Prevalence of overweight and obesity in adolescents: a systematic review

Physical activity habits and associated factors in open green spaces of young adults: A cross-sectional study

OBJECTIVES

This study was conducted to determine the relationship between green space usage habits and physical activity in young adults.

DESIGN

A cross-sectional and correlational design.

SAMPLE

The study was conducted with 455 young adults who were studying at a faculty between February and May 2023.

MEASUREMENTS

The research data were collected face-to-face using a form prepared by the researchers in line with the literature and tested before collection. The form includes questions about green space use habits, green exercise levels, and leisure time activities in green spaces.

RESULTS

The probability of male young adults to do physical activity in green spaces compared to women aOR: 2.4 (95% CI: 1.4-3.9, p =  .001), the probability of young adults with higher family income to do physical activity in green spaces than those with low-income aOR: 5.4 (95% CI: 2.7-10.8, p <  .001), the probability of young adults who do physical activity in indoor spaces to do physical activity in green spaces compared to those who do not aOR: 2.4 (95% CI: 1.5-3.6, p <  .001), 500 m away from the green space aOR: 2.8 (95% CI: 1.6-4.9, p <  .001) is more likely for those living farther away to engage in physical activity in green spaces than those living closer than 100 m.

CONCLUSIONS

Young adults' gender, income, distance to green spaces, and sports activities under various conditions have an impact on physical activity in open green spaces.

Epidemiology of obesity and influential factors in China: a multicenter cross-sectional study of children and adolescents

OBJECTIVE

To determine the prevalence of and risk factors for overweight and obese among Chinese children and adolescents.

METHODS

This analytical cross-sectional study included 16,640 children and adolescents aged 6-18 years across four provinces of China in 2016. Physical characteristics and responses to questionnaires were analyzed. Body Mass Index (BMI) and the prevalence of overweight and obesity were calculated.

RESULTS

Among children and adolescents, the overall prevalence of overweight and obesity in 2016 in four regions of China was 27.2% and 29.6%, respectively. Among different stages and sexes, the highest prevalence of obesity (15.8%) was observed in adolescent boys. From childhood to adolescence, the obesity rate among boys increased by 0.7% (from 15.1% to 15.8%), while the obesity rate among girls decreased by 0.9% (from 10.8% to 9.9%). Children and adolescents who were overweight or obese had significantly higher systolic blood pressures, larger waist circumferences and larger hip sizes than those with a normal BMI. Logistic regression analyses identified thirteen factors associated with overweight or obesity in children and adolescents.

CONCLUSIONS

Our results indicate that the prevalence of overweight and obesity is high among children and adolescents, especially among male adolescents in four regions of China. A suitable intervention program should not only help parents understand the serious risk of childhood obesity but also, more importantly, help to encourage a healthy lifestyle among children and adolescents.

The Definition and Prevalence of Obesity and Metabolic Syndrome: Correlative Clinical Evaluation Based on Phenotypes

Increase in the prevalence of obesity has become a major worldwide health problem in adults as well as among children and adolescents. In the last four decades, studies have revealed that the significant increase in the prevalence of obesity has become a pandemic. Obesity is the result of complex interactions between biological, genetic, environmental, and behavioral factors. Indeed, almost all of the children suffering from obesity in early childhood face with being overweight or obese in adolescence. Different phenotypes have different risk factors in the clinical evaluation of obesity. Individuals suffering from metabolically unhealthy obesity (MUO) are at an excess risk of developing cardiovascular diseases (CVDs), several cancer types, and metabolic syndrome (MetS), whereas the metabolically healthy obesity (MHO) phenotype has a high risk of all-cause mortality and cardiometabolic events but not MetS. While most obese individuals have the MUO phenotype, the frequency of the MHO phenotype is at most 10-20%. Over time, approximately three-quarters of obese individuals transform from MHO to MUO. Total adiposity and truncal subcutaneous fat accumulation during adolescence are positively and independently associated with atherosclerosis in adulthood. Obesity, in general, causes a large reduction in life expectancy. However, the mortality rate of morbid obesity is greater among younger than older adults. Insulin resistance (IR) develops with the central accumulation of body fat. MHO patients are insulin-sensitive like healthy normal-weight individuals and have lower visceral fat content and cardiovascular consequences than do the majority of MUO patients. MetS includes clustering of abdominal obesity, dyslipidemia, hyperglycemia, and hypertension. The average incidence of MetS is 3%, with a 1.5-fold increase in the risk of death from all causes in these patients. If lifestyle modifications, dietary habits, and pharmacotherapy do not provide any benefit, then bariatric surgery is recommended to reduce weight and improve comorbid diseases. However, obesity treatment should be continuous in obese patients by monitoring the accompanying diseases and their consequences. In addition to sodium-glucose co-transporter-2 (SGLT2) inhibitors, the long-acting glucagon-like peptide-1 (GLP-1) receptor agonist reduces the mean body weight. However, caloric restriction provides more favorable improvement in body composition than does treatment with the GLP-1 receptor (GLP1R) agonist alone. Combination therapy with orlistat and phentermine are the US Food and Drug Administration (FDA)-approved anti-obesity drugs. Recombinant leptin and synthetic melanocortin-4-receptor agonists are used in rarely occurring, monogenic obesity, which is due to loss of function in the leptin-melanocortin pathway.

Does body mass index distinguish motor proficiency, social and emotional maturity among adolescent girls?

BACKGROUND

The objective of this study was to investigate whether different body mass index (BMI) groups could serve as a distinguishing factor for assessing motor proficiency and social and emotional maturity in adolescent girls.

METHODS

140 girls ranging from 12 to 14.5 years old were selected from the schools of Tabriz city, Iran. After their height and weight were measured to calculate body mass index, they completed the following questionnaires: Bruininks-Oseretsky Test of motor proficiency, Second Edition,Vineland Social Maturity Scale, and Emotional Maturity scale.

RESULTS

normal-weight girls had a meaningful advantage against overweight and underweight participants in the gross motor factor of motor proficiency (p = 0.004), but there wasn't a meaningful difference in the fine motor p = 0.196) and coordination factors (p = 0.417). Also, social maturity showed an advantage of normal and underweight adolescent girls in the self-help dressing factor (p = 0.018), while the locomotion skills (p = 0.010) factor revealed a better performance of normal weight and overweight groups over underweight adolescents. No significant differences were observed in the emotional maturity subscales (p = 0.63) between the groups.

CONCLUSIONS

The present study demonstrates that BMI has a direct influence on adolescents' gross motor proficiency and social maturity.

Effects of combined training or moderate intensity continuous training during a 3-week multidisciplinary body weight reduction program on cardiorespiratory fitness, body composition, and substrate oxidation rate in adolescents with obesity

This study aimed to investigate the effects of combined training (COMB, a combination of moderate-intensity continuous training-MICT and high-intensity interval training-HIIT) vs. continuous MICT administered during a 3-week in-hospital body weight reduction program (BWRP) on body composition, physical capacities, and substrate oxidation in adolescents with obesity. The 3-week in-hospital BWRP entailed moderate energy restriction, nutritional education, psychological counseling, and two different protocols of physical exercise. Twenty-one male adolescents with obesity (mean age: 16.1 ± 1.5 years; mean body mass index [BMI] 37.8 ± 4.5 kg m-2) participated in this randomized control trial study (n:10 for COMB, n:11 MICT), attending ~ 30 training sessions. The COMB group performed 3 repetitions of 2 min at 95% of peak oxygen uptake (V'O2 peak) (e.g., HIIT ≤ 20%), followed by 30 min at 60% of V'O2 peak (e.g., MICT ≥ 80%). Body composition, V'O2 peak, basal metabolic rate (BMR), energy expenditure, and substrate oxidation rate were measured during the first week (W0) and at the end of three weeks of training (W3). The two training programs were equivalent in caloric expenditure. At W3, body mass (BM) and fat mass (FM) decreased significantly in both groups, although the decrease in BM was significantly greater in the MICT group than in the COMB group (BM: - 5.0 ± 1.2 vs. - 8.4 ± 1.5, P < 0.05; FM: - 4.3 ± 3.0 vs. - 4.2 ± 1.9 kg, P < 0.05). V'O2 peak increased only in the COMB by a mean of 0.28 ± 0.22 L min-1 (P < 0.05). The maximal fat oxidation rate (MFO) increased only in the COMB group by 0.04 ± 0.03 g min-1 (P < 0.05). COMB training represents a viable alternative to MICT for improving anthropometric characteristics, physical capacities, and MFO in adolescents with obesity during a 3-week in-hospital BWRP.

Malondialdehyde as an independent predictor of body mass index in adolescent girls

Background

Given the fact that the studies that examined oxidative stress in relation to obesity that included late adolescents are scarce and show inconclusive results we aimed to investigate a wide spectrum of nitro-oxidative stress biomarkers i.e., malondialdehyde (MDA), xanthine oxidase (XO), xanthine oxidoreductase (XOD), xanthine dehydrogenase (XDH), advanced oxidation protein products (AOPP) and nitric oxide products (NOx), as well as an antioxidative enzyme, i.e., catalase (CAT) in relation with obesity in the cohort of adolescent girls ages between 16 and 19 years old.

Methods

A total of 59 teenage girls were included in this cross-sectional study. Binary logistic regression analysis was performed to examine possible associations between biochemical and nitro-oxidative stress markers and body mass index (BMI).

Results

There were not significant differences between oxidative stress markers between normal weight and overweight/obese girls (i.e., AOPP, XOD, XO, XDH) and CAT, except for MDA (p<0.001) and NOx (p=0.010) concentrations which were significantly higher in overweight/obese adolescent girls. Positive associations were evident between BMI and high sensitivity C-reactive protein (hsCRP) (OR=2.495), BMI and uric acid (OR=1.024) and BMI and MDA (OR=1.062). Multivariable binary regression analysis demonstrated significant independent associations of BMI and hsCRP (OR=2.150) and BMI and MDA (OR=1.105). Even 76.3% of the variation in BMI could be explained with this Model.

Conclusions

Inflammation (as measured with hsCRP) and oxidative stress (as determined with MDA) independently correlated with BMI in teenage girls.

The Implications of Health Disparities: A COVID-19 Risk Assessment of the Hispanic Community in El Paso

Since the outbreak of the COVID-19 pandemic in the United States, Latinos have suffered from disproportionately high rates of hospitalization and death related to the virus. Health disparities based on race and ethnicity are directly associated with heightened mortality and burden of illness and act as underlying causes for the staggering impacts of COVID-19 in Latin communities in the United States. This is especially true in the city of El Paso, Texas, where over 82% of the population is Hispanic. To ascertain the level of danger that COVID-19 poses in El Paso, we constructed a point-in-time risk assessment of its Latin population and assessed a Latin individual's likelihood of hospitalization or death related to COVID-19 by comparing relevant health profiles with high-risk co-morbidities that the Centers for Disease Control (CDC) identified in 2020. Data for this risk assessment come from 1152 surveys conducted in El Paso. The assessment included comprehensive demographic, socioeconomic, and health data to analyze disparities across Hispanic sub-populations in the city. Results revealed that around 49.3% of Hispanics in the study had been previously diagnosed with a high-risk co-morbidity and therefore have an increased likelihood of hospitalization or death related to COVID-19. Additional factors that led to increased risk included low income, homelessness, lack of U.S. citizenship, and being insured. The findings from this study additionally demonstrate that structural inequality in the U.S. must be addressed, and preventive measures must be taken at local and state levels to decrease the mortality of pandemics. Baseline population health data can help with both of these goals.

Evaluation of center of mass estimation for obese using statically equivalent serial chain

The complex structure of the human body makes its center of mass (CoM) estimation very challenging. The typically used estimation methods usually suffer from large estimation errors when applied to bodies with structural differences. Thus, a reliable estimation method is of utmost importance. In this paper, we present a detailed evaluation of a subject-specific CoM estimation technique named Statically Equivalent Serial Chain (SESC) by investigating its estimation ability over two different groups of subjects (Fit and Obese) in comparison to the segmental analysis method. For this study, we used an IMU-based motion capture system and a force platform to record the joint angles and corresponding center of pressure (CoP) values of twenty-five participants while performing a series of static postures. The root-mean-square errors (RMSE) of SESC's estimation for both groups showed close and lower mean values, whereas the segmental analysis method showed significantly larger RMSE values in comparison to SESC (p < 0.05). In addition, we used the Bland-Altman analysis to evaluate the agreement between the two techniques and the ground truth CoP, which showed the accuracy, precision, and reliability of SESC over both groups. In contrast, the segmental analysis method did not present neither accurate nor precise estimations, as our analysis revealed considerable fixed and proportional biases.

The food environment in schools and their immediate vicinities associated with excess weight in adolescence: A systematic review and meta-analysis

AIM

The present study systematically reviewed the characteristics of the food environment in schools and their immediate vicinities associated with excess weight in adolescents.

METHODS

We searched for relevant articles in seven databases. No restrictions were applied on language, publication date, and status of publication. The study selection process and data extraction were conducted by two authors independently. For meta-analyses, the random-effects model and the maximum-likelihood method were applied.

RESULTS

A total of 9327 publications were identified from the initial search. Of these, 20 studies met the inclusion criteria and were included in the systematic review. The sale of food in school or immediate vicinity was associated with high BMI [Odds ratio (OR)= 1.14, 95% confidence interval (CI) 1.01, 2.06]. The availability of healthy food provided by school significantly decreased the odds of obesity [OR= 0.89, 95%CI 0.82, 0.96]. However, the presence of nutrition policies or programs at school was not associated with obesity (OR= 0.81, 95%CI 0.57, 1.16).

CONCLUSIONS

This study highlights the need for improvement in school food environment, including restricting students' exposure to unhealthy foods. The quality of food (healthy vs unhealthy) provided or made available to adolescents in the school food environment influences their weight status. Therefore, promotion of healthy food programs and availability of healthy food at school would limit the prevalence of excess weight in adolescents.

A ten-year review of childhood obesity in a teaching hospital, South West Nigeria

Background

Obesity is an important cosmopolitan cause of morbidity in children and adolescence age groups. Information on obesity in this age group in Nigeria is scant.

Aim

To determine the prevalence of obesity and the associated morbidities seen at the Paediatric Endocrinology clinic of Ekiti State University Teaching Hospital, South West, Nigeria.

Methods

A retrospective review of all obese children attending the Paediatric Endocrinology clinic. Sociodemographic and other information related to paediatric obesity and associated morbidities were extracted from the case notes. Data obtained was analyzed using Statistical Package for Social Sciences (SPSS) version 20.

Results

A total of 21 obese children attended the clinic in the 10 years of study. The 21 children were made of 14 (66.7%) girls and 7 (33.3%) boys, giving a 2:1 female to male ratio. The ages of the children ranged from 1 to 16 years with a mean age of 8.79 ± 4.35 years. Obesity was secondary to a nutritional cause in 16 (76.2%) of the cases and Type 1 diabetes mellitus, Type 2 diabetes mellitus, Cushing's syndrome, Iatrogenic Cushing's syndrome and post-meningitis in the remaining 1 (4.8%) case each. Seventeen (81%) of the children were from the higher socioeconomic class, and the remaining three (19.0%) from lower socioeconomic class. Four (19.0%) of the children had hypertension with their blood pressure (BP) above the 95^th percentile for age and sex. Hypertension was more common among the higher socioeconomic group, children older than 10 years and the female gender. This association was not statistically significant. A greater proportion of children with body mass index (BMI) >30 had significantly higher rates of hypertension (P < 0.001).

Conclusion

Obesity is a common disease condition amongst children attending paediatric endocrine clinic. Strategies to control obesity and progression of severity of obesity may have a place in reducing the prevalence of hypertension in obese children and adolescents.

Prevalence and contributing factors for adolescent obesity in present era: Cross-sectional Study

Background

Adolescent obesity is a very common issue in our culture. Recent studies have shown that this is a form of global burden that may predispose factors in advanced life for many other diseases. Adolescents are a positive force for a country, responsible for their future prosperity and also for their nations.

Objectives

The main objective of the study was to identify the prevalence of obesity among adolescents and its diverse contributing factors.

Methods

The analysis was a cross-sectional sample method and was carried out using a sampling methodology which was not possible. Through using standardized questionnaires and using validated and calibrated heighometers and weighting devices, data was obtained from 385 participants. Body mass index (BMI) scale of the World Health Organization (WHO) has been used to create a category for obesity. BMI values greater than + 1 SD fall in the range of overweight, and levels of obese greater than + 2 SD.

Results

It was found that 6.8% of adolescents were obese and that about 17.1% were overweight. Remaining 53.8% percent had normal category of BMI and 22.3 percent were category of underweight. A significant association of gender, socioeconomic status, dietary habits, chocolate eating habits, mode of transportation to school, sports participants, physical activity, and screen time. Adolescents who were athletic enthusiasts and those who did physical activity had a good BMI. The teens who watched more than 2 h of screen time were more obese, and these were only a few reasons that were responsible for teenage obesity.

Conclusion

Health care practitioners and policy makers need to be aware of the prevalence and contributing factor to teenage obesity. Adolescents will embrace practices such as healthy eating habits, avoiding smoking and physical inactivity. This obesity may increase their risk of developing chronic illnesses in adulthood and later life stage.

Evaluation of body mass index and related lifestyle factors among 14-17-year-old Turkish adolescents

OBJECTIVE:

During adolescence, unhealthy body weight status is considered as a global concern as it may lead to adverse health consequences in adulthood, therefore evaluation of the risk factors is crucial. The aim of the study was to determine the prevalence of adolescents under the risk of being underweight, overweight, and obese among 14–17-year-old Turkish adolescents. In addition, we examined the association between unhealthy body weight categories and lifestyle factors.

METHODS:

This study was designed as cross-sectional study which included body weight status and associated parameters of 1561 adolescents aged between 14 and 17 who were registered 25 different high schools in Istanbul, Uskudar. Height and body weight of participants were measured and related factors were obtained through a questionnaire. Differences in distributions were analyzed using the Chi-square test and to control confounding factors, multivariate logistic regression analysis was performed. As statistical significance limit of p<0.05 was determined.

RESULTS:

Body mass index (BMI) percentile analyses indicated that 3.6% of participants were underweight, 14.3% were overweight, and 13.8% were obese. We demonstrated that age, gender, and school types were statistically very significantly associated with BMI (p<0.001) and daily meal frequency, eating speed, and mealtime regularity were significantly related with BMI (p<0.05). In addition, according to multivariate analysis results, gender and school types were closely related with obesity among 14–17-year old Turkish adolescents.

CONCLUSION:

This study has been demonstrated that frequency of adolescent obesity in Istanbul, Turkey, has increased and obesity closely related to gender and type of school. Further educational and interventional studies should be organized in this region with consideration of relevant risk factors.

A Case of Double Standard: Sex Differences in Multiple Sclerosis Risk Factors

Multiple sclerosis is a complex, multifactorial, dysimmune disease prevalent in women. Its etiopathogenesis is extremely intricate, since each risk factor behaves as a variable that is interconnected with others. In order to understand these interactions, sex must be considered as a determining element, either in a protective or pathological sense, and not as one of many variables. In particular, sex seems to highly influence immune response at chromosomal, epigenetic, and hormonal levels. Environmental and genetic risk factors cannot be considered without sex, since sex-based immunological differences deeply affect disease onset, course, and prognosis. Understanding the mechanisms underlying sex-based differences is necessary in order to develop a more effective and personalized therapeutic approach.

Disentangling the Drivers of Obesity: An Analytical Framework Based on Socioeconomic and Intrapersonal Factors

Obesity is increasing at exponential rates in developed economies despite the numerous policy interventions being implemented. The causes of obesity are multifactorial demanding a holistic review for targeted intervention. This study, therefore, provides a holistic overview of multiple factors affecting body weights i.e., socioeconomic and intrapersonal factors. We used data from a household and experimental survey carried out in Spain (Barcelona) in 2014. A non-linear path analysis was used considering the non-linear relationships that might exist between these factors and body weight. Results confirm non-linear relationships between some socioeconomic, intrapersonal factors and body weight. Among the intrapersonal factors, obesity is directly influenced by volitional control of obesity, attitude toward obese persons, holding a correct body image and body image dissatisfaction. Socioeconomic factors that have significant influence on obesity were age, education and gender. Risk attitudes do not correlate with obesity.

Chronic Mild Unpredictable Stress and High-Fat Diet Given during Adolescence Impact Both Cognitive and Noncognitive Behaviors in Young Adult Mice

Stress and diet are intricately linked, and they often interact in a negative fashion. Increases in stress can lead to poor food choices; adolescence is a period that is often accompanied by increased levels of stress. Stress and poor dietary choices can affect learning and memory; it is important to understand their combined effects when occurring during crucial developmental periods. Here, we present evidence that chronic mild unpredictable stress (CMUS) and high-fat diet (HFD) impact both cognitive and noncognitive behaviors when assessed after four weeks of manipulation in four-week old mice. CMUS mice had increased anxiety in the open field test (OFT) (p = 0.01) and spent more time in the open arms of the elevated zero maze (EZM) (p < 0.01). HFD administration was shown to interact with CMUS to impair spatial memory in the Morris Water Maze (MWM) (p < 0.05). Stress and diet also led to disturbances in non-cognitive behaviors: CMUS led to significantly more burrowing (p < 0.05) and HFD administration led to the poorer nest construction (p < 0.05). These findings allow for researchers to assess how modifying lifestyle factors (including diet and stress) during adolescence can serve as a potential strategy to improve cognition in young adulthood.

Adapting the SPOTLIGHT Virtual Audit Tool to assess food and activity environments relevant for adolescents: a validity and reliability study

Background

Physical inactivity and unhealthy diet are key behavioral determinants underlying obesity. The neighborhood environment represents an important arena for modifying these behaviors, and hence reliable and valid tools to measure it are needed. Most existing virtual audit tools have been designed to assess either food or activity environments deemed relevant for adults. Thus, there is a need for a tool that combines the assessment of food and activity environments, and which focuses on aspects of the environment relevant for youth.

Objective

The aims of the present study were: (a) to adapt the SPOTLIGHT Virtual Audit Tool (S-VAT) developed to assess characteristics of the built environment deemed relevant for adults for use in an adolescent population, (b) to assess the tool’s inter- and intra-rater reliability, and (c) to assess its criterion validity by comparing the virtual audit to a field audit.

Methods

The tool adaptation was based on literature review and on results of a qualitative survey investigating how adolescents perceived the influence of the environment on dietary and physical activity behaviors. Sixty streets (148 street segments) in six neighborhoods were randomly selected as the study sample. Two raters assessed the inter- and intra-rater reliability and criterion validity, comparing the virtual audit tool to a field audit. The results were presented as percentage agreement and Cohen’s kappa (κ).

Results

Intra-rater agreement was found to be moderate to almost perfect (κ = 0.44–0.96) in all categories, except in the category aesthetics (κ = 0.40). Inter-rater agreement between auditors ranged from fair to substantial for all categories (κ = 0.24–0.80). Criterion validity was found to be moderate to almost perfect (κ = 0.56–0.82) for most categories, except aesthetics and grocery stores (κ = 0.26–0.35).

Conclusion

The adapted version of the S-VAT can be used to provide reliable and valid data on built environment characteristics deemed relevant for physical activity and dietary behavior among adolescents.

Prevalence and determinants of overweight/obesity among school-aged adolescents in the United Arab Emirates: a cross-sectional study of private and public schools

OBJECTIVES

To estimate the prevalence and predictors of obesity among adolescents in the United Arab Emirates.

DESIGN

Cross-sectional study.

SETTING

Private and public secondary schools.

PARTICIPANTS

Adolescents aged 13-19 years; 434 (46.6%) from private schools and 498 (53.4%) from public schools.

MEASURES

Self-report questionnaires were used to assess adolescents' sociodemographic factors, fruit/vegetable (F/V) intake and physical activity. Participants' weight, height, waist circumference (WC), hip circumference and body fat percentage (%BF) were measured, and waist-to-height ratio (WHtR), waist-to-hip ratio (WHR) and body mass index (BMI) were calculated. Overweight/obesity was determined by BMI ≥85th percentile for age, abdominal obesity (AO) (WC, WHtR and WHR) and %BF.

RESULTS

A total of 34.7% of participants were overweight/obese (BMI ≥85th percentile) and 378 (40.6%) had high %BF. AO was noted in 47.3%, 22.7% and 27.1% of participants, based on WC, WHR and WHtR, respectively. Significantly more participants from public schools were overweight/obese (37.8% vs 31.1%) and had greater AO (based on WC, WHR, WHtR) compared with those from private schools. Predictors of obesity based on BMI were: consuming less than five servings of F/V (adjusted OR (AOR) 2.41, 95% CI: 1.73 to 3.36), being physically inactive (AOR 2.09, CI: 1.36 to 3.22) and being men (AOR 3.35, 95% CI: 2.20 to 5.10). Predictors of AO were being men (WC: AOR 1.42, 95% CI: 1.01 to 2.00; WHtR: AOR 2.72, 95% CI: 1.81 to 4.08); studying at public school (WHR: AOR 1.67, 95% CI: 1.06 to 2.66); being Emirati (WHR: AOR 0.62, 95% CI: 0.43 to 0.90); consuming less than five servings of F/V (WC: AOR 1.71, 95% CI: 1.27 to 2.30; WHtR: AOR 1.46, 95% CI: 1.05 to 2.03), and being physically inactive (WC: AOR 1.63; 95% CI: 1.13 to 2.35).

CONCLUSIONS

Focused interventions are needed to combat obesity while considering AO indicators and BMI to diagnose obesity in adolescents.

Effects of the Rango Cards game intervention on food consumption, nutritional knowledge and self-efficacy in the adoption of healthy eating practices of high school students: a cluster randomised controlled trial

OBJECTIVE

The study aimed to assess the impact of a game-based nutritional intervention on food consumption, nutritional knowledge and self-efficacy in the adoption of healthy eating practices.

DESIGN

This cluster randomised controlled trial included both male and female high school students from private schools in the Federal District, Brazil. Four schools were randomly selected for each group. Investigated variables were age, sex, monthly family income, maternal education level, dietary perceptions and practices, nutritional knowledge and self-efficacy in the adoption of healthy eating practices.

SETTING

Intervention group participants were instructed to play Rango Cards, a digital game developed for the study, on their own, for a period of 7-17 d, while the control group was not provided with any game or material during the study.

PARTICIPANTS

The study included 319 adolescents (mean age = 15·8 (sd 0·7) years).

RESULTS

Significant reductions were observed in the intervention group compared with the control group for the following variables: habit of eating while watching TV or studying and having meals at fast food restaurants. The intervention group showed increased knowledge of the effects of fruit and vegetable consumption as well as improved self-efficacy in the adoption of healthy eating practices such as reducing Na intake and preparing healthy meals.

CONCLUSIONS

The design of Rango Cards is potentially capable of effecting positive changes. Therefore, the digital game promotes autonomy and self-care among adolescents with regard to healthy eating.

Evaluation of Microbiota and Weight Alterations After the Administration of Tetracycline and Lactobacillus gasseri in Rats

Obesity is one of the largest current public health problems. Recent studies suggest that persistent changes in the intestinal microbiota (dysbiosis) can eventually lead to obesity. A stable core of intestinal microbiota exists, primarily composed of the phyla Firmicutes and Bacteroidetes, but their proportions can be altered by antibiotics. Such changes appear to not only alter host energy consumption but also modify host satiety mechanisms. Our study evaluated possible changes in the gut microbiota caused by oral administration of tetracycline, both alone or in combination with Lactobacillus gasseri in rats. Zoometric analyses were conducted and qPCR of fecal samples were analyzed to allow comparison before and during treatment regarding Firmicutes Bacteroidetes proportions. The results showed increased weight and body mass index (BMI) in animals treated with tetracycline alone (P < 0.05) when compared to the group that received tetracycline with probiotic, except for BMI in phase two when there was no statistical significance. Molecular analysis showed that after animals were treated with tetracycline, Firmicutes predominated over Bacteroidetes bacteria, which was coincident with increased weight and BMI. Probiotic addition may have minimized tetracycline dysbiosis, preventing excessive weight gain. Changes in microbiota caused by antibiotics have been shown to be an important factor related to childhood obesity. Microbiological manipulation of microbiota can play an important role in weight control, especially with antibiotic acting microbiota. More studies are needed to elucidate this mechanism.

Prevalence of Key Modifiable Cardiovascular Risk Factors among Urban Adolescents: The CRO-PALS Study

The occurrence of chronic diseases in youth has become a serious global issue requiring early prevention. Due to the specific environment in large cities, urban youth are especially exposed to risky lifestyle patterns.

OBJECTIVE

This survey aimed to determine the prevalence of key modifiable cardiovascular risk factors in the adolescent population of the Croatian capital Zagreb.

METHODS

A clustered two-stage random sample design was employed to select a representative group of 903 adolescents (girls n = 444; boys n = 459; age 15.6 ± 0.4) starting their secondary education. Participants were invited to fulfil an electronic questionnaire meant to collect data on daily physical activity, screen time and tobacco use. In addition, anthropometric and blood pressure measurements were taken by medically trained personnel. Data that were not originally categorical were dichotomized based on internationally accepted cut-off values for each risk factor, summarized for females and males, and presented as percentages and 95% confidence intervals.

RESULTS

The outcomes suggest that more than one half did not meet the recommended daily physical activity (girls 59.4%; boys 45.5%), a vast majority exceeded 2 h of screen time per day (girls 87.9%; boys 91.6%), and one quarter had high blood pressure (girls 21.6%; boys 27.0%). Moreover, the results indicated nearly one fifth of adolescents had excess weight (girls 16.1%; boys 22.2%) and a similar proportion smoked tobacco (girls 20.8%; boys 17.0%).

CONCLUSIONS

Local and regional health stakeholders should make additional efforts to promote healthy lifestyles in urban teenagers. Special emphasis should be placed on promoting physical activity.

APOLO-Teens, a web-based intervention for treatment-seeking adolescents with overweight or obesity: study protocol and baseline characterization of a Portuguese sample

PURPOSE

APOLO-Teens is an ongoing web-based program combining a manualized intervention delivered by Facebook^®, a self-monitoring web application and monthly chat sessions to optimize treatment as usual for adolescents with overweight and obesity. The aims of this paper are twofold: (1) to describe the study protocol of the APOLO-Teens randomized controlled effectiveness trial and (2) to present baseline descriptive information of the Portuguese sample.

METHODS

APOLO-Teens includes adolescents aged between 13 and 18 years with BMI percentile ≥ 85 (N = 210; 60.00% girls, BMI z-score 2.40 ± 0.75) undergoing hospital ambulatory treatment for overweight/obesity. Participants completed a set of self-report measures regarding eating behaviors and habits, psychological functioning (depression, anxiety, stress, and impulsivity), physical activity, and quality of life.

RESULTS

Depression, anxiety, stress, impulsivity, and percentage body fat were inversely associated with health-related quality of life (r_s = - 0.39 to - 0.62), while physical activity out-of-school was positively correlated with health-related quality of life (r_s = 0.22). When compared to boys, girls demonstrated statistically significant higher scores on psychological distress, disturbed eating behaviors, impulsivity, were less active at school and had lower scores on the health-related quality of life (p < 0.05).

CONCLUSION

The results showed that there were gender differences in key psychological constructs that are likely to determine success with the treatment and that, therefore, need to be considered in future interventions. The results of APOLO-Teens randomized controlled trial will determine the impact of these constructs on the efficacy and adherence to a web-based intervention for weight loss in the Portuguese population.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Behavioral Interventions for Weight Management in Overweight and Obese Adolescents: A Comparison Between a Motivation-based Educational Program and Conventional Dietary Counseling

OBJECTIVES

This study aimed to compare the effects of a three-month motivation-based educational program and conventional dietary counseling on body composition and relevant outcomes among overweight and Obese adolescents.

METHODS

A total of 115 overweight and obese adolescents (46% boys) were randomly assigned to either a motivation-based program or a conventional dietary counseling. The assessments were conducted at baseline and 3, 6, and 12 months after intervention.

RESULTS

Mean age and body mass index (BMI) Z-score were 14.5 ± 1.2 and 2.42 ± 0.62, respectively. Considering time trend analysis, the two groups achieved significant improvements in BMI Z-score, wrist and waist circumferences, body composition indices, and HRQoL total scores after a one-year follow-up. Wrist circumference and the HRQoL reported by parents revealed significant differences between the study groups in favor of the motivation-based program.

CONCLUSIONS

Although both programs could improve anthropometric indices and HRQoL over time, the motivation-based program was more effective in reducing adolescents' wrist circumference and improving HRQoL, as the parents reported.

Effect of HIIT versus MICT on body composition and energy intake in dietary restrained and unrestrained adolescents with obesity

High-intensity interval training (HIIT) has been suggested as an effective alternative to traditional moderate-intensity continuous training (MICT) that can yield improvements in a variety of health outcomes. Yet, despite the urgent need to find effective strategies for the treatment of pediatric obesity, only a few studies have addressed the impact of HIIT on eating behaviors and body composition in this population. This study aimed to compare the effect of HIIT versus MICT on eating behaviors in adolescents with obesity and to assess if the participants' baseline dietary status is associated with the success of the intervention. Forty-three adolescents with obesity were randomly assigned to a 16-week MICT or HIIT intervention. Body composition and 24-h ad libitum energy intake were assessed at baseline and at the end of the program. Restrained eating, emotional eating, and external eating were assessed using the Dutch Eating Behavior Questionnaire at baseline. Both interventions led to significant weight, body mass index (BMI), and fat mass percentage (FM%) reductions, with better improvements in FM% in the HIIT group; whereas 24-h ad libitum energy intake increased to a similar extent in both groups. HIIT provides better body composition improvements over MICT, despite a similar increase in energy intake. Restrained eaters experienced less weight loss and smaller BMI reduction compared with unrestrained eaters; higher baseline cognitively restrained adolescents showed a greater increase of their ad libitum energy intake. Novelty HIIT favors better body composition improvements compared with MICT. Both MICT and HIIT increased ad libitum energy intake in adolescents with obesity. Weight loss achievement is better among unrestrained eaters.

Trends and Correlates of Overweight among Pre-School Age Children, Adolescent Girls, and Adult Women in South Asia: An Analysis of Data from Twelve National Surveys in Six Countries over Twenty Years

Overweight has become a global pandemic and is associated with a rise in diet-related non-communicable diseases and associated co-morbidities. Most of the world’s undernourished people live in South Asia, yet the number of overweight and obese individuals in this region is growing. This study explores trends and correlates of overweight among pre-school age children, adolescent girls, and adult women in South Asia. Using pooled data from 12 national surveys in six countries, generalized linear mixed models were run to analyze relationships. Overweight children had significantly higher odds than non-overweight children of having an overweight mother (Adjusted Odds Ratio: 1.34, p < 0.01). Overweight adolescent girls were more likely to come from a wealthier household (Adjusted Prevalence Ratio (APR): 2.46, p < 0.01) in an urban area (1.74, p < 0.01), and have formal education (1.22, p < 0.01), compared to non-overweight girls. Similar relationships were seen among overweight vs. non-overweight adult women. In Bangladesh, India, and Nepal, overweight among girls and women increased over time, while differentials associated with household wealth, urban residence, and formal education attenuated over time. Overweight and obesity are becoming more prevalent across South Asia in a context of persisting undernutrition. Once a condition of the wealthier, more educated and urban, rates of overweight are increasing among poorer, less educated, and rural women. This requires immediate attention to ‘multi-use’ policies and programmes.

Physical activity, BMI and body weight perception among 15-year-old boys and girls in Poland in the light of international comparisons

BACKGROUND

The wrong subjective assessment of body mass may have consequences for the health, quality of life and proper functioning of adolescents in society.

AIM

The purpose of the study is to provide a detailed analysis of the discrepancies between the objective and subjective assessment of body mass by 15-year-old boys and girls in Poland against the background of international statistics and to assess the effect of physical activity on the level and directions of these discrepancies.

MATERIAL AND METHODS

The data concerned 72037 schoolchildren from 42 countries, including 1484 in Poland. The measure of objective body mass was the BMI categorized according to Cole's criteria. Research focused on the relation between the mean BMI and the subjective perception of their body mass by adolescents and the discrepancy in this assessment. In addition, the level of physical activity (MVPA) was taken into account.

RESULTS

In Poland the percentage of adolescents with overweight was lower than the international average and amounted to 12.3% vs. 15.2%. The percentage of 15-year-old boys with overweight in Poland is nearly three times higher than girls of the same age (18.7% vs. 6.5%) and is at the mean level for Health Behaviour in School-aged Children (HBSC) countries. According to international statistics, the percentage of adolescents who consider themselves overweight is 32.7%, which is two times higher than the percentage of actual excess body weight. Polish girls are systematically first in the ranking of those who consider themselves too fat. It was demonstrated that Polish girls with a normal BMI for their age who consider themselves too fat are on average slimmer than their peers in other countries. There is a correlation between Moderate-to-Vigorous Physical Activity (MVPA) and the accuracy of self-assessment of body mass and the type of mistakes made in that assessment, which is more clearly marked among boys.

CONCLUSION

There are clear geographical and cultural differences in the level of discrepancies between the objective and subjective assessment of body mass among teenagers. Physical activity modifies these discrepancies.

Relationship between lower-extremity defects and body mass among polish children: a cross-sectional study

BACKGROUND

Lower extremity defects in healthy children raises interest of researchers as confirmed by numerous published original and review articles. The relationship between lower extremity postural defects and body mass are unclear as published data are inconclusive. The aim of the present cross-sectional study was to analyse the prevalence of lower extremity defects in a large group of 8- to 12-year-old children; and further to assess the probability of defects associated with values of body mass variables.

METHODS

The study included prospective anthropometric measurements data of 6992 children (3476 boys and 3516 girls) from Gdansk (Northern Poland). Standard screening test used in Poland for assessment of lower limb defects were used (intermalleolar or intercondylar distance for knee alignment, linear vertical compass for valgus heel, computer podoscope or classical footprint and measuring the Sztriter-Godunow index for flatfeet). Body mass was assessed with local centile charts and IOTF cutoffs. Prevalence of postural defects was compared with an aid of Pearson's chi-squared test and Fisher's exact test. Probability of lower extremities postural defect was estimated on the basis of logistic regression analysis, and expressed as an odds ratio (OR) and its 95.0% CI.

RESULTS

The study demonstrated that cumulative prevalence of lower extremity defects (31.5%) was lower than reported in most published studies, most common defects were valgus heel (21.8%) and valgus knee (14.5%). Boys were significantly more frequently diagnosed with lower limb defects overall (p < 0.001), as well as with varus knee, valgus heel, flatfoot of any degree. Limb defects were found in 90,2% of obese children, 25,7% of normal weight and 15,1% of underweight children.

CONCLUSIONS

Prevalence of some lower extremities defects seems to be sex specific. Prevalence varied across body weight categories and was rising with the increase of BMI. Increased body mass is correlated with a higher risk of developing lower extremity postural defects in children.

What are the most frequent diagnoses in adolescence? The reality of an Adolescent Medicine Clinic

Objective

To characterize the care flow and the primary diagnoses of an Adolescent Medicine Clinic.

Methods

A retrospective descriptive study, with analysis of clinical processes of adolescents (10-18 years) seen at the Adolescent Medicine Clinic, from January 2006 to December 2013. The following variables were analyzed: sex, age, number of visits, referring service and primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. As to the variable age, the adolescents were divided into two groups: Group I comprised those aged 10-14 years, and Group II, 15-18 years.

Results

A total of 7,692 visits were carried out, in that, 1,659 first visits (22%), with an annual growth rate of 6%. The mean age was 14.2 years, and 55% of patients were female. The group of endocrine, nutritional and metabolic diseases was the most representative in our sample (34%), with obesity being the most frequent diagnosis in both sexes and age groups (23%), with a higher prevalence in males (13% male versus 10% female, p<0.001) and younger adolescents (18% in Group I versus 5% in Group II p<0.001). The group of mental and behavioral disorders was the second most prevalent (32%), affecting mainly females (39% female versus 22% male, p<0.001) and the older age group (39% Group II versus 27% Group I, p<0.001). Social problems were the primary diagnosis in 8% of visits.

Conclusion

Most diseases diagnosed have a strong behavioral and social component, particularly mental disorders and obesity. This specific type of diagnoses reinforces the need for a global approach for adolescents and specialized adolescent medicine units/clinics.

Efficacy of gamification-based smartphone application for weight loss in overweight and obese adolescents: study protocol for a phase II randomized controlled trial

BACKGROUND

Overweight and obesity are significant public health concerns that are prevalent in younger age cohorts. Preventive or therapeutic interventions are difficult to implement and maintain over time. On the other hand, the majority of adolescents in the United States have a smartphone, representing a huge potential for innovative digitized interventions, such as weight loss programs delivered via smartphone applications. Although the number of available smartphone applications is increasing, evidence for their effectiveness in weight loss is insufficient. Therefore, the proposed study aims to assess the efficacy of a gamification-based smartphone application for weight loss in overweight and obese adolescents. The trial is designed to be a phase II, single-centre, two-arm, triple-blinded, randomized controlled trial (RCT) with a duration of 6 months.

METHOD

The intervention consists of a smartphone application that provides both tracking and gamification elements, while the control arm consists of an identically designed application solely with tracking features of health information. The proposed trial will be conducted in an urban primary care clinic of an academic centre in the United States of America, with expertise in the management of overweight and obese adolescents. Eligible adolescents will be followed for 6 months. Changes in body mass index z score from baseline to 6 months will be the primary outcome. Secondary objectives will explore the effects of the gamification-based application on adherence, as well as anthropometric, metabolic and behavioural changes. A required sample size of 108 participants (54 participants per group) was calculated.

DISCUSSION

The benefits of the proposed study include mid-term effects in weight reduction for overweight and obese adolescents. The current proposal will contribute to fill a gap in the literature on the mid-term effects of gamification-based interventions to control weight in adolescents. This trial is a well-designed RCT that is in line with the Consolidated Standards of Reporting Trials statement.

Trends in Obesity, Overweight, and Thinness in Children in the Seychelles Between 1998 and 2016

OBJECTIVE

This study assessed trends in the prevalence of children and adolescents with obesity, overweight, and thinness in the Seychelles, a rapidly developing nation in the Indian Ocean, and changes in the distribution of BMI over time.

METHODS

Between 1998 and 2016, examination surveys were conducted every year in all students of four selected school grades (kindergarten, primary 4, secondary 1, and secondary 4) in all schools. We categorized BMI by using the International Obesity Task Force criteria.

RESULTS

Based on 70,187 observations, the prevalence of combined overweight or obesity increased largely and monotonically between 1998 and 2016, from 8.9% to 20.0% in boys and from 12.3% to 23.6% in girls, but the prevalence of underweight did not decrease. BMI increased mostly in the upper range of the BMI population distribution: percentile 5 (P5), -1.7%; P10, -0.8%; P25, 0.3%; P50, 2.5%; P75, 7.4%; P90, 12.7%; and P95, 13.3%.

CONCLUSIONS

The distribution of BMI was increasingly skewed, with a rising prevalence of obesity, a modest or null increase in BMI in a substantial proportion of the population, and a continued burden of underweight. Further studies should assess child growth trajectories and their underlying determinants, which may bear significance for weight control strategies.

Anti-obesity effects of pectinase and cellulase enzyme‑treated Ecklonia cava extract in high‑fat diet‑fed C57BL/6N mice

The present study investigated the anti‑obesity effects of enzyme‑treated Ecklonia cava extract (EEc) in C57BL/6N mice with high‑fat diet (HFD)‑induced obesity. The EEc was separated and purified with the digestive enzymes pectinase (Rapidase X‑Press L) and cellulase (Rohament CL) and its effects on the progression of HFD‑induced obesity were examined over 10 weeks. The mice were divided into 6 groups (n=10/group) as follows: Normal diet group, HFD group, mice fed a HFD with 25 mg/kg/day Garcinia cambogia extract and mice fed a HFD with 5, 25 or 150 mg/kg/day EEc (EHD groups). Changes in body weight, fat, serum lipid levels and lipogenic enzyme levels were determined. The body weight and liver weight were increased in the HFD group compared with those in the ND group, which was significantly reduced by EEc supplementation. In addition, significant reductions in epididymal, perirenal and mesenteric white adipose tissues were present in the EHD groups and all three EHD groups exhibited decreases in insulin, leptin and glutamate pyruvate transaminase levels compared with those in the HFD group. In addition, EEc treatment significantly decreased the serum and hepatic triglyceride levels compared with those in the HFD group. However, the levels of high‑density lipoprotein cholesterol/total cholesterol ration increased significantly in EHD‑25 and ‑150 groups compared with those in the HFD group. Changes in adipogenic and lipogenic protein expression in the liver was assessed by western blot analysis. The EHD‑25 and -150 groups exhibited reduced levels of CCAAT/enhancer‑binding protein α and peroxisome proliferator activated receptor γ. However, the phosphorylation ratios of AMP‑activated protein kinase and acetyl‑CoA carboxylase were significantly increased in the liver tissue obtained from the EHD (5, ‑25 and ‑150 mg/kg/day) groups compared with those in the HFD group. EEc supplementation reduced levels of sterol regulatory element‑binding protein‑1c, adipose fatty acid‑binding protein, fatty acid synthase and leptin, while it significantly increased glucose transporter type 4 and adiponectin protein levels in the liver tissues of all three EHD groups compared with those in the HFD group. Taken together, these results suggest that EEc exerts anti‑obesity effects by reducing body weight and the serum and hepatic levels of obesity‑associated factors. Thus, EEc supplementation reduces HFD‑induced obesity in C57BL/6N mice and has the potential to prevent obesity and subsequent metabolic disorders.

Association between arterial hypertension and nutritional status in adolescents from Goiânia, Goiás, Brazil

INTRODUCTION

Adolescents are a population with unique lifestyle challenges, including physical inactivity, inadequate nutrition, and obesity, all of which increase the risk of developing hypertension (HTN). The objective of this study has been to estimate the prevalence of factors associated with hypertension in adolescents in the city of Goiânia City, Central Brazil.

METHODS

Between 2013and2014, a cross-sectional population study on cardiovascular risk in adolescents, was conducted with the participation of 1,586 adolescents in 108 classes at 36 schools (public and private) in Goiânia city. All of the adolescents were interviewed to establish their sociodemographic and behavioral characteristics related to hypertension and nutritional status. Anthropometric and blood pressure data were collected following a protocol. A Poisson regression, stratified by gender, was used to verify the factors associated with HTN.

RESULTS

In this mixed-gender group of 1,586 students, the prevalence of HTN was 6.2% (95% CI: 4.6-8.2%) in girls and 14.0% (95% CI: 10.2-18.8%) in boys-about twice as high in boys as in girls (p <0.001). Obesity was independently associated with HTN in both genders. Being overweight was a risk factor for HTN. In addition, there was a positive correlation between the SBP/SBP percentile and the BMI Z-score/Nutritional status (NS)in both genders. A high prevalence of physical inactivity was also observed in the adolescents investigated, especially in the girls. On the other hand, more boys than girls were found to be obese.

CONCLUSION

The results of this investigation revealed the need for strategies to prevent and control HTN and its risk factors, especially in Brazil's schools. In addition to the constant surveillance of HTN prevalence and risk factors (in particular, being overweight or obese), information should be distributed to promote beneficial health behaviors among adolescents.

Prevalence of obesity among youths in Mississippi: United States, 1999-2015

Background The prevalence of obesity among youths has become a public health problem. The trend in the prevalence of obesity among high school students in Mississippi has not been examined in the last 17 years. Methods The data from the Mississippi High School Youth Risk Behavior Survey from 1999 to 2015 were used to determine the prevalence of obesity. The definition of obesity was based on age- and sex-specific body mass index (BMI) of more than 95th percentile, according to 2000 Centers for Disease Control and Prevention (CDC) growth charts. The differences in the groups were examined using the univariate t-test statistical analysis at p < 0.05 and frequency distribution to determine the percentage differences. Results There was a decline in the prevalence of obesity from 1999 to 2015 among Whites but no significant decrease among Blacks. The prevalence based on race in 2105 was 18.9%, which is higher than 14.4% in 1999 and remaining years. The rate of obesity based on race and sex was 27.7% among Blacks and 15.9% among White males in 2015. The Black females had prevalence of 20.6%, which is higher than their White counterpart (12.1%) in 2015 and previous years. Conclusion The prevalence of obesity among Blacks was higher when compared to White students. There was an increased prevalence of obesity in males over females. Students in 9th and 10th grade had a higher prevalence of obesity than those in 11th and 12th grade.

The Definition and Prevalence of Obesity and Metabolic Syndrome

Increase in prevalence of obesity has become a worldwide major health problem in adults, as well as among children and adolescents. Furthermore, total adiposity and truncal subcutaneous fat accumulation during adolescence are positively and independently associated with atherosclerosis at adult ages. Centrally accumulation of body fat is associated with insulin resistance, whereas distribution of body fat in a peripheral pattern is metabolically less important. Obesity is associated with a large decrease in life expectancy. The effect of extreme obesity on mortality is greater among younger than older adults. In this respect, obesity is also associated with increased risk of several cancer types. However, up to 30% of obese patients are metabolically healthy with insulin sensitivity similar to healthy normal weight individuals, lower visceral fat content, and lower intima media thickness of the carotid artery than the majority of metabolically "unhealthy" obese patients.Abdominal obesity is the most frequently observed component of metabolic syndrome. The metabolic syndrome; clustering of abdominal obesity, dyslipidemia, hyperglycemia and hypertension, is a major public health challenge. The average prevalence of metabolic syndrome is 31%, and is associated with a two-fold increase in the risk of coronary heart disease, cerebrovascular disease, and a 1.5-fold increase in the risk of all-cause mortality.

Differences in physical activity, eating habits and risk of obesity among Kuwaiti adolescent boys and girls: a population-based study

The study aimed to assess gender differences among Kuwaiti adolescents in healthy living choices that impact the risk of obesity. A cross-sectional multistage cluster design was employed with a representative sample of 2672 students aged 13-15 years who completed a self-administered Global School-based Student Health (GSHS) survey. The study found that around 48.0% of adolescents were overweight and obese. More boys than girls were obese (28.2% vs. 22.3%, p < 0.0001). However, boys were more likely than girls to report healthy food choices regarding fruit (38.1% vs. 33.2%), and vegetables (21.8% vs. 16.7%). Only 20.7% of adolescents reported physical activity for more than 60 min/day, predominately by boys rather than girls (30.8% vs. 10.5%, respectively, p < 0.0001). Multivariate analysis revealed that male gender, skipping breakfast and physical inactivity were significantly correlated with the risk of overweight and obesity among adolescents. These results suggest that lifestyle education for promoting healthy body masses targeting adolescents should take gender into account.

Regulation of visceral and epicardial adipose tissue for preventing cardiovascular injuries associated to obesity and diabetes

Nowadays, obesity is seriously increasing in most of the populations all over the world, and is associated with the development and progression of high-mortality diseases such as type-2 diabetes mellitus (T2DM) and its subsequent cardiovascular pathologies. Recent data suggest that both body fat distribution and adipocyte phenotype, can be more determinant for fatal outcomes in obese patients than increased general adiposity. In particular, visceral adiposity is significantly linked to long term alterations on different cardiac structures, and in developed forms of myocardial diseases such as hypertensive and ischaemic heart diseases, and diabetic cardiomyopathy. Interestingly, this depot may be also related to epicardial fat accumulation through secretion of lipids, adipokines, and pro-inflammatory and oxidative factors from adipocytes. Thus, visceral adiposity and its white single-lipid-like adipocytes, are risk factors for different forms of heart disease and heart failure, mainly in higher degree obese subjects. However, under specific stimuli, some of these adipocytes can transdifferentiate to brown multi-mitochondrial-like adipocytes with anti-inflammatory and anti-apoptotic proprieties. Accordingly, in order to improve potential cardiovascular abnormalities in obese and T2DM patients, several therapeutic strategies have been addressed to modulate the visceral and epicardial fat volume and phenotypes. In addition to lifestyle modifications, specific genetic manipulations in adipose tissue and administration of PPARγ agonists or statins, have improved fat volume and phenotype, and cardiovascular failures. Furthermore, incretin stimulation reduced visceral and epicardial fat thickness whereas increased formation of brown adipocytes, alleviating insulin resistance and associated cardiovascular pathologies.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prospective associations of meat consumption during childhood with measures of body composition during adolescence: results from the GINIplus and LISAplus birth cohorts

BACKGROUND

Higher meat and protein intakes have been associated with increased body weight in adults, but studies evaluating body composition are scarce. Furthermore, our knowledge in adolescents is limited. This study aimed to investigate the prospective associations of intakes of different meat types, and their respective protein contents during childhood, with body composition during adolescence.

METHODS

Dietary (using food frequency questionnaires) and body composition (measured by bioelectrical impedance) data were collected from the 10- and 15-year follow-up assessments respectively, of the GINIplus and LISAplus birth cohort studies. Sex-stratified prospective associations of meat and meat protein intakes (total, processed, red meat and poultry) with fat mass index (FMI) and fat free mass index (FFMI), were assessed by linear regression models (N = 1610).

RESULTS

Among males, higher poultry intakes at age 10 years were associated with a higher FMI at age 15 years [β = 0.278 (SE = 0.139), p = 0.046]; while higher intakes of total and red meat were prospectively associated with higher FFMI [0.386 (0.143), p = 0.007, and 0.333 (0.145), p = 0.022, respectively]. Additionally in males, protein was associated with FFMI for total and red meat [0.285 (0.145) and 0.356 (0.144), respectively].

CONCLUSIONS

Prospective associations of meat consumption with subsequent body composition in adolescents may differ by sex and meat source.

Regional differences in the prevalence of underweight, overweight and obesity among 13-year-old adolescents in Greece

Background and objectives

To assess regional differences in the weight status and abdominal obesity among 13-year-old Greek adolescents.

Design and setting

Cross-sectional, nationwide study in Greece.

Patients and methods

A representative sample of 4833 13-year-old adolescents (50.7% boys) was recruited throughout the nine regional districts of Greece from 2010 to 2012. Basic anthropometry measurements (weight, height, and waist circumference) were obtained. Abdominal obesity and weight status were assessed according to the International Obesity Task Force criteria.

Results

The majority of the sample had a healthy body weight (60.3%), 4.1% were underweight, 27.2% were overweight, and 8.5% were obese. For boys, the highest prevalence of underweight was recorded in Epirus, normal body weight on the Ionian Islands, overweight in Central Greece and Macedonia, and obesity on the Ionian Islands. Among girls, the highest underweight prevalence was on the Ionian Islands, normal body weight in Macedonia, overweight in Central Greece and Macedonia, and obesity in Crete. Abdominal obesity affected 12.9% of the sample, with the greatest prevalence among Cretan boys and Thracian girls. Additionally, residing on the Greek islands was associated with a higher prevalence of central adiposity.

Conclusion

Greek 13-year-old adolescents who are subjected to geographical changes exhibit high obesity and abdominal obesity rates. This study provides evidence to design regionally tailored interventions that aim to tackle and prevent the disease among the nine regional districts in Greece.

Overweight and obesity in Slovak high school students and body composition indicators: a non-randomized cross-sectional study

BACKGROUND

Physical development can be considered as an indicator of the overall health status of the youth population. Currently, it appears that the increasing trend of the prevalence of obesity among children and youths has stopped in a number of countries worldwide. Studies point to the fact that adolescence is a critical period for the development of obesity. Body mass index (BMI) seems to be an orientation parameter in the assessment of prevalence of obesity which is not sufficient for more accurate identification of at risk individuals. The purpose of this study was to evaluate association between BMI percentile zones as health-risk for being overweight and obese and body composition indicators in high-school students from the Prešov (Slovakia) region.

METHODS

A non-randomized cross-sectional study in high school students from the Prešov (Slovakia) region was conducted. The research sample consisted of 1014 participants (boys n = 466, girls n = 549). Body composition was measured using direct segmental multi-frequency bioelectrical impedance analysis (DSM-BIA). To examine the association between obesity and selected body composition indicators, Kruskal-Wallis ANOVA and Eta(2) were used. The relationship between selected body composition indicators and percentile BMI zones was determined using the Kendall tau correlation.

RESULTS

In groups with different BMI percentile zones (normal weight, overweight, obese), ANOVA showed significant differences for girls and boys (p ˂.05) with high effect size (η(2) ˂.26) in body weight, body fat mass index, body fat percentage, fat free mass index, fat-free mass percentage, visceral fat area, waist-to-hip ratio, waist circumference, protein mass and mineral mass. The highest degree of correlation among boys was between BMI values indicating overweight and obesity and fat free mass index and waist circumference, respectively (τ = .71, τ = .70, respectively). In girls, the highest correlation was found between classification of BMI percentile zones and waist circumference (t = .78).

CONCLUSION

The characteristics of body composition are very useful determinants of health and nutrition status. Our data revealed a direct association between BMI value and chosen body composition indicators. The most accurate indicator of overweight and obesity in our study appears to be waist circumference for both male and female population.

Effects of a 'school-based' physical activity intervention on adiposity in adolescents from economically disadvantaged communities: secondary outcomes of the 'Physical Activity 4 Everyone' RCT

BACKGROUND/OBJECTIVES:

Obesity prevention during adolescence is a health priority. The ‘Physical Activity 4 Everyone' (PA4E1) study tested a multi-component physical activity intervention in 10 secondary schools from socio-economically disadvantaged communities. This paper aimed to report the secondary outcomes of the study; to determine whether the intervention impacted on adiposity outcomes (weight, body mass index (BMI), BMI z-score), and whether any effect was moderated by sex, baseline BMI and baseline physical activity level, at 12 and 24 months.

SUBJECTS/METHODS:

A cluster randomised controlled trial was conducted in New South Wales, Australia. The school-based intervention included seven physical activity strategies targeting the following: curriculum (strategies to maximise physical activity in physical education, student physical activity plans, an enhanced school sport programme); school environment (physical activity during school breaks, modification of school policy); and parents and the community (parent engagement, links with community physical activity providers). Students' weight (kg), BMI and BMI z-score, were collected at baseline (Grade 7), 12 and 24 months. Linear Mixed Models were used to assess between-group mean difference from baseline to 12 and 24 months. Exploratory sub-analyses were undertaken according to three moderators of energy balance.

RESULTS:

A total of 1150 students (mean age=12 years) provided outcome data at baseline, 1051 (91%) at 12 months and 985 (86%) at 24 months. At 12 months, there were group-by-time effects for weight (mean difference=–0.90 kg (95% confidence interval (CI)=–1.50, −0.30), P<0.01) and BMI (−0.28 kg m⁻² (−0.50, −0.06), P=0.01) in favour of the intervention group, but not for BMI z-score (−0.05 (−0.11; 0.01), P=0.13). These findings were consistent for weight (−0.62 kg (−1.21, 0.03), P=0.01) and BMI (−0.28 kg m⁻² (−0.49, −0.06), P=0.01) at 24 months, with group-by-time effects also found for BMI z-score (−0.08 (−0.14; −0.02), P=0.02) favouring the intervention group.

CONCLUSION:

The PA4E1 school-based intervention achieved moderate reductions in adiposity among adolescents from socio-economically disadvantaged communities. Multi-component interventions that increase adolescents' engagement in moderate-to-vigorous physical activity (MVPA) may assist in preventing unhealthy weight gain.

Sleep quality and duration is related with diet and obesity in young adolescent living in Sicily, Southern Italy

The aim of this study was to evaluate the association between sleeping habits, Mediterranean diet pattern, and weight status in an adolescent population. The sample consisted of 1586 individuals aged 11–14 years attending 15 secondary schools of Sicily, Southern Italy. School were randomly selected and the data collected during two school years. Anthropometric data was collected and body composition was assessed by bioelectrical impedance analysis. Demographic information, sleep duration, pediatric daytime sleepiness questionnaire (PDSS), physical activity and dietary habits (including adherence to the Mediterranean Diet using the KIDMED score) were further collected. The mean age was 12±0.7 and about 24% were overweight and obese. An inverse correlation between total sleep time and body mass index (β=−0.829, P=0.021), fat mass (β=−0.526, P=0.025), and waist circumference (β=−0.426, P=0.045) was found. Similar results were found for weekdays sleep time, while an inverse relationship was found with PDSS score. Adherence to Mediterranean Diet was higher in under/normal weight adolescent with a significant linear association between the KIDMED score and the PDSS, weekdays sleep time and total sleep time. Sleep duration was also associated positively with fruits and vegetable intake and negatively with sweet and snack consumption and eating outside habits. Short sleep duration and poor sleep were associated with an increase in BMI and fat mass as well as to unhealthy eating behaviors. These findings suggest that sleep patterns could be a potential target for obesity prevention programs in young adolescence.

Sleep Duration Trajectories and Body Composition in Adolescents: Prospective Birth Cohort Study

We aimed to estimate the association between sleep duration trajectories and body composition in adolescents. We used data from participants of the 1993 Pelotas (Brazil) Birth Cohort Study who were later followed up at age 18 years (response rate of 81.3%). At the time, 3974 adolescents had complete data on body composition, which was assessed by air displacement plethysmography. Sleep duration was self-reported by participants at ages 11 and 18 years. Analyses were sex-stratified. The mean sleep duration at 11 years was 9.7 (SD 1.4) and 8.4 (SD 1.9) at 18 years. Sleep duration was dichotomized as inadequate (<8 hours/day) or adequate (≥8 hours/day). Mean body mass, fat mass, and fat-free mass indices at 18 years were 23.4 kg/m² (SD 4.5), 6.1 kg/m² (SD 3.9) and 17.3 kg/m² (SD 2.5), respectively. Girls who reported inadequate sleep duration at 11 years of age, but adequate sleep duration at 18, on average experienced an increase in body mass index (β = 0.39 z-scores; 95% CI 0.13, 0.65), fat mass index (β = 0.30 z-scores; 95% CI 0.07, 0.53), and fat-free mass index (β = 0.24 z-scores; 95% CI 0.08, 0.39) compared to those who had adequate sleep duration at both time points. The results suggest that changes in sleep duration across adolescence may impact body composition in later adolescence and that this may differ by sex.

Ten-year trends in overweight/obesity among Ontario middle and high school students and their use in establishing baseline measures for government reduction targets

OBJECTIVES

Public health concern about increasing levels of child/youth overweight and obesity has resulted in initiatives to address this issue. In 2012, the Ontario Ministry of Health and Long-Term Care (MOHLTC) established a target to reduce childhood obesity by 20% within five years. In this paper, we examine trends and establish baseline levels of overweight/obesity to assess the impacts of population-level interventions.

METHODS

We analyzed 10 years (2003-2013) of data accumulated from six cycles of the Ontario Student Drug Use and Health Survey using logistic regression to assess trends in the prevalence of overweight/obesity among middle and high school students. The 2013 data are used to begin monitoring progress toward achieving the MOHLTC target.

RESULTS

From 2003 through 2013, the prevalence of overweight/obesity among middle school students in the province remained stable overall and among all subgroups except 7th-grade females, who showed a significant linear decline. Among high school students, the prevalence of overweight/obesity showed a significant linear increase and an increase among 11th graders, females, and 10th- and 11th-grade females specifically. The prevalence remained stable but elevated among 9th- and 12th-grade females as well as among males in all grades. In 2013 (baseline for the MOHLTC target), 25.1% of students in grades 7-12 were overweight or obese, implying a presumed 2018 target of 20.1%.

CONCLUSION

Ten-year trends in overweight/obesity indicate stability among males and significant linear increases in some female subgroups. Also, baseline data (2013) will facilitate the monitoring of future interventions aimed at achieving the 2018 MOHLTC target.

Adiposity trajectory and its associations with plasma adipokine levels in children and adolescents-A prospective cohort study

OBJECTIVE

This study aimed to examine the associations of longitudinal adiposity measures with two adipokines, leptin and adiponectin, and their ratio in children and adolescents.

METHODS

A total of 953 children and adolescents participated in a 6-year longitudinal study. Body mass index (BMI), percentage body fat (%BF), and fat mass index (FMI) were used to assess adiposity status.

RESULTS

After adjusting for possible confounders, our regression models revealed that BMI, %BF, and FMI, in both the baseline and follow-up surveys were independently associated with a higher level of leptin and the leptin/adiponectin ratio at the follow-up survey, whereas the significant association with adiponectin only partly existed in adiposity measures at the follow-up visit. Moreover, the longitudinal change in adiposity measures was found to be a significant predictor for follow-up plasma adipokine levels. Compared with the low→low group, the medium→medium group, up-trend group, and high→high group all showed a significantly increased level of leptin and leptin/adiponectin ratio. The up-trend group and high→high group also had significantly decreased adiponectin levels.

CONCLUSIONS

These findings highlight the importance of adiposity surveillance and the utility of adipokines as biomarkers for adverse metabolic consequences of childhood adiposity.

Stabilization of Overweight and Obesity in Slovenian Adolescents and Increased Risk in Those Entering Non-Grammar Secondary Schools

BACKGROUND/AIM

To estimate overweight and obesity prevalence trends in Slovenian adolescents entering secondary schools in the years 2004, 2009 and 2014 and differences in the prevalence between different types of secondary schools.

METHODS

Data from 17,538 adolescents entering secondary schools (mean age ± standard deviation 15.4 ± 0.5 years) collected during obligatory medical examination in years 2004, 2009 and 2014 was analyzed. Overweight and obesity were defined using International Obesity Task Force criteria.

RESULTS

In 2004-2009 overweight and obesity prevalence increased, especially in males and stabilized thereafter (2009-2014) in both genders. It was significantly higher (p < 0.0001) in those attending secondary vocational and technical/professional versus grammar schools (2009; 28.7 vs. 16.8% overweight females and 31.6 vs. 22.3% overweight males; 2014: 29.7 vs. 17.9% overweight females and 33.6 vs. 20.4% overweight males).

CONCLUSIONS

Overweight and obesity prevalence in Slovenian adolescents entering secondary schools stabilized recently. Adolescents attending secondary vocational and technical/professional schools are at an increased risk of overweight and obesity.

The prevalence of overweight, obesity and stunting in school children aged 6-19 years in Beijing, China

BACKGROUND

Childhood/adolescent obesity and stunting are associated with heightened risk of metabolic syndrome. Understanding the prevalence and patterns of stunting, the emergence of overweight/obesity in children and adolescents and the concomitant risk for metabolic syndrome is of critical importance for public health policy.

AIM

To investigate the prevalence of overweight, obesity and stunting in school children and adolescents aged 6-19 years in Beijing and to compare the differences in screening rates by national and international references.

SUBJECTS AND METHODS

School children aged 6-19 years in Xuanwu, Haidian and Fangshan district were selected. Overweight and obesity in the children was screened for using the International Obesity Task-force (IOTF) and Chinese standards. Stunting was defined as height-for-age Z-score (HAZ) less than -2 using the 2009 Chinese standards and 2007 WHO reference.

RESULTS

A total of 99 482 children were included in this survey. The prevalences of overweight and obesity are 17.7% and 14.4% in the Chinese standard, but they are 18.1% and 8.6% in the IOTF standard; there were significant differences between the prevalences of these two standards (p < 0.01). The prevalences of overweight/obesity in boys are all significantly higher than that of girls in every age-group (p < 0.05). Overall there was stunting in 2630 children and adolescents (2.6%) according to the Chinese standards, with 2.8% in boys, higher than the 2.5% of girls (p < 0.01). According to WHO standards, there was stunting in 1201 children and adolescents (1.2%) with 1.1% in boys and 1.3% in girls (p < 0.05). The prevalence of stunting in urban areas was 1.3%, which is significantly lower than that of suburban areas, at 3.9% (p < 0.01).

CONCLUSION

The prevalence of overweight/obesity in children and adolescents aged 6-19 years in Beijing was close to western countries, which should be highly valued when considering public health policies and the problem of growth stunting should not be ignored.

A predictive model of progressive chronic kidney disease in idiopathic nephrotic syndrome

BACKGROUND

There are limited data on the risk factors for chronic kidney disease (CKD) in children with idiopathic nephrotic syndrome (INS). This retrospective cohort study aimed to develop a predictive model for CKD progression in children with INS.

METHODS

Between 1970 and 2012, a total of 294 patients with INS were followed up. The primary outcome was progression to CKD stage 3 or higher. A predictive model was developed using a Cox proportional hazards model. A score was calculated using b-coefficients and summing up points assigned to each significant variable. Prognostic score was grouped into categories: low risk, medium risk, and high risk.

RESULTS

Median follow-up was 6.9 years. Median renal survival was 26.1 years and probability of CKD stage 3 or higher was 8% in 10 years. Multivariate analysis showed that the most accurate model included initial age, hematuria, and steroid resistance. Accuracy was high with a c-statistic of 0.95 (95% confidence interval [CI] 0.91-0.99), 0.92 (95% CI 0.88-0.96), and 0.92 (95% CI 0.87-0.97) at 2, 5, and 10 years of follow-up respectively. By survival analysis, 10-year renal survival was 100% for the low-risk and 95% for the medium-risk group, while 40% of high-risk patients would exhibit CKD stage 3 or higher (P < 0.001).

CONCLUSIONS

Our predictive model of CKD may contribute to the early identification of a subgroup of INS patients at a high risk of renal dysfunction.

Are associations between electronic media use and BMI different across levels of physical activity?

Background

The use of electronic media has been found to be a risk factor for higher BMI and for being overweight. Physical activity has been found to be associated with lower BMI and lower risk for being overweight. Little is known about whether the associations between physical activity and electronic media use are additive or interactive in predicting BMI and risk for overweight among adolescents.

Methods

The data used in this study stem from the 2009/2010 survey of “Health Behaviour in School-aged Children (HBSC) study: A WHO Cross-National Survey. The sample consisted of 107184 13 and 15 year students from 30 different countries. Multilevel regression models were used to produce the presented estimates.

Results

Overall, 18% of boys and 11% of girls were classified as overweight. EM use was found to be associated with increased BMI z-scores and odds for overweight among both boys and girls who did not comply with physical activity guidelines. Among physically active adolescents, EM was found to be significantly associated with BMI or odds for overweight among girls, but not among boys.

Conclusion

While the usage of EM appear to be inconsequential for BMI and the risk of overweight among physically active boys, we find evidence indicating that EM use is associated with BMI and risk for overweight among girls, including those who report complying with MVPA guidelines.