Case Report: A developmental and epileptic encephalopathy 45 due to de novo variant of GABRB1.

Background: The gamma-aminobutyric acid (GABA) variant causes developmental and epileptic encephalopathy 45 (DEE45), an autosomal dominant disorder that results in oculocortical visual impairment, reduced muscle tone, psychomotor retardation, and epilepsy. Analysis of the clinical features and genetics of DEE45 may be helpful in complementing genotype-phenotype studies. Case presentation: We collected peripheral blood samples from the affected children and parents and extracted genomic DNA. Whole exome sequencing (WES) was utilized to identify the underlying disease-causing variant. WES showed that the prior carried a heterozygous variant c.686C > T p.(Ala229Val) in exon 7 of the GABRB1 (NM_000812.4), and no variant was detected in either parental sample. The child has DEE45. Conclusion: The variant c.686C > T of the GABRB1 is a possible cause of DEE45. Gene variant analysis of the relevant family lines using WES provides effective genetic counseling for developing and regressing such patients in the clinic. However, further studies are needed to verify the pathogenic mechanism.

Attitudes of Chinese residents toward sugar-sweetened beverage tax and their willingness to pay: a cross-sectional survey.

Background: Excessive consumption of sugar-sweetened beverages (SSBs) is associated with increased risks of obesity and chronic diseases. To effectively control SSB consumption, several countries including Mexico, France, and the United Kingdom have implemented SSB taxes. However, research on SSB taxes in China is limited. Objective: To assess the attitudes of Chinese residents toward the SSB tax and their willingness to pay the tax. Methods: Data were collected through a questionnaire survey among 881 respondents. The generalized ordered logit regression model and marginal effect analysis were used to analyze Chinese participants' attitudes toward SSB tax and their willingness to pay it. Results: The average monthly expenditure on SSBs was 44.8 ± 45.3 Yuan (RMB) (6.95 ± 7.02$), and 54.6% of residents supported the SSB tax; they were willing to pay, on average, 1.19 times the original price after additional tax. Age, physical exercise, self-rated health status, weight control plan, awareness of SSBs, children's consumption of SSBs, and proximity to the nearest SSB outlet significantly influenced attitudes toward tax. Notably, SSB awareness had the greatest effect on tax attitudes, with a 17% increase in the probability of supporting SSB tax for every one-level increase in SSB awareness among residents. Conclusion: Residents in China have attained a certain level of awareness of, support for, and willingness to pay SSB tax. However, promoting knowledge about the health effects of SSBs and conducting further research to evaluate the effect of SSB tax on obesity prevention in China is still essential.

Partial Oxidation of Methane to Methanol on the M-O-Ag/Graphene (M = Ag, Cu) Composite Catalyst: A DFT Study.

Partial oxidation of methane (CH4) to methanol (CH3OH) remains a great challenge in the field of catalysis due to its low selectivity and productivity. Herein, Ag-O-Ag/graphene and Cu-O-Ag/graphene composite catalysts are proposed to oxidize methane (CH4) to methanol (CH3OH) by using the first-principles calculations. It is shown that reactive oxygen species (µ-O) on both catalysts can activate the C-H bond of CH4, and in addition to CH4 activation, the catalytic activity follows the order of Ag-O-Ag/graphene (singlet) > Ag-O-Ag/graphene (triplet) ≈ Cu-O-Ag/graphene (triplet) > Cu-O-Ag/graphene (singlet). For CH3OH* formation, the catalytic activity follows the order of Cu-O-Ag/graphene (triplet) > Ag-O-Ag/graphene (triplet) > Ag-O-Ag/graphene (singlet) > Cu-O-Ag/graphene (singlet). It can be inferred that the introduction of Cu not only reduces the use of noble metal Ag but also exhibits a catalytic effect comparable to that of the Ag-O-Ag/graphene catalyst. Our findings will provide a new avenue for understanding and designing highly effective catalysts for the direct conversion of CH4 to CH3OH.

Low Dietary Diversity for Recommended Food Groups Increases the Risk of Obesity among Children: Evidence from a Chinese Longitudinal Study.

The association between dietary diversity and childhood obesity remains unclear; therefore, this longitudinal study was conducted to analyze the effect of dietary diversity on childhood obesity. One year after the first investigation, a follow-up was completed in 2010. A total of 4538 participants were included for analysis. Dietary diversity scores were calculated based on the consumption of nine recommended food groups which were categorized in accordance with the 2013 United Nations Food and Agriculture Organization guidelines. After a one-year follow-up, the low-score group underwent a significantly more considerable change in weight, body mass index, and body fat percentage than the high-score group (4.62 vs. 4.06 kg, 0.76 vs. 0.51 kg/m2, and 1.99% vs. 1.13%, respectively). Furthermore, in the low-score group, the odds ratios for overweight, obese, and overweight and obese were 1.76 (95% CI: 1.17, 2.65), 0.99 (95% CI: 0.67, 1.46), and 1.35 (95% CI: 1.01, 1.81), and the relative risks were 1.81 (95% CI: 1.03, 3.19), 2.31 (95% CI: 0.81, 6.59), and 1.98 (95% CI: 1.20,3.28), respectively. Low dietary diversity for the recommended food groups was associated with a high weight, high body mass index, and high body fat, which was associated with an increased risk of being overweight or obese in Chinese children.

The effect of steamed potato-wheat bread intake on weight, lipids, glucose, and urinary Na+/K+: A randomized controlled trial in Chinese adults.

Steamed potato bread has received much attention from nutritionists and agriculturalists since it became a staple food of China in 2015. Epidemiological studies have indicated that potatoes may cause diabetes and hypertension, but few trials have evaluated this effect. Through a clinical trial, we evaluated the effect of steamed potato bread intake on adults. In total, 49 and 30 individuals were assigned to the intervention and control groups, respectively. Potato-wheat bread (raw wheat flour and cooked potato flour in the ratio 3:7) and steamed wheat bread (100% raw wheat flour) were provided to the intervention and control groups, respectively, once a day for 4 weeks. Compared with the control group, the intervention group showed significant net changes in weight (-0.6 kg; 95% confidence interval [CI]: -1.2, -0.1; p = 0.016), body mass index (BMI, -0.2 kg/m2; 95% CI: -0.4, -0.1; p = 0.020), low-density lipoprotein cholesterol (LDL-c, -0.22 mmol/L; 95% CI: -0.49, -0.01; p = 0.035), and the urinary level of Na+/K+ (-2.4; 95% CI: -4.1, -0.7; p = 0.007). In conclusion, the steamed potato-wheat bread intake for 4 weeks resulted in decreases in weight, BMI, LDL-c, and the urinary Na+/K+ level among Chinese adults.

Speed of Movement, Fatness, and the Change in Cardiometabolic Risk Factors in Children.

We aimed to examine speed of movement and its interactive association with fatness to changes in cardiometabolic risk factors over one year in children. The analysis included 8345 children aged 6-13 years. Cardiometabolic risk score was computed by summing Z-scores of waist circumference, the average of systolic and diastolic blood pressure, fasting glucose, high-density lipoprotein cholesterol (multiplied by -1), and triglycerides. Both high baseline and improvement in speed of movement were associated with favourable changes in percent body fat, lipids, and cardiometabolic risk score. Percentages of the association between baseline speed of movement and changes in cardiometabolic risk score, triglycerides, and high-density lipoprotein cholesterol explained by baseline BMI were 24.6% (19.6-29.1%), 26.2% (19.7-31.1%), and 12.5% (9.6-15.4%), respectively. The corresponding number for percent body fat was 47.0% (40.4-54.1%), 43.3% (36.7-51.7%), and 29.8% (25.0-34.6%), respectively. Speed of movement mediated the association between fatness and cardiometabolic risk factors. Improved speed of movement was associated with a lower increase in blood pressure in obese children only. Speed of movement is a strong predictor of changes in cardiometabolic risk factors. Fatness and speed of movement are interactively associated with cardiometabolic risk factors. Speed of movement may attenuate the positive association between fatness and blood pressure.

Evidence based systematic review on the association between social built environment and childhood obesity / 中国学校卫生

Objective@#To evaluate the impact of community built environment and the distribution of fast food restaurants on childhood obesity, and to provide evidence support for childhood obesity prevention and control strategies in China.@*Methods@#A systematic review method was used to search relevant literatures published to November 30，2020 from 8 databases including CNKI, VIP, Wanfang Data, PubMed, SpringerLink, Web of Science, Science Direct. The high quality system reviews published since 2016 were included directly, and those published before 2016 were reviewed before combined with other literatures.@*Results@#A total of 20 articles were included for evaluation, including systematic reviews, cohort studies, randomized controlled trials and cross sectional studies. High walkability near the living area could increase children s physical activity levels and reduce the risk of obesity. The fast food sales environment increased the risk of obesity; while large supermarkets or health food sales environment could reduce the risk of obesity.@*Conclusion@#Improving walking suitability in residential areas and reducing the density of unhealthy fast food sales could help decrease the risk of childhood obesity.

Evidence based systematic review on the association between sugar sweetened beverages tax and childhood obesity / 中国学校卫生

Objective@#To evaluate the impact of sugar sweetened beverages (SSBs) tax on childhood obesity by literatures reveiew, and to provide evidence support for childhood obesity prevention and control strategies in China.@*Methods@#A systematic review method was used to search relevant literatures published to November 30，2020 from 8 databases including CNKI, VIP, Wanfang Data, PubMed, Medline, SpringerLink, Web of Science, and Science Direct. The high quality system reviews published since 2016 were included directly, and those published before 2016 were rereviewed before combined with other literatures.@*Results@#Twelve studies including 5 systematic reviews (or Meta analysis), 1 cohort study and 6 cross sectional studies were included. Comprehensive analysis showed that the prevention effect on childhood obesity was small or even ineffective if the tax on SSBs lower than 5%, a certain protective effect on childhood obesity could be shown if the tax on SSBs increased to 20%. From the perspective of cost benefit analysis, the implementation of SSBs tax showed certain net benefits.@*Conclusion@#SSBs tax can help reduce the risk of childhood obesity.

Evidence based systematic review on the association between food advertising with childhood obesity / 中国学校卫生

Objective@#To evaluate the impact of food advertising on childhood obesity by reviewing relevant literatures, and to provide evidence support for childhood obesity prevention and control strategies in China.@*Methods@#A systematic review method was used to search relevant literatures published to November 30，2020 from 8 databases including CNKI, VIP, Wanfang Data, PubMed, Medline, SpringerLink, Web of Science, Science Direct. The high quality systematic reviews published since 2016 were included directly, and those published before 2016 were rereviewed after combined with other literatures.@*Results@#A total of 13 articles were included for evaluation, including systematic reviews, cohort studies, randomized controlled trials and cross sectional studies. Children s exposure to food advertisements could increase energy intake. Television food advertising could influence children s food choices and increase the consumption of unhealthy foods such as sweets and sugary drinks. Children s exposure to unhealthy food advertisements could increase the risk of obesity.@*Conclusion@#Regulating the food advertisement can help reduce the risk of childhood obesity.

Promoting childhood obesity prevention and control through social environment optimization / 中国学校卫生

Abstract@#Obesity has become a global public health problem that affects human health and poses a huge threat to the health of children in China. More and more studies have shown that social environment including social culture, food tax, food advertising and marketing, community food environment and community built environment exerts impact on childhood obesity. With the aim of fully developing the Healthy China and building a moderately prosperous society in all respects, as well as achieving the goal of "Achieving socialist modernization by 2035", it is also necessary to strengthen the comprehensive social environment, develop a sustainable and health supported environment for childhood obesity control and healthy growth and development for all children.

Effect of Comprehensive Interventions Including Nutrition Education and Physical Activity on High Blood Pressure among Children: Evidence from School-Based Cluster Randomized Control Trial in China.

Childhood hypertension has increasingly become a public health problem globally. However, limited literature research examined the effect of comprehensive interventions including nutrition education and physical activity on blood pressure among children. A total of 6764 children aged 7-13 years were analyzed based on a multicenter randomized controlled trial for comprehensive interventions in 30 primary schools in China to evaluate the effects on blood pressure, which lasted for two semesters. The standards used for the diagnosis of high blood pressure were the cut-off points based on age and sex for Chinese children. Compared with the control group, the intervention effects were -0.5 mm Hg (95% confidence interval (CI): -1.1, 0; p = 0.064) for diastolic blood pressure and -0.9 mmHg (95% CI: -1.5, -0.3; p = 0.005) for systolic blood pressure. For the incidence of high blood pressure, the changes were -1.4% in the intervention group and 0.4% in the control group (1.8% difference between the two groups, p = 0.015) after trial. The school-based comprehensive interventions appeared to have moderate effects on high blood pressure prevention among children in China.

Cost-utility and cost-benefit analyses of school-based obesity prevention program.

BACKGROUND: Economic evaluation of school-based obesity interventions could provide support for public health decision of obesity prevention. This study is to perform cost-utility and cost-benefit assessment of three school-based childhood obesity interventions including nutrition education intervention (NE), physical activity intervention (PA) and comprehensive intervention (both NE and PA, CNP) with secondary data analysis of one randomized controlled trial. METHODS: The standard cost-effectiveness analysis methods were employed from a societal perspective to the health outcome and costs that are attributable to the intervention. NE, PA and CNP were carried out separately for 2 semesters for childhood obesity interventions in primary schools. The additional quality-adjusted life years (QALYs) resulting from the interventions were measured as the health outcome. A cost-utility ratio (CUR) and A cost-benefit ratio (CBR) was calculated as the ratio of implementation costs to the total medical and productivity loss costs averted by the interventions. RESULTS: The CUR and CBR were ¥11,505.9 ($1646.0) per QALY and ¥1.2 benefit per ¥1 cost respectively, and the net saving was ¥73,659.6 ($10,537.9). The CUR and CBR for nutrition education and physical activity interventions were ¥21,316.4 ($3049.6) per QALY and ¥0.7 benefit per ¥1 cost, ¥28,417.1 ($4065.4) per QALY and ¥0.4 benefit per ¥1 cost, respectively (in 2019 RMB). Compared with PA intervention, the ICERs were ¥10,335.2 ($1478.6) and 4626.3 ($661.8) for CNP and NE respectively. The CBR was ¥1.2, 0.7, and 0.4 benefits per ¥1 cost for CNP, NE, and PA interventions, respectively. Net estimated savings were achieved only through CNP intervention, amounting to ¥73,659.6 ($10,537.9). CONCLUSIONS: Comprehensive school-based obesity intervention is a beneficial investment that is both cost-effective and cost saving. Compared with PA intervention, both CNP and NE intervention were more cost-effective.

Leading dietary determinants identified using machine learning techniques and a healthy diet score for changes in cardiometabolic risk factors in children: a longitudinal analysis.

BACKGROUND: Identifying leading dietary determinants for cardiometabolic risk (CMR) factors is urgent for prioritizing interventions in children. We aimed to identify leading dietary determinants for the change in CMR and create a healthy diet score (HDS) to predict CMR in children. METHODS: We included 5676 children aged 6-13 years in the final analysis with physical examinations, blood tests, and diets assessed at baseline and one year later. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure (SBP and DBP), fasting glucose, high-density lipoprotein cholesterol (HDL-C, multiplying by - 1), and triglycerides. Machine learning was used to identify leading dietary determinants for CMR and an HDS was then computed. RESULTS: The nine leading predictors for CMRS were refined grains, seafood, fried foods, sugar-sweetened beverages, wheat, red meat other than pork, rice, fungi and algae, and roots and tubers with the contribution ranging from 3.9 to 19.6% of the total variance. Diets high in seafood, rice, and red meat other than pork but low in other six food groups were associated with a favorable change in CMRS. The HDS was computed based on these nine dietary factors. Children with HDS ≥8 had a higher decrease in CMRS (ß (95% CI): - 1.02 (- 1.31, - 0.73)), BMI (- 0.08 (- 0.16, - 0.00)), SBP (- 0.46 (- 0.58, - 0.34)), DBP (- 0.46 (- 0.58, - 0.34)), mean arterial pressure (- 0.50 (- 0.62, - 0.38)), fasting glucose (- 0.22 (- 0.32, - 0.11)), insulin (- 0.52 (- 0.71, - 0.32)), and HOMA-IR (- 0.55 (- 0.73, - 0.36)) compared to those with HDS ≦3. Improved HDS during follow-up was associated with favorable changes in CMRS, BMI, percent body fat, SBP, DBP, mean arterial pressure, HDL-C, fasting glucose, insulin, and HOMA-IR. CONCLUSION: Diets high in seafood, rice, and red meat other than pork and low in refined grains, fried foods, sugar-sweetened beverages, and wheat are leading healthy dietary factors for metabolic health in children. HDS is strongly predictive of CMR factors.

The effect of comprehensive intervention for childhood obesity on dietary diversity among younger children: Evidence from a school-based randomized controlled trial in China.

BACKGROUND: Little evidence from developing countries on dietary transition demonstrates the effects of comprehensive childhood obesity interventions on dietary diversity and food variety among younger children. This study aimed to evaluate the effects of comprehensive childhood obesity interventions on dietary diversity among younger children. METHODS: A total of 4846 children aged 7-13 years were included based on a multicenter randomized controlled trial for childhood obesity interventions in 38 primary schools. Nutrition education intervention (NE), physical activity intervention (PA) and comprehensive intervention including both NE and PA (CNP) were carried out separately for 2 semesters. Dietary Diversity Score (DDS9 and DDS28 for 9 and 28 food groupings, respectively), Food Variety Score (FVS, the number of food items) and the proportions of different foods consumed were calculated according to the food intake records collected with the 24-h dietary recall method. RESULTS: The intervention effects per day of comprehensive intervention group were 0 (95% Confidence Interval (CI): 0, 0.1; p = 0.382) on DDS9, 0.1 (95% CI: -0.1, 0.2; p = 0.374) on DDS28 and 0.1 (95% CI: -0.1, 0.3; p = 0.186) on FVS of overall diet, which was 0.1 (95% CI: 0, 0.1; p < 0.001) on DDS9, 0 (95% CI: 0, 0.1; p = 0.168) on DDS28 and 0.1 (95% CI: 0, 0.1; p = 0.067) on FVS of dietary scores of breakfast only. Additionally, CNP group had greater increases in cereals, meat and fruits, and more decreases in eggs, fish and dried legumes consumption proportions as compared with the control group. Decreasing side effect on dietary diversity and food variety were found for PA intervention, but not for NE intervention only. CONCLUSIONS: Though the comprehensive obesity intervention didn't improve the overall dietary diversity per day, the positive intervention effects were observed on breakfast foods and some foods' consumption.

Independent and Interactive Associations of Fitness and Fatness With Changes in Cardiometabolic Risk in Children: A Longitudinal Analysis.

Background: Findings for associations between cardiorespiratory fitness (CRF) and cardiometabolic risk (CMR) factors are inconsistent, and the interactive association between CRF and fatness with CMR factors is unclear in children. Our study aimed to examine whether CRF and fatness are independently and interactively associated with CMR factors. Methods: We included 5,869 children aged 6-13 years in the analysis. Physical examinations, blood tests, and CRF were measured at baseline and 1 year later. Cardiometabolic risk score (CMRS) was computed by summing Z scores of waist circumference (WC), averaged systolic and diastolic blood pressure, glucose, high-density lipoprotein cholesterol (HDL-C, multiplied by -1), and triglycerides. Results: There was a high correlation between fatness and CRF in both boys and girls. High baseline CRF was independently associated with favorable changes in CMRS, BMI, WC, percent body fat (PBF), total cholesterol, LDL-C, and HDL-C (all P < 0.025). Improved CRF was independently associated with favorable changes in CMRS, BMI, WC, PBF, total cholesterol, LDL-C, HDL-C, triglycerides, and fasting glucose (all P < 0.0321). Baseline BMI was positively associated with changes in CMRS, WC, blood pressure, triglycerides, insulin, and HOMA-IR (all P < 0.0462). Low PBF at baseline was associated with favorable changes in CMRS, BMI, WC, blood pressure, HDL-C, triglycerides, insulin, and HOMA-IR (all P < 0.0423). The percentage of the total effect of baseline CRF on changes in CMRS, triglycerides, HDL-C, PBF, and WC mediated by baseline BMI was 66.0, 61.6, 40.3, 20.7, and 9.2%, respectively. Baseline CRF was a significant mediator for the association between baseline BMI and changes in CMRS (mediated by 4.3%), triglycerides (5.1%), and HDL-C (12.0%). An inverse association was found between baseline CRF and CMRS in children with high baseline BMI/PBF only. Improved CRF was associated with decreased BMI and WC in children with low baseline CRF. Conclusions: Fatness and CRF are each independently associated with changes in CMR factors. Fatness is a major mediator for the association between CRF and CMR factors, whereas the association between fatness and CMR factors is also mediated by CRF. The beneficial effect of high CRF on CMR factors was more evident in obese or unfit children.

Healthy breakfast habits and changes in obesity-related cardiometabolic markers in children: a longitudinal analysis.

BACKGROUND: Data on the association of breakfast habits and changes in cardiometabolic markers in children are limited. METHODS: In total, 6964 children aged 6-13 years from Beijing, Shanghai, Chongqing, Jinan, Harbin, and Guangzhou were included in the final analysis. Daily consumption, consumption of ≥3 food groups, and at-home consumption were defined as healthy breakfast habits. Blood pressure, % fat mass, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, glucose, and 50-m × 8 shuttle run were measured at baseline (May 2009) and follow-up (May 2010). Clustered cardiometabolic risk score (CCRS) was computed by summing Z scores of five components: % fat mass, systolic blood pressure, glucose, TC to HDL-C ratio, and triglyceride. RESULTS: Children who ate breakfast daily had a higher decrease in TC to HDL-C ratio and a higher increase in HDL-C compared with breakfast skippers (both P values < 0.05). There was an inverse association of the number of food groups consumed at breakfast with the change in CCRS (P trend = 0.005). At-home breakfast consumption was associated with a lower increase in BMI, LDL-C, TC to HDL-C ratio, fasting glucose, and 50-m × 8 shuttle run and a higher increase in HDL-C (all P values < 0.05). Children with two or three healthy breakfast habits had a lower increase in CCRS, LDL-C, TC to HDL-C ratio, glucose, and a higher increase in HDL-C compared with those with none or one (all P values < 0.05). CONCLUSIONS: Healthy breakfast habits might help minimize the cardiometabolic risk factors in children.

Effect of Steamed Potato Bread Intake on Glucose, Lipids, and Urinary Na+ and K+: A Randomized Controlled Trial with Adolescents.

Although potatoes are highly nutritious, many epidemiological studies have connected their consumption with abnormal lipids, diabetes, and hypertension. Steamed potato bread has recently become one of China's staple foods. A randomized controlled trial was designed to evaluate the effect of steamed potato bread consumption on Chinese adolescents. Four classes from a high school were randomly selected and assigned to the intervention group (two classes) or control group (two classes). The steamed wheat bread (100% raw wheat flour) and potato bread (raw wheat flour to cooked potato flour ratio of 3:7) were provided to the control group and intervention group as staple food once a school day for 8 weeks, respectively. Compared with the control group, the intervention group had significant net changes in systolic blood pressure (4.6 mmHg, p = 0.010), insulin (-4.35 mIU/L, p < 0.001), total cholesterol (-0.13 mmol/L, p = 0.032), and high-density lipoproteins cholesterol (-0.07 mmol/L, p = 0.010). The urinary level of Na+/K+ did not differ between the groups. In conclusion, the intake of steamed potato bread for 8 weeks resulted in positive effects on the total cholesterol and insulin profiles but a negative effect on the systolic blood pressure and high-density lipoproteins cholesterol of adolescents.

Meal Patterns and Changes in Cardiometabolic Risk Factors in Children: A Longitudinal Analysis.

We examined whether energy and macronutrient intake from different meals was associated with changes in cardiometabolic risk (CMR) factors in children. CMR score (CMRS) was computed by summing Z-scores of waist circumference, the average of systolic and diastolic blood pressure, fasting glucose, high-density lipoprotein cholesterol (multiplying by -1), and triglycerides. We included 5517 children aged 6-13 years from six major cities in China. Five meal patterns were identified according to energy intake: balanced, breakfast dominant, lunch dominant, dinner dominant, and snack dominant patterns. These patterns were not significantly associated with changes in CMR factors. Carbohydrate intake (% energy) at lunch was positively associated with the change in CMRS (beta coefficient (95% CI): (0.777 (0.509, 1.046) in quintile 5 versus quintile 1). A positive association between carbohydrate intake at dinner and change in CMRS was observed. High protein intake at both lunch and dinner was associated with a favorable change in CMRS. Moderate fat intake at lunch was associated with a lower increase in CMRS. Meal patterns driven by energy were not significantly associated with CMR factors; however, a low carbohydrate-high protein-moderate fat lunch and low carbohydrate-high protein dinner were associated with favorable changes in CMRS in children.

Effect of multidimensional lifestyle interventions on metabolic risk reduction in children: a cluster randomised controlled trial.

Few clinical trials have investigated lifestyle intervention effect on metabolic health in children. The study aimed to examine the effect of diet and physical activity intervention on the reduction of clustered metabolic risk score (CMRS) in children and moderators and mediators of the intervention effect. A multicentre, clustered randomised controlled trial was conducted with examination conducted at baseline and after intervention over one year. 7110 children (49.7% girls) with a mean of 9.06 (95% CI: 9.03, 9.09) years were included in the analysis. In Beijing, each three schools were randomly assigned to diet-only, physical activity-only intervention and control groups. In five other urban cities, each 15 schools were randomly assigned to comprehensive intervention and control groups. CMRS was computed by summing the Z scores of % fat mass, systolic blood pressure, fasting glucose, ratio of cholesterol to high-density lipoprotein, and triglyceride. Compared with controls (n = 2808), children in the comprehensive intervention group (n = 2848) had more reduction in CMRS (multivariate-adjusted mean difference (95% CI): -0.49 (-0.85, -0.14)). The body mass index (BMI) reduction explained 7.3% (95% CI 2.8%-18.1%) of the total intervention effect. The intervention was more effective in children with higher birthweight, lower parental BMI, or complete parental data. Diet-only or physical activity-only intervention had non-significant effects on CMRS reduction. Our multidimensional comprehensive intervention resulted in significant reduction in CMRS in primary school children and this effect was modified by birthweight, parental BMI, and parental involvement. A minority of metabolic risk reduction was mediated through BMI. Clinical Trial Registry number and website: ChiCTR-PRC-09000402, URL: http://www.chictr.org.cn.

The Clustering of Low Diet Quality, Low Physical Fitness, and Unhealthy Sleep Pattern and Its Association with Changes in Cardiometabolic Risk Factors in Children.

The clustering of diet quality, physical activity, and sleep and its association with cardiometabolic risk (CMR) factors remains to be explored. We included 5315 children aged 6-13 years in the analysis. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure, fasting glucose, high-density lipoprotein cholesterol (multiplying by -1), and triglycerides. Low diet quality and low cardiorespiratory fitness (CRF) were more likely to be seen in a pair, but low diet quality was less likely to be clustered with unhealthy sleep patterns. Low diet quality, low CRF, and unhealthy sleep pattern was associated with a 0.63, 0.53, and 0.25 standard deviation (SD) higher increase in CMRS, respectively. Compared to children with no unhealthy factor (-0.79 SD), those with ≥1 unhealthy factor had a higher increase (-0.20 to 0.59 SD) in CMRS. A low diet quality-unhealthy sleep pattern resulted in the highest increase in CMRS, blood pressure, and triglycerides. A low diet quality-low CRF-unhealthy sleep pattern resulted in the highest increase in fatness and fasting glucose. Unhealthy factor cluster patterns are complex; however, their positive associations with changes in CMR factors are consistently significant in children. Some specific patterns are more harmful than others for cardiometabolic health.