Childhood obesity classification systems and cardiometabolic risk factors: a comparison of the Italian, World Health Organization and International Obesity Task Force references

Trends in the prevalence of obesity, overweight, and thinness among schoolchildren aged 7-14 years from southern Brazil (2002-2019)

OBJECTIVE

To analyze the obesity, overweight, and thinness trends among Brazilian schoolchildren by sex, age group, and type of school according to World Health Organization (WHO) and International Obesity Task Force (IOTF) criteria.

METHODS

We conducted four surveys between 2002 and 2018/19 involving schoolchildren aged 7-14 years from a state capital in southern Brazil. Weight status was classified using both WHO and IOTF criteria.

RESULTS

In the total sample, obesity prevalence based on the IOTF and the WHO criteria were 72% and 44% higher in 2018/19 compared with 2002, respectively. Over the whole period, the obesity prevalence increased among children (WHO: 10.1% vs. 14.1%; IOTF: 5.0% vs. 8.3%), and those from public schools (WHO: 10.5% vs. 16.4%; IOTF: 5.6% vs. 10.1%). There was no significant reduction in thinness prevalence over the analyzed period.

CONCLUSION

Obesity prevalence remains on an upward trend in a state capital in southern Brazil, especially among children from public schools. A higher prevalence of overweight and obesity was observed using the WHO criteria compared with IOTF criteria.

MULT: A new BMI reference to assess nutritional status of multi-ethnic children and adolescents

OBJECTIVES

To develop a new Body Mass Index (BMI) reference (MULT) based on longitudinal data of multi-ethnic populations and to compare it to international BMI references.

METHODS

The MULT BMI reference was constructed through the LMS method and the Generalized Additive Models for Location Scale and Shape (GAMLSS), with 81 310 observations of 17 505 subjects aged 0-22 years old, from the United Kingdom, Ethiopia, Peru, India, Vietnam, Brazil, and Portugal. Outlier values were removed based on weight z-scores (population level) and based on BMI z-scores using the linear mixed effects model (individual level). The MULT M, S and L curves were compared to the ones of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF), and Dutch Growth Study (DUTCH). The MULT BMI percentile cutoffs for overweight and obesity were calculated using the adult BMI values of 25 and 30 kg/m2 at 17, 18, 19, and 20 years old.

RESULTS

MULT presented the lowest mean BMI values for the ages 102-240 months for boys and 114-220 months for girls. MULT S values were similar to the WHO and IOTF for children under 60 months of age and the highest during puberty, while the L curve showed to be more symmetric than the other BMI references.

CONCLUSION

The MULT BMI reference was constructed based on recent data of populations from 10 countries, being a good option to assess the nutritional status of multi-ethnic populations.

Different criteria for body mass index classification for excess weight screening in children aged six to ten years

OBJECTIVE

To evaluate the agreement between body mass index (BMI) parameters applied to children aged six to ten years in the city of Montes Claros (MG), Brazil with national and international criteria, also calculating their sensitivity and specificity regarding excess weight screening.

METHODS

A sample comprising 4151 children aged six to ten years was assessed, with height and body mass determined for BMI calculation. The obtained values were classified according to cutoff points established by the World Health Organization (WHO), International Obesity Task Force (IOTF), Centers for Disease Control and Prevention (CDC), Conde & Monteiro, and a recent local proposal. The agreement index between the mentioned criteria was calculated and thereafter the sensitivity and specificity.

RESULTS

The local proposal was proven to be highly consistent in most combinations, especially concerning the excess weight criteria of the World Health Organization (WHO) (k=0.895). Regarding excess weight, the local proposal presented sensitivity and specificity values of 0.8680 and 0.9956, respectively, indicating high BMI discrimination power.

CONCLUSIONS

The locally applied BMI parameters for children aged six to ten years represent a valid, highly viable and practical proposal for excess weight screening in this population group, improving professional decision-making in their follow-up.

Childhood Obesity and the Cryptic Language of the Microbiota: Metabolomics’ Upgrading

The growing obesity epidemic in childhood is increasingly concerning for the related physical and psychological consequences, with a significant impact on health care costs in both the short and the long term. Nonetheless, the scientific community has not yet completely clarified the complex metabolic mechanisms underlying body weight alterations. In only a small percentage of cases, obesity is the result of endocrine, monogenic, or syndromic causes, while in much more cases, lifestyle plays a crucial role in obesity development. In this context, the pediatric age appears to be of considerable importance as prevention strategies together with early intervention can represent important therapeutic tools not only to counteract the comorbidities that increasingly affect children but also to hinder the persistence of obesity in adulthood. Although evidence in the literature supporting the alteration of the microbiota as a critical factor in the etiology of obesity is abundant, it is not yet fully defined and understood. However, increasingly clear evidence is emerging regarding the existence of differentiated metabolic profiles in obese children, with characteristic metabolites. The identification of specific pathology-related biomarkers and the elucidation of the altered metabolic pathways would therefore be desirable in order to clarify aspects that are still poorly understood, such as the consequences of the interaction between the host, the diet, and the microbiota. In fact, metabolomics can characterize the biological behavior of a specific individual in response to external stimuli, offering not only an eventual effective screening and prevention strategy but also the possibility of evaluating adherence and response to dietary intervention.

Association of socioeconomic position and childhood obesity in Finland: a registry-based study

OBJECTIVE

To identify what dimensions of socioeconomic position (SEP) are most closely associated with childhood obesity in Finland, leveraging population-wide data among the whole child population aged 2-17 years in Finland.

DESIGN

Registry-based study.

SETTING

Data from several administrative registries linked on individual level covering the whole of Finland were used. Data on height and weight measurements in 2018 were obtained from the Register of Primary Health Care visits and data on sociodemographic and socioeconomic indicators (2014-2018) from Statistics Finland.

PARTICIPANTS

Children aged 2-17 years with valid height and weight measurements performed at the child health clinic or school healthcare in 2018 (final n=194 423).

MAIN OUTCOME MEASURES

Obesity was defined according to WHO Growth Reference curves. Sociodemographic and socioeconomic indicators were linked on individual level for adults (both parents) who lived in the same household (42 predictors). Boosted regression model was used to analyse the contribution of SEP to obesity.

RESULTS

From socioeconomic indicators, annual household income (12.6%) and mother and father's educational level (12.6% and 8.1%, respectively) had the highest relative influence on obesity risk. The relative influence of a child's sex was 7.7%.

CONCLUSIONS

The parents' SEP was inversely associated with obesity among the offspring. A remarkable number of objective SEP indicators were analysed with parents' education and household income finally being the indicators most strongly associated with obesity among children. In future research, more attention should be paid to reliable and objective ways of measuring educational status and income rather than on developing new SEP indicators. Administrative registries with information on both healthcare and socioeconomic indicators can in future provide better opportunities to assess the influence of SEP on various health risks.

Role of obesity and blood pressure in epicardial adipose tissue thickness in children

BACKGROUND

Elevated body mass index (BMI) has been associated with cardiac changes, such as higher epicardial adipose tissue (EAT) thickness. This fat has been identified as a predictive factor of cardiovascular diseases during adulthood. However, few studies have tested the association of multiple cardiovascular risk factors (high weight or blood pressure) with EAT in adolescents and children. Therefore, the main objective of this current research was to determine the impact of BMI, overweight, obesity, and blood pressure on EAT thickness in children.

METHODS

A descriptive cross-sectional study focused on elementary and high school students aged 6-16 years was carried out by utilizing diverse measurements and instruments, such as echocardiography.

RESULTS

EAT thickness (N = 228) was linked to sex (more predominant in boys 2.3 ± 0.6; p = 0.044), obesity (2.3 ± 0.6; p < 0.001), and hypertension (2.6 ± 0.6; p = 0.036). The logistic regression indicated that age, sex, and BMI seemed to be more relevant factors in EAT thickness in children (adjusted R square = 0.22; p < 0.001).

CONCLUSIONS

This paper examined the associations of sex, age, and cardiovascular risk factors (arthrometric measures and blood pressure) with EAT thickness, indicating that it is necessary to assess whether the findings are associated with future events.

IMPACT

Excessive weight gain and blood pressure in the early stages of life have been associated with adipose tissue. This increase in weight and blood pressure has been attributed to alterations in the epicardial adipose tissue linked to anthropometric markers in adults, but no related study has been implemented in Spanish children. This study revealed how higher epicardial adipose tissue is linked to body mass index, other anthropometric parameters, and blood pressure in Spanish children. These measurements are related to high epicardial adipose tissue thickness, which in early stages does not imply pathology but increases the risk of developing cardiovascular diseases.

The weight status of children in late childhood within south East Wales and predictions for their future health

BACKGROUND

Current child measurements of weight status in Wales are determined at early childhood only. A further measurement at late childhood could identify adiposity levels prior to adolescence and young adulthood. The aim of this study therefore was to determine current adiposity levels in a cohort of children at late childhood and present a prediction of future levels upon entering young adulthood.

METHODS

In total, 288 boys (M age = 10.94 years, SD = 0.58) and 257 girls (M age = 10.78 years, SD = 0.63) from South East Wales were measured for anthropometry and their body mass index (BMI) (kg/m2) determined. International Obesity Task Force data predicted their BMI at age 18 years.

RESULTS

Approximately one quarter of boys and girls in late childhood were classified at an unhealthy weight. Predictive data showed that by age 18 years, this percentage had increased to approximately one-third in both genders.

CONCLUSION

The overweight and obesity levels in our cohort were high and predicted that many could become obese adults. This study therefore supports the call for the current Wales child measurement programme to be extended to report weight status in late childhood.

Prevalence of early childhood obesity in Ireland: Differences over time, between sexes and across child growth criteria

BACKGROUND

Various child growth criteria exist for monitoring overweight and obesity prevalence in young children.

OBJECTIVES

To estimate early overweight and obesity prevalence in Ireland and compare the differences in prevalence across ages, growth criteria and sexes.

METHODS

Longitudinal body mass index data from the nationally representative Growing Up in Ireland infant cohort (n = 11 134) were categorized ('under-/normal weight', 'risk of overweight', 'overweight', 'obesity') using the sex- and age-specific International Obesity Task Force growth reference, World Health Organization growth standard and World Health Organization growth reference criteria. Differences in prevalences between criteria and sexes, and changes in each weight category and criterion across ages (9 months, 3 years, 5 years), were investigated.

RESULTS

Across criteria, 11%-40% of children had overweight or obesity at 9 months, 14%-46% at 3 years and 8%-32% at 5 years of age. Prevalence estimates were highest using the World Health Organization growth reference, followed by International Obesity Task Force estimates. Within each criterion, prevalence decreased significantly over time (p < 0.05). However, when combining both World Health Organization criteria, as recommended for population studies, prevalence increased, due to differences in definitions between them. Significantly more boys than girls had overweight/obesity using either World Health Organization criterion, which was reversed using the International Obesity Task Force growth reference.

CONCLUSIONS

To increase transparency and comparability, studies of childhood obesity need to consider differences in prevalence estimates across growth criteria. Effective prevention, intervention and policy-making are needed to control Ireland's high overweight and obesity prevalence.

Association between recreational screen time and excess weight and obesity assessed with three sets of criteria in Spanish residents aged 2-14 years

INTRODUCTION AND OBJECTIVE

Studies that assess the association between excess weight and screen time in childhood and adolescence are methodologically heterogeneous, and few studies have analysed the exposure to smartphones and tablets. Our study aimed to assess the association between daily recreational screen time and excess weight (overweight+obesity) and obesity in children aged 2-14 years residing in Spain using different sets of standards.

METHODS

We conducted a cross-sectional study using data from the 2017 Spanish National Health Survey (N=4528). We assessed the prevalence of overweight and obesity applying the criteria of the World Health Organization (WHO), International Obesity Task Force (IOTF), and Orbegozo 2011 study. We categorised daily recreational screen time in minutes as 0-59, 60-119, 120-179, and ≥180. We calculated crude and adjusted prevalence ratios (aPR) of excess weight and obesity based on the daily minutes of recreational screen time with the corresponding 95% confidence intervals (95%CI). Moreover, we calculated crude and adjusted change (aΔ) in the expected number of fulfilled excess weight/obesity criteria based on the minutes of daily recreational screen time with the corresponding 95% CI. We adjusted the association analyses for potential confounders.

RESULTS

We found that spending 180min or more a day of recreational screen time was associated with an increase in the adjusted prevalence of excess weight (e.g. Orbegozo 2011 aPR_≥180, 1.20; 95% CI, 1.02-1.42) and of obesity (e.g. IOTF aPR_≥180, 1.41; 95% CI, 1.06-1.86) as well as an increase in the adjusted number of fulfilled criteria for excess weight (aΔ_≥180, 1.18; 95% CI, 1.06-1.31).

CONCLUSIONS

Longer periods of recreational screen time were associated with excess weight and obesity in children aged 2-14 years. Cohort studies are required to confirm these findings, as this may be a determinant of health in children.

A Mediterranean-Diet-Based Nutritional Intervention for Children with Prediabetes in a Rural Town: A Pilot Randomized Controlled Trial

Prediabetes is a pathological condition in which the blood glucose concentration is higher than normal concentrations but lower than those considered necessary for a type 2 diabetes mellitus diagnosis. Various authors have indicated that the Mediterranean Diet is one of the dietary patterns with the most healthy outcomes, reducing high levels of HbA1c, triglycerides, BMI, and other anthropometric parameters. The main objective of this study was to determine the efficacy of the nutritional intervention for children with prediabetes, including the effectiveness of this nutritional education regarding anthropometric parameters. A randomized pilot trial with two groups, an experimental group (EG) and a control group (CG), using intervention in dietary habits with nutritional reinforcement was carried out on 29 children with prediabetes from a rural area. The nutritional intervention was analyzed through astrophotometric and glycemic measurements and validated surveys. Results: The results indicated improvement in eating habits, adherence to the Mediterranean diet, anthropometric measurements, mainly body mass index and perimeters, and analytical parameters, with a significant decrease in glycated hemoglobin in the EG compared to the CG (p < 0.001). Although the results showed that both groups’ anthropometric parameters improved, a more significant decrease was observed in the experimental group compared to the control.

Considerations for the translation of nutrient recommendations as dietary plans for infants, children, and adolescents as reported in Italian Guidelines for healthy eating

Healthy eating in childhood and adolescence is important for proper growth and development and to establish a healthy foundation for future dietary habits. This paper aims to describe the elaboration of dietary plans for pediatric ages highlighting critical points related to the application of the Italian nutrient recommendations. National databases on food composition data were used to compile the dietary plans. Starting from the definition of serving size for adults, the suggested portion size for pediatric ages was shaped to produce appropriate dietary plans according to the different classes of age. Items from “cereals and derivatives,” “milk,” “fruit,” “vegetables,” “olive oil,” and “water” groups were included daily. Pizza was included once a week. Sweets and snacks were gradually introduced, once a week in infants and up to five times a week in adolescents. Legumes were provided three times a week, as a source of vegetable and sustainable proteins. The main critical aspect of the dietary plans was related to the monotony, especially for snacks and breakfasts. This work demonstrated the limits of the translation of Italian nutrient recommendations into dietary plans for pediatric age groups. Keeping the protein intake in the recommended range of 8–12% of daily energy resulted in inadequate provision of calcium and iron. Other critical points were the reference values for body weight and physical activity. The proposed dietary plans are adequate with regard to food composition, the intake of energy and several nutrients, and in terms of food selection. However, their implementations require action, information, and advocacy.

Prevalence of overweight and obesity among saudi children: A comparison of two widely used international standards and the national growth references

Objective

To compare three body mass index (BMI) classifications that are used to assess the prevalence of overweight and obesity among Saudi children aged 6-13 years: the International Obesity Task Force (IOTF) age and gender cutoffs, the World Health Organization (WHO) growth references for school-aged children, and the Saudi (KSA) national growth references.

Methods

The sample comprised 2,169 children (52.5% girls) derived from two cross-sectional studies conducted in Riyadh and Jeddah during the 2017 and 2019 school years, respectively. Body weight and height were measured, and BMI was calculated.

Results

The proportions (%) of the participants who were classified as underweight, overweight, and obese varied according to the reference used: IOTF reference (13.8, 18.4, and 12.7), WHO reference (17.2, 19.1, and 18.9), and KSA reference (7.0, 22.4, and 9.3), respectively, indicating higher values for overweight and obesity prevalence when the WHO references were used. Kappa agreement measures between the three references were found to be high, with the coefficients ranging from 0.936 (between the IOTF and KSA references) to 0.849 (between the IOTF and WHO references). In all three classifications, girls exhibited lower overweight or obesity prevalence than boys. Family income, but not paternal or maternal education, was significantly (p = 0.015) associated with overweight/obesity when using the IOTF standards. In addition, having a small family in the house was significantly (p < 0.05) associated with obesity, irrespective of the classification system.

Conclusion

Inconsistency was observed when estimating the prevalence of underweight, overweight, and obesity among Saudi children. However, when defining the overall prevalence of overweight plus obesity among Saudi children, the IOTF classification system performed in a similar way to the KSA references (31.1% versus 31.7%) compared to the WHO references (38.0%).

Accuracy of international growth charts to assess nutritional status in children and adolescents: a systematic review

OBJECTIVE

To verify, through a systematic review, the accuracy of nutritional assessment in children and adolescents using the length/height-for-age and BMI-for-age growth charts of the Centers for Disease Control and Prevention (CDC) (2000), the World Health Organization (WHO) (2006/2007) and the International Obesity Task Force (IOTF) (2012).

DATA SOURCE

We selected articles from the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), through PubMed, National Library of Medicine and The National Institutes of Health (NIH), Scientific Electronic Library Online (SciELO) and Virtual Health Library (VHL). The following descriptors were used for the search: "Child", "Adolescent", "Nutritional Assessment", "Growth Chart", "Ethnic Groups", "Stature by age", "Body Mass Index", "Comparison", "CDC", "WHO", and "IOTF". The selected articles were assessed for quality through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the NIH.

DATA SYNTHESIS

Thirty-three studies published between 2007 and 2020 were selected and, of these, 20 presented good quality, 12 presented fair quality and one presented poor quality. For children under five years old, the WHO length/height-for-age growth charts were shown appropriate for children from Argentina, South Africa, Brazil, Gabon, Qatar, Pakistan and the United States. For those five years old and older, the WHO BMI-for-age growth charts were accurate for the Brazilian and Canadian populations, while the IOTF growth charts were accurate for the European populations.

CONCLUSIONS

There are difficulties in obtaining international growth charts for children from 5 years old and older that go along with a long period of growth, and which include genetic, cultural and socioeconomic differences of multiethnic populations who have already overcome the secular trend in height.

Mediterranean Diet and Genetic Determinants of Obesity and Metabolic Syndrome in European Children and Adolescents

Childhood obesity and metabolic syndrome (MetS) are multifactorial diseases influenced by genetic and environmental factors. The Mediterranean Diet (MD) seems to modulate the genetic predisposition to obesity or MetS in European adults. The FTO gene has also been shown to have an impact on the MD benefits to avoid obesity or MetS. Since these interaction effects have been scarcely analyzed in European youth, the aim was to describe the gene–MD interplay, analyzing the impact of the genetic factors to reduce the obesity and MetS risk through MD adherence, and the MD impact in the obesity and MetS genetic profile. From the limited evidence on gene–MD interaction studies in European youth, a study showed that the influence of high MD adherence on adiposity and MetS was only observed with a limited number of risk alleles; the gene–MD interplay showed sex-specific differences, being higher in females. Most results analyzed in European adults elucidate that, the relationship between MD adherence and both obesity and MetS risk, could be modulated by obesity genetic variants and vice versa. Further research is needed, to better understand the inter-individual differences in the association between MD and body composition, and the integration of omics and personalized nutrition considering MD.

Recess and Overweight and Obesity in Children 5-11 Years of Age: 2013-2016 National Health and Nutrition Examination Survey

BACKGROUND

Recess has been shown to increase total daily energy expenditure, which may favorably impact body mass index by decreasing adiposity. This study examines associations between recess participation and adiposity.

METHODS

The study sample included male (N = 1434) and female (N = 1409) children 5 to 11 years of age participating in the 2013-2016 National Health and Nutrition Examination Survey. Overweight and obesity were defined using age- and sex-specific percentiles. Recess participation interview questions were answered via proxy response.

RESULTS

Compared to a referent group participating in recess 5 days/week for >30 minutes/day and independent of demographic and behavioral factors, analysis revealed significantly greater odds of obesity in females reporting no recess participation (odds ratio 1.80; 95% confidence interval, 1.03-3.15, p = .03). Furthermore, minority females were consistently found to possess greater odds of overweight and obesity independent of recess participation time. Only Mexican American boys were found to have greater odds of obesity independent of participation recess time.

CONCLUSIONS

In a large nationally representative sample of US children, reporting no recess was associated with significantly greater odds of obesity in females. Minority females were also more likely to be overweight and obese and Mexican American boys are more likely to be obese independent of recess participation time.

Comparison analysis of childhood body mass index cut-offs in predicting adulthood carotid intima media thickness: Tehran lipid and glucose study

Background

The prevalence of obesity among children and adolescences have been increased, which can consequently increase the prevalence of metabolic and cardiovascular diseases later in life. The objective of this study is to compare the ability of different childhood body mass index cut-offs in prediction of carotid intima media thickness (CIMT) as an indicator of subclinical atherosclerosis.

Methods

Participants were categorized into normal weight, overweight and obesity group, based on world health organization (WHO), center for disease control and prevention (CDC), international obesity task force (IOTF) and local IOTF cut-offs. After 18 years of follow up CIMT was measured. Akaike’s information criterion and relative efficiency were measured in order to compare regression models on the role of obesity on CIMT.

Results

In this prospective cohort study, 1295 subjects aged 3 to 18 years old were enrolled. The overall prevalence of overweight was 15.4, 11.5, 16.3 and 14.1 along with obesity prevalence of 6.6, 8.5, 7.7 and 5.0% based on WHO, CDC, local IOTF and international IOTF criteria, respectively. CIMT was higher in obese compare to normal groups across all classification criteria. After regression analysis, international IOTF was the best to predict adulthood CIMT, followed by local IOTF and WHO. CDC had the least discriminatory ability.

Conclusion

Due to the results of this study, IOTF could be a better tool in national and international surveillances of children in order to define overweight and obesity, which can help us to intervene more effectively in reducing the burden of cardiovascular diseases.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02963-y.

Social mobility by parent education and childhood overweight and obesity: a prospective cohort study

BACKGROUND

The association of social mobility, measured by parent education and childhood overweight and obesity (OWOB) has been scarcely reported on. This study evaluated the associations between social mobility measured by parent education and childhood OWOB at child age 6 and 10 years.

METHODS

We analyzed data of 4030 children and parents participating in the Generation R study. We used generalized linear models controlling for potential confounders to determine if social mobility (upward mobility, static-low and static-high based on the change of parent education) was associated with age- and sex-specific standard deviation scores of body mass index (BMI-SDS) or OWOB (the cut-offs of International Obesity Task Force).

RESULTS

Mean BMI-SDS of the children was 0.23 ± 0.89 and 0.26 ± 1.03 at child age 6 and 10 years, respectively; the prevalence of OWOB increased from 15.2 to 17.4%. Compared with children from mothers in the upward mobility group, children from mothers in the static-high group had lower BMI-SDS and lower odds of OWOB at both ages (all P < 0.001). Compared with children from fathers in the upward mobility group, children from fathers in static-low group had higher BMI-SDS and higher odds of OWOB at both ages (all P < 0.05).

CONCLUSIONS

Our study contributes to the literature by showing that the behaviors of parents' obtaining a higher level of education after the child was born may be beneficial to attenuate the odds of the child developing overweight in late childhood.

Distribution of Cardiometabolic Risk Factors in School-Aged Children with Excess Body Weight in the Al Ain City, United Arab Emirates: A Cross-Sectional Study

(1) Background: This study aimed to examine the distribution of cardiometabolic risk factors (CMRF) in school-aged children with excess body weight (overweight and obese) in Al Ain City, United Arab Emirates and identify the factors associated with increased cardiovascular risk factors between boys and girls. (2) Methods: A cross-sectional survey of children aged 6-17 years was conducted in Al Ain from 1 August 2019 to 31 December 2020. Binary logistic regression analysis was performed to investigate the relationship between excess body weight and CMRF between the groups and reported odds ratios (OR) with 95% confidence intervals (CI). (3) Results: A total of 966 school-aged children (490 boys and 476 girls) participated in the study, and the mean age of the children was 11.8 ± 2.9 years. The proportions of overweight and obesity were 13.5% and 10.2% in boys and 11.1% and 10.3% in girls. Higher glucose of ≥100 mg/dL (26.4%), triglycerides of ≥150 mg/dL and low-density lipoprotein cholesterol: ≥130 mg/dL (23.2%) were more prevalent in children with excess body weight. These children were at least two times more likely to have higher triglycerides levels, high total cholesterol (≥200 mg/dL) in girls (OR:2.06, 95% CI: 1.01-4.21) and low high-density lipoprotein (<35 mg/dL) in boys (OR: 2.20; 95% CI: 1.12-4.31). (4) Conclusions: Excess body weight in school-aged children was associated with increased CMRF, particularly triglycerides.

Childhood Obesity in Serbia on the Rise

The aim of the study was to examine changes in obesity prevalence among primary school children in Serbia between 2015 and 2019 rounds of the national WHO European Childhood Obesity Surveillance Initiative (COSI-Serbia). Cross-sectional studies were conducted in 2015 and 2019. The nationally representative samples of primary school children were measured for body height and weight, following the COSI protocol. Body Mass Index was calculated, and the IOTF and WHO definitions were used to classify children as overweight or obese. Participants were children of both sexes aged 7.00–8.99 years (n = 6105). Significant differences in overweight (obesity included) prevalence between two COSI rounds were identified regardless of definitions applied. According to the WHO definitions, prevalence of overweight and obesity combined increased in 7–9-year-old children in Serbia from 30.7% in 2015 to 34.8% in 2019 (z = −3.309, p < 0.05), and according to the IOTF standards, the increase from 22.8% to 30% was registered (z = −6.08, p = 0.00). The childhood overweight/obesity rate is increasing in Serbia, which places monitoring and surveillance of children’s nutritional status high on the public health agenda.

Prevalence of overweight and obesity in 3-to-10-year-old children: assessment of different cut-off criteria WHO-IOTF

This study compares the prevalence of overweight and obesity between WHO/IOTF criteria. A total of 17,277 Portuguese children aged 3-10 years old were analysed. The prevalences of overweight-obesity were higher at WHO classification (19.8%-20.7%) than at IOTF classification (8.2%-16.1%), (p<0.001). Agreement between the criteria were substantial for overweight (Kappa= 0.67, p<0.001) and moderate for obesity (Kappa= 0.47, p<0.001). The prevalences ratio for inequality between criteria were greater for boys than for girls and lesser for children aged 6-7 than children aged 8-10 years old. The disparities between the two criteria and the higher overweight obesity prevalences highlight the needs to develop more studies.

Double burden of malnutrition in children aged 24 to 59 months by socioeconomic status in five South Asian countries: evidence from demographic and health surveys

OBJECTIVES

We aimed to investigate the socioeconomic inequalities in the burden of underweight and overweight among children in South Asia. We also examined other factors that were associated with these outcomes independently of household's socioeconomic status.

DESIGN

Nationally-representative surveys.

SETTINGS

Demographic and Health Surveys from Bangladesh, India, Pakistan, Maldives and Nepal, which were conducted between 2009 and 2016.

PARTICIPANTS

Children aged 24 to 59 months with valid measurement for height and weight (n=146 996).

PRIMARY EXPOSURE AND OUTCOME MEASURES

Primary exposures were household's wealth index and level of education. Underweight and overweight were defined according to the WHO and International Obesity Task Force definitions, respectively.

RESULTS

Underweight prevalence was 37% in Bangladesh, 38% in India, 19% in Maldives, 29% in Nepal and 28% in Pakistan. Bangladesh, India and Nepal had similar overweight prevalence (between 2% and 4%) whereas Pakistan (7%) and Maldives (9%) had higher prevalence. Households with higher wealth index or education had lower odds of having underweight children. Adjusted ORs of underweight for richest versus poorest households were 0.4 (95% CI: 0.3 to 0.5), 0.5 (95% CI: 0.5 to 0.6), 0.5 (95% CI: 0.2 to 1.4), 0.5 (95% CI: 0.3 to 0.8) and 0.7 (95% CI: 0.5 to 1.1) for Bangladesh, India, Maldives, Nepal and Pakistan, respectively. Compared with poorest households, richest households were more likely to have overweight children in all countries except Pakistan, but such associations were not significant after adjustment for other factors. There were higher odds of having overweight children in households with higher education in Bangladesh (OR 2.1 (95% CI: 1.3 to 3.5)), India (OR 1.2 (95% CI: 1.2 to 1.3)) and Pakistan (OR 1.8 (95% CI: 1.1 to 2.9)) when compared with households with no education. Maternal nutritional status was consistently associated with children's nutritional outcomes after adjustments for socioeconomic status.

CONCLUSIONS

Our study provides evidence for socioeconomic inequalities for childhood underweight and overweight in South Asian countries, although the directions of associations for underweight and overweight might be different.

Gender-based differences in the clustering of metabolic syndrome factors in children and adolescents

Background We depicted gender-differences in metabolic syndrome (MS) clustering before and after puberty in pediatrics, in order to develop gender specific preventive strategies for childhood obesity. Methods We considered 1079 children and adolescents (529 females and 550 males; mean age 11.5 ± 2.8 year). According to body mass index (BMI) percentiles the subjects were classified as normal weight BMI <75th, overweight BMI 75-95th and with obesity BMI >95th. MS was diagnosed when three of the following criteria for age and sex percentiles were met: BMI >95th, triglycerides (TGs) level >95th, high-density lipoprotein-cholesterol (HDL-c) level <5th, blood pressure (blood pressure) >95th percentile, fasting blood glucose (FBG) >100 mg/dL and/or homeostatic model assessment- insulin resistance (HOMA-IR) >97.5th percentile. Results The prevalence of dismetabolic factors was similar in both genders, except for pathological BP, which was higher in males (p = 0.02). MS was detected only in patients with obesity, with a higher prevalence in pubertal than late/post-pubertal subjects (p < 0.001), without any significant difference between gender. In pre-puberty, the most common MS combination was obesity (HBMI) + hypertension (HBP) + hyperglycemia/insulin resistance (HGLY/IR) followed by HBMI + low HDL-levels (LHDL) + HGLY/IR versus HBMI + HBP + HGLY/IR followed by HBMI + HBP + LHDL, respectively, in females and males. In the early and late/post-pubertal periods, the most prevalent combination remained similar to pre-puberty, additionally in both sexes other combinations, such as HBMI + HTG + HBP + HGLY/IR, HBMI +  HBP + LHDL + HGLY/IR, HBMI + HTG + LHDL + HGLY/IR and HBMI + HTG + LHDL + HBP + HGLY/IR were also detected, differently distributed in males and females. Conclusions We confirm that MS is an important consequence related to obesity, particularly in the post-puberty stage. Some gender-based differences should be considered early in order to identify specific preventive and treatment strategies.

Childhood obesity, cardiovascular and liver health: a growing epidemic with age

BACKGROUND

The frequency of childhood obesity has increased over the last 3 decades, and the trend constitutes a worrisome epidemic worldwide. With the raising obesity risk, key aspects to consider are accurate body mass index classification, as well as metabolic and cardiovascular, and hepatic consequences.

DATA SOURCES

The authors performed a systematic literature search in PubMed and EMBASE, using selected key words (obesity, childhood, cardiovascular, liver health). In particular, they focused their search on papers evaluating the impact of obesity on cardiovascular and liver health.

RESULTS

We evaluated the current literature dealing with the impact of excessive body fat accumulation in childhood and across adulthood, as a predisposing factor to cardiovascular and hepatic alterations. We also evaluated the impact of physical and dietary behaviors starting from childhood on cardio-metabolic consequences.

CONCLUSIONS

The epidemic of obesity and obesity-related comorbidities worldwide raises concerns about the impact of early abnormalities during childhood and adolescence. Two key abnormalities in this context include cardiovascular diseases, and nonalcoholic fatty liver disease. Appropriate metabolic screenings and associated comorbidities should start as early as possible in obese children and adolescents. Nevertheless, improving dietary intake and increasing physical activity performance are to date the best therapeutic tools in children to weaken the onset of obesity, cardiovascular diseases, and diabetes risk during adulthood.

Alcohol consumption or cigarette smoking and cardiovascular disease risk in youth with type 1 diabetes

AIM

To assess the association between alcohol consumption and/or cigarette smoking with other unhealthy behaviors and clinical cardiovascular risk factors in youth with type 1 diabetes.

METHODS

Two hundred and twenty-eight youth with type 1 diabetes (age 13-19 years) were consecutively enrolled in three Regional Pediatric Diabetes Centers in Italy. Demographic, anthropometric, lifestyle (adherence to the Mediterranean diet pattern and sports participation) and laboratory parameters were compared among youth reporting isolated or combined alcohol consumption and/or cigarette smoking.

RESULTS

Ten percent of the youth reported alcohol consumption, 10% cigarette smoking and 6% both alcohol and cigarette use; 74% did not report alcohol or cigarette use. Compared to non-drinker non-smoker youth, smokers showed significantly higher percentages of each of the behavioral and clinical cardiovascular risk factors. Drinkers showed a significantly higher proportion of abdominal adiposity, dyslipidemia and poor adherence to the Mediterranean diet. Alcohol consumption was independently associated with both dyslipidemia and high glycosylated hemoglobin.

CONCLUSIONS

Our findings emphasize the need to increase the awareness of youth with T1D about the negative impact of alcohol drinking on cardiovascular risk, since the effects of alcohol might be underestimated with respect to the well-known detrimental effects of smoking. Clustering of unhealthy lifestyle should be discouraged in type 1 diabetes youth in order to promote cardiovascular protection.

The risk of overweight and obesity in children with autism spectrum disorders: A systematic review and meta-analysis

Multiple studies have suggested that autism spectrum disorders seem to increase the risk of overweight and obesity. We examined the pooled prevalence and relative risk of developing overweight or obesity among children with autism spectrum disorders in a systematic review and meta-analysis. We searched PubMed, Scopus, ProQuest, and Web of Science databases and subsequently screened the records to identify studies that reported prevalence of overweight and/or obesity in children with ASD and matched groups of neurotypical children. DerSimonian-Laird random-effects meta-analyses were performed to examine pooled prevalence and relative risk of obesity in children with autism spectrum disorders using the "meta" package in R software. Among children with autism spectrum disorders, the prevalence of obesity was 22.2%. Children with ASD had a 41.1% greater risk (P = .018) of development of obesity. Non-Caucasian race, increasing age, female sex, and living in the United States emerged as positive moderators of the association between autism spectrum disorders and prevalence of overweight or obesity. Autism spectrum disorders seem to increase the risk of childhood obesity. Increased awareness of this association may allow the implementation of early interventions to reduce obesity and prevent potential deterioration of quality-of-life in this population.

Childhood Dietary Intake in Italy: The Epidemiological "MY FOOD DIARY" Survey

Promoting a healthy lifestyle during the first years of life is a key strategy for controlling obesity risk in later life; having good-quality epidemiological data on eating habits of infants and toddlers can improve awareness and possibly the education given by pediatricians to parents and children. With this aim, we performed a survey about the dietary pattern of Italian children in early childhood. We described the intake of energy, macronutrients and fiber, minerals, and vitamins of 443 Italian children (range 6.4–131 months), through a three-day food record filled out by their parents and assessed by family pediatricians. The results were compared with the Italian Dietary Reference Values. The median protein intake, in g/kg per body weight, exceeded the average requirement in all age groups, and in the 12–36 month period, the intake as % of energy was outside the reference range (>15%). The majority of the children consumed quantities of simple carbohydrates (consisting of both natural sugars and free or added sugars, 82.3% of the children in the study) and saturated fats (69% of the children in the study) above the limits of the Italian Dietary Reference Values, with low intake of fiber and polyunsaturated fats. Median mineral intake, in our study, was different depending on age, while vitamin D intake was very low in all age groups. This is one of the few studies reporting on the nutrient intake of Italian children with reference to nutrition recommendations in order to identify the principal nutritional errors. The present results underline the need for healthcare policies starting from the first years of life in order to ameliorate nutrient intake during childhood, possibly impacting long-term health outcomes.

The Asti Study: The Induction of Oxidative Stress in A Population of Children According to Their Body Composition and Passive Tobacco Smoking Exposure

Obesity and exposure to second-hand tobacco smoking (SHS) may influence oxidative stress (OS) levels, especially in children. This study investigated body composition and SHS influence on OS induction in the paediatric population. The first purpose was identifying an appropriate BMI standard for adiposity assessment in OS investigations. Secondly, SHS and obesity were analysed as inductors of OS. The epidemiologic sample involved 330 children. Three BMI (body mass index) references (IOTF, CDC, and WHO) and an impedentiometric scale supplied body-composition measurements. Partecipants filled out a questionnaire and provided urinary samples for biomarker quantifications: isoprostane (15-F2t IsoP) and cotinine as OS and SHS biomarker, respectively. Obesity prevalence changed over different BMI references (14%, 21%, and 34% for IOTF, CDC, and WHO, respectively). Obese children, by IOTF, showed an increase of 56% in 15-F2t IsoP compared to those normal weight (p = 0.020). Children belonging to the third and the fourth cotinine quartile compared to those of the first quartile had higher 15-F2t IsoP (1.45 ng/mg, 95% CI: 1.06⁻1.97, p = 0.020 and 2.04 ng/mg, 95% CI: 1.55⁻2.69, p < 0.0001, respectively). Obesity assessment in children requires appropriate BMI reference depending on research field. Both SHS exposure and obesity may increase OS in children.

Triponderal mass index rather than body mass index: An indicator of high adiposity in Italian children and adolescents

OBJECTIVE

The aims of this study were to compare body mass index (BMI) and triponderal mass index (TMI) as predictors of fat mass percentage (FM%) and to develop TMI cutoffs for screening high adiposity. Therefore, TMI- and BMI-based references against FM% criterion for indicating adiposity in Italian children and adolescents were compared.

METHODS

This was a cross-sectional study conducted at the University of Rome Tor Vergata, Human Nutrition Unit, from 2008 to 2015. The sample included 485 children and adolescents from 8 to 17 y of age from central-southern Italy. Body weight (kg) and height (m) were assessed to calculate BMI and TMI. FM% was assessed by dual-energy x-ray absorptiometry. The prevalence of high adiposity was based on the 75th percentile of FM%, according to Ogden et al. curves. Statistical tests such as Mann-Whitney, Kruskal-Wallis, polynomial regression, receiver operating characteristics curve, and Cohen's κ, were performed using SPSS version 24 and MedCalc version 18.

RESULTS

Prevalence of high adiposity according to FM% was 50.2% (95% confidence interval [CI], 43.2-57.2) in boys and 43.2% (95% CI, 37.3-49.2) in girls. TMI rather than BMI could better predict FM% for both sexes (boys R² = 0.67 and girls R² = 0.79 versus boys R² = 0.44 and girls R² = 0.74, respectively). TMI was found to present a significantly higher area under the curve than BMI for indicating high adiposity in children and adolescents. TMI sex- and age-specific cutoffs were responsible by better classification of adiposity, followed by the International Obesity Task Force, World Health Organization, and Cacciari reference curves.

CONCLUSION

TMI is a useful screening tool in pediatric clinical practice and epidemiologic studies concerning childhood obesity.

Peri-operative management of overweight and obese children and adolescents

Obesity has become endemic, even in children. Systemic complications associated with obesity include metabolic syndrome, cardiovascular disease, and respiratory compromise. These comorbidities require adequate investigation, targeted optimisation, and, if surgery is required, specific management during the peri-operative period. Specific peri-operative strategies should be used for paediatric patients who are overweight or obese to prevent postoperative complications, and optimising the respiratory function during surgery is particularly crucial. This Review aims to provide up-to-date information on peri-operative management for physicians who are caring for children and adolescents (usually younger than 18 years) who are overweight or obese undergoing surgery, including bariatric surgery. We have particularly focussed on the physiological consequences of obesity-namely, obstructive sleep apnoea, respiratory compromise, and pharmacological considerations.

The role of dental practitioners in addressing overweight and obesity among children: A scoping review of current interventions and strategies

INTRODUCTION

With the growing prevalence of childhood obesity worldwide, there is a need for interventions to identify and address overweight and obesity in childhood. Although guidelines recommend general practitioners routinely screen for overweight and obesity among children, research suggests this is often not done. To address this, dental practitioners may be able to play a role in identifying and addressing overweight and obesity among children.

METHODS

This review aimed to explore the evidence and efficacy of existing obesity and overweight interventions targeting children in the dental setting. A systematic search of nine electronic databases was conducted to identify relevant published and grey literature. This was expanded to also include strategies for promoting oral health in the dental setting.

RESULTS

A total of 11 records were included in this review, which focussed on the current role and effectiveness of dental practitioners in addressing obesity among children, and the available strategies and resources. Although there was a paucity of research on the training of dental practitioners in this area and their efficacy in identifying and addressing obesity among children, evidence suggests that parents found it acceptable for dental practitioners to promote healthy practices to children who experience overweight or obesity. This review also identified screening tools and strategies for identifying and addressing overweight and obesity among children in dental practice.

CONCLUSION

There is a clear role for dental practitioners in addressing overweight and obesity among children, however further research is required to identify the most effective interventions to implement in dental practice.

Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics

The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.

Advances in pediatrics in 2017: current practices and challenges in allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology from the perspective of Italian Journal of Pediatrics

This review provides an overview of a remarkable number of significant studies in pediatrics that have been published over the past year in the Italian Journal of Pediatrics. We have selected information from papers presented in the Journal that deal with allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology. The relevant epidemiologic findings, and developments in prevention, diagnosis and treatment of the last year have been discussed and placed in context. We think that advances achieved in 2017 will help readers to make the future of patients better.

Relation between circulating oxidized-LDL and metabolic syndrome in children with obesity: the role of hypertriglyceridemic waist phenotype

BACKGROUND

The association between oxidative stress (OS) and metabolic syndrome (MetS) has been reported in adults. We analyzed the relation between circulating oxidized low-density lipoproteins (Ox-LDL) and MetS in pediatric ages in order to define whether plasma Ox-LDL levels are correlated to obesity and whether oxidative damage, using serum Ox-LDL levels as a proxy, are associated with MetS.

METHODS

We enrolled 178 children (11.8±2.6 years). On the basis of a body mass index (BMI) threshold, the subjects were classified as: normal weight BMI <75th percentile; overweight BMI 75-97th percentile; obese BMI >97th percentile. Patients were classified as having MetS if they met three or more of the following criteria for age and sex: BMI >97th percentile, triglyceride levels >95th percentile, high-density lipoprotein (HDL) cholesterol level <5th percentile, systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) >95th percentile and impaired glucose tolerance.

RESULTS

Obese children showed increased MetS prevalence (p=0.001) and higher Ox-LDL levels compared to normal- and overweight subjects (p<0.05), with a limited relation between Ox-LDL and MetS (p=0.06). Waist-to-height ratio (W/HtR) (p=0.02), triglycerides (TG) (p=0.001) and LDL-cholesterol (p<0.001) resulted independent predictors of increased plasma Ox-LDL levels.

CONCLUSIONS

Oxidative damage was correlated with a hypertriglyceridemic waist phenotype and can be a precocious marker of MetS and cardiometabolic risk in obese children.