The relationship between the home environment and child adiposity: a systematic review

Early life factors that affect obesity and the need for complex solutions

The prevalence of obesity increases with age but is apparent even in early life. Early childhood is a critical period for development that is known to influence future health. Even so, the focus on obesity in this phase, and the factors that affect the development of obesity, has only emerged over the past two decades. Furthermore, there is a paucity of iterative work in this area that would move the field forward. Obesity is a complex condition involving the interplay of multiple influences at different levels: the individual and biological level, the sociocultural level, and the environmental and system levels. This Review provides a brief overview of the evidence for these factors with a focus on aspects specific to early life. By spotlighting the complex web of interactions between the broad range of influences, both causal and risk markers, we highlight the complex nature of the condition. Much work in the early life field remains observational and many of the intervention studies are limited by a focus on single influences and a disjointed approach to solutions. Yet the complexity of obesity necessitates coordinated multi-focused solutions and joined-up action across the first 2,000 days from conception, and beyond.

Family-Based Motivational Interviewing and Resource Mobilization to Prevent Obesity: Living Well Together Trial

OBJECTIVE

Test an obesity intervention for families with low incomes.

METHODS

A total of 208 families were included (a parent with a body mass index [BMI] ≥ 30 and a child aged 6-12 years). A 12-month randomized controlled trial combining family health coaching (motivational interviewing) and connection to community resources. Comparison group: referrals for basic needs, written educational materials. Questionnaires, accelerometry, and anthropometrics. Intention-to-treat analysis of change in outcomes. Two-sided t test with multiple imputation.

RESULTS

Parents were 95% female, 31% Black, and 27% Hispanic. Children had a mean BMI-Z score of 1.15. Primary outcomes did not differ between groups at 12 months. Both groups significantly (P < 0.05) improved on the Family Nutrition and Physical Activity Scale for behaviors related to childhood obesity (mean ± SE: comparison, 2.8 ± 1.0; intervention, 2.2 ± 0.9), increased child sedentary activity (comparison, 32.5 ± 12.1; intervention, 39.9 ± 12.4 min/d), and decreased child moderate-vigorous physical activity (comparison, -9.6 ± 3.3; intervention -7.0 ± 3.0 min/d). Parents had no change in BMI.

CONCLUSIONS AND IMPLICATIONS

We successfully embedded screening and referral to address social needs within an obesity intervention. The coaching intervention did not provide additional benefits. Future research could explore ways to make these interventions more accessible, valuable, and effective for families.

Universal healthy school start intervention reduced the body mass index of young children with obesity

AIM

To evaluate the effect of a universal, school-based family support programme on body mass index (BMI) of children aged 5-7 years, using pooled data from three trials.

METHODS

The programme has three to four components and is delivered during the first school year. It aims to promote healthy dietary and physical activity behaviours, and secondarily prevent unhealthy weight gain. Three cluster-randomised controlled trials were conducted between 2010 and 2018 in low and mixed socioeconomic status areas in Sweden. Weight and height were measured. Multiple mixed linear regression analysis was performed on the pooled data.

RESULTS

In total, 961 children were included (50% girls, mean age 6.3 years). The post-intervention effect on BMI z-score in all children was small, but in those with obesity at baseline, we observed a significant, clinically relevant, decrease in BMI z-score (-0.21). This was most pronounced in children with a non-Nordic born parent (-0.24). Five to six months after the intervention, decreases were no longer statistically significant.

CONCLUSION

The intervention resulted in changes in BMI comparable to obesity treatment programmes focusing on behaviour change. However, the effect attenuated with time suggesting the programme should be sustained and evaluated for a longer time.

The association between parental cardiovascular health status and the risk of obesity in their offspring: Tehran Lipid and Glucose Study

BACKGROUND AND AIMS

Little is known about the association of parental cardiovascular risk factors with the risk of obesity in offspring. We aimed to investigate whether parental ideal cardiovascular health (ICVH) status was associated with the risk of general and central obesity in their young/adult offspring.

METHODS AND RESULTS

Of individuals who participated in the 2012-15 phase of the Tehran Lipid and Glucose Study, 2395 pairs of parent-unmarried offspring aged ≥6 years were selected in this cross-sectional study. General and central obesity were defined based on Iranian BMI percentile reference data for offspring aged ≤18 years. For subjects aged ≥19 years, central obesity was defined based on the introduced cut-off points for Iranian adults. We employed the American Heart Association's 2020 impact goal criteria of ICVH. The mean ± SD age of fathers and mothers were respectively 55.4 ± 9.79 and 48.4 ± 9.88. About 55% of offspring were older than 19 years. Higher adherence to ICVH score in mothers was associated with lower risk of overweight/obesity in female offspring (OR for Q1-Q4: 1, 0.56, 0.57, 0.37, P < 0.05 for all quartiles). Among ICVH components, only ideal BMI status in fathers was observed to be associated with a lower risk of overweight/obesity in their male offspring. The risk of abdominal obesity decreased in female offspring with increasing total ICVH score in mothers.

CONCLUSION

Higher adherence of parents to ICVH and its components was positively associated with a lower risk of general and abdominal obesity in their offspring. Our findings demonstrate that maternal-offspring relationship was stronger than paternal-offspring association.

A systems thinking framework for understanding rising childhood obesity in the Caribbean

OBJECTIVE

The aim of this study is to develop a systems thinking framework to describe the common complexities of childhood obesity in the Caribbean region and identify potential areas of intervention.

METHODS

Group model building (GMB) is a form of systems science. Trained GMB facilitators in Puerto Rico, the US Virgin Islands, Barbados, and Trinidad and Tobago convened a group of multi-disciplinary stakeholders in a series of virtual meetings in 2021 to elaborate a hypothesis of the system driving childhood obesity represented by causal loop diagrams (CLD). Commonalities and differences between the CLDs from each island were identified and reconciled to create a synthesized CLD.

RESULTS

A single explanatory CLD across the islands was developed and includes nine reinforcing loops. These loops addressed the interconnected role of schools, policy, commercial determinants, community and the personal experience of the child in rising childhood obesity rates.

CONCLUSIONS

Despite differences across settings, there is a core system driving childhood obesity in the Caribbean, as described by stakeholders in GMB workshops. Policy solutions to the problem must be multi-faceted and multi-level to address the interlinked reinforcing loops of the complex system and reduce rates of childhood obesity.

A Latent Class Analysis of Family Eating Behaviors and Home Environment Habits on Preschool-Aged Children's Body Mass Index

Background: The etiology of obesity is multifaceted, with multiple risk factors occurring during early childhood (e.g., fast food frequency, eating dinner as a family, TV in the bedroom). Many past studies have largely considered obesity risk factors in isolation, when in reality, the risk factors likely cluster together. A latent class analysis can be used to identify patterns in child eating behaviors, parent feeding behaviors, and household habits among preschool-aged children and their families to identify distinct, heterogenous classes and to determine if classes are associated with overweight and obesity. Methods: We used data from a community-based study of 624 three- to five-year-old children and a parent in New Hampshire, from March 2014 to October 2015. Parent-reported data were used to determine frequency of eating behaviors and household habits. Height and weight were objectively measured. Results: Four classes were identified; Class 1: "Healthy/Mildly accommodating," Class 2: "Healthy/Accommodating," Class 3: "Moderately healthy/Moderately accommodating," and Class 4: "Least healthy/Least accommodating." Compared with Class 1, children in Class 4 had increased odds of being overweight or obese [adjusted odds ratio (aOR): 1.64, 95% confidence interval (CI): 1.13-2.15], whereas Classes 2 and 3 were not associated with BMI (Class 2: aOR: 1.24, 95% CI: 0.62-1.86; Class 3: aOR: 1.31, 95% CI: 0.81-1.81). Conclusion: Study findings highlight that child-parent interactions around meals differentially relate to children's weight status given the context of children's eating habits. Most important, our study findings confirm the importance of adapting multiple healthy habits within the home social and physical environment to offset obesity risk in young children.

Examining the association of family environment and children emotional/behavioral difficulties in the relationship between parental anxiety and internet addiction in youth

Introduction

Associations between parental anxiety and adolescent internet addiction have been documented in the literature; however, few studies have analyzed the role of the family environment in this relationship. This study aims to explore the relationship between parental anxiety and adolescent internet addiction while also investigating the indirect relationships involving multiple dimensions of the family environment and child emotional behavior issues.

Methods

Surveys were conducted among 6,296 parent-child pairs. We administered SDQ, CIAS-R, and FES-CV to assess adolescents' issues and internet addiction, and evaluate family environment. Additionally, parents completed GAD-7 to assess parental anxiety levels.Results: Correlation analysis revealed that the family environment and adolescent emotional behavior issues played an indirect relationship in the link between parental anxiety and internet addiction.

Discussion

The findings emphasize the importance of addressing parental anxiety and fostering a positive family environment as effective measures to alleviate adolescent emotional behavior problems and reduce the risk of internet addiction.

Lifestyle Factors Counteract the Neurodevelopmental Impact of Genetic Risk for Accelerated Brain Aging in Adolescence

BACKGROUND

The transition from childhood to adolescence is characterized by enhanced neural plasticity and a consequent susceptibility to both beneficial and adverse aspects of one's milieu.

METHODS

To understand the implications of the interplay between protective and risk-enhancing factors, we analyzed longitudinal data from the Adolescent Brain Cognitive Development (ABCD) Study (n = 834; 394 female). We probed the maturational correlates of positive lifestyle variables (friendships, parental warmth, school engagement, physical exercise, healthy nutrition) and genetic vulnerability to neuropsychiatric disorders (major depressive disorder, Alzheimer's disease, anxiety disorders, bipolar disorder, schizophrenia) and sought to further elucidate their implications for psychological well-being.

RESULTS

Genetic risk factors and lifestyle buffers showed divergent relationships with later attentional and interpersonal problems. These effects were mediated by distinguishable functional neurodevelopmental deviations spanning the limbic, default mode, visual, and control systems. More specifically, greater genetic vulnerability was associated with alterations in the normative maturation of areas rich in dopamine (D2), glutamate, and serotonin receptors and of areas with stronger expression of astrocytic and microglial genes, a molecular signature implicated in the brain disorders discussed here. Greater availability of lifestyle buffers predicted deviations in the normative functional development of higher density GABAergic (gamma-aminobutyric acidergic) receptor regions. The two profiles of neurodevelopmental alterations showed complementary roles in protection against psychopathology, which varied with environmental stress levels.

CONCLUSIONS

Our results underscore the importance of educational involvement and healthy nutrition in attenuating the neurodevelopmental sequelae of genetic risk factors. They also underscore the importance of characterizing early-life biomarkers associated with adult-onset pathologies.

Family characteristics in adolescents with overweight or obesity: a network analysis

Background

Rates of overweight and obesity continue to grow in adolescents. Overweight and obesity in adolescence are associated with numerous immediate and long-term adverse health conditions. Throughout adolescence, parents and the family have an important and central influence on adolescents' health and lifestyle. The home environment may be a major factor in shaping children's weight. However, our current understanding of the interplay between family-related variables in adolescents with overweight or obesity is limited and fragmented. This study aimed to assess the relationship between family-related variables in adolescents who are overweight or obese using network analysis and inform future health promotion for family-based intervention.

Methods

Participants (n = 488) were recruited from middle schools in Nanjing from October 2022 to March 2023. Participants, together with their parents, completed a questionnaire at school about the family food environment, family size, family APGAR index, family physical activity facilities, parental mental health, rearing behavior, parental weight status, drinking history, marital satisfaction, and sociodemographic characteristics.

Results

The network split into three distinct communities of items. Network analysis showed that parental mental health and paternal rearing styles-rejection were the most central nodes in the network. In contrast, maternal weight status was the most peripheral and least connected nodes.

Conclusion

Family-related variables constituted a connected network in adolescents with overweight or obesity. The pattern of network node connections supports that interventions could prioritize targeting changing parental mental health and paternal rearing styles in adolescents with overweight or obesity.

Examining the Long-term Association Between Neighborhood Socioeconomic Status and Obesity and Obesity-related Unhealthy Behaviors Among Children: Results From the Fragile Families and Child Wellbeing Study

BACKGROUND

Literature has focused on neighborhood environments and their possible impacts on obesity and obesity-related behaviors. However, few longitudinal studies have examined the effect of neighborhood socioeconomic status (nSES) on childhood obesity.

PURPOSE

Investigate the longitudinal association between nSES and obesity and obesity-related unhealthy behaviors.

METHODS

We obtained data from the Fragile Families and Child Wellbeing Study (N = 2,072). The main exposure was nSES (measured using an index of five variables representing wealth, income, education, and occupation from the Decennial Census 2000) at ages 3, 5, and 9. The outcome was children's body mass index z-score (BMIz) at ages 5, 9, and 15. Three measures of obesity-related behaviors (i.e., child- or caregiver-reported soda/snack food intake, fast-food intake, and sedentary behaviors) at ages 5, 9, and 15 were included as mediators and outcomes. Cross-lagged path analyses were conducted.

RESULTS

Higher nSES at a previous wave was associated with consuming less soda/snack foods (βs = -0.15 to -0.11 [varying by ages], p < .05) and fast-food intake (βs = -0.21 to -0.14 [varying by ages], p < .01), and less frequent sedentary behaviors (βs = -0.14 to -0.06 [varying by ages], p < .01), but not with BMIz (βs = -0.08 to 0.05 [varying by ages], p > .05). Unhealthy behaviors did not mediate the nSES-BMIz association at alpha .05.

CONCLUSION

Health policies need to target low-socioeconomic neighborhoods to shape healthy lifestyles in children. To develop effective interventions, future research needs to examine comprehensive potential mediators like obesity-related parenting skills, home environments, and built and social environments on the risk of childhood obesity and obesity-related behaviors.

Alterations in Dietary Behavior, Appetite Regulation, and Health-Related Quality of Life in Youth with Obesity in Germany during the COVID-19 Pandemic

BACKGROUND

This study aimed to evaluate the impact of the COVID-19 pandemic on the nutritional patterns, eating behavior, dietary content, and health-related quality of life (HrQoL) of adolescents with preexisting obesity.

METHODS

Anthropometric and metabolic parameters were measured, and validated questionnaires on eating habits, nutritional content, and HrQoL were administered to 264 adolescents with obesity during the COVID-19 pandemic (June 2020-June 2022) and 265 adolescents with obesity before the pandemic (from June 2017 to June 2019).

RESULTS

Both study cohorts were comparable in age and sex distribution. Significant differences were found between the COVID-19 and pre-COVID-19 cohorts in HOMA-index (3.8 (interquartile range [IQR])): 3.3; 4.1) vs. 3.2 (IQR: 2.8; 3.5, p < 0.001), total cholesterol (208.8 mg/dL (IQR: 189.9; 214.5) vs. 198.5 mg/dL (IQR: 189.5; 207.4), p < 0.001), and GPT (93.4 (IQR 88.7; 96.5) vs. 72.8 U/L (IQR 68.9; 75.7), p < 0.001). The COVID-19 cohort reported significantly higher consumption of obesity-promoting food components, such as soft drinks, meat, sausages, fast food and delivery food, chocolate, and sweets. There was also a significant decrease in cognitive hunger control (p = 0.002) and an increase in distractibility potential (p = 0.001) while eating. HrQoL was significantly lower in the COVID-19 cohort (p = 0.001).

CONCLUSIONS

This study reveals the adverse associations of exposure to the public health measures during the COVID-19 pandemic with nutrition, dietary content, and HrQoL in adolescents with preexisting obesity. These findings underscore the importance of tailored preventive and treatment strategies for addressing the specific challenges of disruptive events such as pandemics, especially in population-based context.

Parent Weight, Diet, Active Living, and Food-Related Outcomes of the Family-Focused:NU-HOME Randomized Controlled Trial: NU-HOME Randomized Controlled Trial

BACKGROUND

Little is known about parent outcomes of rural, family-focused childhood obesity prevention trials.

OBJECTIVE

Our aim was to evaluate parent outcomes of the rural, family-focused NU-HOME (New Ulm at HOME [Healthy Offerings via the Mealtime Environment]) randomized controlled trial designed to prevent obesity in children aged 7 through 10 years.

DESIGN

Families were randomized to the intervention or wait-list control group after baseline data collection. Staff measured parent height, weight, and percent body fat. Surveys measured parent cognitive and behavioral outcomes (eg, portion-size confidence, dietary intake, total and moderate-to-vigorous physical activity, and screen time). Post-intervention data were collected 8 to 10 months after baseline.

PARTICIPANTS/SETTING

The randomized controlled trial took place in rural, south central Minnesota, and enrolled parent and child dyads (N = 114; 2017-2018); 98 parents provided data at post intervention (2018-2019) and comprise the analytic sample. Parent inclusion criteria were being the primary meal preparer, living with the child most of the time, and being willing to attend intervention sessions. Exclusion criteria were planning to move or having a medical condition that would contraindicate participation.

INTERVENTION

The theory-guided intervention (7 sessions and 4 goal-setting calls) focused on family eating and active living behaviors.

MAIN OUTCOME MEASURES

Height, weight, and percent body fat were measured and the survey assessed diet, active living, and food-related outcomes.

STATISTICAL ANALYSES PERFORMED

Multiple linear regression models tested change in parent outcomes from baseline to post intervention by treatment group adjusted for demographic characteristics and baseline values.

RESULTS

In the intervention group vs control group, parent total weekly hours of physical activity was 1.73 hours higher (95% CI 0.11 to 3.35 hours) and portion-size confidence was 1.49 points higher (95% CI 0.78 to 2.19). No other statistically significant changes were observed by treatment group.

CONCLUSIONS

Findings indicate that parent cognitive and behavioral outcomes are amenable to change in family-focused childhood obesity prevention programs. Parent increases in portion-size confidence and total physical activity hours may support long-term parent health and provide positive context for child health.

Attachment, Feeding Practices, Family Routines and Childhood Obesity: A Systematic Review of the Literature

Childhood obesity is considered a major public health problem. To help prevention and intervention programs targeting families with obese children, this paper is aimed at synthesizing multifactorial and transactional data resulting from studies and reviews assessing relational factors between the child and his or her parents and the child's obesity risk, including the child's and CG's attachment quality, parental feeding practices, and family routines. It is also aimed at assessing the mediation of these links by specific self-regulatory capacities across different developmental periods (0-2, 2-8, and 8-18 years old). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were applied in the review methodology. Ten papers were analyzed, including seven empirical studies and three reviews proposing etiological models of childhood obesity. The quality of empirical studies was assessed, and a synthetical model of the results was proposed. This literature review showed that the caregiver's (CG) and the child's attachment quality, along with controlling or permissive feeding practices, and few family routines are mostly mediated by appetite dysregulation and emotional regulation strategies with the development of child obesity. New research topics are proposed to understand other facets of childhood obesity, as well as how to better prevent and treat it.

The association among SES, screen time, and outdoor play in children at different ages: The GECKO Drenthe study

Introduction

This study examined the association among socioeconomic status (SES), screen time, and outdoor play in children at different ages in the GECKO Drenthe birth cohort study.

Methods

Valid data were obtained from two surveys at ages 3-4 years and 10-11 years. Screen time (TV watching and computer use) and outdoor play were reported by parents. Childhood SES was derived by a synthetic "Equivalized Household Income Indicator," an estimated disposable income. Quantile regression models (cross-sectional analysis) and linear regression models (change between 3-4 and 10-11 years) were used.

Results

In general, screen time increased strongly from a median of 51 min/day at 3-4 years (n = 888) to 122 min/day at 10-11 years (n = 1023), whereas time spent on outdoor play remained stable over age (77 min/day at 3-4 years and 81 min/day at 10-11 years). More time spent on outdoor play (50th quantile) was found in children with low SES families at 3-4 years, while at 10-11 years, more outdoor play was found in the high SES group. At 10-11 years, in the higher ranges of screen time, children from high SES had relatively lower screen time [50th quantile: -10.7 (-20.8; -0.6); 75th quantile: -13.6 (-24.4; -2.8)]. In the longitudinal analysis (n = 536), high SES was associated with an increasing time spent on outdoor play [11.7 (2.7; 20.8)].

Conclusion

Socioeconomic disparities in children's outdoor play and screen behavior may be more obvious with increasing age. Low SES may facilitate both outdoor play (at 3-4 years) and screen time (at 10-11 years); however, children from high SES families develop slightly more favorable behavior patterns with age.

Young children’s interest-driven information practices

Purpose

This study aims to explore young children’s information practices within the context of their individual interests, examining children’s interest-related information activities, challenges encountered and enablers received.

Design/methodology/approach

Participants included 18 children between five and seven years of age and their parents. Data were collected using a multi-stage participatory approach. Children shared their experiences via a book discussion, poster activity, participant-generated photography and a photo-elicitation interview. Parents provided information about family demographics and their perceptions of their children’s individual interests, information practices and digital media use via questionnaires. Data were analyzed using the constant comparative method.

Findings

Young children seek information via print and digital objects, other people and experiences, and use information by applying it to their activities and sharing information with others. Challenges to information activities include children’s own capabilities and skills, constraints of information sources and parental restrictions on their activities. Enablers include affordances of technology and parental support.

Originality/value

This study takes a holistic approach to understanding young children’s perspectives of their information activities, examining information use and sharing activities in addition to information seeking.

Associations between the home environment and childhood weight change: a cross-lagged panel analysis

BACKGROUND

The obesogenic quality of the home environment is hypothesised to play an important role in children's weight development but few prospective studies have investigated relationships between the home environment and adiposity across childhood.

OBJECTIVE

To investigate the continuity and stability of the home environment from ages 4 to 12, and bi-directional relationships between the home environment and BMI-SDS from ages 4 to 12.

METHODS

Parents from the Gemini cohort completed the Home Environment Interview (HEI), a comprehensive measure of the obesogenic home environment, when their children were aged 4 and 12 (n = 149 families, n = 298 children). The obesogenic home environment was measured using four composite scores capturing the food, activity, media environments, and the overall home environment. Child weights and heights were used to calculate BMI-SDS. Continuity was assessed with Pearson's correlations between scores at each time point, and stability by changes in mean scores over time. Cross-lagged analyses were performed (HEI composites at age 4 to BMI-SDS at age 12 and the reverse) to measure the magnitude and direction of associations.

RESULTS

The home environment showed moderate-to-high continuity from ages 4 to 12 (r = 0.30-0.64). The overall home environment (r = 0.21, p < 0.01) and media composites (r = 0.23, p < 0.01) were cross-sectionally associated with child BMI-SDS at age 12, but not at age 4. Longitudinally, the home media environment at age 4 predicted increases in child BMI-SDS at age 12 (β; 95% CI = 0.18; 0.08,0.28, p < 0.01). No associations were observed for the reverse path, or the remaining composites (the overall, food and activity) in either direction.

CONCLUSION

This study provides evidence that the obesogenic home environment tracks across childhood and highlights the importance of the early home media environment for child weight development. The findings provide insight into key aspects of the home environment that could be targeted when developing obesity treatment or prevention strategies.

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. 

Determinants of High Fat Mass Index in Preschoolers Living in Brazilian Urban Areas

OBJECTIVE

Determine the social, environmental, and personal factors associated with high fat mass index in preschoolers.

DESIGN

A quantitative, exploratory, and cross-sectional study.

SETTING AND PARTICIPANTS

Fifty-one Brazilian preschoolers from public schools living in urban areas.

MAIN OUTCOME MEASURE(S)

The preschoolers' fat mass index was determined using dual-energy radiological absorptiometry. The quality of home and school environments were accessed using the Early Childhood Home Observation for Measurement of the Environment and Early Childhood Environment Rating Scales. The physical activity levels were recorded by accelerometers. The daily energy intake was recorded and sociodemographic data using the Brazilian Economic Classification criterion. Data on exposure time to screens and parental obesity were collected according to the parents' reports.

ANALYSIS

Data analyses were performed using simple and multiple regressions models.

RESULTS

Parental obesity (β, 0.516; 95% confidence interval [CI], 2.078-5.133), high quality of environmental stimulation of home (β, 0.429; 95% CI, 1.294-4.023), and high exposure time to screens (β, 0.256; 95% CI, 0.215-2.554) explained 43% of preschoolers' high fat mass index.

CONCLUSIONS AND IMPLICATIONS

Identification of parental obesity, high quality of environmental stimulation of home, and high exposure time to screens as the most important determinants of the high fat mass index in preschoolers from Brazilian urban areas.

Family Food Environments and Their Association with Primary and Secondary Students' Food Consumption in Beijing, China: A Cross-Sectional Study

Family is the most fundamental and proximal context for children, and children’s eating behavior occurs mostly in the home or together with family members. With this study, we aimed to evaluate the distribution of family food environment dimensions and their relationship with healthy and unhealthy food consumption in primary and secondary students in order to provide evidence in the Chinese context and explore environmental solutions for improved child nutrition. Multi-stage stratified cluster sampling was used to conduct a cross-sectional survey among students in Beijing, China, from September 2020 to June 2021. Family food environment (FFE) was measured by the validated Family Food Environment Questionnaire for Chinese School-age Children, which was self-administered by the children’s caregivers. The students were asked to answer questions about food consumption frequencies in the past 7 days. Binary logistic regression models were used to investigate the relationships between food consumption frequency and FFE, and odds ratios (ORs) with 95% confidence intervals (CI) were computed for independent variables. Among the study population, 9686 students in grades 3−12 and their caregivers completed the survey. The mean score of FFE was 65.7 (±8.4) out of a total possible score of 100, with 76.6% of students categorized as relatively healthier according to their FFE score (≥ 60). Compared with the reference group, students in primary schools and those cared for principally by parents were more likely to be in a healthy FFE category (p < 0.05). Daily consumption of fruits and vegetables was reported by 62.6% and 71.6% of students, respectively, and weekly sugared soft drink consumption was reported by 70.9% of the students. Students with a healthier FFE score (≥60) were more likely to consume fruits (OR = 1.578, 95% CI: 1.428~1.744) and vegetables (OR = 1.402, 95% CI: 1.263~1.556) but less likely to consume sugared soft drinks (OR = 0.592, 95% CI: 0.526~0.667). Family food availability (β = 0.137), caregivers’ nutritional literacy (β = 0.093), meal practices (β = 0.079) and food rules (β = 0.050) were positively correlated with food consumption behavior (p < 0.05). The students with healthier FFE scores (OR = 1.130, 95% CI: 1.014~1.258) and whose caregiver was obese (OR = 2.278, 95% CI: 1.973~2.631) were more likely to be overweight. The family food environment plays an important role in shaping food consumption in children. Provision of healthy foods instead of unhealthy foods, positive meal practices and food rules, and nutrition education for parents can promote healthy eating in children.

Risk Factors for Overweight and Obesity within the Home Environment of Preschool Children in Sub-Saharan Africa: A Systematic Review

Sub-Saharan Africa (SSA) is experiencing an increasing prevalence of young children being overweight and obese. Many feeding and physical activity-related behaviours are established at home during preschool years, yet the precise factors that contribute to preschool overweight and obesity have not been fully elucidated. This review aims to identify factors in the home environment associated with overweight and or obesity in preschool children in SSA. Ovid MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Africa Journals Online (AJOL) and the African Index Medicus databases were systematically searched for qualitative and quantitative studies published between 2000 and 2021. Eleven studies (ten quantitative, one qualitative) met the inclusion criteria. Overall, the results highlight the paucity of studies exploring factors in the home environment associated with overweight and obesity in preschool children in Sub-Saharan Africa. The home food environment and maternal BMI appear to be important factors associated with overweight and obesity in preschool children; however, the information for all other factors explored remains unclear due to the lack of evidence. For successful obesity prevention and treatment interventions to be developed, more research in this area is required to understand how different aspects of the home environment contribute to overweight and obesity in preschool Sub-Saharan African children.

Chronic kidney disease predictors in obese adolescents

BACKGROUND

Glomerular hyperfiltration, initiating development of obesity-related glomerulopathy, results in an enlargement of the glomeruli and unsealing of the filtration barrier. It can be followed by adaptive focal segmental glomerulosclerosis and chronic kidney disease (CKD). The aim of the study was to determine the expression pattern of lipid metabolism and selected kidney damage markers in obese adolescents and to identify potential factors which can predict CKD.

METHODS

The study group consisted of 142 adolescents with a BMI z-score > 2. Sixty-two healthy and normal-weight individuals served as controls. The factors associated with the rate of glomerular filtration in obese adolescents were assessed by linear regression methods using univariate and multivariate analyses. The risk of developing CKD was estimated using the Fisher's exact test.

RESULTS

The study group was divided into "elevated," "normal," and "decreased" glomerular filtration rate (GFR) patients. Increased urine galectin-3 (Gal-3) concentration was diagnosed in all patients. "Decreased GFR" subjects expressed increased urine concentration of neutrophil gelatinase-associated lipocalin (NGAL) and daily megalin excretion. Thirty-nine study participants developed CKD. Increased uric acid (UA) concentration was associated with CKD development both in "normal" and "decreased GFR" patients. Additionally, in "normal" GFR patients, increased concentrations of cholesterol (Ch), triglycerides (TG), and NGAL were associated with CKD.

CONCLUSIONS

Increased serum concentrations of Ch, TG, and UA and increased urine concentration of NGAL might predict CKD development in obese adolescents with normal and decreased GFR. A higher resolution version of the Graphical abstract is available as Supplementary information.

Where and when are portion sizes larger in young children? An analysis of eating occasion size among 1·5-5-year-olds in the UK National Diet and Nutrition Survey (2008-2017)

OBJECTIVE

To identify eating occasion-level and individual-level factors associated with the consumption of larger portions in young children and estimate their relative importance.

DESIGN

Cross-sectional.

SETTING

Data from parent-reported 4-d food diaries in the UK National Diet and Nutrition Survey (2008-2017) were analysed. Multilevel models explored variation in eating occasion size (kJ) within (n 48 419 occasions) and between children (n 1962) for all eating occasions. Eating contexts: location, eating companion, watching TV, and sitting at a table and individual characteristics: age, gender, ethnicity and parental socio-economic status were explored as potential correlates of eating occasion size.

PARTICIPANTS

Children aged 1·5-5 years.

RESULTS

Median eating occasion size was 657 kJ (IQR 356, 1117). Eating occasion size variation was primarily attributed (90 %) to differences between eating occasions. Most (73 %) eating occasions were consumed at home. In adjusted models, eating occasions in eateries were 377 kJ larger than at home. Eating occasions sitting at a table, v. not, were 197 kJ larger. Eating in childcare, with additional family members and friends, and whilst watching TV were other eating contexts associated with slightly larger eating occasion sizes.

CONCLUSIONS

Eating contexts that vary from one eating occasion to another are more important than demographic characteristics that vary between children in explaining variation in consumed portion sizes in young children. Strategies to promote consumption of age-appropriate portion sizes in young children should be developed, especially in the home environment, in eating contexts such as sitting at the table, eating with others and watching TV.

Inequalities in body mass index, diet and physical activity in the UK: Longitudinal evidence across childhood and adolescence

We use longitudinal data across a key developmental period, spanning much of childhood and adolescence (age 5 to 17, years 2006-2018) from the UK Millennium Cohort Study, a nationally representative study with an initial sample of just over 19,000. We first examine the extent to which inequalities in overweight, obesity, BMI and body fat over this period are consistent with the evolution of inequalities in health behaviours, including exercise and healthy diet markers (i.e., skipping breakfast) (n = 7,220). We next study the links between SES, health behaviours and adiposity (BMI, body fat), using rich models that account for the influence of a range of unobserved factors that are fixed over time. In this way, we improve on existing estimates measuring the relationship between SES and health behaviours on the one hand and adiposity on the other. The advantage of the individual fixed effects models is that they exploit within-individual changes over time to help mitigate biases due to unobserved fixed characteristics (n = 6,883). We observe stark income inequalities in BMI and body fat in childhood (age 5), which have further widened by age 17. Inequalities in obesity, physical activity, and skipping breakfast are observed to widen from age 7 onwards. Ordinary Least Square estimates reveal the previously documented SES gradient in adiposity, which is reduced slightly once health behaviours including breakfast consumption and physical activity are accounted for. The main substantive change in estimates comes from the fixed effects specification. Here we observe mixed findings on the SES associations, with a positive association between income and adiposity and a negative association with wealth. The role of health behaviours is attenuated but they remain important, particularly for body fat.

The Home Environment Interview and associations with energy balance behaviours and body weight in school-aged children - a feasibility, reliability, and validity study

BACKGROUND

The home environment is thought to influence children's weight trajectories. However, few studies utilise composite measures of the home environment to examine associations with energy balance behaviours and weight. The present study aimed to adapt and update a comprehensive measure of the obesogenic home environment previously developed for pre-schoolers, and explore associations with school-aged children's energy balance behaviours and weight.

METHODS

Families from the Gemini cohort (n = 149) completed the Home Environment Interview (HEI) via telephone when their children were 12 years old. The HEI comprises four composite scores: one for each domain (food, activity and media) of the environment, as well as a score for the overall obesogenic home environment. The primary caregiver also reported each child's height and weight (using standard scales and height charts), diet, physical activity and sedentary screen-based behaviours. A test-retest sample (n = 20) of caregivers completed the HEI a second time, 7-14 days after the initial interview, to establish test-retest reliability.

RESULTS

Children (n = 298) living in 'higher-risk' home environments (a 1 unit increase in the HEI obesogenic risk score) were less likely to consume fruits (OR; 95% CI = 0.40; 0.26-0.61, p < 0.001), and vegetables (0.30; 0.18-0.52, p < 0.001), and more likely to consume energy-dense snack foods (1.71; 1.08-2.69, p = 0.022), convenience foods (2.58; 1.64-4.05, p < 0.001), and fast foods (3.09; 1.90-5.04, p < 0.001). Children living in more obesogenic home environments also engaged in more screen-time (β (SE) = 4.55 (0.78), p < 0.001), spent more time playing video games (β (SE) = 1.56 (0.43), p < 0.001), and were less physically active (OR; 95% CI = 0.57; 0.40-0.80, p < 0.01). Additionally, there was a positive association between higher-risk overall home environment composite score and higher BMI-SDS (β (SE) = 0.23 (0.09), p < 0.01). This finding was mirrored for the home media composite (β (SE) = 0.12 (0.03), p < 0.001). The individual home food and activity composite scores were not associated with BMI-SDS.

CONCLUSION

Findings reveal associations between the overall obesogenic home environment and dietary intake, activity levels and screen-based sedentary behaviours, as well as BMI in 12 year olds. These findings suggest that the home environment, and in particular the home media environment, may be an important target for obesity prevention strategies.

[Entorno social y obesidad infantil: implicaciones para la investigación y la práctica en Estados Unidos y en los países latinoamericanos]

The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.

The social environment and childhood obesity: Implications for research and practice in the United States and countries in Latin America

The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.

The Association Between Sedentary Screen Time, Non-screen-based Sedentary Time, and Overweight in Chinese Preschool Children: A Cross-Sectional Study

Introduction: Less is known about the effects of the different domains of sedentary behaviors on healthy weight in young children. This cross-sectional study examined the association between sedentary screen time (SST), non-screen-based sedentary time (NSST), and overweight (and obesity) in Chinese preschoolers. Methods: Data were collected from the Physical Activity and Health in Tianjin Chinese Children study (PATH-CC), involving healthy children 3-6 years old and their families. Children's overweight status was classified according to the international (IOTF) childhood BMI cut-offs. SST and NSST were reported in minutes/day by parents using the leisure-time sedentary behaviors questionnaire. Logistic regression models adjusted by sex, age, socioeconomic status, outdoor play, and sleep duration were used. Results: In a total of 971 children (55.4% boys), 11.8% were overweight. Generally, children spent 1 h/day in SST and 1 h/day in NSST. Multiple models showed that children who spent more time in SST were more likely to be overweight [OR and 95% CI: 1.22 (1.03-1.45)]. No correlation between time spent on NSST and children with overweight was found (P > 0.05). Conclusions: This study indicated that children who spent more time in SST were more likely to be overweight, but a null correlation between NSST and overweight was found. Longitudinal studies designed to identify associations between exposures to screen media and changes in metabolic parameters during a child's early years are needed.

Amidst the COVID-19 pandemic childhood obesity is still an epidemic-spotlight on obesity's multifactorial determinants

PURPOSE

Childhood obesity is a global epidemic and a chronic disease. Multifactorial determinants have long been linked with childhood obesity. These have been challenged with the onset of COVID-19 and the associated mitigation measures. The study aimed to re-highlight these determinants while exploring the effects of the ongoing COVID-19 pandemic on these pre-existing childhood obesity determinants, while providing evidence that may be beneficial for the post-COVID-19 recovery plan.

METHODS

A PubMed literature search (2016-2021) using the keywords, "childhood obesity", "gender", "sex", "obesity in youth", "obesity in adolescents", "COVID-19″ and "SARS-CoV2" was performed.

RESULTS

Genetic predisposition, biologically low leptin levels, certain cultural beliefs and socio-economic statuses, as well as exposure to an "obesogenic" environment were found to have a positive association with childhood obesity. Additionally, the onset of COVID-19 further aggravates the childhood obesity epidemic, increasing childrens' susceptibility to obesity and all associated consequential diseases.

DISCUSSION

A possible key to the control and prevention of the burden of childhood obesity, lies in dealing with its precursors and risk factors. Certain factors, including socio-cultural norms, cultural beliefs and geographical factors are amenable. COVID-19 further challenged these and it is evident that the childhood obesity epidemic is still a critical one. Encouraging preventative interventions, such as screening programs, public awareness and policies targeting the environment, amongst others, are recommended.