Trends in overweight and obesity by socioeconomic status in Year 6 school children, Australian Capital Territory, 2006-2018

Prevalence and associated factors of overweight in Chinese adolescents: A cross-sectional study

Background and Aim

Obesity has been a global public health issue due to the increasing mortality rate and prevalence among children. However, there are scarce studies on obesity prevalence in Hong Kong children. The study aims to identify the risk factors of obesity among primary and secondary school students by assessing the relationship between sociodemographic factors, health-related behaviors, and social relationships.

Methods

Self-administrated surveys were collected from 30 primary schools and 25 secondary schools participating in the "Quality Education Fund Thematic Network on Health Schools" project. Descriptive analysis was conducted to examine the proportions of different characteristics and to compare the disparity between primary and secondary school students with obesity.

Results

A total of 4884 responses were collected. A larger proportion of primary school students with obesity were male (adjusted odds ratio [aOR]: 2.55, 95% confidence interval [CI]: 1.77-3.67, p < 0.001) and actively gamed (aOR: 1.64, 95% CI: 1.07-2.51, p = 0.024). Secondary school students with obesity were male (aOR: 1.61, 95% CI: 1.21-2.13, p = 0.001), had poor self-perceived academic performance (aOR:1.51, 95% CI: 1.10-2.08, p = 0.011) and expressed higher life satisfaction (family) (aOR: 1.13, 95% CI: 1.01-1.26, p = 0.032). There were negative associations found between obesity and physical activity, high consumption of sugary drinks, chocolate or candies, and insufficient consumption of vegetables.

Conclusion

Male sex, physical inactivity, low self-perecived academic performance, and poor dietary behaviors were the risk factors for obesity among primary and secondary school students. The findings highlighted the importance of identifying younger individuals who were at risk of becoming clinically obese. Further studies should explore the effectiveness of various interventions through longitudinal study.

Body Mass Index Trends before and during the COVID-19 Pandemic in Primary School Students in Split-Dalmatia County, Croatia: A Retrospective Study

Within the last decade, childhood obesity has become a serious problem, especially during the COVID-19 pandemic. This research paper aimed to examine whether body mass index (BMI) was higher during the pandemic (2020-2022) than in the pre-pandemic period (2012/2013-2019) using trends related to sex, urban-rural area, and physical activity (PA). This study included data from physical examinations of an entire population of primary school children from Split-Dalmatia County (Croatia) over a period of 10 years. There were 103,804 students from the first, fifth, and eighth grades who participated in the analysis. During the pandemic, the BMI of all the students increased, except for eighth-grade girls. Generations of eighth graders have had significantly different BMIs throughout the past decade. We found that first graders were overweight and obese in urban areas, while in rural areas, this problem was experienced by upper grades. Girls were more overweight and obese in the first and eighth grades, but boys experienced this more in the fifth grade. Reduced PA influenced an increase in BMI in both sexes, especially in girls. During the pandemic, this situation became worse. This study could be useful to experts for the creation of new policies for Split-Dalmatia County and surrounding regions that are similar economically and culturally.

Potential Mediating Roles of Children's Health-Related Quality of Life and Weight-Related Behaviors in the Relationship Between Socio-Educational Advantage and Weight Status

Background: Socioeconomic status is inversely associated with weight status in developed countries. Underlying mechanisms are still to be clarified. Our aim was to determine if weight-related behaviors and health-related quality of life (HRQoL) mediate the relationship between socio-educational advantage and weight status in Australian children 9 to 13 years of age. Methods: Secondary analysis of data collected by two cluster randomized trials (2019 wave). We measured children's (n = 3978) height, weight, diet, physical activity, sedentary behavior, and HRQoL. Socio-.educational advantage was assessed at school level using the Index of Community Socio-Educational Advantage (ICSEA). A counterfactual framework was used to explore potential mediators in the relationship between socio-educational disadvantage and (1) overweight/obesity and (2) BMI z-score (BMIz). Results: Low socio-educational advantage was associated with increased overweight/obesity and BMIz. The overweight/obesity association was mediated by sedentary behavior (natural indirect effect as a proportion of total, 7.5%) sugar-sweetened beverage (SSB) consumption (12.7%), physical functioning (11.9%), psychosocial health (10.9%), school (6.8%) and social functioning (15.6%), and total HRQoL score (13.8%). The ICSEA-BMIz relationship was mediated by sedentary behavior (5.7%), sleep duration (4.1%), SSB (10.6%), physical functioning (9.9%), psychosocial health (9.1%), school (5.5%) and social (13.7%) functioning, and total HRQoL score (11.7%). Conclusion: Victorian Children with low socio-educational advantage were more likely to be living with overweight or obesity. This relationship was mediated by children's sedentary behavior, SSB consumption, and HRQoL. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616000980437 (registered July 26, 2016, retrospectively registered) and ACTRN12618001986268 (registered December 11, 2018, prospectively registered). https://www.anzctr.org.au/Trial/Registration.

Twelve-month effectiveness of telephone and SMS support to mothers with children aged 2 years in reducing children's BMI: a randomized controlled trial

BACKGROUND/OBJECTIVES

Few quality intervention studies have assessed whether a combined telephone and short message service (SMS) intervention to mothers is effective in reducing BMI and obesity risk behaviors of children at 3 years of age. This study aimed to assess effectiveness of telephone and SMS support in reducing children's body mass index (BMI) and obesity risk behaviors.

SUBJECTS/METHODS

A randomized controlled trial (RCT) with 662 women of 2-year-old children (with the proportion of overweight and obesity being similar to the general population) was conducted in Sydney, Australia, March 2019-October 2020. The mothers in the intervention group received three telephone support sessions plus SMS messages and mailed-intervention-booklets over a 12 months period i.e., 24-26, 28-30, and 32-34 months of the child's age. Mothers in the control group received usual care and two mailed booklets on information not related to the intervention. The primary outcome was child's BMI at 3 years of age. Secondary outcomes were children's dietary and activity behaviors. All outcome measures were based on mothers' self-report using standardized tools due to COVID-19 pandemic restrictions.

RESULTS

537 (81%) mothers completed the post-intervention assessment at 3 years with only 470 (71%) children having weight and height measures. Multiple imputation analysis showed no statistically significant difference in mean BMI between the groups. Children in the intervention group were more likely not to eat in front of the TV [AOR 1.79 (95% CI 1.17-2.73), P = 0.008], more likely to meet the dietary recommendations [AOR 1.73 (95% CI 0.99-3.02), P = 0.054] and meet the activity recommendations [AOR 1.72 (95% CI 1.11-2.67), P = 0.015] than those in the control group respectively. Among those with an annual household income (

CONCLUSIONS

A staged telephone and SMS support intervention to mothers with children aged 2 years was associated with improved dietary and activity behaviors. The intervention was also associated with reduced children's BMI at age 3 years only for those from lower income households.

TRIAL REGISTRATION

The trial is registered with the Australian Clinical Trial Registry (ACTRN12618001571268).

Collapse

Key Words

• epidemiology
• risk factors

Collapse

MESH Headings

• Female
• Humans
• Child, Preschool
• Mothers
• Body Mass Index
• Australia/epidemiology
• COVID-19
• Obesity/epidemiology
• Weight Loss
• Telephone

Collapse

Grants Collapse

Affiliation(s)

Li Ming Wen Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia. Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia. NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia. Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia.
Huilan Xu Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
Philayrath Phongsavan Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
Chris Rissel Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia College of Medicine and Public Health, Rural and Remote Health, South Australia and Northern Territory, Flinders University, Bedford Park, SA, Australia
Alison Hayes Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
Sarah Taki Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
Limin Buchanan Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
Lisa Simone Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
Renee Moreton Population Health, Sydney Local Health District, Sydney, NSW, Australia
Louise A Baur Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

Collapse

Do family characteristics contribute to a socioeconomic gradient in overweight in early childhood? - Single mediation analyses of data on preschool children of Germany

Children's overweight is strongly associated with family socioeconomic position (SEP) and family characteristics (FC). There is limited research on the extent to which FC account for a socioeconomic gradient in childhood overweight. This study examined whether FC explain SEP differences in the prevalence of overweight. The study used baseline data of preschool-aged children from the German 'PReschool INtervention Study'. The sample (n = 872, 48% girls) was recruited at kindergartens in Baden-Württemberg, Germany. Data included children's measured weight status and parents' reports on socioeconomic indicators (e.g., school education, vocational education, income) and FC. Variables represent main determinants of overweight (nutrition: sweets consumption in front of TV, soft drink consumption, regular breakfast, child sets table; physical activity: outdoor sports; parental role model). In single mediation analyses indirect effects of SEP on overweight were analysed (OR[95%CI]). Preschool girls and boys with low parental education had higher odds for overweight than children with high parental education. Among boys, low levels of parental education contributed to the odds of overweight via indirect effects by both factors 'sweets consumption in front of TV' (OR = 1.31[1.05-1.59]) and 'no sports' (OR = 1.14[1.01-1.38]). Among girls, FC measured did not explain SEP differences in overweight. Family nutrition and parental/family physical activity contribute to inequalities in overweight among preschool boys, but not girls. Research is needed to identify FC that explain inequalities in overweight for both.

Disparities in Childhood Obesity Prevalence and Spatial Clustering Related to Socioeconomic Factors in Isaan, Thailand

Globally, rapid economic growth has contributed to an overall increase in the incidence of childhood obesity. Although the prevalence of obesity has been well recognized, the disparities related to a region's socioeconomic environment in terms of the incidence of obesity are still less understood. Therefore, the purpose of this study was to examine the spatial pattern of childhood obesity and identify the potential associations between childhood obesity and socioeconomic environment in the northeastern region of Thailand, Isaan. Using nationally collected obesity data from children aged 0-5 years in 2019, we employed a geographic information system (GIS) to perform obesity cluster analysis at the smaller regional level, investigating a total of 322 districts in study area. Global and local statistical approaches were applied to calculate spatial associations between the socioeconomic status of neighborhoods and childhood obesity. The study revealed that 12.42% of the total area showed significant clusters at the district level, with high values observed in the western and northeastern areas. The results of the spatial statistical model revealed that childhood obesity was significantly positively associated with areas exhibiting high levels of socioeconomic environment factors. Identifying the associated factors and highlighting geographic regions with significant spatial clusters is a powerful approach towards understanding the role of location and expanding the knowledge on the factors contributing to childhood obesity. Our findings, as a first step, offer valuable references that could support policy-makers and local authorities in enhancing policy development with the aim of reducing childhood obesity and improving public health.

Protocol for a randomised controlled trial of a family strengthening program to prevent unhealthy weight gain among 5 to 11-year-old children from at-risk families: the Strong Families Trial

Background

Obesity is an increasing health concern in Australia among adult and child populations alike and is often associated with other serious comorbidities. While the rise in the prevalence of childhood obesity has plateaued in high-income countries, it continues to increase among children from disadvantaged and culturally diverse backgrounds. The family environment of disadvantaged populations may increase the risk of childhood obesity through unhealthy eating and lifestyle practices. The Strong Families Trial aims to assess the effectiveness of a mixed behavioural and lifestyle intervention for parents and carers of at-risk populations, i.e. families from culturally diverse and disadvantaged backgrounds, in preventing unhealthy weight gain among children aged 5 to 11 years.

Methods

Eight hundred families from low socio-economic areas in Greater Western Sydney, NSW, and Melbourne, VIC, will be recruited and randomised into a lifestyle intervention or control group. The intervention comprises 90-minute weekly sessions for 6 weeks (plus two-booster sessions) of an integrated, evidence-based, parenting and lifestyle program that accounts for the influences of family functioning. Primary (anthropometric data) and secondary (family functioning, feeding related parenting, physical activity, consumption of healthy foods, health literacy, family and household costs) outcome measures will be assessed at baseline, immediately following the intervention, and 12 months post-intervention.

Discussion

This study will elucidate methods for engaging socially disadvantaged and culturally diverse groups in parenting programs concerned with child weight status.

Trial Registration

This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001019190). Registered 16 July 2019. 

Physical Activity and Food Environments in and around Schools: A Case Study in Regional North-West Tasmania

A better understanding of the physical activity (PA) infrastructure in schools, the walkability of neighborhoods close to schools, and the food environments around schools, particularly in rural, socioeconomically challenged areas such as the North-West (NW) of Tasmania, could be important in the wider effort to improve the health of school-age children. Accordingly, this research aimed to assess PA resources, walkability, and food environments in and around schools in three socioeconomically disadvantaged, regional/rural Local Government Areas (LGAs) of Tasmania, Australia. A census of schools (including assessment of the PA infrastructure quality within school grounds), a walkability assessment, and a census of food outlets surrounding schools (through geospatial mapping) were executed. Most of the schools in the study region had access to an oval, basketball/volleyball/netball court, and free-standing exercise equipment. In all instances (i.e., regardless of school type), the quality of the available infrastructure was substantially higher than the number of incivilities observed. Most schools also had good (i.e., within the first four deciles) walkability. Numerous food outlets were within the walking zones of all schools in the study region, with an abundance of food outlets that predominantly sold processed unhealthy food.

Trends of overweight and obesity among preschool children from 2013 to 2018: a cross-sectional study in Rhine-Neckar County and the City of Heidelberg, Germany

BACKGROUND

Early childhood overweight and obesity is a growing public health concern worldwide. Few recent studies have addressed how time trends varied by sociodemographic characteristics at the regional level using large and high-quality data. This study determines how time trends vary in the prevalence of early childhood overweight and obesity by age, gender, and migration background at the regional level.

METHODS

We used a Kernel-density curve to describe the BMI distribution, and evaluated the trends of overweight and obesity by age, gender, and migration background using logistic regression.

RESULTS

Mean BMI and the overall prevalence of overweight and obesity increased among preschool children aged 4-6 years in the Rhine-Neckar County and the City of Heidelberg. After adjusting for age, sex, and migration background, trends of overweight significantly increased only among male children in the age 5 year group with migration background (P < 0.05), and an upward trend of obesity was observed only among male children in the age 5 year group and female children in the age 6 year group with migration background (P < 0.05).

CONCLUSIONS

BMI distribution as well as general prevalence of overweight and obesity are still increasing among preschool children. Children with migration backgrounds, particularly male children in the age 5 year groups and female children in the age 6 year group should be prioritized. Health promotion strategies for children with migration backgrounds will help address this challenge.

The central nervous system control of energy homeostasis: high fat diet induced hypothalamic microinflammation and obesity

Obesity is believed to arise through the imbalance of energy homeostasis controlled by the central nervous system, where the hypothalamus plays the fundamental role in energy metabolism. In this review, we will provide an overview regarding the functions of POMC neurons and AgRP neurons in acute nucleus of the hypothalamus which mediated the energy metabolism, highlighting their interactions with peripheral organs derived hormones in control of energy homeostasis. Furthermore, the role of high fat diet induced hypothalamic microinflammation in the pathogenesis of obesity will be discussed. We hope this review could help researchers to understand the mechanism of hypothalamus in control of energy metabolism, and design related drugs to block the pathways involving in the impaired metabolism in obese patients.

DNA methylation profiles in the blood of newborn term infants born to mothers with obesity

Maternal obesity is an important risk factor for childhood obesity and influences the prevalence of metabolic diseases in offspring. As childhood obesity is influenced by postnatal factors, it is critical to determine whether children born to women with obesity during pregnancy show alterations that are detectable at birth. Epigenetic mechanisms such as DNA methylation modifications have been proposed to mediate prenatal programming. We investigated DNA methylation signatures in male and female infants from mothers with a normal Body Mass Index (BMI 18.5-24.9 kg/m2) compared to mothers with obesity (BMI≥30 kg/m2). BMI was measured during the first prenatal visit from women recruited into the Ontario Birth Study (OBS) at Mount Sinai Hospital in Toronto, ON, Canada. DNA was extracted from neonatal dried blood spots collected from heel pricks obtained 24 hours after birth at term (total n = 40) from women with a normal BMI and women with obesity matched for parity, age, and neonatal sex. Reduced representation bisulfite sequencing was used to identify genomic loci associated with differentially methylated regions (DMRs) in CpG-dense regions most likely to influence gene regulation. DMRs were predominantly localized to intergenic regions and gene bodies, with only 9% of DMRs localized to promoter regions. Genes associated with DMRs were compared to those from a large publicly available cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC; total n = 859). Hypergeometric tests revealed a significant overlap in genes associated with DMRs in the OBS and ALSPAC cohorts. PTPRN2, a gene involved in insulin secretion, and MAD1L1, which plays a role in the cell cycle and tumor suppression, contained DMRs in males and females in both cohorts. In males, KEGG pathway analysis revealed significant overrepresentation of genes involved in endocytosis and pathways in cancer, including IGF1R, which was previously shown to respond to diet-induced metabolic stress in animal models and in lymphocytes in the context of childhood obesity. These preliminary findings are consistent with Developmental Origins of Health and Disease paradigm, which posits that adverse prenatal exposures set developmental health trajectories.

Prevalence of Childhood Obesity by Country, Family Socio-Demographics, and Parental Obesity in Europe: The Feel4Diabetes Study

The Feel4Diabetes study recruited 12,193 children (age: 8.20 ±1.01 years) and their parents from six European countries as part of the broader attempt to prevent type 2 diabetes. The current work collected data pre-intervention to identify the prevalence of childhood obesity by country and describe its association with socio-demographic characteristics and parental obesity status. One in four children were overweight or obese, and one in four families had at least one obese parent. Multivariate logistic regression examined the associations between childhood obesity, family socio-demographics, and parental obesity status. Children had a higher chance of being overweight or obese if they were living in “low income” countries (OR: 2.11, 95% CI: 1.62, 2.74) and countries “under economic crisis” (OR: 2.48, 95% CI: 1.89, 3.24) compared to “high-income” countries; if their fathers completed fewer than nine years of education (OR: 2.16, 95% CI: 1.54, 3.05) compared to children whose fathers had a higher level (>14 years) of education; and if one (OR: 2.46, 95% CI: 0.32, 0.62) or both of their parents (OR: 6.83, 95% CI: 5.15, 9.05) were obese. Future childhood obesity prevention-programs should target the whole family while taking into consideration the socioeconomic and weight status of parents. Future research should examine these associations in more countries and in socio-demographically diverse populations in order to facilitate the generalisability of the present study’s findings.

Childhood malnutrition and hypo mineralized molar defects ;a cross sectional study, Egypt

Background:  Malnutrition is well-known to yield high morbidities and it has pre-eruptive and post-eruptive consequences. The objective of the study was to evaluate the prevalence of Hypomineralized Second Primary Molars (HSPM), Molar Incisor Hypomineralization (MIH) and dental caries in malnourished children, as well as addressing the relation between types of malnutrition and the dental morbidities.

Methods: This is a cross sectional analytical study. A consecutive sample of 54 malnourished cases aged 5-10 years and presented to the Outpatient Clinic of Pediatric Dentistry Department, Faculty of Dentistry, Cairo University across 6 months period were examined for HSPM, MIH – using the  European Academy of Pediatric Dentistry criteria - and dental Caries using def/ DMF indices. Outcomes were the presence or absence of MIH and HSPM and their levels measured as percentage as well as Caries Indices. Exposures were types of malnutrition and the socioeconomic status.

  Results :  The mean age of study participants was 7.10 ± 1.34 years. HSPM and MIH were found in 47.2% and 45.2% of the study participants respectively, while dental caries was observed in 83% and 64.3% for primary and permanent teeth respectively. There was co-occurrence between HSPM and MIH in 39% of the cases.

HSPM level was significantly different in various types of malnutrition. It showed significant difference between the stunted group (median HSPM of 14.2%) and the overweight or obese group (median HSPM of 0.0%) (P value 0.01). MIH level showed significant differences between the stunted group (median MIH of 19.4%) and overweight or obese group (median MIH of 0.0%) (p value 0.001), as well as between the stunted group (median MIH of 19.4%) and wasted group (median MIH of 0.0%) (p value 0.025).

Conclusions : Malnourished children have high prevalence of dental abnormalities. HSPM could expect the presence of MIH.

Investigating socioeconomic inequalities in BMI growth rates during childhood and adolescence

BACKGROUND

Many countries report socioeconomic inequalities in childhood obesity, but when they develop is not well-characterised. Studies rarely isolate BMI growth rates from overall BMI, perhaps overlooking an important precursor to the observed inequalities in obesity. The objective of this study was to determine the age at which inequalities in BMI growth rates develop in children and whether they are similar across the BMI spectrum.

METHODS

Using the Longitudinal Study of Australian Children (n = 9024), a cohort study, we measured socioeconomic inequalities in annual BMI growth from age 2 to 17 years by age, sex and weight status. We fit a linear model using generalised estimating equations (GEE) to estimate simultaneously the effects of age and weight status on inequalities in BMI growth rate.

RESULTS

The slope (SII) and relative (RII) indexes of inequality for annual BMI growth were greatest in middle childhood (age 4-11 years) (SII 0.25, RII 1.83 (boys) 1.78 (girls)) and were moderate during adolescence (age 10-17 years) (SII 0.11, RII 1.16 [boys] 1.15 [girls]). In early childhood, there was little evidence of inequality in annual BMI growth except in children with obesity. In middle childhood and adolescence, inequalities were greater at higher weight status. The GEE indicated that both weight status (P < 0.001) and age period (P < 0.001) affected inequalities in BMI growth rates.

CONCLUSIONS

Inequalities in annual BMI growth were strongest in middle childhood, and widest in children at the upper end of the BMI spectrum. This could signify a key age bracket to intervene clinically and at a public health level and improve inequalities in childhood obesity.

Inequality in early childhood chronic health conditions requiring hospitalisation: A data linkage study of health service utilisation and costs

BACKGROUND

The cost of socioeconomic inequality in health service use among Australian children with chronic health conditions is poorly understood.

OBJECTIVES

To quantify the cost of socioeconomic inequality in health service use among Australian children with chronic health conditions.

METHODS

Cohort study using a whole-of-population linked administrative data for all births in Queensland, Australia, between July 2015 and July 2018. Socioeconomic status was defined by an areas-based measure, grouping children into quintiles from most disadvantaged (Q1) to least disadvantaged (Q5) based on their postcode at birth. Study outcomes included health service utilisation (inpatient, emergency department, outpatient, general practitioner, specialist, pathology and diagnostic imaging services) and healthcare costs.

RESULTS

Of the 238,600 children included in the analysis, 10.4% had at least one chronic health condition. Children with chronic health conditions in Q1 had higher rates of inpatient (6.6, 95% confidence interval [CI] 6.4, 6.7), emergency department (7.2, 95% CI 7.0, 7.5) and outpatient (20.3, 95% CI 19.4, 21.3) service use compared to children with chronic health conditions in Q5. They also had lower rates of general practitioner (37.5, 95% CI 36.7, 38.4), specialist (8.9, 95% CI 8.5, 9.3), pathology (10.7, 95% CI 10.2, 11.3), and diagnostic imaging (4.3, 95% CI 4.2,4.5) service use. Children with any chronic health condition in Q1 incurred lower median out-of-pocket fees than children in Q5 ($0 vs $741, respectively), lower median Medicare funding ($2710, vs $3408, respectively), and higher median public hospital funding ($31, 052 vs $23, 017, respectively).

CONCLUSIONS

Children of most disadvantage are more likely to access public hospital provided services, which are accessible free of charge to patients. These children are less likely to access general practitioner, specialist, pathology and diagnostic imaging services; all of which are critical to the ongoing management of chronic health conditions, but often attract an out-of-pocket fee.

Childhood malnutrition and hypo mineralized molar defects: a cross sectional study

Background:  Malnutrition is well-known to yield high morbidities and mortalities and considering its consequence on the oral cavity, malnutrition is shown to have pre-eruptive and post-eruptive outcomes. The objective was to assess the prevalence of hypo-mineralized second primary molar (HSPM), molar–incisor hypo-mineralization (MIH) and dental caries in malnourished children as well as addressing the relation between types of malnutrition of the children and their dental morbidities represented in HSPM, MIH and dental caries. Methods: This is a cross sectional analytical study. Malnourished children aged 5-10 years and presented to the Outpatient Clinic of Pediatric Dentistry Department, Faculty of Dentistry, Cairo University were examined for HSPM. MIH using European Academy of Pediatric Dentistry criteria and dental Caries using def/ DMF indices. Results:  A consecutive sample (a long six months) of 54 malnourished children were enrolled in the study. Dental caries was a greater dental morbidity in the overweight and obese group. Besides, stunting was a greater risk in HSPM and MIH. There was an association between HSPM and MIH in a considerable percentage of the study group. Conclusions: Malnutrition is a risk factor for dental abnormalities. HSPM could expect the presence of MIH.

Influence of socioeconomic status on the incidence of aneurysmal subarachnoid haemorrhage and clinical recovery

BACKGROUND

The relevance of socioeconomic status (SES) on the incidence of aneurysmal subarachnoid haemorrhage (aSAH) and discharge functional outcomes following treatment is not clear.

METHODS

A retrospective cross-sectional study was performed on data retrieved from the Nationwide Hospital Morbidity Database for all aSAH cases in Australia between 2012 and 2018. Information on patient characteristics, procedures performed, discharge disposition and SES were extracted. SES data was derived from classifications by the Australian Bureau of Statistics. Putative risk factors were evaluated with univariate and multivariate logistic regression analysis to identify independent predictor of unfavourable discharge outcomes (defined as death or dependency).

RESULTS

A total of 3,591 low SES patients (49.8%) were identified in our study cohort. Average crude incidence of aSAH was persistently higher among the SES disadvantaged (6.6 cases per 100,000 person-years, 95% CI 6.3 - 6.8), compared to the SES advantaged group (4.1 cases per 100,000 person-years, 95% CI 4.0-4.2) (p < 0.0001). Patients in the Low SES group were more likely to be active smokers, have type 2 diabetes mellitus, or live in non-metropolitan residence, and have overall worse discharge functional outcomes (27.7% versus 24.5%, p = 0.0015). Adjusting for well-established risk factors such as older age, and intracranial bleed (ICH and/or IVH), disadvantaged SES remained a significant predictor of poor discharge outcome following aSAH (p = 0.0003).

CONCLUSION

aSAH occurs more frequently among low SES communities, and once ruptured, there is a greater risk of poor recovery..

The impact of a community-based intervention on weight, weight-related behaviours and health-related quality of life in primary school children in Victoria, Australia, according to socio-economic position

Background

Approximately a quarter of Australian children are classified as overweight or obese. In high-income countries, childhood obesity follows a socio-economic gradient, with greater prevalence amongst the most socio-economically disadvantaged children. Community-based interventions (CBI), particularly those using a systems approach, have been shown to be effective on weight and weight-related behaviours. They are also thought to have an equitable impacts, however there is limited evidence of their effectiveness in achieving this goal.

Methods

Secondary analysis was conducted on data collected from primary school children (aged 6–13 years) residing in ten communities (five intervention, five control) involved in the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) cluster randomised trial in Victoria, Australia. Outcomes included Body Mass Index z-score (BMI-z) derived from measured height and weight, self-reported physical activity and dietary behaviours and health related quality of life (HRQoL). Repeat cross-sectional data from 2015 (n = 1790) and 2019 (n = 2137) were analysed, stratified by high or low socio-economic position (SEP). Multilevel linear models and generalised estimating equations were fitted to assess whether SEP modified the intervention effect on the outcomes.

Results

There were no overall changes in BMI-z for either SEP strata. For behavioural outcomes, the intervention resulted in a 22.5% (95% CI 5.1, 39.9) point greater improvement in high-SEP compared to low-SEP intervention schools for meeting physical activity guidelines. There were also positive dietary intervention effects for high SEP students, reducing takeaway and packaged snack consumption, although there was no significant difference in effect between high and low SEP students. There were positive intervention effects for HRQoL, whereby scores declined in control communities with no change in intervention communities, and this did not differ by SEP.

Conclusion

The WHO STOPS intervention had differential effects on several weight-related behaviours according to SEP, including physical activity. Similar impacts on HRQoL outcomes were found between high and low SEP groups. Importantly, the trial evaluation was not powered to detect subgroup differences. Future evaluations of CBIs should be designed with an equity lens, to understand if and how these types of interventions can benefit all community members, regardless of their social and economic resources.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12150-4.

A trial of a six-month sugar-sweetened beverage intervention in secondary schools from a socio-economically disadvantaged region in Australia

OBJECTIVE

This study assessed the effectiveness of a school-based intervention in reducing adolescents' sugar-sweetened beverage (SSB) consumption and percentage of energy from SSBs. Secondary outcomes were SSB consumption within school, average daily energy intake, and body mass index z-scores.

METHODS

Six secondary schools located in New South Wales, Australia were recruited to participate in a six-month pilot randomised controlled trial (1:1). The intervention included components targeting the school nutrition environment, curricula and community. Outcomes were collected via online surveys, observations, anthropometric measurements and project records. Between-group differences were assessed via linear mixed models.

RESULTS

At the six-month intervention endpoint (n=862) there were no statistically significant differences between students in intervention or control schools for mean daily intake of SSBs (8.55mL; CI -26.77, 43.87; p=0.63), percentage daily energy from SSBs (0.12% kJ; CI -0.55, 0.80; p=0.72), or for secondary outcomes. Acceptability of the school-based strategies were high, however intervention fidelity varied across schools.

CONCLUSION

While acceptable, improving fidelity of implementation and increasing the duration or intensity of the intervention may be required to reduce SSB intake. Implications for public health: Engaging parents and education stakeholders in the development phase to co-design interventions may prove beneficial in improving intervention fidelity and enhance behavioural outcomes.

Overweight and obesity by school socioeconomic composition and adolescent socioeconomic status: a school-based study

BACKGROUND

The main objective of this study was to investigate the interaction effect of school socioeconomic composition (SEC) and adolescent socioeconomic status (SES) in the prevalence of overweight and obesity among a representative sample of French adolescents of the third most populous département of France.

METHODS

1038 adolescents agreed to participate (response rate: 91.4%). They self-reported anthropomorphic variables, SES, school lunch and physical activity. The body mass index was divided into six categories according to the Center for Disease Control. Multivariable binary logistic regressions analysis without and with interaction term were performed on overweight or obesity. Models fit was compared using the Aikaike Information Criterion. Odds-ratios (OR) and their 95% accelerated-bootstrap confidence interval (95%BCa CI) were computed to estimate overweight or obesity risk.

RESULTS

8.9% of the adolescents were overweight. 3.4% were obese. No school-SEC effect was observed among low-SES adolescents. Medium-SES adolescents were at greater risk in low-SEC (OR = 10.75, 95%BCa CI = 2.67-64.57) and medium-SEC (OR = 5.08, 95%BCa CI = 1.55-24.84) compared with high-SEC schools. High-SES adolescents in low-SEC schools were at greater risk compared with those in medium-SEC (OR = 5.94, 95%BCa CI = 1.94-17.29) and high-SEC schools (OR = 4.99, 95%BCa CI = 1.71-13.14). A social gradient was observed in medium-SEC (OR_low/high = 2.79, 95%BCa CI = 1.22-7.41) and high-SEC (OR_low/medium = 6.86, 95%BCa CI = 1.06-5.22*10⁶) schools.

CONCLUSIONS

Physical activity and lunch at and outside school help to understand these differences. Implications for obesity prevention initiatives are discussed.

Mechanistic insight into high-fat diet-induced metabolic inflammation in the arcuate nucleus of the hypothalamus

A high-fat diet (HFD) is linked with cytokines production by non-neuronal cells within the hypothalamus, which mediates metabolic inflammation. These cytokines then activate different inflammatory mediators in the arcuate nucleus of the hypothalamus (ARC), a primary hypothalamic area accommodating proopiomelanocortin (POMC) and agouti-related peptide (AGRP) neurons, first-order neurons that sense and integrate peripheral metabolic signals and then respond accordingly. These mediators, such as inhibitor of κB kinase-β (IKKβ), suppression of cytokine signaling 3 (SOCS3), c-Jun N-terminal kinases (JNKs), protein kinase C (PKC), etc., cause insulin and leptin resistance in POMC and AGRP neurons and support obesity and related metabolic complications. On the other hand, inhibition of these mediators has been shown to counteract the impaired metabolism. Therefore, it is important to discuss the contribution of neuronal and non-neuronal cells in HFD-induced hypothalamic inflammation. Furthermore, understanding few other questions, such as the diets causing hypothalamic inflammation, the gender disparity in response to HFD feeding, and how hypothalamic inflammation affects ARC neurons to cause impaired metabolism, will be helpful for the development of therapeutic approaches to prevent or treat HFD-induced obesity.

And yet Again: Having Breakfast Is Positively Associated with Lower BMI and Healthier General Eating Behavior in Schoolchildren

Given the high prevalence of childhood overweight, school-based programs aiming at nutritional behavior may be a good starting point for community-based interventions. Therefore, we investigated associations between school-related meal patterns and weight status in 1215 schoolchildren. Anthropometry was performed on-site in schools. Children reported their meal habits, and parents provided family-related information via questionnaires. Associations between nutritional behavior and weight status were estimated using hierarchical linear and logistic regression. Analyses were adjusted for age, socio-economic status, school type, migration background, and parental weight status. Having breakfast was associated with a lower BMI-SDS (βadj = -0.51, p = 0.004) and a lower risk of being overweight (ORadj = 0.30, p = 0.009), while having two breakfasts resulting in stronger associations (BMI-SDS: βadj = -0.66, p < 0.001; risk of overweight: ORadj = 0.22, p = 0.001). Likewise, children who regularly skipped breakfast on school days showed stronger associations (BMI-SDS: β = 0.49, p < 0.001; risk of overweight: OR = 3.29, p < 0.001) than children who skipped breakfast only occasionally (BMI-SDS: β = 0.43, p < 0.001; risk of overweight: OR = 2.72, p = 0.032). The associations persisted after controlling for parental SES and weight status. Therefore, our data confirm the school setting as a suitable starting point for community-based interventions and may underline the necessity of national programs providing free breakfast and lunch to children.

Socioeconomic inequalities in children's weight, height and BMI trajectories in Norway

Studies exploring when social inequalities in body mass index (BMI) and its composites emerge and how these evolve with age are limited. Thus, this study explored parental income and education related inequalities in children's weight, height, weight velocity and body mass index among Norwegian children from 1 month to 8 years. The study population included 59,927 family/children pairs participating in the Norwegian Mother, Father, and Child Cohort Study. Growth was modelled using the Jenss-Bayley model and linear mixed effects analyses were conducted. Maternal and paternal educational differences in children's weight and BMI trajectories emerged during infancy, continuing to age 8 years. Parental income-related inequalities in children's weight were observed from the age of 1 month to 4 years for maternal and up to 1 year for paternal income-related differences but then disappeared. Parental income-related inequalities in child's BMI were observed from 18 months to 8 years for maternal income, and from 9 months to 8 years for paternal income-related differences. These results suggest that social inequalities in children's BMI present early in infancy and continue to 8 years of age. The inequalities sometimes differed by indicator of socioeconomic position used. Interventions to combat these inequalities early in life are, thus needed.

Sex and gender differences in childhood obesity: contributing to the research agenda

Childhood obesity is a major public health challenge and its prevalence continues to increase in many, but not all, countries worldwide. International data indicate that the prevalence of obesity is greater among boys than girls 5–19 years of age in the majority of high and upper middle-income countries worldwide. Despite this observed sex difference, relatively few studies have investigated sex-based and gender-based differences in childhood obesity. We propose several hypotheses that may shape the research agenda on childhood obesity. Differences in obesity prevalence may be driven by gender-related influences, such as societal ideals about body weight and parental feeding practices, as well as sex-related influences, such as body composition and hormones. There is an urgent need to understand the observed sex differences in the prevalence of childhood obesity; incorporation of sex-based and gender-based analysis in all childhood obesity studies may ultimately contribute to improved prevention and treatment.