Impact of the COVID-19 Pandemic and Related Lockdown Measures on Lifestyle Behaviors and Well-Being in Children and Adolescents with Severe Obesity

Progression of comorbidities in youth with overweight or obesity during the COVID-19 pandemic

BACKGROUND

Childhood obesity rates have continued to increase with the COVID-19 pandemic. However, data are limited on the impact of increasing obesity on associated comorbidities.

METHODS

We evaluated the progression of overweight- or obesity-associated comorbidities by investigating change in laboratory results pre-COVID-19 pandemic and post-COVID-19 pandemic onset in youth with overweight or obesity. We defined progression of comorbidities based on increase in category rather than absolute change in value.

RESULTS

HbA1c progression was seen in 19%, and LDL cholesterol progression was seen in 26%, as defined by categories. HbA1c progression and LDL cholesterol progression were significantly correlated. HbA1c and LDL cholesterol progression were significantly associated with older age and Hispanics, respectively.

CONCLUSION

The results indicate youths with overweight or obesity have experienced progression of comorbidities during the COVID-19 pandemic. This study emphasizes the importance of early detection of comorbidities among a high-risk pediatric population.

After the first lockdown due to the COVID-19 pandemic: Perceptions, experiences, and effects on well-being in Italian people

Background

Since the COVID-19 pandemic and the subsequent measures of containment, multiple studies have been conducted aimed at assessing the impacts on people's psychophysical well-being; however, few studies have investigated the general population's perceptions, experiences, and effects by adopting a mixed-method approach.

Methods

A total of 855 Italian participants completed an online survey, conducted in the period following the first lockdown in Italy. Psychological well-being, perceived stress and COVID-19-related fears were assessed by standardized questionnaires (Psychological General Well-Being Index-Short version, Perceived Stress Scale 10, and Multidimensional Assessment of COVID-19-Related Fears). The process of sense-making of the experience during the lockdown period was also evaluated by means of an open-ended question.

Results

Participants reported a lower level of general well-being, and a higher level of both perceived stress and COVID-19-related fear during the lockdown period compared to the time of the survey (1 month after the resumption of activities). The thematic analysis of responses to the open-ended question revealed two factors and five clusters, which explain the thematic variance among the narratives: the first factor refers to the type of experience (emotional states and feelings vs. objective descriptions of daily activities), while the second concerns positive or negative connotations of the experiences reported.

Conclusions

This study explored the psychological impact of the first lockdown on people's well-being, and described the process of making sense of the experience during the lockdown 1 month after going back to previous habits. Results highlighted the effectiveness of the mixed-method approach for an in-depth and exhaustive investigation of people's psychological condition during and after the first lockdown.

The Impacts of COVID-19 Restrictions on Physical Activity in Children and Youth: A Systematic Review of Qualitative Evidence

BACKGROUND

The objectives of this systematic review were to synthesize qualitative evidence on the impacts of COVID-19 restrictions on physical activity (PA) for children and youth, and explore factors perceived to influence those impacts.

METHODS

Five databases (MEDLINE, Embase, SPORTDiscus, ERIC, and CINAHL) were searched initially in June 2021 and updated in December 2021 to locate qualitative articles considering COVID-19 restrictions and PA for children and youth (≤18 y old), in any setting. Eligibility, quality assessments, and data extraction were completed by 2 independent reviewers. Data were synthesized using meta-aggregation with confidence of findings rated using ConQual.

RESULTS

After screening 3505 records, 15 studies were included. Curriculum-based PA, organized sport, and active transportation were negatively impacted by COVID-19 restrictions. Negative changes were affected by COVID-19 exposure risks, inadequate instruction, poor access, screen time, and poor weather. Unstructured PA was inconsistently impacted; outdoor unstructured PA increased for some. Positive changes were facilitated by family co-participation, availability of outdoor space, and perceived mental health benefits.

CONCLUSION

Qualitative data indicated restrictions had a predominantly negative impact on PA for children and youth, but inconsistent impacts on unstructured PA. The improved contextual understanding offered by our review will be foundational knowledge for health strategies moving forward.

The Impact of COVID-19 Pandemic Lockdown on the Relationship between Pediatric MAFLD and Renal Function

BACKGROUND

Both direct and indirect effects of COVID-19 have been found in all age groups. In particular, adult data demonstrated significant changes in patients with chronic and metabolic disease (e.g., obesity, diabetes, chronic kidney disease (CKD), and metabolic associated fatty liver dysfunction (MAFLD)), while similar pediatric evidence is still limited. We aimed at investigating the impact of the COVID-19 pandemic lockdown on the relationship between MAFLD and renal function in children with CKD due to congenital abnormalities of the kidney and urinary tract (CAKUT).

METHODS

A total of 21 children with CAKUT and CKD ≥ stage 1 underwent a comprehensive evaluation within 3 months before and 6 months after the first Italian lockdown.

RESULTS

At follow-up, CKD patients with MAFLD presented higher BMI-SDS, serum uric acid, triglycerides, and microalbuminuria levels and lower eGFR levels than those without MAFLD (all p < 0.05). Higher ferritin and white blood cell concentrations were also found in patients with CKD diagnosed with MAFLD than peers without MAFLD (both p = 0.01). Compared to children without MAFLD, a higher delta of BMI-SDS, eGFR levels, and microalbuminuria levels was found in patients with MAFLD.

CONCLUSIONS

Due to the negative influence of the COVID-19 lockdown on cardiometabolic health in childhood, a careful management of children with CKD is warranted.

Temporal Changes in Energy-Balance Behaviors and Home Factors in Adolescents with Normal Weight and Those with Overweight or Obesity

This study aimed to examine the temporal changes in energy-balance behaviors and home factors in adolescents with normal weight and those with overweight or obesity (OWOB). Adolescents or parent proxies completed survey assessments two to four years before (T0; n = 82 ), ≤ six months before (T1; n = 68 ), and ≤ three months after the COVID-19 pandemic outbreak (T2; n = 82 ), to capture energy-balance behaviors (i.e., physical activity [PA], screen time, sleep) and home factors (i.e., food environment, food worry, parent support for PA). At T0 and T1 (before pandemic), participants visited our laboratory for anthropometric measurements. At T2, parent proxies also completed a survey to report the COVID-19 pandemic exposure and impact. The participating families experienced moderate levels of pandemic exposure and impact, although exposure was higher in the OWOB group F 1,78 = 5.50 , p < . 05 . Repeated-measure multivariate analyses of covariance (RM-MACOVAs) did not show significant time by weight status interaction effects (p > 0.05 ; adjusted for race and sex). However, the models detected significant time (T0 vs. T2) by race (White vs. non-White) interaction effect λ 7,66 = 0.81 , p < 0.05 , with greater increase in food worry F 1,72 = 4.36 , p < . 05 but less increase in screen time F 1,72 = 4.54 , p < . 05 among the non-White group. Graphical visualization depicted some favorable change patterns in adolescents with normal weight (vs. those with OWOB) for certain behaviors and home factors (e.g., number of days per week ≥ 60 mins PA, food worry). These findings suggest that the COVID-19 pandemic exerted greater adverse effects on adolescents with OWOB and specifically on screen time and food worry among non-White adolescents.

The Impact of the COVID-19 Pandemic on Lifestyle and Wellbeing of Children, Adolescents and Their Parents: A Qualitative Study

Prior studies have shown that changes in daily structure and habits due to the COVID-19 pandemic affected the lifestyle and wellbeing of families. This study aimed to obtain in-depth information on children's and adolescents' experiences regarding their lifestyle and wellbeing during the pandemic. Semi-structured interviews with fifteen families were carried out between May and November 2021. Directed content analysis was used to analyze the transcripts and fundamental qualitative description to describe the results. Children and adolescents revealed an overall unhealthier lifestyle and decreased wellbeing. These negative effects were even larger in adolescents and children with overweight or psychosocial complaints. Our results revealed that parents were actively involved in maintaining a normal daily structure. Furthermore, diet changes were inconsistent and dependent on food availability. An increase in screen time was experienced as inevitable, and external influences were necessary to keep children and adolescents active. Almost no effects were reported on physical health, whereas negative emotions were experienced in varying degrees. Moreover, the decrease in social interactions was reported as the most negative effect of the pandemic. The above-mentioned insights may contribute to the development of preventive measures to promote a healthy lifestyle and wellbeing of children and adolescents during future pandemics.

Assessment of Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic: A Systematic Review and Meta-analysis

IMPORTANCE

To limit the spread of COVID-19, numerous restrictions were imposed on youths, including school closures, isolation requirements, social distancing, and cancelation of extracurricular activities, which independently or collectively may have shifted screen time patterns.

OBJECTIVE

To estimate changes in the duration, content, and context of screen time of children and adolescents by comparing estimates taken before the pandemic with those taken during the pandemic and to determine when and for whom screen time has increased the most.

DATA SOURCES

Electronic databases were searched between January 1, 2020, and March 5, 2022, including MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials. A total of 2474 nonduplicate records were retrieved.

STUDY SELECTION

Study inclusion criteria were reported changes in the duration (minutes per day) of screen time before and during the pandemic; children, adolescents, and young adults (≤18 years); longitudinal or retrospective estimates; peer reviewed; and published in English.

DATA EXTRACTION AND SYNTHESIS

A total of 136 articles underwent full-text review. Data were analyzed from April 6, 2022, to May 5, 2022, with a random-effects meta-analysis.

MAIN OUTCOMES AND MEASURES

Change in daily screen time comparing estimates taken before vs during the COVID-19 pandemic.

RESULTS

The meta-analysis included 46 studies (146 effect sizes; 29 017 children; 57% male; and mean [SD] age, 9 [4.1] years) revealed that, from a baseline prepandemic value of 162 min/d (2.7 h/d), during the pandemic there was an increase in screen time of 84 min/d (1.4 h/d), representing a 52% increase. Increases were particularly marked for individuals aged 12 to 18 years (k [number of sample estimates] = 26; 110 min/d) and for device type (handheld devices [k = 20; 44 min/d] and personal computers [k = 13; 46 min/d]). Moderator analyses showed that increases were possibly larger in retrospective (k = 36; 116 min/d) vs longitudinal (k = 51; 65 min/d) studies. Mean increases were observed in samples examining both recreational screen time alone (k = 54; 84 min/d) and total daily screen time combining recreational and educational use (k = 33; 68 min/d).

CONCLUSIONS AND RELEVANCE

The COVID-19 pandemic has led to considerable disruptions in the lives and routines of children, adolescents, and families, which is likely associated with increased levels of screen time. Findings suggest that when interacting with children and caregivers, practitioners should place a critical focus on promoting healthy device habits, which can include moderating daily use; choosing age-appropriate programs; promoting device-free time, sleep, and physical activity; and encouraging children to use screens as a creative outlet or a means to meaningfully connect with others.

Quality of Life of Elementary School Students with Type 1 Diabetes in a Developing Country during the COVID Pandemic

Type 1 diabetes (T1D) is a condition that affects all aspects of life, and thus is closely related to the quality of life itself. Dealing with it during the COVID-19 pandemic is a big challenge. A case-control study conducted in Montenegro at the end of 2021 included 87 elementary school students with T1D and 248 of their peers as controls matched by gender. Standardized questionnaires were distributed to participants (Peds-QL Generic core 4.0 questionnaire for all participants and Peds-QL Diabetes Module 3.2 only for cases). Based on them, the results of obtained scores were measured and compared using non-parametric statistical methods in relation to gender, region and type of household. Children with T1D reported lower quality of life comparing to matching controls with lower scores in almost all domains. Differences in the same domains among patients and their classmates were also observed in the different gender subgroups, environment type subgroups and in the central region. Results of the study provide insights to prioritizing actions for children with diabetes care as well as for public healthcare planning.

Eating habits of children and adolescents during the COVID-19 era: A systematic review

The COVID19 pandemic has affected all aspects of people's lives. Eating habit plays a crucial role in children and adolescents' physical and mental development and the impacts might last until adulthood. This systematic review aimed to summarize a comprehensive and updated overview of eating habits changes due to COVID19 confinements among children and adolescents. A systematic literature search was performed in three databases for all the English studies published from the start of the confinements until April 2022. Two researchers screened articles independently and included observational studies which evaluated children's and adolescents' eating habits before and during confinements. The quality of the included studies was assessed by Newcastle-Ottawa Quality Assessment checklists for cross-sectional and cohort studies. Among 2,436 studies, 39 final full-text articles were included. The total participants of this systematic review consist of 157,900 children and adolescents. Seven categories were identified: daily eating patterns, junk food, beverage, fruits and vegetables, milk and dairy, protein-rich foods, and legumes and cereals. In summary, most of the included studies reported a significant increase in consumption of home-cooked meals, amount of food, snack, french fries, sweets, fruits, vegetables, legumes, bread, and bakery products. On the other hand, studies demonstrated significantly lower intake of fast food and soft drink. The studies reported controversial results about breakfast consumption, sugar-added drinks, caffeinated drinks, milk and dairy products, protein-rich foods (including meat, fish, egg and chicken, and poultry), rice, and cereal. Changes in children's and adolescents' eating habits during the COVID-19 era were both positive and negative, for example, a decrease in fast food, fruit, and vegetable consumption vs. an increase in snacking and sweet consumption. Both changes have significant short-term and long-term impacts on population health. This study could provide us with insight into the changes in eating habits in children and adolescents in the COVID-19 era which we can use to limit the negative consequences on health.

Weight Gain in Children during the COVID-19 Pandemic and the Protective Effect of Lifestyle Intervention in Children with Obesity

INTRODUCTION

School closures due to the COVID-19 pandemic affect children's daily structure, mealtimes, physical activity, and sleeping habits, possibly exacerbating weight gain, particularly in vulnerable children with overweight and obesity. This study aimed to evaluate both perceived and objectively measured weight gain in children in the Netherlands during the COVID-19 pandemic and the effect of prior lifestyle intervention.

METHODS

A total of 150 children of the Children, Obesity and Lifestyle during COVID-19 (COLC) study (cohort A) reported perceptions of weight change during the COVID-19 pandemic. Anthropometric data of 65 children with overweight and obesity were collected at the expertise Centre for Overweight Adolescent and Children's Healthcare in the same period (COACH; cohort B).

RESULTS

In cohort A, 43% of children with overweight and obesity perceived weight gain during the pandemic, compared to 15% of lean children. In cohort B, the BMI z-score increased significantly (+0.065 SD) within 5 months. Participation in a lifestyle intervention for >1 year and having parents with Dutch background was associated with less weight gain, specifically in children with obesity.

DISCUSSION/CONCLUSION

In particular, children with overweight and obesity seem to be at risk for accelerated weight gain during the COVID-19 pandemic. Prior long-term participation in a lifestyle intervention protects against this weight gain, which emphasizes the importance of strong support for vulnerable populations during health crises and pleads for wide implementation of lifestyle interventions for children.