The epidemic of obesity in children and adolescents in the world

Physical fitness in children in Cabo Verde: differences between gender, eutrophic vs. overweight subjects, and practitioners vs. non-practitioners of sports

BACKGROUND

There are few or even rare studies conducted in Cabo Verde (Republic of Cabo Verde) that address the issue of physical fitness and body composition in the juvenile population. This investigation aims to study the physical fitness in children in Cabo Verde: differences between gender, eutrophic, and overweight subjects, between practitioners and non-practitioners of sports.

METHODS

The sample consisted of 93 individuals aged between 10 and 15 years, from the 2nd and 3rd cycles and secondary school of the Portuguese College based in Cabo Verde. The instruments used for data collection were the FITescola® test battery (Lisboa, Portugal), and the questionnaire Quantification de l'activite physique en altitude chez les enfants (QAPACE) for assessment of physical activity level. Regarding the statistical analysis using the SPSS 23.0 software (SPSS Inc., Chicago, IL, USA), the first analysis was performed to verify the distribution of the sample (Kolmogorov-Smirnov Test and Shapiro-Wilk Test). Then, for variables with normal distribution we used the t-test and for the remaining variables with non-normal distribution we used the Mann-Whitney Test, with a significance level of 5%.

RESULTS

Gender differences were found, in which the male gender obtained more favorable mean values in the "sit-ups," "push-ups," "horizontal impulsion," "shuttle" and "agility" variables, while the females showed superiority in the variables "sit and reach;" differences between the eutrophic and overweight group where, as expected, more favorable mean values for eutrophics than the overweight group in all PF tests. Finally, differences between practitioners and non-practitioners of sports, with the best results being attributed to practitioners of sports.

CONCLUSIONS

We concluded that male subjects have greater proficiency in strength and aerobic fitness tests while female subjects have greater flexibility. High BMI values in overweight children have been found to be associated with increased abdominal fat as well as a reduction in overall PF. As expected, sports practitioners show better results in motor performance on PF tests.

Association of adipocytokines and adipocytokine ratios with cardiovascular risk factors in Japanese preadolescents

OBJECTIVES

Asians are particularly susceptible to obesity-associated disorders and rapid progression of obesity from childhood to adulthood. Data on the association between adipocytokine parameters, particularly adipocytokine ratios, and cardiovascular risk factors in childhood remain limited. Herein, we assessed the association of resistin, adiponectin, and leptin levels and leptin/adiponectin and resistin/adiponectin ratios with selected cardiovascular risk factors and the influence of unhealthy weight on such associations in children aged 9-10 years.

METHODS

We included 380 children aged 9-10 years from three public elementary schools in Japan.

RESULTS

The body mass index (BMI) was significantly higher in male preadolescents than in female adolescents (median 16.5 kg/m² vs. 16.2 kg/m², p=0.032). No differences in height, weight, waist circumference (WC), waist/height ratio (W/Hr), total cholesterol and high-density lipoprotein cholesterol levels, or atherosclerosis index (AI) were observed between the sexes. Of the adipocytokine levels and ratios analyzed, only the leptin level and leptin/adiponectin ratio (L/Ar) were strongly and significantly positively correlated with the cardiovascular risk factors WC, W/Hr, and BMI (all p<0.05). The AI was not strongly correlated with any adipocytokine levels or ratios. Apart from the strong positive correlation between the L/Ar and W/Hr, no other significant associations were observed between any of the adipocytokine levels or ratios and the selected cardiovascular risk factors.

CONCLUSIONS

Our findings confirmed the value of adipocytokine ratios in risk assessment in pediatric populations, with leptin levels and leptin/adiponectin ratios strongly correlating with risk factors in children aged 9-10 years.

The Association of Junk Food Consumption with Preadolescents' Environmental Influences: A School-Based Epidemiological Study in Greece

The aim of the present study was to evaluate the impact of environmental influences on Greek preadolescents' junk food consumption. A cross-sectional study, was conducted among 1718 preadolescents (mean (standard deviation(SD)) age: 11.2(0.8) years old; 54% girls) and their parents, during the school years 2014-2016. Parental and child characteristics were collected anonymously, through self-administered and validated questionnaires. Among others, junk food consumption was recorded, classifying children as low, moderate, and high consumers. The majority of the preadolescents were classified as at least moderate junk food consumers, while almost 3/10 children were classified as high junk food consumers. A significantly lower junk food consumption was observed among preadolescents with a healthier family environment, consisting of normal-weight parents who consume junk foods less frequently, prefer home-cooked meals and adhere more to the Mediterranean diet, while more frequent family meals were also associated with lower junk food consumption. In addition, influence from teachers and participation in extracurricular sports activities were significantly associated with lower junk food consumption, while advertisements were found to have a significant negative impact on preadolescents' eating habits. Notwithstanding, peers were not found to influence their dietary choices in terms of junk food consumption. Both parents and teachers seem to be positive influencers on preadolescents' low junk food consumption. The detrimental role of advertisements on junk food consumption is reconfirmed, while peers' influence is not significant on junk food consumption. The need for urgent public health initiatives for the promotion of healthy dietary habits among preadolescents is warranted.

Associations of muscle-strengthening exercise with overweight, obesity, and depressive symptoms in adolescents: Findings from 2019 Youth Risk Behavior Surveillance system

Background

Previous studies have focused on the opposite relation between muscle strength, obesity, and depression in adults. Moreover, the evidence has indicated that obesity and depression in adults might be significantly decreased with Muscle Strength Exercise (MSE) albeit it might be insufficient. Therefore, the current study aimed to investigate the association between MSE, adiposity, and depression among United States adolescents.

Materials and methods

This cross-sectional study used the Youth Risk Behavioral Survey (YRBS) data. In YRBS, a cluster sample was used, and the investigation was divided into three stages. The study surveyed 13,677 high school students and conducted self-reported questionnaires on sex, grade, race/ethnicity, MSE days, overweight, obesity, and depressive symptoms. The study got the nationally representative population of American students in Grade 9 to 12 (around 12–18 years).

Results

A total of 13,677 participants (female = 6,885, male = 6641) were included in the final analysis. The participants meeting the guidelines’ requirements seemed more likely to be obese than those not meeting (OR = 1.28, 95% CI = 1.06–1.55). There was no statistical significance in the relations between the MSE guidelines and overweight and depression (OR = 0.86, 95% CI = 0.73–1.01: OR = 0.94, 95% CI = 0.83–1.06). For all the participants, the prevalence of those conforming to MSE was 30.1%. One-fifth of the participants reported no MSE per week, 7.8% reported 3 days of MSE per week, and 7.7% reported 7 days.

Conclusion

The main finding of this study indicated a positive relationship between the normative MSE required in guidelines and low-level obesity. Beyond that, the evidence was insufficient to confirm the positive links between MSE and depression among American adolescents. Our study could offer evidence for future MSE interventions in adolescents.

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.

Recreational fishing, health and well-being: findings from a cross-sectional survey

We evaluated the associations between marine recreational fishing, stress, seafood consumption, and sleep quality in a cross-sectional questionnaire-based survey of a convenience sample of 244 fishers recruited in 2019 in Spain. Fishers' stress levels were moderate, with a mean stress index score of 36.4 units on a scale from 14 (very low stress) to 70 (very high). Their average emotional condition was positive, with a mean index of negative affect of 7.8 units on a scale from 5 (very low negative affect) to 25 (very high). Seafood intake was low, with a mean index of seafood in diets of 38.0 units on a scale from 20 (very low seafood consumption) to 160 (very high). Fishers' perceived quality of night sleep was good because the mean index of sleep problems was 39.5 units on a scale from 21 (very low sleep problems) to 107 (very high). Each hour of self-reported monthly fishing activity was associated with 0.016 units of lower stress score. Thus, the most engaged fishers reported up to 15.4% lower stress score than less avid fishers. Since recreational fishing is a highly accessible outdoor activity for people in older age groups, it is possible that public health could be improved by access to sustainably managed recreational fisheries. Fishing engagement was positively associated with seafood intake. Each hour of fishing per month was associated with one-unit higher seafood consumption. The higher seafood consumption observed among avid recreational fishers compared with less avid fishers might have health implications.

Spanish Translation and Cultural Adaptation of the Canadian Assessment of Physical Literacy-2 (CAPL-2) Questionnaires

Background: This study aimed to translate and culturally adapt the questionnaires belonging to the Canadian Assessment of Physical Literacy-2 (CAPL-2) into Spanish and to explore the reliability for its use in children and adolescents aged from 8 to 12 years. Methods: The CAPL-2 questionnaires were translated using the translation–back-translation methodology into Spanish and adapted to the Spanish context. The test–retest reliability and internal consistency of the CAPL-2 questionnaires of this Spanish version were analysed in 57 schoolchildren from a school in the region of Extremadura (Spain). Results: High internal consistency (α = 0.730 to 0.970) and test–retest reliabilities ranging from moderate to almost perfect in the knowledge and understanding domain (ICC = 0.486 to 0.888); from substantial to almost perfect in the motivation and confidence domain (ICC = 0.720 to 0.981); and almost perfect in the daily activity domain (ICC = 0.975) were found. The test–retest correlation was significantly weak to strong (r = 0.266 to 0.815) in both the motivation and confidence and knowledge and understanding domains, except for the third predilection item and the muscular endurance question. Significant test–retest differences were observed in the first intrinsic motivation item (p = 0.027) and the knowledge and understanding domain total score (p = 0.014). Conclusion: The Spanish version of the CAPL-2 questionnaires, translated and adapted to the context, are reliable measurement tools, serving to complete the full adaptation of the CAPL-2 test battery for use in children aged 8 to 12 years.

Avoiding hypersensitive reluctance to address parental responsibility in childhood obesity

Childhood obesity is an increasing health problem. Prior empirical research suggests that, although discussing lifestyle behaviours with parents could help prevent childhood obesity and its health-related consequences, physicians are reluctant to address parental responsibility in the clinical setting. Therefore, this paper questions whether parents might be (or might be held) responsible for their children's obesity, and if so, whether parental responsibility ought to be addressed in the physician-patient/parent encounter. We illustrate how different ideal-typical models of the physician-patient/parent interaction emphasise different understandings of patient autonomy and parental responsibility and argue that these models advocate different responses to an appeal for discussing parents' role in childhood obesity. We suggest that responsibility should be attributed to parents because of their parental roles in providing for their children's welfare. We also argue that whether, and how, this responsibility gives rise to a requirement to act depends on the parents' capacities. A deliberative-oriented physician-patient/parent interaction best captures the current ideals of antipaternalism, patient autonomy, and shared and evidence-informed decision-making, and might facilitate parental role development. We conclude that, while not discussing parental responsibility for childhood obesity in the clinical setting can be warranted in particular cases, this cannot be justified as a general rule.

Association between Physical Literacy and Self-Perceived Fitness Level in Children and Adolescents

Simple Summary

Alarming data on physical inactivity and sedentary lifestyles in children and young people are increasing. The level of physical fitness is considered a predictor of morbidity and comorbidities resulting from physical inactivity. Physical literacy, which includes the assessment of physical fitness, could be considered a crucial element for understanding adolescents’ health status and physical activity-related behaviours. Moreover, the self-perceived physical fitness should also be considered. Thus, this study analysed the relationship between physical literacy and self-perceived physical fitness in children and adolescents aged 8–12 years. It could be concluded that a higher level of self-perceived physical fitness would be associated with a greater level of physical literacy.

Abstract

Background: Physical fitness is considered a predictor of mortality and comorbidities resulting from physical inactivity in children and adolescents. Physical literacy provides a robust and comprehensive assessment of physical fitness. Thus, it is considered a crucial element for understanding children and adolescents’ health status and their physical activity-related behaviours. Moreover, the self-perceived fitness should also be considered. Therefore, this study aims to analyse the relationship between physical literacy and self-perceived physical fitness in children and adolescents aged 8–12 years. Methods: A single-measure cross-sectional study was conducted with 135 children and adolescents. Anthropometric measurements and the Canadian Assessment of Physical Literacy Development (CAPL-2) were applied. Descriptive statistics and correlations were calculated. The Fitness Perception Scale for Adolescents (FP VAS A) scale was also administered to assess participants’ self-perceived fitness. Results: Moderate significant correlations were found between “physical competence”, “motivation and confidence”, and the total CAPL-2 score with FP VAS A. Conclusions: The influence of motivation on self-perceived fitness has been demonstrated. Moreover, cardiorespiratory fitness could be considered one of the most relevant and influential factors in the total CAPL-2 score. It means that higher levels of self-perceived fitness would be associated with greater levels of physical literacy.

Interval Training with Different Intensities in Overweight/Obese Adolescent Females

To compare the effects of 12 weeks of high-intensity interval training (HIIT) versus moderate-intensity interval training (MIIT) on hematological and inflammatory markers in youth females, 38 overweight/obese females (16.4±1.0 yrs.) were randomly assigned to HIIT (2×6-8 repetitions of 30 s at 100-110% maximal aerobic speed (MAS), with 30 s active recovery between repetitions at 50% MAS; n=13), MIIT (2×6-8 repetitions of 30 s at 70-80% MAS, with 30 s active recovery between repetitions at 50% MAS; n=13), and a control group (CG, no intervention; n=12). Body composition, blood pressure, maximal heart rate, hematological and inflammatory markers (C-reactive protein [CRP], and erythrocyte sedimentation rate [ESR]) markers were assessed in all groups before and following the training program. Results revealed a significant (P<0.05) interaction effect for body composition, systolic blood pressure (SBP), MAS, maximal heart rate, and CRP. Within-group analyses for the HIIT and MIIT groups showed significant improvements in body mass (P=0.009 and P=0.025, respectively), BMI Z-score (P=0.011 and P=0.028, respectively), and MAS (P<0.001 and P=0.011, respectively). The HIIT program showed a significant decrease in body fat (P=0.002), waist circumference (P=0.002), maximal heart rate (P=0.003), SBP (P=0.001), and plasma CRP (P=0.004). In both groups, no significant changes were observed in ESR and hematological markers after intervention. No variable changed in CG. HIIT was the effective method to manage cardiometabolic health and inflammatory disorders in obese youth.

Amount of Fibre in the Diet with Regard to Excessive Weight and Obesity among Children and Adolescents in Rural Communities

One component of a correctly balanced diet is dietary fibre. Fibre acts protectively-it improves the functioning of the intestines, regulates the rhythm of bowel movements, inhibits the absorption of sugar and also lowers the level of cholesterol. The aim of the research was to determine the intake of fibre in relation to the occurrence of excessive weight and obesity among children and adolescents living in rural areas. The research was conducted using an authored questionnaire. The study questionnaire was completed by the study participants and their parents over 7 d. The anthropometric measurements were carried out on pupils in their underwear in conditions of privacy. Based on the results obtained, the BMI index was calculated for each pupil and then ranked according to WHO reference values. Among the pupils in the study group, the intake of fibre was at a very low level. The lowest amount of fibre in the diet was found among those with excessive weight and with obesity. Over 39% pupils never consumed wholegrain bread. Fruit and vegetables were consumed most seldom by pupils with excessive body weight. Knowledge about the lifestyles of children and adolescents is of crucial importance in taking multidirectional preventative actions to make changes to such lifestyles.

An accurate and dual-effective body slimming method through a soluble microneedle patch with variable temperature

Obesity is a chronic and recurrent disease with potential risks. Traditional weight-loss methods (like exercises, surgeries, oral drugs, etc.) have shown different side effects. In this experiment, the microneedle (MN) patch was selected as the drug carrier of the weight-loss drug Rosiglitazone (Rosi). Besides, melanin was added to enhance the photo-thermal effect and accelerate the release of drugs to the target fat region under near-infrared (NIR) light. Afterwards, with exterior cold stimulation, the significant and accurate effect of body slimming could be achieved. This combination of soluble MN patches and variable temperatures provides an attractive nonsurgical method for future accurate body slimming management.

Temporal trend of cardiorespiratory endurance in urban Catalan high school students over a 20 year period

Background

Physical fitness is considered an important indicator of health in adolescents. However, in recent years several studies in the scientific literature have shown a considerable lower trend and an alarming worsening of the current adolescents’ physical condition when comparing with previous decades, especially in urban populations. The aim of the current study was to analyse the temporal trend in cardiorespiratory endurance (CRE) in urban Catalan adolescents over a 20-year period (1999–2019).

Methods

A cross-sectional analysis study considering the 20-m Shuttle Run test (SRT) results obtained in the last 20 years was carried out. 1,701 adolescents between 15 and 16 years old (914 boys and 787 girls) were divided into four groups, corresponding to consecutive periods of five years (Group 1: 1999–2004; Group 2: 2005–2009; Group 3: 2010–2014 and Group 4: 2015–2019). ANOVA was used to test the period effect on CRE and post hoc Bonferroni analysis was performed to test pairwise differences between groups (p < 0.05).

Results

Results showed a significantly lower performance in CRE in both sexes. The percentual negative difference was 0.67%, 9.6% and 7% for boys and 5.06%, 14.97% and 9.41% for girls, when comparing the performance in 20-m Shuttle Run test for the first period, respectively.

Conclusions

Results suggest that the physical fitness of Catalan urban adolescents is lower in both sexes when comparing the different analysed periods of time. Therefore, CRE adolescents should be improved in order to help to protect against cardiovascular disease and other health risks in adulthood.

Exergaming and Aquatic Exercises Affect Lung Function and Weight Loss in Obese Children

We investigated the effect of exergames and aquatic exercises on lung function and weight loss in obese children. Sixty-one obese male primary-school children were randomly allocated to video game, aquatic exercise, and control groups. Lung functions and anthropometric variables were measured before and after the intervention and after one month (follow-up). In the video game group, an Xbox Kinect game was played for 60 min during three sessions a week. The aquatic aerobic exercise was performed three times per week and consisted of a warm-up, main exercises, and a cool down phase. For the video game group, there was a significant reduction in body weight between (i) pre- and (ii) post-intervention and follow-up. In the aquatic exercise group, there was a significant reduction in body weight between pre- and post-intervention and between pre-intervention and follow-up. Both exercise groups improved the waist/hip ratio index compared to the control group. Forced vital capacity was significantly improved in the follow-up of the video game group and the aquatic exercise group compared to the control group. A significant improvement was found in forced expiratory volume in the first second at post-intervention and follow-up in the video game and the aquatic exercise groups. Exergames and aquatic exercises improved weight loss and lung function in obese children.

The association between adherence to the Mediterranean diet and childhood obesity; the role of family structure: Results from an epidemiological study in 1728 Greek students

BACKGROUND

Childhood obesity is among the leading public health challenges, worldwide.

AIM

To examine the association between children's adherence to the Mediterranean diet (MD) and weight status taking into account family structure and related behaviors.

METHODS

1728 primary-school Greek students (46% males), from Athens metropolitan area, island of Crete, and the Peloponnese region, were enroled during school years 2014-2016. Children and their parents completed questionnaires which, among others, recorded family structure (i.e., married/cohabited, divorced, single parent, and widowed), dietary and lifestyle habits. Adherence to the MD was assessed through the KIDMED score (range - 4 to 12). Children's body mass index was calculated and classified as normal, overweight/obese, according to the International Obesity Task Force classification. The working sample was 1142 children (44% males) with a recorded family structure.

RESULTS

The prevalence of overweight was 21.7% and obesity was 5.0%; overweight/obesity prevalence was higher among males than females (32.4% vs. 23.3%; p < 0.001). Overweight/obese children had a lower KIDMED score compared to normal weight (median (range): 4 (-2, 11) vs. 5 (-1, 10), p = 0.05). An inverse association between KIDMED score and children's weight status (odds ratio (OR) (95% confidence interval (CI)): 0.95 (0.89-0.99)) was observed. Interaction between family structure and KIDMED was observed (p < 0.001); stratified analysis revealed that in children from nuclear families the KIDMED score was inversely associated with the likelihood of overweight/obesity (OR (95% CI): 0.95 (0.88-1.00)), whereas in children from single-parent families it was not (OR (95% CI): 0.94 (0.79-1.12)).

CONCLUSION

Adherence to the MD plays a protective role against childhood overweight/obesity, particularly among children living in nuclear families.

The Predictors of Obesity among Urban Girls and Boys Aged 8-10 Years-A Cross-Sectional Study in North-Western Poland

BACKGROUND

Children worldwide are increasingly becoming overweight and obese and developing related health problems, including hypertension, lipid disorders, abnormal glucose tolerance, type 2 diabetes, and secondary psychological disorders. The aim of the study was to determine sociodemographic risk factors that predict an increase in BMI in children at an early school age.

MATERIAL AND METHOD

The study covered 4972 children aged 8-10 years, including boys (N = 2461) and girls (N = 2511). Measurements of basic anthropometric indicators were used, such as body height, body weight, body composition, and physical fitness. The criteria developed by the International Obesity Task Force (IOTF) were adopted. Sociodemographic features were analyzed based on a diagnostic survey. IBM SPSS Statistics v.25 (Mineral Midrange SA, Warsaw, Poland) and IBM SPSS Amos software (Mineral Midrange SA, Warsaw, Poland) were used to perform descriptive statistics, the Kolmogorov-Smirnov test, Pearson's chi-square test, Student's t-test, and the Mann-Whitney U test. The statistical significance index was assumed to be p < 0.05, while p < 0.01 was taken as an indicator of a trend which was not completely statistically significant.

RESULTS

Both the children and their parents had mainly moderate BMI. A total of 78.7% of children were within the weight norm. Among girls, extreme obesity was two times more frequent than extreme underweight. The examined boys were significantly taller, heavier, and had a higher BMI than girls. There were significant differences between boys and girls in BMI; however, gender alone accounted for less than 1% variance. The influence of parents' characteristics was much greater, increasing the explained variance to 10%. Body weight of mothers and fathers (p < 0.001), mother's height (p < 0.01) and both parents' level of education (p < 0.001) were detected as significant predictors of children's BMI.

CONCLUSIONS

The analysis of selected sociodemographic and health factors determining the BMI of the child population indicates the need for preventive action and health promotion both among children and their parents.

Prevention of adolescent obesity: The global picture and an indian perspective

BACKGROUND AND AIMS

Adolescent obesity is an increasing health burden with a growing prevalence in low- and middle-income countries. The aim of this review is to assess and compare current best practice obesity prevention interventions for adolescents in developed nations and in India METHODS: Medline (PubMed), CINAHL, Scopus and Google Scholar electronic databases from 2000 to 2020 were searched using the key terms obesity, overweight, child and adolescent obesity, child and adolescent overweight, interventions for childhood and adolescent obesity and dietary interventions for adolescents, developed countries, and India.

RESULTS

Developed nations worldwide have formed and implemented policies and programs at national and local levels to attempt to minimize and manage adolescent obesity. In 2019, scientific and government consultation groups in India have recommended national cross-sectoral structures to action interventions to restrict high-fat food intake, increase physical activity in children and adolescents and to link current research and school-based interventions in a national framework.

CONCLUSIONS

Obesity is a multifactorial problem, and multimodal interventions involving all Indian stakeholders, combined with government policy reform, are urgently needed.

Insights into smell and taste sensitivity in normal weight and overweight-obese adolescents

Research examining connections between BMI and smell and taste sensitivity in adolescents has been minimal, methodologically inconsistent, and inconclusive. We sought to address this issue with an exploratory study of smell and taste sensitivity in overweight-obese (high BMI) and normal BMI male and female adolescents (ages 12-16 years), using previously validated chemosensory testing measures (Sniffin' Sticks, Taste Strips, 6-n-propylthiouracil: PROP), and taking pubertal stage into account. Puberty was evaluated with the validated Pubertal Development Scale and participants were then classified as either "early" or "late" pubertal stage. We used the phenylethyl alcohol (PEA) version of the Sniffin' Sticks olfactory threshold test and found that high BMI adolescents had significantly greater olfactory sensitivity than normal BMI adolescents. This observation contradicts previous results in overweight adults tested with the n-butanol version of Sniffin' Sticks. We also found that participants in early puberty had significantly higher olfactory sensitivity than participants in late puberty. No significant findings for taste sensitivity were obtained, though there is a suggestion that puberty may affect salty taste thresholds. Our results illuminate a potentially important difference in sensitivity to pure olfactory versus olfactory-trigeminal stimuli as a function of BMI, which the PEA and n-butanol versions of the Sniffin' Sticks respectively assess; and for the first time demonstrate variation in chemosensory acuity in relation to pubertal stage. These findings have implications for eating behavior during adolescence.

Near final adult height, and body mass index in overweight/obese and normal-weight children with idiopathic central precocious puberty and treated with gonadotropin-releasing hormone analogs

Background The standard treatment of central precocious puberty (CPP) is gonadotropin-releasing hormone analogues (GnRHa). It is a concern that children treated with GnRHa are at risk of developing obesity which could impair the treatment outcomes. This study aimed to investigate the effect of GnRHa on body mass index (BMI) standard deviation score (SDS), and the influence of BMI status on treatment outcomes in children with idiopathic CPP (iCPP). Methods A retrospective cohort study in children with iCPP who completed GnRHa treatment and had attained near final adult height (NFAH) was conducted. Children with a history of disease or drug ingestion which could affect their BMI were excluded. BMI, BMI SDS, height (Ht), Ht SDS, predicted adult height (PAH), and NFAH were compared at baseline, 1 and 2 years during treatment, and at NFAH according to the baseline BMI status; normal weight and overweight/obesity. Results Fifty-eight children with iCPP treated with GnRHa were enrolled. The BMI SDS was significantly increased at 1 and 2 years during treatment in the overweight/obese group and at 1 year during treatment in the normal-weight group. However, at NFAH (2 years after treatment discontinuation), the BMI SDS was not statistically different from baseline in both groups. Ht gain, change in Ht SDS and BMI SDS were not statistically different from the baseline in both groups. Conclusions GnRHa results in a transient increase in BMI SDS during treatment and returned to baseline after treatment cessation. The benefit of GnRHa treatment on final Ht improvement is similar between overweight/obese and normal-weight patients.

Translating knowledge into action to prevent pediatric and adolescent diabesity: a meeting report

Background

The obesity and Type 2 Diabetes Mellitus (T2DM) rates are at an all-time high globally. This diabesity epidemic is increasingly impacting children and adolescents, and there is scarce evidence of interventions with favourable long-term outcomes.

Purpose

In order to understand the determinants of diabesity and how to address them, multiple stakeholders were invited to a meeting to discuss current state of knowledge and to help design a program to prevent pediatric and adolescent diabesity.

Participants and methods

The meeting was held at McMaster University on March 4th, 2015. The event involved presentations to deliver state-of-the-art knowledge about diabesity, and roundtable discussions of several domains including nutrition, physical activity, sleep, and mental health. Discussion transcripts were analyzed using NVivo.

Results

Forty-nine participants took part in the workshop. They included clinical healthcare professionals, public health, Aboriginal Patient Navigator, research scientists, students, and patients with family members. A total of 628 reference counts from the roundtable discussions were coded under 20 emerging themes. Participants believed that the most important elements of the program involve the provision of knowledge and education, family involvement, patient motivation, location of program delivery, and use of surveys and questionnaires for outcome measurement.

Conclusion

Effective pediatric and adolescent diabesity prevention programs should be conceptualized by multidisciplinary stakeholders and embrace the complexity of diabesity with multiprong interventions. This meeting provided a framework for developing such interventions.

Age-specific and sex-specific reference intervals for non-fasting lipids and apolipoproteins in 7260 healthy Chinese children and adolescents measured with an Olympus AU5400 analyser: a cross-sectional study

AIMS

Ethnic, demographic, lifestyle, genetic and environmental factors influence lipids and apolipoproteins. The aim of this study was to establish age-specific and gender-specific reference intervals for non-fasting lipids and apolipoproteins in healthy Chinese children and adolescents.

METHODS

This study followed the Clinical and Laboratory Standards Institute EP28-A3c guidelines. Non-fasting samples were collected from 7260 healthy Chinese children and adolescents, and they were analysed using the Olympus AU5400 analyser for: triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 and apolipoprotein B (ApoB). The age-related and gender-related reference intervals were partitioned using the Harris-Boyd method. The non-parametric method was used to establish the lower limit (2.5th percentile) and the upper limit (97.5th percentile) for the reference intervals. The 90% CIs for the lower and upper limits were also calculated.

RESULTS

Based on the Harris-Boyd method, gender partitions were required for TC, LDL-C and ApoB. Age differences were observed for all analytes. Paediatric reference intervals were established for non-fasting lipids and apolipoproteins based on a large population of healthy children and adolescents.

CONCLUSIONS

Previously used reference intervals did not take age and gender into account. These age-specific and gender-specific reference intervals established in this study may contribute to improved management and assessment of paediatric diseases.

Prevalence and associated factors of childhood overweight/obesity among primary school children in urban Nepal

BACKGROUND

Childhood overweight/obesity has become a major public health concern globally because of its adverse health consequences and escalating prevalence. The factors underlying the disease conditions manifested during adulthood commonly originate in childhood. Nepal is going through a transition where under-nutrition co-exists with obesity; however, there is a lack of well-documented information on childhood overweight or obesity in Nepal. This study was carried out to determine the prevalence and associated factors of childhood overweight/obesity among urban primary school children.

METHODS

A cross-sectional survey was conducted from May to October of 2017. Behavioral data were collected using a structured self-administered questionnaire with parents of children aged 6-13 years old in grades 1-5 studying in private schools of Lalitpur district in Nepal. Study participants were selected using two-stage cluster random sampling from 10 private schools. Height and weight measurements of 575 children were taken and BMI-for-age-sex was calculated using WHO AnthroPlus. Data were analyzed using SPSS version 21. Associated factors were examined using Chi-square tests followed by multivariate logistic regression analyses.

RESULTS

The study found that out of 575 students, 107 (18.6%) were overweight and 41 (7.1%) were obese. Among 328 male children, 62 (19.0%) were overweight and 35 (10.6%) were obese. Likewise, among 247 female children, 45 (18.2%) were overweight and 6 (2.4%) were obese. Male children (aOR = 2.21, 95% CI: 1.38-3.53), children of mothers with a high school (aOR = 3.13, 95% CI: 1.39-7.12) or university level of education (aOR = 3.09, 95% CI: 1.23-7.70) and children of mothers in a professional field (aOR = 1.34, 95% CI: 1.02-4.05) had a greater likelihood of being overweight/obese. Likewise, students consuming energy-dense less nutrient food (aOR = 2.92, 95% CI: 1.66-5.12), lacking active travel to and from school (aOR = 2.38, 95% CI: 1.12-4.79) and those having sedentary behaviors (aOR = 3.01, 95% CI: 1.20-7.29) were likely to be overweight/obese.

CONCLUSIONS

More than one-quarter of the children in urban Lalitpur were found to be overweight/obese. High junk food consumption and sedentary activity were found to be significantly associated with childhood overweight/obesity. School health and awareness programs aiming to reduce the intake of energy-dense foods and promote an active lifestyle including active transportation to school among children are imperative. Future studies to objectively measure the type and amount of food intake and physical activity of students are recommended.

Study protocol for a cluster randomized controlled trial to test "¡Míranos! Look at Us, We Are Healthy!" - an early childhood obesity prevention program

BACKGROUND

One in three Head Start children is either overweight or obese. We will test the efficacy of an early childhood obesity prevention program, "¡Míranos! Look at Us, We Are Healthy!" (¡Míranos!), which promotes healthy growth and targets multiple energy balance-related behaviors in predominantly Latino children in Head Start. The ¡Míranos! intervention includes center-based (policy changes, staff development, gross motor program, and nutrition education) and home-based (parent engagement/education and home visits) interventions to address key enablers and barriers in obesity prevention in childcare. In partnership with Head Start, we have demonstrated the feasibility and acceptability of the proposed interventions to influence energy balance-related behaviors favorably in Head Start children.

METHODS

Using a three-arm cluster randomized controlled design, 12 Head Start centers will be randomly assigned in equal number to one of three conditions: 1) a combined center- and home-based intervention, 2) center-based intervention only, or 3) comparison. The interventions will be delivered by trained Head Start staff during the academic year. A total of 444 3-year-old children (52% females; n = 37 per center at baseline) in two cohorts will be enrolled in the study and followed prospectively 1 year post-intervention. Data collection will be conducted at baseline, immediately post-intervention, and at the one-year follow-up and will include height, weight, physical activity (PA) and sedentary behaviors, sleep duration and screen time, gross motor development, dietary intake and food and activity preferences. Information on family background, parental weight, PA- and nutrition-related practices and behaviors, PA and nutrition policy and environment at center and home, intervention program costs, and treatment fidelity will also be collected.

DISCUSSION

With endorsement and collaboration of two local Head Start administrators, ¡Míranos!, as a culturally tailored obesity prevention program, is poised to provide evidence of efficacy and cost-effectiveness of a policy and environmental approach to prevent early onset of obesity in low-income Latino preschool children. ¡Míranos! can be disseminated to various organized childcare settings, as it is built on the Head Start program and its infrastructure, which set a gold standard for early childhood education, as well as current PA and nutrition recommendations for preschool children.

TRIAL REGISTRATION

ClinicalTrials.Gov ( NCT03590834 ) July 18, 2018.

Feasibility of incorporating high-intensity interval training into physical education programs to improve body composition and cardiorespiratory capacity of overweight and obese children: A systematic review

BACKGROUND/OBJECTIVE

High-intensity interval training (HIIT) can produce similar or improved results compare with traditional training, but the question as to whether HIIT can be used in the setting of physical education (PE) remains unanswered. The aim of this systematic review was to critically analyze the feasibility of incorporating HIIT programs into PE classes to improve the body compositions and cardiorespiratory fitness of overweight students.

METHODS

We conducted database searches for literature dating between January 2012 and January 2017. Of the final six studies selected, three were conducted in children under 12 years old and three involved adolescents between 12 and 18 years old.

RESULTS

The HIIT protocols consisted of 2-3 sessions per week, with intervals of 15 s and passive or active rests of 15 s, totaling up to 6 min of work with 4 min of rest. The duration of HIIT programs was 6-24 weeks. Significant changes were reported in body composition, body mass index, body fat (%), waist circumference, and sum of skinfolds; and increases in muscle mass were observed. The inclusion of HIIT programmes improved maximal oxygen uptake (VO2max), performance in the intermittent Yo-Yo test and maximal aerobic speed.

CONCLUSIONS

The HIIT programmes showed improvements in the variables studied, with interventions two or three times weekly. Therefore, they can be used in schools, as a strategy to combat the childhood obesity pandemic and HIIT can be use alongside with existing PE activities within the same lesson or in specific periods during day school.

Association of Anthropometric Indices With Metabolic Phenotypes of Obesity in Children and Adolescents: The CASPIAN-V Study

Background: Obesity, particularly in the upper part of the body, is a major health problem. Measuring the neck circumference (NC) and wrist circumference (WrC) is a relatively new method of differentiating between normal and abnormal fat distributions. This study aimed to evaluate the association of NC, hip circumference (HC), and WrC with different phenotypes of obesity and their metabolic status. Methods: In this multi-centric cross-sectional study, 4,200 students aged 7-18 years were selected from 30 provinces in Iran in 2014 by using a multistage cluster random sampling method. Metabolic syndrome (MetS) was defined based on the ATP III criteria modified for the pediatric age group. The subjects were classified into four groups according to their weight and metabolic status: metabolically healthy obese (MHO), metabolically non-healthy non-obese (MNHNO), metabolically non-healthy obese (MNHO), and metabolically healthy non-obese (MHNO). Results: Significant but different associations of NC, HC, and WrC with obesity phenotypes were documented in the entire population. Significant but different associations of NC, HC, and WrC with metabolic phenotypes were also found in the entire population. In the multinomial logistic regression, the association of the different obesity phenotypes with the study anthropometric indices increased significantly with increasing NC, WrC, and HC. Also, per one unit increment in NC, HC, and WrC, the odds of MHO, MNHNO, and MNHO increased compared to that of the MHNO phenotype. Conclusion: In children and adolescents, HC, NC, and WrC are significantly associated with obesity phenotypes and their metabolic status, and these metrics are suggested to be innovative, low-cost, and alternative tools for assessing them in different age and sex pediatric age groups.

Prevalence of obesity and its risk factors among school children in Karachi, Pakistan

A cross-sectional questionnaire study was conducted during 2012 in private and public-sector schools of Karachi to determine the prevalence and factors influencing overweight and obesity among school children (aged 11-15 years). Sociodemographic characteristics and dietary habits were explored. The CDC Growth Chart was used to record height and weight. Of a total of 887 children, being overweight and frankly obese was found in 169 (19.1%) and 96 (10.8%), respectively. Of these, 176 (66.4%) were from private schools, and significant associations were found in 202 (76.2%) who were spending > 2 h/day watching television and 139 (52.5%) sleeping > 8 h/day.

Factors associated with overweight and childhood obesity in Spain according to the latest national health survey (2011)

Abstract Objective: To describe the factors associated with overweight/obesity in Spain according to the latest National Health Survey (2011). Method: Descriptive cross-sectional study with 3,752 children aged 2 to 15 years (boys=2,007; girls=1,745). Main variables: overweight; obesity; gender; level of education of the head of the family; monthly income; hours of sleep; physical exercise; hours of TV and/or computer use; daily breakfast; parents' weight perception. Diagnostic criterion was based on WHO growth patterns, defined overweight with +1SD and obesity, +2SD. Results: Boys more obese than girls. Children whose parents had a lower level of education, those who did not practice physical activity and whose parents had an income of less than 900€ per month showed a higher percentage of overweight/obesity. Conclusions: Children whose parents had a lower education and monthly income presented a higher percentage of obesity. Sleeping the recommended hours and doing some type of physical activity reduces obesity.

Modified Healthy Eating Index and Incidence of Metabolic Syndrome in Children and Adolescents: Tehran Lipid and Glucose Study

OBJECTIVE

To assess the relationship between modified healthy eating index (mHEI) with the development of metabolic syndrome (MetS) among children and adolescents.

STUDY DESIGN

Dietary data were collected using a food frequency questionnaire among 424 healthy subjects, aged 6-18 years. The components of mHEI were grains, vegetables and fruits, dairy, red to white meat ratio, butter, sweet snacks, sweetened beverages, salty snacks, and fast food. Multivariable logistic regression models were used to estimate the incidence of MetS after 3.6 years of follow-up in each quartile of the mHEI score, adjusted for baseline age, sex, total energy intake, physical activity, and body mass index.

RESULTS

The mean ± SD age and mHEI scores of participants were 13.6 ± 3.7 years and 55.9 ± 10.0, respectively, at baseline. MetS developed in 11% of the participants at the end of follow-up. After adjustment for confounders, the occurrences of MetS decreased in the highest quartile compared with the lowest quartile of the mHEI score (OR = 0.35, 95% CI 0.13-0.98, P for trend = .025). In addition, higher scores of mHEI components including fruits, salty snacks, and fast food were associated with lower risk of MetS.

CONCLUSIONS

Higher scores of mHEI as an indicator of diet quality may hinder the development of MetS among children and adolescents.

Investigating the impact of a health game on implicit attitudes towards food and food choice behaviour of young adults

Improving diets by stimulating fruit and vegetable consumption might be beneficial, in particular when they substitute energy-dense products. The aim of present study was to investigate whether a health game can be used to positively affect healthy implicit attitudes (IAs) towards food and subsequent food choice behaviour of young adults. A 2 (Time: baseline vs. post-test) x 2 (Condition: health game vs. control game) x 2 (Baseline IAs: healthy IAs vs. less healthy IAs) mixed-subjects design was used with 125 participants (age: M = 20.17, SD = 1.88). IAs towards food were assessed at baseline and post-test using an Implicit Association Test (IAT). Additionally, food choice behaviour was assessed after game play. At baseline, the majority of participants had healthy IAs (i.e., favouring fruit over chocolate snacks). At post-test, significantly less healthy IAs were observed in the control condition, while this reduction was not significant in the health game condition. Regarding food choice behaviour, participants with healthy baseline IAs were more likely to select fruit in the health game condition than participants with healthy baseline IAs in the control game condition. However, participants with less healthy baseline IAs were less likely to select fruit in the health game condition than in the control condition. We found tentative support that health games can be used to influence IAs towards food and positively affect food choice behaviour. However, this influence was only observed for those with healthy baseline IAs. The current version of the health game would primarily benefit those already healthy and could negatively affect those that need the intervention most, so modifications are recommendable.

Physical Education and Leisure-Time Physical Activity in Youth Are Both Important for Adulthood Activity, Physical Performance, and Health

BACKGROUND

The importance of youth physical activity (PA) for adulthood PA, performance, and health was retrospectively evaluated.

METHODS

A total of 258,146 participants (49% women), aged 19-70, with a first-time health-profile assessment between 1982 and 2015, provided self-reported data on current perceived health, PA, lifestyle, and physical education class participation, and PA outside school hours before age 20. Data on anthropometrics, blood pressure, and estimated maximal oxygen consumption (VO_2max) were obtained.

RESULTS

Women participating in physical education class, compared with those who did not, had significantly lower OR (range: 0.81-0.87) for perceiving poor overall health, general obesity, and high diastolic blood pressure after adjustment for potential confounders, and increased OR (range: 1.17-1.23) for exercising regularly and a normal/high VO_2max in adulthood. For men, the ORs were significantly lower (range: 0.66-0.86) for poor perceived overall health, general, and abdominal obesity. These associations were seen for participants up to 70 years. Increased PA outside school hours revealed even stronger beneficial associations. In joint analyses, both youth and current PA were important for lower OR of poor health and being obese in adulthood.

CONCLUSIONS

Physical education class participation and additional PA after school hours were both important for perceived health, PA, VO_2max, and metabolic health in adulthood up to 70 years.

Current data in Greek children indicate decreasing trends of obesity in the transition from childhood to adolescence; results from the National Action for Children's Health (EYZHN) program

Introduction

The aim of the study is to present the most recent estimates of obesity (total and central) prevalence in Greek children and associated risk factors.

Methods

Population data are derived from a yearly, school-based health survey polled in 2015 on 336,014 (51% boys) children aged 4 to 17 years old from almost 40% of all schools of primary and secondary education in Greece. Anthropometric and physical fitness measurements were obtained by trained investigators. Dietary habits, physical activity status, sedentary activities and sleeping hours were assessed through self-completed questionnaires. The gender and age-specific Body Mass Index (BMI) cut-off points were used in order to define BMI groups.

Results

The prevalence of overweight and obesity in the whole population was 22.2% and 9.0% in boys and 21.6% and 7.5% in girls, respectively. Obesity presented decreasing trends in the transition from childhood to adolescence. Central obesity was diagnosed in 95.3% and 93.5% of the simple obese boys and girls, respectively, in almost two to three of overweight children (68.6% of boys and 64.3% of girls), and in 12% of normal weight children. Age, physical fitness, low adherence to Mediterranean diet, insufficient sleeping hours, inadequate physical activity levels and increased screen time were all associated with higher odds of total and central obesity.

Conclusions

Serious and urgent actions need to be taken from public health policy makers in order not only to prevent a further increase in obesity rates but, more important, to treat obesity and/or the obesity associated co-morbidities.

Subtle inflammation: a possible mechanism of future cardiovascular risk in obese children

Purpose

The risk of cardiovascular disease (CVD) has been shown to be associated with systemic inflammation in obese adults with metabolic syndrome (MetS). The aims of this study were to evaluate the prevalence of MetS and its relation to inflammatory markers in obese Thai children.

Methods

A cross-sectional study was conducted. Children with history of endogenous obesity, chronic diseases, drug ingestion, and any acute illness within 2 weeks prior to enrollment were excluded. Their fasting blood glucose (FBG) levels, oral glucose tolerance tests, insulin, lipid profiles, and selected inflammatory markers, including interleukin-6, tumor necrosis factor-alpha, and high-sensitivity C-reactive protein (hs-CRP) levels, were tested.

Results

In this study, 58 obese Thai children (female, 20; male, 38) with a mean body mass index z score of 5.1±2.2 were enrolled. The prevalence of MetS and prediabetes was 31% and 17.2%, respectively. None of the children had diabetes. FBG levels, 2-hour glucose levels, and lipid profiles were not statistically different between those with and without MetS. However, obese children with MetS had higher insulin levels and homeostasis model assessment of insulin resistance values. Elevated hs-CRP levels were found in 69% of the cases, although it was not statistically different between the 2 groups.

Conclusion

We described a substantial prevalence of MetS in Thai obese children. Regardless of MetS status, two-thirds of the obese children had elevated hs-CRP level, indicating subtle ongoing inflammatory process. This chronic inflammation feasibly predisposes them to CVD in the future, even in children without MetS.

Adiponectin Predicts High-Density Lipoprotein Cholesterol Efflux Capacity in Adults Irrespective of Body Mass Index and Fat Distribution

CONTEXT

Obesity is associated with hypoadiponectemia, dyslipidemia, and increased risk of cardiovascular disease (CVD). Mechanisms linking these conditions remain to be fully understood. Cholesterol efflux capacity (CEC) is a crucial functional property of high-density lipoprotein (HDL) that strongly predicts CVD incidence.

OBJECTIVE

We investigated whether age, fat distribution, and other obesity-related factors affect CEC in juvenile and adult overweight/obese participants of the STYJOBS/EDECTA cohort (NCT00482924).

DESIGN

We performed an observational study.

MAIN OUTCOME MEASURES

CEC and its association with body measures and related metabolic parameters was assessed in 683 participants (281 juveniles, of whom 227 were overweight/obese; 402 adults, of whom 197 were overweight/obese).

RESULTS

Pearson correlation analysis showed that, after Bonferroni correction, CEC was significantly inversely correlated with body mass index (BMI), carotid diameter, waist circumference, waist-to-hip, waist-to-height ratio, oxidized low-density lipoprotein, and uric acid and with the liver markers alanine-aminotransferase and choline esterase. CEC was positively correlated with HDL cholesterol, total cholesterol, apolipoprotein A1, and adiponectin in adults, whereas in juveniles only apolipoprotein A1 showed a significant positive correlation with CEC. Age-stratified linear regression analyses with CEC as the outcome variable identified adiponectin as the most significant predictor of CEC in adults. The results did not change when either BMI or waist-to-hip ratio as a factor of fat distribution was included in the models.

CONCLUSIONS

Hypoadiponectemia is a robust predictor of reduced cholesterol efflux capacity in adults irrespective of BMI and fat distribution. Further investigations are needed to assess whether adiponectin is a causal determinant of CEC.

Do Preschools Offer Healthy Beverages to Children? A Nationwide Study in Poland

Background: Children’s beverage consumption patterns have received increased attention in light of the obesity epidemic in this group. In day care centers (DCCs), children spend up to 10 h a day, and typically consume half to three quarters of their daily food intake. The purpose of the study was to investigate what beverages are typically served to children in preschools in Poland, and to evaluate the practices associated with adding sugar and other sweetening agents to beverages. Methods: Direct interviews with preschools staff were conducted with a questionnaire regarding offered beverages and adding sugar and other sweetening agents. The menu of 10 consecutive days and inventory reports were analyzed to verify information. Results: A total of 720 preschools were included in the study. Cocoa and milk coffee substitute were served in 95% of preschools, followed by compote (92%), tea (84%), fruit/herbal tea (73%) and water (69%). Water was the only beverage available between meals (93% DCCs). 86% of preschools added sugar to tea/cocoa/coffee substitute drinks, and 74% to compote. Conclusions: In the majority of preschools, beverages which are not recommended were offered. Such an assortment of beverages and common practice of sweetening can increase the amount of added sugar in a children diet. Nutrition education and legal regulations concerning the assortment of beverages served in preschools are urgently needed.

User Statistics for an Online Health Game Targeted at Children

OBJECTIVE

Given that many households in western countries nowadays have home access to the Internet, developing health-promoting online interventions has the potential to reach large audiences. Studies assessing usage data of online health interventions are important and relevant but, as of yet, scarce. The present study reviewed usage data from Monkey Do, an existing online health game developed specifically for children from 4 to 8 years old. In addition, the effect of advertising on usage was examined.

MATERIALS AND METHODS

In an observational study, a web-based analysis program was used to examine usage data of all visits to the online health game for the first 31 months following the launch. We reported descriptives for usage data. We analyzed the relationship between advertising and usage with a Mann-Whitney U test, and used a Pearson's chi-square test to investigate the association between advertising and the number of first-time visitors.

RESULTS

In the period of data analysis, there were 224,859 sessions. Around 34% of the visitors played the game more than once. Compared with first-time visitors, the average session time of returning visitors was doubled. The game was most frequently accessed via search engine query, on a desktop computer (compared to mobile devices). Advertising was found to be positively related to the number of sessions and the number of first-time visitors.

CONCLUSIONS

Placing a game online can reach a large audience, but it is important to also consider how to stimulate retention. Furthermore, repeated advertisement for an online game appears to be necessary to maintain visitors over time.

The Association between Self-reported Sleep Duration and Body Mass Index among Korean Adolescents

Previous research has shown that lack of sleep is related to Body Mass Index (BMI) in adolescence. This study was designed to investigate the association between sleep duration and BMI among Korean adolescents. We conducted a school-based cross-sectional study of 3,785 adolescents (males: 58.2%, females: 41.8%) in middle and high school between the ages of 11 and 18 years (mean age 15.26 ± 1.45). Using a self-reported questionnaire, we obtained information regarding weekday sleep duration, weekend sleep duration, height, weight, time spent at private tutoring institutes, socioeconomic status and scores on the Beck Depression Inventory (BDI). We investigated the association between self-reported sleep duration and BMI. After adjusting for confounding factors including age, gender, time spent at private tutoring institutes, academic performance, economic status and BDI scores, longer sleep duration on both weekdays and weekends was associated with decreased BMI (P = 0.002 and P < 0.001, respectively) for both genders. Increased weekend catch-up sleep duration was associated with decreased BMI in females (P = 0.038), but not in males (P = 0.343). The results of the present study indicated that longer sleep duration on weekdays and weekends in adolescents was associated with lower BMI. Longer weekend catch-up sleep may compensate effects of insufficient sleep on BMI for female adolescents.

Oral drug therapy following bariatric surgery: an overview of fundamentals, literature and clinical recommendations

Bariatric surgery is the most effective solution for severe obesity and obesity with comorbidities, and the number of patients going through bariatric surgery is rapidly and constantly growing. The modified gastrointestinal anatomy of the patient may lead to significant pharmacokinetic alterations in the oral absorption of drugs after the surgery; however, because of insufficient available literature and inadequate awareness of the medical team, bariatric surgery patients may be discharged from the hospital with insufficient instructions regarding their medication therapy. In this article, we aim to present the various mechanisms by which bariatric surgery may influence oral drug absorption, to provide an overview of the currently available literature on the subject, and to draw guidelines for the recommendations bariatric surgery patients should be instructed before leaving the hospital. To date, and until more robust data are published, it is essential to follow and monitor patients closely for safety and efficacy of their medication therapies, both in the immediate and distant time post-surgery.

The use of new technologies for nutritional education in primary schools: a pilot study

INTRODUCTION

The aim of this study was evaluating if the presence of a humanoid robot could improve the efficacy of a game-based, nutritional education intervention.

STUDY DESIGN

This was a controlled, school-based pilot intervention carried out on fourth-grade school children (8-10 years old). A total of 112 children underwent a game-based nutritional educational lesson on the importance of carbohydrates. For one group (n = 58), the lesson was carried out by a nutritional educator, the Master of Taste (MT), whereas for another group, (n = 54) the Master of Taste was supported by a humanoid robot (MT + NAO). A third group of children (n = 33) served as control not receiving any lesson.

METHODS

The intervention efficacy was evaluated by questionnaires administered at the beginning and at the end of each intervention. The nutritional knowledge level was evaluated by the cultural-nutritional awareness factor (AF) score.

RESULTS

A total of 290 questionnaires were analyzed. Both MT and MT + NAO interventions significantly increased nutritional knowledge. At the end of the study, children in the MT and MT + NAO group showed similar AF scores, and the AF scores of both intervention groups were significantly higher than the AF score of the control group.

CONCLUSIONS

This study showed a significant increase in the nutritional knowledge of children involved in a game-based, single-lesson, educational intervention performed by a figure that has a background in food science. However, the presence of a humanoid robot to support this figure's teaching activity did not result in any significant learning improvement.

High-Normal Arterial Blood Pressure in Children With Excess Body Weight

Background

Childhood overweight and obesity are common causes of metabolic disorders that persist until adulthood.

Objectives

The purpose of this study was to determine the prevalence of high-normal arterial blood pressure (ABP) in children with excess body weight.

Material and Methods

A total of 1,093 schoolchildren aged 10 - 12 years (51% girls and 49% boys) participated in the study. The children’s weight, height, body fat percentage (BFP), waist and hip circumference, and ABP were measured. The waist-to-height ratio (WHtR) and body mass index (BMI) were calculated and compared to the normative reference values accepted by the International obesity task force (IOTF).

Results

Excess weight was identified in 20% of the participants, and obesity in 5%. A total of 35.5% of overweight children had above-normal ABP, which implied hypertension. In obese children, that proportion equaled 59.3%. BFP was 6.5% greater in children with hypertension than in those with normal BP. The children with hypertension also had a 7.6-cm larger waist circumference, a 7.6-cm larger hip circumference, and a greater WHtR (by 0.04).

Conclusions

Excess body weight was identified in 25% of children aged 10 - 12 years, significantly increasing their risk of developing hypertension.

Impact of 20 Week Lifestyle Intervention Package on Anthropometric Biochemical and Behavioral Characteristics of Schoolchildren in North India

BACKGROUND

Childhood obesity is a public health problem worldwide. There is convincing evidence that school-based interventions are effective in managing childhood obesity. However, the nature of interventions, its impact on prevention of obesity and how they work remain poorly understood. The primary objective of this study was to examine the impact of a multicomponent lifestyle intervention on weight and body mass index (BMI) of children in a school-based setting.

METHODS

It is a cluster randomized trial where four schools were randomly selected and allocated to intervention and control arm equally. Of the 462 schoolchildren selected, 201 were assigned to the intervention group and 261 belonged to the control group. Children in the intervention arm received a multicomponent lifestyle package. Primary outcome measures included anthropometric measurements (weight, BMI, skinfold thickness and waist and hip circumference), whereas secondary outcomes were biochemical parameters, physical activity and dietary intake.

RESULTS

Compared with controls and adjusting for age, sex and clustering within classes, children in the intervention group showed decrease in the weight by - 0.08 (-0.15 to - 0.00, p  =  0.048) z-score units, waist circumference by - 0.14 (-0.25 to - 0.03, p  =  0.01) and triceps thickness by - 0.35 (-0.47 to - 0.22, p < 0.001) z-score units; however, BMI showed no significant decrease. There was significant reduction in intake of energy, protein and fat but no to minimal reduction in biochemical parameters.

CONCLUSION

A school-based lifestyle intervention package favorably affected anthropometric (weight, waist circumference and triceps and biceps thickness) and behavioral parameters. At least 20 weeks of healthy lifestyle promoting intervention package should be included in school curriculum in each academic year for sustainable impact and behavioral change to reduce the burden of lifestyle disorders.

Regular family breakfast was associated with children's overweight and parental education: Results from the ENERGY cross-sectional study

INTRODUCTION

This study aims to assess (i) the prevalence of having regular family breakfast, lunch, dinner (i.e. 5-7days/week together with their family) among 10-12year olds in Europe, (ii) the association between family meals and child weight status, and (iii) potential differences in having family meals according to country of residence, gender, ethnicity and parental levels of education.

METHODS

7716 children (mean age: 11.5±0.7years, 52% girls) in eight European countries (Belgium, Greece, Hungary, The Netherlands, Norway, Slovenia, Spain, Switzerland) participated in a cross-sectional school-based survey in 2010. Data on family meals were self-reported by the parents and children's height and weight were objectively measured to determine overweight status. Binary regression analyses assessed the associations of having regular family meals (adjusted for potential confounders) with children's overweight/obesity and to assess potential differences in having family meals according to gender, ethnicity and parental education, in the total sample and for each country respectively.

RESULTS

The prevalence of regular family meals was 35%, 37% and 76% for breakfast, lunch and dinner respectively. Having regular family breakfast, but not lunch or dinner, was inversely associated with overweight (OR=0.78 (95% CI 0.67-0.91)). Children of higher educated parents were more likely to have regular family breakfast (1.63 (95% CI 1.42-1.86)) and less likely to have regular family lunch (0.72 (95% CI 0.63-0.82)) compared to children of lower educated parents.

CONCLUSION

This study showed that having regular family breakfast - but not other family meals- was inversely associated with children's weight status.

Association between gestational weight gain and risk of obesity in preadolescence: a longitudinal study (1997-2007) of 5125 children in Greece

BACKGROUND

The present study aimed to investigate the association between gestational weight gain (GWG) and birth weight, as well as the body mass index (BMI) status, of children at the ages of 2 and 8 years.

METHODS

Population-based data were obtained from a database of all 7-9-year-old Greek children who attended primary school during 1997-2007. The study sample consisted of 5125 children matched with their mothers, randomly selected according to region and place of residence, and equally distributed (approximately 500 per year) throughout the study period (1997-2007). A standardised questionnaire was applied; telephone interviews were carried out to collect maternal age, BMI status at the beginning and the end of pregnancy and GWG, birth weight of offspring and BMI status at the ages of 2 and 8 years, as well as several other pregnancy characteristics (e.g. pregnancy duration, gestational medical problems, maternal smoking and alcohol consumption habits, and lactation of offspring after pregnancy).

RESULTS

Gestational weight gain was positively associated with the weight status of offspring at all three life stages studied: newborn (birth weight), infant (BMI) and child (BMI) [b = 0.008 (0.001), b = 0.053 (0.009) and b = 0.034 (0.007), respectively, all P < 0.001], after adjusting for maternal age at pregnancy (significant inverse predictor only at age 2 years). The same applied to excessive GWG, as defined by the Institute of Medicine guidelines.

CONCLUSIONS

Excessive GWG was associated with a higher risk of greater infant size at birth and a higher BMI status at the ages of 2 and 8 years. Healthcare providers should encourage women to limit their GWG to the range indicated by the current guidelines.