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Ijaiya MA, Anjorin S, Uthman OA. Individual and contextual factors associated with childhood malnutrition: a multilevel analysis of the double burden of childhood malnutrition in 27 countries. Glob Health Res Policy 2022; 7:44. [PMID: 36419186 PMCID: PMC9686063 DOI: 10.1186/s41256-022-00276-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/30/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Malnutrition is a key global health challenge and a major contributor to childhood morbidity and mortality. In recent times, the contrasting coexistence of undernutrition including micronutrient deficiencies and overweight/obesity called double burden of malnutrition has been noted at individual, household or population level and/or at different times in life. The objective of this study was to examine individual, neighborhood and country level factors that are associated with the double burden of childhood malnutrition. METHODS We conducted multivariable multilevel logistic regression analyses on the most recent demographic and health datasets from surveys conducted between 2015 and 2020 in low- and middle-income countries. We analyzed data of 138,782 children (level 1) living in 13,788 communities (level 2) from 27 countries (level 3). RESULTS The results of our analysis show variation in childhood malnutrition across the 27 countries from as low as 6.5% in Burundi to as high as 29.5% in Timor Leste. After adjusting for all level factors, we found that those who were wasted/overweight tended to have had an episode of diarrhea or fever in the last two weeks preceding the survey, were part of a multiple birth, were being breastfed at the time of the survey and born to mothers with more than one under 5-child resident in neighborhoods with high illiteracy and unemployment rates. The intra-neighbourhood and intra-country correlation coefficients were estimated using the intercept component variance; 44.3% and 21.0% of variance in odds of double burden of childhood malnutrition are consequent upon neighborhood and country level factors respectively. CONCLUSIONS Evidence of geographical clustering in childhood malnutrition at community and country levels was found in our study with variability due to neighborhood level factors twice that of country level factors. Therefore, strategies in tackling the double burden of malnutrition must consider these shared drivers, contextual barriers and geographical clustering effects.
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Affiliation(s)
- Mukhtar A. Ijaiya
- Jhpiego, Plot 971, Rueben Okoya Crescent, Off Okonjo Iweala Street, Wuye District, Abuja, FCT Nigeria
| | - Seun Anjorin
- Division of Health Sciences, Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Olalekan A. Uthman
- Division of Health Sciences, Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
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Social determinants of malnutrition in Chilean children aged up to five. BMC Public Health 2022; 22:44. [PMID: 34996396 PMCID: PMC8740415 DOI: 10.1186/s12889-021-12455-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to ascertain the Social Determinants (SDs) of malnutrition (over and undernutrition) of Chilean children aged up to five. Methods The study was carried out using a sample of children from zero to five years old (n = 1,270,485; 52.2% female) from the National Socioeconomic Characterization Survey (CASEN) 2017. A multinomial logistic regression model was used, where the “child nutritional status” outcome variable assumed three possible values: normal nutrition, overnutrition, and undernutrition, while taking those variables reported in previous literature as independent variables. Results The model, by default, set normal nutrition as the reference group, Count R2 = 0.81. Results show a higher likelihood of both overnutrition and undernutrition among male children from the lowest quintiles, with native ethnic backgrounds, reporting health problems, having public health insurance, and who attend kindergarten. Additionally, higher probabilities of undernutrition in younger than two and living in the north of the country, while overnutrition is more likely in the south. Conclusions Socioeconomic variables are fundamentally related to both over and undernutrition; the current single schema program to prevent malnutrition should consider SDs such as ethnicity and geographical location, among others; moreover, successful nutritional programs—which focused on the lowest quintiles, need to be expanded to other vulnerable groups and pay more attention to overnutrition.
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Øvrebø B, Bergh IH, Stea TH, Bere E, Surén P, Magnus PM, Juliusson PB, Wills AK. Overweight, obesity, and thinness among a nationally representative sample of Norwegian adolescents and changes from childhood: Associations with sex, region, and population density. PLoS One 2021; 16:e0255699. [PMID: 34343207 PMCID: PMC8330951 DOI: 10.1371/journal.pone.0255699] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/22/2021] [Indexed: 01/12/2023] Open
Abstract
Objective To estimate the prevalence of overweight, obesity, and thinness among Norwegian 13-year-olds and the changes from childhood (age 8 years) to adolescence (age 13 years); and to explore associations with sex, region, and population density from childhood to adolescence. Design We used longitudinal, anthropometric data collected by school health nurses conducted in Norway. Weight status was classified according to the International Obesity Task Force cut-offs for overweight, obesity, and thinness, and according to mean body mass index (kg/m2). Participants The Norwegian Youth Growth Study, consisting of a nationally representative sample of Norwegian 13-year-olds (n = 1852; 50.7% girls), which is a part of The Norwegian Growth Cohort. Results Among 13-year-old Norwegians, the prevalence of overweight (including obesity), obesity, and thinness was 15.8%, 2.5%, and 7.3%, respectively. There was little evidence that these had changed from 8 to 13 years. From 8 to 13 years, the odds of obesity was highest in the Northern region of Norway compared to the South-East (odds ratio (OR): 3.78 (95% confidence interval (CI): 1.13, 12.65; p = 0.036) and in rural areas (OR: 4.76 (95% CI: 1.52, 14.90; p = 0.027). Over the same age period, girls had a trend towards a higher odds of thinness compared to boys (OR: 1.65 (95% CI: 0.98, 2.78; p = 0.057). Conclusions In Norway, the prevalence of overweight, obesity, and thinness among 13-year-olds seem to be established by age 8 years. The prevalence of obesity was higher in the North and in rural areas. The results indicate the continued need for early prevention and treatment, and targeted interventions to certain areas.
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Affiliation(s)
- Bente Øvrebø
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
- * E-mail:
| | - Ingunn H. Bergh
- Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
| | - Tonje H. Stea
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway
| | - Elling Bere
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Surén
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Per M. Magnus
- Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Petur B. Juliusson
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
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Donkor HM, Toxe H, Hurum J, Bjerknes R, Eide GE, Juliusson P, Markestad T. Psychological health in preschool children with underweight, overweight or obesity: a regional cohort study. BMJ Paediatr Open 2021; 5:e000881. [PMID: 33817347 PMCID: PMC7970241 DOI: 10.1136/bmjpo-2020-000881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine if underweight (UW), overweight (OW) or obesity (OB), or body mass index (BMI) expressed as its SD score (BMI SDS), were associated with psychological difficulties in preschool children. DESIGN Regional cohort study. SETTING Oppland County, Norway. METHODS At the routine school entry health assessment at 5-6 years of age, parents were invited to participate by local public health nurses. The parents completed questionnaires on sociodemographic, health and lifestyle factors of the child and the family, and on the child's neurocognitive development. They assessed psychological health with the Strengths and Difficulties Questionnaire (SDQ). Public health nurses measured weight and height on all eligible children and reported age, sex, height and weight anonymously for the children who declined to participate. PARTICIPANTS We obtained information on 1088 of 1895 (57%) eligible children. The proportion of UW, OW and OB was slightly higher among the children who declined. MAIN OUTCOME MEASURES SDQ subscale and Total Difficulties Scores. RESULTS The mean SDQ scores and proportion of scores ≥the 90th percentile had a curvilinear pattern from UW through normal weight (NW), OW and OB with NW as nadir, but the pattern was only significant for the mean Emotional problems, Peer problems and Total SDQ Scales, and for the Total SDQ Score ≥the 90th percentile (TDS90). After adjusting for relevant social, developmental, health and behavioural characteristics, TDS90 was only significantly associated with UW in multiple logistic regression analyses, and only with the lowest quartile of BMI SDS in a linear spline regression analysis. CONCLUSIONS The study suggests that UW and low BMI, but not OW, OB or higher BMI, are independent risk factors for having psychological symptoms in preschool children.
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Affiliation(s)
- Hilde Mjell Donkor
- Department of Paediatrics, Sykehuset Innlandet HF Divisjon Lillehammer, Lillehammer, Norway
| | - Helene Toxe
- Clinic of Child and Adolescent Psychiatry, Otta, Sykehuset Innlandet HF Psykisk Helsevern, Brumunddal, Norway
| | - Jørgen Hurum
- Department of Paediatrics, Sykehuset Innlandet HF Divisjon Lillehammer, Lillehammer, Norway
| | - Robert Bjerknes
- Department of Clincal Science, Universitetet i Bergen Det Medisinske Fakultet, Bergen, Norway
| | - Geir Egil Eide
- Department of Public Health and Primary Health Care, Universitetet i Bergen Det Medisinske Fakultet, Bergen, Norway
| | - Petur Juliusson
- Department of Clincal Science, Universitetet i Bergen Det Medisinske Fakultet, Bergen, Norway.,Department of Paediatrics and Adolescent Medicine, Haukeland Universitetssjukehus, Bergen, Norway
| | - Trond Markestad
- Department of Clincal Science, Universitetet i Bergen Det Medisinske Fakultet, Bergen, Norway.,Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
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A Meta-Analysis of the Association Between Breastfeeding and Early Childhood Obesity. J Pediatr Nurs 2020; 53:57-66. [PMID: 32464422 DOI: 10.1016/j.pedn.2020.04.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/11/2023]
Abstract
PROBLEM Several studies have indicated a protective effect of breastfeeding on reducing the risk of childhood obesity, however, this remains controversial. The aim of this meta-analysis is to clarify the association between breastfeeding and the risk of preschoolers' obesity. ELIGIBILITY CRITERIA Prospective cohort studies published prior to December 1, 2019 were systematically searched in PubMed, EMBASE, the Web of Science and the Cochrane Library databases. Meta-analysis was performed using Stata 15.1. SAMPLE Twenty-six publications involving 332,297 participants were eligible for inclusion. RESULTS The pooled odds ratio (OR) of the risk of obesity in ever-breastfed preschoolers was 0.83 (95%CI [0.73,0.94]) compared with their never-breastfed counterparts. Random-effects dose-response model revealed a negative correlation between the duration of breastfeeding and risk of obesity (regression coefficient = -0.032, p = .001). Categorical analysis confirmed this dose-response association (1 day to <3 months of breastfeeding: OR = 1.07, 95%CI [0.94,1.21]; 3 months to <6 months: OR = 0.96, 95%CI [0.60,1.54]; ≥6 months: OR = 0.67, 95%CI [0.58,0.77]). One month of breastfeeding was associated with a 4.0% decrease in risk of obesity (OR = 0.96/month of breastfeeding, 95% CI [0.95, 0.97]). Under the reference of never breastfeeding, the summary OR of exclusive breastfeeding was 0.53 (95%CI [0.45,0.63]). CONCLUSIONS Breastfeeding is inversely associated with a risk of early obesity in children aged two to six years. Moreover, there is a dose-response effect between duration of breastfeeding and reduced risk of early childhood obesity. IMPLICATIONS Clinical nurses' guidance and advice that prolong the duration of breastfeeding and promote exclusive breastfeeding are needed to prevent the development of later childhood obesity.
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Donkor HM, Grundt JH, Júlíusson PB, Eide GE, Hurum J, Bjerknes R, Markestad T. A family-oriented intervention programme to curtail obesity from five years of age had no effect over no intervention. Acta Paediatr 2020; 109:1243-1251. [PMID: 31677296 DOI: 10.1111/apa.15080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/01/2019] [Accepted: 10/31/2019] [Indexed: 02/01/2023]
Abstract
AIM To examine the effect of a family-oriented multidisciplinary intervention programme to curtail weight increase in young children with obesity. METHODS Children who weighed more than one kilogram above the 97th percentile for height at the preschool assessment in Oppland County, Norway, were identified. Parents residing in one part of the county were invited to participate in a group-based three-year intervention programme while the rest had no interventions. Body mass index (BMI) and family characteristics at entry and measurements at birth were explanatory variables, and change in BMI standard deviation score (SDS) the outcome measure. For the intervention group, outcome was also related to skinfold thicknesses, waist-to-height ratio and physical ability. RESULTS The programme was completed by 31 families in the intervention and 33 in the control group. At entry, the respective median (interquartile) age was 5.83 (0.36) and 5.74 (0.66) years, and the BMI SDS 2.35 (1.06) and 1.95 (0.49), P = .012. The median decrease in BMI SDS was 0.19 in both groups. The decline increased with increasing BMI SDS at entry, but irrespective of group. Social or behavioural factor or other anthropometric measures were not associated with outcome. CONCLUSION The intervention programme had no effect on BMI SDS.
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Affiliation(s)
| | | | | | - Geir Egil Eide
- Centre for Clinical Research Haukeland University Hospital Bergen Norway
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
| | - Jørgen Hurum
- Department of Paediatrics Innlandet Hospital Trust Lillehammer Norway
| | - Robert Bjerknes
- Department of Clinical Science Faculty of Medicine University of Bergen Bergen Norway
| | - Trond Markestad
- Department of Clinical Science Faculty of Medicine University of Bergen Bergen Norway
- Department of Research Innlandet Hospital Trust Brumunddal Norway
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Kalloo G, Wellenius GA, McCandless L, Calafat AM, Sjodin A, Romano ME, Karagas MR, Chen A, Yolton K, Lanphear BP, Braun JM. Exposures to chemical mixtures during pregnancy and neonatal outcomes: The HOME study. ENVIRONMENT INTERNATIONAL 2020; 134:105219. [PMID: 31726361 DOI: 10.1016/j.envint.2019.105219] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Exposure to mixtures of environmental chemicals are prevalent among pregnant women and may be associated with altered fetal growth and gestational age. To date, most research regarding environmental chemicals and neonatal outcomes has focused on the effect of individual agents. METHODS In a prospective cohort of 380 pregnant women from Cincinnati, OH (enrolled 2003-2006), we used biomarkers to estimate exposure to 43 phenols, phthalates, metals, organophosphate/pyrethroid/organochlorine pesticides, polychlorinated biphenyls, polybrominated diphenyl ethers, perfluoroalkyl substances (PFAS), and environmental tobacco smoke. Using three approaches, we estimated covariate-adjusted associations of chemical mixtures or individual chemicals with gestational-age-specific birth weight z-scores, birth length, head circumference, and gestational age: k-means clustering, principal components (PC), and one-chemical-at-a-time regression. RESULTS We identified three chemical mixture profiles using k-means clustering. Women in cluster 1 had higher concentrations of most phenols, three phthalate metabolites, several metals, organophosphate/organochlorine pesticides, polychlorinated biphenyls, and several PFAS than women in clusters 2 and 3. On average, infants born to women in clusters 1 (-1.2 cm; 95% CI: -1.9, -0.5) and 2 (-0.5 cm; 95% CI: -1.1, 0.1) had lower birth length than infants in cluster 3. Six PCs explained 50% of the variance in biomarker concentrations and biomarkers with similar chemical structures or from shared commercial/industrial settings loaded onto commons PCs. Each standard deviation increase in PC 1 (organochlorine pesticides, some phenols) and PC 6 (cadmium, bisphenol A) was associated with 0.2 cm (95% CI: -0.4, 0.0) and 0.1 cm (95% CI: -0.4, 0.1) lower birth length, respectively. Organochlorine compounds, parabens, and cadmium were inversely associated with birth length in the one-chemical-at-a-time analysis. Cluster membership, PC scores, and individual chemicals were not associated with other birth outcomes. CONCLUSION All three methods of characterizing multiple chemical exposures in this cohort identified inverse associations of select organochlorine compounds, phenols, and cadmium with birth length, but not other neonatal outcomes.
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Affiliation(s)
- Geetika Kalloo
- Department of Epidemiology, Brown University, Providence, RI, USA.
| | | | | | | | - Andreas Sjodin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Megan E Romano
- Department of Epidemiology, Dartmouth College, Hanover, NH, USA
| | | | - Aimin Chen
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; Child and Family Research Institute, BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
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O'Connor TG, Williams J, Blair C, Gatzke-Kopp LM, Francis L, Willoughby MT. Predictors of Developmental Patterns of Obesity in Young Children. Front Pediatr 2020; 8:109. [PMID: 32266187 PMCID: PMC7105829 DOI: 10.3389/fped.2020.00109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/03/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction: The current study characterizes longitudinal patterns in obesity in young children and their prediction from developmental programming and social determinant hypotheses. Materials and Methods: The data are based on the Family Life Project, a prospective longitudinal study of 1,292 families recruited from low-income, racially diverse, rural communities in Pennsylvania, and North Carolina. Pre-natal, peri-natal, and post-natal risks for childhood obesity were collected from 2 months of age; in-person assessments of child growth were used to identity obesity on multiple occasions from 24 to 90 months of age. Results: Two major novel findings emerged. First, longitudinal analyses identified four distinct obesity development profiles: stable obesity, later-onset obesity, moderate/declining obesity, and non-obese; these groups had distinct risk profiles. Second, prediction analyses favored developmental programming explanations for obesity, including evidence even in early childhood that both low- and high birth weight was associated with stable obesity. There was no indication that pre- and peri-natal and post-natal factors predicted obesity differently in non-minority and minority children. Discussion: Factors derived from the developmental programming model of obesity overlapped with, but predicted early onset obesity independently from, risks associated with social determinant models of obesity.
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Affiliation(s)
- Thomas G O'Connor
- Department of Psychiatry, University of Rochester, Rochester, NY, United States.,Department of Psychology, University of Rochester, Rochester, NY, United States.,Department of Neuroscience, University of Rochester, Rochester, NY, United States.,Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, United States.,Wynne Center for Family Research, University of Rochester, Rochester, NY, United States
| | - Jason Williams
- RTI International, Research Triangle Park, Durham, NC, United States
| | - Clancy Blair
- Department of Population Health, New York University, New York, NY, United States
| | - Lisa M Gatzke-Kopp
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, United States
| | - Lori Francis
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, United States
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Bjertnæs AA, Grundt JH, Donkor HM, Juliusson PB, Wentzel‐Larsen T, Vaktskjold A, Markestad T, Holten‐Andersen MN. No significant associations between breastfeeding practices and overweight in 8-year-old children. Acta Paediatr 2020; 109:109-114. [PMID: 31299109 DOI: 10.1111/apa.14937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 06/25/2019] [Accepted: 07/09/2019] [Indexed: 12/29/2022]
Abstract
AIM The aim was to examine if breastfeeding practices were associated with body mass index (BMI) and risk of overweight or obesity in third grade (8 years) of elementary school. METHODS In a regional cohort, we related BMI z-scores and presence of overweight or obesity at 8 years of age with ever being breastfed and with duration of exclusive and partial breastfeeding after adjusting for potential confounders. Parents completed questionnaires on breastfeeding and sociodemographic and lifestyle factors at school entry, and public health nurses measured height and weight. For non-participants, the nurses anonymously reported these measurements together with sex and age. RESULTS 90% of participants had been breastfed. In adjusted analyses, BMI z-scores were not significantly related to whether or not the child had been breastfed (P = .64), or to the duration of exclusive (P = .80) or partial breastfeeding (P = .94). Logistic regression also showed no significant association between breastfeeding measures and overweight or obesity. CONCLUSION This study on 8-year-old Norwegian children did not support a commonly held notion that breastfeeding reduces the risk of overweight or obesity.
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Affiliation(s)
- Asborg A. Bjertnæs
- Department of Paediatrics Innlandet Hospital Trust Lillehammer Norway
- Department of Clinical Medicine University of Oslo Norway
| | - Jacob H. Grundt
- Department of Paediatrics Oslo University Hospital Oslo Norway
| | - Hilde M. Donkor
- Department of Paediatrics Innlandet Hospital Trust Lillehammer Norway
| | - Petur B. Juliusson
- Department of Health Registries Norwegian Institute of Public Health Norway
- Department of Clinical Science University of Bergen Bergen Norway
- Department of Paediatrics Haukeland University Hospital Bergen Norway
| | - Tore Wentzel‐Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies Oslo Norway
- Regional Centre for Child and Adolescent Mental Health Eastern and Southern Norway Oslo Norway
| | - Arild Vaktskjold
- Department of Research Innlandet Hospital Trust Brumunddal Norway
- Department of Public Health Science Inland Norway University Elverum Norway
| | - Trond Markestad
- Department of Research Innlandet Hospital Trust Brumunddal Norway
| | - Mads N. Holten‐Andersen
- Department of Paediatrics Innlandet Hospital Trust Lillehammer Norway
- Department of Clinical Medicine University of Oslo Norway
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10
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Fernández M, Pereira A, Corvalán C, Mericq V. Precocious pubertal events in Chilean children: ethnic disparities. J Endocrinol Invest 2019; 42:385-395. [PMID: 30047066 DOI: 10.1007/s40618-018-0927-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 07/18/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Puberty onset exhibits remarkable inter-individual and ethnic differences. 5% of Chileans are indigenous but puberty ethnic disparities have not been studied. We aim for evaluating precocious puberty prevalence in children with Mapuche ancestry vs non-indigenous Chilean children (according to their surnames). METHODS Longitudinal cohort study: 1003 children (50.2% girls) participating in the Growth and Obesity Chilean Cohort Study (GOCS) were studied. Annual anthropometry was measured since 4-7 years. Subsequently, Tanner staging and anthropometry were measured every 6 months. In girls, Tanner stage was assessed by breast palpation and in boys by testicular volume measurements. The cohort was stratified in three groups depending on Mapuche surname numbers as follows: (A) no indigenous surnames (n = 811), (B) one to two indigenous surnames (n = 147), and (C) three or more indigenous surnames (n = 45). We evaluated the prevalence of precocious thelarche, pubarche, menarche and gonadarche (testicular volume ≥ 4 ml-G2), using a cutoff age of 8 years in girls and 9 years in boys while controlling for socioeconomic status, body mass index, waist circumference, IGF-1 and DHEAS at 7 years. RESULTS In girls, no significant differences were observed. On the contrary, in boys, precocious gonadarche prevalence was higher in group C (29.2%) vs group A (6.0%) and vs group B (10.5%) (p =0.001, p = 0.004, respectively). Increased precocious gonadarche and pubarche risks in group C were observed even after adjustment [OR 7.31; 95% IC (2.32-23.51); p = 0.001] and [OR 6.17, 95% CI (1.62-23.49); p = 0.008], respectively. CONCLUSION Indigenous origin in Chile is an independent risk factor for precocious gonadarche and pubarche in boys but not in girls.
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Affiliation(s)
- M Fernández
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2a Piso, PO Box 226-3, Santiago, Chile
| | - A Pereira
- Institute of Nutrition and Food Technology (INTA), Faculty of Medicine, University of Chile, Santiago, Chile
| | - C Corvalán
- Institute of Nutrition and Food Technology (INTA), Faculty of Medicine, University of Chile, Santiago, Chile
| | - V Mericq
- Institute of Maternal and Child Research (IDIMI), Faculty of Medicine, University of Chile, Santa Rosa 1234, 2a Piso, PO Box 226-3, Santiago, Chile.
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Moreira C, Meira-Machado L, Fonseca MJ, Santos AC. A Multistate Model for Analyzing Transitions Between Body Mass Index Categories During Childhood: The Generation XXI Birth Cohort Study. Am J Epidemiol 2019; 188:305-313. [PMID: 30312367 DOI: 10.1093/aje/kwy232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022] Open
Abstract
Prevalences of overweight and obesity in young children have risen dramatically in the last several decades in most developed countries. Childhood overweight and obesity are known to have immediate and long-term health consequences and are now recognized as important public health concerns. We used a Markov 4-state model with states defined by 4 body mass index (BMI; weight (kg)/height (m)2) categories (underweight (<-2 standard deviations (SDs) of BMI z score), normal weight (-2 ≤ SD ≤ 1), overweight (1 < SD ≤ 2), and obese (>2 SDs of BMI z score)) to study the rates of transition to higher or lower BMI categories among children aged 4-10 years. We also used this model to study the relationships between explanatory variables and their transition rates. The participants consisted of 4,887 children from the Generation XXI Birth Cohort Study (Porto, Portugal; 2005-2017) who underwent anthropometric evaluation at age 4 years and in at least 1 of the subsequent follow-up waves (ages 7 and 10 years). Children who were normal weight were more likely to move to higher BMI categories than to lower categories, whereas overweight children had similar rates of transition to the 2 adjacent categories. We evaluated the associations of maternal age and education, type of delivery, sex, and birth weight with childhood overweight and obesity, but we observed statistically significant results only for sex and maternal education with regard to the progressive transitions.
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Affiliation(s)
| | - Luís Meira-Machado
- Centre for Molecular and Environmental Biology, University of Minho, Braga, Portugal
- Department of Mathematics and Applications, School of Sciences, University of Minho, Guimarães, Portugal
| | | | - Ana Cristina Santos
- Unidade de Investigação em Epidemiologia
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Solmi M, Köhler CA, Stubbs B, Koyanagi A, Bortolato B, Monaco F, Vancampfort D, Machado MO, Maes M, Tzoulaki I, Firth J, Ioannidis JPA, Carvalho AF. Environmental risk factors and nonpharmacological and nonsurgical interventions for obesity: An umbrella review of meta-analyses of cohort studies and randomized controlled trials. Eur J Clin Invest 2018; 48:e12982. [PMID: 29923186 DOI: 10.1111/eci.12982] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Multiple environmental factors have been implicated in obesity, and multiple interventions, besides drugs and surgery, have been assessed in obese patients. Results are scattered across many studies and meta-analyses, and they often mix obese and overweight individuals. MATERIALS AND METHODS PubMed and Cochrane Database of Systematic Reviews were searched through 21 January 2017 for meta-analyses of cohort studies assessing environmental risk factors for obesity, and randomized controlled trials investigating nonpharmacological and nonsurgical therapeutic interventions for obesity. We excluded data on overweight participants. Evidence from observational studies was graded according to criteria that included the statistical significance of the random-effects summary estimate and of the largest study in a meta-analysis, the number of obesity cases, heterogeneity between studies, 95% prediction intervals, small-study effects and excess significance. The evidence of intervention studies for obesity was assessed with the GRADE framework. RESULTS Fifty-four articles met eligibility criteria, including 26 meta-analyses of environmental risk factors (166 studies) and 46 meta-analyses of nondrug, nonsurgical interventions (206 trials). In adults, the only risk factor with convincing evidence was depression, and childhood obesity, adolescent obesity, childhood abuse and short sleep duration had highly suggestive evidence. Infancy weight gain during the first year of life, depression and low maternal education had convincing evidence for association with paediatric obesity. All interventions had low or very-low-quality evidence with one exception of moderate-quality evidence for one comparison (no differences in efficacy between brief lifestyle primary care interventions and other interventions for paediatric obesity). Summary effect sizes were mostly small across compared interventions (maximum 5.1 kg in adults and 1.78 kg in children) and even these estimates may be inflated. CONCLUSIONS Depression, obesity in earlier age groups, short sleep duration, childhood abuse and low maternal education have the strongest support among proposed risk factors for obesity. Furthermore, there is no high-quality evidence to recommend treating obesity with a specific nonpharmacological and nonsurgical intervention among many available, and whatever benefits in terms of magnitude of weight loss appear small.
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Affiliation(s)
- Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Cristiano A Köhler
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Francesco Monaco
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.,University Psychiatric Centre, KU Leuven, University of Leuven, Leuven-Kortenberg, Belgium
| | - Myrela O Machado
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,IMPACT Strategic Research Center, Deakin University, Geelong, Vic., Australia
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,MRC-PHE Centre for Environment, School of Public Health, Imperial College London, London, UK.,Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Joseph Firth
- NICM, School of Science and Health, University of Western Sydney, Sydney, NSW, Australia.,Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - John P A Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.,Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California.,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California
| | - André F Carvalho
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
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Abstract
PURPOSE OF REVIEW Although childhood obesity has leveled off in the last decade, 'severe obesity' continues to be on the rise. Various genetic, environmental and hormonal factors contribute to obesity. This article reviews the most current understanding of obesity's multifactorial origin and recent recommendations for its management in childhood and adolescence. RECENT FINDINGS Epigenetics plays a key role in transmitting obesity risk to offspring. Single-nucleotide polymorphisms at genetic loci for adipokines and their receptors are associated with obesity. Gut microbiota is an important regulator of weight status, and Bifidobacterium species improves metabolic status. The incidence of comorbidities including prediabetes and type 2 diabetes has increased. Novel biomarkers such as alpha-hydroxybutyrate and branched-chain amino acids correlate with insulin sensitivity and predict glycemic control in adolescents. Lifestyle modifications and pharmacotherapy can produce small BMI changes. Bariatric surgery induces substantial weight loss and remission of comorbidities. SUMMARY Alterations in genetics, epigenetics and microbiota influence childhood obesity. Lifestyle modification remains the mainstay of management and pharmacotherapy with Food and Drug Administration approved medications is recommended only for patients resistant to lifestyle changes and for comorbidities. Bariatric surgery produces sustained weight loss and cardiovascular benefits and is an effective option for adolescents with severe obesity.
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Affiliation(s)
- Charumathi Baskaran
- Pediatric Endocrinology, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
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