text:
Research has highlighted links between impulsivity and weight in children and adults. Nevertheless, little is known about the nature of this link in very young children or about the underlying mechanism by which impulsivity leads to greater adiposity.
The present study aimed to explore relationships between impulsivity, weight and eating behaviour in a sample of 95 2 to 4-year-olds.
Parent–child dyads visited the laboratory and consumed a meal after which parents completed measures of child impulsivity, eating behaviour and parental feeding, whilst children completed impulsivity tasks measuring the impulsivity facet delay of gratification (Snack Delay task), motor impulsivity (Line Walking task) and inhibitory control (Tower task).
Pearson's correlations showed that girls with greater motor impulsivity were heavier. Additionally, monitoring moderated the relationship between impulsivity and food approach behaviour, indicating that monitoring may protect more impulsive children from displaying problematic eating behaviours.
The motor impulsivity facet appears particularly relevant to child weight; parents can modulate the impact of impulsivity on child eating behaviour through their feeding style.
The obesity epidemic has spared no age group, even young infants. Most childhood obesity is incident by the age of 5 years, making prevention in preschool years a priority.
To examine 2-year changes in age- and sex-specific BMI z-scores and obesity-related behaviours among 441 of the 475 originally recruited participants in High Five for Kids, a cluster randomized controlled trial in 10 paediatric practices.
The intervention included a more intensive 1-year intervention period (four in-person visits and two phone calls) followed by a less intensive 1-year maintenance period (two in-person visits) among children who were overweight or obese and age 2–6 years at enrolment. The five intervention practices restructured care to manage these children including motivational interviewing and educational modules targeting television viewing and intakes of fast food and sugar-sweetened beverages.
After 2 years, compared with usual care, intervention participants had similar changes in BMI z-scores (−0.04 units; 95% CI −0.14, 0.06), television viewing (−0.20 h/d; −0.49 to 0.09) and intakes of fast food (−0.09 servings/week; −0.34 to 0.17) and sugar-sweetened beverages (−0.26 servings/day; −0.67 to 0.14).
High Five for Kids, a primarily clinical-based intervention, did not affect BMI z-scores or obesity-related behaviours after 2 years.
Dog ownership has been associated with increased physical activity in children which in turn may mitigate childhood obesity.
To measure the association between child–dog attachment and child physical activity and screen time.
Cross-sectional study including 370 children (ages 4–10) who had pet dogs in the home. Parents completed the DartScreen, a web-based screener, before a well-child visit. Screener domains included child body mass index (BMI), physical activity, screen time and dog-related questions. The Companion Animal Bonding Scale (CABS) was used to measure child attachment to the dog. Clinic nurses weighed and measured the children. Associations between CABS, BMI z-score, screen time and physical activity were estimated.
CABS was strongly associated with time spent being active with the dog (F = 22.81, p < 0.0001), but not with BMI z-score or screen time.
A higher level of child attachment to a pet dog is associated with increased child physical activity.
Obesity is associated with multiple health problems and often originates in childhood. The purpose is to investigate the associations of genetic polymorphisms in genes related to risk-taking behaviours with body mass index (BMI) trajectory over adolescence among Mexican Americans.
This study included 1229 Mexican American adolescents who participated in a large population-based cohort study in Houston, Texas. BMI data were obtained at baseline and two follow-ups. The median follow-up time was 59 months. Participants were genotyped for 672 functional and tagging variants in genes involved in the dopamine, serotonin and cannabinoid pathways.
After adjusting for multiple comparisons, three genetic variants, namely, rs933271 and rs4646310 in COMT gene, and rs9567733 in HTR2A gene were significantly associated with BMI growth over adolescence. Using those three variants, we created an allelic score, and the allelic score was associated with BMI growth over adolescence (P < 0.001). With the increase number of variant allele, the rate of BMI growth over adolescence was slower. Finally, we identified another two genetic variants, namely, rs17069005 in HTR2A gene and rs3776511 in SLC6A3A gene were associated with obesity at last follow-up.
The results suggest that genetic variants in selected genes involved in dopamine and serotonin pathways have noticeable effects on BMI over adolescence.
Bisphenol A (BPA) exposure has been associated with increased incidence of diabetes and obesity in adults.
To evaluate whether an association between BPA urinary levels and insulin resistance as well as adiponectin and resistin production and serum concentrations may occur in obese children.
Clinical and biochemical features of 141 obese children were collected. Serum resistin and adiponectin were evaluated. Insulin resistance and urinary BPA levels were assessed. Moreover, the effect of BPA on adiponectin and resistin gene expression in adipocytes from eight normal weight prepubertal children was investigated by quantitative real-time RT-PCR (qPCR).
Direct association between BPA and homeostasis model assessment (r = 0.23; p: 0.0069) and a strong inverse association between BPA and adiponectin have been found (r = −0.48; p < 0.0001). In adipocytes, resistin expression was detected only after BPA treatment, while adiponectin expression resulted down-regulated after BPA exposure (p < 0.05 at both 10 and 100 nM BPA concentrations).
We suggest the involvement of BPA in the development of insulin resistance in childhood obesity highlighting that urinary BPA levels are directly associated with insulin resistance regardless of BMI. This association may be explained, at least partly, by the findings that BPA affects resistin and adiponectin production in adipose tissue cultures.
Dyslipidemia is an important risk factor for the development of several diseases. The genetic component of hypertriglyceridemia has been studied in adults, but little is known in children.
The objective is to evaluate the association of two variants in APOA5 (rs662799) and APOA1 (rs5072) with triglyceride (TG) levels in Mexican children.
Anthropometric parameters were measured in 1559 Mexican children 5–14 years of age. DNA was isolated from blood samples. Lipid profiles and glucose concentrations were determined from serum and genotyping of rs662799, and rs5072 was performed using TaqMan® technology. Additive and dominant models adjusted for age, gender and body mass index were used to evaluate the association of these single nucleotide polymorphisms with TG levels.
Children with high TG levels were found to have a higher body mass index and waist circumference as well as a worse lipids profile and glucose levels (p < 0.001). Additive and dominant models demonstrated a significant association between the rs662799 and rs5072 with TG. The dominant model showed the strongest significant association (OR = 1.81; 95% CI 1.46–2.24; p = 5.40 × 10−08 for rs662799 and OR = 1.54; 95% CI 1.05–2.25; p = 2.60 × 10−02 for rs5072).
The minor alleles of rs662799 (APOA5) and rs5072 (APOA1) modulate TG levels in Mexican children.
Childhood obesity is associated with increased cardiometabolic risk.
To study the relationship between body mass index (BMI) and cardiometabolic risk factors in American Indian children and adolescents.
Differences in metabolic variables by age and sex-specific BMI percentiles (2000 Centers for Disease Control and Prevention Growth Charts) were examined in a cross-sectional analysis of 2977 individuals across three age categories. Children with an exam in two consecutive age categories were included in a longitudinal analysis. Spearman's correlations were used to test the association of BMI percentile with anthropometric and biochemical variables.
Body mass index percentile correlated with systolic (r = 0.24 to 0.38) and diastolic (r = 0.13 to 0.22) blood pressure, fasting plasma glucose (r = 0.20 to 0.33), 2-h plasma glucose (r = 0.30 to 0.46), total cholesterol (r = 0.12 to 0.23), serum triglycerides (r = 0.40 to 0.51) and HDL cholesterol (r = −0.36 to −0.43) in each age group (5–9, 10–13 and 14–17 years). Among participants examined in multiple age categories, BMI percentile increased over time. Change in BMI percentile from one age category to the next was associated with an increase in fasting glucose, 2-h glucose and triglycerides and a decrease in HDL cholesterol.
Higher BMI was associated with blood pressure elevation, hyperglycaemia and dyslipidaemia in American Indian children and adolescents.
The reported association between birth weight and subsequent body mass index (BMI) is conflicting.
To examine the relationship between birth weight and BMI in children aged 6–7 years.
Secondary analysis of data from a multi-centre, multi-country, cross-sectional study (International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three). Parents/guardians of children aged 6–7 years completed questionnaires about their children's birth weight, current height and weight and whether their mother smoked in the first year of the child's life. A general linear mixed model was used to determine the association between BMI and birth weight.
A total of 72 111 children (17 countries) were included in the analysis. There was a positive association of birth weight with BMI (for each kg increase in birth weight the BMI at 6–7 increased by 0.47 (SE 0.02) kg/m2; p < 0.0001) with a clear gradient by birth weight category. There was no statistically significant interaction between birth weight and Gross National Income (GNI).
There is a positive linear relationship between birth weight and BMI in 6–7 year old children, which is present in both high and low income countries.
The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial documented that metformin plus rosiglitazone, but not metformin plus lifestyle intervention, provided superior durability of glycemic control relative to metformin monotherapy.
We examined weight changes among TODAY participants that completed at least 6 months of treatment, evaluated predictors of lifestyle outcome, and examined whether weight changes were related to cardiometabolic outcomes across treatment arms.
The 595 youth with type 2 diabetes, (85.1% of randomized participants aged 11–17 years) completed assessments of weight-related and cardiometabolic measures at months 0, 6, 12 and 24. Repeated measures models were used to investigate associations over time.
Lifestyle intervention did not enhance outcome relative to metformin alone and no predictors of response to lifestyle treatment were identified. However, changes in percent overweight across treatment arms were associated with changes in multiple cardiometabolic risk factors, and decreases of ≥ 7% in overweight were associated with significant benefits over 24 months.
Although adjunctive intensive lifestyle intervention did not improve weight-related outcomes, weight changes in the full TODAY sample were associated with small, but significant improvements in cardiometabolic status, highlighting the importance of optimizing weight management in youth with T2DM.
Many studies have documented that breastfeeding is associated with a significant reduction in child obesity risk. However, a persistent problem in this literature is that unobservable confounders may drive the correlations between breastfeeding behaviors and child weight outcomes.
This study examines the effect of breastfeeding practices on child weight outcomes at age 2.
This study relied on population-based data for all births in Oregon in 2009 followed for two years. We used instrumental variables methods to exploit variations in breastfeeding by mothers immediately after delivery and the degree to which hospitals encouraged mothers to breastfeed in order to isolate the effect of breastfeeding practices on child weight outcomes.
We found that for every extra week that the child was breastfed, the likelihood of the child being obese at age 2 declined by 0.82% [95% CI −1.8% to 0.1%]. Likewise, for every extra week that the child was exclusively breastfed, the likelihood of being obese declined by 0.66% [95% CI −1.4 to 0.06%]. While the magnitudes of effects were modest and marginally significant, the results were robust in a variety of specifications.
The results suggest that hospital practices that support breastfeeding may influence childhood weight outcomes.
There are no academic studies that characterize advertisements directed at children from the companies that signed the self-regulation.
The aim of this paper was to assess the extent and nature of food advertisements and the persuasive techniques used to market unhealthy food and beverages (UFB) to children, by signatory companies of self-regulation.
From December 2012 to April 2013, 600 h of programming were recorded on the four broadcast public television channels in Mexico with the highest rating nationwide. Marketing aimed at children directly (broadcast on children's programmes or advertisements with a specific appeal to children) or indirectly (aimed at other target audiences with messages or scenes that link children to the product) were considered.
About 74.9% (2148) of the total food and beverage advertisements tried to influence children directly and indirectly. Companies, which had signed the self-regulation, focused 92.7% of their advertisements on UFB. Of the total number, 23.9% were aimed at children, 7.1% at adolescents, 12.5% at parents and 56.2% at the general public. Most of these advertisements were broadcast on movies (29.8%), cartoons (18%), soap operas (17.6%), entertainment shows (17.2%) and sports programs (6.4%).
Despite the self-regulation of television marketing, children were surrounded by UFB advertisements. Signatory companies influence children indirectly by targeting other audiences and by marketing during family television programs, which are also watched by children.
Beyond pre-pregnancy BMI, maternal weight change before and during pregnancy may also affect offspring adiposity.
To investigate the relationship between maternal weight history before and during pregnancy with children's adiposity at 5–6 years.
In 1069 mother–child dyads from the EDEN Cohort, we examined by linear regression the associations of children's BMI, fat mass and abdominal adiposity at 5–6 years with maternal pre-pregnancy BMI, pre-pregnancy average yearly weight change from age 20 and gestational weight gain. The shapes of relationships were investigated using splines and polynomial functions were tested.
Children's BMI and adiposity parameters were positively associated with maternal pre-pregnancy BMI, but these relationships were mainly seen in thin mothers, with no substantial variation for maternal BMI ranging from 22 to 35 kg/m2. Gestational weight gain was positively associated with children's BMI Z-score, but again more so in thin mothers. We found no association with pre-pregnancy weight change.
Before the adiposity rebound, maternal pre-pregnancy thinness explains most of the relationship with children's BMI. The relationship may emerge at older ages in children of overweight and obese mothers, and this latency may be an obstacle to early prevention.
Gut microbes are active participants of host metabolism. At birth, child physiology is committed towards healthiness or sickness depending, in part, on maternal condition (i.e. lean vs obesity) and delivery. Finally, changes from breastfeeding to solid food also account to define gut microbiota ecology in adulthood. Nowadays, alterations of gut microbiota, named dysbiosis, are acquired risk factors for multiple diseases, especially type 2 diabetes and obesity. Despite important evidence linking nutrition to dysbiosis to energetic dysmetabolism, molecular mechanisms for causality are still missing. That the status of gut microbiota of mother and child is crucial for future diseases is witnessed by adulthood overweight and obesity observed in children with dysbiosis. In this short review we highlight the importance of early life events related to the microbiota and their impact on future adult disease risk. Therefore, our effort to treat or prevent metabolic diseases should be addressed towards early or previous life steps, when microbial decisions are going to affect our metabolic fate.
Weight-based bullying is a prevalent problem among youth with overweight and obesity, but remains neglected in existing policy-level strategies to address youth bullying. Parental support is an influential catalyst motivating political will for policy decisions affecting youth, but has received limited research attention.
To assess levels of, and predictors of, parental support for school-based policies and state/federal legal measures to address weight-based bullying in 2014 and 2015.
Identical online questionnaires were completed by two independent national samples of parents in 2014 and 2015 (N = 1804).
Parental support for all policy actions was high (at least 81%) and significantly increased from 2014 to 2015 for legal measures that would a) require state anti-bullying laws to add protections against weight-based bullying, and b) enact a federal anti-bullying law that includes weight-based bullying.
These findings can inform policy discourse about remedies for youth bullying, and suggest that parental support for improved legal protections against weight-based bullying is present, consistent, and strong.
Physical activity contributes to children's energy expenditure and prevents excess weight gain, but fluid replacement with sugar-sweetened beverages (SSBs) may diminish this benefit.
The aim of this study was to explore the net energy expenditure (EE) after physical education (PE) class given the competition between water and SSB consumption for rehydration and explore environmental factors that may influence the net EE, e.g. PE duration, affordability of SSB and students' SSB preference.
We built an agent-based model that simulates the behaviour of 13-year-old children in a PE class with nearby water fountains and SSB vending machines available.
A longer PE class contributed to greater prevalence of dehydration and required more time for rehydration. The energy cost of a PE class with activity intensity equivalent to 45 min of jogging is about 300 kcal on average, i.e. 10–15% of average 13-year-old children's total daily EE. Adding an SSB vending machine could offset PE energy expenditure by as much as 90 kcal per child, which was associated with PE duration, students' pocket money and SSB preference.
Sugar-sweetened beverage vending machines in school may offset some of the EE in PE classes. This could be avoided if water is the only readily available source for children's fluid replacement after class.
Body composition in early life influences the development of obesity during childhood and beyond. It is, therefore, important to adequately determine longitudinal body composition during the first months of life.
In 203 healthy term infants, we investigated longitudinal body composition, including fat mass percentage (FM%) and fat-free mass (FFM), by air-displacement plethysmography, at 1, 3 and 6 months of age and abdominal visceral fat and abdominal subcutaneous fat, by ultrasound, at 3 and 6 months.
We found a significant increase in FM% between 1 and 3 months but not between 3 and 6 months (p < 0.001, p = 0.098, respectively). Girls had higher FM% than boys at 1 and 6 months (p = 0.05, p < 0.001 respectively) and less FFM than boys at 1, 3 and 6 months (p = 0.02, p = 0.02, p < 0.001, respectively). There was a large variation in FM% at all ages even between infants with similar weight standard deviation scores. Visceral fat and abdominal subcutaneous fat did not change between 3 and 6 months. FM% was highly correlated with abdominal subcutaneous fat but not with visceral fat.
Changes in FM% occur mainly in the first 3 months of life, and FM%, visceral and abdominal subcutaneous fat do not change between 3 and 6 months, supporting the concept of a critical window for adiposity development in the first three months of life. In addition, our study provides longitudinal reference data of FM%, FFM, visceral fat and abdominal subcutaneous fat during the first 6 months of life.
This review highlights our current understanding of the role of gut microbiota in paediatric obesity and the potential role for dietary manipulation of the gut microbiota with prebiotics in managing paediatric obesity. The aetiology of obesity is multifactorial and is now known to include microbial dysbiosis in the gut. Prebiotics are non-digestible carbohydrates which selectively modulate the number and/or composition of gut microbes. The goal of prebiotic consumption is to restore symbiosis and thereby confer health benefits to the host. There is convincing evidence that prebiotics can reduce adiposity and improve metabolic health in preclinical rodent models. Furthermore, there are several clinical trials in adult humans highlighting metabolic and appetite-regulating benefits of prebiotics. In paediatric obesity, however, there are very limited data regarding the potential role of prebiotics as a dietary intervention for obesity management. As the prevalence of paediatric obesity and obesity-associated comorbidities increases globally, interventions that target the progression of obesity from an early age are essential in slowing the obesity epidemic. This review emphasizes the need for further research assessing the role of prebiotics, particularly as an intervention in effectively managing paediatric obesity.
Prader–Willi syndrome (PWS) is associated with hyperphagia and hyperghrelinemia with major morbidity because of obesity without effective medical treatment targeting hyperphagia. Exenatide (Byetta [synthetic Exendin-4]; AstraZeneca, Wilmington DE) is a GLP-1 receptor agonist which reduces appetite and weight and may be an effective treatment in PWS.
The objective of this study is to determine the effect of a 6-month trial of exenatide on appetite, weight and gut hormones in youth with PWS.
Ten overweight and obese subjects with PWS (13–25 years) were recruited for a 6-month open-label, non-randomized, longitudinal study conducted at Children's Hospital Los Angeles. Exenatide was given using standard diabetes dosing without dietary modifications. Weight, body mass index (BMI), truncal fat, appetite and plasma acylated ghrelin were measured over 6 months. Mixed meal tolerance tests were performed at 0 and 6 months.
Appetite scores significantly decreased from baseline (32.2 ± 8.7) after 1, 3 and 6 moths of treatment (27.5 ± 8.8, 25.4 ± 9.3, and 25.4 ± 7.2 respectively; p = 0.004). Hemoglobin A1c decreased significantly after treatment, but weight, BMI z-score and adiposity did not. There was no significant change in ghrelin.
This is the first longitudinal investigation of the effects of exenatide in subjects with PWS. It was effective in decreasing appetite, without change in weight or BMI in the short term. Larger, controlled, longer-term trials in patients with PWS are needed to confirm the efficacy and safety of exenatide and to evaluate whether its use might induce weight loss when given in conjunction with behavioural modification.
Latino children and youth have some of the highest rates of overweight and obesity. Early intervention is important to prevent future obesity and illness in this population.
A 3-year, multifaceted intervention was designed to reduce the rate of growth of body mass index (BMI) among Mexican-origin children. Two communities in California's agricultural Central Valley were targeted for intervention and comparison. To assess impact, anthropometric measures of participating children (N = 422) were collected and analysed at baseline and after 1 year of intervention.
After 1 year of intervention, triceps skin-fold thickness in girls showed a significant decrease in unadjusted analysis between children in the two communities. In multivariate analysis, a reduction in BMI growth was seen among obese boys in the intervention community (ß-coefficient = −1.94, P = 0.05). Obese boys in the intervention community also had a smaller increase in waist circumference (ß-coefficient = −5.2, P = 0.04) than the comparison community.
These early findings indicate the intervention's effectiveness for preventing BMI growth among obese boys. Longitudinal follow-up is needed to determine the sustainability of results and whether similar results extend to obese girls and overweight boys or girls.
Shorter telomeres have been associated with elevated risk for age-related diseases. However, little is known about the biomarker role of telomere length (TL) for predicting inflammation and glucose alterations.
The objective of this research is to evaluate the association between TL, inflammatory markers and glucose levels after a 2-month weight-loss programme in obese adolescents.
Telomere length was measured using a quantitative polymerase chain reaction in 66 obese adolescents aged 12–17 years (51% men) from the EVASYON programme. The adolescents were genotyped for the polymorphism -174G/C (rs1800795) in the IL-6gene, and anthropometric and biochemical markers as well as inflammatory cytokines were analysed.
Multiple-adjusted models showed that longer telomeres at baseline were associated with a higher reduction in glucose (B = −4.08, 95% confidence interval: −6.66 to −1.50) and IL-6 (B = −1.03, 95% confidence interval: −2.01 to −0.05) serum levels after 2 months of the weight-loss treatment. The -174G/C polymorphism modulated the association between basal TL and changes in IL-6 (P interaction = 0.029). Thus, subjects with the GG + GC genotype and with longer telomeres showed a higher decrease in IL-6 levels than CC homozygotes.
Longer telomeres are associated with an improvement in glucose tolerance and inflammation after a weight-loss programme in obese adolescents. Moreover, the -174G/C polymorphism may influence the relationship between TL and IL-6 changes.
Telomere length at birth is a major determinant of telomere length in late adulthood. However, the prenatal setting of telomere length is poorly understood. Individuals born large from non-diabetic mothers are at lower risk for later-life disorders than those born small, a feature of their longer health span being a higher lean mass that provides more muscle strength and that is already present in infancy.
At birth, we studied leukocyte telomere length (by quantitative polymerase chain reaction) in 103 small-for-gestational-age, appropriate-for-gestational-age or large-for-gestational-age (SGA, AGA or LGA) infants born after uncomplicated, term, singleton pregnancies. All infants were breastfed for ≥4 months. At 2 weeks and 12 months, body composition was assessed by dual X-ray absorptiometry.
Telomere lengths were shorter in SGA newborns and longer in LGA newborns than in AGA newborns (P < 0.001), also after adjustment for maternal age, pre-gestational body mass index, gestational weight gain and gestational age. Telomere length at birth associated (all P ≤ 0.001) to birthweight (r = 0.50) and to both lean mass (r = 0.43) and fat mass (r = 0.48) at age 2 weeks, but only to lean mass at 12 months (r = 0.51).
Higher weight and longer telomeres at birth are followed by more lean mass in late infancy. Relatively large, breastfed infants from non-diabetic mothers may become models of how to make a healthy start.
Laparoscopic Roux-en-Y gastric bypass (RYGB) causes changes in body composition and bone metabolism, yet little is known about effects in adolescents.
The objective of this study was to report dual-energy X-ray absorptiometry measures and serum bone markers, hypothesizing that bone turnover increases after surgery.
Inclusion criteria included the following: age 13–18 years and body mass index (BMI) >35 kg/m2. Seventy-two adolescents (22 boys; mean age 16.5 years; BMI 44.8 kg/m2) undergoing RYGB underwent dual-energy X-ray absorptiometry and serum bone marker analyses preoperatively and annually for 2 years.
Mean BMI reduction at 2 years was 15.1 kg/m2. Body composition changes included a reduction in fat mass (51.8% to 39.6%, p < 0.001) and relative increase in lean mass (47.0% to 58.1%, p < 0.001). In contrast to previous studies in adults, adolescent boys lost a greater percentage of their body fat than girls (−17.3% vs. −9.5%, p < 0.001). Individual bone mineral density Z-scores (BMD-Z) at baseline were within or above the normal range. The mean (SD) BMD-Z was 2.02 (1.2) at baseline, decreasing to 0.52 (1.19) at 2 years.
Higher concentrations of serum CTX (p < 0.001) and osteocalcin (p < 0.001) were observed in boys throughout the study period. Levels rose in the first year, before decreasing modestly in the second. Levels of serum markers of bone synthesis and resorption were higher in boys, whose skeletal maturity occurs later than girls'.
Differences in body fat and lean mass proportions were observed according to sex following RYGB. Bone turnover increased, and BMD decreased to levels approaching a norm for age. Long-term outcome will determine the clinical relevance.
Research on the types of interventions needed for population-level prevention of childhood obesity in complex societal systems can benefit from greater use of systems-science concepts and tools.
We report outcomes of a funding programme promoting incorporation of systems-science approaches into studies of imminent policy or environmental changes potentially impacting childhood obesity.
Seven funding cycles over 3 years yielded 172 initial submissions from 29 US states and 25 other countries were analyzed.
Submissions focused primarily on aspects of school or child-care settings, parks and recreational settings, or access to healthy food; about half reflected attention to systems perspectives.
Analysis of initial submissions as well as the 15 funded projects showed some success in motivating use of systems concepts and tools but suggested the need for a more focused effort to educate and prepare the childhood obesity prevention research community for this potentially crucial type of research.
Circulating microRNAs (miRNAs) may act as biomarkers of metabolic disturbances.
The aim of this study was to identify serum miRNAs signature of early insulin resistance in obese preschoolers.
Twelve obese children, aged 2–6 years, six insulin resistant (IR) and six controls were selected being age-matched, sex-matched and body mass index-matched. Profiling of 179 circulating miRNAs, known to be widely expressed in the bloodstream, was investigated by quantitative polymerase chain reaction at fasting and 120 min following a standard oral glucose tolerance test (OGTT).
Twenty-one miRNAs were differentially regulated in IR obese preschoolers. miR-200c-3p, miR-190a and miR-95 were differently regulated both at fasting and 120 min after the OGTT. In controls, the fold changes of some miRNAs were correlated with Δglucose0-120 (miR-660, miR-26b-5p and miR-22-3p: p = 0.005 for all) and Δinsulin0-120 (miR-660 and miR-22-3p: p = 0.02 for both and miR-423-5p: p = 0.042). In IR patients, miR-1 fold changes were correlated with Δglucose0-120 (r = −0.786; p = 0.036) and Δinsulin0-120 (r = −0.821; p = 0.023).
Our study identifies circulating miR-200c-3p, miR-190a and miR-95 as biomarkers of insulin resistance in obese preschoolers, being differentially regulated in IR patients both in fasting condition and after the OGTT. Expression of some circulating miRNAs seems reflecting glucose and insulin excursion following the OGTT differently in controls and IR obese preschoolers.
Taxing sugar-sweetened beverages (SSBs) has been proposed as a strategy to combat child obesity. Yet it is unclear how a tax on SSBs might influence the overall quality of diet in preschool children. Thus, we use simulated price increases and the 2010 Healthy Eating Index (HEI-2010) to explore the relationship between SSB taxes and diet quality in preschool children.
Price and purchase data from the 2009–2012 Nielsen Homescan Panel and a two-part marginal effects model were used to estimate relative changes in purchases with a 20% increase in the price of SSBs. Demand elasticities were applied to dietary intake data for children ages 2–5 years from the National Health and Nutrition Examination Survey (2009–2010 and 2011–2012) to estimate the impact of a 20% SSB tax on dietary intake and quality (HEI-2010).
A 20% increase in the price of SSBs was associated with lower total caloric intake (−28 kcal d−1, p < 0.01), caloric intake from juice drinks (−20 kcal d−1, p < 0.01), added sugars (−4.1 servings d−1, p = 0.03), refined grains (−0.63 servings d−1, p < 0.01) and total meat (−0.56 servings d−1, p < 0.01). Beneficial decreases in empty calories and refined grains were offset by unfavourable changes in fatty acid profile, total protein, vegetables and fruit, such that total HEI scores (0–100 range) were not meaningfully changed with a 20% increase in SSB price (difference: −0.85, p < 0.01).
A 20% tax on SSBs could decrease caloric intake, and intakes of added sugars and SSBs, but may not improve diet quality as an isolated intervention among US preschool children.
CPG, consumer-packaged goods; D, day; FPI, Food Price Index; FPL, federal poverty level; G, grams; HEI, Healthy Eating Index; kcal, kilocalories; RTE, ready-to-eat; SSBs, sugar-sweetened beverages; Y, year.
The prevalence of childhood obesity has been dramatically increasing in developing countries as it has been reported for developed nations. Identifying susceptibility genes in early life could provide the foundations for interventions in lifestyle to prevent obese children to become obese adults.
The objective of this study was to evaluate the influence of genetic variants related to obesity identified by genome-wide association studies (MC4R, TMEM18, KCTD15, SH2B1, SEC16B, BDNF, NEGR1, OLFM4 and HOXB5 genes) on anthropometric and dietary phenotypes in two Brazilian cohorts followed-up since birth.
There were 745 children examined at birth, after 1 year and after 3.5 years of follow-up. Ten single nucleotide polymorphisms were genotyped. Anthropometric and dietary parameters were compared among genotypes. Children were classified as overweight when body mass index Z-score was >+1.
Overweight prevalence was 30.7% at 3.5 years old. Significant associations were identified at 3.5 years old for TMEM18 rs6548238, NEGR1 rs2815752, BDNF rs10767664 and rs6265 (1 year old and 3.5 years old) with anthropometric phenotypes and at 3.5 years old for SEC16B rs10913469 with dietary parameters.
Our results indicate that genetic variants in/near these genes contribute to obesity susceptibility in childhood and highlight the age at which they begin to affect obesity-related phenotypes.
The objectives are to identify breakfast location patterns (frequency and place of breakfast consumption) and explore the association between breakfast patterns and weight status over time among preadolescents.
Surveys and physical measurements were completed among students from 12 randomly selected schools in a medium-sized urban school district. All students were followed from fifth (Fall, 2011) to seventh grade (Fall, 2013). Latent transition analysis and longitudinal analyses were used in the study.
Six distinct breakfast location patterns emerged at baseline (1) frequent skippers; (2) inconsistent school eaters; (3) inconsistent home eaters; (4) regular home eaters; (5) regular school eaters and (6) double breakfast eaters. Results from the longitudinal analyses revealed that there was an increased odds of overweight/obesity among frequent skippers compared with double breakfast eaters after adjusting for school, year and students' race/ethnicity (AOR: 2.66, 95% CI: 1.67, 4.24). Weight changes from year to year were similar between double breakfast eaters and other students.
Concerns that a second breakfast at school increases risk of excessive weight gain are unsupported. Students who regularly consumed breakfasts at school, including double breakfast eaters, were more likely to exhibit a healthy weight trajectory. Additional research is needed to understand the impact of universal school breakfast on students' overall diets.
Statements on childhood overweight and obesity (COO) have focused on different avenues for prevention and treatment, critical stages of the life cycle, including pregnancy and lactation, individual, family, school and community-based interventions, multidisciplinary family programmes and multicomponent interventions. This commentary is concerned with the less-addressed relationship between COO and inequality. It describes current global patterns of inequality and COO and the ways in which those inequalities are linked to COO at micro-level, meso-level and macro-level. It then describes current programmatic approaches for COO inequality, preventive and medical, and considers important pitfalls in the framing of the problem of COO and inequality. It ends with describing how childhood and adolescent overweight and obesity prevention and treatment programmes might be formulated within broader socio-political frameworks to influence outcomes.
Maternal obesity, excessive gestational weight gain (EGWG), gestational diabetes mellitus (GDM) and breastfeeding are four important factors associated with childhood obesity.
The objective of the study was to assess the interplay among these four factors and their independent contributions to childhood overweight in a cohort with standard clinical care.
The cohort included 15 710 mother–offspring pairs delivered in 2011. Logistic regression was used to assess associations between maternal exposures and childhood overweight (body mass index >85th percentile) at age 2 years.
Mothers with pre-pregnancy obesity or overweight were more likely to have EGWG, GDM and less likely to breastfeed ≥6 months. Mothers with GDM had 40–49% lower EGWG rates and similar breastfeeding rates compared with mothers without GDM. Analysis adjusted for exposures and covariates revealed an adjusted odds ratio (95% confidence interval) associated with childhood overweight at age 2 years of 2.34 (2.09–2.62), 1.50 (1.34–1.68), 1.23 (1.12–1.35), 0.95 (0.83–1.10) and 0.76 (0.69–0.83) for maternal obesity, overweight, EGWG, GDM and breastfeeding ≥6 months vs. <6 months, respectively.
In this large clinical cohort, GDM was not associated with, but maternal pre-pregnancy obesity or overweight and EGWG were independently associated with an increased risk, and breastfeeding ≥6 months was associated with a decreased risk of childhood overweight at age 2 years.
Early postnatal antibiotic use has been shown to promote excess weight gain, but it is unclear whether intrauterine exposure to antibiotics is associated with foetal growth and adiposity. The objective of this study was to examine associations of antibiotic prescription in each trimester of pregnancy with foetal size and adipokine levels at birth.
In 2128 pregnant women from the pre-birth Project Viva cohort, from electronic medical records, we estimated antibiotic prescribing by timing during pregnancy. Outcomes were sex-specific birth weight-for-gestational-age z-score (BW/GA-z) and levels of umbilical cord leptin and adiponectin. We used linear regression models adjusted for maternal age, pre-pregnancy body mass index, parity, race/ethnicity, education, smoking during pregnancy, household income and child sex and additionally adjusted cord blood leptin and adiponectin models for gestation length.
Of the 2128 women in our sample, 643 (30.2%) were prescribed with oral antibiotics during pregnancy. Mean (standard deviation) BW/GA-z was 0.17 (0.97), cord blood leptin was 9.0 ng mL−1 (6.6) and cord blood adiponectin was 28.8 ng mL−1 (6.8). Overall, antibiotic prescription in pregnancy was associated with lower BW/GA-z [multivariable adjusted β −0.11; 95% confidence interval {CI} −0.20, −0.01]. In trimester-specific analyses, only second trimester antibiotic prescription was associated with lower BW/GA-z (β −0.23; 95% CI −0.37, −0.08). Overall, antibiotic prescription in pregnancy was not associated with cord blood leptin or adiponectin levels. However, in trimester-specific analyses, third trimester antibiotic prescription was associated with higher cord blood leptin (β 2.28 ng mL−1; 95% CI 0.38, 4.17).
Antibiotics in mid-pregnancy were associated with lower birth weight for gestational age, whereas third trimester antibiotics were associated with higher cord blood leptin.
The aim of this paper is to test whether α-defensins and bacterial/permeability-increasing protein were related to obesity and cardiovascular risk factors in prepubertal children.
Plasma α-defensins and bacterial/permeability-increasing protein, body mass index (BMI), waist circumference, systolic blood pressure (SBP), carotid intima media thickness (cIMT), HOMA-IR and HMW-adiponectin were assessed.
In a cross-sectional study (N = 250), higher α-defensins concentrations were positively associated with BMI, waist, SBP, cIMT, HOMA-IR and negative correlated with HMW-adiponectin (all between r = 0.191 and r = 0.377, p ≤ 0.01 and p ≤ 0.0001). Conversely, plasma bacterial/permeability-increasing protein concentrations presented inversed associated with the same parameters (all between r = −0.124 and r = −0.329; p ≤ 0.05 and p ≤ 0.0001). In a longitudinal study (N = 91), α-defensins at age 7 were associated with BMI (β = 0.189, p = 0.002; model R2 = 0.847) and waist (β = 0.241, pthinsp;= 0.001; model R2 = 0.754) at age 10.
α-Defensins and bacterial/permeability-increasing protein may be the markers of childhood obesity. Increased concentrations of α-defensins may predict BMI and abdominal fat deposition in children.
Maternal symptoms of depression are related to suboptimal parenting practices and child well-being; women with elevated symptoms tend to be less responsive to their children.
The objective is to explore how maternal depressive symptomatology is related to childhood obesity-promoting parenting behaviours, and whether depressive symptomatology moderates the association between perceived child negativity and the use of food to soothe among low-income mothers.
There is a cross-sectional sample of 60 mothers and their formula fed infants/toddlers participating in the Special Supplemental Woman, Infants and Children Program. Measures included the Infant Behaviors Questionnaire, Baby's Basic Needs Questionnaire, the feeding problem assessment form and Center for Epidemiological Studies Depression Scale.
Depressive symptoms exceeded the clinical screening cut-off for 38% of women. Mothers with depressive symptoms perceived their child to be more negative and were more likely to use food to soothe, add cereal to the bottle and put baby to bed with bottle than mothers without depressive symptoms. Generalized linear models revealed that child negativity was associated with greater use of food to soothe but that this effect was moderated by maternal depression: negativity was positively associated with food to soothe among non-depressed but not depressed mothers.
A high proportion of low-income mothers reported elevated depressive symptoms; depressive symptomatology was positively associated with perceived child negativity and greater reported use of controlling feeding practices. Screening for maternal depressive symptoms may help in providing more individually tailored counselling on responsive feeding.
Structured exergaming with prescribed moderate intensity physical activity has reduced adiposity among adolescents. The extent to which adolescents reduce adiposity when allowed to self-select intensity level is not known.
The objective of the study was to examine the influence of exergaming on adolescent girls' body composition and cardiovascular risk factors.
This randomized controlled trial assigned 41 overweight and obese girls aged 14 to 18 years to group-based dance exergaming (36 h over 3 months) or to a self-directed care control condition. Body size and composition were measured by anthropometry, dual-energy X-ray absorptiometry [%fat and bone mineral density {BMD}] and magnetic resonance imaging. Cardiovascular risk factors included blood pressure, cholesterol, triglycerides, glucose and insulin.
Attrition was 5%. Using analysis of covariance controlling for baseline value, age and race, there were no significant condition differences. Per protocol (attended >75%), the intervention group significantly decreased abdominal subcutaneous adiposity and increased trunk and spine BMD (ps < 0.05). Per protocol (>2600 steps/session), the intervention group significantly decreased leg %fat and decreased abdominal subcutaneous and total adiposity (ps < 0.05).
Exergaming reduced body fat and increased BMD among those adolescent girls who adhered. Further research is required before exergaming is recommended in clinical settings.
In recent decades, there has been an increase in the prevalence of childhood overweight in most high-income countries. Within northern Europe, prevalence tends to be higher in the UK compared with the Scandinavian countries. We aimed to study differences in body mass index (BMI) trajectories between large cohorts of children from UK and Scandinavian populations.
We compared BMI trajectories in participants from the English Avon Longitudinal Study of Parents and Children born in 1991–1993 (ALSPAC) (N = 6517), the Northern Finland Birth Cohorts born in 1966 (NFBC1966) (N = 3321) and 1986 (NFBC1986) (N = 4764), and the Danish Aarhus Birth Cohort born in 1990–1992 (ABC) (N = 1920). We used multilevel models to estimate BMI trajectories from 2 to 18 years. We explored whether cohort differences were explained by maternal BMI, height, education or smoking during pregnancy and whether differences were attributable to changes in the degree of skew in the BMI distribution.
Differences in mean BMI between the cohorts were small but emerged early and persisted in most cases across childhood. Girls in ALSPAC had a higher BMI than all other cohorts throughout childhood, e.g. compared with the NFBC1986 BMI was 2.2–3.5% higher. For boys, the difference emerging over time (comparing the two NFBC's) exceeded the differences across populations (comparing NFBC1986, ABC and ALSPAC). BMI distribution demonstrated increasing right skew with age.
Population-level differences between cohorts were small, tended to emerge very early, persisted across childhood, and demonstrated an increase in the right-hand tail of the BMI distribution.
The effects of regular physical activity on energy intake in obese adolescents are unknown.
The objective is to determine how physical activity interventions affect energy and macronutrient intake in overweight/obese youth.
Databases were searched from December 2014 to December 2015 for studies that measured energy and/or macronutrient consumption in response to physical activity intervention in overweight/obese youth.
The review comprises primary source articles published in English in peer-reviewed journals. Articles that presented data on energy and/or macronutrient intake before and after a physical activity intervention (without dietary restriction) in overweight or obese children and teenagers (up to 18 years old) were included. Of the initial 307 references found, nine were included.
The nine included studies analysed the effect of 15 different physical activity interventions. Nine showed a decrease and six unchanged energy intakes. The effect size for total energy intake ranged from −2.108 to −0.207 (n = 14). Results of the meta-analysis revealed a mean effect of physical intervention to reduce intake of −1.003 (95% confidence interval = −1.261 to −0.745, p < 0.001). Results for heterogeneity among these studies were I2 = 67.421; Q = 39.903; df = 13, p < 0.001. The mean energy intake reduction was −323 ± 286 kcal. Macronutrient intake was assessed in 11 interventions. Protein intake was found decreased in five (reduction of −26.8 ± 19.2 g), seven reported fat decrease (reduction of −26.4 ± 17.8 g) and five a decrease in CHO (reduction of −72.5 ± 22.8 g). The meta-analysis revealed significant decreases of each macronutrient (p < 0.001).
Structured physical activity interventions favour decreased daily energy intake in obese adolescents.
Obesity is associated with cardiometabolic disturbances, which may have significant implications for musculoskeletal health and exercise tolerance.
We sought to determine the association between muscle structure, function, and metabolism in adolescents across the weight spectrum.
This cross-sectional case–control study included overweight and obese participants (n = 24) 8–18 years of age with a body mass index (BMI) ≥ 85th percentile for age and gender, and non-obese participants (n = 24) with a BMI < 85th percentile. Body composition, physical activity, peak aerobic capacity, cardiometabolic blood markers and insulin resistance (measured by the homeostatic model assessment of insulin resistance, HOMA-IR), skeletal muscle mitochondrial oxidative capacity (via 31Phosphorous-Magnetic Resonance Spectroscopy, 31P-MRS, to assess phosphocreatine (PCr) recovery after exercise), and extramyocellular and intramyocellular lipid (IMCL) levels (via 1Hydrogen-MRS) were assessed. Stepwise regression was performed to examine the factors associated with oxidative capacity.
bese and overweight patients had similar age, height, and physical activity to non-obese controls, but obese and overweight participants exhibited higher insulin resistance. Obese and overweight participants had longer PCr recovery than non-obese controls following 5x30s of moderate-intensity exercise (51.2 ± 20.1 s vs. 23.9 ± 7.5 s, p = 0.004). In univariate correlation analysis, impaired PCr recovery was associated with a higher BMI z-score (rs = 0.51, p < 0.001), circulating triglycerides (rs = 0.41, p = 0.005), and HOMA-IR (rs = 0.46, p = 0.001). In stepwise multivariate regression analysis, impaired PCr recovery was associated with a higher BMI z-score (β = 0.47, p = 0.002), but not insulin resistance (β = 0.07, p = 0.07) or circulating triglycerides (β = 0.16 p = 0.33).
A slower phosphocreatine recovery following aerobic exercise is strongly associated with increasing adiposity. A slower metabolic recovery following aerobic exercise stress suggests that endurance exercise training in obese adolescents may be an optimal strategy to target exercise intolerance in this cohort.
The Healthy Weight Research Network (HWRN) for children with autism and developmental disabilities is an interdisciplinary network with national representation. This paper discusses the modified Delphi procedure that was used to develop the HWRN's research agenda to address the problem of obesity in children with autism and developmental disabilities. The five research areas identified for priority included: (i) family practices around food/mealtimes; (ii) physical activity and sedentary behaviours in relation to weight; (iii) relationship between food patterns, behaviour and weight gain; (iv) programme-adaption and delivery; and (v) influence of school and community-based organizations on food intake and physical activity. The goals and agenda of the HWRN hold promise for making progress toward the prevention and successful treatment of obesity in this population.
Both parents' and children's perception of children's weight status may be important predictors of slimming and energy-balance related behaviours, independent of children's actual weight status.
We examined the cross-sectional association of children's self-reported slimming and energy-balance related behaviours with children's (i) actual, (ii) self-perceived and (iii) parent-perceived weight status.
Data of 10- to 12-year-old European children and their parents were used. Multilevel logistic and linear regression analyses were performed, adjusting for age, gender, parental weight controlling behaviours, education, marital status and ethnicity.
Independent of their actual weight status, a higher proportion of children reported slimming when they or their parents perceived them as too fat. Children's self-perceived weight status was more strongly associated with slimming than their parents' perception or their actual weight status. Moreover, children who perceive themselves as overweight reported less physical activity and more screen time. Children whose parents perceive them as overweight reported less physical activity.
Children's own perception of their weight status appears to be more important for their self-reported slimming than their actual or their parent's perceptions of their weight status. Additionally, children's self-perceived weight status seems important in engaging more physical activity and reduces screen time.
Variation in the existing literature on the psychosocial benefits of weight loss in obese youth results, in part, from methodological limitations and modest weight loss. Accordingly, this research assessed perceived self-competence and low self-esteem during an intensive weight loss programme in a large sample of obese youth and related these to starting weight, gender and weight loss.
Over 4 years, 303 obese male and female adolescents (body mass index [BMI] 34.3 kg m−2, BMI standard deviation score 2.99; 14.7 years) attended a residential weight loss camp for a mean duration of 31 d. Outcome variables included dimensional self-esteem (Harter) and weight change over the camp.
At the start of camp, obese youth scored highest on social acceptance and lowest on physical appearance and athletic competence. Global self-worth and most domains of self-competence improved significantly over the intervention. The proportion with low global self-worth reduced from 35% to 16%, but there was little change in the proportion reporting high self-competence (23%). Mean weight loss was −5.5 kg (BMI standard deviation scores −0.25) with boys and those heaviest at the start losing most. Weight loss was significantly correlated with improved physical appearance (r = 0.13) and athletic competence (r = 0.19), but not global self-worth.
This intensive weight loss intervention yielded significant psychological benefit, especially in self-competence and among individuals achieving most weight loss. The weak association with weight loss suggests the influence of other contributing environmental or social features that should be the focus of further research.
Socioeconomic status has been associated with obesity in children and adolescents. This association may be dependent according with where adolescents lives.
The aim of this study was to evaluate the association between different socioeconomic indicators such as parental education and occupation and socioeconomic status with abdominal obesity in adolescents from two observational studies: the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional study (HELENA-CSS) and the Brazilian Cardiovascular Adolescent Health (BRACAH) study.
European (n = 3192, aged 12.5–17.5 years, with 53.1% girls from HELENA-CSS) and Brazilian (n = 991, aged 14–18 years, with 54.5% girls from BRACAH study) adolescents from two cross-sectional studies were included in this analysis. Complete data on waist circumference (WC), height, socioeconomic status indicators and several confounders were collected. Socioeconomic indicators were measured using a self-reported questionnaire in order to assess the family social status of the adolescents. Multilevel linear regression models were used to examine associations, and results were adjusted for potential confounders.
Adjusted results showed inverse associations between mother's and father's education levels (p < 0.001) and father's occupation level (p < 0.001) with waist-to-height ratio (WHtR) and WC in HELENA-CSS girls. Similarly in European girls, socioeconomic indicators by socioeconomic status and maternal occupation level were associated with WHtR. In HELENA-CSS boys, the same significant association was found between WHtR and WC with maternal occupation level. Moreover, in European boys WHtR was also associated with parental education. In Brazilian adolescents, both indicators of abdominal obesity did not remain associated with the independents variables, after adjustment for potential confounders.
Abdominal obesity was associated with socioeconomic indicators in higher-income countries, but this association was not observed in a lower-middle-income country.
Childhood and adolescent obesity may lead to obesity and related complications in adulthood. Biomarkers of obesity can be useful for screening for obesity complications and promoting early intervention during school age. Thus, the metabolomic differences in obese children and adolescents should be investigated for identification of potential biomarkers.
We investigated urinary biomarkers to distinguish metabolomic characteristics between obesity and normal weight in adolescents.
Adolescent subjects were divided into non-obese (n = 91) and obese (n = 93) groups according to body mass index. Untargeted and targeted metabolomic profiling of urine was performed using high-performance liquid chromatography (LC)-quadrupole time-of-flight mass spectrometry (MS), LC-MS/MS and flow injection analysis-MS/MS systems, respectively.
Multivariate statistical analysis showed clear discrimination between the untargeted metabolomes of non-obese and obese groups. Seven endogenous metabolites were distinguished in the obese group, and inflammation-related metabolite markers showed strong predictive power for group classification. From targeted metabolomics, 45 metabolites mostly related to inflammation were significantly different in the obese group.
Significantly different metabolome signatures were identified between normal-weight and obese adolescents. Combined untargeted and targeted metabolomics demonstrated that inflammation-driven insulin resistance, ammonia toxicity and oxidative stress may represent crucial metabolomic signatures in obese adolescents.
In adults, obesity is associated with abnormalities of thyroid function; there are fewer studies in paediatric cohorts.
To examine associations of weight and adiposity with indices of thyroid function and thyroid-related metabolic factors in children.
A sample of 1203 children without obesity (body mass index [BMI] < 95th percentile; N = 631) and with obesity (BMI ≥ 95th percentile; N = 572), age 5–18 years, had height and weight measured (to calculate BMI-Z score for age and sex) and had blood collected in the morning for thyroid-stimulating hormone (TSH), free thyroxine (FT4) and leptin. A subset (N = 829) also underwent measurement of fat mass by dual-energy X-ray absorptiometry. Analyses examined associations of TSH and FT4 with adiposity and obesity-related conditions accounting for sociodemographic factors.
Thyroid-stimulating hormone was positively related to BMIz and fat mass (both p-values < 0.001). FT4 was negatively related to BMIz and fat mass (both p-values < 0.001). TSH was positively correlated to leptin (p = 0.001) even after accounting for fat mass.
Paediatric obesity is associated with higher TSH and lower FT4 concentrations and with a greater prevalence of abnormally high TSH. Leptin concentrations may in part explain obesity's effects on thyroid status, perhaps through leptin's effects on TSH secretion.
This paper aims to assess association between breastfeeding and maternal immigration background and body mass index development trajectories from age 2 to 16 years.
A cohort of children born in Stockholm during 1994 to 1996 was followed from age 2 to 16 years with repeated measurement of height and weight at eight time points (n = 2278). Children were categorized into groups by breastfeeding status during the first 6 months of life and maternal immigration background. Body mass index (BMI) trajectories and age at adiposity rebound were estimated using mixed-effects linear models.
Body mass index trajectories were different by breastfeeding and maternal immigration status (P-value < 0.0001). Compared with exclusively breastfed counterparts, never/short breastfed children of Swedish mothers had a higher BMI trajectory, whereas never/short breastfed children of immigrant mothers followed a lower BMI trajectory. Ages at adiposity rebound were earlier for higher BMI trajectories regardless of maternal immigration background.
Differences in BMI trajectories between offspring of immigrant and of Swedish mothers suggest a lack of beneficial association between breastfeeding and long-term BMI development among children of immigrant mothers. Given the relation between long-term BMI development and risk of overweight/obesity, these differences challenge the notion that exclusive breastfeeding is always beneficial for children's BMI development and subsequent risk of overweight/obesity.
Background: Many programmes for children that involve gardening and nutrition components exist; however, none include experimental designs allowing more rigorous evaluation of their impact on obesity.
Objectives: The objective of this study is to explore the effects of a novel 12-week gardening, nutrition and cooking intervention {'LA Sprouts'} on dietary intake, obesity parameters and metabolic disease risk among low-income, primarily Hispanic/Latino youth in Los Angeles..
Methods: This study used a randomized control trial involving four elementary schools [two randomized to intervention {172, 3rd–5th grade students}; two randomized to control {147, 3rd–5th grade students}]. Classes were taught in 90-min sessions once per week for 12 weeks. Data collected at pre-intervention and post-intervention included dietary intake via food frequency questionnaire, anthropometric measures {body mass index, waist circumference}, body fat, and fasting blood samples.
Results: LA Sprouts participants compared with controls had significantly greater reductions in body mass index z-scores {−0.1 vs. −0.04, respectively; p = 0.01} and waist circumference {−1.2 vs. 0.1 cm; p < 0.001}. Fewer LA Sprouts participants had the metabolic syndrome after the intervention than before, while controls with metabolic syndrome increased. LA Sprouts participants compared with controls increased dietary fiber intake {+3.4% vs. −16.5%; p = 0.04}. All participants decreased vegetable intake, but decreases were less in LA Sprouts than controls {−3.7% vs. −26.1%; p = 0.04}. Change in fruit intake did not differ between LA Sprouts and controls.
Conclusions: LA Sprouts was effective in reducing obesity and metabolic risk; however, additional larger and longer-term studies are warranted.
Low levels of energy expenditure (TEE) may contribute to excess weight during childhood, but limited longitudinal data exist.
This is to test whether low TEE during the first 6 years of life could predict excess weight status at 8 years.
Total energy expenditure from doubly labelled water, weight, stature, waist circumference and fat mass and fat-free mass (FFM) in children at 0.25, 2, 4 and 6 years of age. This cohort includes individuals at high (n = 27) and low risk (n = 26) for childhood obesity, based upon whether pre-pregnant maternal obesity. A linear mixed effects model was fit to TEE. Individual variation was accounted for as a random effect. Residual TEE was calculated for age and individually averaged across time.
Fat-free mass (kg) was highly correlated (R2 = 0.91) with TEE (kcal/day), and waist circumference and sex were also significant predictors of TEE. TEE residual tracked within individuals. TEE residuals did not correlate with either BMI or %fat at age 8 years.
Using the residual TEE approach to identify high and low TEE during the first 6 years of life did not explain excess weight at 8 years of life in this cohort of children at high and low risk of obesity based upon maternal obesity status.
Increased consumption of sweetened beverages has previously been linked to the degree of childhood obesity.
The aim of the present study was to assess whether the intake of sweetened beverages, candy, snacks or fast food at baseline in a multidisciplinary childhood obesity treatment program was associated with the baseline degree of obesity or the treatment effect.
This prospective study included 1349 overweight and obese children (body mass index standard deviation scores (BMI SDS) ≥ 1.64) enrolled in treatment at The Children's Obesity Clinic, Copenhagen University Hospital Holbæk. The children were evaluated at baseline and after up to 5.9 years of treatment (median 1.3 years).
Both boys and girls decreased their BMI SDS during treatment with a mean decrease in boys of 0.35 (p < 0.0001) and in girls of 0.22 (p < 0.0001) after 1 year of treatment. There were no associations between the baseline intake of sweetened beverages, candy, snacks, and/or fast food and BMI SDS at baseline or the change in BMI SDS during treatment.
The intake of sweetened beverages, candy, snacks or fast food when entering a childhood obesity treatment program was not associated with the degree of obesity at baseline or the degree of weight loss during treatment.
Overt or subclinical hypothyroidism is a common finding in adult populations affected by non-alcoholic fatty liver disease (NAFLD). Currently, there are only sparse data available on the association of thyroid dysfunction and NAFLD in obese children and adolescents.
The study aims to investigate the association of thyroid function test values with NAFLD and metabolic risk factors in a population of obese children and adolescents.
A total of 332 overweight and obese children and adolescents (170 girls) aged between 10 and 19 years were analysed. Subjects underwent ultrasound examination of the liver. Thyroid function was evaluated by laboratory determination of thyroid-stimulating hormone (TSH), total triiodothyronine (T3) and total thyroxine levels. All included subjects were either euthyroid or had subclinical hypothyroidism (TSH > 4 μU mL−1, normal thyroxine). Further metabolic profiling included the determination of lipid status, insulin and liver function tests. Anthropometric parameters body mass index, waist and hip circumference were documented.
The prevalence of hepatic steatosis was 29.8%. Subjects with NAFLD had significantly higher TSH levels than those without (p = 0.0007). After dividing TSH values into quartiles, both univariate and multivariate analyses (adjusted for age, body mass index–standard deviation scores and stage of puberty) showed a significant association with hepatic steatosis (p < 0.05).
Taking possible variables into consideration, our results show that there is a significant association between hepatic steatosis and the TSH levels in obese children and adolescents. Mild thyroid dysfunction may therefore have a role in determining an unfavourable metabolic profile in obese children and adolescents.
In the USA, half of children are regularly cared for before or after school by someone other than a parent.
Describe the relationship between childcare arrangements and obesity among school-aged children.
Data are from the fifth-grade wave of the Early Childhood Longitudinal Study – Kindergarten Cohort 1998–1999, a nationally representative study of US children who were in kindergarten in 1998–1999 or first grade in 1999, collected in spring 2004 (analytic sample = 9617). We estimated survey-adjusted logistic regression models to examine the association between childcare arrangements before and after school and obesity.
The prevalence of obesity was highest among fifth graders who received care from multiple sources and lowest among children who received care from adults not related to them in either the child's or the caregiver's home [29.9%, 95% confidence interval {CI}: 18.7%, 44.3%; and 17.3%, 95% CI: 12.1%, 24.0%]. Childcare arrangement was not an independent risk factor for obesity for most children. However, Hispanic children who were cared for by a person who was not a relative had significantly higher odds of obesity compared with non-Hispanics in similar care arrangements (odds ratio: 5.11, 95% CI: 2.00, 13.06).
Type of childcare before or after school was not an independent risk factor for obesity in most fifth graders, but implications of childcare for Hispanic children should be explored further.
Prenatal exposure to traffic pollution has been associated with faster infant weight gain, but implications for cardiometabolic health in later childhood are unknown.
Among 1418 children in Project Viva, a Boston-area pre-birth cohort, we assessed anthropometric and biochemical parameters of cardiometabolic health in early (median age 3.3 years) and mid- (median age 7.7 years) childhood. We used spatiotemporal models to estimate prenatal and early life residential PM2.5 and black carbon exposure as well as traffic density and roadway proximity. We performed linear regression analyses adjusted for sociodemographics.
Children whose mothers lived close to a major roadway at the time of delivery had higher markers of adverse cardiometabolic risk in early and mid-childhood. For example, total fat mass was 2.1 kg (95%CI: 0.8, 3.5) higher in mid-childhood for children of mothers who lived <50 m vs. ≥200 m from a major roadway. Black carbon exposure and traffic density were generally not associated with cardiometabolic parameters, and PM2.5 exposure during the year prior was paradoxically associated with improved cardiometabolic profile.
Infants whose mothers lived close to a major roadway at the time of delivery may be at later risk for adverse cardiometabolic health.
Investigations on sugar-sweetened beverage (SSB) intake and cardiometabolic risks among Asians are scant.
This study aimed to examine associations between SSB intake and cardiometabolic risks among Malaysian adolescents.
Anthropometric data, blood pressure (BP), fasting blood glucose (FBG), lipid profiles and insulin levels measured involved 873 adolescents (aged 13 years). SSB intake, dietary patterns and physical activity level (PAL) were self-reported.
Mean SSB consumption was 177.5 mL day−1 with significant differences among ethnicities (Malay, Chinese, Indians and Others) (p < 0.05). SSB intake was deleteriously associated with increased waist circumference, elevated triglycerides, FBG, insulin, insulin resistance and low HDL-cholesterol, independent of PAL, body mass index and dietary patterns. Significant U-shaped and inverse trends were noted between SSB intake and LDL-cholesterol and BP, respectively.
Sugar-sweetened beverage intake was unfavourably associated with cardiometabolic health outcomes among young adolescents. Concerted efforts towards healthy hydration are imperative to mitigate risk of cardiometabolic events.
The impact of vitamin D status on body composition is not well understood.
Evaluate how vitamin D supplementation in infancy affects body composition at 3 years of age.
Double-blind randomized trial of 132, 1-month-old healthy, breastfed infants randomly assigned to receive oral vitamin D3 supplements of 400, 800, 1200 or 1600 IU d−1 for 11 months. In the present analysis, 87 (66%) returned at 3 years of age. Body composition was measured using dual-energy x-ray absorptiometry and plasma 25-hydroxyvitamin D [25(OH)D] concentrations by liquid chromatography tandem mass spectrometry.
Anthropometry, body composition, diet, activity and demographics were similar across dosage groups at 3 years. Mean 25(OH)D concentration from 1 month to 3 years was higher (P < 0.001) in the 1200 IU group than 800 and 400 IU groups. Children with 25(OH)D concentrations above 75 nmol L−1 had lower fat mass (~450 g; P = 0.049). In multiple linear regression, mean 25(OH)D was associated with lean mass percent (β = 0.06; CI: 0.00, 0.12; P = 0.042), fat mass (β = −11.29; CI: −22.06, −0.52; P = 0.048) and body fat percent (β = −0.06; CI: −0.12, −0.01; P = 0.045).
Higher vitamin D status from infancy through to 3 years of age associates with leaner body composition.
Macrophages are known to be involved in low-grade inflammatory processes such as obesity. soluble cluster of differentiation 163 (sCD163) is shed from the cell surface as specific macrophage activation marker. In prepubertal children, we studied if circulating sCD163 is associated with metabolic and cardiovascular risk markers.
A population of 236 school-aged Caucasian children (111 girls and 125 boys) aged 8 ± 1 year [81 normal weight (body mass index [BMI]-SDS < 1); 74 overweight (1 ≤ BMI-standard deviation score [SDS] < 2) and 81 with obesity (BMI-SDS ≥ 2)] were studied. BMI, waist circumference, fat mass and visceral fat were measured. Fasting serum sCD163, homeostatic model assessment of insulin resistance, high sensitivity C-reactive protein, gamma-glutamyl transpeptidase and lipids were quantified.
Circulating sCD163 concentrations were higher in children with obesity (p < 0.0001). Associations were observed between circulating sCD163 and a less favourable metabolic profile as judged by higher waist circumference, fat mass, visceral fat, epicardial fat, homeostatic model assessment of insulin resistance, high sensitivity C-reactive protein, gamma-glutamyl transpeptidase and triglycerides (all between r = 0.173 and r = 0.363; p < 0.05 to p < 0.0001) and lower high-density lipoprotein-cholesterol (r = −0.285, p < 0.0001). In multiple regression analyses, circulating sCD163 was independently associated with HOMA-IR (β = 0.162, p = 0.016; model R2 = 0.179) and high density lipoprotein-cholesterol/triglycerides ratio (β = −0.167, p = 0.012; model R2 = 0.209).
Childhood obesity may increase the risk of developing metabolic diseases later in life through chronic macrophage activation having deleterious effects on metabolism.
Breakfast consumption has been associated with reduced risk of overweight and obesity among children, but previous evidence reviews fail to confirm a causal relationship.
To review recent literature on breakfast consumption and adiposity among children and discuss potential underlying mechanisms.
A comprehensive literature search of studies published since the 2010 US National Evidence Library review (January 2010–January 2015) was conducted.
Twelve studies met inclusion criteria. All were conducted in industrialized countries: six in Europe, four in the USA, one in China and one in Australia. Ten of the studies used observational longitudinal designs, with follow-up periods ranging from 1 to 27 years (median: 3, mean: 7.4); of these, eight reported inverse associations between breakfast consumption and excess adiposity, while two found no association. The other studies (1 case-control, 1 experimental) each reported a protective effect of breakfast consumption on overweight and obesity among children.
Findings corroborate results from previous reviews, adding support for a possible, protective role for breakfast consumption in preventing excess adiposity during childhood and adolescence. However, drawing a causal conclusion from the collective evidence is curtailed by methodological limitations and inconsistencies, including study design, follow-up duration and frequency, exposure and outcome assessment, as well as limited consideration of confounding, mediating and effect-modifying variables. More rigorous study designs employing valid and standardized measurement of relevant variables are needed.
Obese adults have a higher risk of obstructive sleep apnoea (OSA); however, the relationship between childhood obesity and adult OSA risk is unclear.
This study aimed to examine overweight/obesity (OW) in childhood and risk of OSA in middle age.
Childhood OW status was classified as never OW, weight cycling, persistent OW and incident OW. After 35 years of follow-up, high risk for OSA was determined by a positive score in ≥2 domains on the Berlin Questionnaire with obesity removed from scoring.
At initial assessment, mean (SD) age was 9.9 (2.9) years, and 23.9% were OW. Overall, 25.7% had scores indicating a high risk for OSA. Compared with participants who were never OW, those with persistent OW and incident OW were 1.36 (95%CI: 1.04–1.77) and 1.47 (1.11–1.96) times more likely to be high risk for OSA, after adjustment for multiple risk factors and adult OW status. Participants with an OW duration of 1–4 years, 5–8 years, and 8+ years were 0.96 (0.44–2.09), 1.20 (0.70–2.04) and 1.52 (1.22–1.90) times more likely to be high risk for OSA compared with those who were never OW (P for trend: 0.0002).
These results suggest that childhood OW is associated with a high risk of OSA in middle age.
Epigenetic mechanisms may be involved in obesity onset and its consequences. The aim of the present study was to evaluate whether DNA methylation status in microRNA (miRNA) coding regions is associated with childhood obesity.
DNA isolated from white blood cells of 24 children (identification sample: 12 obese and 12 non-obese) from the Grupo Navarro de Obesidad Infantil study was hybridized in a 450 K methylation microarray. Several CpGs whose DNA methylation levels were statistically different between obese and non-obese were validated by MassArray® in 95 children (validation sample) from the same study.
Microarray analysis identified 16 differentially methylated CpGs between both groups (6 hypermethylated and 10 hypomethylated). DNA methylation levels in miR-1203, miR-412 and miR-216A coding regions significantly correlated with body mass index standard deviation score (BMI-SDS) and explained up to 40% of the variation of BMI-SDS. The network analysis identified 19 well-defined obesity-relevant biological pathways from the KEGG database. MassArray® validation identified three regions located in or near miR-1203, miR-412 and miR-216A coding regions differentially methylated between obese and non-obese children.
The current work identified three CpG sites located in coding regions of three miRNAs (miR-1203, miR-412 and miR-216A) that were differentially methylated between obese and non-obese children, suggesting a role of miRNA epigenetic regulation in childhood obesity.
Animal models have suggested that maternal diet quality may reduce offspring obesity risk regardless of maternal body weight; however, evidence from human studies is scarce.
The aim of this study was to evaluate associations between adherence to the Mediterranean diet (MD) during pregnancy and childhood overweight and abdominal obesity risk at 4 years of age.
We analysed 1827 mother–child pairs from the Spanish 'Infancia y Medio Ambiente' cohort study, recruited between 2003 and 2008. Diet was assessed during pregnancy using a food frequency questionnaire and MD adherence by the relative Mediterranean diet score (rMED). Overweight (including obesity) was defined as an age-specific and sex-specific body mass index ≥85th percentile (World Health Organization referent), and abdominal obesity as a waist circumference (WC) >90th percentile. Multivariate adjusted linear and logistic regression models were used to evaluate associations between pregnancy rMED and offspring overweight and abdominal obesity.
There was no association between rMED and body mass index z-score, whereas there was a significant association between higher adherence to MD and lower WC (β of high vs. low rMED: −0.62 cm; 95% confidence interval: −1.10, −0.14 cm, P for trend = 0.009).
Pregnancy adherence to the MD was not associated with childhood overweight risk, but it was associated with lower WC, a marker of abdominal obesity.
Infant body mass index (BMI) is increasingly used as a marker of obesity risk based on its association with young-adulthood BMI.
The aim of this study is to test the association of infant BMI with young-adulthood fat mass and fat-free mass, and how this association changes during advancing adulthood.
Body mass index Z-score at age 9 months was measured in 350 White, non-Hispanic Fels Longitudinal Study participants. This exposure was entered into multilevel models to test its association with trajectories describing 2665 BMI observations and 1388 observations of fat mass index (FMI, kg m−2) and fat-free mass index (FFMI, kg m−2) between ages 20 and 60 years.
Partitioning young-adulthood BMI into its fat and fat-free components, infant BMI Z-score was associated with FFMI (β = 0.745; 95% confidence interval = 0.367 to 1.124) but not FMI (0.528; −0.055 to 1.110) at age 20 years. Greater infant BMI Z-score was associated with slower age-related increases in all outcomes, such that (looking at 10-year intervals) only FFMI at age 30 years was related to infant BMI Z-score (0.338; 0.119, 0.557).
Focus on infant BMI reduction for adulthood obesity prevention warrants caution as high infant BMI values are associated with greater lean mass, which is protective against ageing changes.
Physical activity (PA) promotion/obesity prevention in toddlerhood should include home environments.
The aim of the study was to determine social/physical home environment factors associated with toddler PA using ecological momentary assessment (EMA, real-time data collection).
Low-income mother–toddler dyads were recruited and given a handheld EMA device (53 random beeps followed by social/physical environment survey over 8 d). Simultaneously, PA was assessed via accelerometry (data extracted 15 min before/after response, average activity counts per minute). Linear mixed-effects models were used, adjusting for toddler age, urban/suburban residence and time of day; covariate moderating effects were examined; within-subjects and between-subjects findings were reported. PA was hypothesized to be greater when toddlers are outside (vs. inside), children are nearby (vs. alone), toddlers are interacting with their mothers (vs. not) and TV is off (vs. on).
The final count was 2454 EMA/PA responses for 160 toddlers (mean age 20 months, range 12–31; 55% male, 66% Black and 54% urban). Associations with PA include (within subjects) the following: outside location (212 additional counts min−1), children nearby (153 additional counts min−1) and interacting with mother (321 additional counts min−1), compared with alternatives. Age was moderated by outside location/PA association (within subjects), with 90 additional counts min−1 per 3-month age group outside vs. inside. No between-subjects or television/PA associations were found.
Home environment factors were associated with PA, including outside location, children nearby and mother interaction. EMA is a novel method, allowing identification of contextual factors associated with behaviours in natural environments.
The effectiveness of once per week (OPW) delivery of a family-based childhood obesity programme was compared with twice per week (TPW) delivery in achieving health and behavioural outcomes at a population level and in improving programme attendance. Both programmes were delivered over 10–weeks, and the contact hours in the OPW and TPW programmes were 20 and 35–h, respectively.
A cluster-randomised controlled trial with stratification by local health district was conducted. Height, weight and global self esteem of participants and parent-reported diet and physical activity were measured at programme commencement and completion and at 6-month follow-up. Attendance was defined as the proportion of total sessions attended.
There were no differences between the OPW and TPW arms in changes from pre-programme baseline for body mass index (BMI) z-score and other health and behaviourial measures at programme completion and at follow-up, except for the increase in physical activity outside of the programme at programme completion (OPW, 3.5 h/week; TPW, 1.9 h/week; p = 0.03). OPW and TPW participants attended 71.2% and 69.2% of the total sessions, respectively. Attendance was the only contributing factor to a positive BMI z-score outcome (β = −2.45, p < 0.01) with no effects of child age and gender, language spoken at home or highest qualification of mother.
A family−based childhood obesity programme can be delivered OPW with no compromise to health or behavioural outcomes compared with TPW. Higher attendance, as a proportion of available sessions, leads to better outcomes for children.
To investigate whether health-related physical fitness is associated with total and central body fat in preschool children.
A total of 403 Spanish children aged 3–5 years (57.8% boys) participated in the study. Health-related physical fitness was measured by the PREFIT battery: the handgrip strength and the standing long-jump tests (muscular strength), the 4 × 10 m shuttle run (speed–agility), the one-leg stance tests (balance) and the PREFIT-20 m shuttle run test (cardiorespiratory fitness). Body mass index and waist circumference were used as markers of total and central body fat, respectively.
There were significant associations between all health-related physical fitness tests and body mass index (β = 0.280 ± 0.054, β = −0.020 ± 0.006, β = 0.154 ± 0.065 and β = −0.034 ± 0.011 for the handgrip strength, standing long jump, 4 × 10 m shuttle run and PREFIT-20 m shuttle run tests, respectively, all P ≤ 0.019) after adjusting for sex and age. Similarly, there was significant associations of standing long jump (β = −0.072 ± 0.014), 4 × 10 m shuttle run (β = 0.652 ± 0.150) and PREFIT-20 m shuttle run tests (β = −0.102 ± 0.025) with waist circumference (all P ≤ 0.001), except for handgrip strength (β = 0.254 ± 0.145, P = 0.081) and one-leg stance (β = −0.012 ± 0.009, P = 0.156).
The present study extends previous findings in older youth. Fitness assessment should be introduced in future epidemiological and intervention studies in preschool children because it seems to be an important factor determining health.
The prevalence of childhood obesity is increasing worldwide and this trend is no exception for South Korea. A multidisciplinary approach is needed for the prevention and management of childhood obesity. To do so, among many other strategies, managing the family unit can be a very effective strategy.
The purpose of this study was to identify the relationship between frequency of family meals and overweight/obesity in elementary students and to suggest the management and prevention strategies of childhood obesity.
Data from a total of 2904 elementary students were analyzed from the 2008–2012 Korea National Health and Nutrition Examination Survey. Multiple logistic regression analysis was used to examine the association between overweight/obesity and family meals.
Of the total 2904 elementary students, 573 (19.4%) were overweight or obese. The odds ratio of overweight or obese students who had family dinner only was 1.21 (95% CI: 0.89–1.64), that of those who had family breakfast only was 3.20 (95% CI: 1.70–6.02), and that of those who had neither family breakfast nor family dinner was 4.17 (95% CI: 1.98–8.78) compared with those who had both family breakfast and family dinner.
The frequency of family meals was strongly an inverse association with childhood overweight or obesity. Therefore, we suggest that the intervention of childhood obesity should include family meals.
Individuals born at low or high birth weight (BW) have elevated adiposity. The extent to which physical activity can mitigate this risk is unknown.
The aim of this study was to determine if associations between BW and adiposity vary by self-reported moderate-to-vigorous physical activity (MVPA) among adolescents.
We used data on adolescents in the National Health and Nutrition Examination Survey (1999–2006; 12–15 years; n = 4064). Using gender-stratified linear regression, we modelled body mass index (BMI) and waist circumference (WC) z-scores as a function of low, normal and high BW, MVPA (weekly Metabolic Equivalent of Task hours) and MVPA*BW cross-product terms, adjusting for sociodemographics, diet and, in WC models, BMI.
Among girls with low MVPA, those born with high BW had greater BMI than normal BW; this difference diminished with greater MVPA (coefficient [95% confidence interval]: low MVPA: 0.72 [0.29, 1.14]; high MVPA: −0.04 [−0.48, 0.39]; P for interaction = 0.05). Among boys, MVPA did not modify the associations between BW and BMI. WC was unrelated to BW, regardless of MVPA.
Findings suggest that effects of high BW in total adiposity can be more easily modified with MVPA in adolescent girls than in boys.
Insufficient information is available on the relationship between obesity and outcome of paediatric patients with acute pancreatitis.
This study aimed to investigate the effect of obesity on outcomes of paediatric patients with acute pancreatitis based on a national administrative database.
A total of 500 cases in 416 paediatric patients with acute pancreatitis (aged 5–17 years) were referred from 260 hospitals between 2010 and 2012 in Japan. Patients were divided into two groups according to the presence of obesity: with obesity (n = 65) and without obesity (n = 435). Patient data were collected from the administrative database to compare the prevalence of severe acute pancreatitis, in-hospital mortality, length of stay (LOS) and medical costs between the groups.
Both prevalence of severe acute pancreatitis and in-hospital mortality were significantly higher in paediatric patients with obesity than those without (36.9% vs. 16.3% and 3.1% vs. 0.0%; P < 0.001, respectively). Longer LOS and higher medical costs were also observed in paediatric patients with obesity (25.7 vs. 15.2 days, P < 0.001 and 14 169.5 vs. 7457.7 US dollars, P < 0.001, respectively).
This study demonstrated that obesity significantly influenced the outcomes of paediatric acute pancreatitis.
Temperament is associated with obesity risk. However, the mechanisms linking temperament and eating behaviour to childhood adiposity are unclear.
To examine whether three temperament dimensions (surgency, effortful control and negative lability) are uniquely associated with an increased BMI z score (BMIz) concurrently and an excessive rate of change in BMIz longitudinally through four eating behaviours (food responsiveness, enjoyment of food, emotional overeating and satiety responsiveness) among low-income pre-schoolers, independent of home environment quality.
379 pre-schoolers were recruited from Head Start in the Midwest region of the United States. Primary caregivers reported child temperament, eating behaviours and the level of chaos at home. Child BMIz was derived from weight and height measurements at ages 4, 5 and 6 years on average.
Path analyses revealed that higher levels of surgency predicted more food responsiveness and enjoyment of food, which was in turn associated with higher concurrent BMIz, independent of effortful control, negative lability and home chaos.
Low-income surgent pre-schoolers were more likely to have elevated BMIz as they were more inclined to eat in response to external cues and have a high appetitive drive. Obesity prevention programmes might target low-income children with surgent temperaments, and the identified eating behaviours.
There is limited research describing associations between food insecurity and dietary intake.
To examine differences in dietary intake by food security status among a nationally representative sample of children and adolescents in the USA.
The sample included 5136 children, ages 2–15 years, from the National Nutrition and Health Examination Survey, 2007–2010. Propensity score weighting was used to improve covariate balance between food-secure and food-insecure (marginal, low or very low food security) participants. Multivariate measurement error models were used to model usual intake of various dietary components and assess differences by food security status.
Initial analyses using multivariate measurement error models determined there were no differences between food-insecure and food-secure children across several dietary components. In sensitivity analyses, children experiencing very low food security consumed fewer whole grains and more solid fats and added sugars compared with their food-secure counterparts. Some of these differences were attenuated after propensity score weighting, although intake of whole grains and added sugars remained significantly different.
Food insecurity was largely not associated with dietary intake among 2–15-year-old US children, although some differences were observed comparing food-secure children to those experiencing very low food security.
Investigate associations of TV viewing time and accelerometry-derived sedentary time with inflammatory and endothelial function biomarkers in children.
Cross-sectional analysis of 164 7–10-year-old children. TV viewing time was assessed by parental proxy report and total and patterns of sedentary time accumulation (e.g. prolonged bouts) were assessed by accelerometry. C-reactive protein (CRP), homeostasis model assessment of insulin resistance, interleukin-2, -6, -8, -10, tumour necrosis factor alpha, adiponectin, resistin, brain-derived neurotrophic factor, soluble intercellular and vascular adhesion molecule 1, plasminogen activator inhibitor 1 and soluble E-selectin were assessed. Generalised linear models assessed the associations of TV viewing and sedentary time with biomarkers, adjusting for sex, waist circumference, moderate- to vigorous-intensity physical activity and diet density.
Each additional h week−1 of TV viewing was associated with 4.4% (95% CI: 2.1, 6.7) greater CRP and 0.6% (0.2, 1.0) greater sVCAM-1 in the fully adjusted model. The association between frequency and duration of 5–10 min bouts of sedentary time and CRP was positive after adjustment for sex and waist circumference but attenuated after adjustment for diet density.
This study suggests that TV viewing was unfavourably associated with several markers of inflammation and endothelial dysfunction. The detrimental association between 5 and 10 min bouts of sedentary time and CRP approached significance, suggesting that further research with a stronger study design (longitudinal and/or experimental) is needed to better understand how the accumulation of sedentary time early in life may influence short and longer term health.
Maternal smoking during pregnancy has been associated with increased risk of childhood overweight/obesity defined by body mass index (BMI). We examined its association with a range of adiposity measures and cardiovascular indicators in children aged 3–10 years.
We used data from a cross-sectional study of schoolchildren across mainland Portuguese districts (2009–2010). We applied quantile regressions to examine maternal smoking associations with adiposity (n = 17 286), blood pressure (BP) and resting pulse rate (RPR) (n ≈ 2500) measures across the age range, adjusting for prenatal and early life factors.
Maternal smoking during pregnancy was associated with increases in offspring adiposity levels. The difference in median BMI between children of smokers and non-smokers was 0.39 kg m−2 (95% confidence interval: 0.25, 0.53) in boys and 0.46 kg m−2 (0.31, 0.62) in girls; 0.55 cm (0.24, 0.87) and 0.82 cm (0.45, 1.19), respectively, in median waist circumference; and 0.94 mm (0.49, 1.40) and 1.47 mm (0.87, 2.07) in median sum of (triceps, subscapular, suprailiac) skin-folds. The associations appeared to be stronger with increasing age. The differences in the 90th centile tended to be greater than those in median. There was no consistent association of maternal smoking with BP and RPR.
Children whose mother smoked during pregnancy had higher adiposity levels than children of non-smokers, across several measures, particularly among older children. Although there was no consistent association with cardiovascular indicators, maternal smoking association with childhood obesity may have implications for cardiovascular risk factors over the life course.
Evidence is lacking to recommend one diet over another when treating polycystic ovary syndrome (PCOS).
To obtain preliminary data, comparing the impact of a low-glycaemic load (LGL) vs. low-fat (LF) diet on biochemical hyperandrogenism in overweight and obese adolescents with PCOS. To ascertain feasibility of recruiting study participants, in partnership with an adolescent clinic, and implementing dietary interventions.
Randomized controlled trial of 19 overweight and obese adolescents with PCOS and not using hormonal contraceptives (HCs). Interventions comprised nutrition education, dietary counselling and cooking workshops to foster adherence to a LGL (45% carbohydrate, 35% fat, 20% protein) or LF (55% carbohydrate, 25% fat, 20% protein) diet over 6 months. Serum bioavailable testosterone was the primary outcome.
Sixteen (LGL, n = 7; LF, n = 9) participants completed the study. Body fat percentage decreased (P < 0.05) in response to the interventions, with no difference between the LGL and LF groups (−1.2% vs. −2.2%; P = 0.16). Bioavailable testosterone did not change for either group (−0.4 vs. −1.8 ng dL−1; P = 0.35). Regarding feasibility, recruiting adolescents posed a challenge, and use of HCs was a main reason for ineligibility. Participants attended 5.9 of 6 in-person visits and 2.6 of 3 cooking workshops, completed 4.9 of 6 telephone counselling calls, and reported high satisfaction with the diets and cooking workshops (≥8 on a 10-cm scale).
Dietary interventions were beneficial for weight control but did not attenuate biochemical hyperandrogenism. Innovative strategies are needed to recruit adolescents for studies aimed at assessing independent effects of diet on features of PCOS.
Obesity in childhood is related to multiple lifestyle factors. Our objective was to evaluate the relationship between consumption of 100% fruit juice and weight status over time among pre-school children.
We used linear and logistic multivariable regression to evaluate body mass index (BMI) z-score and overweight/obese status as a function of 100% fruit juice intake for 8950 children examined at ages 2, 4 and 5 years as part of the Early Childhood Longitudinal Study–Birth Cohort, a representative sample of the United States.
Cross-sectional analysis at ages 4 and 5 years showed no difference in the prevalence of overweight and obesity between consistent juice drinkers and inconsistent/non-drinkers. Longitudinal analysis found that children who drank 100% juice consistently at age 2 years had greater increases in BMI z-score by age 4 years than infrequent/non-drinkers (P < 0.0001), a difference driven by lesser increases in height z-score (P = 0.0003) and slightly greater increases in weight z-score (P = 0.0550) among consistent juice drinkers over the 2 to 4 year time period. Additionally, consistent juice drinkers at age 2 had higher odds of becoming overweight by age 4 (adjusted odds ratio 1.30; CI 1.06–1.60). These differences in growth parameters were not noted between ages 4 and 5 years.
Drinking 100% fruit juice regularly at age 2 is associated with higher odds of becoming overweight between 2 and 4 years. Paediatricians and parents can discourage excessive fruit juice consumption as part of a larger effort to avoid unhealthy gain in BMI in young children.
Childhood obesity is an increasing health challenge related to increased risk of chronic diseases. microRNAs (miRNAs) are noncoding short RNA molecules regulating multiple biological processes linked to obesity.
We aimed at evaluating the association between circulating miRNA levels and lipid metabolism in obese and non-obese children and adolescents.
By constituting study group, 45 obese children and adolescents were recruited. To perform comparisons with study group, 41 lean controls were matched for age and sex. Using real-time quantitative PCR analysis, circulating miRNAs were evaluated in both groups.
Circulating miR-335 (P < 0.001), miR-143 (P = 0.001) and miR-758 (P = 0.006) in obese children were significantly lower than those of controls. However, circulating miR-27 (P = 0.032), miR-378 (P < 0.001) and miR-370 (P = 0.045) in obese children were significantly higher, compared with those of controls. In addition, circulating miR-33 in obese children was higher than those of controls, but no significant difference was present (P = 0.687).
Our findings showed that a significant association is present between circulating miR-370, miR-33, miR-378, miR-27, miR-335, miR-143 and miR-758 values, and childhood obesity. Low levels of miR-335, miR-143 and miR-758, and high levels of miR-27, miR-378, miR-33 and miR-370 may have been responsible for elevated triglycerides and low-density lipoprotein (LDL-C) levels, and low level of high-density lipoprotein (HDL-C) in obese subjects. Therefore, miRNAs may be a good novel biomarker for childhood obesity.
We tested the hypothesis that patients with Prader–Willi syndrome (PWS) may be at lower risk of developing non-alcoholic fatty liver disease (NAFLD) because of a higher insulin sensitivity. Twenty-one PWS patients and 42 control subjects closely similar for age, gender, pubertal stage and body mass index (CNT), were studied. Metabolic profile and body composition were assessed. NAFLD was established by a validated method of US grading (range from G0 to G3). PWS patients showed a significantly better metabolic profile (lower waist circumference, fasting glucose levels, HOMA-IR, cholesterol, transaminase levels and trunk fat mass/fat mass ratio). Furthermore, NAFLD G1stage was significantly more frequent in PWS subjects (P < 0.05), whereas G2 stage was significantly more frequent in control patients (P < 0.05). NAFLD grading seems to correlate with body composition in PWS, also after adjustment for sex and GH treatment. To our knowledge, this is the first report suggesting a reduced risk of NAFLD in PWS children.