Cardiovascular disease risk in healthy children and its association with body mass index: systematic review and meta-analysis

The association between dietary intake of branched-chain amino acids and the odds of nonalcoholic fatty liver disease among overweight and obese children and adolescents

Objectives

Dietary supplementation with branched-chain amino acids (BCAAs), including leucine, isoleucine, and valine, has shown potential benefits for the metabolic profile. However, emerging population-based studies suggest that BCAAs may mediate pathways related to cardiometabolic risk factors, possibly due to their involvement in the dysregulation of insulin metabolic pathways. This study aimed to investigate the association between BCAAs intake and the odds of nonalcoholic fatty liver disease (NAFLD) in children and adolescents with overweight and obesity.

Methods

This cross-sectional study encompassed individuals aged 6 to 18 years with WHO body mass index (BMI)-for-age z-score ≥ 1. NAFLD diagnosis was done using an ultrasonography scan of the liver and gastroenterologist confirmation. Dietary BCAAs intake was assessed using a validated 147-item food frequency questionnaire. Logistic regression models, adjusted for potential confounders, were used to estimate the odds ratios (OR) and 95% confidence interval (CI) of NAFLD across quartiles of BCAAs intake.

Results

A total of 505 (52.9% boys) with mean ± SD age and BMI-for-age-Z-score of 10.0 ± 2.3 and 2.70 ± 1.01, respectively, were enrolled. After adjusting for potential confounders, participants in the highest quartile of total dietary BCAAs (OR: 1.87;95%CI:1.06-3.28) and leucine (OR: 1.84;95%CI:1.03-3.29) intake had greater odds of developing NAFLD compared with those in the lowest quartile. There was no significant association between dietary valine and isoleucine intake and the odds of NAFLD.

Conclusions

The study findings suggest that increased dietary intake of BCAAs, particularly leucine, may have detrimental effects on the development of NAFLD.

Dental-nutrition counseling for children with overweight and obesity: Evidence from a pilot study

BACKGROUND

Given the relationship between overweight and obesity (OV/OB) and poor oral health in children, paediatric dentists are uniquely positioned to provide educational interventions to children with OV/OB during dental visits.

AIM

To assess how an educational nutrition intervention delivered by dentists affected dental-nutritional behaviors and body mass index (BMI) percentile in children with OV/OB.

DESIGN

Retrospective analysis was performed using data collected on 217 patients with OV/OB aged 6-11 years who received nutritional counseling during dental visits at a Federally Qualified Health Center from September 1, 2021, through September 30, 2022. Data were collected on sociodemographic variables, oral health, and BMI percentile. Participants and their guardians were surveyed to measure the frequency of behaviors related to oral health and weight. Multivariable generalized estimating equations were constructed to determine the effect of the intervention on BMI percentile and reported dental-nutritional behaviors.

RESULTS

The intervention had no effect on the BMI percentile (p = .35). There were statistically significant reductions in the reported average number of sugar-sweetened beverages consumed daily (p < .001), reported average daily water intake (p < .001), and the reported frequency of brushing teeth (p < .001), the clinical significance of these reductions remains unclear.

CONCLUSION

Further research is needed to establish the efficacy of behavioral interventions at reducing weight and changing health behaviors.

Green Cities, Healthier Children: The Effect of Expanding Urban Green Space on Body Weight for Primary School Starters

The discussion on tackling childhood obesity is often centered around fostering physical activity. A potential relationship yet overlooked could run from providing the proper environment for healthy lifestyles to reduced weight problems. A unique quasi-experimental setting of transforming former airport grounds to a large urban green space allows me to apply a difference-in-differences approach within an intention-to-treat framework, comparing several weight outcomes of residential children to children living further away before and after park opening. I use new administrative data on the Berlin district level from mandatory school entrance examinations and provide robust evidence of a lower probability by 4.3% points for treated children to be overweight (BMI > 90 P.), driven entirely by girls, mainly by children from foreign cultural backgrounds and children with less childcare exposure. My results are robust to corrective methods of inference, including synthetic controls, and may open a new perspective for obesity policy action and prevention.

Dietary and lifestyle indices for hyperinsulinemia and odds of MAFLD in overweight and obese children and adolescents

Lifestyle and dietary intake play a pivotal role in development of metabolic dysfunction-associated fatty liver disease(MAFLD). We performed this cross-sectional study to evaluate the association between lifestyle and dietary insulinemic potential and odds of MAFLD in overweight and obese children and adolescents. The insulinemic potential of the diet and lifestyle was assessed by computing the scores of the empirical dietary index for hyperinsulinemia(EDIH), the empirical lifestyle index for hyperinsulinemia(ELIH), the empirical dietary index for insulin resistance(EDIR), and the empirical lifestyle index for insulin resistance(ELIR). MAFLD was diagnosed according to the consensus definitions. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by logistic regression. A total of 334 (49.1% boys) with mean ± SD age and BMI-for-age-Z-score of 9.3 ± 1.8 and 2.55 ± 0.69, respectively, were enrolled. After adjusting for all potential confounders, participants in the highest quartile of ELIH score had greater odds of developing MAFLD (OR:3.50;95%CI:1.49-8.22) compared with those in the lowest quartile. This association remained significant among boys and pubertal ones. However, no significant association between EDIH, EDIR, or ELIR and odds of MAFLD was found. Our study suggests that the collective insulinemic potential of dietary intake, BMI, and physical activity is associated with increased odds of MAFLD.

Challenges in blood pressure measurement in children with obesity: focus on the cuff

Childhood obesity is a well-known risk factor for primary hypertension (HTN), especially during puberty. Validated automated oscillometric devices based on universal protocols using proper cuffs according to arm sizes must be selected for blood pressure (BP) measurement in clinical practice. Recent recommendations have addressed the importance of accurate BP measurement in patients with obesity. The American Heart Association (AHA) suggests using a cone-shaped cuff, while the European Society of Hypertension (ESH) emphasizes the significance of cuff characteristics based on arm size. The applicability of cone-shaped cuffs over cylindrical cuffs has been studied in adults with obesity. Most studies focused on the upper arm's shape and provided evidence that the use of cylindrical cuffs may overestimate BP in individuals with obesity, while the conical cuff was proposed as a proper alternative. However, current validation studies for BP measurement devices have not included the arm's size as a recruiting criterion, which may compromise the accuracy of devices in individuals with obesity. This review discusses the role of arm characteristics in cuff selection and the potential role of conical cuffs as an alternative to commonly used cylindrical ones in BP measurement in pediatric patients with obesity.

Exploring the mechanisms and relationship between body mass index and asthma: findings from Mendelian randomization

BACKGROUND

The mechanism linking BMI and asthma remains unclear.

METHOD

Mendelian Randomization (MR) analysis was conducted using summary-level GWAS data from the FinnGen Biobank and the Open GWAS project. The analysis considering potential variables as mediators, including blood cell counts, blood pressure, and blood biomarkers. Three commonly used MR methods-the inverse-variance-weighted (IVW) method, weighted median (WM) method, and MR-Egger method-were employed to infer causal links. A two-step approach was used in mediation analysis to evaluate the causal links among BMI, candidate mediators, and asthma.

RESULT

Elevated BMI demonstrated a substantial correlation with increased asthma risk. Thirteen biomarkers mediated the relationship between BMI and asthma, mainly including leukocyte count (5.070%), apolipoprotein A levels (7.395%), cystatin C levels (5.345%), urate levels (9.057%), diastolic blood pressure (7.365%), and albumin levels (10.888%). These factors collectively explained over 50% of the increased asthma risk associated with BMI elevation. Additionally, eosinophil count and C-reactive protein were also identified as important mediators using the WM method.

CONCLUSION

This study highlights the complex relationship between obesity, blood biomarkers, and asthma risk. Additional studies are required to validate these results and investigate causal relationships in various populations.

Maternal Macronutrient Intake at Pregnancy and Offspring Growth Trajectory through Childhood: A Prospective Analysis in the Growing Up Today Study 2 Cohort

BACKGROUND

Childhood obesity has become a public health challenge globally. Existing studies have indicated a potential link between maternal dietary macronutrient compositions and subsequent weight changes in their offspring during early childhood, although few studies have been conducted through early adulthood.

OBJECTIVE

We aim to investigate the relationship between maternal macronutrient intake before or during pregnancy and offspring body weight from late childhood till early adulthood.

METHODS

We included 5,715 children from the Growing Up Today Study 2 (GUTS2; mean 11.8 years old at baseline in 2004) born to 4,731 mothers who participated in the Nurses' Health Study II (NHSII) during 1989-1995. Diet during or before pregnancy was assessed using a validated food frequency questionnaire (FFQ) in 1991 and 1995. Age- and sex-specific body mass index (BMI) were used to define overweight and obesity in childhood and adolescence. Multivariable linear and log-binomial regression models with generalized estimating equations were used to evaluate the associations of interest.

RESULTS

The mean (SD) maternal macronutrients percent energy intake during pregnancy were 19.3% (3.1) for protein, 51.2% (6.6) for carbohydrates, and 30.8% (5.0) for total fat. For diet during pregnancy, after multivariate adjustment for maternal and offspring risk factors, compared with the lowest quartile, the highest quartile of trans fatty acid consumption was associated with a 0.20 unit (95% CI: 0.00, 0.40) increase in BMI z-score without a significant linear trend (P-trend = 0.06). A positive association with BMI z-score was also observed for total fat intake (β: 0.21; 95% CI: 0.05, 0.36; P-trend = 0.02) when replacing total carbohydrate, and vice versa (β: -0.24; 95% CI: -0.40, -0.08; P-trend = 0.02 for total carbohydrate intake). For diet before pregnancy, none of the macronutrients were associated with offspring BMI z-score or the risk of overweight or obesity.

CONCLUSIONS

Higher fat, especially trans fat intake, during pregnancy was positively associated with higher body weight among offspring. Other macronutrients from various food sources were not associated with the offspring weight. Overall, these data suggest that, apart from trans fatty acids, other macronutrient composition of maternal diet may have minimal impact on offspring body weight in this well-nourished population.

Carotid-Femoral Pulse Wave Velocity in Children in South Africa: Reference Values for the Vicorder Device

Atherosclerosis often starts in childhood, tracking to adulthood. In children, early vascular disease can be detected as arterial stiffness. Carotid-femoral pulse wave velocity is considered the non-invasive gold standard method for measuring arterial stiffness and widely accepted for use in children. We define pulse wave velocity (PWV) reference values for African children, in a cohort of children and adolescents living in Cape Town, South Africa, using the oscillometric Vicorder device, and considering the anatomical pathway in growing children. Three hundred and twenty four children (6-16 years old) were followed annually at Tygerberg Hospital, from March 2014 to March 2020, yielding 959 longitudinal PWV measurements. Centile curves for males and females by age and height were constructed using the Lamda-Mu-Sigma (LMS) method. Our study demonstrates that African children have a relatively flat PWV throughout childhood and early adolescence, from 7 to 14 years of age, and between 120 and 170 cm standing height. These gender-specific percentiles for age and height will allow accurate surveillance of arterial elasticity in African children over time. The identification of children at high risk is important given the long-term health implications and the effectiveness of early intervention to prevent progression to cardiovascular disease.

Association between 24-hour movement behaviors and adiposity in children and adolescents: A compositional data meta-analysis

PURPOSE

To quantitatively synthesize published evidence on the association between 24-hour movement behavior composition with adiposity in children and adolescents aged 3-18 years.

METHODS

Systematic literature searches were conducted in five electronic databases to identify papers published between January 2015 and January 2024. A machine learning-assisted systematic review was conducted to identify studies applying compositional data analysis to examine the association between 24-hour movement behaviors and adiposity in children and youth. Random effect meta-analyses were estimated to examine the relative association between each component of the 24-hour movement behavior composition and body mass index z-score (zBMI), waist circumference, fat mass percentage, and fat mass index (FMI).

RESULTS

A total of 16 studies reporting on 15,230 children and youth were included in the review. Most studies reported on zBMI (k = 14), followed by waist circumference (k = 5), body fat percentage (k = 3), and FMI (k = 2). Spending more time sleeping and engaged in moderate-to-vigorous intensity physical activity (MVPA) relative to other behaviors was associated with lower adiposity, while spending more time sedentary and engaged in light-intensity physical activity was associated with higher adiposity.

CONCLUSION

These results provide support for most recommendations of the 24-hour movement behavior guidelines, including getting an adequate amount of sleep, limiting sedentary time, and engaging in MVPA, to improve adiposity outcomes.

Clinical guidelines for the diagnosis, evaluation, and management of hypertension for Korean children and adolescents: the Korean Working Group of Pediatric Hypertension

Pediatric hypertension (HTN) is a significant, growing health concern worldwide and also in Korea. Diagnosis, evaluation, and treatment of HTN in Korean children and adolescents are uncertain due to limitations in using the current international guidelines, since the recommendations by the American Academy of Pediatrics (AAP) and European Society of Hypertension (ESH) guidelines differ. Furthermore, these are guidelines for Western youth, who are racially and ethnically different from Koreans. In addition, reference blood pressure values for all pediatric age groups, which are essential for the diagnosis of HTN according to these two guidelines, are absent in Korea. Therefore, HTN guidelines for Korean children and adolescents should be established. The Korean Working Group of Pediatric Hypertension established clinical guidelines for the diagnosis, evaluation, and management of HTN in Korean children and adolescents. These guidelines were based on reported clinical evidence, expert recommendations, and AAP and ESH guidelines. The characteristics of Korean youth and the Korean medical and insurance system were considered during the establishment of the guidelines. By providing recommendations suitable for Korean youth, these guidelines will help in the prevention and management of childhood HTN, thus relieving the burden of cardiovascular disease in adulthood in Korea.

A Scoping Review of Tailoring in Pediatric Obesity Interventions

Background: Families with children who have or are at risk for obesity have differing needs and a one-size-fits-all approach can negatively impact program retention, engagement, and outcomes. Individually tailored interventions could engage families and children through identifying and prioritizing desired areas of focus. Despite literature defining tailoring as individualized treatment informed by assessment of behaviors, intervention application varies. This review aims to exhibit the use of the term "tailor" in pediatric obesity interventions and propose a uniform definition. Methods: We conducted a scoping review following PRISMA-ScR guidelines among peer-reviewed pediatric obesity prevention and management interventions published between 1995 and 2021. We categorized 69 studies into 6 groups: (1) individually tailored interventions, (2) computer-tailored interventions/tailored health messaging, (3) a protocolized group intervention with a tailored component, (4) only using the term tailor in the title, abstract, introduction, or discussion, e) using the term tailor to describe another term, and (5) interventions described as culturally tailored. Results: The scoping review exhibited a range of uses and lack of explicit definitions of tailoring in pediatric obesity interventions including some that deviate from individualized designs. Effective tailored interventions incorporated validated assessments for behaviors and multilevel determinants, and recipient-informed choice of target behavior(s) and programming. Conclusions: We urge interventionists to use tailoring to describe individualized, assessment-driven interventions and to clearly define how an intervention is tailored. This can elucidate the role of tailoring and its potential for addressing the heterogeneity of behavioral and social determinants for the prevention and management of pediatric obesity.

Association between FTO gene polymorphism and obesity in down syndrome children

Children with Down syndrome (DS) have a higher incidence of overweight and obesity compared to typically developing peers. The fat mass and obesity-associated gene (FTO) is one of the early identified genes linked to obesity in various populations. To date, the FTO rs17817449 gene polymorphism has not been investigated in overweight/obese-DS (ODS) individuals. The current study aimed to explore the potential association between the FTO rs17817449 gene polymorphism and obesity-related markers, and to evaluate the ability of this polymorphism in the prediction of overweight/obesity in DS children and adolescents. This case-control study included 100 DS children under the age of 18, classified into three groups according to BMI-percentile; 50 non-obese DS (NODS), 24 overweight DS, and 26 ODS. Genotyping of FTO gene rs17817449 polymorphism was performed using the restriction fragment length polymorphism (RFLP-PCR) method. Serum lipid and thyroid profiles were also assessed. The results revealed significant increase in the frequency of the FTO rs17817449 T allele among overweight /ODS children compared to NODS children (p=0.0099). Overweight/ODS children exhibited significantly higher frequencies of the FTO rs17817449 GT and TT genotypes compared to NODS children.

CONCLUSION

There is an association between FTO rs17817449 genetic variant and overweight/obesity among the studied DS groups. The FTO rs17817449 GT and TT genotypes, as well as TGs level, were identified as independent risk factors for predicting overweight and obesity in DS children.

WHAT IS KNOWN

• Overweight and obese-DS (ODS) children displayed higher BMI and atherogenic lipid profile than non-obese DS children (NODS). FTO gene polymorphism rs17817449 contributes to obesity development in general population, but there is conflicting information about the risk allele.

WHAT IS NEW

• FTO rs17817449 TT genotype and T allele were considered as independent risk factors for overweight and obesity development in DS children, so they could be used for obesity prediction in DS children.

Mendelian randomization analysis of the association between childhood overweight or obesity and gestational diabetes mellitus

OBJECTIVE

To investigate the association between childhood overweight or obesity and gestational diabetes mellitus (GDM).

METHODS

Data were sourced from the Genome-Wide Association Studies database on childhood body mass index (BMI), with 39 620 samples and 8 173 382 single-nucleotide polymorphisms (SNPs), and GDM, with 143 441 samples, including 12 332 GDM cases and 20 149 608 SNPs. Mendelian randomization (MR) was conducted, including inverse variance weighting (IVW), MR-Egger regression, and the weighted median method. Statistical heterogeneity among SNPs was assessed using Cochran's Q test. MR-Egger's intercept, the MR-Pleiotropy RESidual Sum and Outlier (PRESSO) test, and funnel plots were used to evaluate pleiotropy. The leave-one-out method tested the robustness of the IVW results by excluding individual SNPs.

RESULTS

Fifteen SNPs highly related to childhood BMI were identified. IVW analysis indicated that higher childhood BMI is a significant risk factor for GDM (odds ratio 1.50 [95% confidence interval 1.20-1.87]; p < 0.001). The direction of the β value derived from the weighted median method analysis was consistent with that from the IVW analysis. Cochran's Q test showed statistical heterogeneity among SNPs highly related to childhood BMI (p = 0.001), thus prioritizing IVW analysis results. The MR-Egger regression intercept, MR-PRESSO test, and funnel plot analyses demonstrated no horizontal pleiotropy among SNPs highly related to childhood BMI. The leave-one-out analysis indicated that the MR analysis results were largely unchanged after the exclusion of individual SNPs.

CONCLUSION

Elevated childhood BMI is associated with an increased risk of developing GDM, underscoring the need to address childhood obesity as a preventive strategy. Effective interventions to reduce childhood obesity could be crucial in mitigating this risk.

Cardiometabolic Health in Adolescents with Obesity: The Role of Protein Intake, Diet Quality, and Physical Activity

Background: Although adolescents with obesity have an increased risk of cardiometabolic disease, a subset maintains a healthy cardiometabolic profile. Unhealthy lifestyle behaviors may determine cardiometabolic risk. We aimed to characterize the lifestyle behaviors of adolescents with obesity, compare differences between metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and assess associations between lifestyle behaviors and cardiometabolic profiles. Methods: Participants aged 10-18 years with body mass index (BMI) ≥ 95th percentile were included. Dietary intake (DI) was estimated from 3-day food records, and diet quality (DQ) was assessed using the Healthy Eating Index-Canadian Adaptation. Physical activity (PA), body composition, anthropometrics, blood markers, and blood pressure (BP) were objectively measured. MUO was defined as having high triglycerides, BP, glucose, or low high-density lipoprotein. Regression analyses were performed between lifestyle behaviors and cardiometabolic markers. Results: Thirty-nine participants (BMI z-score 2.8 [2.5-3.5], age 12.5 [10.9-13.5] years, 56.4% female) were included. A high proportion of participants failed to meet lifestyle recommendations, particularly for DQ (94.7%, n = 36), fiber (94.7%, n = 36), and PA (90.9%, n = 30). No differences in lifestyle behaviors were found between MUO (59.0%, n = 22) and MHO (41.0%, n = 16). Protein intake was negatively associated with BMI and waist circumference z-scores, fat mass index, insulin resistance, low-density lipoprotein, and C-reactive protein, whereas higher DQ was associated with lower C-reactive protein. Higher light PA levels were associated with lower total cholesterol and triglycerides. Conclusion: Adolescents with either MUO or MHO displayed low adherence to DQ, DI, and PA recommendations; no differences in lifestyle behaviors were found. Protein intake, DQ, and PA were associated with a healthier cardiometabolic profile.

High Blood Pressure in Children Aged 3 to 12 Years Old With Overweight or Obesity

Objective: (1) To describe the prevalence of high blood pressure (BP) and the association with BMI in young children with overweight/obesity; (2) to evaluate the accuracy of a single high BP to diagnose sustained hypertension over three visits. Methods: We used pre-intervention data from the Improving Pediatric Obesity Practice Using Prompts (iPOP-UP) trial. We included children aged 3-12 years with BMI ≥85th percentile at well-visits in 2019-2021 at 84 primary care practices in 3 US health systems in the Northeast, Midwest, and South. BP percentiles were calculated from the first visit with BP recorded during the study period. Hypertensive-range BP was defined by the 2017 American Academy of Pediatrics guideline. We tested the association between BMI classification and hypertensive BP using multivariable logistic regression. Results: Of 78,280 children with BMI ≥85th percentile, 76,214 (97%) had BP recorded during the study period (mean 7.4 years, 48% female, 53% with overweight, and 13% with severe obesity). The prevalence of elevated or hypertensive BP was 31%, including 27% in children with overweight and 33%, 39%, and 49% with class I, II, and III obesity, respectively. Higher obesity severity was associated with higher odds of hypertensive BP in the multivariable model. Stage 2 hypertensive BP at the initial visit had specificity of 99.1% (95% confidence interval 98.9-99.3) for detecting sustained hypertension over ≥3 visits. Conclusions: High BP is common in 3- to 12-year-olds with overweight/obesity, with higher obesity severity associated with greater hypertension. Children with overweight/obesity and stage 2 BP are likely to have sustained hypertension and should be prioritized for evaluation. Trial Registration: ClinicalTrials.gov Identifier: NCT05627011.

Is underweight associated with poorer diet, nutrient status, bone and cardiometabolic health, and school performance in Danish 8-11-year-olds?

PURPOSE

Underweight, i.e. low body mass index for age and sex, may indicate undernutrition, but despite high prevalence, this aspect is largely overlooked in children in high-income countries. We explored if dietary intake, nutrient status, body composition, bone mineralization, cardiometabolic markers and school performance differed in schoolchildren with underweight compared to normal- and overweight.

METHODS

We used cross-sectional data from 815 Danish 8-11-year-old children collected in 2011. Intake of foods, macronutrients and key micronutrients (vitamin D, vitamin B12, calcium, iron, zinc and selenium) was assessed by 7-day dietary records. Measurements included anthropometry, dual-energy X-ray absorptiometry and tests of attention and reading skills. Fasting blood samples were analyzed for biomarkers of iron, long-chain n-3 fatty acids and vitamin D status as well as blood lipids, insulin and growth markers.

RESULTS

Eighty-three (10.2%) children had underweight and were shown to have a lower intake of energy, red meat, protein and zinc and higher intake of added sugar than children with normal- and overweight. They also had higher fish intake relative to overweight, but blood biomarkers did not differ between groups. Children with underweight had lower fat percent and bone mineralization compared to peers with normalweight, but apart from lower insulin, they did not differ in overall cardiometabolic health or school performance.

CONCLUSION

Although we found some differences in diet, there were no considerable differences in nutrient status, cardiometabolic health or school performance between children with underweight and their normalweight peers. However, the lower bone mineralization is a concern and needs further investigation.

Combined high-intensity interval and resistance training improves cardiorespiratory fitness more than high-intensity interval training in young women with overweight/obesity: a randomized controlled trial

Objective

This study aimed to compare the effects of high-intensity interval training (HIIT) combined with resistance training (RT) versus HIIT alone on body composition, cardiorespiratory fitness and glycolipid metabolism in young women with overweight/obesity.

Methods

This randomized controlled trial divided 40 subjects into an experimental group (HIIT+RT) and a control group (HIIT). Both groups underwent training three times per week for eight weeks. Body composition, cardiorespiratory fitness and glycolipid levels were assessed before and after the intervention.

Results

The results revealed that compared to baseline, both the experimental and control groups showed significant improvements in body weight, body mass index (BMI), Body fat, waist circumference (WC), waist-hip ratio (WHR), peak oxygen uptake (VO2peak), vital capacity (VC), oxygen pulse (VO2/HR), minute ventilation, resting heart rate, blood oxygen saturation, blood pressure, fasting blood glucose, triglycerides and high-density lipoprotein cholesterol (p<0.05). Additionally, a significant increase in muscle mass and a significant reduction in 2-hour postprandial glucose were observed in the experimental group (p<0.05). Muscle mass (mean difference: 2.75%), VO2peak (mean difference: 1.61 mL/min/kg), VC (mean difference: 334mL), and VO2/HR (mean difference: 0.51mL/beat) showed greater improvement in the HIIT+RT group compared to the HIIT group (p<0.05).

Conclusion

In conclusion, an 8-week regimen of either combined HIIT and RT or HIIT significantly improves body composition, cardiorespiratory fitness and glycolipid metabolism in women with overweight/obesity. However, the combined training appears to offer more benefits than HIIT alone. Further research is needed to evaluate the long-term effects and feasibility of combined training.

Trial registration

https://www.chictr.org.cn/, identifier ChiCTR2300075961.

A study on the configuration of factors influencing overweight and obesity in adolescents based on fuzzy set qualitative comparative analysis

OBJECTIVE

Overweight and obesity among adolescents are grave public health issues around the world. Although the conditions that contribute to obesity have been extensively researched, little is known about how multiple conditions interact to cause overweight and obesity. The current study intends to investigate the histomorphic configuration pathways of several conditions of adolescent overweight and obesity by gender.

METHOD

The data came from a social survey conducted in June 2021 in Changchun, Jilin Province, China. The sample collected was 14-year-old adolescents, including 167 boys and 137 girls. The school physicians examined the participants' weight and height, and questionnaires were used to collect risk indicators from adolescents, such as sleep duration, electronic screens times, consumption of sugary drinks and fried foods, and physical activity. Simultaneously, a Fuzzy Qualitative Comparative Analysis will be performed to investigate the combinations of diverse conditions.

RESULT

We found that there is no determining necessary condition that, once present, directly determines that an individual is in a state of overweight and obesity. Simultaneously, this study revealed nine alternative configurational paths of overweight and obesity in teenagers of different genders, with a concordance of 0.805 for six male groupings and 0.916 for three female groupings. The outcomes of overweight obesity in adolescents under different genders are similar but not identical.

CONCLUSION

This study examined the interactions of a number of conditions from the individual, behavioral, learning and living environment that led to the same overweight obese outcome among adolescents of different genders. Our research will be useful to policymakers in that interventions should take into account the combined effects of a number of different aspects rather than focusing on a single factor that causes overweight and obesity.

Association of adiposity, serum vitamin D, and dietary quality with cardiometabolic risk factors in children aged 6-12 years: findings from SEANUTS II Malaysia

Increased cardiometabolic risk among children is increasingly becoming a concern, with evidence indicating that obesity, diet, and serum 25-hydroxyvitamin D (25(OH)D) are associated with cardiometabolic risk. However, such studies among Malaysian children are scarce. Thus, this study explores the associations between adiposity, dietary quality, and 25(OH)D, with cardiometabolic risk factors among Malaysian children aged 4-12 years. Data of 479 children (mean age: 8.2 ± 2.3 years old, 52% females) from the South East Asian Nutrition Surveys (SEANUTS II) Malaysia, were included in this analysis. Adiposity (percentage of body fat) was assessed with bioelectrical impedance technique. Dietary quality was assessed using 24 h dietary recall and calculated as mean adequacy ratio. Vitamin D was assessed based on serum 25-hydroxyvitamin D (25(OH)D). Measurements of cardiometabolic risk factors included waist circumference (WC), mean arterial pressure (MAP), fasting blood glucose (FBG), high-density lipoprotein (HDL), triglyceride, and high-sensitivity C-reactive protein, and cardiometabolic risk cluster score (siMS) was calculated. Overall, higher adiposity was positively associated with all cardiometabolic risk factors (WC, ß = 0.907; 95% CI = 0.865, 0.948; MAP, ß = 0.225; 95% CI = 0.158, 0.292; HDL, ß = -0.011; 95% CI = -0.014, -0.009; Triglyceride, ß = 0.012; 95% CI = 0.009, 0.016; FBG, ß = 0.006; 95% CI = 0.002, 0.011) and siMS score (ß = 0.033; 95% CI = 0.029, 0.037). Serum 25(OH)D was inversely associated with siMS score (ß = -0.002; 95% CI = -0.004, -0.000008) and positively associated with HDL (ß = 0.002; 95% CI = 0.0001, 0.003). Our findings suggest that adiposity is a key determinant of adverse cardiometabolic risk factors in children, while serum 25(OH)D may be associated with overall cardiometabolic health. Interventions to reduce obesity are needed to mitigate the deleterious consequences of cardiometabolic dysregulation in children.

Effectiveness of Smartphone App for the Treatment of Pediatric Obesity: A Randomized Controlled Trial

BACKGROUND

Pediatric obesity treatment is based on high-intensity lifestyle counseling. However, high dropout rates and low effectiveness have been reported, even in specialized centers. Mobile health technologies have been used to overcome these limits with contrasting results. This study aims at evaluating the effectiveness of a six-month intervention with a mobile app for the treatment of pediatric obesity at 6 and 12 months of follow-up.

METHODS

Seventy-five patients were randomly assigned to standard care or standard care plus mobile app (2:1) using an online randomizer system. The mobile app delivered high-intensity lifestyle counseling for diet and physical activity.

RESULTS

At six months of follow-up, the M-App group showed significantly lower dropout rates compared to standard care (p = 0.01). The risk of dropout was significantly higher in controls compared to the intervention group (OR 3.86, 95% C.I. 1.39-10.42, p = 0.01). After one year, we observed lower albeit non-statistically significant dropout rates in the M-App compared to the standard care group (p = 0.24). No differences were observed in z-score BMI and percentage of BMI reduction between the two groups.

CONCLUSIONS

Our findings suggest that the mobile app might help in the clinical management of children and adolescents with obesity in terms of dropout reduction.

Brazilian Guideline for Exercise Testing in Children and Adolescents - 2024

CLASSES OF RECOMMENDATION

LEVELS OF EVIDENCE

Changes in health-related quality of life and sleep habits after a 6-month non-randomised cluster-controlled trial among children with overweight or obesity

Being overweight or obese can have severe negative psychological impacts and reduce health-related functioning. To improve health-related quality of life (HRQoL) and sleep habits for children with overweight or obesity, it is important to design and implement effective interventions. The aim of this study was to evaluate the effects of a 6-month family-based lifestyle intervention on HRQoL and sleep habits in Norwegian children with overweight or obesity in a primary-care setting. This 6-month, non-randomised, cluster-controlled trial included Norwegian children aged 5-13 years with overweight or obesity and their parents. A questionnaire was filled out by the parents. A total of 33 and 52 children in the control group and 41 and 78 children in the intervention group answered the HRQoL and sleep habits questions, respectively, and were included. The intervention group received individual family counselling and participated in physical activity groups and nutrition courses. The Children's Sleep Habits Questionnaire (CSHQ) and Kidscreen-10 index were used to assess sleep habits and HRQoL. At baseline, the mean average scores for HRQoL were 50.0 [standard deviation (SD) 8.1] for the intervention group and 49.0 (SD 10.1) for the control group. For sleep habits at baseline, the mean average scores were 45.2 (SD 11.8) for the intervention group and 46.0 (SD 11.9) for the control group. No significant changes in HRQoL and sleep habits after the intervention were revealed. Overall, the family-based lifestyle intervention targeting overweight and obese children in a primary-care setting showed no significant effect on HRQoL or sleep quality.

Identification and Validation of CXCL2 as a Key Gene for Childhood Obesity

This study aims to identify the key genes and their regulatory networks by bioinformatics, increasing understanding of childhood obesity. The data comes from the GEO and Immport database. The immune microenvironment was explored in GSE104815. Key genes were identified by intersection of DEGs with the immune gene set. Enrichment analysis revealed gene-related functions and correlation analysis explored the relationship. Regulatory networks were constructed based on miRcode, TarBase and TargetScan databases. GSE29718 was used to validate our findings. Intercellular communication and cell differentiation trends were further explored using single-cell data from GSE153643. Based on our research, the immune microenvironment in the obese group showed higher immune infiltration. We found 962 DEGs and CXCL2 was identified as the key gene. The co-regulatory network of lncRNA-miRNA-mRNA suggested that obtaining TM4SF19-AS1, GUSBP11, AC105020.1, LINC00189, COL4A2-AS2, VIPR1-AS1 and LINC00242 may regulate CXCL2 (r > 0.9 and P < 0.01). Differential expression of CXCL2 was validated in GSE29718 (P < 0.05) and CXCL2 was identified as a biomarker for childhood obesity (AUC = 0.885). GSVA enrichment analysis revealed many pathways of high group obtaining the TNF-α signaling via NF-κB pathway and interferon γ response pathway. In GSE153643, 11 cell types were identified and CXCL2 was highly expressed in monocyte, macrophage, endothelial cell and pericyte. In CXCL2 high expressing macrophages, there was a tendency for cells to polarize toward M1 macrophages (P < 0.05). In summary, we identified CXCL2 as a potential biomarker of childhood obesity. The development of childhood obesity may be associated with the activation of immune infiltration of macrophage M1 polarization by CXCL2 expression.

Adolescent bariatric surgery-a survey of referring practitioners

BACKGROUND

Recent guidelines, supported by large, well-designed studies, suggest that bariatric surgery is a safe and effective treatment for adolescents living with severe obesity to improve health and psychosocial functioning. The aim of this study was to assess the opinions and referral practices of general practitioners (GPs) and paediatricians in Ireland.

METHODS

A cross-sectional survey was circulated online to practising paediatricians and GPs. The survey consisted of a short introduction about childhood obesity and 12 questions on adolescent bariatric surgery and obesity medications.

RESULTS

There were 45 unique responses to the survey from 22 GPs (48%), 8 paediatricians (17%), and 15 others. Most GPs (72%) would not consider referring an adolescent for bariatric surgery. Paediatricians were significantly more likely to refer (72% vs. 28%, p = 0.034). A minimum BMI of 40 kg/m2 was the most common response, which GPs (45%) and paediatricians (37.5%) suggested should be a pre-requisite for surgery. There was strong support for family psychological assessment and a reported deficit in the community support needed to manage obesity. GPs were more likely than paediatricians to respond that anti-obesity medications should be made available to adolescents, specifically liraglutide (45% vs. 25%), semaglutide (45% vs. 37.5%), and orlistat (22% vs. 0%).

DISCUSSION

There is a reluctance among GPs to refer adolescents with severe obesity for consideration of bariatric surgery. Concerns regarding the different obesity treatments held by medical professionals should be addressed through education and engagement and should be fundamental to the development of child and adolescent obesity services.

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

Importance

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

Objective

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

Data Sources

MEDLINE, Web of Science, Embase, and Cochrane.

Study Selection

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

Data Extraction and Synthesis

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

Main Outcomes and Measures

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

Results

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

Conclusions and Relevance

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

Lipoprotein(a) serum concentrations in children in relation to body mass index, age and sex

BACKGROUND

Lipoprotein(a) (Lp(a)) is an inherited risk factor for atherosclerotic cardiovascular disease (ASCVD). Limited data exist on Lp(a) values in children. We aimed to evaluate whether Lp(a) concentrations in youth are influenced by BMI.

METHODS

756 blood samples of 248 children with obesity and 264 matched healthy children aged 5 and 18 years, enrolled in the population-based LIFE Child (German civilization diseases cohort) study, were analyzed. Repeat measurements were available in 154 children (1-4 follow ups, ~1 year apart).

RESULTS

The median Lp(a) concentration in the total cohort (n = 512) at first visit was 9.7 mg/dL (IQR 4.0-28.3). Lp(a) concentrations between 30-50 mg/dL were observed in 11.5%, while 12.5% exhibited Lp(a) ≧50 mg/dL. There was no association of Lp(a) with body mass index (BMI) (ß = 0.004, P = 0.49). Lp(a) levels did not correlate with age or sex, while Lp(a) was associated positively with low-density lipoprotein cholesterol (ß = 0.05, P < 0.0001). The Lp(a) risk category remained stable in 94% of all children in repeated measurements.

CONCLUSIONS

The data showed no association of Lp(a) levels in children with BMI, age or sex. Measurement of Lp(a) in youth may be useful to identify children at increased lifetime risk for ASCVD.

IMPACT

In youth, Lp(a) levels are not affected by age, sex and BMI. Lp(a) risk categories remain stable over time in repeated measurements in children. Measurement of Lp(a) in children may be useful as an additional factor to identify children at increased lifetime risk for ASCVD and for reverse family screening.

The impact of reduced muscular fitness on cardiometabolic risk factors in children aged 9-11 years

AIM

To analyse the relationships between muscular fitness (MF), fat mass (FM), fat-free mass (FFM) and its combined ratio with cardiometabolic risk (CMR) and whether the relationship between MF and CMR is mediated by body composition in schoolchildren.

METHODS

A cross-sectional study was conducted on schoolchildren from Cuenca, Spain, between September and November 2017. FM and FFM were estimated using bioimpedance analysis. The CMR index was calculated from triglycerides-HDL-c ratio, arterial pressure and fasting insulin. The MF index was assessed using handgrip and standing long jump tests. Analysis of covariance models assessed CMR index differences across the MF index and the FM/FFM ratio categories. Mediation analysis examined whether the MF index and the CMR index association were mediated by FM, FFM or FM/FFM ratio.

RESULTS

The analyses involved 485 schoolchildren aged 9-11 years (55.4% girls). Children with a higher MF index had a lower CMR index (p < 0.05). This association did not persist after controlling for FM/FFM. FM, FFM and FM/FFM ratio mediated the relationship between the MF index and the CMR index.

CONCLUSION

Better levels of MF are associated with better cardiometabolic profile, but a healthy body composition is determinant to improve future health.

Associations of early childhood body mass index trajectories with body composition and cardiometabolic markers at age 10 years: the Ethiopian infant anthropometry and body composition (iABC) birth cohort study

BACKGROUND

Variability in body mass index (BMI) (kg/m2) trajectories is associated with body composition and cardiometabolic markers in early childhood, but it is unknown how these associations track to later childhood.

OBJECTIVES

We aimed to assess associations of BMI trajectories from 0 to 5 y with body composition and cardiometabolic markers at 10 y.

METHODS

In the Ethiopian infant anthropometry and body composition (iABC) birth cohort, we previously identified 4 distinct BMI trajectories from 0 to 5 y: stable low BMI (19.2%), normal BMI (48.8%), rapid growth to high BMI (17.9%), and slow growth to high BMI (14.1%). At 10 y, we obtained data from 320 children on anthropometry, body composition, abdominal subcutaneous and visceral fat, and cardiometabolic markers. Associations of BMI trajectories and 10-y outcomes were analyzed using multiple linear regression.

RESULTS

Compared with children with the normal BMI trajectory, those with rapid growth to high BMI had 1.7 cm (95% CI: 0.1, 3.3) larger waist circumference and those with slow growth to high had 0.63 kg/m2 (95% CI: 0.09, 1.17) greater fat mass index and 0.19 cm (95% CI: 0.02, 0.37) greater abdominal subcutaneous fat, whereas those with stable low BMI had -0.28 kg/m2 (95% CI: -0.59, 0.03) lower fat-free mass at 10 y. Although the confidence bands were wide and included the null value, children with rapid growth to high BMI trajectory had 48.6% (95% CI: -1.4, 123.8) higher C-peptide concentration and those with slow growth to high BMI had 29.8% (95% CI: -0.8, 69.8) higher insulin and 30.3% (95% CI: -1.1, 71.6) higher homeostasis model assessment of insulin resistance, whereas those with rapid growth to high BMI had -0.23 mmol/L (95% CI: -0.47, 0.02) lower total cholesterol concentration. The trajectories were not associated with abdominal visceral fat, blood pressure, glucose, and other lipids at 10 y.

CONCLUSIONS

Children with rapid and slow growth to high BMI trajectories before 5 y tend to show higher measures of adiposity and higher concentrations of markers related to glucose metabolism at 10 y.

CLINICAL TRIAL REGISTRY

ISRCTN46718296 (https://www.isrctn.com/ISRCTN46718296).

FTO genotype and body mass index reduction in childhood obesity interventions: A systematic review and meta-analysis

Numerous guidelines have called for personalized interventions to address childhood obesity. The role of fat mass and obesity-associated gene (FTO) in the risk of childhood obesity has been summarized. However, it remains unclear whether FTO could influence individual responses to obesity interventions, especially in children. To address this, we systematically reviewed 12,255 records across 10 databases/registers and included 13 lifestyle-based obesity interventions (3980 children with overweight/obesity) reporting changes in body mass index (BMI) Z-score, BMI, waist circumference, waist-to-hip ratio, and body fat percentage after interventions. These obesity-related outcomes were first compared between children carrying different FTO genotypes (rs9939609 or its proxy) and then synthesized by random-effect meta-analysis models. The results from single-group interventions showed no evidence of associations between FTO risk allele and changes in obesity-related outcomes after interventions (e.g., BMI Z-score: -0.01; 95% CI: -0.04, 0.01). The results from controlled trials showed that associations between the FTO risk allele and changes in obesity-related outcomes did not differ by intervention/control group. To conclude, the FTO risk allele might play a minor role in the response to obesity interventions among children. Future studies might pay more attention to the accumulation effect of multiple genes in the intervention process among children.

Independent and Joint Effects of Prenatal Incense-Burning Smoke Exposure and Children's Early Outdoor Activity on Preschoolers' Obesity

Incense burning is a significant source of indoor air pollution in many Asian regions. There is emerging evidence that maternal prenatal exposure to incense-burning smoke may be a risk factor for childhood obesity. We aimed to extend this new line of research by investigating the independent and joint effect of incense-burning smoke exposure, and children's outdoor activity in early life, on preschoolers' obesity. A total of 69,637 mother-child dyads were recruited from all kindergartens in the Longhua District of Shenzhen, China. Information on sociodemographic characteristics, maternal exposure to incense-burning smoke (IBS) during pregnancy, and frequency and duration of outdoor activity at the age of 1-3 years was collected by a self-administered questionnaire. In addition, the heights and weights of the children were measured by the research team. Logistic regression models and cross-over analyses were conducted to investigate the independent and combined effects of maternal exposure to incense-burning smoke during pregnancy and children's early outdoor activity on obesity in preschoolers. We found that prenatal exposure to incense-burning smoke increased the risk of the presence of obesity in preschoolers' (AOR = 1.13, 95% CI = 1.03-1.23). Additionally, lower frequencies (<3 times/week) or shorter durations (<60 min/time) of outdoor activity from the age of 1-3 years were significantly associated with the presence of obesity, with AORs of 1.24 (95% CI =1.18-1.32) and 1.11 (95% CI = 1.05-1.17), respectively. Furthermore, the cross-over analysis showed that prenatal exposure to IBS combined with a lower frequency of early outdoor activity (AOR = 1.47, 95% CI = 1.31-1.66) or a shorter duration of outdoor activity during ages of 1-3 years (AOR = 1.22, 95% CI = 1.07-1.39) increased the risk of obesity in preschoolers. Finally, additive interactions between prenatal exposure to IBS and postnatal outdoor activity on obesity were identified. Our study indicates that maternal exposure to incense-burning smoke during pregnancy and early lower postanal outdoor activity may independently and jointly increase the risk of obesity among preschoolers.

Single-Center Experience of Using Liraglutide in Adolescents With Obesity +/- Type 2 Diabetes

Background Childhood obesity is recognized as a chronic illness with limited therapeutic options. Tackling obesity (BMI; the weight in kilograms divided by the square of the height in meters, at the 95th percentile or higher) with lifestyle interventions, especially in adolescents, has proven to be a daunting task, yielding only modest results. Research on the use of liraglutide for weight reduction in pediatric patients has yielded conflicting results. Notably, there is a lack of studies in the Middle East reporting on the outcomes of glucagon-like peptide 1 (GLP-1) receptor agonists in treating obesity in children and adolescents, with or without diabetes. This study, conducted in the Middle East, represents the first investigation into the utilization of liraglutide for weight reduction in this pediatric population. Methods This retrospective study collected data on 22 consecutive participants, aged 12 to 19 years, who were diagnosed with obesity (defined as having a BMI greater than the 95th percentile for their age and sex) and had either type 2 diabetes mellitus (T2DM) or were non-diabetic who attended endocrine clinics in Sidra Medicine, Doha, Qatar, between 2020 and 2022. The study protocol involved a liraglutide treatment period spanning 18 months (72 weeks), with scheduled follow-up appointments at six-month intervals. The primary endpoints were changes in weight and BMI from baseline to the 72-week mark. Secondary endpoints were safety measures and changes in HbA1c.  Results Out of the initial cohort of 22 patients, 12 completed the full 72-week duration of the study, while 10 patients either discontinued treatment or did not adhere to the prescribed medication regimen due to side effects. Among the 12 patients who completed the study, six had a diagnosis of T2DM. At baseline, the weight, standard deviation score (SDS), BMI, and BMI standard deviation (SD) were 113.9 kg, 2.9, 40.9 kg/m2, and 2.6 respectively. At the 18-month follow-up, the weight, SDS, BMI, and BMI SD were 117.8kg, 2.6, 39kg/m2, and 2.5, respectively. Thus, no statistically significant change in the weight parameters was evident at 18 months compared to baseline. Dropout from the study and poor compliance were high (10 out of 22 patients) due to side effects, mainly gastrointestinal (nausea, abdominal pain, diarrhea, and vomiting). No statistically significant differences were observed between obese vs. obese with T2DM. No significant change in HbA1c was found between baseline and treatment follow-up in the diabetes patients. No adverse effects in terms of impairment of liver and kidney function or pancreatitis were observed. Conclusions The administration of liraglutide to adolescents with obesity, regardless of whether they had T2DM or not, in a real-life setting, did not yield statistically significant reductions in BMI/weight parameters, and HbA1c levels at the 72-week mark. Nevertheless, the study findings indicate that liraglutide is deemed safe for utilization within this age group, despite the presence of mild gastrointestinal side effects.

Rural Family Satisfaction With Telehealth Delivery of an Intervention for Pediatric Obesity and Associated Family Characteristics

Objective: To describe satisfaction with the telehealth aspect of a pediatric obesity intervention among families from multiple rural communities and assess differences in satisfaction based on sociodemographic factors. Methods: This is a secondary analysis of data from a pilot randomized controlled trial of a 6-month intensive lifestyle intervention (iAmHealthy) delivered through telehealth to children 6-11 years old with BMI ≥85th%ile and their parents from rural communities. Parents completed a sociodemographic survey and a validated survey to assess satisfaction with the telehealth intervention across four domains (technical functioning, comfort of patient and provider with technology and perceived privacy, timely and geographic access to care, and global satisfaction) on a 5-point Likert scale. Kruskal-Wallis nonparametric rank test were used to compare mean satisfaction scores based on parent sociodemographics. Results: Forty-two out of 52 parents (67% White, 29% Black, 5% multiracial, and 50% with household income <$40,000) completed the survey. Mean satisfaction scores ranged from 4.16 to 4.54 (standard deviation 0.44-0.61). Parents without a college degree reported higher satisfaction across all domains compared with parents with a college degree, including global satisfaction (mean 4.64 vs. 4.31, p = 0.03). Parents reporting a household income <$40,000 (mean 4.70) reported higher scores in the comfort with technology and perceived privacy domain compared with parents with higher incomes (mean 4.30-4.45, p = 0.04). Discussion: Parents from rural communities, especially those from lower socioeconomic backgrounds, were highly satisfied with the iAmHealthy telehealth intervention. These findings can be used to inform future telehealth interventions among larger more diverse populations. ClinicalTrials.gov Identifier: NCT04142034.

Lipid Profile, Eating Habit, and Physical Activity in Children with Down Syndrome: A Prospective Study

Children with Down Syndrome (DS) frequently undergo health challenges, including a higher prevalence of overweight and obesity. We aimed to evaluate the impact of dietary and physical advice provided by a specialized pediatrician over two years. In this prospective study, 44 children with DS, aged 2 to 17, underwent outpatient follow-up visits every six months between December 2020 and May 2023. Dietary habits, physical activities, anthropometric data, and laboratory results were recorded at baseline and 2-year follow-up. Adherence to the Mediterranean diet and physical activity were investigated using the 'KIDMED' and 'Godin-Shepard Leisure-Time' questionnaires, respectively, completed by the parents of the children. Venous blood samples were taken to determine the lipid profile. A significant reduction in BMI z-scores (p = 0.006) and an improvement in Godin-Shepard questionnaire scores (p = 0.0004) were observed. On the other hand, the lipid profile worsened, with an increase in LDL-c (p = 0.04) and a decrease in HDL-c (p = 0.03). Children with DS may benefit from an educational program on nutrition and physical activity to optimize weight control. Different interventions should target the lipid profile. Preventive intervention and follow-up by the pediatrician are essential for DS, which should continue into adulthood.

Effect of COVID-19 Pandemic Lockdowns on Body Mass Index of Primary School Children from Different Socioeconomic Backgrounds

BACKGROUND

Childhood obesity is associated with various health outcomes. Restrictive measures to contain the spread of the Coronavirus Disease 2019 (COVID-19) pandemic, like lockdowns and school closures, affected children's daily structure, physical activity, dietary habits, and sleep quality, possibly exacerbating risk factors for childhood obesity and higher body mass index (BMI) in children. Poor socioeconomic conditions may have led to relatively higher risk for elevated BMI levels following pandemic measures. In this study, the impact of measures related to the COVID-19 pandemic on the BMI of third graders was investigated regarding children's socioeconomic background (SEB).

METHODS

Data from 41,728 children (8.84 ± 0.56 years, 20,431 female) were collected in the context of a cohort study. Children were tested either before the pandemic (preCOVID: Sept2017-March2020, n = 26,314), or following the first (postLDI: Aug2020-Dec2020, n = 6657) or second lockdown in Germany (postLDII: Aug2021-Jan2022, n = 8757). SEB was based on the official school type classification of the state of Berlin. Outcome was BMI standard deviation scores (SDS).

RESULTS

Significant effects of Time and SEB revealed elevated BMIs in postLDI (M = 0.23, p = 0.011) and postLDII (M = 0.22, p = 0.011) compared to preCOVID (M = 0.17) cohorts and higher BMIs for children with lower SEB (b = - 0.13, p < 0.001). A significant Time × SEB interaction indicated that the effect of SEB on children's BMI increased in response to lockdowns, especially in postLDII (b = - 0.05, p = 0.006). Results suggest that the COVID-19-related measures lead to increased BMI in children, and that children of lower SEB were at particular risk for higher BMIs following lockdowns.

CONCLUSIONS

These findings highlight the dependency of children's BMI on societal circumstances. Over the course of two lockdowns in Germany, children have experienced BMI increments, particularly in low socioeconomic areas. Authorities are called into action to counteract increasing rates of childhood weight by promoting physical activity of children and establishing related post-pandemic offers.

The metabolic load-capacity model and cardiometabolic health in children and youth with obesity

BACKGROUND

The metabolic load-capacity index (LCI), which represents the ratio of adipose to skeletal muscle tissue-containing compartments, is potentially associated with cardiometabolic diseases.

OBJECTIVES

To examine the associations between the LCI and cardiometabolic risk factors in children and youth with obesity.

METHODS

This is a cross-sectional study including 10-18 years-old participants with a BMI of ≥95th . LCI by air-displacement plethysmography (ADP) was calculated as fat mass divided by fat-free mass, and LCI by ultrasound (US) as subcutaneous adipose tissue divided by skeletal muscle thickness. Sex-specific medians stratified participants into high versus low LCI. Single (inflammation, insulin resistance, dyslipidemia and hypertension) and clustered cardiometabolic risk factors were evaluated. Linear and logistic regression models tested the associations between these variables, adjusted for sexual maturation.

RESULTS

Thirty-nine participants (43.6% males; 59% mid-late puberty) aged 12.5 (IQR: 11.1-13.5) years were included. LCI by ADP was positively associated with markers of inflammation and dyslipidemia; having a higher LCI predicted dyslipidemia in logistic regression. Similarly, LCI by US was positively associated with markers of dyslipidemia and blood pressure. In mid-late pubertal participants, LCI by US was positively associated with markers of insulin resistance and inflammation.

CONCLUSIONS

Participants with unfavourable cardiometabolic profile had higher LCI, suggesting its potential use for predicting and monitoring cardiometabolic health in clinical settings.

Effectiveness of a school-based behavioural change intervention in reducing chronic disease risk factors in Chandigarh, India: a cluster-randomised controlled trial

Background

Early behavioural risk factors such as unbalanced diets, physical inactivity and tobacco and alcohol consumption lead to chronic diseases in later life. We conducted a cluster-randomised controlled trial to measure the effect of a school-based health-promotion intervention in reducing the behavioural risk factors of chronic diseases.

Methods

Twelve public schools in the Chandigarh, India were randomised to the intervention and control arm. Adolescents studying in eighth grade (n = 453), their parents (n = 395) and teachers (n = 94) were recruited for the current study. The Precede-Proceed Model was followed for intervention development. Intervention in each cluster comprised of one classroom session, four physical activity (PA) sessions every week for adolescents and four separate sessions for parents and teachers. Primary outcomes were eight binary or continuous measures of behavioural risk factors among adolescents (n = 359). Physical Activity Questionnaire-Adolescents (PAQ-A) scores were used to estimate physical activity. The ANCOVA based on cluster proportions or means was used to estimate the intervention effect accounting for baseline data.

Findings

Among adolescents, the intervention reduced salt intake by 0.5 g/d (95% CI: -0.9, -0.1), proportion of current alcohol users by 5% (95% CI: -9, -0.007), and increased fruit consumption by 18 g/d (95% CI: 5, 30) and PA by 0.2 PAQ-A score (95% CI: 0.07, 0.3). However, the intervention had no effect on the sugar and vegetable intake and on smokers and tobacco chewers. Exploratory analysis revealed that among parents, PA increased by 205 metabolic equivalents task (MET) units (95% CI: 74.5, 336), fruits intake by 20 g/d (95% CI: 6, 34), and vegetable intake by 117 g/d (95% CI: 50.5, 183). Whereas salt consumption decreased by 0.5 g/d (95% CI: 0.15, 0.9) and the proportion of current alcohol users declined by 5% (95% CI: 9, -1) among parents. Vegetable consumption increased by 149 g/d (95% CI: 12, 286) among teachers.

Interpretation

The intervention package implemented among adolescents by involving parents and teachers is an effective model for school-based behaviour-change interventions.

Funding

MK received partial funding from the George Institute for Global Health, Hyderabad, India for the salt-reduction component of the study.

An Increase in Food Insecurity Correlated with an Increase in Plasma Triglycerides among Latinx Children

BACKGROUND

Food insecurity and metabolic diseases both disproportionately affect Hispanic children. Cross-sectional studies have linked food insecurity with adverse cardiometabolic markers, including elevated plasma triglycerides and glucose concentrations. However, the association between changes in food insecurity and changes in cardiometabolic markers in children remains to be explored. Furthermore, few studies have assessed the impact of school-based nutrition interventions on household food insecurity.

OBJECTIVE

The objectives of this study are to assess the effect of the TX Sprouts intervention on household food insecurity and to examine the association between changes in household food insecurity and changes in cardiometabolic markers over 1 academic year.

METHODS

This secondary analysis used data from TX Sprouts, a cluster-randomized school-based gardening, cooking, and nutrition trial. The study enrolled 3rd-5th-grade students from 16 schools that served primarily (>50%) Hispanic families with low income in Austin, TX. Participants (n = 619) provided household food insecurity data and fasting lipid panels at both baseline and postintervention, ∼9 mo following.

RESULTS

There was no intervention effect on household food insecurity. Independent of the intervention, a 1-point increase in food insecurity, indicative of becoming more food insecure, was associated with a 2.61 mg/dL increase in triglycerides (P = 0.001; 95% CI: 1.04, 4.19) at follow-up. Children who were food insecure at baseline and became food secure at follow-up had a mean 5.05 mg/dL decrease in triglycerides compared with a 7.50 mg/dL increase in triglycerides in children who remained food insecure throughout (95% CI: -23.40, -1.71, P = 0.023). There were no other associations between changes in food insecurity and cardiometabolic markers.

CONCLUSION

Although the intervention did not improve food insecurity, reductions in food insecurity over 9 mo were associated with improved cardiometabolic markers in high-risk children, emphasizing the need for interventions targeting food insecurity. The study is registered at clinicaltrials.gov under NCT02668744 (https://classic.

CLINICALTRIALS

gov/ct2/show/NCT02668744).

The Future for the Children of Tomorrow: Avoiding Salt in the First 1000 Days

It is widely known that optimal nutrition in the first 1000 days of life positively impacts the child's development throughout adulthood. In this setting, salt should not be added to complementary feeding. In developed countries, salt intake is generally higher than recommended for children. Excessive salt intake is the major determinant of hypertension and is associated with several cardiovascular outcomes. Therefore, pediatricians have a key role in raising awareness among parents to avoid salt consumption in the first 1000 days of life to ensure better health for their children. Starting from a review of the literature published in PubMed/MedLine regarding the short- and long-term consequences of salt consumption during the first 1000 days of life, our comprehensive review aims to analyze the beneficial effects of avoiding salt at such a vulnerable stage of life as the first 1000 days. Obesity, hypertension, increased salt sensitivity, high sweet drink consumption, increased mortality, and morbidity persisting in adult age represent the principal consequences of a higher salt intake during the first 1000 days of life.

Distinguishing the impact of distinct obstructive sleep apnea syndrome (OSAS) and obesity related factors on human monocyte subsets

Obstructive sleep apnea syndrome (OSAS) and obesity go hand in hand in the majority of patients and both are associated with a systemic inflammation, immune disturbance and comorbidities such as cardiovascular disease. However, the unambiguous impact of OSAS and obesity on the individual inflammatory microenvironment and the immunological consequences of human monocytes has not been distinguished yet. Therefore, aim of this study was to investigate the impact of OSAS and obesity related factors on the inflammatory microenvironment by performing flow cytometric whole blood measurements of CD14/CD16 monocyte subsets in normal weight OSAS patients, patients with obesity but without OSAS, and patients with OSAS and obesity, compared to healthy donors. Moreover, explicitly OSAS and obesity related plasma levels of inflammatory mediators adiponectin, leptin, lipocalin and metalloproteinase-9 were determined and the influence of different OSAS and obesity related factors on cytokine secretion and expression of different adhesion molecules by THP-1 monocytes was analysed. Our data revealed a significant redistribution of circulating classical and intermediate monocytes in all three patient cohorts, but differential effects in terms of monocytic adhesion molecules CD11a, CD11b, CD11c, CX3CR1, CD29, CD49d, and plasma cytokine levels. These data were reflected by differential effects of OSAS and obesity related factors leptin, TNFα and hypoxia on THP-1 cytokine secretion patterns and expression of adhesion molecules CD11b and CD49d. In summary, our data revealed differential effects of OSAS and obesity, which underlines the need for a customized therapeutic regimen with respect to the individual weighting of these overlapping diseases.

Gene variants and the response to childhood obesity interventions: A systematic review and meta-analysis

BACKGROUND

Multiple lifestyle-based childhood obesity interventions have been conducted to address childhood obesity, but individual's response to the universal intervention approach varied greatly. Whether gene variants related to children and adolescents' varied responses to obesity interventions remained unclear.

AIMS

To determine the associations of gene variants with the changes in obesity- and metabolism-related indicators after obesity interventions in children and adolescents.

METHODS

Ten databases and registers (including grey literature) were searched. The lifestyle-based obesity interventions in children and adolescents (≤18 years) that reported the changes in obesity- (body mass index (BMI), BMI Z-score, waist circumference (WC), waist-to-hip ratio (WHR), etc) and metabolism-related (glucose, cholesterol, etc) indicators by genotype after interventions were included. Our primary outcome was the mean difference of the changes in BMI Z-score by genotype after interventions, and secondary outcomes were changes in the remaining obesity- and metabolism-related indicators after interventions. We used the random-effects model to synthesize the results.

RESULTS

This review included 50 studies (15,354 children and adolescents with overweight/obesity) covering 102 genes and 174 single nucleotide polymorphisms (SNPs). Approximately three-quarters of SNPs showed no evidence of association with the changes in obesity- or metabolic-related indicators after interventions. One quarter of SNPs were minorly associated with the changes in the BMI Z-score (median effect size: 0.001) with little clinical significance. Only 6 (12 %) studies focused on the accumulated effect of multiple gene variants.

CONCLUSIONS

Gene variants that have been explored appear to play a minor role in lifestyle-based obesity interventions in children and adolescents. More high-quality studies based on the design of randomized controlled trials are needed to examine the accumulated effect of multiple gene variants in childhood obesity interventions.

PROSPERO REGISTRY NUMBER

This systematic review and meta-analysis was registered at PROSPERO as CRD42022312177.

Extended brief interventions for weight management and obesity prevention in children: A rapid evidence review

Uptake of child weight management (CWM) support is typically low, and services are not available in all areas. Extended brief interventions (EBIs) have been proposed as an affordable way to provide enhanced support, at a level between one-off brief advice and intensive CWM programs. This rapid systematic review sought to synthesize evidence on the efficacy of EBIs for weight management and obesity prevention in children (2-18 years). Embase and Web of Science were searched from January 2012 to January 2022. Nineteen studies, reporting on 17 separate EBIs, were included. The quality of studies was variable, and the EBIs were heterogeneous. The majority of EBIs (n = 14) were based on motivational interviewing. Five of the included studies reported significant improvements in parent or child determinants of health behavior change. However, robust measures of behavioral determinants were rarely used. No studies reported significant positive effects on child weight. No clear patterns in outcomes were identified. There is currently insufficient evidence for EBIs to be adopted as part of CWM services. To improve the evidence base, EBIs that are currently being implemented by local health services, should be evaluated to establish the most effective content, how it should be delivered, and by whom.

"Paediatricians brace thyself" - Healthcare provider perspectives on childhood and adolescent hypertension: A qualitative study

Context

Paediatric and adolescent hypertension is becoming a public health concern as it contributes to the development of cardiovascular diseases. However, the problem largely remains undiagnosed. This makes early detection and institution of appropriate preventive measures difficult. The existing diagnostic guidelines and management policies for paediatric hypertension are complex. They have individual specific cut-offs (based on age, gender and height), making their interpretation difficult.

Aims

The present study aims to gain insights into paediatrician's perspectives on childhood hypertension.

Settings and Design

Qualitative Studies using Key Informant Interviews (KIIs) were conducted with paediatricians to know about their perspectives on blood pressure assessment in children and adolescents, its barriers, their experience, practices and expectations for main streaming hypertensive screening in national health programmes. The interviews were audio recorded after taking their consent.

Statistical Analysis Used

Grounded theory was used to analyse transcripts.

Results

A total of 40 providers within the public and private health sector were invited to participate; 36 consented and completed the interviews. There was a perception of increased prevalence of paediatric hypertension. Several system, provider and patient-level barriers, like unavailability of paediatric-sized cuffs, and complicated guidelines for interpreting blood pressure, prevented screening and accurate diagnosis.

Conclusions

Despite the lack of guidelines for screening, paediatricians still recommended lifestyle interventions. They expressed concerns about implementing standard guidelines for screening. They also expressed the need for a clinical assessment tool to assist in accurate diagnosis. They were willing to contribute to the development and implementation of training programme for health providers to overcome barriers to blood pressure measurement in children.

Effects of urinary tract infection during the first years of life in subsequent growth: a nationwide comparative matched cohort study

Background

Although various childhood illnesses are known to influence growth status, the impact of urinary tract infections (UTI) on subsequent childhood growth remains unclear. This study was conducted to examine the association between UTI during infancy and growth status at 30-36 months.

Methods

Nationwide population-based matched cohort study was done using data from the Korean National Health Insurance System (NHIS) and the Korean National Health Screening Program for Infants and Children (NHSPIC) between January 2018 and December 2020. Height and weight standard deviation scores (SDSs) at the fourth Korean NHSPIC conducted at 30-36 months were compared between children who experienced UTI during infancy and age- and sex-matched controls. We used weighted multiple linear regression analysis with inverse probability of treatment weighting (IPTW) and identified differences between the two groups using β coefficient with corresponding 95% confidence intervals (CIs).

Results

We analyzed 84,519 children diagnosed with UTI during infancy and 84,519 age- and sex-matched controls. The height SDS between children who experienced UTI and the control group was not statistically different (β coefficient for height SDS, -0.0034; 95% CI: -0.0121 to 0.0054). However, the body mass index (BMI) SDS was significantly higher in children who had experienced UTI (β coefficient for BMI SDS, 00426; 95% CI: 0.0304 to 0.0547). Subgroup and sensitivity analysis showed consistent results.

Conclusions

Our findings suggest that a history of UTI during infancy is associated with high BMI measured at 30-36 months.

Adipokines and Bacterial Metabolites: A Pivotal Molecular Bridge Linking Obesity and Gut Microbiota Dysbiosis to Target

Adipokines are essential mediators produced by adipose tissue and exert multiple biological functions. In particular, adiponectin, leptin, resistin, IL-6, MCP-1 and PAI-1 play specific roles in the crosstalk between adipose tissue and other organs involved in metabolic, immune and vascular health. During obesity, adipokine imbalance occurs and leads to a low-grade pro-inflammatory status, promoting insulin resistance-related diabetes and its vascular complications. A causal link between obesity and gut microbiota dysbiosis has been demonstrated. The deregulation of gut bacteria communities characterizing this dysbiosis influences the synthesis of bacterial substances including lipopolysaccharides and specific metabolites, generated via the degradation of dietary components, such as short-chain fatty acids, trimethylamine metabolized into trimethylamine-oxide in the liver and indole derivatives. Emerging evidence suggests that these bacterial metabolites modulate signaling pathways involved in adipokine production and action. This review summarizes the current knowledge about the molecular links between gut bacteria-derived metabolites and adipokine imbalance in obesity, and emphasizes their roles in key pathological mechanisms related to oxidative stress, inflammation, insulin resistance and vascular disorder. Given this interaction between adipokines and bacterial metabolites, the review highlights their relevance (i) as complementary clinical biomarkers to better explore the metabolic, inflammatory and vascular complications during obesity and gut microbiota dysbiosis, and (ii) as targets for new antioxidant, anti-inflammatory and prebiotic triple action strategies.

The complex relationship between obesity and neurodegenerative diseases: an updated review

Obesity is a global epidemic, affecting roughly 30% of the world's population and predicted to rise. This disease results from genetic, behavioral, societal, and environmental factors, leading to excessive fat accumulation, due to insufficient energy expenditure. The adipose tissue, once seen as a simple storage depot, is now recognized as a complex organ with various functions, including hormone regulation and modulation of metabolism, inflammation, and homeostasis. Obesity is associated with a low-grade inflammatory state and has been linked to neurodegenerative diseases like multiple sclerosis (MS), Alzheimer's (AD), and Parkinson's (PD). Mechanistically, reduced adipose expandability leads to hypertrophic adipocytes, triggering inflammation, insulin and leptin resistance, blood-brain barrier disruption, altered brain metabolism, neuronal inflammation, brain atrophy, and cognitive decline. Obesity impacts neurodegenerative disorders through shared underlying mechanisms, underscoring its potential as a modifiable risk factor for these diseases. Nevertheless, further research is needed to fully grasp the intricate connections between obesity and neurodegeneration. Collaborative efforts in this field hold promise for innovative strategies to address this complex relationship and develop effective prevention and treatment methods, which also includes specific diets and physical activities, ultimately improving quality of life and health.

Long-term effects of 12-month integrated weight-loss programme for children with excess body weight- who benefits most?

The aim of the study was to assess long-term effects of the 12-month integrated weight-loss programme in children with excess body weight. We also attempted to identify the determinants of intervention effectiveness. Two groups were included in the analysis: 241 children with excess body weight who participated in the full 12-month intervention (full participation group) and 891 children with excess body weight who did not participate in the intervention (no participation group). Changes in BMI SDS, SBP SDS, DBP SDS and post-exercise HR with a follow-up period of 4 years between this groups were compared. In the full participation group, the reduction in mean BMI SDS was greater, we also observed significantly higher decrease in DBP SDS. Subgroup analysis by age category and sex showed a significant difference in the change in mean BMI SDS (from baseline to follow-up) in the subgroup of younger children and in the subgroup of younger girls. In the subgroup of younger girls significantly higher decrease in DBP SDS and SBP was also observed. Younger children, who participated in the intervention at age 6, particularly girls, benefited the most.

Interventions to prevent obesity in Latinx children birth to 6 years globally: a systematic review

OBJECTIVE

To conduct a systematic review of obesity prevention interventions in Latinx children ages birth to 6 years published in any language from 2010-2020.

DESIGN

We used PubMed, ERIC, PsycINFO, Scopus, Scientific Electronic Library Online (SciELO) and Google Scholar databases to conduct a search on May 1 2020, January 1 2021 and November 1 2022. We included randomised controlled trials, quasi-experimental studies and non-randomised interventions with a control or comparison group that reported measures of adiposity.

SETTING

Interventions taking place in the United States, Latin America or the Caribbean.

PARTICIPANTS

Latinx children ages birth to 6 years.

RESULTS

Of 8601 unique records identified, forty manuscripts about thirty-nine unique studies describing thirty distinct interventions in the United States and nine interventions in Latin America and the Caribbean met our inclusion criteria. Interventions were primarily based in early care and education centres (n 13) or combined home settings, for example home and community (n 7). Randomised interventions taking place in community or home settings were more likely to report significant reductions in adiposity or weight-related outcomes compared to other settings. Using the Cochrane risk of bias tools for randomised and non-randomised studies, we judged thirty-eight randomised trials and nine non-randomised interventions to have a high or unclear risk of bias.

CONCLUSIONS

The results highlight a need for more rigorous designs and more effective intervention strategies in Latinx children at risk for having overweight and obesity. Registered with the PROSPERO database for systematic reviews under registration number CRD42020161339.

The Effectiveness of a Healthy Lifestyle in Obese Pediatric Patients: A Systematic Review and Meta-Analysis

Child and adolescent obesity represents a significant and escalating health concern in the United States. Notably, Hispanic adolescents face a higher prevalence of obesity and an increased risk of cardiovascular disease compared to their peers from different racial and ethnic backgrounds. This was obtained through systematic investigations in which different approaches were used. Therefore, obesity interventions of long duration, at least one year, and with a beginning phase intensive enough to produce significant early weight loss may be needed for adolescents with obesity. Surprisingly, despite this elevated risk, there is a glaring underrepresentation of Hispanics in obesity intervention studies aimed at youth. It is therefore imperative to develop interventions tailored specifically to overweight adolescents, with a particular focus on the Hispanic population. While researchers have addressed numerous interventions targeting adolescent obesity, many of these initiatives have demonstrated limited treatment efficacy, failed to achieve all desired treatment objectives, experienced high attrition rates, and encountered waning participant engagement. To evaluate the impact of adopting a healthy lifestyle among pediatric patients struggling with obesity, we undertook a comprehensive systematic review of the literature, and with the information obtained from the articles chosen, we will undergo a meta-analysis. Our review encompassed a 10-year span of published literature, drawing upon online databases including the Cochrane Library, PubMed, Web of Science, PubMed Central, and Google Scholar. Our review exclusively considered randomized controlled trials that focused on the effectiveness of various lifestyle modifications for pediatric patients grappling with obesity. We synthesized the pooled incidence, risk ratio, and associated 95% confidence intervals to gauge the efficacy of these interventions, employing the fixed-effect model to account for potential between-study variations rather than the random-effect model. After the calculation of each one of the studies selected, we could conclude that it gave good outcomes after the modification of lifestyle in these patients, giving a statistical significance and p-value in our three representative figures of <0.001.

Changes of anthropometric indicators of lithuanian first-graders in 2008-2019 according to International Obesity Task Force (IOTF) and World Health Organization (WHO) definitions

INTRODUCTION

The monitoring of children's growth plays a crucial role in assessing their growth patterns and indicating their weight status. Overweight and obesity, determined by cut-offs of body mass index (BMI), are most commonly associated with unhealthy nutrition, non-communicable diseases, and other health disorders. The World Health Organization (WHO) initiated the WHO European Childhood Obesity Surveillance Initiative (COSI) to measure routinely trends in children's anthropometric changes, which allow intercountry comparisons within the European Region. Lithuania joined the COSI initiative. Our study aims to evaluate and compare underweight, normal and elevated weight (overweight and obesity) changes of Lithuanian first-graders during eleven years period.

METHODS

This study was composed according to the COSI study protocol, and it compares the five rounds of anthropometric measurements of Lithuanian first-graders (7-8-year-old) from 2008 to 2019. The main analysed variables were weight and height; calculated BMI, weight-for-age (W/A), height-for-age (H/A) and body mass index-for-age (BMI/A) z-scores. Changes of the indicators were evaluated according to the International Obesity Task Force (IOTF) cut-offs and WHO child growth standards, grouped by 4 estimates: underweight (thinness), normal weight, overweight and obesity. All comparisons were performed between age groups, gender and COSI round year.

RESULTS

The mean values for weight, height, W/A and H/A Z-scores were significantly higher for both age and gender groups when comparing later COSI round years (2016 or 2019) to earlier years (2008-2013, in some cases 2016 is included in this range). Time trends of the WHO growth standards and IOTF cut-offs indicate significant decrease among 7-year-old overweight group for boys and girls. Also, a significant decrease was indicated among boys aged 8 years in the overweight group according to the WHO definitions. The only significant increase in trend were expressed in girl's group with obesity aged 8 years according to IOTF cut-offs.

CONCLUSION

The prevalence of overweight and obesity of first-grade children in Lithuania indicates positive changes, that is the proportion of children with elevated body weight decreased, during eleven-year period. However, it is important to continue the monitoring of children's growth tendencies.

Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group

There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.