Childhood obesity: a growing public health concern

Comparison of Several Prediction Equations Using Skinfold Thickness for Estimating Percentage Body Fat vs. Body Fat Percentage Determined by BIA in 6-8-Year-Old South African Children: The BC-IT Study

Body composition measurement is useful for assessing percentage body fat (%BF) and medical diagnosis, monitoring disease progression and response to treatment, and is essential in assessing nutritional status, especially in children. However, finding accurate and precise techniques remains a challenge. The study compares %BF determined by bioelectrical impedance analysis (BIA) and calculated from available prediction equations based on skinfolds in young South African children. A cross-sectional study performed on 202 children (83 boys and 119 girls) aged 6-8 years. Height and weight, triceps and subscapular skinfolds were determined according to standard procedures. %BF was determined with BIA and three relevant available equations. SPSS analyzed the data using paired samples tests, linear regression, and Bland-Altman plots. Significant paired mean differences were found for BIA and Slaughter (t₂₀₁ = 33.896, p < 0.001), Wickramasinghe (t₂₀₁ = 4.217, p < 0.001), and Dezenberg (t₂₀₁ = 19.910, p < 0.001). For all of the equations, the standards for evaluating prediction errors (SEE) were above 5. The Bland-Altman plots show relatively large positive and negative deviations from the mean difference lines and trends of systematic under- and over-estimation of %BF across the %BF spectrum. All three equations demonstrated a smaller %BF than the %BF measured by BIA, but the difference was smallest with the Wickramasinghe equation. In comparison, a poor SEE was found in the three %BF predicted equations and %BF derived from BIA. As such, an age-specific %BF equation incorporating criterion methods of deuterium dilution techniques or 'gold-standard' methods is needed to refute these findings. However, in the absence of developed %BF equations or 'gold-standard' methods, the available prediction equations are still desirable.

Relationship between adiponectin, TNFα, and SHBG in prepubertal children with obesity

BACKGROUND

Sex hormone-binding globulin (SHBG) levels are low in adult subjects with obesity when compared to normal-weight individuals. Obesity is associated with higher tumor necrosis factor alpha (TNFα) plasma levels and lower adiponectin levels. Moreover, we have recently elucidated the molecular mechanisms by which TNFα and adiponectin regulate hepatic SHBG production.

AIM

The main objective of this study was to assess if the adult associations between TNFα, adiponectin, and SHBG are present in prepubertal children.

METHODS

We determined several morphometric and biochemical parameters in normal-weight (n=15) and obese prepubertal (n=51) children, as well as quantified plasma SHBG, TNFα receptor 1 (TNFα-R1), and adiponectin levels.

RESULTS

Our results showed that prepubertal children with obesity had decreased plasma SHBG levels compared to normal-weight controls (67 nmol/L vs 172 nmol/L). Importantly, SHBG plasma levels correlated significantly (P < 0.05) with TNFα (negatively, ßstd= - 0.31) and adiponectin (positively, ßstd= 0.58) suggesting an important role of these two cytokines in determining plasma SHBG levels in prepubertal children.

CONCLUSIONS

Our results suggest that plasma adiponectin levels may play a more important role than TNFα in influencing plasma SHBG levels in our prepubertal population with obesity.

Assessing Walking and Cycling around Schools

To encourage students to walk and cycle to school and ensure their health and safety, it is essential to provide safe and operationally efficient infrastructure around schools. This study used an audit tool to assess the infrastructure and environment around schools in the city of Doha, Qatar, with a particular emphasis on active transport (walking and cycling). The aim was to identify strengths, weaknesses, and areas for improvement. Twenty-two schools with varied education levels were assessed. Among all assessed categories, active transport items scored the lowest, requiring the most improvements. A detailed analysis was conducted based on school type (elementary, primary, high, and mixed-schools) and revealed similar results except for elementary schools (scored acceptable for active transport). The study revealed that adding bike lanes, installing bicycle parking, and providing good separation of travel modes are the most needed improvements at school sites. In summary, improving active transport could significantly improve the overall quality of the infrastructure around schools in Qatar. Such improvements could greatly encourage more school children to walk and cycle to school instead of being primarily dropped-off and picked up by their parents’ vehicles or school buses.

The Effects of Foods Embedded in Entertainment Media on Children's Food Choices and Food Intake: A Systematic Review and Meta-Analyses

While watching or playing with media, children are often confronted with food appearances. These food portrayals might be a potential factor that affects a child's dietary behaviors. We aimed to comprehensively expound the effects of these types of food appearances on dietary outcomes of children. Our objectives were to synthetize the evidence of the experiments that study the effects of foods embedded in children's entertainment media throughout a systematic review, to conduct two meta-analyses (food choice and intake) in order to quantify the effects, and to examine to what extent the effects of foods embedded in entertainment media varies across different moderating variables. We conducted a systematic search of five databases for studies published up to July 2018 regarding terms related to children and foods embedded in entertainment media. We identified 26 eligible articles, of which 13 (20 effect sizes) and 7 (13 effect sizes) were considered for a meta-analysis on food choice and intake, respectively. Most of the studies were assessed as having a middle risk of bias. Overall, food being embedded in entertainment media is a strategy that affects the eating behaviors of children. As most of the embedded foods in the included studies had low nutritional values, urgent measures are needed to address the problem of childhood obesity.

Effect of maternal mental health improvement programs on obesity in pediatric populations: a protocol for a systematic review and meta-analysis

BACKGROUND

Childhood obesity has become a global epidemic irrespective of the socioeconomic status of a country or nation. Obesity increases the risk of various diseases in children, for example asthma, sleep apnea, bone and joint problems, type-2 diabetes, and heart problems. The existing literature informs us of the many factors associated with childhood obesity. Among these factors, maternal mental health has been found to be a strong predictor. Maternal mental health programs were implemented to address the issue of childhood obesity but with little or no improvement. It suggests systematically reviewing the literature to assess the contents of these programs and carrying out meta-analysis for the overall effect of these interventions.

METHODS

The studies included in this review will be experimental designs such as randomized controlled trials (RCTs) which provide information on interventions to improve maternal mental health and its effects on childhood obesity. We plan to search MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, ERIC, CINAHL, ProQuest Dissertations and Theses Global, Scopus, and Web of Science with no restrictions as to language. Reference lists of the selected articles will also be searched for additional articles. The Cochrane EPOC Risk of Bias Tool will be used to assess the quality of studies. If the studies lend themselves to a statistical analysis, we will also carry out a meta-analysis.

DISCUSSION

This review will help determine the effect of maternal health improvement programs on childhood obesity. These findings, in turn, will guide the research community on the development of related programs in the future.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO: CRD42017072737 .

Children's Environmental Health in the Digital Era: Understanding Early Screen Exposure as a Preventable Risk Factor for Obesity and Sleep Disorders

The quantity, accessibility and focus on child-targeted programming has exponentially increased since it entered American households in the early 1900s. It may have started with the television (TV), but technology has evolved and now fits in our pockets; as of 2017, 95% of American families own a smartphone. Availability and child-tailored content has subsequently led to a decrease in the age at initial screen exposure. The negative effects that accompany the current culture of early screen exposure are extensive and need to be considered as technology continues to enter the home and inundate social interactions. Increased levels of early screen exposure have been associated with decreased cognitive abilities, decreased growth, addictive behavior, poor school performance, poor sleep patterns, and increased levels of obesity. Research on the adverse effects of early screen exposure is mounting, but further epidemiological studies are still needed to inform prevention and regulation policies.

Targeting and tailoring an intervention for adolescents who are overweight: some ethical concerns

There are important ethical issues to be examined before launching any public health intervention, particularly when targeting vulnerable groups. The aim of this article is to identify and discuss ethical concerns that may arise when intervening for health behavior change among adolescents identified as overweight. These concerns originate from an intervention designed to capacitate adolescents to increase self-determined physical activity. Utilizing an ethical framework for prevention of overweight and obesity, we identified three ethical aspects as particularly significant: the attribution of responsibility for health behavior, liberty to choose, and the effect on the participants' psychosocial well-being. It is discussed whether and how measures can be taken to deal with these aspects. It seems evident that the ethical aspects are mainly concerned with the vulnerability of adolescents identified as overweight. However, we claim that when individual feedback and counseling is provided, tailored interventions have a unique potential to empower adolescents to make ethically anchored decisions about their own health behavior.

Waist circumference and waist circumference to height ratios of Kaingáng indigenous adolescents from the State of Rio Grande do Sul, Brazil

The aim of this study was to describe the distribution of waist circumference (WC) and WC to height (WCTH) values among Kaingáng indigenous adolescents in order to estimate the prevalence of high WCTH values and evaluate the correlation between WC and WCTH and body mass index (BMI)-for-age. A total of 1,803 indigenous adolescents were evaluated using a school-based cross-sectional study. WCTH values > 0.5 were considered high. Higher mean WC and WCTH values were observed for girls in all age categories. WCTH values > 0.5 were observed in 25.68% of the overall sample of adolescents. Mean WC and WCTH values were significantly higher for adolescents with BMI/age z-scores > 2 than for those with normal z-scores. The correlation coefficients of WC and WCTH for BMI/age were r = 0.68 and 0.76, respectively, for boys, and r = 0.79 and 0.80, respectively, for girls. This study highlights elevated mean WC and WCTH values and high prevalence of abdominal obesity among Kaingáng indigenous adolescents.

The association between childhood obesity and tooth eruption

Obesity is a growth-promoting process as evidenced by its effect on the timing of puberty. Although studies are limited, obesity has been shown to affect the timing of tooth eruption. Both the timing and sequence of tooth eruption are important to overall oral health. The purpose of this study was to examine the association between obesity and tooth eruption. Data were combined from three consecutive cycles (2001-2006) of the National Health and Nutrition Examination Survey (NHANES) and analyzed to examine associations between the number of teeth erupted (NET) and obesity status (BMI z-score >95th percentile BMI relative to the Centers for Disease Control and Prevention (CDC) growth reference) among children 5 up to 14 years of age, controlling for potential confounding by age, gender, race, and socioeconomic status (SES). Obesity is significantly associated with having a higher average NET during the mixed dentition period. On average, teeth of obese children erupted earlier than nonobese children with obese children having on average 1.44 more teeth erupted than nonobese children, after adjusting for age, gender, and race/ethnicity (P < 0.0001). SES was not a confounder of the observed associations. Obese children, on average, have significantly more teeth erupted than nonobese children after adjusting for gender, age, and race. These findings may have clinical importance in the area of dental and orthodontic medicine both in terms of risk for dental caries due to extended length of time exposed in the oral cavity and sequencing which may increase the likelihood of malocclusions.

Occurrence and timing of childhood overweight and mortality: findings from the Third Harvard Growth Study

OBJECTIVE

To assess the mortality experience of participants in the Third Harvard Growth Study (1922-1935) who provided ≥ 8 years of growth data.

STUDY DESIGN

A total of 1877 participants provided an average of 10.5 body mass index measurements between age 6 and 18 years. Based on these measurements, the participants were classified as ever overweight or ever >85th percentile for height in childhood. Age at peak height velocity was used to indicate timing of overweight relative to puberty. Relative risks of all-cause and cause-specific mortality according to measures of childhood growth were estimated using Cox proportional hazards survival analysis.

RESULTS

For women, ever being overweight in childhood increased the risks of all-cause and breast cancer death; the risk of death from ischemic heart disease was increased in men. Men with a first incidence of overweight before puberty were significantly more likely to die from ischemic heart disease; women in the same category were more likely to die from all causes and from breast cancer.

CONCLUSION

We find evidence of long-term effects of having ever been overweight, with some evidence that incidence before puberty influences the pattern of risk.

Maternal and child obesity: some policy challenges

The recent rise in the prevalence of obesity in the UK population includes women of reproductive age and children. For both groups there are specific health concerns consequent on excess bodyweight, including obstetric complications, fetal growth abnormalities and a range of obesity co-morbidities seen in children that were rarely found in young people a generation earlier. This paper identifies some of the issues which challenge policy-makers: guidelines for gestational weight gain and for weight loss after pregnancy; inequalities and interventions in pregnancy; interventions to prevent child obesity; and the role of individuals, government and the commercial sector in implementing policies for promoting healthy weight.

Prevalência de excesso de peso e obesidade abdominal, segundo parâmetros antropométricos, e associação com maturação sexual em adolescentes escolares

Este estudo objetivou estimar a prevalência de excesso de peso e obesidade abdominal em escolares segundo antropometria e maturação sexual. Foi um estudo transversal, incluindo 1.405 escolares de 10-14 anos, de ambos os sexos, residentes no Recife, Pernambuco, Brasil, em 2007. Foi avaliado o índice de massa corporal (IMC), a circunferência da cintura (CC) e razão da cintura-estatura (RCEst). A maturação sexual foi auto-avaliada, definindo-se como precoce quando o escolar apresentava idade cronológica inferior à mediana de idade para o referido estágio. A prevalência de excesso de peso foi de 20,4% (IC95%: 18,3-22,6) e a de obesidade abdominal foi de 14,9% (IC95%: 13,1-16,9) para CC e 12,6% (IC95%: 10,9-14,4) para RCE. O IMC, a CC e a RCEst apresentaram uma forte correlação positiva (rho ≅ 0,8; p < 0,001). A prevalência de excesso de peso e de obesidade abdominal foi maior (p < 0,05) nos estágios finais de maturação sexual em ambos os sexos. A alta prevalência de excesso de peso requer medidas urgentes de prevenção e controle desse distúrbio, sendo recomendada a inclusão da maturação sexual na avaliação do estado nutricional.