A cross-sectional study of Health Related Quality of Life and body mass index in a Norwegian school sample (8-18 years): a comparison of child and parent perspectives

Comparison of the EQ-5D-Y and the CHU-9D instruments in a general child population based on self-reports and proxy-reports

OBJECTIVE

This study utilized the EQ-5D-Y and the Child Health Utility 9D (CHU-9D) instruments to empirically investigate a general child population aged 7-8 years in China, with the aim of assessing and comparing the performance, correlation, and agreement between these two instruments. Both self-reported and proxy-reported versions of the instruments were considered in the analysis.

METHODS

Data were collected from 7-8-year-old students in the second grade from four schools in Guangxi and Guiyang provinces, China. Children and their proxies independently completed their respective versions of the questionnaires, including the EQ-5D-Y, the CHU-9D, and other socio-demographic information. The psychometric properties of the EQ-5D-Y and the CHU-9D were assessed, including ceiling effects, internal consistency, and known-group validity. Spearman's correlation coefficient, Intraclass Correlation Coefficient (ICC), and Bland-Altman plots were calculated and plotted to assess the correlation and agreement between the EQ-5D-Y and CHU-9D.

RESULTS

A total of 369 pairs of valid questionnaires were collected from both children and proxies. Due to the study's focus on a general child population, both EQ-5D-Y and CHU-9D yielded high utility values, with a significant ceiling effect observed, particularly in the EQ-5D-Y proxy-reported results. Compared to the EQ-5D-Y, the CHU-9D demonstrated a higher Cronbach's alpha coefficient and better internal consistency. Both instruments also demonstrated known-group validity, distinguishing different health status groups, except for EQ-5D-Y proxy-reported results. Spearman's correlation coefficient indicated some correlations in similar dimensions and utility values between the EQ-5D-Y and CHU-9D. The ICC of the EQ-5D-Y and CHU-9D utility values was 0.290 for self-reports and 0.383 for proxy-reports, indicating poor agreement between the two instruments. The Bland-Altman plots showed that the mean utility values obtained from EQ-5D-Y were significantly higher than those from CHU-9D.

CONCLUSION

The EQ-5D-Y and the CHU-9D demonstrated acceptable performance within the general child population aged 7-8 years in China, except for the EQ-5D-Y proxy-reported version. It suffered from a notable ceiling effect, poor internal consistency, as well as weak known-group validity and discriminative ability. Moreover, although there existed a certain degree of correlation between the EQ-5D-Y and CHU-9D, their utility values exhibited significant differences. Therefore, these instruments are not interchangeable in practice.

Changes in health-related quality of life and sleep habits after a 6-month non-randomised cluster-controlled trial among children with overweight or obesity

Being overweight or obese can have severe negative psychological impacts and reduce health-related functioning. To improve health-related quality of life (HRQoL) and sleep habits for children with overweight or obesity, it is important to design and implement effective interventions. The aim of this study was to evaluate the effects of a 6-month family-based lifestyle intervention on HRQoL and sleep habits in Norwegian children with overweight or obesity in a primary-care setting. This 6-month, non-randomised, cluster-controlled trial included Norwegian children aged 5-13 years with overweight or obesity and their parents. A questionnaire was filled out by the parents. A total of 33 and 52 children in the control group and 41 and 78 children in the intervention group answered the HRQoL and sleep habits questions, respectively, and were included. The intervention group received individual family counselling and participated in physical activity groups and nutrition courses. The Children's Sleep Habits Questionnaire (CSHQ) and Kidscreen-10 index were used to assess sleep habits and HRQoL. At baseline, the mean average scores for HRQoL were 50.0 [standard deviation (SD) 8.1] for the intervention group and 49.0 (SD 10.1) for the control group. For sleep habits at baseline, the mean average scores were 45.2 (SD 11.8) for the intervention group and 46.0 (SD 11.9) for the control group. No significant changes in HRQoL and sleep habits after the intervention were revealed. Overall, the family-based lifestyle intervention targeting overweight and obese children in a primary-care setting showed no significant effect on HRQoL or sleep quality.

Psychological distress and convergence of own and proxy health-related quality of life in carers of adults with an intellectual disability

BACKGROUND

In adults with an intellectual disability, health-related quality of life (HRQoL) is often measured by proxy report. This cross-sectional study investigated whether the mental health of proxy raters impacts the way they rate HRQoL.

METHODS

In this study, 110 carers of adults with an intellectual disability completed measures of psychological distress (Kessler-6) and HRQoL (EQ-5D-3L) about their own HRQoL and that of the care recipient. Differences between HRQoL scores as rated by the carer about themselves and the care recipient were calculated (convergence scores) and multiple regression models were fitted to estimate the association between proxy psychological distress and convergence scores for subjective/objective HRQoL controlling for support needs of the care recipient, carer age and gender of care recipient.

RESULTS

There was a significant association between psychological distress and subjective HRQoL convergence scores (r = .92; P = 0.03; 95%; CI: -1.76 to -0.09). There was no association between psychological distress and objective HRQoL convergence scores (r = .01; CI -0.02 to 0.001; P = 0.08). The association between psychological distress and HRQoL scores was no longer present when models did not include convergence scores.

CONCLUSIONS

Carers experiencing more psychological distress tended to rate their own and the care recipients' subjective HRQoL more similarly. Objective HRQoL measures did not show this convergence in scores with increasing carer psychological distress. Findings differed when the analysis approach was changed, suggesting the results above require replication in future studies.

Health-Related Quality of Life in Children with Overweight and Obesity: An Explorative Study Focused on School Functioning and Well-being

Overweight and obesity in childhood has reached epidemic levels, and their roles in physical and psychological health are now recognized. Recently, researchers have focused on the impact of these weight problems in health-related quality of life (HRQoL) domains, which are less investigated in children. This exploratory study examined the differences in HRQoL domains between a clinical group who were overweight/obesity treatment-seeking (n = 58) and a normal-weight group (n = 44) in a sample of 102 children, with a specific focus on school functioning and well-being. The second aim explored the link between our findings and other HRQoL dimensions. After controlling for sex and age, a multivariate analysis of variance showed lower levels in school functioning and well-being dimensions between overweight/obesity than normal-weight (F = 4.72; p < 0.05). Correlation analyses highlighted positive links between lower school functioning and well-being and lower levels of self-esteem (r = 0.308; p < 0.01) and social domains in terms of friendships (r = 0.522 ; p < 0.001) and family relationships (r = 0.561; p < 0.001) in children who were with overweight and obesity. This study discusses the implications of these findings in educational research and practices.

Pathways of Parental Education on Children's and Adolescent's Body Mass Index: The Mediating Roles of Behavioral and Psychological Factors

Aim

The increasing body mass index (BMI) often followed by overweight and obesity is a global health problem of the 21st century. Children and adolescents with lower socioeconomic status are more affected than their counterparts. The mechanisms behind these differences must be well understood to develop effective prevention strategies. This analysis aims at examining the association of parental education as an indicator of the socioeconomic status on children's and adolescent's body mass index and the role of behavioral and psychological risk factors for a higher BMI longitudinally.

Methods

The analysis was based on a nationwide sample of N = 460 children and adolescents, aged 11 to 17 at baseline (2009-2012), who took part in the representative BELLA study, the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (KiGGS). A follow-up was conducted 5 years later. Using mediation analyses, the mediating effects of breakfast consumption, consumption of sugar-sweetened beverages, screen time, physical activity, mental health problems (Strengths and Difficulties Questionnaire), and health-related quality of life (KIDSCREEN-10) on the association of parent's years of education on their children's BMI were investigated.

Results

A lower level of parental education was significantly associated with a higher BMI in children and adolescents 5 years later. The association was partially mediated by breakfast consumption and total screen time, with breakfast consumption mediating 16.7% and total screen time 27.8% of the association. After controlling for age, gender, and migration status, only breakfast consumption remained a partial mediator (8.5%). Other included variables had no mediating effects.

Conclusions

Preventive measures should be mainly targeted at children and adolescents of parents with lower educational levels. Tailored strategies to prevent the development of overweight and obesity in this population among children and adolescents should promote daily breakfast consumption at home and reducing screen time.

Poor Health Related Quality of Life and Unhealthy Lifestyle Habits in Weight-Loss Treatment-Seeking Youth

Obesity is associated with unhealthy lifestyle behaviors and poor Health Related Quality of Life (HRQOL). The cumulative effect of lifestyle behaviors on HRQOL has been demonstrated in chronically ill adolescents, but not in adolescents with obesity. The present study aimed to assess the association between HRQOL and adherence to the Mediterranean Diet (MD) and/or low levels of physical activity (PA) in a large sample of outpatient adolescents with overweight or obesity seeking weight loss treatment. Four-hundred-twenty participants were enrolled from 10 Italian outpatient clinics. The demographics and anthropometric features, KIDMED scores, and exercise levels of the participants were collected, together with parental features. The HRQOL was assessed by the Pediatric Quality of Life Inventory (PedsQL™), Adolescents Version 4.0. PedsQL total score and functioning subscales were lower in adolescents who reported one or two unhealthy habits. Compared with the high/intermediate groups, the risk of low HRQOL was twice as high for each unit increase in BMI SDS, while the percentage was reduced by 12.2% for every unit increase in the KIDMED score and by 32.3% for each hour increase of exercise. The clustering of these two unhealthy behaviors conferred a 120% higher risk of low HRQOL. Similarly, adolescents displaying better diet quality and/or a physically more active lifestyle have better physical and psychological functioning. Further studies are needed to disclose whether these characteristics may be predictive of better adherence to weight loss treatment.

The Determinants of Health-Related Quality of Life in a Sample of Primary School Children: A Cross-Sectional Analysis

Background: Health-related quality of life (HRQoL) in childhood is a multidimensional construct with many sub dimensions of subjective experience, including physical activity (PA), psychological well-being, social interaction, and school performance, that represents a fundamental health outcome to assess a child’s physical and psycho-social functioning. Our study aims to explore the potential predictors of children’s health-related quality of life, using a convenience sample from the Imola Active Break Study (I-MOVE), considering demographic, anthropometric measures, PA level measured by Actigraph accelerometers, parent-reported/self-reported HRQoL, and body image. Methods: A cross-sectional analysis was conducted among 151 primary school children in Italy. HRQoL was assessed using the Italian version 4.0 of the Paediatric Quality of Life (PedsQL) questionnaire. Results: Children who spent more time partaking in moderate PA were associated with a higher total PedsQL score (p < 0.03). Mother’s body mass index (BMI) was the only variable statistically significant associated with the physical health domain of PedsQL. Parent’s proxy-report perception concerning children’s psychosocial health was statistically relevant. The children’s gender, age, and BMI had no association with any of the HRQoL outcomes. Discussion: Parent proxy-report psychosocial health and mother’s BMI should be considered as predictors of HRQoL for the psychosocial and physical domain. PA should be implemented in order to improve the HRQoL of primary school children.

Ten2Twenty-Ghana: Study Design and Methods for an Innovative Randomized Controlled Trial with Multiple-Micronutrient-Fortified Biscuits among Adolescent Girls in Northeastern Ghana

Investing in adolescent girls' nutrition is vital for health and for breaking the intergenerational cycle of malnutrition and deprivation, but limited knowledge on the type, timing, and efficacy of interventions delays progress. We describe the design of a 26-wk randomized placebo-controlled trial with multiple-micronutrient-fortified biscuits (MMBs) among adolescent girls in northeastern Ghana. Apparently healthy, premenarche (n = 312) and postmenarche (n = 309) girls (10-17 y) were randomly assigned to receive the following for 5 d/wk: 1) MMBs (fortified with 11 vitamins and 7 minerals) or 2) unfortified biscuits. Data included plasma micronutrient status, anthropometry, body composition, cognitive function, psychosocial health, fertility, dietary intake, and sociodemographic and socioeconomic covariates, complemented with in-depth interviews (n = 30) and 4 focus group discussions. We hypothesized an increase in plasma ferritin and retinol-binding protein with a resultant increase in hemoglobin, cognition, vertical height, and psychosocial health. Our study seeks to investigate the efficacy and optimal timing of a multiple-micronutrient food intervention program for adolescent girls. The RCT was registered prospectively with the Netherlands Clinical Trials Register (NL7487).

The Mediating and Moderating Effects of Physical Fitness of the Relationship between Adherence to the Mediterranean Diet and Health-Related Quality of Life in University Students

The aim of this study was to estimate the relationship between the adherence to the Mediterranean diet (MD) and health-related quality of life (HRQoL) in university students and to assess whether this relationship is mediated or moderated by cardiorespiratory fitness (CRF) and handgrip strength. A cross-sectional study was performed involving 310 first-year Spanish university students. Adherence to the MD was evaluated with the 14-item Mediterranean Diet Adherence Screener (MEDAS), and the HRQoL was evaluated with the Short Form-12 (SF-12) questionnaire. CRF was assessed by the 20 m shuttle run test, and the handgrip strength was determined by dynamometry. ANCOVA models showed that participants with higher CRF and handgrip strength levels had significantly higher scores in the physical component summary (PCS) and mental component summary (MCS) of the SF-12 and in the MEDAS questionnaire than those with medium and low scores (p < 0.050). Additionally, the ANCOVA models showed that students with good adherence to the MD showed higher scores in the MCS of HRQoL than those with low adherence (p = 0.044, ES = 0.013), but these results did not appear for the PCS of HRQoL (p = 0.728, ES = 0.001). In the mediation analysis, it was found that CRF and handgrip strength acted as full mediators of the relationship between adherence to the MD and the MCS of HRQoL. In the moderation analysis, it was evidenced that CRF and handgrip strength did not act as moderators in the relationship between adherence to the MD and the MCS of HRQoL. In conclusion, adherence to the MD does not seem to have a direct effect on the MCS of HRQoL because this association seems to be fully mediated by CRF and handgrip strength.

Quality of life in children and adolescents with overweight or obesity: Impact of obstructive sleep apnea

OBJECTIVES

To investigate the association between obstructive sleep apnea (OSA) and health related quality of life (HRQOL) in children and adolescents referred to an obesity treatment clinic. In addition, we examined the association between body mass index standard deviation score (BMI SDS) and HRQOL comparing children and adolescents with overweight or obesity without OSA with a control group of children and adolescents with normal weight without OSA.

METHODS

This cross-sectional study included 130 children and adolescents with overweight or obesity (BMI SDS > 1.28) aged 7-18 years recruited from an obesity treatment clinic. The control group consisted of 28 children and adolescents with normal weight (BMI SDS ≤ 1.28) aged 7-18 years recruited from schools. Sleep examinations were performed using a type 3 portable sleep monitor, Nox T3. OSA was defined as apnea-hypopnea index (AHI) ≥ 2. HRQOL was measured by the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scale.

RESULTS

A total of 56 children and adolescents with overweight or obesity were diagnosed with OSA (43%). The children and adolescents with OSA were older (p = 0.01) and had higher BMI SDS (p = 0.04) than children and adolescents without OSA. In generalized linear regression analyses adjusted for age, sex, BMI SDS and pubertal development stage there was no association between OSA or AHI and HRQOL in children and adolescents with overweight or obesity. In the analysis, including children and adolescents without OSA and the normal-weight control group, the generalized linear regression adjusted for age, sex and AHI revealed an association between BMI SDS and HRQOL (p < 0.001).

CONCLUSION

We found no association between AHI or OSA and HRQOL in children and adolescents with overweight or obesity. However, we found an association between BMI SDS and HRQOL in children and adolescents without OSA.

Confirmatory factor analysis of the proxy version of Kidscreen-27 and relationships between health-related quality of life dimensions and body mass index and physical activity in young schoolchildren

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The full Kidscreen-27 should be used with caution for young children.

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Physical activity was positively associated with physical well-being.

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Body mass was negatively associated with physical well-being.

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Compared to older children, the youngest may have more negative school experiences.

The aim of the study was to perform a confirmatory factor analysis (CFA) to investigate the psychometric properties of the proxy version of Kidscreen-27 in order to determine whether the instrument can be used to assess health-related quality of life (HRQoL) in young children (five to six years of age). Furthermore, we aimed to examine the relationships between the HRQoL dimensions and the body mass index (BMI), physical activity (PA), age, and gender. Altogether, 276 children from schools in eastern Norway were included (September 2016). HRQoL was measured using the Kidscreen-27 proxy version. CFA was conducted to examine the factorial validity of the five-dimension instrument. Structural equation modelling was used to estimate the relationship between the independent variables and the HRQoL subscales that showed an acceptable fit; physical well-being, social support and peers, and school environment. PA was positively, and BMI negatively associated with physical well-being (p < 0.5). Parents of the youngest children reported more negatively on the school environment subscale (p < 0.5). The full 27-item proxy version of Kidscreen should be used with caution for children as young as five to six years as two of the subscales were found to have unsatisfactory factor loadings. The physical well-being, the social support and peers, and the school environment subscales can provide valid and valuable data for research and practice. Even though the associations are small, it is worrying that adverse relationships between PA and BMI and physical well-being are detectable in such a young sample as included here.

Health-related quality of life among 13-14 year old adolescents with overweight-a mixed methods approach

BACKGROUND

Overweight and obesity are public concerns with risk of adverse health outcomes. Health-related quality of life (HRQoL) is lower in adolescents than children in general. An increase in body mass index (BMI) is associated with a decrease in HRQoL. The purpose of this study was to measure and explore the HRQoL among adolescents with overweight or obesity who had participated in an intervention study, Young & Active, with the aim of increasing physical activity (PA), reducing BMI and promoting HRQoL.

METHODS

Mixed methods, with a convergent design, were used to investigate how different methodological approaches could expand our understanding of the adolescents' HRQoL. Quantitative post-intervention data on HRQoL were collected among the 84 intervention participants, aged 13-14 years, using the KIDSCREEN 52 questionnaire. The data were compared with a Norwegian reference population of 244 individuals, and analysed using a non-parametric Mann-Whitney test. Qualitative semi-structured interviews were conducted with 21 adolescents from the intervention. A directed approach to content analysis was adopted, using the ten sub-scales from KIDSCREEN 52.

RESULTS

HRQoL in the intervention sample was significantly reduced on the sub-scale of physical well-being compared to the reference population. The reference population scored significantly lower than the intervention sample on the sub-scale of parent relation and home life. No significant differences were found on the other sub-scales. The qualitative data supported the quantitative findings on the sub-scale of physical well-being, but showed that perceptions of fitness, energy level or health could vary. Regarding parent relations, the interviewees extended this to include relationships to other family members as equally important. Most of the interviewees expressed a negative view of their bodies, but not their clothing or accessories. This may explain why no statistically significant differences were found on these aspects in the results from the KIDSCREEN questionnaire.

CONCLUSION

The use of the KIDSCREEN 52 instrument gave important indications about the adolescents' HRQoL and need for additional follow up. The qualitative data provided an in-depth understanding that nuanced the findings and widened our knowledge of the adolescents HRQoL. Combining methods enabled a comprehensive approach to research on HRQoL.

The "11 for Health in Denmark" intervention in 10- to 12-year-old Danish girls and boys and its effects on well-being-A large-scale cluster RCT

BACKGROUND

The present study investigates the well-being effects for 10- to 12-year-old children  who participated in the school-based intervention "11 for Health in Denmark," which comprises physical activity (PA) and health education. Subgroup analyses were carried out for boys and girls.

METHOD

Three thousand sixty-one children were randomly assigned to an intervention group (IG) or a control group (CG) by 5:1 cluster randomization by school. 2533 children (mean age 11.5 ± 0.4; 49.7% boys) were assigned to IG and 528 children (mean age 11.4 ± 0.5; 50.8% boys) were assigned to CG. IG participated in the "11 for Health in Denmark" 11-week program, consisting of 2 × 45 min per week of football drills, small-sided games, and health education. CG did not participate in any intervention and continued with their regular education. Before and after the intervention period, both groups answered a shortened version of the multidimensional well-being questionnaire KIDSCREEN-27.

RESULTS

The "11 for Health in Denmark" intervention program had a positive effect on physical well-being in girls (IG: 48.6 ± 8.5 to 50.2 ± 9.3), whereas the improvement was not significant in boys. The program also had a positive impact on well-being scores for peers and social support (IG: 50.2 ± 10.2 to 50.8 ± 10.1), though when analyzed separately in the subgroups of boys and girls the changes were not significant. No between-group differences were found for psychological well-being or school environment.

CONCLUSION

The intervention program had a positive between-group effect on physical well-being in girls, whereas the change was not significant in boys. The overall scores for peers and social support improved during the intervention period, but no subgroup differences were found.

The association between children's food habits, anthropometric parameters and health-related quality of life in Chilean school-age children

Introduction

Introduction: children's food habits have an influence on physical and mental health and should be monitored. Objective: the purpose of this study was to determinate the association between children's food habits (i.e., Mediterranean diet adherence), anthropometric parameters and health-related quality of life (HRQoL) in Chilean schoolchildren. Material and methods: girls (n = 282, 11.86 ± 0.82 years) and boys (n = 352, 12.02 ± 0.87 years) enrolled in public schools were included in this study (n = 634). Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), body fat (BF), nutritional level and HRQoL were evaluated. Results: the schoolchildren with high nutritional levels reported higher HRQoL (p = 0.018) and presented lower BMI, WC and WtHR (p < 0.001). Likewise, according to the following questions: Have your parent(s) treated you fairly? and Have you felt full of energy? The schoolchildren with high nutritional levels reported the major proportion in very and extremely answers (p < 0.001). The BMI was negatively correlated with HRQoL (r = -0.33, p < 0.05). Beside, children's food habits had significant correlation with HRQoL (r = 0.48, p = 0.002). The BMI (B = -0.41, 95% CI = -0.55, 0.93, p = 0.001) and children's food habits (B = -0.78, 95% CI = -0.09, -0.02, p = 0.002) reported associations with HRQoL. Conclusion: in conclusion, the nutritional level (i.e., Mediterranean diet adherence) and BMI presented associations with HRQoL in Chilean schoolchildren; therefore, it is important to consider these results and develop different strategies in schoolchildren to improve their nutritional levels, as HRQoL represents a measure of happiness or satisfaction with life.

Sports participation and health-related quality of life: a longitudinal observational study in children

PURPOSE

In this study, longitudinal associations between sports participation and health-related quality of life (HRQoL) were explored. Sports participation was operationalized as membership of a sports club, frequency of sports participation, performing individual versus team sports and performing indoor versus outdoor sports. The concept of HRQoL referred to the self-perceived enjoyment and satisfaction with one's personal health situation.

METHODS

Data from 618 fourth-grade primary school children were included at baseline; 10-13 months later, 417 children (response rate 67.5%) were retained. At both time points, children reported on sports participation (Move and Sports Monitor Questionnaire-youth aged 8-12 years) and health-related quality of life (KIDSCREEN-52). Because of the clustering of children in schools, data were analysed using linear mixed models. Analyses were adjusted for sex, age, BMI, household composition, SES and frequency of sports participation.

RESULTS

The questionnaires were fully completed by 417 children. High sports-active children showed better scores on almost all dimensions of HRQoL than moderate [difference (B) = - 1.82 (p = 0.05) to - 1.51 (p = 0.05)] or low ports-active children [difference (B) = - 3.67 (p < 0.001) to - 1.95 (p = 0.03)] and non-sports club members [difference (B) = - 5.58 (p < 0.001) to - 2.65 (p = 0.02)]. Unlike frequency, the other examined characteristics of sports participation were only to a limited extent longitudinal associated with HRQoL.

CONCLUSION

As frequency is more relevant than the form of sports participation, children should be encouraged to perform any kind of sports activity on a very regular base.

Weight Status, Physical Fitness, and Health-Related Quality of Life among Chinese Adolescents: A Cross-Sectional Study

PURPOSE

The impact of physical fitness (PF) on adolescents' health-related quality of life (HRQOL) is an important health issue in China. The purpose of this study was to identify whether body mass index (BMI), cardiorespiratory fitness (CRF), and musculoskeletal fitness (MSF) influences HRQOL among Chinese adolescents.

METHOD

The participants were 10,007 students (boys = 5276, 14.14 years ± 1.79; girls = 4829, 14.22 years ± 1.81) who were randomly selected from 30 secondary schools in Shandong, China. BMI, CRF, MSF, and HRQOL were measured and analyzed using ANCOVA and multiple regression.

RESULTS

BMI and physical fitness variables were partially associated with HRQOL in Chinese adolescents. ANCOVA showed a significant difference among BMI categories in terms of physical sense (PS), living convenience, and self-satisfaction (SS) for boys, but this difference was only seen with social activity opportunity (SAO) for girls. Multiple regression found that BMI was significantly associated with SAO. For boys, CRF was associated with the teacher and student relationship and SS, whereas MSF was only associated with PS. For girls, CRF was significantly linked with the parent and children relationship, learning capacity, and attitudes and self-perception (S-P), while MSF was associated with S-P.

CONCLUSION

Enforcing physical activity and enhancing PF will be a crucial pathway in improving adolescents' HRQOL in China.

Associations between physical fitness and adherence to the Mediterranean diet with health-related quality of life in adolescents: results from the LabMed Physical Activity Study

Background

Physical fitness (PF) and adherence to the Mediterranean diet are important indicators of healthy lifestyles. The purpose of this study is to analyze the independent and combined associations between PF and adherence to Mediterranean diet with health-related quality of life (HRQoL) in adolescents.

Methods

This is a cross-sectional analysis with 956 Portuguese adolescents aged 12-18 years. HRQoL was measured with the Kidscreen-10 questionnaire. PF was assessed with the ALPHA health-related fitness battery. The 20-m shuttle run test was used for the estimation of cardiorespiratory fitness; handgrip strength and standing long jump tests were applied for the assessment of muscular fitness and the 4 × 10 m shuttle run test for the assessment of motor fitness (speed and agility). The results of the PF tests (cardiorespiratory fitness, muscular fitness and motor fitness) were transformed into standardized values (Z-scores) by age and sex. Adherence to the Mediterranean diet was assessed with the KIDMED index. Regression analysis and analysis of covariance were performed.

Results

PF (B = 0.228; P < 0.05) and adherence to the Mediterranean diet (B = 0.259; P < 0.05) were positively associated with HRQoL, after controlling for several variables. Participants classified as high PF and high adherence to Mediterranean diet had on average the highest HRQoL score compared with those with low PF and low adherence to Mediterranean diet (F(3, 939) = 4.270; P = 0.005), after adjustments for potential confounders.

Conclusions

The combination of high PF levels and optimal adherence to Mediterranean diet is positively associated with HRQoL.

Multidisciplinary obesity treatment program improved health-related quality of life and positively correlated with anthropometric and body composition but not with cardiorespiratory fitness parameters in adolescents

PURPOSE

The aim of the present study was to verify the effects of a 16-week multidisciplinary obesity treatment program (MOTP) on health-related quality of life (HRQoL) in adolescents with weight excess. In addition, we verified a possible association between changes on HRQoL and anthropometric, body composition, and cardiorespiratory fitness (CRF) parameters.

METHODS

Two hundred four adolescents aged from 15 to 18 years were distributed in control group (CG) and intervention group (IG). They underwent a 16-week MOTP composed by nutritional, psychological, and health-related physical activity group sessions. Moreover, they performed physical exercise sessions three times per week during the whole 16-week program. Data on HRQoL, body composition, CRF and anthropometry were collected using standard protocols and validated questionnaires.

RESULTS

The MOTP promoted significant enhancements in all HRQoL domains, except for the school domain in IG. Furthermore, positive correlations between HRQoL and body weight (BW), body fat (BF), waist circumference (WC), and body mass index (BMI) z-score were verified. Higher scores of HRQoL might be achieved by improving these variables.

CONCLUSIONS

The 16-week MOTP was effective to improve HRQoL in adolescents with weight excess. This improvement has a positive correlation with enhancements in BW, BMI z-score, WC, and BF. Nevertheless, these findings have not reached a consensus on literature and still need to be further enlightened.

Is obesity associated with decreased health-related quality of life in school-age children?-Results from a survey in Vietnam

Background

Overweight and obesity have short-term and long-term effects on children's physical and mental health. These conditions currently have a tendency to increase among Vietnamese school children.

Aims

This study aimed to assess the quality of life among 8-10 year-old children in Vietnam.

Methods

This cross-sectional study was conducted with a sample of 264 children aged 8-10 years (including 88 obese children and 176 normal-weight ones) at two primary schools in Hanoi, Vietnam, in 2018 and their mothers or fathers participated in this study. The Vietnamese version of the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic score scales were used to collect information from children and their parents about the children's quality-of-life. Mean and standard deviation of PedsQL scores were calculated. Independent t-test was used to compare mean scores between normal-weight and obese children.

Results

Both child self reports and parent-proxy reports revealed that obese children had significantly lower scores for the total scales compared to normal weight children (80.7 versus 84.0; p < 0.05 for proxy reports and 77.6 vs 84.6; p < 0.001 for self reports). Total scale and subscale scores reported by parents were lower compared to those reported by children. Besides, 79% of normal weight children reported having PedsQL total scores in the highest quartile (≥75%), compared to 56.8 % of obese children (p = 0.01). Similarly, these proportions for parent-proxy reports were 79.5% and 65.9%, respectively (p < 0.05). Emotional scores were both found the lowest among the four subscales (71.6 for child self reports and 73.1 for parent-proxy reports).

Recommendations

Interventions aimed to improve quality of life of overweight and obese children in Vietnam should not focus only on diet adjustment and physical exercise but need to address all dimensions of health-related quality of life, especially emotional, social and school functioning.

Changes in Quality of Life in Elementary School Children-The Health Oriented Pedagogical Project (HOPP)

BACKGROUND

Quality of life (QoL) studies may provide information of change in health status in the population. Few studies have followed up previous cross-sectional studies to investigate any change in the QoL status of healthy children. The aim of the current study is to compare QoL in children 6⁻12 years old in two large cross-sectional studies of healthy children completed a decade apart.

METHODS

In the current study children and parents from nine elementary schools (n = 2816) were included in a cross-sectional study investigating children's QoL. Using the Life Quality in Children and Adolescents (ILC), completed by both children and parents, the global QoL-score was estimated for 2297 children and 1639 parental reports. These results were compared to a similar study performed in 2004. The scores from both studies were divided into categories of below average, average and above average QoL. The percentage change of QoL between the two studies is presented.

RESULTS

Our results show that parents report that more children have below and above average QoL in 2015 compared to 2004. In contrast, more children scored in the average and above average QoL category in 2015 than in 2004.

CONCLUSION

Parents reported lower QoL and children higher QoL in 2015 compared to 2004.

Relationship between obesity and health-related quality of life in children aged 7-8 years

BACKGROUND

The dramatic increase in the prevalence of obesity in developed and developing countries has become a major health care concern. Accordingly, there is growing recognition of the relationship between health-related quality of life (HRQOL) and obesity in the pediatric population. This study aimed to explore the relationship between HRQOL and different indicators of obesity in children aged 7-8 years.

METHOD

In total, 182 children participated in this study (mean age 7.71 (0.29) years, 48.91% girls). To assess obesity, an InBody 230 analyzer was used to calculate body mass index (BMI) and body fat percentage (BFP). The proxy version of the KIDSCREEN-27 questionnaire was used to assess HRQOL.

RESULTS

Among boys, 17.2% were overweight and 4.3% were obese according to BMI, while in terms of body fat percentage (BFP), the corresponding percentages were 12.9 and 9.7%, respectively. Among girls, the prevalence of overweight and obesity was 11.2 and 9.0% by BMI and 10.1 and 7.9% in terms of BFP, respectively. The analysis of BFP showed a significantly higher score in normal weight boys than in obese boys in the Social Support & Peers domains (KW H-test = 10.472, p = 0.03), while in girls, there were no significant differences between weight categories and any HRQOL dimensions.

CONCLUSION

Obesity at 7-8 years of age could negatively affect some HRQOL domains; in particular, obese boys may have low social support and peer functioning.

Body weight and quality of life among adolescents in Krakow

AIM

The aim of this study was to assess the relationship between body weight and the quality of life among adolescents in Krakow, Poland.

MATERIAL AND METHODS

The study comprised 1291 pupils - 632 girls and 659 boys from 17 Krakow middle schools. Their quality of life (QoL) was assessed by means of the Polish version of the KIDSCREEN-27 questionnaire. Five dimensions of QoL were analyzed as low, average and high QoL according to Polish cut-off points. The body mass index (BMI) of the adolescents was classified as underweight, normal weight, or excessive weight according to Polish growth charts.

RESULTS

Low QoL was observed significantly more often in girls than in boys. Excessive weight among both girls and boys was found to be a risk factor for low QoL in the "Physical Well-being" dimension as compared to normal weight adolescents. Additionally, boys with excessive weight had a two-fold higher risk of low QoL in the "Social Support % Peers" dimension (OR=2.00; 95%CI:1.14-3.50). Underweight was associated with higher risk of low QoL in the "Physical Well-being", "Autonomy & Parents", and "Social Support % Peers" dimensions, but only among boys.

CONCLUSIONS

Both, underweight and excessive weight were associated with low QoL. Excessive weight in youth was linked mainly with lower physical well-being. Underweight was a predictor of low QoL only among boys in the dimensions related to physical health, as well as relations with family and peers.

Association of obesity and health related quality of life in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study

BACKGROUND

Considering the role of different ethnical, cultural and geographical factors in health related quality of life (HRQOL) as well as the perception of different populations regarding various weight disorders, we aimed to evaluate the association between body mass index (BMI) and HRQOL in Iranian children and adolescents.

METHODS

This cross-sectional study was part of the Weight Disorders Survey of the CASPIAN-IV study. During this study, students aged 6-18 years from urban and rural areas of 30 provinces of Iran were selected. HRQOL of the students was evaluated by using the Persian version of the Pediatric Quality of Life inventory (PedsQL™ 4.0™ 4.0) Generic Core Scales. The mean of total HRQOL and its subscales were compared in underweight, normal weight, overweight and obese students.

RESULTS

The mean of total HRQOL, physical functioning and psychological functioning scores in the total population were 83.31, 84.25 and 82.79, respectively. The mean of the total HRQOL score and the psychosocial score were significantly lower in underweight students aged 6-12 years than in other groups (p<0.05). The mean of the total HRQOL score and psychosocial score were significantly lower in obese students aged 13-18 years than in other groups (p<0.05). Overweight and obesity was negatively associated with total HRQOL, psychosocial and school functioning subscales (p<0.05). There was a significant negative association between emotional functioning and obesity (p<0.05).

CONCLUSIONS

The findings or this study support the importance of personal perception and cultural norm roles in HRQOL. Given the association between weight disorders and psychosocial health, it is suggested that social and cultural factors have a more crucial role in the HRQOL of children and adolescents.

Subjective evaluation of psychosocial well-being in children and youths with overweight or obesity: the impact of multidisciplinary obesity treatment

PURPOSE

To investigate the effects of a multidisciplinary childhood obesity treatment programme on subjective evaluations of psychosocial well-being and quality of life.

METHODS

This longitudinal observational study included 1291 children, adolescents and young adults, 6-22 years of age, with overweight or obesity. At entry and after 2-82 months of obesity treatment, the patients evaluated the following domains of psychosocial well-being on a visual analogue scale: quality of life, mood, appetite, bullying, motivation for weight loss and body image satisfaction. The degree of overweight was calculated using a body mass index (BMI) standard deviation score (SDS) at each visit.

RESULTS

At entry, the mean BMI SDS was 2.81 (range: 1.35-6.65, 95% confidence interval (95% CI): 2.44-3.18). After a median of 14 months of treatment, the median reduction in BMI SDS was 0.29 (95% CI: 0.26-0.31, p < 0.0001). Improvements were observed in the domains of quality of life, mood, appetite, bullying and body image satisfaction (p < 0.0001). Larger reductions in BMI SDS were associated with greater improvements in the domains of quality of life (p = 0.001), mood (p = 0.04) and body image satisfaction (p < 0.0001), independent of BMI SDS at entry. However, improvements in psychosocial well-being were also observed in those increasing their BMI SDS (n = 315).

CONCLUSIONS

In a large group of children and youths, psychosocial well-being improved during a multidisciplinary childhood obesity treatment programme, irrespective of the degree of obesity at treatment entry. Greater reductions in BMI SDS were associated with greater improvements in psychosocial well-being, but even in the group increasing their BMI SDS improvements were observed.

A comparison of health-related quality of life in 5- and 10-year-old Swedish children with and without cleft lip and/or palate

BACKGROUND

The current understanding on health-related quality of life (HRQoL) in young Swedish children with cleft lip and/or palate (CL/P) is sparse, and therefore, research on impact of CL/P on HRQoL in children is needed.

AIMS

To investigate HRQoL in 5- and 10-year-old Swedish children with CL/P in comparison with non-cleft controls. Also to analyse whether there were any differences in HRQoL between children with cleft lip (with or without cleft palate, CL ± P) and cleft palate only (CP) and/or gender differences.

DESIGN

A total of 137 children with CL/P and 305 non-cleft controls participated. HRQoL was measured with KIDSCREEN-52.

RESULTS

All children in the study exhibited HRQoL within or above the age-matched reference interval of the method with similar results in both groups; however, in the dimension 'social support and peers', the 10-year-old children with CL/P perceived lower HRQoL than the non-cleft controls, but it did not reach statistical significance. Type of cleft or gender did not influence HRQoL.

CONCLUSIONS

Both 5- and 10-year-old Swedish children with CL/P had HRQoL in the normal reference interval. Their general life situations were well adjusted to their clefts, but the older children with CL/P felt more excluded and less supported by peers.

Obesity

Excessive fat deposition in obesity has a multifactorial aetiology, but is widely considered the result of disequilibrium between energy intake and expenditure. Despite specific public health policies and individual treatment efforts to combat the obesity epidemic, >2 billion people worldwide are overweight or obese. The central nervous system circuitry, fuel turnover and metabolism as well as adipose tissue homeostasis are important to comprehend excessive weight gain and associated comorbidities. Obesity has a profound impact on quality of life, even in seemingly healthy individuals. Diet, physical activity or exercise and lifestyle changes are the cornerstones of obesity treatment, but medical treatment and bariatric surgery are becoming important. Family history, food environment, cultural preferences, adverse reactions to food, perinatal nutrition, previous or current diseases and physical activity patterns are relevant aspects for the health care professional to consider when treating the individual with obesity. Clinicians and other health care professionals are often ill-equipped to address the important environmental and socioeconomic drivers of the current obesity epidemic. Finally, understanding the epigenetic and genetic factors as well as metabolic pathways that take advantage of 'omics' technologies could play a very relevant part in combating obesity within a precision approach.

Quality of life improves in children and adolescents during a community-based overweight and obesity treatment

PURPOSE

The quality of life is compromised in children and adolescents with overweight or obesity. The aim of this study was to evaluate whether the quality of life improves during a community-based overweight and obesity treatment, and whether improvements depend on reductions in the degree of obesity.

METHODS

Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 in children and adolescents aged 3-18 years with overweight or obesity [body mass index (BMI) ≥85th percentile] upon entry into a community-based chronic care overweight and obesity treatment based upon The Children's Obesity Clinic's Treatment protocol, and upon follow-up after 10-30 months of treatment. Height and weight were measured at each consultation and converted into a BMI standard deviation score (SDS).

RESULTS

Upon entry, 477 children (212 boys) completed a PedsQL, and 317 (143 boys) completed another PedsQL after a median of 13 months of treatment. Quality of life improved (p < 0.001), regardless of sex, age, and pubertal development stage upon entry (p ≥ 0.108). Greater reductions in BMI SDS and high socioeconomic status were associated with greater improvements in the quality of life (p ≤ 0.047). However, improvements also occurred in children and adolescents with low socioeconomic status or who increased their BMI SDS (p < 0.001).

CONCLUSIONS

Improvements in quality of life occurred in children and adolescents during a community-based overweight and obesity treatment, even in children and adolescents who increased their BMI SDS. Thus, improvements may be due to the treatment itself and not exclusively to reductions in BMI SDS.

TRIAL REGISTRATION

Clinicaltrials.gov, ID-no.: NCT02013843.

Relationship between weight status and health-related quality of life in Chinese primary school children in Guangzhou: a cross-sectional study

BACKGROUND

To investigate the association between weight status and health-related quality of life (HRQOL) among pupils in Guangzhou, China.

METHODS

The study comprised 5781 children aged 8-12 years from 29 schools. Height and weight were objectively measured using standardized methods, and BMI z-score derived using the age and sex specific WHO reference 2007 for 5-19 years. Weight status was classified as underweight (<-2SD), healthy weight (between -2SD and 1SD), overweight/obesity (>1SD). HRQOL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0.

RESULTS

After controlling for gender, age, school type, parental education, and family income, HRQOL scores were significantly lower in overweight/obese compared with healthy weight children only in the social functioning domain (β = -1.93, p = 0.001). Compared with healthy weight children, underweight children had significantly lower total (β = -1.47, p = 0.05) and physical summary scores (β = -2.18, p = 0.02). Subgroup analysis for gender indicated that compared to healthy weight, total (β = -1.96, p = 0.02), psychosocial (β = -2.40, p = 0.01), social functioning (β = -3.36, p = 0.001), and school functioning (β = -2.19, p = 0.03) scores were lower in overweight/obese girls, but not boys. On the other hand, being underweight was associated with lower physical functioning (β = -2.27, p = 0.047) in girls, and lower social functioning (β = -3.63, p = 0.01) in boys. The associations were mainly observed in children aged 10 and over, but were not significant in younger children. Children from private schools had generally lower HRQOL compared to those in public schools, but the associations with weight status were similar in both groups.

CONCLUSIONS

The relationship between overweight/obesity and HRQOL in children in China is not as prominent as that seen in children in western or high-income countries. However, there appears to be gender and age differences, with more of an impact of overweight on HRQOL in girls and older children compared with boys and younger children. Underweight is also associated with lower HRQOL. Future intervention to prevent both obesity and undernutrition may have a positive impact on the HRQOL in children in China.

[Quality-of-life-related factors in adolescents]

OBJECTIVE

To determine quality of life (QoL) and its relationship to lifestyles in adolescents in high schools.

METHODS

Cross-sectional, observational study with 256 students aged 12 to 17 in Seville (Spain). Multiple linear regression models were tested (p <0.05).

RESULTS

The boys had higher scores in most of the QoL areas. The female gender was inversely related to physical, psychological, familial QoL areas and the general QoL index. Family functionality and performing physical activity were the factors most associated with better QoL in all areas. All multivariate models were statistically significant and explained from 11% of social QoL variability to 35% of the general QoL index.

CONCLUSIONS

The findings could be useful for developing interventions to promote health in schools, with the objective of promoting healthy lifestyles and QoL.