8%; 169,180 deaths), followed by excess body weight (7.8% and 6.5%, respectively) and alcohol intake (5.6% and 4.0%, respectively). Lung cancer had the highest number of cancers (184,970 cases) and deaths (132,960 deaths) attributable to evaluated risk factors, followed by colorectal cancer (76,910 cases and 28,290 deaths). These results, however, may underestimate the overall proportion of cancers attributable to modifiable factors, because the impact of all established risk factors could not be quantified, and many likely modifiable risk factors are not yet firmly established as causal. Nevertheless, these findings underscore the vast potential for reducing cancer morbidity and mortality through broad and equitable implementation of known preventive measures. CA Cancer J Clin 2018;68:31-54. © 2017 American Cancer Society.
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Affiliation(s)
- Farhad Islami
- Strategic Director, Cancer Surveillance Research, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ann Goding Sauer
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Strategic Director, Surveillance Information, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Strategic Director, Risk Factors and Screening Surveillance, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Eric J Jacobs
- Strategic Director, Pharmacoepidemiology, Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Marjorie L McCullough
- Strategic Director, Nutritional Epidemiology, Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Alpa V Patel
- Strategic Director, Cancer Prevention Study-3, Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Jiemin Ma
- Strategic Director, Cancer Interventions Surveillance, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Isabelle Soerjomataram
- Scientist, Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - W Dana Flanders
- Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Otis W Brawley
- Chief Medical and Science Officer, Executive Vice President, Research, American Cancer Society, Atlanta, GA
| | - Susan M Gapstur
- Vice President, Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
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26
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Islami F, Miller KD, Siegel RL, Fedewa SA, Ward EM, Jemal A. Disparities in liver cancer occurrence in the United States by race/ethnicity and state. CA Cancer J Clin 2017; 67:273-289. [PMID: 28586094 DOI: 10.3322/caac.21402] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 12/11/2022] Open
Abstract
Liver cancer is highly fatal, and death rates in the United States are increasing faster than for any other cancer, having doubled since the mid-1980s. In 2017, it is estimated that the disease will account for about 41,000 new cancer cases and 29,000 cancer deaths in the United States. In this article, data from the Surveillance, Epidemiology, and End Results (SEER) Program and the National Center for Health Statistics are used to provide an overview of liver cancer incidence, mortality, and survival rates and trends, including data by race/ethnicity and state. The prevalence of major risk factors for liver cancer is also reported based on national survey data from the Centers for Disease Control and Prevention. Despite the improvement in liver cancer survival in recent decades, only 1 in 5 patients survives 5 years after diagnosis. There is substantial disparity in liver cancer death rates by race/ethnicity (from 5.5 per 100,000 in non-Hispanic whites to 11.9 per 100,000 in American Indians/Alaska Natives) and state (from 3.8 per 100,000 in North Dakota to 9.6 per 100,000 in the District of Columbia) and by race/ethnicity within states. Differences in risk factor prevalence account for much of the observed variation in liver cancer rates. Thus, in contrast to the growing burden, a substantial proportion of liver cancer deaths could be averted, and existing disparities could be dramatically reduced, through the targeted application of existing knowledge in prevention, early detection, and treatment, including improvements in vaccination against hepatitis B virus, screening and treatment for chronic hepatitis C virus infections, maintaining a healthy body weight, access to high-quality diabetes care, preventing excessive alcohol drinking, and tobacco control, at both the state and national levels. CA Cancer J Clin 2017;67:273-289. © 2017 American Cancer Society.
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Affiliation(s)
- Farhad Islami
- Strategic Director, Cancer Surveillance Research, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Strategic Director, Surveillance Information Services, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Strategic Director, Risk Factors and Screening Surveillance, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Elizabeth M Ward
- Senior Vice President, Intramural Research, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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27
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Olstad DL, Ancilotto R, Teychenne M, Minaker LM, Taber DR, Raine KD, Nykiforuk CIJ, Ball K. Can targeted policies reduce obesity and improve obesity-related behaviours in socioeconomically disadvantaged populations? A systematic review. Obes Rev 2017; 18:791-807. [PMID: 28434185 DOI: 10.1111/obr.12546] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/05/2017] [Accepted: 03/07/2017] [Indexed: 12/19/2022]
Abstract
This review synthesized evidence from controlled studies pertaining to the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged children and adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity guidelines were followed. Eligible studies were published from 2004 to August 2015 and examined the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged populations. Twenty articles (18 studies) were included. Eight studies examined organizational policies within multi-component interventions in schools. Common elements of successful policy-containing interventions included nutritional standards, enhancements to physical education, additional physical activity opportunities, school self-assessments, and nutrition and physical activity education. Of the 10 studies of government policies, policies providing information/education and fruit and vegetable subsidies had positive impacts amongst children, but no impact amongst adults. Policies involving changes to built environments yielded nearly uniformly null findings in children and adults. Overall, the largest quantity of high-quality evidence of effectiveness was for comprehensive interventions that included school policies, and government policies targeting disadvantaged children in schools. None of the government policies targeting disadvantaged adults proved effective. Interventions during childhood may ameliorate negative obesity-related manifestations of socioeconomic disadvantage. Gaps in knowledge remain surrounding effective policies in adults, adolescents and very young children.
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Affiliation(s)
- D L Olstad
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - R Ancilotto
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - M Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - L M Minaker
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, Ontario, Canada
| | - D R Taber
- Healthy Food America, Seattle, Washington, USA
| | - K D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - C I J Nykiforuk
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - K Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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28
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Frontini R, Haycraft E, Canavarro MC, Moreira H. The Indirect Effect of Family Cohesion on Children’s Weight Status Through Maternal Quality of Life and Children’s Internalizing and Externalizing Symptoms. CHILD & YOUTH CARE FORUM 2017. [DOI: 10.1007/s10566-017-9408-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Mendoza W, Miranda JJ. Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors: Toward a New Practice of Global Health Cardiology. Cardiol Clin 2017; 35:1-12. [PMID: 27886780 DOI: 10.1016/j.ccl.2016.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One of the major drivers of change in the practice of cardiology is population change. This article discusses the current debate about epidemiologic transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness for disease surveillance and meeting global targets; health system, prevention, and treatment efforts; and physiologic traits and human-environment interactions are identified. This article concludes that a focus on the most populated regions of the world will contribute substantially to protecting the large gains in global survival and life expectancy accrued over the last decades.
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Affiliation(s)
- Walter Mendoza
- United Nations Population Fund, Peru Country Office, Av. Guardia Civil 1231, San Isidro, Lima 27, Peru
| | - J Jaime Miranda
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima 31, Peru; CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru.
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30
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Shao X, Ding X, Wang B, Li L, An X, Yao Q, Song R, Zhang JA. Antibiotic Exposure in Early Life Increases Risk of Childhood Obesity: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2017; 8:170. [PMID: 28775712 PMCID: PMC5517403 DOI: 10.3389/fendo.2017.00170] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/03/2017] [Indexed: 12/21/2022] Open
Abstract
A number of studies have previously assessed the impact of antibiotic exposure in early life on the risk of childhood obesity, but no systematic assessment is currently available. A systematic review and meta-analysis was performed to comprehensively and quantitatively elucidate the risk of childhood obesity caused by antibiotic exposure in early life. Literature search was performed in PubMed, Embase, and Web of Science. Random-effect meta-analysis was used to pool the statistical estimates. Fifteen cohort studies involving 445,880 participants were finally included, and all those studies were performed in developed countries. Antibiotic exposure in early life significantly increased risk of childhood overweight [relative risk (RR) = 1.23, 95% confidence interval (CI) 1.13-1.35, P < 0.001] and childhood obesity (RR = 1.21, 95% CI 1.13-1.30, P < 0.001). Antibiotic exposure in early life also significantly increased the z-score of childhood body mass index (mean difference: 0.07, 95% CI 0.05-0.09, P < 0.00001). Importantly, there was an obvious dose-response relationship between antibiotic exposure in early life and childhood adiposity, with a 7% increment in the risk of overweight (RR = 1.07, 95% CI 1.01-1.15, P = 0.03) and a 6% increment in the risk of obesity (RR = 1.06, 95% CI 1.02-1.09, P < 0.001) for each additional course of antibiotic exposure. In conclusion, antibiotic exposure in early life significantly increases risk of childhood obesity. Moreover, current analyses are mainly taken from developed countries, and therefore the impact of antibiotic exposure on risk of childhood obesity in vulnerable populations or developing countries still needs to be evaluated in future studies.
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Affiliation(s)
- Xiaoqing Shao
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xiaolian Ding
- Department of Nephrology and Endocrinology, Weinan Central Hospital, Weinan, China
| | - Bin Wang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Ling Li
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xiaofei An
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Qiuming Yao
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Ronghua Song
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Jin-an Zhang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
- *Correspondence: Jin-an Zhang,
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