Associations of physical activity and fruit and vegetable intake with well-being and depressive symptoms among obese schoolchildren in Wuhan, China: a cross-sectional study

Body Mass Index (BMI) Is the Strongest Predictor of Systemic Hypertension and Cardiac Mass in a Cohort of Children

BACKGROUND

Hypertension (HTN) is a well-established cardiovascular (CV) risk factor in adults. The presence of HTN in children appears to predict its persistence into adulthood. Early diagnosis of HTN is crucial to reduce CV morbidity before the onset of organ damage.

AIM

The aim of this study is to investigate cardiac damage in HTN, its risk factors (RFs), and evolution.

METHODS

We conducted a prospective/retrospective study involving children referred to the Childhood Hypertension Outpatient Clinic. This study included clinical and echocardiographic assessments of cardiac morphology and function at three time points: enrollment (T0) and follow-up (T1 and T2).

RESULTS

Ninety-two patients (mean age 11.4 ± 3 years) were enrolled. Cardiac eccentric and concentric hypertrophy were present in 17.9% and 9%, respectively, with remodeling in 10.5%. Overweight/obese subjects exhibited significantly higher systolic blood pressure (SBP), frequency of HTN, and body mass index (BMI) at T0 compared with patients with chronic kidney disease (CKD). SBP and BMI persisted more during follow-up. Normal-weight vs. overweight/obese patients were significantly more likely to have normal geometry. Positive correlations were found between BMI and left ventricular (LV) mass at T0, BMI and SBP at T0 and T1. Gender, BMI, SBP, and diastolic blood pressure (DBP) significantly predicted LV mass index (LVMI), but only BMI added significance to the prediction. During follow-up, the variation of BMI positively correlated with the variation of SBP, but not with LVMI.

CONCLUSIONS

In our cohort, body weight is strongly associated with HTN and cardiac mass. Importantly, the variation in body weight has a more significant impact on the consensual variation of cardiac mass than blood pressure (BP) values. A strict intervention on weight control through diet and a healthy lifestyle from early ages might reduce the burden of CV morbidity in later years.

Temporal trend and subgroup disparities in the prevalence and treatment of those who screen positive for depression in China: A population-based study

Background

In China, improving mental health has been far behind its accomplishments for other diseases. With depression as one of the most prevalent mental disorders, the aim of this study was to evaluate temporal trends in the prevalence and treatment of those who screen positive for depression in China, by age, gender, and province.

Methods

We used data from three nationally representative sample surveys: the China Health and Retirement Longitudinal Study (CHARLS), the China Family Panel Studies (CFPS), and the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depression was judged by the Centre for Epidemiologic Studies Depression Scale. Access to treatment was judged by two items: if respondents received any treatment like anti-depressants, or if respondents received counselling from a mental health professional. Survey-specific weighted regressions were fitted to estimate the temporal trend and subgroup disparities, and then pooled by meta-analysis.

Results

In total 168,887 respondents were investigated. The overall prevalence of China populations who screen positive for depression was 25.7% (95% CI 25.2-26.2) during 2016-2018, decreased from 32.2% (95% CI 31.6-32.8) during 2011-2012. The gender gap increased with age and had no significant improvement from 2011-2012 to 2016-2018. The prevalence of depression in developed areas is more likely to show a lower value and decreasing trend, while the prevalence in underdeveloped areas is more likely to show a higher value and increasing trend, from 2011-2012 to 2016-2018. The overall proportion of those who received any needed treatment or counselling from a mental health professional slightly increased from 2011 (0.5%, 95% CI 0.4-0.7) to 2018 (0.9%, 95% CI 0.7-1.2), and mainly occurred for older adults aged 75 and above.

Conclusion

The prevalence of those who screen positive for depression decreased by about 6.5% from 2011-2012 to 2016-2018 in China, but only tiny improvements were made in accessibility to mental health care. Corresponding disparities were identified in age, gender, and province.

Associations between dietary intake, diet quality and depressive symptoms in youth: A systematic review of observational studies

Background: Depression is the third leading cause of worldwide disease burden among youth, and nutrition- and diet-related behaviors have been considered as an effective strategy for reducing the risk of depressive symptoms. This systematic review aims to examine associations between dietary intake and diet quality with depressive symptoms among youth. Methods: In this systematic review, a search of scientific articles published between 2000 and 2021 was performed in four databases (CINAHL, Embase, PsycInfo, and PubMed) according to the PRISMA checklist. After applying inclusion and exclusion criteria, observational studies that focused on associations between micronutrient, macronutrient, food group intake, and diet quality and depressive symptoms among youth, ages 3 to 18, were selected for review. Results: Thirty-two articles met the review criteria. Dietary intake of magnesium, vitamin B12, fiber, fruits, vegetables, and fish were consistently inversely related to depressive symptoms. However, the evidence of associations between intake of vitamins B6, C, D, and E, iron, copper, zinc, omega-3 fatty acids, carbohydrate, and dietary fat and depressive symptoms was mixed. Dietary effects on decreased depressive symptoms were more pronounced in children than adolescents. Additionally, most studies failed to adjust for potential confounding variables. Conclusion: This review provides preliminary and comprehensive evidence for a relationship between dietary intake, diet quality, and depressive symptoms in youth. Although the results are heterogeneous and more research is needed, our findings indicate the importance of nutrition interventions for youth for decreasing depressive symptoms or for preventing further symptom exacerbation.

The association of child neglect with lifestyles, depression, and self-esteem: Cross-lagged analyses in Chinese primary schoolchildren

Child neglect robustly predicts many behavioral problems and adulthood mental disorders, but little is known about its association with daily lifestyles and psychological development during childhood, particularly in the longitudinal study. We aimed to examine the association of child neglect with physical activity (PA), screen time (ST), eating habits (EHs), and depression/self-esteem using a two-wave follow-up study of primary schoolchildren in Wuhan, China. Data of 1085 schoolchildren aged 8-10 years (boys: 53.5%) were analyzed. Child neglect, lifestyles, and depression/self-esteem were collected in 2018 (T1) and 2019 (T2). Autoregressive cross-lagged models (ARCLMs) were fitted to explore the interrelationships among these variables. In ARCLM including child neglect and lifestyles, higher child neglect at T1 was significantly associated with higher ST and more risky EHs at T2, while insignificantly associated with PA. In ARCLM including child neglect and depression/self-esteem, lower T1 child neglect significantly predicted a higher T2 depression, but insignificantly for T2 self-esteem. In ARCLM including all variables, child neglect still significantly predicted later ST and depression, but insignificantly predicted EHs. Our study underscores that child neglect is strongly intertwined with ST, EHs, and depression during childhood. The prevention of child neglect may promote some healthy lifestyles and depression in children.

Improving the Metabolic and Mental Health of Children with Obesity: A School-Based Nutrition Education and Physical Activity Intervention in Wuhan, China

This study aimed to evaluate the effectiveness of a school-based nutrition education and physical activity intervention on cardiovascular risk profile and mental health outcomes among Chinese children with obesity. Two primary schools were randomly allocated to the control group (CG) and the intervention group (IG). We selected children with obesity from 1340 students in the third and fourth grades as participants. The IG received 8 months of nutrition education and physical activity intervention, while the CG was waitlisted. A generalized estimating equation model was applied to assess repeated variables over time. A total of 171 children with obesity (99 IG and 72 CG) aged 9.8 ± 0.7 years completed the post-intervention stage. Compared with baseline, significant reductions were observed within the IG for depression and fasting plasma glucose at post-intervention. After adjusting for confounders, group and time interaction effects showed that the IG achieved improvements in the risk of poor well-being (p = 0.051) and social anxiety (p = 0.029), had decreased diastolic blood pressure (p = 0.020) and fasting plasma glucose (p < 0.001), and had significantly increased high-density lipoprotein (p < 0.001) from baseline to post-intervention relative to the CG. The effects of school-based nutrition education and physical activity intervention on children with obesity are diverse, including not only the improvement of metabolic health but also mental health promotion.

Fruit and vegetable intake and odds of pediatric migraine

Purpose

Diet is recognized as a possible potential factor in migraine pathogenesis. Limited evidence exists on the effect of diet on pediatric migraine, so this paper aims to investigate the association between fruit and vegetable consumption and odds of migraine in children.

Design/methodology/approach

The authors conducted a case-control study in tertiary Sina hospital, Tehran, Iran. A hundred children with migraine as case group and 190 sex-matched healthy controls were included in this study. Definite diagnosis of migraine was based on 2018 international classification of headache disorder 3 (ICHD3) criteria. Demographic and anthropometric characteristics were collected. Common dietary intake of participants was obtained using a validated semi-quantitative food frequency questionnaire.

Findings

Children in the migraine group had significantly higher BMI and age compared with the control group (p-value = <0.01). After adjustment for age, gender, BMI and total energy intake, a significant association between higher intake of vegetables in second tertile (OR: 0.47; CI: 0.24-0.92), fruits in third tertile (OR: 0.31; CI:0.14-0.69) and fiber in fourth quartile (OR:0.28; CI:0.095-0.85) was obtained. Controlling for all confounders in Model 3, the odds of migraine, decreased by 50 per cent and 70 per cent as the consumption of vegetables and fruits increased, in the second tertile of vegetables (p-value = 0.04) and the third tertile of fruits (p-value = <0.01).

Originality/value

The findings confirm a plausible protective role of dietary fruits and vegetables against the risk of migraine in children, which can be attributed to the probable effect of dietary fiber.

Prevalence of depressive symptoms in overweight and obese children and adolescents in mainland China: A meta-analysis of comparative studies and epidemiological surveys

BACKGROUND

Obesity is associated with a higher risk of depression in children and adolescents. This is a meta-analysis of studies examining depressive symptoms in overweight and obese children and adolescents in China.

METHODS

A systematic literature search was performed independently in both English (PubMed, EMBASE, Web of Science and Medline Complete) and Chinese (China National Knowledge Internet, WANFANG Data and WeiPu VIP) databases from their commencement date to December 31, 2018. The pooled prevalence of depressive symptoms was calculated using a random-effects model. Data analyses were performed with STATA Version 12.0, R Version 3.3.0 and R Studio Version 0.99.903.

RESULTS

Twenty-two epidemiological and 18 comparative studies were included in the meta-analysis. The overall prevalence of depressive symptoms was 24.02% (95% CI: 15.92%-33.16%) in obese children and adolescents and 22.61% (95% CI: 14.87%-31.34%) in overweigh children and adolescents. Obese children and adolescents were more likely to suffer from depressive symptoms (OR = 1.877, 95% CI: 1.459-2.415, P < 0.001) than their non-obese counterparts. The use of different screening scales for depressive symptoms was significantly associated with the prevalence of depressive symptoms.

CONCLUSIONS

Depressive symptoms are common in overweight and obese children and adolescents in China. Obese, but not overweight children and adolescents had higher risk of depressive symptoms. In order to lessen the risk of depressive symptoms, regular screening and effective interventions should be implemented to reduce obesity and overweight in this population.