Is COVID-19 to Blame? Trends of Incidence and Sex Ratio in Youth-Onset Type 2 Diabetes in Germany.

OBJECTIVE: We investigated the incidence of pediatric type 2 diabetes (T2D) in Germany during 2 years of the coronavirus disease 2019 (COVID-19) pandemic (2020-2021) compared with the control period 2011-2019. RESEARCH DESIGN AND METHODS: Data on T2D in children (aged 6 to <18 years) were obtained from the DPV (German Diabetes Prospective Follow-up) Registry. Poisson regression was used to estimate incidences for 2020 and 2021 based on data from 2011 to 2019, and these were compared with observed incidences in 2020 and 2021 by estimating incidence rate ratios (IRRs) with 95% CIs. RESULTS: Incidence of youth-onset T2D increased from 0.75 per 100,000 patient-years (PYs) in 2011 (95% CI 0.58, 0.93) to 1.25 per 100,000 PYs in 2019 (95% CI 1.02, 1.48), an annual increase of 6.8% (95% CI 4.1, 9.6). In 2020, T2D incidence increased to 1.49 per 100,000 PYs (95% CI 1.23, 1.81), which was not significantly higher than predicted (IRR 1.15; 95% CI 0.90, 1.48). In 2021, the observed incidence was significantly higher than expected (1.95; 95% CI 1.65, 2.31 vs. 1.38; 95% CI 1.13, 1.69 per 100,000 PYs; IRR 1.41; 95% CI 1.12, 1.77). Although there was no significant increase in incidence in girls in 2021, the observed incidence in boys (2.16; 95% CI 1.73, 2.70 per 100,000 PYs) significantly exceeded the predicted rate (IRR 1.55; 95% CI 1.14, 2.12), leading to a reversal of the sex ratio of pediatric T2D incidence. CONCLUSIONS: In Germany, incidence of pediatric T2D increased significantly in 2021. Adolescent boys were more affected by this increase, resulting in a reversal of the sex ratio of youth-onset T2D.

Stress, Stress Reduction and Obesity in Childhood and Adolescence.

BACKGROUND: Obesity in childhood and adolescence remains a great global health challenge. Stress exposure during childhood and adolescence is associated with a higher risk for obesity, yet the linkage between stress and obesity is multidimensional, and its biological and behavioral mechanisms are still not fully understood. SUMMARY: In this literature review, we identified different types of stress exposure in children and adolescents, including first studied effects of the COVID-19 pandemic as a prolonged stress exposure and their association with obesity risk. We investigated studies on the connection of altered stress biology and behavioral pathways as well as intervention programs on stress reduction in children and adolescents with obesity. Key Messages: There is evidence that stress exposure in childhood and adolescence promotes biological and behavioral alterations that contribute to the multifactorial pathogenesis of obesity. COVID-19 related-stress presents the most current example of a negative influence on weight development in children and adolescents. However, longitudinal studies on the linkage between environmental, behavioral, and biological factors across development are few, and results are partly equivocal. Intervention programs to reduce stress in children through mindfulness might be a promising adjunctive tool in the prevention and treatment of childhood and adolescent obesity that could further offer proof of concept of theoretically elaborated cause-and-effect relationships.

Predictors of Effectiveness and Adherence in a Multimodal Obesity Treatment Program for Children and Adolescents in Routine Care.

Multimodal obesity treatments for children and adolescents generally showed only small to modest treatment effects and high dropout rates. Potential variations by patients' clinical and sociodemographic factors remain, however, largely unclear. For this reason, our study analyzed psychological, physical, and sociodemographic predictors of treatment success and adherence in a multimodal obesity treatment over 12 months. The intent-to-treat sample included n = 361 children and adolescents (ages 3-17 years), of which n = 214 or 59.28% of patients completed treatment. A younger age and, in the sensitivity analysis, additionally a greater eating disorder psychopathology and treatment initiation before COVID-19 pandemic predicted greater BMI-SDS reductions (Body Mass Index-Standard Deviation Score). In contrast, predictors of treatment adherence were not found. The results underline the importance of early treatment of juvenile obesity. Additionally, eating disorder psychopathology includes restrained eating, which implies the ability to self-regulate eating behavior and therefore may have a positive effect on the treatment goal of controlled food intake. Challenges from altered treatment procedures due to the COVID-19 pandemic nonetheless remain.

Families' Worries during the First and Second COVID-19 Wave in Germany: Longitudinal Study in Two Population-Based Cohorts.

This study aimed to compare worries related to the Coronavirus disease 2019 (COVID-19) in families with young children in two regions in Germany differently affected by the pandemic (Regensburg in Southeast Germany, Leipzig in Eastern Germany) during the first and the second waves of the COVID-19 pandemic. 720 parents participating in the KUNO Kids health study in Regensburg (n = 507) or the LIFE Child study in Leipzig (n = 213) answered questions regarding COVID-19-related worries and trust in anti-pandemic policy measures during the first wave (spring 2020) and during the second wave (winter 2020/2021) of the pandemic. Ordinal mixed-effects models were performed to assess differences depending on region and time, adjusting for education and migration background. Participants worried most about the general economic situation and their family and least about their own health or financial situation. Worries about oneself, family, friends, hometown, and country were stronger during the second than during the first wave. In regional comparisons, worries about family, friends, and hometown increased more pronouncedly from wave 1 to wave 2 in Leipzig (OR ranging from 2.67 (95% CI 1.71-4.19) to 3.01 (95% CI 1.93-4.71), all p < 0.001) than in Regensburg (OR ranging from to 1.38 (95% CI 1.08-1.78) to 1.72 (95% CI 1.33-2.21), all p < 0.05), running parallel with the increase in SARS-CoV-2 infections. Trust in anti-pandemic policy measures, in contrast, decreased significantly between wave 1 and wave 2, with a stronger decrease in Regensburg (OR = 0.30 (95% CI 0.22-0.39), p < 0.001) than in Leipzig (OR = 0.91 (95% CI 0.59-1.41), n.s.). The degree of families' COVID-19-related worries differs by region and time, which might be related to differences in infection rates and public interest. Regional differences should be taken into account when developing communication strategies and policy measures during the COVID-19 pandemic.

Loss of childcare and classroom teaching during the Covid-19-related lockdown in spring 2020: A longitudinal study on consequences on leisure behavior and schoolwork at home.

AIM: In spring 2020, the first Covid-19-related lockdown included the closing of kindergartens and schools. Home schooling, the lack of social contacts with peers and the care of the children at home posed an enormous challenge for many families. METHODS: The present study investigated the leisure behavior of 285 one- to 10-year-old German children at two time points (t1 and t2) during the Covid-19-related lockdown in spring 2020. In the subsample of primary school children (n = 102), we also explored children's attitudes towards schoolwork at home. Analyses focused on the change of behavior from t1 to t2, on differences in these changes depending on socio-economic status (SES), and on associations of behavior with SES, the number of children at home, and the frequency of receiving learning materials from school. RESULTS: While the frequency of playing outside increased significantly from t1 to t2, the frequency of handicrafts, playing board games, indoor sports, and motivation to do schoolwork decreased. The observed changes between t1 and t2 did not differ depending on SES. However, a lower SES was associated with higher media use, less outdoor activity, and (though only marginally significant) a reduced time doing schoolwork and a reduced ability to concentrate on schoolwork at t1. In households with more children, children played outside more often, but were read to less frequently and (though only marginally significant) watched movies and series less frequently. Children receiving learning materials from school on a regular basis spent significantly more time doing schoolwork at home than children receiving materials only irregularly. CONCLUSIONS: A continuing loss of childcare in day-care facilities and schools entails the danger of declining education in the form of (inter)active indoor activities and schoolwork.

Age- and weight group-specific weight gain patterns in children and adolescents during the 15 years before and during the COVID-19 pandemic.

BACKGROUND/OBJECTIVES: There is a concern that measures aiming to limit a further spread of COVID-19, e.g., school closures and social distancing, cause an aggravation of the childhood obesity epidemic. Therefore, we compared BMI trends during the 15 years before and during the COVID-19 pandemic. SUBJECTS/METHODS: To assess the change in weight dynamics during the first months of COVID-19, we compared the trends of 3-month change in BMI-SDS (ΔBMI-SDS) and the proportions of children showing a high positive (HPC) or high negative (HNC) weight change between 2005 and 2019 and the respective changes from 2019 (pre-pandemic) to 2020 (after the onset of anti-pandemic measures) in more than 150,000 children (9689 during the pandemic period). The period of 3 months corresponds approximately to the first lockdown period in Germany. RESULTS: During the COVID-19 pandemic, we found a substantial weight gain across all weight and age groups, reflected by an increase in the 3-month change in BMI-SDS (ß = 0.05, p < 0.001), an increase in the proportion of children showing HPC (OR = 1.4, p < 0.001), and a decrease in the proportion of children showing HNC (OR = 0.7, p < 0.001). Besides, we found the same trends since 2005 on a low but stable level with a yearly increase of ΔBMI-SDS by ß = 0.001 (p < 0.001), the odds of HPC increased by ORhigh_pos = 1.01 (p < 0.001), and the odds of HNC decreased by ORhigh_neg = 0.99 (p < 0.001). These rather small effects accumulated to ß = 0.02, ORhigh_pos = 1.14, and ORhigh_pos = 0.85 over the whole period 2005-2019. Alarmingly, both the long-term and the short-term effects were most pronounced in the obese subgroup. CONCLUSIONS: There are positive dynamics in different measures of weight change, indicating a positive trend in weight gain patterns, especially within the group of children with obesity. These dynamics are likely to be escalated by COVID-19-related measures. Thus, they may lead to a significant further aggravation of the childhood obesity pandemic.

COVID-19 pandemic and families' utilization of well-child clinics and pediatric practices attendance in Germany.

OBJECTIVE: The COVID-19 pandemic and the measures implemented to stop the pandemic had a broad impact on our daily lives. Besides work and social life, health care is affected on many levels. In particular, there is concern that attendance in health care programs will drop or hospital admissions will be delayed due to COVID-19-related anxieties, especially in children. Therefore, we compared the number of weekly visits to 78 German pediatric institutions between 2019 and 2020. RESULTS: We found no significant differences during the first 10 weeks of the year. However, and importantly, from April, the weekly number of visits was more than 35% lower in 2020 than in 2019 (p = 0.005). In conclusion, the COVID-19 pandemic seems to relate to families´ utilization of outpatient well-child clinics and pediatric practice attendance in Germany.

Well-being and COVID-19-related worries of German children and adolescents: A longitudinal study from pre-COVID to the end of lockdown in Spring 2020.

BACKGROUND: There is concern that pandemic measures put a strain on the health and well-being of children. We investigated the effects of the COVID-19 pandemic, the lockdown, and social distancing on the well-being, media use, and emotions of children and adolescents between 9 and 18 years. METHODS: We used linear and proportional odds logistic regression correcting for age, sex, and socioeconomic status (SES) and to compare media use, peers/social support, physical, and psychological well-being between 2019 (pre-COVID baseline) and two time points shortly after the start of the lockdown (last week of March and April 2020, respectively) in 391 9-19-year-old healthy children and adolescents of the LIFE Child cohort. COVID-19-related feelings and their relationship to age, sex, and SES were assessed at two time points during lockdown. RESULTS: We found significantly lower scores in physical and psychological well-being during lockdown compared to baseline. The effect was significantly stronger in children with medium/low SES. Perceived social support scores were also significantly lower during the lockdown. The percentage of children who had no contact with their peers (in-person or online) increased from 3% pre-COVID to 14% and 13% in April and March 2020, respectively. About 80% of the children missed in-person contacts with friends. Most of the children worried more about the health of their families than their own. Sixty percent worried about the international situation at least moderately, whereas only 20% were afraid of COVID-19 itself. The percentage of children who believed it would never be as before COVID-19 rose from 7.4% at the beginning lockdown end of March to 16.2% a month later. In contrast, all other COVID-19-related worries, showed a (nonsignificant) decline during the same period. CONCLUSION: Our study supports the notion that pandemic measures have to be balanced against adverse public health effects. Especially vulnerable groups have to be protected.