A Systematic Examination of the Association between Parental and Child Obesity across Countries

Temporal trends and educational inequalities in obesity, overweight and underweight in pre-pregnant women and their male partners: a decade (2010-2019) with no progress in Sweden

BACKGROUND

Trends in overweight and obesity among expectant parents can provide useful information about the family environment in which children will grow up and about possible social inequalities that may be passed on to them. Therefore, we aimed to assess whether the prevalence of underweight, overweight and obesity changed over time in pre-pregnant women and their male partners in northern Sweden, and if there were any educational inequalities.

METHODS

This study is based on cross-sectional data from a repeated survey of the population in Västerbotten, Sweden. The study population included 18,568 pregnant women and 18,110 male partners during the period 2010-2019. Multinomial logistic regression models were fitted separately for pregnant women and male partners to assess whether the prevalence of age-adjusted underweight, normal weight, overweight and obesity had evolved between 2010 and 2019, and whether trends differed by educational level.

RESULTS

Among women, obesity prevalence increased from 9.4% in 2010 to 11.7% in 2019. Among men, it went from 8.9 to 12.8%. Educational inequalities were sustained across the study period. In 2019, the prevalence of obesity was 7.8 percentage points (pp) (CI = 4.4-11.3) higher among women with low compared to high education. The corresponding figure for men was 6.4 pp (CI = 3.3-9.6).

CONCLUSIONS

It is not obvious that the prevalence of obesity among parents-to-be will decrease under current dispositions. Public health policies and practice should therefore be strengthened.

Association of parental obesity with the profile of metabolic-bariatric surgery patients: a cohort study of the German StuDoQ|MBE registry

OBJECTIVES

To investigate the association of parental obesity (PO) with onset of obesity, pre-surgical disease duration and body mass index (BMI) at the time of surgery in patients undergoing metabolic-bariatric surgery (MBS).

DESIGN

This is a cohort study of the German StuDoQ registry for metabolic-bariatric diseases. All surgical cases from initiation of the registry in September 2015 until August 2020 were screened for pertinent information.

SETTING

The registry is based on participating German hospitals of various sizes.

PARTICIPANTS

A total of 11 891 patients were included in this analysis, 74.2% of which were females and 25.8% males. Roux-en-Y gastric bypass was performed in 5652 (47.5%) cases, sleeve gastrectomy in 4618 (38.8%) cases and one-anastomosis gastric bypass in 1621 (13.6%) cases.

RESULTS

One-sided and two-sided PO are independently associated with early-onset obesity (OR 1.61, [95% CI, 1.47 to 1.76], p<0.001 and OR 2.45, [95% CI, 2.22 to 2.71], p<0.001) and prolonged pre-surgical disease duration (regression coefficient 2.39, [95% CI, 1.93 to 2.83], p<0.001 and regression coefficient 4.27, [95% CI, 3.80 to 4.75], p<0.001). Unlike one-sided PO, two-sided PO had a significant association with BMI at the time of surgery (regression coefficient 0.49, [95% CI, 0.14 to 0.85], p=0.006). Age at the onset of obesity and disease duration had a negative association with BMI at the time of surgery (regression coefficient -0.13, [95% CI, -0.14 to -0.11], p<0.001 and regression coefficient -0.05, [95% CI, -0.07 to -0.04], p<0.001).

CONCLUSIONS

This study established a clear association between PO status of patients undergoing MBS and their pre-surgical patient profile as well as known risk factors for poor postoperative response.

Chronic oral disease burden at the first 1000 days: Intergenerational risk factors, BRISA cohort

OBJECTIVE

To analyze multiple-causal models, including socioeconomic, obesity, sugar consumption, alcohol smoking, caries, and periodontitis variables in pregnant women with early sugar exposure, obesity, and the Chronic Oral Disease Burden in their offspring around the first 1000 days of life.

METHODS

The BRISA cohort study, Brazil, had two assessments: at the 22nd-25th gestational weeks and during the child's second year (n = 1141). We proposed a theoretical model exploring the association between socioeconomic and pregnancy factors (age, smoking, alcohol, sugars, obesity, periodontitis, and caries) and child's variables (sugars and overweight) with the outcome, Chronic Oral Disease Burden (latent variable deduced from visible plaque, gingivitis, and tooth decay), using structural equation modeling.

RESULTS

Caries and periodontitis were correlated in pregnant women. Addictive behaviors in the gestational period were correlated. Obesity (Standardized coefficient - SC = 0.081; p = 0.047) and added sugar consumption (SC = 0.142; p = 0.041) were observed intergenerationally in the pregnant woman-child dyads. Sugar consumption by the children (SC = 0.210; p = 0.041) increased the Chronic Oral Disease Burden.

CONCLUSIONS

Poor caries and periodontal indicators were correlated in pregnant women and their offspring. Obesity and sugar consumption act intergenerationally. Oral health in early life may change life trajectory since the worst oral conditions predict main NCDs.

Predicting higher child BMI z-score and obesity incidence in Malaysia: a longitudinal analysis of a dynamic cohort study

BACKGROUND

To target public health obesity prevention, we need to predict who might become obese i.e. predictors of increasing Body Mass Index (BMI) or obesity incidence. Predictors of incidence may be distinct from more well-studied predictors of prevalence, therefore we explored parent, child and sociodemographic predictors of child/adolescent BMI z-score and obesity incidence over 5 years in Malaysia.

METHODS

The South East Asia Community Observatory in Segamat, Malaysia, provided longitudinal data on children and their parents (n = 1767). Children were aged 6-14 years at baseline (2013-14) and followed up 5 years later. Linear multilevel models estimated associations with child BMI z-score at follow-up, adjusting for baseline BMI z-score and potential confounders. Predictors included parent cardiometabolic health (overweight/obesity, central obesity, hypertension, hyperglycaemia), and socio-demographics (ethnicity, employment, education). Logistic multilevel models explored predictors of obesity incidence.

RESULTS

Higher baseline BMI z-score predicted higher follow-up BMI z-score both in childhood to late adolescence (0.60; 95% CI: 0.55, 0.65) and early to late adolescence (0.76; 95% CI: 0.70, 0.82). There was inconsistent evidence of association between child BMI z-score at follow-up with parent cardiometabolic risk factors independent of baseline child BMI z-score. For example, maternal obesity, but not overweight, predicted a higher BMI z-score in childhood to early adolescence (overweight: 0.16; 95% CI: -0.03, 0.36, obesity: 0.41; 95% CI: 0.20, 0.61), and paternal overweight, but not obesity, predicted a higher BMI z-score in early to late adolescence (overweight: 0.22; 95% CI: 0.01, 0.43, obesity: 0.16; 95% CI: -0.10, 0.41). Parental obesity consistently predicted five-year obesity incidence in early to late adolescence, but not childhood to early adolescence. An adolescent without obesity at baseline with parents with obesity, had 3-4 times greater odds of developing obesity during follow-up (incidence OR = 3.38 (95% CI: 1.14-9.98, mother) and OR = 4.37 (95% CI 1.34-14.27, father) respectively).

CONCLUSIONS

Having a higher BMI z-score at baseline was a stronger predictor of a higher BMI z-score at follow-up than any parental or sociodemographic factor. Targeting prevention efforts based on parent or sociodemographic factors is unwarranted but early childhood remains a key period for universal obesity prevention.

Does 'portion size' matter? Brain responses to food and non-food cues presented in varying amounts

Larger portions of food elicit greater intake than smaller portions of food, particularly when foods are high in energy density (kcal/g; ED). The neural mechanisms underlying this effect remain unclear. The present study used fMRI to assess brain activation to food (higher-ED, lower-ED) and non-food (office supplies) images presented in larger and smaller (i.e., age-appropriate) amounts in 61, 7-8-year-olds (29 male, 32 female) without obesity. Larger amounts of food increased activation in bilateral visual and right parahippocampal areas compared to smaller amounts; greater activation to food amount (larger > smaller) in this cluster was associated with smaller increases in food intake as portions increased. Activation to amount (larger > smaller) was stronger for food than office supplies in primary and secondary visual areas, but, for office supplies only, extended into bilateral parahippocampus, inferior parietal cortex, and additional visual areas (e.g., V7). Activation was greater for higher-vs. lower-ED food images in ventromedial prefrontal cortex for both larger and smaller amounts of food; however, this activation extended into left lateral orbital frontal cortex for smaller amounts only. Activation to food cues did not differ by familial risk for obesity. These results highlight potentially distinct neural pathways for encoding food energy content and quantity.

The Dimensionality, Consistency, and Structural Validity of an Instrument Used to Measure Obesogenic Attitudes in Parents from Southern Spain (The PRELSA Scale)

(1) Background: We aimed to analyze the dimensionality, internal consistency, and structural validity of the Preschool Eating, Lifestyle, and Sleeping Attitudes Scale (PRELSA Scale), which is an instrument that was designed to measure obesogenic behaviors. (2) Methods: We carried out an observational study by means of an online survey. The PRELSA Scale consists of 13 dimensions and 60 items relating to the most common obesogenic behaviors and attitudes. Additionally, we obtained sociodemographic characteristics and concrete habits from the sample. We obtained the responses of 791 parents and caregivers of preschool children between 2 and 6 years of age in Andalusia (southern Spain). We analyzed dimensionality through an Exploratory Factor Analysis (EFA), consistency through Cronbach's Alpha, structural validity through a Confirmatory Factor Analysis (CFA), and measurement invariance with multigroup CFA models. (3) Results: The EFA showed a 14-dimensional structure with 48 items. The internal consistency was acceptable in all dimensions (Cronbach's Alpha range of 0.72 to 0.97). The structure was confirmed in the CFA with good fit indices (CFI and TLI > 0.9 and RMSEA < 0.05). We ensured that the scale had measurement invariance regarding education, income, and marital status. (4) Conclusions: The PRELSA Scale shows promising properties that have the potential to measure obesogenic behaviors in Spain, which could be the basis for future interventions associated with the prevention of childhood obesity in healthcare and educational settings.

Healthful Eating Behaviors among Couples Contribute to Lower Gestational Weight Gain

Through longitudinal analysis from the GLOWING cohort study, we examined the independent and joint relationships between couples' eating behaviors and gestational weight gain (GWG). Pregnant persons (n = 218) and their non-pregnant partners (n = 157) completed an Eating Inventory. GWG was calculated as gestation weight at 36 weeks minus that at 10 weeks. General linear models were used to examine the relationships between GWG and the pregnant persons, non-pregnant partners, and couples (n = 137; mean of pregnant persons and non-pregnant partners) cognitive restraint (range 0-21), dietary disinhibition (range 0-18), and perceived hunger (range 0-14), with higher scores reflecting poorer eating behaviors. The adjusted models included race/ethnicity, education, income, marital status, and age. The pregnant persons and their non-pregnant partners' cognitive restraint, dietary disinhibition, and perceived hunger scores were 9.8 ± 4.7, 4.8 ± 3.2, and 4.4 ± 2.5 and 6.6 ± 4.6, 5.4 ± 3.4, and 4.7 ± 3.2, respectively. Higher cognitive restraint scores among the pregnant persons and couples were positively associated with GWG (p ≤ 0.04 for both). Stratified analyses revealed this was significant for the pregnant persons with overweight (p ≤ 0.04). The non-pregnant partners' eating behaviors alone were not significantly associated with GWG (p ≥ 0.31 for all). The other explored relationships between GWG and the couples' eating behaviors were insignificant (p ≥ 0.12 for all). Among the pregnant persons and couples, reduced GWG may be achieved with higher levels of restrained eating. Involving non-pregnant partners in programs to optimize GWG may be beneficial.

Association between children's caregivers time preferences and childhood overweight and obesity in Mexico

BACKGROUND

Parents or children's primary caregivers are a key influence on child weight as both decision makers and role models for eating patterns, physical activity, and other social behaviors. It is unknown whether caregivers' time preferences are associated with overweight or obesity in children. The primary objective was to estimate the association between parents' or caregivers' time preferences and children having overweight or obesity in Mexico.

METHODS

A cross-sectional study was conducted using a representative survey of the Mexican population. A multinomial logistic model was used to examine the association between parents' or caregivers' time preferences (patience and time consistency) and child overweight or obesity, adjusting for potential confounders.

RESULTS

The study included 9,102 children (mean age 10, 43% female) and 5,842 caregivers (mean age 37; 95% female). Intertemporal preference was strongly associated with increased odds of overweight or obesity in children. A medium patient caregiver had higher odds of having overweight (adjusted OR: 1.73; 95% CI: 1.19, 2.52). Similarly, having a caregiver with a present (OR: 2.52; 95% CI: 1.72, 3.70) or future bias (OR: 1.48; 95% CI: 1.11, 1.98) was associated with higher odds of obesity.

CONCLUSION

Caregivers' time preferences were associated with having overweight and obesity in children and should be considered when developing policies to reduce children's obesity status.

Unsupervised identification of cardiometabolic profiles among adolescents: findings from the PARIS birth cohort study

Metabolic syndrome (MetS) is known as a risk factor in cardiometabolic morbidity but there is no consensus on its definition for teenagers. We aimed to identify cardiometabolic health profiles and which parameters best discriminate them. K-means partitioning identified cardiometabolic profiles by sex using data on health measurements of 530 adolescents from the PARIS birth cohort. A discriminant analysis was performed. Cardiometabolic risk score and handgrip strength were also measured. Depending on definitions, MetS prevalence ranged from 0.2% to 1.3%. Two profiles were identified for the entire group and by sex: "healthy" and "at cardiometabolic risk." Weight and waist-to-height ratio or waist circumference explained more than 87% of the variance in the profile differentiation. The "at cardiometabolic risk" profiles included adolescents with overweight, a waist-to-height ratio over 0.5, and prehypertension. They had higher cardiometabolic risk scores and parents who were more likely to be overweight and have cardiometabolic diseases themselves. They also had higher birthweights, earlier adiposity-rebound and puberty ages, and lower relative handgrip strength.  Conclusion: The two profiles identified, based on cardiometabolic health, were associated with early indicators and handgrip strength. Results suggest that the waist-to-height ratio is a useful clinical tool for screening individuals at cardiometabolic risk and who therefore require clinical follow-up. What is Known: • Although there is a need for tools to assess cardiometabolic health during adolescence, there is no consensus on the definition of metabolic syndrome for this age group. What is Knew: • The findings suggest that waist-to-height ratio can serve as a simple and valuable clinical tool for screening individuals at cardiometabolic risk who may require clinical monitoring for early prevention of cardiovascular diseases.

Weight development from childhood to motherhood-embodied experiences in women with pre-pregnancy obesity: a qualitative study

BACKGROUND

Pre-pregnancy obesity increases the risk of perinatal complications. Post-pregnancy is a time of preparation for the next pregnancy and lifestyle advice in antenatal care and postpartum follow-up is therefore recommended. However, behavioral changes are difficult to achieve, and a better understanding of pregnant women's perspectives and experiences of pre-pregnancy weight development is crucial.

METHODS

We used a qualitative design and conducted semi-structured interviews with 14 women in Norway with pre-pregnancy obesity 3-12 months postpartum. Data were analyzed using thematic analysis.

RESULTS

Four themes addressing women's experiences and understanding of their weight development were generated: (1) Unmet essential needs, (2) Genetic predisposition for obesity, challenging life course transitions and turning points, (3) Under a critical eye: an ever-present negative bodily awareness, and (4) Wrestling with food. Parents' inability to meet children's essential needs caused weight gain through an unbalanced diet, increased stress, and emotional eating patterns. Body criticism and a feeling of not belonging led to negative body awareness that influenced behavioral patterns and relationships. Participants reporting having had a good childhood more often described their weight development as a result of genetic predisposition, challenging life course transitions and turning points, such as illness and injuries. Nevertheless, these participants also described how eating patterns were influenced by stress and negative emotions.

CONCLUSIONS

Healthcare providers should pay attention to the insider perspectives of pre-pregnancy weight development. An open and shared understanding of the root causes of these women's weight development can form a basis for more successful lifestyle guidance.

Children at high familial risk for obesity show executive functioning deficits prior to development of excess weight status

OBJECTIVE

The objective of this study was to determine whether children with healthy weight who vary by familial risk for obesity differ in executive functioning.

METHODS

Children (age 7-8 years) without obesity (n = 93, 52% male) who differed by familial risk for obesity (based on maternal weight status) completed go/no-go and stop-signal tasks to assess inhibitory control and an N-back task to assess working memory. Dual energy x-ray absorptiometry measured adiposity. Linear and mixed-effect models assessed unique effects and relative importance analysis-quantified relative effects of familial risk and percent body fat.

RESULTS

Children at high compared with low familial risk showed worse inhibitory control; however, child adiposity was not associated with inhibitory control. Both high familial risk and greater child adiposity were associated with worse N-back performance when cognitive demand was high (2-back), but not low (0- and 1-back). The relative effect of familial risk on executive functioning was 2.7 to 16 times greater than the relative effect of percent body fat.

CONCLUSIONS

These findings provide initial evidence that deficits in executive functioning may precede the development of obesity in children at high familial risk for this disease. Additional family risk studies are needed to elucidate the pathways through which maternal obesity influences child executive functioning and risk for obesity.

Multilevel needs assessment of physical activity, sport, psychological needs, and nutrition in rural children and adults

Introduction

Physical activity yields significant benefits, yet fewer than 1 in 4 youth meet federal guidelines. Children in rural areas from low socioeconomic (SES) backgrounds face unique physical activity contextual challenges. In line with Stage 0 with the NIH Stage Model for Behavioral Intervention Development, the objective of the present study was to conduct a community-engaged needs assessment survey with middle school children and adults to identify perceptions, barriers, and facilitators of physical activity, sport, psychological needs, and nutrition from a multi-level lens.

Methods

A cross-sectional survey data collection was conducted with children (n = 39) and adults (n = 63) from one middle school community in the Midwestern United States. The child sample was 33% 6th grade; 51% 7th grade and was 49% female. The adult sample was primarily between 30 and 39 years old (70%) and comprised predominantly of females (85%). Multi-level survey design was guided by the psychological needs mini-theory within self-determination theory and aimed to identify individual perceptions, barriers, and facilitators in line with the unique context of the community.

Results

At the individual level, 71.8% of children and 82.2% of the overall sample (children and adults) were interested in new physical activity/sport programming for their school. Likewise, 89.7% of children and 96.8% of adults agree that PA is good for physical health. For basic psychological needs in the overall sample, relatedness was significantly greater than the autonomy and competence subscales. Children's fruit and vegetable intake were below recommended levels, yet only 43.6% of children were interested in nutritional programming. Conversely, 61.5% indicated interest at increasing leadership skills. At the policy-systems-environmental level, the respondents' feedback indicated that the condition and availability of equipment are areas in need of improvement to encourage more physical activity. Qualitative responses are presented within for physical activity-related school policy changes.

Discussion

Interventions addressing children's physical activity lack sustainability, scalability, and impact due to limited stakeholder involvement and often neglect early behavioral intervention stages. The present study identified perspectives, barriers, and facilitators of physical activity, sport, psychological needs, and nutrition in a multi-level context and forms the initial campus-community partnership between scientists and community stakeholders.

Cardiometabolic risk profile among children with migrant parents and role of parental education: the IDEFICS/I.Family cohort

BACKGROUND AND AIMS

Evidence shows that migrant children have a higher risk of developing obesity than those with native parents. We aimed to investigate the association between parental migration background and cardiometabolic health in children and adolescents in Europe.

METHODS AND RESULTS

We included 8745 children aged 2-17 from the second follow-up of the European IDEFICS/I.Family cohort. Linear regression models were used to investigate the association between parental migration background (one or two migrant parent(s) vs native parents) and body mass index (BMI), metabolic syndrome (MetS) score and its individual components. Outcome variables were parametrized as age and sex-specific z-scores. We adjusted for age, sex, country, and parental education, and additionally for parental income, lifestyle including dietary factors, and maternal BMI. On average, children with two migrant parents had higher z-scores of BMI (+0.24 standard deviation (SD)) and MetS score (+0.30 SD) compared to those with native parents, whereas no significant differences were seen for children with one migrant parent. Associations were attenuated when controlling for maternal BMI and sports club activity. Parental education modified the associations with BMI and MetS z-scores such that they were more pronounced in children with low parental education.

CONCLUSION

Children with two migrant parents were at higher risk for adverse cardiometabolic health compared to children with native parents, especially in families with low parental education. These associations were explained by lower physical activity and maternal body weight and encourages early intervention strategies by schools and communities.

Parent factors associated with BMI, diet, and physical activity of adolescents with intellectual and developmental disabilities

BACKGROUND

Adolescents with intellectual and developmental disabilities (IDD) experience overweight and obesity (OW/OB) up to 1.8 times the rate of their typically developing peers. Parents may influence adolescent weight management behaviors in this population, but the association between parent factors and adolescent weight management behaviors is unclear.

OBJECTIVE

To examine the associations between parent BMI and sociodemographic characteristics with adolescents' BMI, diet quality, daily energy intake, moderate to vigorous physical activity (MVPA), and sedentary behavior.

METHODS

This study analyzed baseline data from an 18-month randomized controlled weight loss trial for adolescents with IDD. We assessed parent BMI (kg/m2) and sociodemographic factors, and adolescent BMI z-score, MVPA, sedentary time, daily energy intake, and diet quality. Associations between parent and adolescent factors were assessed with Pearson, Spearman or Kendall Tau-b correlations; mean differences for categorical outcomes were assessed with independent samples t-tests/Mann-Whitney U tests or ANOVA/Kruskall-Wallis tests.

RESULTS

Ninety-five adolescent and parent dyads were included. Parent BMI was positively correlated with adolescent BMI z-score (n = 94: rs = 0.37, p < 0.01). Household income was inversely correlated with adolescent BMI z-score (n = 95: Tb = -0.18, p = 0.02). Parents with less than a bachelor's degree had adolescents with higher BMI z-scores than those with bachelor's or higher (2.1 ± 0.5 vs. 1.8 ± 0.5, p = 0.02) as well as higher sedentary behavior (n = 28, 515.2 ± 102.6 min/day vs. n = 40, 463.9 ± 148.1 min/day, p = 0.02).

CONCLUSION

We found parent BMI, income, and education associated with adolescent BMI z-score. These findings contribute to the sparse literature on parental factors associated with OW/OB in this population.

CLINICAL TRIALS NUMBER

NCT02561754.

Malnutrition in mother-child dyads in the Brazilian National Survey on Child Nutrition (ENANI-2019)

Malnutrition affects billions of individuals worldwide and represents a global health challenge. This study aimed to determine the prevalence of malnutrition (undernutrition or overweight) among mother-child dyads in children under 5 years old in Brazil in 2019 and to estimate changes in this prevalence from 2006 to 2019. Individual-level data from the Brazilian National Survey on Child Nutrition (ENANI-2019) and the Brazilian National Survey of Demography and Health of Women and Children carried out in 2006 (PNDS 2006) were analyzed. Malnutrition outcomes in mother-child dyads included overweight mother and child, undernourished mother and child, and the double burden of malnutrition, i.e., overweight mother and child having any form of undernourishment (stunting, wasting, or underweight). Prevalence and 95% confidence intervals (95%CI) were estimated. Most women (58.2%) and 9.7% of the children were overweight, 6.9% were stunted, and 3.1% of mothers and 2.9% of the children were underweight. The prevalence of overweight in the mother-child dyad was 7.8% and was statistically higher in Southern Brazil (9.7%; 95%CI: 7.5; 11.9) than in the Central-West (5.4%; 95%CI: 4.3; 6.6). The prevalence of overweight mother and stunted child was 3.5%, with statistically significant difference between the extremes of the mother's education [0-7 vs. ≥ 12 years, 4.8% (95%CI: 3.2; 6.5) and 2.1%, (95%CI: 1.2; 3.0), respectively]. Overweight in the dyad increased from 5.2% to 7.8%, and the double burden of malnutrition increased from 2.7% to 5.2% since 2006. Malnutrition in Brazilian mother-child dyads seems to be a growing problem, and dyads with lower formal education, higher maternal age, and from the South Region of Brazil were more vulnerable.

Exploring factors associated with obesity in Argentinian children using structural equation modeling

Habits and behaviors related to obesity risk are strongly associated with the family environment and are affected by socioeconomic factors. Structural equation modeling (SEM) allows us to hypothesize on how the relationships between these factors occur and measure their impact. This study aimed to explore the relationship between family socioeconomic indicators and childhood obesity, mediated by habits linked to energy balance, applying a SEM. A cross sectional study was performed on 861 Argentinian schoolchildren aged 6-12 years, from 2015 to 2016. The model included three latent variables: socioeconomic status, healthy habits, and obesity. Socioeconomic status indicators and healthy habits were surveyed by self-administered parental questionnaires, whereas obesity indicators were evaluated with anthropometry. The applied model showed an acceptable fit (NFI = 0.966; CFI = 0.979; RMSEA = 0.048). Socioeconomic status positively influenced parental education, health insurance, and car possession, while negatively influenced crowding (p < 0.001). Healthy habits significantly influenced physical activity, meals frequency, and sleep hours, while negatively influenced sedentary hours and mother's nutritional status (p < 0.001). Obesity factor positively influenced body mass index, body fat, and waist-to-height ratio (p < 0.001). Finally, socioeconomic status positively influenced health habits, which in turn negatively influenced obesity factor. Healthy habits (especially physical activity and mother's nutritional status) mediated the relationship between socioeconomic status and child obesity. Further research should include other indicators related to diet, eating habits, and physical activity like neighborhood characteristics.

Rationale and design of integrating a parents first obesity intervention with a pediatric weight management intervention for rural families - Evaluating the ripple effect

Rural families are disproportionately affected by obesity. Obesity often runs in families and is impacted by hereditary components, the shared home environment, and parent modeling/child observational learning. Moreover, parent changes in weight predict child changes in weight. Thus, targeting the family unit has the potential to enhance outcomes for adults and children simultaneously. Additionally, engaging rural nurses in medical clinics and schools may be important in determining whether rural telehealth programs are successfully implemented and sustained. This paper describes the rationale and design of a randomized control trial (RCT) evaluating the effectiveness of an integrated adult- and child-focused obesity treatment tailored for rural participants. Outcomes of this study include participant weight loss from baseline to 9-months, device-measured physical activity, and dietary intake. This project will additionally compare reach between clinic and school settings and evaluate the impact of nurse engagement. This study will include 240 participants from eight rural communities who will be randomized to either a Parent +Family-based group or a Newsletter +Family-based group. Parents in the Parent +Family-based group will receive a 3-month adult obesity treatment designed for adult behavior change as a first step. Then, parents and children together will enter the family-based program (iAmHealthy), allowing for potential enhancement of a theorized ripple effect. Parents in the Newsletter +Family-based group will receive 3 monthly newsletters and then participate in the 6-month family-based intervention designed for child behavior change. This study is the first RCT to examine the effectiveness of an integrated adult- and child-focused obesity treatment program. Registered with ClinicalTrials.gov NCT ID NCT05612971.

Using electronic health record data to link families: an illustrative example using intergenerational patterns of obesity

OBJECTIVE

Electronic health record (EHR) data are a valuable resource for population health research but lack critical information such as relationships between individuals. Emergency contacts in EHRs can be used to link family members, creating a population that is more representative of a community than traditional family cohorts.

MATERIALS AND METHODS

We revised a published algorithm: relationship inference from the electronic health record (RIFTEHR). Our version, Pythonic RIFTEHR (P-RIFTEHR), identifies a patient's emergency contacts, matches them to existing patients (when available) using network graphs, checks for conflicts, and infers new relationships. P-RIFTEHR was run on December 15, 2021 in the Northwestern Medicine Electronic Data Warehouse (NMEDW) on approximately 2.95 million individuals and was validated using the existing link between children born at NM hospitals and their mothers. As proof-of-concept, we modeled the association between parent and child obesity using logistic regression.

RESULTS

The P-RIFTEHR algorithm matched 1 157 454 individuals in 448 278 families. The median family size was 2, the largest was 32 persons, and 247 families spanned 4 generations or more. Validation of the mother-child pairs resulted in 95.1% sensitivity. Children were 2 times more likely to be obese if a parent is obese (OR: 2.30; 95% CI, 2.23-2.37).

CONCLUSION

P-RIFTEHR can identify familiar relationships in a large, diverse population in an integrated health system. Estimates of parent-child inheritability of obesity using family structures identified by the algorithm were consistent with previously published estimates from traditional cohort studies.

Examining the Association Between Parental Factors and Childhood Obesity

PURPOSE

To examine associations between parent's diet and BMI (body mass index) and child's sedentary behavior and physical activity (PA) with child's BMI.

DESIGN

A descriptive design.

METHODS

Study participants were a parent-child dyad in a subsample of families enrolled in Chicago Heights Early Childhood Center.

FINDINGS

Approximately 80% of parents had a BMI classifying as overweight or obese. Associations between children's sedentary behavior, PA, and BMI were insignificant.

CONCLUSIONS

Findings highlight the importance of including parents when developing strategies for promoting healthy behavior of children.

CLINICAL EVIDENCE

Community health nurses are well-positioned to promote healthy behaviors.

Motivational and self-regulatory processes associated with weight-related parenting behaviors

Background

Parents play an influential role on their child's eating and physical activity. How maternal personality and individual differences, such as motivation and self-regulation, are associated with their weight-related parenting has yet to be studied. The current study examined relationships of mothers' motivational and self-regulatory characteristics with weight-related parenting practices.

Methods

Mothers (N = 149, MAge = 42.78 years, 49% Hispanic/Latino) of school-aged children (ages 10-14 years, 55.7% female) completed questionnaires assessing behavioral inhibition system/behavioral activation system (BIS/BAS), self-control, and weight-related parenting practices (i.e., role modeling, food restriction, rule enforcement, limiting, discipline, pressure to eat). Structural equation modeling examined associations of BIS, BAS, and self-control with parenting practices.

Results

Among mothers, higher avoidance motivation was associated with difficulty with rule enforcement. Higher approach motivation was associated with less limiting of unhealthy food and sedentary behavior. Higher self-control predicted more role modeling and less difficulty with rule enforcement.

Conclusion

Findings support associations of maternal motivational and self-regulatory processes with weight-related parenting behaviors. Results may inform tailored strategies based on individual differences for family-based interventions for parenting.

Do parental risk factors for type 2 diabetes predict offspring risk of overweight and obesity? The Feel4Diabetes study

OBJECTIVES

The prevention of children being overweight/obese is of utmost importance. Parental characteristics play a pivotal role in shaping offspring weight status. This study aimed to examine associations between parental obesity and children's overweight/obesity status, and whether other parental type 2 diabetes (T2D) risk factors can predict children's obesity status.

METHODS

Logistic regression and receiver operating characteristic (ROC) analyses were conducted, using cross-sectional data from a European cohort of 20 151 adults (10 967 mothers; 9184 fathers) and children (n = 10 967) participating in the Feel4Diabetes study. Anthropometric measurements were conducted in children, and overweight/obesity was defined according to the International Obesity Task Force criteria. Parents' T2D risk was assessed applying the Finnish Diabetes Risk Score (FINDRISC).

RESULTS

After adjusting for all other FINDRISC variables, region and maternal/parental education, maternal (adjusted odds ratio [aOR]: 2.64; 95% confidence interval [CI], 2.18-3.20) and parental (aOR: 3.21; 95% CI, 2.65-3.91) obesity, maternal (aOR: 1.46; 95% CI, 1.23-1.74) and parental (aOR: 1.59; 95% CI, 1.32-1.92) high waist circumference, as well as maternal (aOR: 1.60; 95% CI, 1.27-2.01) and parental (aOR: 1.87; 95% CI, 1.58-2.21) high FINDRISC score, were associated with child overweight/obesity status. Maternal (area under the curve- ROC: 0.638; 95% CI, 0.628-0.647) and paternal body mass index (BMI; area under the curve-ROC: 0.632; 95% CI, 0.622-0.642) were the most accurate in predicting child overweight/obesity status.

CONCLUSIONS

Among parental risk factors for T2D, maternal/parental overweight/obesity status, central obesity, and high FINDRISC score were the main predictors of childhood overweight/obesity status, with BMI the most accurate. Maternal or paternal BMI is simple to use, and might be useful for the early identification of children at risk of being overweight/obese rather than other T2D factors.

Barriers, facilitators, and opportunities to promote healthy weight behaviors among preschool-aged children in two rural U.S communities

BACKGROUND

Obesity levels are higher in rural versus urban children. Multi-level community-based interventions can be effective in promoting healthy child weight, but few of such interventions have focused on rural children. This formative study assessed barriers, facilitators, and opportunities to promote healthy child weight in two rural communities.

METHODS

Multiple data collection methods were used concurrently in two rural communities in Indiana and North Carolina. Focus groups and interviews were conducted with participants, including parents of children aged 2-5 years (n = 41), childcare providers (n = 13), and stakeholders from 23 community organizations. Observational audits were conducted at 19 food outlets (grocery stores) and 50 publicly-accessible physical activity resources. Focus groups/interviews were analyzed thematically. Surveys were analyzed using descriptive statistics, Fisher's exact test, and t-tests.

RESULTS

Family level barriers included limited financial resources and competing priorities, whereas parental role-modeling was perceived as a facilitator of healthy weight behaviors. At the organizational level, childcare providers and community stakeholders cited limited funding and poor parental engagement in health promotion programs as barriers. Childcare providers explained that they were required to comply with strict nutrition and physical activity guidelines, but expressed concerns that similar messages were not reinforced at home. Facilitators at the organizational level included healthy meals provided at no cost at childcare programs, and health promotion programs offered through community organizations. At the community level, lack of public transportation, and limited access to healthy food outlets and physical activity-promoting resources posed barriers, whereas existing physical activity resources (e.g., parks) and some ongoing investment to improve physical activity resources in the community were assets. In designing/implementing a potential child obesity prevention intervention, participants discussed the need to garner community trust, emphasize wellness instead of obesity prevention, establish community partnerships, and leverage existing community resources.

CONCLUSIONS

Rural areas experience multiple challenges that make it difficult for children/families to engage in healthy weight behaviors. This study highlights several assets (existing programs/resources, expertise within communities) that can be leveraged as facilitators. Findings will guide the study team in developing a child obesity prevention intervention for the two rural communities.

Longitudinal effects of school policies on children's eating behaviors and weight status: findings from the childhood obesity study in China megacities

OBJECTIVES

To examine longitudinal effects of school policies on children's weight status and eating behaviors, and study how these effects may vary by children's age, sex, and baseline weight status in China.

METHODS

Data were collected in 2015, 2016, and 2017 in an open cohort of 3298 children aged 6-17, their parents, and schools in five large cities across China (Beijing, Shanghai, Xi'an, Nanjing, and Chengdu). Children's weight, height, and waist circumference were measured, and their eating behaviors were self-reported. The 1691 children with such repeated measures in ≥ two waves were included in longitudinal data analysis with mixed effects models, testing the associations.

RESULTS

Having school vicinity food stall policy was associated with less frequent consumption of fast food (β = -0.14, p < 0.01) and snack (β = -0.84, p < 0.01). More significant associations were found between school policies and unhealthy eating behaviors for girls and children aged 6-11 than their counterparts. Among children without overweight or central obesity at baseline, having school cafeteria food policy was associated with lower risks for overweight and obesity (OR = 0.33, 95% CI: 0.17-0.63) and central obesity (OR = 0.47, 95% CI: 0.26-0.85). This existed for girls, but not for boys. School vicinity food stall policy was associated with lower BMI (β = -0.20, 95% CI: -0.37, -0.03) among all children and in girls (β = -0.28, 95% CI: -0.50, -0.05) without overweight at baseline.

CONCLUSIONS

School policies could reduce children's unhealthy eating behaviors and obesity risk in megacities in China. Children's age, sex, and baseline weight status modify the effects. School policies are important to fight the growing childhood obesity epidemic.

Perinatal exposure to environmental endocrine disruptor bisphenol A aggravates the onset of non-alcoholic fatty liver disease (NAFLD) in weanling F1 offspring of obese rats

Bisphenol A (BPA) is a major environmental pollutant and food contaminant with endocrine-disrupting effects on human and animal health. Perinatal and developmental exposure to BPA has been known to cause hepatotoxicity in adulthood. However, its intergenerational effects in a metabolically challenged population have been scarcely investigated. Our study was designed to assess the intergenerational effect of an environmentally relevant dose of BPA and diet-induced parental obesity on the hepatic health outcome of F1 offspring. Wistar rats were given a high-fat diet to induce obesity, followed by chronic low dosages of BPA (10 ppm × 180 days) in drinking water. Post-treatment, rats were crossed within groups to obtain the F1 generation. Weanling pups were observed for weight gain, levels of hepatic antioxidants, liver function enzymes, cholesterol, C-reactive protein, and triglyceride in the serum. Histological changes in the liver tissue were also investigated. mRNA expression of energy homeostasis genes (FTO and MCR-4) in the liver was analyzed alongside blood biomarkers. We observed higher birth weight and rapid weight gain in the test group in comparison with controls, which was consistent with the changes in mRNA and protein expression of FTO and MCR-4. BPA caused a significant, treatment-related change in the inflammatory marker C-reactive protein, lipid peroxidation, antioxidants, and lipid profile. These findings were accompanied by histological changes in the liver tissue characteristic of hepatic steatosis indicating the onset of the non-alcoholic fatty liver disease (NAFLD). Our study offers a link between exposure to BPA in parents and onset of NAFLD in their offspring.

Process and effect evaluation of the app-based parenting program Samen Happie! on infant zBMI: A randomized controlled trial

Background

Although energy balance-related parenting practices are regarded critical components in the prevention of childhood obesity, most programs targeting parenting practices with respect to a wide range of energy balance-related behaviors were not aimed at high-risk families with a lower socioeconomic position (SEP).

Objective

The Samen Happie! app-based program aimed to stimulate healthy child weight development especially among families with a lower SEP, by encouraging healthy energy balance-related parenting practices.

Methods

A two-armed randomized controlled trial examined the process and effectiveness of the Samen Happie! program on child zBMI outcomes at 6- and 12-months follow-up. In total, 357 Dutch parents with infants aged 5-15 months old at baseline participated. Parents in the app condition (n = 179) received access to the Samen Happie! app and were compared to a waitlist-control condition (n = 178). Changes in zBMI were examined through linear mixed-effects models based on intention-to-treat and exploratory per-protocol principles.

Results

Process data showed low levels of sustained app use and moderate app acceptability. A general increase in child zBMI was observed in both conditions after 6 and 12 months. Intention-to-treat analyses using multiple imputations showed several statistically significant differences between conditions and high-risk subgroups. Specifically, at 6-months follow-up, zBMI increase was least pronounced in the app condition among children of parents with lower educational level. These findings were supported by exploratory per-protocol analyses including only frequent app users. In addition, per-protocol analyses showed benefits of app use at 6-months follow-up for children of parents with higher BMI. However, these effects were reversed at 12-months follow-up in both intention-to-treat and per-protocol analyses, where children of parents in the app condition in general increased the most in zBMI.

Conclusions

This study suggests that the Samen Happie! program might prevent zBMI increases after 6 months among children of parents with lower educational level, and children of parents with higher BMI who more frequently use the app. However, the app did not prevent increases in zBMI after 12 months. Future research should investigate strategies to increase sustained app use and engagement in mHealth parenting programs for childhood obesity as well as options to combine app-based programs with additional support strategies aimed at high-risk families.

Trial registration

Netherlands trial register (ID: NTR6938), https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6938.

The Severity of Obesity Promotes Greater Dehydration in Children: Preliminary Results

The state of hydration of the body depends on the balance between the amount of water and salt consumed and excreted (the urinary extraction of excess sodium requires water). Inappropriate nutrition, particularly consuming too much processed food, causes obesity in children and additionally causes excessive sodium consumption, thus increasing the risk of excessive water loss. The aim of this study was to assess the hydration status of children with obesity and the relation between hydration, body composition, urinary sodium extraction, and nutrient intake. The study group consisted of 27 patients with obesity, with a mean age of 12.89 ± SD 2.79. Each patient's height, weight, body composition (electrical bioimpedance (BIA)), diet (7-day record), and biochemical tests were assessed. The hydration status was assessed using 24-hour urine collection, 24-hour urine osmolality, and an ultrasound of the vena cava (IVC/Ao index). Overall, 55% of children (n = 15) had urine osmolality values above 800 mOsm/kgH2O, which indicates significant dehydration, and 53% (n = 14) were dehydrated, based on the IVC/Ao index. Children with obesity and dehydration had a significantly higher BMI (31.79 vs. 27.32; p = 0.0228), fat mass percentage (37.23% vs. 30.07% p = 0.0051), and fat mass in kg (30.89 vs. 20.55; p = 0.0158), and significantly higher sodium intake from their diet (3390.0 mg vs. 2921.0 mg; p = 0.0230), as well as their sodium/potassium ratio (2.4 vs. 2.0; p = 0.0043). The 24-hour urinary sodium excretion and osmolality values were directly related to fat-mass percentage and fat-mass (in kg) in a simple linear correlation analysis. Our preliminary results confirm that obesity is related to dehydration. The overall high sodium excretion in children with obesity indicates an excessive salt intake along with low potassium intake, which is a significant predictor of dehydration, regardless of the total water intake (TWI).

Prevalences of cardiometabolic risk and lifestyle factors in young parents: evidence from a German birth cohort study

BACKGROUND

Studies show that parents significantly impact their children's health through their cardiometabolic risk profile and health behavior. There is only little information about the prevalence of cardiometabolic risk factors and lifestyle factors among new parents yet. The aims of this study are therefore to evaluate the prevalences of cardiometabolic risk factors in parents of infants in Germany and to examine their lifestyle and health behavior.

METHODS

In the KUNO-Kids health study, an ongoing birth cohort, parents (n = 930 mothers and 769 fathers) were asked about cardiometabolic risk factors (obesity/hypertension/type 2 diabetes mellitus) and lifestyle factors (dietary/sports/smoking habits/alcohol consumption) during the first year after the birth of their children via questionnaires. Chi-square as well as fisher exact tests were conducted to analyse associations between lifestyle factors and cardiometabolic risk factors.

RESULTS

34.2% of mothers and 58.5% of fathers were overweight or obese. In 11.8% of the families, at least one parent suffered from hypertension, in 2.4% from type 2 diabetes mellitus. One year after delivery, 8.5% of mothers were smoking, 6.9% showed a risky alcohol consumption (> 10 g/d). 16.0% of fathers were smoking 4 weeks after childbirth, 10.7% showed risky alcohol consumption (> 20 g/d). 21.6% of mothers carried out sports activity for more than 2 h a week then. Parental hypertension was linked to a higher prevalence of risky alcohol consumption, obesity to a lower prevalence of daily fruits consumption.

CONCLUSIONS

Cardiometabolic risk factors were widespread among new parents with obesity and overweight having the highest prevalences. A considerable number of parents also practiced an unhealthy lifestyle showing that there is potential for improvement to promote the healthy development of their children.

School-Based Health Center Utilization During COVID-19 Pandemic-Related School Closures

BACKGROUND

Little is known regarding utilization of school-based health centers (SBHCs) during prolonged school closures, such as those that occurred during the COVID-19 pandemic. We sought to compare SBHC utilization before and after pandemic-related school closures across a network of SBHCs affiliated with a large Southern Californian urban school district.

METHODS

We conducted a secondary analysis of encounter data extracted from electronic health records from 12 SBHCs that remained open despite school closures, including patient demographics and diagnostic and billing codes. We used the Clinical Classifications Software Refined to group encounters for common primary care conditions. Utilization before and during pandemic-related school closures was compared using logistic regression with cluster-robust standard errors to account for clustering within clinics, after adjusting for month of encounter.

RESULTS

During the pandemic, study SBHCs conducted 52,530 encounters and maintained ∼4040 encounters/month. The frequency of encounters for annual preventative health exams increased for school-aged patients but decreased for other age groups while the frequency of encounters for mental health problems increased for all age groups.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Despite pandemic-related school closures, SBHCs appeared play a critical role in providing primary care to vulnerable communities.

CONCLUSIONS

SBHCs may hold value beyond their co-location with academic instruction.

Association between breastfeeding, parents' body mass index and birth weight with obesity indicators in children

Background

Childhood obesity is potentially affected by breastfeeding, parents’ body mass index and birth weight. Thus, this study aimed to verify the association between breastfeeding, parents’ body mass index and birth weight with obesity indicators in children.

Methods

This is a cross-sectional study, including data from 402 schoolchildren between 9 and 11 of age in the city of São Caetano do Sul, Brazil. Parents or guardians answered a questionnaire about breastfeeding (month), birth weight (kg), and parental body weight and height (parents’ body mass index [kg/m²] was calculated). Body mass index (kg/m²), waist circumference (cm) and body fat (%), determined via bio-impedance, were measured and used as obesity indicators. Multi-level linear regression models were used to assess the respective associations adjusted for the potential confounders.

Results

Considering body mass index of children, the overall prevalence of eutrophic, overweight and obese were 58.2%, 20.9% and 17.2%, respectively. Significant and positive correlations were observed between breastfeeding, maternal as well as paternal body mass index and the children’s body mass index, body fat and waist circumference. Birth weight was weakly and positively associated with body mass index and body fat but was not associated with waist circumference. After adjusting for school, sex, age, race/ethnicity, annual household income, sedentary time and moderate-to-vigorous physical activity, maternal body mass index and birth weight were positively associated with children’s body mass index (β: 0.228; 95%CI: 0.142; 0.314 and β: 0.001; 95%CI: 0.001; 0.002), body fat (β: 0.484; 95%CI: 0.297; 0.671 and β: 0.002; 95%CI: 0.001; 0.003) and waist circumference (β: 0.509; 95%CI: 0.304; 0.715 and β: 0.003; 95%CI: 0.001; 0.005). Breastfeeding was not associated with any obesity indicators.

Conclusion

Maternal body mass index and birth weight were associated with children’s obesity indicators. The perinatal environment, therefore, appears to be a critical contributor to childhood obesity and public policies need to address parental obesity in order to tackle childhood obesity.

Trial registration:

The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500).

Influence of maternal obesity on the multi-omics profiles of the maternal body, gestational tissue, and offspring

Epidemiological studies show that obesity during pregnancy affects more than half of the pregnancies in the developed countries and is associated with obstetric problems and poor outcomes. Obesity tends to increase the incidence of complications. Furthermore, the resulting offspring are also adversely affected. However, the molecular mechanisms of obesity leading to poor pregnancy outcomes remain unclear. Omics methods are used for genetic diagnosis and marker discovery. The aim of this review was to summarize the maternal and fetal pathophysiological alterations induced by gestational obesity,identified using multi-omics detection techniques, and to generalize the biological functions and potential mechanisms of the differentially expressed molecules.

Influence of parental weight change on the incidence of overweight and obesity in offspring

BACKGROUND

There is limited information on the association of parental weight change with overweight and obesity in offspring. This study aimed to investigate the association between parental weight change and incident overweight and obesity in offspring.

METHODS

This longitudinal cohort study included 2,963 parent-offspring trios who participated in at least two waves of the China Health and Nutrition Survey. The children without overweight and obesity defined by the International Obesity Task Force were included at the initial survey. Parental overweight and obesity were defined as body mass index ≥ 25 kg/m².

RESULTS

The incidence of overweight and obesity in offspring was 5.8% during a mean follow-up of 5.4 years. Paternal and maternal overweight and obesity at baseline were associated with this condition in offspring at follow-up (both P_s < 0.05). Compared with the persistent normal group, the persistent overweight and obesity group and incident overweight and obesity group (normal weight to overweight and obesity), but not the reversion group (overweight and obesity to normal weight), were more likely to report overweight and obesity in offspring at follow-up, regardless of father's or mother's condition. Additionally, compared with offspring whose both parents remained normal weight, those whose both parents changed from overweight and obesity to normal weight or whose one parent changed from overweight and obesity to normal weight while the other remained normal weight had no higher risks of overweight and obesity.

CONCLUSION

This study highlights the importance of parental weight management in the prevention of overweight/obesity in offspring.

Prevalence and Correlates of Overweight, Obesity and Physical Activity in Italian Children and Adolescents from Lombardy, Italy

Investigating pediatric overweight and physical activity correlates is essential to design effective preventive programs. We used regional data (Lombardy, northern Italy) from the 2019 survey “OKKio alla Salute” (3093 children aged 8–9 years with measured anthropometric data), and from the 2018 wave of the “Health Behaviour in School-aged Children” survey (2916 adolescents aged 11–15 years with self-reported anthropometric data). In both the surveys, a cluster sampling methodology was used. Unconditional multiple logistic regression models were applied to estimate the odds ratios (OR) and corresponding 95% confidence intervals (CI) of overweight, obesity and poor physical activity. The prevalence of overweight (including obesity) was 22.4% for children aged 8–9 years and 14.4% for adolescents aged 11–15 years. A higher prevalence of overweight was observed among males, children with greater birth weight and those with obese parents. Scant physical activity was higher among females and older adolescents. There was a direct relationship between obesity and increased psychological distress (OR = 2.44; 95% CI: 1.12–5.27) or being victims of bullying (OR = 2.25; 95% CI: 1.17–4.34). Increasing physical activity significantly decreased the frequency of mental health outcomes. Prevention campaigns should be promoted to safeguard childhood physical and psychological wellbeing.

Intergenerational transmission of body mass index and associations with educational attainment

Background

Individual differences in educational attainment (EA) and physical health, as indexed by body mass index (BMI), are correlated within persons and across generations. The present aim was to assess these associations while controlling for parental transmission.

Methods

We analyzed BMI and EA obtained for 8,866 families from the Netherlands. Data were available for 19,132 persons, including 6,901 parents (mean age 54) and 12,234 of their adult offspring (mean age 32). We employed structural equation modeling to simultaneously model the direct and indirect transmission of BMI and EA from parents to offspring, spousal correlations, and the residual within-person BMI-EA association and tested for gender differences in the transmission parameters.

Results

We found moderate intergeneration transmission for BMI (standardized beta ~ .20) and EA (~ .22), and substantial spousal correlations for BMI (.23) and EA (.51). Cross-trait parent to offspring transmission was weak. The strength of transmission was largely independent of parent or offspring gender. Negative within person EA-BMI correlations were observed for all family members (fathers, -0.102; mothers, -0.147; sons, -0.154; daughters, -0.173). About 60% of the EA-BMI correlation in offspring persisted after taking into account the intergeneration transmission.

Conclusions

The intergenerational transmission for BMI and EA is mainly predictive within traits. Significant spousal and within person correlations in the parental generation are responsible for the effect of parental EA on offspring BMI. Offspring EA and BMI are further correlated beyond parental influences.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13270-1.

Pathways in the association between added sugar consumption, obesity in mother-child dyads, and chronic oral disease burden in early childhood

In this study, we modeled the pathways in the association of socioeconomic status, frequency of added sugar consumption, and obesity in mother-child dyads with chronic oral disease burden in early childhood using structural equation modeling. A population-based study was conducted on preschoolers from public daycare centers in São Luís, Brazil (n = 674) and their mothers. Chronic oral disease burden in early childhood was a latent variable, representing the shared variance of the following indicators: visible plaque index, gingivitis, and dental caries. A higher consumption frequency of added sugars by children [standardized regression coefficient (SC) = 0.219] explained the chronic oral disease burden. A higher consumption frequency of added sugars by mothers was associated with greater consumption of sugar by children (SC = 0.236), and indirectly with a greater chronic oral disease burden (SC = 0.052). Maternal obesity was associated with obesity in the offspring (SC = 0.130). The chronic oral disease burden is already present in early childhood and can be explained by the higher consumption of added sugars by the mother-child dyad. Approaches to preventing chronic oral diseases should focus on common risk factors, start early in life, and promote family involvement in this process.

Intergenerational cardiovascular disease risks among Hispanics living in the United States

BACKGROUND

Few studies have assessed intergenerational associations of obesity and cardiovascular disease risks from parents to their children among Hispanic Americans.

OBJECTIVES

To assess intergenerational cardiovascular associations among Hispanic families.

METHODS

Using baseline data from an obesity-focused efficacy trial targeting Hispanic adolescents (n = 280) and their parents, we conducted a series of logistic regression analyses to investigate the effects of parental BMI and blood pressure on adolescents' BMI and blood pressure, respectively.

RESULTS

After adjusting for significant socio-demographic variables and adolescents' lifestyle behaviours, adolescents were more than twice as likely to be in the severely obese versus overweight range when their parents had obesity (vs. non-obese; OR = 2.55, 95% CI = 1.20, 5.39) and more than twice as likely to be in the severely obese versus obese weight range (OR = 2.44, 95% CI = 1.22, 4.87) when their parents had obesity. When compared to those with normal blood pressure, adolescents who had parents with elevated blood pressure/hypertension were more than twice as likely to have elevated blood pressure (OR = 2.05, 95% CI = 1.04, 4.00) or be classified as hypertensive stage 1/2 (OR = 2.81, 95% CI = 1.31, 6.01).

CONCLUSIONS

Both severe obesity and elevated blood pressure are highly associated among Hispanic parent-child dyads. Findings underscore the potential benefits of intervening with the family system.

Multigenerational transmission of obesity: A systematic review and meta-analysis

There is a strong link between parental and offspring obesity status. However, the state of epidemiological evidence on multigenerational transmission of overweight/obesity, such as from grandparents to grandchildren, is relatively unknown. This systematic review collates and appraises existing evidence on multigenerational transmission of overweight/obesity and uses meta-analytic estimates for quantitative synthesis. Six electronic databases were searched for publications reporting the relationship between grandparents and their grandchildren overweight/obesity status. A total of 25 studies from 17 countries with a combined population of 238,771 study participants met the inclusion criteria. About 60% (15) of the reviewed studies reported a positive association between grandparent-grandchild (GP-GC) overweight/obesity, out of which 11 were statistically significant. Seven studies reported odds ratios of GP-GC overweight/obesity associations and were included in the meta-analysis. The pooled estimates showed a significant GP-GC association in overweight/obesity status (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.01-2.57). Thus, the current research evidence shows that grandchildren's overweight/obesity status is associated with their grandparents' overweight/obesity status, indicating a multigenerational transmission of obesity. However, more studies, especially from developing countries, are required to assess the robustness of these findings. Future studies should also focus on the mechanisms through which this transmission occurs.

Fatores associados ao estado nutricional de crianças menores de cinco anos da Paraíba, Brasil

Resumo Objetivou-se analisar se o estado nutricional de crianças menores de cinco anos de idade está relacionado às condições biológicas de suas mães, ao acesso a serviços de saúde, ao benefício de programas sociais e às condições socioeconômicas. Trata-se de um estudo transversal realizado no contexto da Estratégia Saúde da Família, em sete municípios do interior do estado da Paraíba. A metodologia incluiu o diagnóstico do déficit de estatura e do excesso de peso (sobrepeso e obesidade) das crianças, cujos determinantes foram analisados por meio de árvore de decisão. Como resultado, foram avaliadas 469 crianças, das quais 7,9% apresentaram déficit de estatura e 12,8% excesso de peso. Encontrou-se associação desses desfechos com o estado nutricional materno. A baixa estatura também teve como exposições relevantes a idade da criança inferior a dois anos (p = 0,018) e a insegurança alimentar e nutricional moderada/grave (p = 0,008). Para o excesso de peso, não ser beneficiário do Programa Bolsa Família (p = 0,049) e a pior situação socioeconômica (p = 0,006) também representaram fatores associados ao desfecho. Como conclusão do presente estudo, podemos afirmar que existe uma associação entre o estado nutricional materno e o da criança.

Sex differences in metabolically healthy and metabolically unhealthy obesity among Chinese children and adolescents

OBJECTIVES

To analyze sex differences in the prevalence of obesity phenotypes and their risk factors among children and adolescents aged 7-18 years in China.

METHODS

We enrolled 15,114 children and adolescents aged 7-18 years into the final analysis. Obesity phenotypes were classified by body mass index (BMI) and metabolic status as metabolically healthy or unhealthy obesity. In addition, we collected four possible influencing factors on obesity phenotypes through questionnaires, including demographic, parental, early life, and lifestyle indicators. Multinomial logistic regression analysis in a generalized linear mixed model (GLMM) was selected to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for identifying risk factors and control the cluster effects of schools. More importantly, the interaction terms of sex and each indicator were established to demonstrate the sex differences.

RESULTS

The prevalence of metabolically healthy obesity (MHO), metabolically unhealthy obesity (MUO), metabolically healthy overweight and obesity (MHOO), and metabolically unhealthy overweight and obesity (MUOO) were 3.5%, 5.6%, 11.1%, and 13.0% respectively, with higher prevalence in boys (5.3% vs. 1.6%, 7.9% vs. 3.1%, 14.3% vs. 7.7%, 15.6% vs. 10.1%). In addition, younger ages, single children, parental smoking, parental history of diseases (overweight, hypertension, diabetes), caesarean, premature, and delayed delivery time, high birth weight, insufficient sleep time, and excessive screen time were considered as important risk factors of MHO and MUO among children and adolescents (p < 0.05). More notably, boys were at higher risks of MUO when they were single children (boys: OR = 1.56, 95% CI: 1.24-1.96; girls: OR = 1.12, 95% CI: 0.82-1.54), while girls were more sensitive to MUO with parental smoking (girls: OR = 1.34, 95% CI: 1.02-1.76; boys: OR = 1.16, 95% CI: 0.97-1.39), premature delivery (girls: OR = 3.11, 95% CI: 1.59-6.07; boys: OR = 1.22, 95% CI: 0.67-2.22), high birth weight (girls: OR = 2.45, 95% CI: 1.63-3.69; boys: OR = 1.28, 95% CI: 0.96-1.70), and excessive screen time (girls: OR = 1.47, 95% CI: 1.06-2.04; boys: OR = 0.97, 95% CI: 0.79-1.20), with significant interaction term for sex difference (p_interaction < 0.05).

CONCLUSIONS

MHO and MUO are becoming prevalent among Chinese children and adolescents. Significant sex differences in the prevalence of obesity phenotypes as well as their environmental and genetic risk factors suggest it might be necessary to manage obesity phenotypes problems from a sex perspective.

PROGNOSTIC CRITERIA OF EXCESSIVE BODY WEIGHT DEVELOPMENT AMONG SCHOOLCHILDREN BY THE RESULTS OF ANAMNESTIC SURVEY

OBJECTIVE

The aim: To elaborate prognostic criteria to assess the risk of excessive body weight development among schoolchildren on the basis of hereditary and behavioral predictors.

PATIENTS AND METHODS

Materials and methods: 90 parents of school age children were interviewed by means of the social study method.

RESULTS

Results: Hereditary status (1 and 2 congeniality degree to type 2 diabetes mellitus, arterial hypertension, excessive body weight, cases of myocardial infarction and/or stroke available among relatives) and behavioral characteristics (peculiarities of diet and physical activity of a child) were studied among school age children. The risks promoting development of an excessive body weight under conditions of hereditary and behavioral factors were assessed. The prognostic matrix elaborated enables to predict development of an excessive body weight of a child under a comprehensive effect of unfavorable hereditary and behavioral characteristics with a high accuracy (AUC = 0,88, Std. Dev. = 0,0451).

CONCLUSION

Conclusions: The method elaborated enables to find children with the risk of an excessive body weight development and introduce individualized prophylaxis measures in order to prevent development of obesity and diseases associated with an excessive body weight.

Associations of preschoolers' dietary patterns with eating behaviors and parental feeding practices at a 12-month follow-up of obesity treatment

Although dietary patterns are key to the management of childhood obesity, they are rarely assessed and thus poorly understood. This study examines preschoolers' dietary patterns and correlates 12 months after the start of obesity treatment (n = 99, mean age 5.2 years, 52% girls). A food frequency questionnaire (FFQ), the Child Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire (CFQ) and Lifestyle Behavior Checklist (LBC) were answered by parents to assess children's food intake, eating behaviors, parental feeding practices, and obesity-related behaviors, respectively. Principal component analysis identified dietary patterns based on FFQ data. Through multiple linear regressions we examined correlations between a healthy (HD) and a less healthy (LHD) dietary pattern and mean scores of the CEBQ, CFQ, LBC scales as well as BMI z-scores. The reported intake of items in the LHD decreased after treatment while no differences were found for the HD. Children's eating behaviors, in particular food fussiness, showed consistent associations with diet (b = -0.39, 95% CI -0.63, -0.14 for HD and b = 0.41, 95% CI 0.15, 0.66 for LHD). Feeding practices and obesity-related behaviours were weakly associated with the dietary patterns (HD and Monitoring: b = 0.36, 95% CI 0.09, 0.62; LHD and Screen time b = 0.08, 95% CI 0.01, 0.15). Among the measured variables, eating behaviors had the largest impact on children's dietary patterns. The LHD was associated with a higher BMI z-score but no associations were found between changes in LHD intake and changes in BMI z-scores. Our findings suggest that decreasing food fussiness in children with obesity is key to positive dietary changes. Assessment of children's eating behaviors can help tailor dietary advice and provide support for families of children with obesity.

Global relationship between parent and child obesity: a systematic review and meta-analysis

BACKGROUND

The growing prevalence of overweight and/or obese children is an important public health problem in both developed and developing countries. Although the association of obesity between parents and their children is well known, its underlying mechanisms are not well established.

PURPOSE

This meta-analysis examined parent-child (PC) relationships in obesity and identified factors such as world region and country income level that may influence this relationship.

METHODS

We identified all related studies published between January 1, 2015 and May 31, 2020 by conducting a literature search using the MeSH terms "obesity," "overweight," "body mass index," "parent," "child," "associate," and "relate" in the PubMed database in English.

RESULTS

The meta-analysis of 23 studies that reported an odds ratio (OR) for parent and child obesity associations found a significant association between parents and children who were overweight or obese (pooled OR, 1.97; 95% confidence interval, 1.85-2.10). A meta-regression analysis was used to examine the sources of interstudy heterogeneity. The association between parent and child obesity was higher in Asia than in Europe and the Middle East and higher in high-income countries than in middle-or low-income countries. In addition, a higher association between parent and child obesity was found when both parents were obese than when only the father or mother was obese. This study from multiple countries indicates a significant PC relationship in weight status that varies according to PC pair type, parent and child weight statuses, world region, and country income level.

CONCLUSION

These results demonstrate that the risk of childhood obesity is greatly influenced by parental weight status and indicate that parents could play an important role in preventing child obesity.

The association of parental involvement with adolescents' well-being in Oman: evidence from the 2015 Global School Health Survey

BACKGROUND

The parent-adolescent relationship plays a key role in adolescent development, including behaviour, physical health, and mental health outcomes. Studies on the parental factors that contribute to an adolescent's dietary habits, exercise, mental health, physical harm and substance use are limited in the Middle East and North Africa region, with none in Oman. This study aims to investigate the association between parental involvement and adolescent well-being in Oman.

METHODS

Cross-sectional data from the 2015 Global School Health Survey for Oman was analysed. The dataset consisted of 3468 adolescents. Adolescents reported on their parental involvement (checking to see if they did their homework, understanding their problems, knowing what they are doing in their free time and not going through their things without permission). Parental involvement was scored on a 20-point scale. Associations with the following dependent variables: nutrition, exercise, hygiene, physical harm, bullying, substance use, tobacco use and mental health well-being were done using Spearman's correlations, linear and logistic regressions.

RESULTS

The surveyed population was 48% male, 65% aged 15 to 17 years old and 5% reported that they "most of the time or always" went hungry. Parental involvement was positively correlated with each of the dependent variables. Adolescents with higher parental involvement had significantly higher odds of good nutrition (1.391), hygiene (1.823) and exercise (1.531) and lower odds of physical harm (0.648), being bullied (0.628), poor mental health (0.415), tobacco use (0.496) and substance use (0.229).

CONCLUSIONS

Parental involvement plays a positive role in all aspects of adolescents' well-being in Oman. Awareness campaigns and interventions aimed to help improve the well-being of adolescents should incorporate such positive role in their designs.

Association between childhood obesity and familial salt intake: analysis of data from Korean National Health and Nutrition Examination Survey, 2014-2017

High salt intake is known as a risk factor of childhood obesity. As family members share not only genes but also their diet habit, parents' salt intake may affect to their children's obesity. In this study, we investigated correlations between childhood obesity and parents' or children's sodium intakes based on a nationwide survey data. From the Korean National Health and Nutrition Examination Survey data from 2014 to 2017, 802 boys and 657 girls aged 10-18 years, and their parents were included. BMI z-score and 24-hour urinary sodium excretion, which is estimated through Tanaka's equation, were used to examine associations between obesity and sodium intakes. The BMI status and the prevalence of obesity between children and their parents showed strong positive correlations in both sexes (all p < 0.001). The urinary sodium excretion between children and their parents showed positive correlations in both sexes (all p < 0.05). Children with higher urinary sodium excretion showed higher BMI (in both sexes, p < 0.001) and higher parental obesity compared to those with lower urinary sodium excretion, however, statistical significances of the latter relationship were varied by sex. In conclusion, our study suggests close relationship between childhood obesity and their sodium intakes, which also correlate well with parental BMIs and diet behavior. Therefore, parental education and active participation could be crucial in regulating childhood obesity.

Effectiveness of family-based eHealth interventions in cardiovascular disease risk reduction: A systematic review

Family-based eHealth interventions to reduce cardiovascular disease risk have potential as a primary prevention strategy to improve the health of parents and their children. This systematic review evaluated the effectiveness of such interventions in modifying parent and child/adolescent risk factors such as body mass index, physical activity, dietary intakes and alcohol use. Five electronic databases were searched up to April 2020. Of 2193 articles identified, seven randomised controlled trials met inclusion criteria and were reviewed. Data were extracted regarding study setting, design, methods, eHealth technology used, intervention and control group components, retention rates, outcome measures, incentives and limitations. Risk of bias and quality assessment were carried out using Cochrane methods. A qualitative narrative data synthesis of the studies was conducted. Our review found that three studies showed an improvement in alcohol use among parents and adolescents as a result of the eHealth intervention. Among children/adolescents, two studies showed an improvement in dietary intake, one study showed an improvement in physical activity, and one study showed an improvement in body mass index as a result of the eHealth intervention. Interventions appeared more likely to be effective if they were theory-based, had longer follow-up periods, were incentivised and included regular interaction. Our findings suggest that, despite a paucity of high-quality trials, there is some evidence that family-based eHealth interventions have potential to reduce cardiovascular disease risk. However, more sufficiently powered, higher-quality trials with theory driven, clearly described interventions and unambiguous outcomes are needed.

Relative Importance of Determinants of Changes in Eating Behavior during the Transition to Parenthood: Priorities for Future Research and Interventions

Background: Healthy eating behavior throughout pregnancy and postpartum is important. This study aimed to investigate the perceived sex-specific importance of determinants of changes in eating behavior during pregnancy and postpartum. Methods: Fifty-four determinants were rated by first-time parents (n = 179) on their impact. Experts (n = 31) rated the determinants in terms of their modifiability, relationship strength, and population-level effect from which a “priority for research”-score was calculated. Results: During pregnancy, the three highest rated determinants by women were “health concerns”, “physiological changes”, and “fatigue”. Men perceived “health concerns”, “health consciousness”, and “influence of the pregnant partner” as important. Postpartum, the three highest rated determinants by women were “adaptation to rhythm of baby”, “baby becomes priority”, and “practical constraints because of the baby”. Men perceived “adaptation to rhythm of baby”, “fatigue”. and “(lack of) anticipation” as important. According to the experts, “professional influence”, “food knowledge”, and “home food availability” received high priority scores for both sexes and during both periods. Conclusions: Priority for research and interventions should go towards tailored family-based approaches focusing on food education in a broad sense taking into account aspects such as health consciousness, self-efficacy skills, and the social and home food environment while being supported by healthcare professionals.

A Comprehensive Multidisciplinary Management Plan Is Effective in Reducing the Prevalence of Overweight and Obesity in Childhood and Adolescence

BACKGROUND

Obesity in childhood and adolescence represents a major health problem of our century. In Greece, 30-35% of children and adolescents are overweight or obese. Objective and Hypotheses: To investigate the effectiveness of a comprehensive multidisciplinary personalized management plan at reducing the prevalence of overweight and obesity in childhood and adolescence.

PATIENTS AND METHODS

One thousand (n = 1,000) children and adolescents aged 2-18 years (mean age ± SD: 10.09 ± 2.86 years; 520 females, 480 males) were studied prospectively. Subjects were classified as obese (n = 579, 57.9%), overweight (n = 295, 29.5%) or having a normal body mass index (BMI) (n = 126, 12.6%) according to the International Obesity Task Force cutoff points. All subjects were evaluated by a multidisciplinary team at frequent intervals, received personalized advice on diet and exercise and were studied prospectively for 1 year. Detailed clinical evaluation and laboratory investigations were performed at the beginning and at the end of the study.

RESULTS

At initial evaluation, 57.9% of subjects were obese, 29.5% overweight and 12.6% of normal BMI. Indices of cardiometabolic disease were higher in obese than in overweight and normal-BMI subjects. Following 1 year of multidisciplinary management interventions, the prevalence of obesity decreased by 16.8%, the prevalence of normal BMI increased by 8.2%, and all cardiometabolic indices improved significantly.

CONCLUSIONS

A personalized multidisciplinary management plan is effective at reducing the prevalence of obesity in childhood and adolescence.

Policy and Food Consumption: What Nutrition Guidelines Are Swiss Children Meeting and What Determines Adherence?

Objectives: To describe the adherence of the children to the Swiss Society for Nutrition (SSN) dietary guidelines, assess determinants of adherence, and compare these findings with a previous study in the same population.

Methods: Data from 312 children ages 5–12 were collected through a survey and a 2-day food record. The associations of children- and parent-related factors with adherence of the children to guidelines were assessed by logistic regression analyses.

Results: SSN guidelines were not met for any food category, although there were improvements: vegetables (4.5% in this study vs. 0% in the previous study), sweets, snacks, and soft drinks (SSD) (12.5 vs. 9.5%), and fruit (45.5 vs. 10.4%). Higher Body Mass Index (BMI) in children was associated with higher adherence to guidelines for protein intake. Higher parental BMI was associated with higher adherence to vegetables. Parental lower educational level was associated with higher adherence for cereal.

Conclusion: Despite improvements since the last eating behavior assessment in this population, children consume too little fruit, vegetables, cereal, and milk and dairy products, and too much SSD and proteins. Further efforts are needed to promote healthy eating to children and achieve adherence to guidelines.

Mendelian randomization: estimation of inpatient hospital costs attributable to obesity

BACKGROUND

Mendelian Randomization is a type of instrumental variable (IV) analysis that uses inherited genetic variants as instruments to estimate causal effects attributable to genetic factors. This study aims to estimate the impact of obesity on annual inpatient healthcare costs in the UK using linked data from the UK Biobank and Hospital Episode Statistics (HES).

METHODS

UK Biobank data for 482,127 subjects was linked with HES inpatient admission records, and costs were assigned to episodes of care. A two-stage least squares (TSLS) IV model and a TSLS two-part cost model were compared to a naïve regression of inpatient healthcare costs on body mass index (BMI).

RESULTS

The naïve analysis of annual cost on continuous BMI predicted an annual cost of £21.61 [95% CI £20.33 - £22.89] greater cost per unit increase in BMI. The TSLS IV model predicted an annual cost of £14.36 [95% CI £0.31 - £28.42] greater cost per unit increase in BMI. Modelled with a binary obesity variable, the naïve analysis predicted that obese subjects incurred £205.53 [95% CI £191.45 - £219.60] greater costs than non-obese subjects. The TSLS model predicted a cost £201.58 [95% CI £4.32 - £398.84] greater for obese subjects compared to non-obese subjects.

CONCLUSIONS

The IV models provide evidence for a causal relationship between obesity and higher inpatient healthcare costs. Compared to the naïve models, the binary IV model found a slightly smaller marginal effect of obesity, and the continuous IV model found a slightly smaller marginal effect of a single unit increase in BMI.

The association of dietary choline and betaine and anthropometric measurements among Iranian children: a cross-sectional study

Background

Previous studies have suggested that choline and betaine are associated with improved anthropometric measures including, BMI and waist circumference however, results are largely inconsistent and limited studies exist in children. Our objective was to investigate the relationship between dietary choline and betaine, and anthropometric measurements among Iranian children.

Methods

In this cross-sectional study, dietary information was collected for 788 six-year-old children, who attended Tehran health centers in 2018. We measured dietary intakes using a valid and reliable semi-quantitative food frequency questionnaire. The USDA database was used to calculate dietary choline and betaine. We assessed anthropometric characteristics, physical activity, and socio-demographic status based on a reliable and valid protocol. Logistic regression adjusted for energy, physical activity, socio-economic status, and maternal age, physical activity, BMI, and HEI2015 was used to assess this association.

Results

Free choline, glycero-phospho-choline, phospho-choline, phosphatidyl-choline, total choline, and total betaine, and choline were not related to overweight, obesity, underweight and wasting in the crude and adjusted model after controlling for children’s energy intake, children’s physical activity, socio-economic status, maternal physical activity, and BMI. Betaine intake was associated with mid-arm circumference and risk of overweight.

Conclusions

We did not find any evidence to support the association between dietary choline with anthropometric measurements among Iranian children. Further prospective studies with a large sample size in different populations are needed.

Adherence to the 24-hour movement guidelines and adiposity in a cohort of at risk youth: A longitudinal analysis

BACKGROUND

The 24-hour movement guidelines provide recommendations for physical activity, screen time and sleep duration for children.

OBJECTIVES

Describe adherence to the guidelines and their cross-sectional and longitudinal associations with adiposity from childhood to adolescence.

METHODS

Data are from the QUALITY Cohort. Children were followed at 8 to 10 years (childhood; n = 630), 10 to 12 years (early adolescence; n = 564) and 15 to 17 years (adolescence; n = 377). Physical activity, screen time, and sleep duration were measured by accelerometry and questionnaires. Body mass index z-scores (zBMI), waist circumference, waist-to-height ratio and percent body fat were based on clinical measurements. Multiple linear regressions estimated associations.

RESULTS

In childhood, early adolescence and adolescence, 14%, 6%, and 0% of participants met the 24-hour movement guidelines, respectively. Meeting fewer guideline components was cross-sectionally associated with higher adiposity at each visit. Meeting fewer guideline components in childhood was longitudinally associated with higher adiposity at later visits. For example, those meeting none of the guideline components (vs all) in childhood had a 1.66 SD (95% CI: 0.42, 2.89) higher zBMI in early adolescence.

CONCLUSION

Few participants met the guidelines. Not meeting the guidelines in childhood is associated with higher adiposity 2 and 7 years later. Interventions are needed to increase adherence to the 24-hour movement guidelines across childhood and adolescence.