Selenoprotein-p and insulin resistance in children and adolescents with obesity.

BACKGROUND: Insulin resistance and obesity present significant challenges in pediatric populations. Selenoprotein P1 (SEPP1) serves as a biomarker for assessing selenium levels in the body. While its association with metabolic syndrome is established in adults, its relevance in children remains underexplored. AIM: To ascertain SEPP1 blood levels in children and adolescents diagnosed with obesity and to assess its correlation with insulin resistance and adiposity indices. METHODS: 170 children participated in this study, including 85 diagnosed with obesity and an equal number of healthy counterparts matched for age and sex. Each participant underwent a comprehensive medical evaluation, encompassing a detailed medical history, clinical examination, and anthropometric measurements like waist circumference and waist-to-height ratio. Furthermore, routine blood tests were conducted, including serum SEPP1, visceral adiposity index (VAI), and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) level. RESULTS: Our findings revealed significantly lower serum SEPP1 levels in children with obesity compared to their healthy peers. Moreover, notable negative correlations were observed between serum SEPP1 levels and body mass index, VAI, and HOMA-IR. CONCLUSION: The study suggests that SEPP1 could serve as a valuable predictor for insulin resistance among children and adolescents diagnosed with obesity. This highlights the potential utility of SEPP1 in pediatric metabolic health assessment and warrants further investigation.

Long-term health outcomes of children born by cesarean section: A nationwide population-based retrospective cohort study in Taiwan.

BACKGROUND: Taiwan had high cesarean rate which exceeded the recommended threshold (15%), set by WHO. However, there have not a comprehensive study to discuss the long-term offspring consequences of cesarean section (CS). This study aimed to show whether allergy disorders, obesity and respiratory infection of children are associated with modes of delivery, using the National Health Insurance Research Database (NHIRD) of Taiwan. METHODS: This study used the maternal and child health database of NHIRD. We included the children who birth between 2004 and 2013 and inter-linked the database of the mother and children. The participants were followed until 2018/12/31. We performed a Cox proportional hazards model to identify the association of CS with respiratory tract infection, allergy disorder, and obesity diagnosed in childhood. RESULTS: CS significantly increased the risk of developed childhood asthma (adjusted hazard ratio [aHR] = 1.03; 95% confidence interval [CI]: 1.02-1.03), allergy rhinitis (aHR = 1.04; 95% CI: 1.04-1.05), atopic dermatitis (aHR = 1.05; 95% CI: 1.04-1.06), respiratory tract infection (aHR = 1.07; 95% CI: 1.06-1.07) and overweight (aHR = 1.29; 95% CI: 1.18-1.40) even after adjusting with confounding factor. Development of food allergy (aHR = 1.13; 95% CI: 0.87-1.47) was not associated with cesarean section. CONCLUSION: This study indicated that children delivered by CS more commonly developed respiratory tract infections, asthma, allergic rhinitis, atopic dermatitis, obesity than children delivered vaginally. Among these, obesity have a stronger association with cesarean section.

The Metabolic Programming of Pubertal Onset.

BACKGROUND: There is increasing evidence that maternal factors such as nutritional status (both under and over-nutrition) and diabetes, alongside prenatal exposure to endocrine disrupting chemicals (EDCs), are associated with early pubertal onset in offspring. Such children are also at increased risk of the metabolic syndrome during adolescence and young adulthood. AIM: This literature review focuses on the role of the prenatal environment in programming pubertal onset, and the impact of prenatal metabolic stressors on the declining average age of puberty. METHOD: A review of all relevant literature was conducted in PubMed by the authors. OUTCOME: The mechanism for this appears to be mediated through metabolic signals, such as leptin and insulin, on the kisspeptin-neuronal nitric oxide-gonadotropin releasing hormone (KiNG) axis. Exposed children have an elevated risk of childhood obesity and display a phenotype of hyperinsunlinaemia and hyperleptinaemia. These metabolic changes permit an earlier attainment of the nutritional "threshold" for puberty. Unfortunately, this cycle may be amplified across subsequent generations, however early intervention may help "rescue" progression of this programming.

Associations of childhood physical activity and screen time with cardiometabolic health in preteens who were born to mothers with previous macrosomic delivery: Findings from the ROLO longitudinal birth cohort study.

BACKGROUND: Macrosomia (birthweight ≥4 kg) may alter the associations of physical activity (PA) and screen time (ST) throughout childhood with later cardiometabolic risk. OBJECTIVE: To investigate associations of PA and ST over a 4-6-year follow-up period with cardiometabolic outcomes in preteens (9-11-year-olds) who were born to mothers with previous macrosomic delivery. METHODS: This is an analysis of 402 preteens from the ROLO study, who were born to mothers that previously delivered an infant with macrosomia. Parental-reported measures of PA and ST were obtained in early childhood at 5-years of age. Preteen self-reported PA, parental-reported ST, anthropometry, dual-energy x-ray absorptiometry, blood pressure, heart rate, cardiorespiratory endurance, and blood biomarkers were obtained at 9-11-years. Crude and adjusted linear regression models explored associations and the interaction of birthweight was investigated in all models. RESULTS: Early childhood PA and ST at the 5-year follow-up were not related to preteen cardiometabolic outcomes. In adjusted models, higher preteen PA was associated with lower sum of skinfolds (B = -3.00, 95% CI -5.98, -0.02, p = 0.048) and higher cardiorespiratory endurance (B = 0.50, 95% CI 0.20, 0.80, p = 0.001) at the same time point. No strong evidence for modification by birthweight was found. CONCLUSION: Higher preteen PA may have potential benefits for cardiometabolic health, irrespective of birthweight.

Type 2 diabetes in children and adolescents: Challenges for treatment and potential solutions.

Historically perceived as a disease mainly affecting adults, the prevalence of type 2 diabetes mellitus (T2DM) among children and adolescents has been rising, mirroring the increasing rates of childhood obesity. Currently, youth-onset T2DM poses a significant public health challenge globally. Treating youth-onset T2DM poses numerous critical challenges, namely limited and inadequate therapeutic options, and difficulties with conducting therapeutic studies. As a result, current treatment guidelines are based on adult studies and expert consensus. Few prominent guidelines on the treatment of youth-onset T2DM have been published recently, i.e., by the American Diabetes Association (ADA) 2024, National Institute for Healthcare and Excellence United Kingdom (NICE UK) 2023, International Society Paediatric and Adolescents Diabetes (ISPAD) 2022, Australasian Paediatric Endocrine Group (APEG) 2020 and Diabetes Canada 2018. This review first explores the unique aspects of youth-onset T2DM. It then summarises the different treatment guidelines, discusses the different treatment modalities based on available evidence and identifies any gaps. The review also explores challenges in the treatment of youth-onset T2DM with potential solutions and discusses recent trials on the treatment of youth-onset T2DM. Continued research aims to optimise treatment, improve outcomes, and alleviate the burden of T2DM on youths.

Preventing and treating childhood obesity by sleeping better: a systematic review.

Background: Childhood obesity represents a major public health issue worldwide. Evidence showed the need to implement prevention strategies mainly focused on lifestyle habits. Sleep hygiene is a variable of great interest and this review systematically examined the effects of sleep duration in increasing childhood obesity risk. Methods: A systematic literature review was conducted from December 2023 to February 2024. Study selection and data extraction procedures were performed in accordance with Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines and Statement, and risk of publication bias was assessed by the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results: Original works in English were eligible for review and eleven studies that met the inclusion criteria were included. Studies collected were heterogeneous in terms of duration, sample characteristics, hours of sleep manipulation, anthropometric and hematological parameters collected, therefore it was not possible to perform a meta-analysis. A narrative synthesis of the reported evidence highlighted the impact of sleep duration above all on food intake, eating habits and hormone levels and consequently on the risk of childhood obesity development. Conclusion: This finding suggests the need to consider sleep hygiene as a modifiable lifestyle habit like diet and physical activity, in order to early prevent childhood obesity. Poor sleep hygiene can significantly contribute to weight gain and exacerbation of metabolic disorders linked to childhood obesity. Although more rigorous studies are needed, clinicians need to be aware of the role of sleep hygiene in reducing childhood obesity risk.

Gut microbiome shifts in adolescents after sleeve gastrectomy with increased oral-associated taxa and pro-inflammatory potential.

Background: Bariatric surgery is highly effective in achieving weight loss in children and adolescents with severe obesity, however the underlying mechanisms are incompletely understood, and gut microbiome changes are unknown. Objectives: 1) To comprehensively examine gut microbiome and metabolome changes after laparoscopic vertical sleeve gastrectomy (VSG) in adolescents and 2) to assess whether the microbiome/metabolome changes observed with VSG influence phenotype using germ-free murine models. Design: 1) A longitudinal observational study in adolescents undergoing VSG with serial stool samples undergoing shotgun metagenomic microbiome sequencing and metabolomics (polar metabolites, bile acids and short chain fatty acids) and 2) a human-to-mouse fecal transplant study. Results: We show adolescents exhibit significant gut microbiome and metabolome shifts several months after VSG, with increased alpha diversity and notably with enrichment of oral-associated taxa. To assess causality of the microbiome/metabolome changes in phenotype, pre-VSG and post-VSG stool was transplanted into germ-free mice. Post-VSG stool was not associated with any beneficial outcomes such as adiposity reduction compared pre-VSG stool. However, post-VSG stool exhibited an inflammatory phenotype with increased intestinal Th17 and decreased regulatory T cells. Concomitantly, we found elevated fecal calprotectin and an enrichment of proinflammatory pathways in a subset of adolescents post-VSG. Conclusion: We show that in some adolescents, microbiome changes post-VSG may have inflammatory potential, which may be of importance considering the increased incidence of inflammatory bowel disease post-VSG.

Association between obesogenic environments and childhood overweight/obesity across the United States: Differences by rurality.

PURPOSE: Childhood obesity is more prevalent in rural compared to urban communities and may be related to urban-rural differences in environmental factors known to affect obesity. However, understanding of how environmental factors impact childhood obesity in rural settings remains limited. This study aimed to address this gap by exploring the relationship between obesogenic environments and childhood overweight/obesity rates, including variations across the urban-rural continuum. METHODS: This study analyzed data for counties in the United States (N = 3140). Linear regression models were employed to examine the relationship between the Childhood Obesogenic Environment Index, which consisted of ten variables from a variety of sources associated with physical activity and healthy eating, and childhood overweight/obesity rates estimates derived from the 2016 National Survey of Children's Health. County rurality was categorized using Rural-Urban Continuum Codes and a moderation analysis was conducted to identify potential variations by rurality. FINDINGS: There was a significant positive association between the COEI and childhood overweight/obesity rates nationally, with notable variations across the urban-rural continuum for specific index components. Neighborhood walkability showed a significant positive association across rurality, indicating that childhood overweight/obesity rates were higher in less walkable communities. Full-service restaurants exhibited an inverse relationship with childhood overweight/obesity rates across all RUCC levels. CONCLUSIONS: These results underscore the obesogenic environmental factors associated with childhood overweight/obesity rates nationally and how they vary across the urban-rural continuum. This study highlights the importance of considering these variations when designing interventions to address childhood obesity.

Eating in the Absence of Hunger is a stable predictor of adiposity gains in middle childhood.

BACKGROUND: Eating in the Absence of Hunger (EAH) is a behavioral phenotype of pediatric obesity characterized by consumption of palatable food beyond hunger. Studies in children have identified EAH as stable over time, but findings are unclear on whether it predicts development of adiposity, particularly in middle childhood, a period of increased autonomy over food choice. OBJECTIVE: We hypothesized that EAH would remain stable and be associated with increased adiposity over a ≥1-year prospective study in 7-8-year-old children without obesity. Secondary hypotheses tested whether physical activity moderated the impact of EAH on adiposity. METHODS: Children (n=72, age 7.8±0.6 years; BMI%<90th), in a 7-visit longitudinal study, had EAH, adiposity, and physical activity assessed at baseline (Time 1-T1) and follow-up (Time 2-T2). EAH was determined by measuring children's intake from 9 energy-dense (>3.9 kcal/g) sweet and savory foods during a 10-minute access period following intake of a standard meal eaten to satiation. Adiposity was measured with dual-energy X-ray absorptiometry (DXA), with an outcome of fat mass index (FMI; fat mass/ht in m-sq). Seven days of wrist-worn Actigraphy quantified moderate-to-vigorous-physical activity (MVPA) and sedentary time. RESULTS: EAH had moderate stability across timepoints (ICC=0.54). ICCs were stronger for sweet (ICC=0.53) than savory (ICC=0.38) foods. Linear regression predicting 1-yr change in FMI (adjusted for income, parent education, sex, time to follow-up, T2 Tanner stage, maternal weight status, and baseline adiposity) found that both total and sweet food EAH at baseline predicted increases in adiposity (p<0.05 for both). EAH and adiposity were negatively correlated among children with high MVPA and low sedentary time. CONCLUSIONS: These findings show that EAH is a stable predictive phenotype of increases in adiposity over 1 year among youth in middle childhood, although activity related behaviors may moderate this effect. If replicated, targeting EAH as part of interventions may prevent excess adiposity gain. CLINICAL TRIAL REGISTRY: The data was obtained from the Food and Brain study (ClinicalTrials.gov) NCT03341247.

Trend analysis, gender-specific patterns, and age dynamics of childhood and adolescent obesity: insights from the Tehran lipid and glucose study.

BACKGROUND: Childhood and adolescent obesity pose significant challenges to global health, with escalating prevalence and associated short- and long-term health consequences. This longitudinal study leveraged data from the Tehran Lipid and Glucose Study (TLGS) to investigate the trends of obesity among Tehranian children and adolescents over a 21-year period. METHODS: Utilizing data from TLGS phases I to VII (1999-2021), we included 3845 participants aged 3-18 years at the beginning of phase I. Anthropometric measures, including height and weight, were collected, and body mass index (BMI) was calculated. Childhood obesity (2-19 years) was defined as BMI-for-age > 2SD based on World Health Organization (WHO) standards, and adult obesity was defined as BMI ≥ 30. Descriptive statistics, trend analysis, prevalence calculations, odds ratios, and interaction analyses were employed for data interpretation. RESULTS: The mean BMI increased from 18.46 ± 4.37 kg/m² at Phase I to 26.36 ± 5.03 kg/m² at Phase VII. Boys exhibited a greater increase in BMI than girls, and age at study entry influenced BMI trajectories. The prevalence of obesity rose from 6.4% at Phase I to 21.5% at Phase VII, with a more pronounced increase in boys. Odds ratios for obesity steadily increased across phases, indicating a growing risk. Interaction analyses revealed age-specific dynamics, with older participants demonstrating lower odds ratios initially but higher odds ratios in later phases. CONCLUSION: Our study shows a worrisome increase in childhood obesity among Tehranian children and adolescents over 21 years. Sex- and age-specific trends emphasize the necessity for targeted interventions, informing policymakers, healthcare practitioners, and educators regarding public health strategies and interventions against the obesity epidemic.

Early life social conditions and adverse experiences are associated with childhood BMI and perceived overeating.

BACKGROUND: Early life socioeconomic disadvantage and adverse experiences may lead to overeating, which is in turn associated with increased body mass index (BMI). However, recent evidence indicated that the association between childhood BMI and overeating might be bidirectional. This bidirectionality prompts the need for further investigation of early life predictors of BMI in childhood. OBJECTIVES: To longitudinally assess the directionality of the association between childhood BMI and perceived overeating and to investigate their antecedent early life predictors. METHODS: The sample included data from 5151 children from the ELSPAC study, collected between 18 months and 11 years of child age. The outcomes were child BMI and mother-reported overeating, assessed at the age of 3, 5, 7 and 11 years. Predictors included maternal BMI, maternal education, single parenthood, financial difficulties and adverse childhood experiences (ACEs) reported by parents and paediatricians. The random intercept cross-lagged panel model was applied. RESULTS: The mean child's BMI at age 3 was 15.59 kg/m2 and increased to 17.86 kg/m2 at age 11. The percentage of parent-reported overeating increased in the following period, from about 12% at age 3 to 17% at age 11. The results showed temporal stability in perceived overeating and BMI, with a bidirectional relationship strengthening over time. The child's BMI was associated with maternal BMI. Maternal BMI was positively associated with child-perceived overeating, but a stronger effect was found for ACEs. ACEs mediated the impact of maternal education, financial difficulties and single parenthood on overeating. CONCLUSIONS: We observed stable bidirectional associations between BMI and perceived overeating. The results indicated two main pathways: one linked to maternal BMI and early childhood BMI increase followed by perceived overeating and the second associated with ACEs mediating the effect of early childhood social factors on perceived overeating, leading to gradual BMI gain.

Effects of school closure on lifestyle behaviours and health outcomes in children during the COVID-19 pandemic in Chile: A time-matched analysis.

BACKGROUND: The COVID-19 pandemic led to school closures, potentially impairing children's behaviours and health. We aimed to explore the effects of school closure on lifestyle behaviours (dietary habits, physical activity) and health outcomes (adiposity, fitness, self-esteem, self-concept) in children. METHODS: We measured 247 children before school closure (October-November 2019) and after school reopening (October-November 2021) (COVID-19 group). To distinguish the changes due to school closure from changes due to growth, we included 655 age-matched children with cross-sectional measurements in October-November 2019 (control group). The response of this group (i.e., differences between children with 2 years of difference) was considered the expected response to growth. Two-way ANOVA was used to test age-by-group interactions, indicating an effect of school closure. RESULTS: In 7-to-9-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.4 points), resulting in higher physical inactivity prevalence (by 19 percent points) at 9 years. This was accompanied by larger-than-expected increases in fat percentage (by 6.1 percent point). In 8-to-10-year-old children, the COVID-19 group had higher physical inactivity prevalence at 10 years (by 20 percent points). This was accompanied by larger-than-expected increases in fat percentage (by 8.3 percent points), z-score BMI (by 0.90 units), and waist circumference (by 6.1 cm). In 9-to-11-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.3 points) and increases in self-concept (by 0.2 points). The response in dietary habits, fitness, or self-esteem was not different between groups. CONCLUSION: Overall, school closure negatively impacted physical activity and adiposity, particularly in the youngest children.

Factors beyond Body Mass Index Associated with Cardiometabolic Risk among Children with Severe Obesity.

Background: The increasing prevalence of severe obesity among children and adolescents poses a significant challenge for pediatricians and general practitioners. This study aimed to investigate the relationships between biochemical results, anthropometry, blood pressure measurements, and bioimpedance analysis (BIA)-derived parameters to identify potential cardiometabolic complications associated with severe obesity. Methods: This study included 347 children (162 boys, 185 girls) aged 0-19 years, meeting the criteria for severe obesity based on BMI thresholds for different age groups. The patients were recruited in four pediatric endocrinology centers in Poland (Zabrze, Cracow, Rzeszow, Szczecin). Each participant underwent anthropometric measurements, pubertal stage assessment, blood pressure measurement, biochemical and hormonal tests, and BIA. Results: BMI showed significant associations with fat mass percentage (FM%) and waist-to-height ratio (WHtR) but not waist-to-hip ratio (WHR). The relationship between BMI and FM% was stronger in girls and prepubertal children. The metabolic syndrome (MetS) Z-score showed a strong positive correlation with BMI in the pubertal children. A negative correlation between HDL and triglycerides was observed only in the boys. The prepubertal children exhibited more significant correlations, despite a smaller sample size and shorter duration of obesity. Conclusions: Considering multiple parameters beyond BMI alone provides a better understanding of cardiometabolic risks associated with severe obesity in children. MetS Z-score was not a reliable indicator of increased cardiometabolic risk in younger children. Early-onset severe obesity was associated with a higher risk of metabolic complications. Early intervention is crucial to mitigate metabolic complications in this population.

Pre-pregnancy and gestational interventions to prevent childhood obesity.

Childhood obesity is a significant global health issue with complex and multifactorial origins, often beginning before conception and influenced by both maternal and paternal health. The increased prevalence of pre-pregnancy obesity and gestational diabetes mellitus in women of reproductive age contributes to a heightened risk of metabolic dysfunction in offspring. Current clinical practices often implement lifestyle interventions after the first trimester, and have limited success, implying that they miss a critical window for effective metabolic adjustments. This review examines the limitations of lifestyle interventions during pregnancy in improving perinatal outcomes and highlights the importance of initiating such interventions before conception to positively impact parental health and fetal development. A re-evaluation of strategies is needed to enhance the metabolic health of prospective parents as a preventive measure against childhood obesity.

Associations of 1.5- and 3-year Phthalate Exposure Levels with Early Adiposity Rebound and Overweight/Obesity in Japanese Children: An Adjunct Study of the Japan Environment and Children's Study.

The relationship between early childhood phthalate exposure and early adiposity rebound is unclear. This study aimed to investigate the association between 1.5- and 3-year phthalate exposure and EAR and overweight/obesity in 7.5-year-old Japanese children. A total of 452 mother-child pairs were enrolled from the Aichi Regional Cohort of the Japan Environment and Children's Study. The children were followed up at birth and at 1.5, 2, 3, 4, 5, 6, and 7.5 years of age for physical examination. Human biomonitoring of 16 urinary metabolites of eight phthalates was performed at 1.5 and 3 years of age. Latent class mixed models, binary logistic regression, and quantile g-computation were performed to identify body mass index (BMI) trajectories and investigate the relationships of single or mixed phthalate exposure with EAR and overweight/obesity. A one-unit increase in log10-transformed 3-year-old Σdi(2-ethylhexyl) phthalate (ΣDEHP) exposure levels was significantly associated with 6-year-old BMI in girls. The 1.5-year mono-iso-butyl phthalate and 3-year Σdi-isodecyl phthalate exposure levels were significantly associated with the repeated measures of longitudinal BMIs in girls. Single phthalate exposure showed null associations with EAR or overweight/obesity in the 7.5-year-old children. Σdi-isononyl phthalate, ΣDEHP, and mono-n-butyl phthalate exhibited the highest proportion of partial positive weights of being in the EAR trajectory after confounder adjustment. Phthalate mixture exposure in 1.5- and 3-year-old children was not significantly associated with EAR. Early childhood phthalate exposure was not related to EAR or overweight/obesity in 7.5-year-old Japanese children. However, few phthalates were positively associated with longitudinal BMIs in girls.

Sex-specific associations between body mass index trajectories and risk of hypertension.

BACKGROUND: Although it is well established that obesity is a risk factor for hypertension, the effect of distinct long-term patterns of body mass index (BMI) on blood pressure (BP) in later life is poorly understood. METHODS: Based on the China Health and Nutrition Survey, we analyzed 2920 participants aged 3-17 years with initial normal BP at baseline (1991-2011), who were followed up for the development of hypertension (1993-2015). The group-based trajectory model was applied to identify BMI trajectories, and Cox regression was used to assess their associations with hypertension risk. Stratified analyses were conducted to explore differences across subgroups. RESULTS: During an average follow-up time of 11.20 (7.69) years for males and 7.20 (5.21) years for females, 339 males and 212 females were identified with hypertension, respectively. Three BMI trajectories were identified: low-increasing (60.58% of males and 73.03% of females), moderate-increasing (33.08% of males and 24.22% of females), and high-increasing (6.34% of males and 2.76% of females). Our study found a significant positive association between a higher BMI trajectory and hypertension risk in males (all P for trend < 0.05). Specifically, males in the high-increasing BMI group had a higher risk of hypertension compared with those in the low-increasing group (HR = 1.76, 95% CI: 1.04-2.97). Stratified analyses revealed stronger associations among smokers, drinkers, and inactive individuals. CONCLUSION: Our findings suggest that maintaining a normal BMI and healthy lifestyle from childhood may lower subsequent risk of hypertension.

Waist circumference as a parameter in school-based interventions to prevent overweight and obesity - a systematic review and meta-analysis.

BACKGROUND: Preventing childhood obesity remains an important public health issue worldwide. Since visceral fat in particular is understood as an important risk factor for many chronic diseases, waist circumference is recommended as a measurement parameter for global obesity surveillance. This systematic review and meta-analysis focused on waist circumference as an outcome parameter for studies of school-based interventions to prevent overweight and obesity. METHODS: A systematic literature search was conducted at the end of 2019 in nine data bases, including Medline and Embase, in order to identify relevant studies evaluating interventions in schools aimed at preventing obesity. Eligibility criteria admitted randomised and non-randomised controlled trials. After screening titles, abstracts and full texts, the data of the identified studies were systematically extracted. Risk of bias was assessed according to study type with the appropriate Cochrane Risk of Bias Tool. The review gives a qualitative overview over all included studies structured by extracted data. Separate meta-analyses were done for the outcome mean difference in change in waist circumference, measured in cm or reported as z-score value, using an inverse variance random-effects model due to study design. RESULTS: A total of 2421 publications were screened based on titles, abstracts and full texts. Complemented by results of a former systematic literature search 44 studies were identified for inclusion, comprising a total of 39.837 participants (age range: 6 to 18 years). Nearly half of the studies were conducted in Europe, two-thirds combined diet and exercise-based interventions. Likewise two thirds of the studies were conducted as cluster-randomised trials. Most of the reported effects favoured the experimental groups, indicating the basic effectiveness of school-based measures. Based on reported data, only one third of the studies could be included in the meta-analyses. For the difference in mean change of the outcome parameter waist circumference measured in cm (95% CI), we found a pooled effect estimate of -0.95 (-1.87; -0.46). For the difference in mean change of the outcome parameter waist circumference reported as z-score value (95% CI), the pooled effect estimate was -0.10 (-0.15; -0.05). Both effect estimates were in favour of the experimental group. The overall effect sizes were small with a p-value < 0.05. CONCLUSIONS: Pooled effect estimates were small but in favour of the experimental groups. The same applies to the majority of the effects reported in the included studies. The included cluster of randomised controlled trials demonstrated an especially sound methodological standard. The possibility of achieving larger effects in studies of preventive interventions and health promotion is limited. Schools can only realise their full potential in preventing overweight and obesity in children and adolescents if they are accompanied by measures in other areas of the obesogenic environment.

Associations between maternal diet, family eating habits and preschool children's dietary patterns: insights from the UPBEAT trial.

BACKGROUND: Dietary behaviours in early life often track across the life course, influencing the development of adverse health outcomes such as obesity and cardiovascular disease. This study aimed to explore the between dietary patterns (DP) in preschool children and maternal DP and family eating habits. METHODS: We conducted a secondary analysis of 488 mother-child pairs from the UK pregnancy Better Eating and Activity Trial (UPBEAT) at 3-year follow-up. Previously published DP from mothers and children (derived from food-frequency questionnaires and exploratory factor analysis) were used. Mothers' DP were "Fruits-Vegetables", "African-Caribbean", "Processed and Snacks", and children's DP were "Prudent", "Processed-Snacking", and "African-Caribbean". Family meal environments were evaluated using a 5-point Likert scale. RESULTS: Linear regression models revealed that child's prudent pattern was positively associated with maternal Fruits-Vegetables (B = 0.18 (0.08, 0.27)), Snacks patterns (B = 0.10 (0.01, 0.18)), and eating the same foods during meals (B = 0.25 (0.07, 0.43)). Child's Processed-Snacking pattern was directly associated with maternal Processed (B = 0.22 (0.13, 0.30)) and Snacks (B = 0.27 (0.18, 0.36)) patterns, receiving food as reward (B = 0.22 (0.04, 0.39)) and watching TV during meals (B = 0.27 (0.09, 0.45)). Finally, the child African-Caribbean pattern was directly associated with that from the mother (B = 0.41 (0.33, 0.50)) and watching TV during meals (B = 0.15 (0.09, 0.30)), and inversely associated with maternal processed (B=-0.09 (-0.17, -0.02)) and snacking (B=-0.08 (-0.15, -0.04)) patterns. CONCLUSIONS: Unhealthy dietary patterns in childhood are directly linked to similar maternal patterns and family meal behaviours, such as television viewing and food rewards. These findings highlight targetable behaviours for public health interventions.

Combination effects of environmental tobacco smoke exposure and nutrients supplement during pregnancy on obesity in Chinese preschool children.

Objective: This study aimed to explore the combination effects of prenatal exposure to environment tobacco smoke (ETS) and nutrients supplement during pregnancy on childhood obesity in preschoolers. Methods: A cross-sectional study was conducted with 58,814 child-mother dyads from 235 kindergartens in Longhua District of Shenzhen, China in 2021. A self-administered structured questionnaire was completed by mothers to collect socio-demographic characteristics, prenatal ETS exposure, and nutrients supplement in pregnancy, and preschoolers' heights and weights were measured at the same time. After controlling for potential confounding variables, logistic regression models and cross-analyses were used to examine the independent and combination effects of maternal prenatal ETS exposure and nutrients supplementation during pregnancy on obesity in preschool children. Results: The results of our study showed that prenatal ETS exposure increased the risk of childhood obesity (AOR = 1.22, 95% CI = 1.11-1.34) in preschoolers. In addition, risk of childhood obesity was significantly higher when mothers didn't take supplements of multivitamins (AOR = 1.12, 95% CI = 1.05-1.20), folic acid (AOR = 1.23, 95% CI = 1.10-1.37) and iron (AOR = 1.11, 95% CI = 1.04-1.19) during pregnancy. The cross-over analysis showed that the combination of prenatal ETS exposure with mothers taking no multivitamins (AOR = 1.40, 95% CI = 1.21-1.62), no folic acid (AOR = 1.55, 95% CI = 1.12-2.14) and no iron (AOR = 1.38, 95% CI = 1.19-1.59) during pregnancy also increased the risk of obesity among Chinese preschoolers. We also discovered additive interactive effects between prenatal ETS exposure and no maternal multivitamin, folic acid and iron supplementation in pregnancy on the risk of obesity in preschoolers. Conclusion: The combination of prenatal exposure to ETS with no supplementation of these nutrients might jointly increase the risk of childhood obesity. Public health interventions are needed to reduce prenatal exposure to ETS and to encourage mothers to take appropriate multivitamin, folic acid and iron supplements during pregnancy.

Unraveling Childhood Obesity: A Grounded Theory Approach to Psychological, Social, Parental, and Biological Factors.

Childhood obesity is a major medical and public health issue of global interest, which is influenced by a diverse array of factors and carries significant medical and psychosocial implications. Despite the extensive studies that have been conducted to explore the specific issue, the impact of several factors that influence, generate, worsen, and make chronic the phenomenon needs further exploration. This study aimed to construct a grounded theory that includes and connects the psychological, social, parental, and biological factors affecting childhood obesity. Key psychological factors include mental health issues such as depression and emotional eating, while social factors encompass socioeconomic status and cultural influences. Parental factors involve parenting styles and feeding practices, and biological factors relate to genetic predispositions and prenatal conditions. These factors interact in complex ways, highlighting the multifactorial nature of childhood obesity. The study employed a qualitative grounded theory approach, using research articles to achieve a thorough understanding. Qualitative analysis of the articles was conducted using Atlas.ti 24.0 software. Twenty-five research articles were required to reach theoretical saturation. The analysis resulted in 336 codes that were grouped into seven broad categories and twenty-four different subcategories. Through the construction of the theoretical framework, it was recognized that obesity in minors is a complex and multifactorial issue and that the network of causes and influencing factors covers a broad spectrum ranging from the individual to the family, and subsequently to society at large, which interact with each other.