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OBJECTIVE: This study aimed to assess the trend and factors associated with central obesity in four cross-sectional panels in schoolchildren aged 7-14 years between 2002 and 2019. METHODS: Waist circumference data were used to assess central obesity, and independent variables were gender, age, school shift (morning and afternoon), commuting to school method, mother's schooling, and family income. The chi-square test was used to assess the association between outcome and independent variables, and binary logistic regression was used to assess the predictors of central obesity and the effect size by odds ratio. RESULTS: In total, 9939 students participated in all years of the research. The prevalence of central obesity was 26.4%, 27.1%, 30.0%, and 32.9% in 2002, 2007, 2013, and 2019, with an increase of ~25% between 2002 and 2019. In the adjusted analysis, schoolchildren assessed in 2019 were more likely to have central obesity at 49% (95% CI: 1.26-1.76), those who commuted passively had a probability of 13% (95% CI: 1.03-1.25) of being centrally obese; females and children aged 11-14 were 14% (95% CI: 0.78-0.94) and 13% (95% CI: 0.78-0.98) less likely to be centrally obese. CONCLUSION: These findings reinforce the need to strengthen and expand public actions and policies that encourage a healthier and active lifestyle.
Assuntos
Obesidade Abdominal , Humanos , Brasil/epidemiologia , Estudos Transversais , Obesidade Abdominal/epidemiologia , Criança , Masculino , Feminino , Adolescente , Prevalência , Obesidade Infantil/epidemiologia , Fatores de RiscoRESUMO
OBJECTIVE: To assess the association between the combination of corporal adiposity (CA) and cardiorespiratory physical fitness (CRF) with cardiometabolic risk factors in children aged 7-10 years. METHODS: Cross-sectional observational study with a sample of 251 children registered in Family Health Units. Sociodemographic, lifestyle, anthropometric, biochemical, blood pressure, and CRF data were collected. Cardiometabolic risk factors assessed: total cholesterol, HDL-c, LDL-c, triglycerides (TG), fasting glucose and blood pressure. CRF was assessed by the 6-minute run/walk test and classified into: "physically unfit" and "physically fit". Nutritional status was assessed by body mass index (BMI)/age and categorized into CA groups: "no excess weight [≤ z-score+1]" and "excess weight [> z-score+1]". CRF and CA were combined, and the children were classified as "no excess weight + physically fit", "no excess weight + physically unfit", "excess weight + physically fit" and "excess weight + physically unfit". Bivariate analyses were performed, and Poisson regression models were tested. The Statistical Package for the Social Sciences (SPSS) version 21.0 software was used, adopting p<0.05. RESULTS: Around 65% of the children had low CRF and 59% had excess weight (overweight+obesity). After adjustment, there was a greater occurrence of having altered HDL-c, TG and presence of ≥ 3 grouped cardiometabolic factors among those who had excess weight + physically unfit. CONCLUSIONS: The prevalence of altered HDL and TG and of ≥3 grouped cardiometabolic risk factors was significantly higher among children who had excess weight and were physically unfit.
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Adiposidade , Fatores de Risco Cardiometabólico , Aptidão Cardiorrespiratória , Humanos , Estudos Transversais , Criança , Masculino , Feminino , Aptidão Cardiorrespiratória/fisiologia , Adiposidade/fisiologia , Obesidade Infantil/epidemiologia , Índice de Massa Corporal , Fatores de Risco , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologiaRESUMO
INTRODUCTION: Childhood obesity is a major global public health issue globally and in Brazil. The impacts of childhood obesity include higher risk of disease during childhood and of obesity and non-communicable diseases in adulthood and represent an important epidemiological and economic burden to countries. This study aims to analyze the trends and to estimate the direct healthcare costs of childhood and adolescent obesity to the National Health System from 2013 to 2022. METHODS: We used Prais-Winsten regressions for determining the trends in the prevalence of obesity and modeled the attributable to childhood and adolescent obesity in the Brazilian National Health System using previous meta-analysis of studies. RESULTS: The hospitalizations of children and adolescents with obesity as a primary cause totaled Int$2.6 million to the Brazilian National Health System from 2013 to 2022, demonstrating that obesity is rarely considered as a cause of hospitalization especially among children and adolescents. The additional costs of hospitalizations attributable to childhood obesity totaled Int$101.5 million during the same period. The additional non-hospital, outpatient and medication cost attributable to childhood obesity in Brazil were estimated at Int$6.0 million, so the total estimated healthcare costs were of approximately Int$107.5 million in the last decade. CONCLUSION: This study highlights that childhood and adolescent obesity are increasing for most age-groups and that its costs are not limited to the economic impacts on adult health and represent a relevant economic burden to the Brazilian National Health System and to families because of additional costs during childhood and adolescence. Therefore, the prevention and control of childhood and adolescent obesity must be public health priorities.
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Custos de Cuidados de Saúde , Hospitalização , Obesidade Infantil , Humanos , Adolescente , Brasil/epidemiologia , Criança , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/tendências , Prevalência , Obesidade Infantil/epidemiologia , Obesidade Infantil/economia , Masculino , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Pré-EscolarRESUMO
BACKGROUND: Alterations in spatiotemporal parameters during walking modify and limit movement capacity in children with obesity. This study aimed to describe and compare the alterations in spatiotemporal parameters in schoolchildren according to body weight during all phases of walking. METHODS: We carried out a cross-sectional study of 94 schoolchildren aged 6 to 12 years and divided them into three study groups (normal weight, overweight, and obesity). Subsequently, we performed a gait study using a 3D motion analysis system and extracted the spatiotemporal parameters, and we compared the parameters obtained between the study groups. RESULTS: The stride length in both limbs was lower in schoolchildren with obesity compared to the overweight group, with a mean difference of 0.08 m on the right side (CI 95% 0.01-0.16; p = 0.02) and 0.09 m on the left side (CI 95% 0.01-0.17; p = 0.02); also, on the left side, the swing speed (m/s) was lower in the children with obesity than in the normal weight group, with a mean difference of 0.23 m/s (CI 95% 0.03-0.43; p = 0.01). Lastly, the step width (m) was greater in the group of schoolchildren with obesity compared to the normal weight group, with a difference of 0.05 m (CI 95% 0.01-0.09; p = 0.01). A moderate positive correlation was found between the width of the step and the weight gain, r = 0.41 (p < 0.001). However, we found a poor correlation between right stride length (m), left side swing speed (m/s), left stride length (m), and weight gain, r = 0.26 (p = 0.01), r= -0.21 (p = 0.04) and r = 0.21 (p = 0.04), respectively. CONCLUSIONS: Spatiotemporal parameters such as stride length, swing speed, and step width were more altered in schoolchildren with obesity and correlated with body weight gain.
Assuntos
Marcha , Obesidade Infantil , Humanos , Estudos Transversais , Criança , Masculino , Feminino , Marcha/fisiologia , Obesidade Infantil/fisiopatologia , Obesidade Infantil/epidemiologia , Obesidade Infantil/diagnóstico , Sobrepeso/epidemiologia , Sobrepeso/fisiopatologia , Análise da Marcha , Caminhada/fisiologia , Fenômenos BiomecânicosRESUMO
OBJECTIVE: To describe independent factors related to the interaction of FTO rs9939609, TMEM18 rs6548238, leptin, and adiponectin in children/adolescents with asthma, under the influence of obesity. METHODS: The authors performed a cross-sectional study with 57 children/adolescents, ages 8-19 years, at a tertiary hospital, from 2017 to 2018. Participants were classified by nutritional status, performed spirometry with a bronchodilator test and completed an asthma questionnaire, higher scores indicated more asthma symptoms. Two asthma groups were formed: Group 1(G1)-normal-weight; Group 2(G2)-overweight/obese. Serum was collected for adipokines (n = 32) and genetic polymorphisms (n = 53) dosages. RESULTS: Age and body mass index (BMI) correlated directly in normal-weight (p = 0.009) and obese participants (p = 0.004). Girls reported more asthma complaints (p = 0.044). Participants with negative bronchodilator responses presented lower BMI (14.55-17.16) than responders (19.4-26.84) (p = 0.049). Leptin dosages are related directly to BMI (5,34-40 ng/ml in obese × 0,54-42 ng/ml in nonobese) (p = 0.003). Levels were high in girls (4.78-17.55 µg/ml) (p = 0.029) and low in nonobese boys (0.54-6.92 µg/ml) (p = 0.006). In obese, low leptin levels (< 10 ng/ml) were found in small airway dysfunction carriers (p = 0.025); elevated adiponectin (> 5 µg/ml) correlated with FEV1/FVC > 80 % (p = 0.035) and positive bronchodilator tests (8.84-13 µg/ml) (p = 0.039); and FTO A allele correlated with low adiponectin 0-8.84 µg/ml (p = 0.021) and low FEV1/FVC (46 %-88 %) (p = 0.023). CONCLUSION: BMI correlated directly with age and leptin levels. Obese participants presented high serum levels of leptin and FTO A allele correlated with low FEV1/FVC. Larger cohorts are necessary for better elucidation of the role of adipokines and polymorphisms in the pathophysiology of asthma and obesity.
Assuntos
Adiponectina , Adiposidade , Dioxigenase FTO Dependente de alfa-Cetoglutarato , Asma , Índice de Massa Corporal , Leptina , Proteínas de Membrana , Humanos , Asma/genética , Asma/sangue , Asma/fisiopatologia , Feminino , Masculino , Adolescente , Criança , Estudos Transversais , Leptina/sangue , Adiponectina/sangue , Adiponectina/genética , Proteínas de Membrana/genética , Proteínas de Membrana/sangue , Dioxigenase FTO Dependente de alfa-Cetoglutarato/genética , Adiposidade/genética , Adulto Jovem , Obesidade Infantil/genética , Obesidade Infantil/sangue , Adipocinas/sangue , Polimorfismo GenéticoRESUMO
OBJECTIVE: The objective of this study was to analyze the implications of social contingency measures and interruption of outpatient follow-up on weight gain in children and adolescents with a previous diagnosis of obesity. METHODS: This is an observational study with data from electronic medical records of children and adolescents followed up at a specialized outpatient clinic from 2019 to 2023. Weight gain, height, BMI variation, BMI z-score, laboratory tests, and associated comorbidities were analyzed. The data were computed and analyzed using the Statistical Package for the Social Sciences (SPSS), and the results were considered statistically significant when p<0.05. RESULTS: There was a weight gain of approximately 17.66% in the total set of participants, corresponding to a median increase of 14 kg. When analyzing between genders, we observed an approximate increase of 21.38% in body weight for men, while for women, it was 21.45%. CONCLUSIONS: The COVID-19 pandemic has led to significant weight gain among previously obese children and adolescents in follow-up at a specialized outpatient clinic.
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Índice de Massa Corporal , COVID-19 , Obesidade Infantil , Aumento de Peso , Humanos , COVID-19/epidemiologia , Masculino , Adolescente , Feminino , Criança , Obesidade Infantil/epidemiologia , Pandemias , SARS-CoV-2 , Brasil/epidemiologiaRESUMO
INTRODUCTION: Rapid climate changes in the early 21st century have triggered a global syndemic intertwining obesity, undernutrition and climate change, profoundly affecting health, especially children. Despite increasing research, a significant gap persists in understanding the mechanisms linking climate change to child malnutrition, particularly in children under 5 years old. This protocol proposes a scoping review to address this gap, with the aim of mapping the available evidence on the relationship between climate change and malnutrition among children under 5 years old. METHODS AND ANALYSIS: This scoping review will be conducted according to the Joanna Briggs Manual for Evidence Synthesis, and the results will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist to ensure a replicable process. The search will be conducted using MEDLINE (PubMed), Web of Science, Scopus and Embase databases. The studies to be included will be selected according to the inclusion and exclusion criteria defined based on the Population, Concept and Context technique. The study population will consist of children under 5 years old, with a focus on examining the impact of climate change on health outcomes related to nutrition, obesity and undernutrition. Original articles in English, Spanish and Portuguese will be selected without any restrictions on the publication year. Two researchers will independently select the articles and extract the data. The results will be presented through narrative synthesis. ETHICS AND DISSEMINATION: This study relies on analysing existing scientific literature and does not require ethical approval. The outcomes of this scoping review will be submitted for publication in a peer-reviewed journal, with a preference for open access. STUDY REGISTRATION: OSF (osf.io/swt4b).
Assuntos
Transtornos da Nutrição Infantil , Mudança Climática , Pré-Escolar , Humanos , Lactente , Transtornos da Nutrição Infantil/epidemiologia , Obesidade Infantil/epidemiologia , Projetos de Pesquisa , Revisões Sistemáticas como AssuntoRESUMO
Introducción. Adolescentes con exceso de peso confrontan a diario con estereotipos que condicionan su imagen corporal, autoestima y ánimo. Objetivos. Describir, en adolescentes con exceso de peso, las vivencias subjetivas relativas al cuerpo en la vida diaria y sus percepciones respecto a las intervenciones y empatía del equipo de salud. Población y métodos. Estudio descriptivo con enfoque cualitativo. Se realizaron entrevistas semiestructuradas a adolescentes entre 11 y 18 años con índice de masa corporal (IMC) ≥ 26 autorreferenciado y/o que refirieran seguimiento médico o nutricional por exceso de peso, asistidos en el Servicio de Adolescencia de un hospital de la Ciudad Autónoma de Buenos Aires, entre el 1 de octubre de 2021 y el 31 de mayo de 2022. Resultados. Se evaluaron 20 adolescentes, con mediana de edad de 13,5 años, mayoritariamente de sexo femenino (16/20). La totalidad refirió insatisfacción corporal desde edades tempranas (edad mediana: 10 años). Mencionan dificultad para vestirse por falta de talles; limitan incluso la práctica deportiva. Padecieron humillación corporal relacionada con el peso en la escuela, la familia o la vía pública (15/20). Percibieron el control de peso de manera dual: su descenso fue el principal estímulo del tratamiento, pero su centralidad en las consultas generó malestar. Las principales causas de abandono terapéutico fueron la imposibilidad de sostener temporalmente las recomendaciones y la falta de descenso de peso. Se percibió del equipo tratante buena predisposición y escucha, pero cierta incomprensión sobre las vivencias cotidianas, condicionamientos físicos, materiales, estéticos, sociales, de sus creencias y percepciones.
Introduction. Overweight adolescents are confronted daily with stereotypes that condition their body image, self-esteem, and mood. Objectives. To describe, in adolescents with overweight, the subjective experiences related to the body in daily life and their perceptions regarding the interventions and empathy of the health team. Population and methods. Descriptive study with qualitative approach. Semi-structured interviews were conducted with adolescents aged 11 to 18 years with selfreported mass index (BMI) ≥ 26 and referring to medical or nutritional follow-up for overweight, attended at the Adolescence Service of a hospital in the Autonomous City of Buenos Aires, between October 1, 2021, and May 31, 2022. Results. Twenty adolescents were evaluated, with a median age of 13.5 years, most of them from female sex (16/20). All reported body dissatisfaction from an early age (median age: 10 years old). They mention difficulty dressing due to the lack of different sizes; they even limit sports practice. They suffered weightrelated body humiliation at school, in the family, or public (15/20). They perceived weight control in a dual way: weight loss was the primary stimulus for treatment, but its centrality in the consultations generated discomfort. The leading causes of therapeutic abandonment were the impossibility of temporarily sustaining the recommendations and the lack of weight loss. The treating team was willing to listen to the patients but needed to understand their daily experiences, physical, material, esthetic, social conditioning, beliefs,and perceptions. Conclusion. The adolescents included in this study perceived specific interventions of the healthcare team as beneficial, with empathic deficiencies
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Imagem Corporal/psicologia , Empatia , Sobrepeso/psicologia , Sobrepeso/terapia , Equipe de Assistência ao Paciente/organização & administração , Autoimagem , Epidemiologia Descritiva , Obesidade Infantil/psicologia , Obesidade Infantil/terapiaRESUMO
Introducción. Los mayores valores de sobrepeso y obesidad infantil de Latinoamérica corresponden a Argentina, condición que incrementa el riesgo de obesidad en la adultez, diabetes tipo 2, enfermedades cardiovasculares, cerebrovasculares y otras. Más del 25 % de los casos de obesidad infantojuvenil pueden atribuirse al consumo de bebidas azucaradas (BA). El objetivo fue evaluar la carga de enfermedad y la económica del consumo de BA en niños y adolescentes rionegrinos; morbimortalidad en la adultez e impacto de lograr una reducción del consumo de azúcares con la implementación de la Ley 27642 de Promoción de la Alimentación Saludable. Población y métodos. Se utilizó un modelo de simulación matemática con enfoque de evaluación de riesgo comparativo en la población rionegrina de 0 a 17 años. Se evaluó la carga de obesidad atribuible al consumo de BA a corto y largo plazo, y los costos médicos directos. Resultados. El consumo promedio de BA fue de 348 ml/día y la prevalencia de sobrepeso y obesidad fueron del 16,6 % y el 11,6 %, respectivamente. Se estimaron más de 6600 casos de exceso de peso en niños y adolescentes; y, en la adultez, más de 17 500 casos de exceso de peso, 34 muertes atribuibles a BA, 3200 casos de diabetes y más de 4230 en otros eventos de salud. Se calcularon costos médicos directos por $ 250 000 000 atribuibles al consumo de BA. Conclusión. La implementación de una política integral como establece la Ley 27642 de Promoción de la Alimentación Saludable en Río Negro disminuiría el 24 % de los casos de exceso de peso, la morbimortalidad y los costos médicos asociados.
Introduction. The highest levels of childhood overweight and obesity in Latin America correspond to Argentina; this condition increases the risk of obesity, type 2 diabetes, cardiovascular and cerebrovascular diseases, and other conditions in adulthood. More than 25% of childhood and adolescent obesity are attributable to the consumption of sugar-sweetened beverages (SSBs). Our objective was to assess the disease and financial burden of SSB consumption among children and adolescents in Río Negro, the morbidity and mortality in adulthood, and the impact of reducing sugar consumption via the implementation of Law no. 27642 on the Promotion of Healthy Eating. Population and methods. We used a mathematical simulation model with a comparative risk assessment approach in the Río Negro population aged 0 to 17 years. The burden of obesity attributable to SSB consumption in the short and long term and direct medical costs were assessed. Results. The average consumption of SSBs was 348 mL/day; the prevalence of overweight and obesity was 16.6% and 11.6%, respectively. There were over 6600 cases of overweight in children and adolescents; while in adulthood, there were over 17 500 cases of overweight, 34 deaths attributable to SSBs, 3200 cases of diabetes, and over 4230 other health events. Direct medical costs were estimated at ARS 250 000 000 attributable to SSB consumption. Conclusion. The implementation of a comprehensive policy as established by Law no. 27642 on the Promotion of Healthy Eating in Río Negro would decrease 24% of overweight cases, morbidity, mortality, and associated medical costs.
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Obesidade Infantil/etiologia , Obesidade Infantil/epidemiologia , Bebidas Adoçadas com Açúcar/efeitos adversos , Bebidas Adoçadas com Açúcar/legislação & jurisprudência , Promoção da Saúde/legislação & jurisprudência , Argentina/epidemiologia , Prevalência , Efeitos Psicossociais da Doença , Dieta SaudávelRESUMO
Obesity is a consequence of multiple factors, including genetics, lifestyle and nutritional choices, physical activity, sleep duration, screen time, and mood disorders. These behavioral elements can impair the regulation of energy balance and obesity management that link obesity to a constellation of chronic conditions that lead to a high prevalence of cardiometabolic risk factors, metabolic syndrome, and nonalcoholic fatty liver disease. Multidisciplinary therapy is defined as an approach delivered by a multidisciplinary-trained health team covering at least two components of behavior, physical activity/exercise, dietary habits, and/or psychological counseling associated with clinical interventions. This narrative review summarizes the effects of multidisciplinary therapy on neuroendocrine regulation of energy balance, inflammatory biomarkers, cardiometabolic risk factors, metabolic syndrome, nonalcoholic fatty liver diseases, behavior, and quality of life. We found that multidisciplinary therapy, including medical, nutritional, exercise, and behavioral counseling, and/or education, was useful for addressing outcomes such as visceral adiposity, neuroendocrine regulation of energy balance, inflammatory biomarkers, cardiometabolic risk factors, nonalcoholic fatty liver disease, and metabolic syndrome. The effects were mediated by improvements in neuroendocrine regulation of energy balance, downregulation of the pro-inflammatory states, and a reduction in comorbidities. Multidisciplinary therapy also improved mood disorders and quality of life.
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Metabolismo Energético , Inflamação , Humanos , Inflamação/metabolismo , Inflamação/terapia , Adolescente , Qualidade de Vida , Obesidade Infantil/terapia , Obesidade Infantil/metabolismo , Obesidade Infantil/psicologia , Síndrome Metabólica/terapia , Síndrome Metabólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/terapia , Hepatopatia Gordurosa não Alcoólica/metabolismo , Doenças Metabólicas/terapia , Doenças Metabólicas/metabolismo , Exercício FísicoRESUMO
BACKGROUND: Between 2006 and 2016 the prevalence of overweight and obesity among children and adolescents aged 5-19 years in Peru increased from 22.7 to 27.0%. This investment case quantifies the economic impacts of childhood and adolescent overweight and obesity in Peru. It identifies and quantifies the potential impact of a set of new or expanded interventions that can strengthen current national efforts to prevent and reduce child and adolescent overweight and obesity. METHODS: A deterministic Markov cohort model with a societal cost perspective estimated reductions in mortality and morbidity from implementing interventions to prevent and reduce child and adolescent overweight and obesity and the impact in savings in healthcare costs and gains in wages and productivity. Interventions identified through a review of published literature includes a school-based social marketing campaign, exclusive breastfeeding promotion and support, a healthy food and drink policy for school premises, and a 20% subsidy on fruits and vegetables for people living below the national poverty line. The return on investment (ROI) was calculated along with the estimated cost savings associated with the interventions. Analysis was conducted to test ROI sensitivity to changes in the key parameters and assumptions. RESULTS: Between 2025 and 2092, the expected combined direct and indirect healthcare costs attributable to child and adolescent overweight and obesity in Peru are 210.6 billion USD. The direct healthcare costs are 1.8 billion USD, and the indirect costs are 208.8 billion USD. Expected savings for all interventions combined is 13.9 billion USD with a per-person savings of 12,089.8 USD. The expected ROI of the four interventions combined is 39.3 USD (30-years), 64.6 USD (50-years), and 164.1 USD (66-years) per one USD invested. CONCLUSIONS: The overweight and obesity epidemic among children and adolescents in Peru requires wide-ranging and expanded implementation of policies to achieve long-term reductions in prevalence. This study's findings show that the four priority interventions have high ROIs and can be used to guide policy to address the complex interplay of factors that contribute to the obesogenic environment.
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Obesidade Infantil , Humanos , Adolescente , Criança , Peru , Obesidade Infantil/prevenção & controle , Pré-Escolar , Feminino , Masculino , Promoção da Saúde/métodos , Adulto Jovem , Análise Custo-Benefício , Cadeias de Markov , Sobrepeso/prevenção & controle , Prevalência , Custos de Cuidados de Saúde/estatística & dados numéricosRESUMO
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is a prevalent hepatic condition linked to metabolic alterations. It gradually causes liver damage and potentially progresses to cirrhosis. Despite its significance, research, especially in the pediatric population, is limited, leading to contradictory findings in diagnosis and treatment. This meta-analysis aims to synthesize existing literature on therapeutic interventions for MASLD in children and adolescents. METHODS: A comprehensive search of randomized controlled clinical trials yielded 634 entries from PubMed, Scopus, and Web of Science up to 2023. Interventions included medications, behavioral modifications, dietary changes, probiotics, supplements, surgical procedures, or combinations. The analysis focused on studies with treatment duration of at least 3 months, employing a random-effects REML meta-analysis model. Treatment effects on anthropometric measurements and biochemical components were examined and adjusted for heterogeneity factors analysis. A bibliometric analysis for insights into research contributors was performed. RESULTS: The systematic review incorporated 31 clinical trials, with 24 meeting criteria for meta-analysis. These comprised 3 medication studies, 20 with supplements, 4 focusing on lifestyle, and 4 centered on diets. Significant overall treatment effects were observed for ALT, AST, BMI, and HOMA-IR mainly by supplements and lifestyle. Meta-regression identified age, BMI changes, and treatment duration as factors modifying ALT concentrations. Bibliometric analysis involving 31 linked studies highlighted contributions from 13 countries, with the USA, Spain, and Chile being the most influential. CONCLUSIONS: We conclude that supplementation and lifestyle changes can effectively impact ALT and AST levels, which can help address liver issues in obese children. However, the evaluation of risk bias, the high heterogeneity, and the bibliometric analysis emphasize the need for more high-quality studies and broader inclusion of diverse child populations to provide better therapeutic recommendations. TRIAL REGISTRATION: PROSPERO, CRD42023393952. Registered on January 25, 2023.
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Bibliometria , Hepatopatia Gordurosa não Alcoólica , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Hepatopatia Gordurosa não Alcoólica/terapia , Criança , Adolescente , Obesidade Infantil/terapiaRESUMO
BACKGROUND: The aim was to investigate the effects of 12 and 24 weeks of interdisciplinary interventions on health-related physical fitness, biochemical markers, and food processing levels in overweight or obese adolescents. METHODS: Thirty-one adolescents completed 24 weeks of nutritional, psychoeducational, and physical activity interventions in addition to assessments and tests carried out before, at 12 weeks, and after 24 weeks. RESULTS: There were increases in lean mass (p = 0.003) and decreases in absolute and relative fat mass (p < 0.001) for both sexes, as well as increases in flexibility on the right and left sides (p < 0.001), maximum oxygen consumption (p < 0.001) increased after the interventions, time spent in isometric exercises on the plank increased (p > 0.05), total cholesterol after 12 weeks decreased (p = 0.014), triglycerides were reduced (p = 0.002), low-density lipoproteins were reduced (p < 0.001), consumption of more processed foods after 24 weeks decreased (p < 0.001), consumption of fresh foods in grams and kilocalories increased (p < 0.001), and, in addition, the consumption of processed and ultra-processed foods was reduced (p = 0.020). CONCLUSIONS: The 24-week interventions promoted superior benefits for adolescents' physical, nutritional, and biochemical health, although the dropout rate was high (~50%).
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Biomarcadores , Sobrepeso , Aptidão Física , Humanos , Adolescente , Masculino , Feminino , Estudos Longitudinais , Aptidão Física/fisiologia , Biomarcadores/sangue , Sobrepeso/terapia , Exercício Físico , Obesidade/terapia , Criança , Obesidade Infantil/terapia , DietaRESUMO
BACKGROUND: Considering the previous research that suggested that screen time (ST), sleep duration, physical activity (PA), obesity and cardiometabolic risk factors are related, it is essential to identify how these variables are associated over time, to provide knowledge for the development of intervention strategies to promote health in pediatric populations. Also, there is a lack of studies examining these associations longitudinally. The aims of the present study were: (1) to investigate the longitudinal relationships between ST, sleep duration, leisure PA, body mass index (BMI), and cardiometabolic risk score (cMetS) in children and adolescents; and (2) to verify scores and prevalence of cMetS risk zones at baseline and follow-up. METHODS: This observational longitudinal study included 331 children and adolescents (aged six to 17 years; girls = 57.7%) from schools in a southern city in Brazil. ST, sleep duration, and leisure PA were evaluated by a self-reported questionnaire. BMI was evaluated using the BMI z-scores (Z_BMI). The cMetS was determined by summing sex- and age-specific z-scores of total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, triglycerides, glucose, and systolic blood pressure and dividing it by four. A two-wave cross-lagged model was implemented. RESULTS: ST, sleep duration, and leisure PA were not associated with cMetS after 2-years. However, it was observed that higher ST at baseline was associated with shorter sleep duration at follow-up (B=-0.074; 95%IC=-0.130; -0.012), while higher Z_BMI from baseline associated with higher cMetS of follow-up (B = 0.154; 95%CI = 0.083;0.226). The reciprocal model of relationships indicated that the variance of ST, sleep time, leisure PA, Z_BMI, and cMetS explained approximately 9%, 14%, 10%, 67% and 22%, respectively, of the model. Individual change scores and prevalence indicated that cMetS had individual changes from 2014 to 2016. CONCLUSION: Sleep duration, ST and leisure PA were not associated with cMetS after 2 years. ST showed an inverse association with sleep duration, and Z_BMI was positively associated with cMetS after a 2-year follow-up. Finally, the prevalence of no clustering of risk factors increased after two years. These findings suggest the need to promote healthy lifestyle habits from childhood and considering individual factors that can influence cardiometabolic health in children and adolescents.
Assuntos
Fatores de Risco Cardiometabólico , Exercício Físico , Atividades de Lazer , Obesidade Infantil , Tempo de Tela , Sono , Humanos , Feminino , Masculino , Criança , Adolescente , Fatores de Tempo , Estudos Longitudinais , Medição de Risco , Obesidade Infantil/epidemiologia , Obesidade Infantil/diagnóstico , Obesidade Infantil/fisiopatologia , Brasil/epidemiologia , Prevalência , Fatores Etários , Índice de Massa Corporal , Comportamento do Adolescente , Comportamento Infantil , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Comportamento Sedentário , Duração do SonoRESUMO
OBJECTIVE: To assess effects of Healthy Change intervention on maternal perception of her child's body weight (MPCW), maternal feeding style, and obesogenic home environment. METHODS: A randomized control trial was conducted, consisting of two arms: the intervention group received the Healthy Change program, and the control group received the Hygiene and Accident Prevention program. A total of 356 mother-preschool child dyads participated, 182 in the intervention group and 174 in the control group, residing in Mexico and the United States. Data were collected at baseline and after the program through self-administered questionnaires completed by mothers and child anthropometric measurements. RESULTS: Although no significant between-group difference in pre- and post-intervention change of MPCW was found, sub-analyses revealed that a higher proportion of mothers in the intervention group accurately perceived their child's body weight at the study endpoint using categorical (67% vs. 57.1%, p < 0.005) and visual scales (48.9% vs. 41.8%, p < 0.015). Additionally, more mothers of overweight children in the intervention group accurately perceived their children's overweight and obese status compared to those in the control group (29.8% vs. 10.3%, X2 = 4.26, df = 1, p < 0.039). The intervention group also displayed a higher proportion of mothers with authoritative feeding style (26.4% vs. 16.5%, p < 0.036) and significantly higher family nutrition and physical activity scores (29.1 vs. 28.0, p < 0.000) at the study endpoint. CONCLUSIONS FOR PRACTICE: Healthy Change Intervention led to improved accuracy of MPCW, a shift toward maternal authoritative feeding styles, and positive changes in obesogenic home environments.
Assuntos
Promoção da Saúde , Mães , Obesidade Infantil , Adulto , Pré-Escolar , Feminino , Humanos , Masculino , Peso Corporal , Comportamento Alimentar/psicologia , Promoção da Saúde/métodos , México , Mães/psicologia , Obesidade Infantil/prevenção & controle , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVES: Mexican children with obesity are at a higher risk of developing type 2 diabetes mellitus (T2DM). The aim of the study was to compare oral glucose tolerance test (OGTT) characteristics: time of peak glucose, glucose level ≥155â¯mg/dL at 1â¯h, presence of metabolic syndrome (MetS), sensitivity, secretion, and oral disposition index (oDI) in children with and without obesity, according to oral glucose tolerance curve shape: monophasic or biphasic. METHODS: Cross-sectional study including 143 children. Groups were divided into (a) obese: biphasic (B-Ob) (n=55) and monophasic (M-Ob) (n=50), (b) without obesity: biphasic (B-NonOb) (n=20) and monophasic (M-NonOb) (n=18). RESULTS: Late glucose peak was more frequent in the M-Ob group (p<0.001). Glucose levels ≥155â¯mg/dL and MetS were more frequent in the M-Ob group but did not show significance. The groups with obesity (biphasic and monophasic) had higher indices of insulin resistance and insulin secretion compared to the nonobese groups (biphasic and monophasic) (p<0.001). AUC glucose was higher in the M-Ob group (p<0.05), and AUC insulin was higher in the M-NonOb group. oDI (Matsuda) was significantly lower in the M-Ob group compared to the other groups (p<0.001), and oDI-HOMA IR was higher in M-NonOb group (p=0.03). CONCLUSIONS: All OGTT parameters could help to identify Mexican children at increased risk of developing T2DM, not only fasting plasma glucose and 2â¯h glucose. M-Ob in non-T2DM Mexican children reflects an early defect in glucose metabolism. Higher level of IR indexes in M-NonOb vs. B-NonOb could indicate an increased risk for T2DM of genetic origin.
Assuntos
Glicemia , Diabetes Mellitus Tipo 2 , Teste de Tolerância a Glucose , Resistência à Insulina , Humanos , Estudos Transversais , Criança , Feminino , Masculino , Adolescente , México/epidemiologia , Glicemia/análise , Diabetes Mellitus Tipo 2/epidemiologia , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Obesidade Infantil/epidemiologia , Prognóstico , Obesidade/epidemiologia , Seguimentos , Biomarcadores/análise , Biomarcadores/sangue , Estudos de Casos e ControlesRESUMO
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.
Assuntos
COVID-19 , Exercício Físico , Estilo de Vida , SARS-CoV-2 , Instituições Acadêmicas , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Criança , Feminino , Masculino , Chile/epidemiologia , Estudos Transversais , Comportamentos Relacionados com a Saúde , Autoimagem , Obesidade Infantil/epidemiologia , Obesidade Infantil/psicologia , Obesidade Infantil/prevenção & controle , Comportamento Alimentar/psicologia , Pandemias , Adiposidade , Comportamento SedentárioRESUMO
OBJECTIVE: To evaluate the predictive validity and cut-off point of heart rate and blood pressure on heart rate variability (HRV) changes in children with and without obesity. METHODS: This study included 125 children, of whom 41 were normal weight and 84 were obese. Anthropometry, blood pressure, heart rate, and HRV were measured using an electronic scale and stadiometer, a sphygmomanometer, and HRV monitor. In addition, the receiver operating characteristic (ROC) curve was obtained by statistical analysis of the data. RESULTS: Heart rate proved to be a good predictor for changes in the square root of the mean of the square of the differences between consecutive NN intervals (RMSSD) parameter in students of both sexes for the normal-weight group (ROC 0.89; 95%CI 0.77-1.00) and obesity (ROC 0.90; 95%CI 0.83-0.97). In addition, the heart rate cut-off point for alterations in the RMSSD parameter for normal-weight boys was 93 bpm (sensitivity 100.00% and specificity 87.50%) and for boys with obesity, the established cut-off point was 91 bpm (sensitivity 94.74% and specificity 63.64%). Heart rate also proved to be a good predictor considering low-frequency/high-frequency ratio (LF/HF) and standard deviation of long-term continuous NN intervals /standard deviation of the instantaneous variability of continuous NN intervals in the Poincaré graph ratio (SD2/SD1). Systolic and diastolic blood pressures were good predictors in more specific stratifications and, therefore, can be used in some cases. CONCLUSIONS: The predictive validity of heart rate was shown to be at a good level, with high sensitivity and acceptable specificity for the cut-off points according to the different analyses stratified by gender and nutritional status. In this sense, health professionals will be able to use heart rate to estimate cardiovascular risk in children of different sexes and nutritional status.
Assuntos
Frequência Cardíaca , Humanos , Frequência Cardíaca/fisiologia , Masculino , Feminino , Criança , Valor Preditivo dos Testes , Obesidade Infantil/fisiopatologia , Adolescente , Pressão Sanguínea/fisiologiaRESUMO
Este estudo objetiva apresentar intervenções de enfermagem na promoção da saúde através de uma alimentação adequada e saudável, para controle da obesidade na infância e adolescência, no ambiente escolar. Método: revisão integrativa da literatura, com margem temporal entre 2014 e 2024. Resultados: foram encontrados 429 estudos nas bases de dados, e após a análise dos critérios de inclusão, selecionados 07 estudos. O tempo de intervenção dos estudos variou de 4 a 36 meses, sendo desenvolvidas aulas sobre alimentação adequada, orientações em grupo, aplicação de questionário de preferência alimentar, avaliação antropométrica, visitas domiciliares e dinâmicas educativas. Conclusão: escola é território para educação em saúde e combate ao sobrepeso e obesidade na infância e adolescência. Neste sentido, intervenções de enfermagem no ambiente escolar devem ocorrer embasadas em métodos efetivos, de forma sistemática, para desenvolver nos estudantes a compreensão do autocuidado em relação à saúde e alimentação.(AU)
This study aims to present nursing interventions in health promotion through adequate and healthy nutrition, to control obesity in childhood and adolescence, in the school environment. Method: integrative literature review, with a time frame between 2014 and 2024. Results: 429 studies were found in the databases, and after analyzing the inclusion criteria, 07 studies were selected. The intervention time of the studies ranged from 4 to 36 months, with classes on proper nutrition, group guidance, application of a food preference questionnaire, anthropometric assessment, home visits and educational dynamics. Conclusion: school is a territory for health education and combating overweight and obesity in childhood and adolescence. In this sense, nursing interventions in the school environment should be based on effective methods, in a systematic way, to develop students' understanding of self-care in relation to health and nutrition.(AU)
Este estudio tiene como objetivo presentar las intervenciones de enfermería en la promoción de la salud a través de una alimentación adecuada y saludable, para el control de la obesidad en la infancia y adolescencia, en el ámbito escolar. Método: revisión bibliográfica integradora, con un marco temporal entre 2014 y 2024. Resultados: se encontraron 429 estudios en las bases de datos, y tras analizar los criterios de inclusión, se seleccionaron 07 estudios. El tiempo de intervención de los estudios osciló entre 4 y 36 meses, con clases sobre alimentación adecuada, orientación grupal, aplicación de cuestionario de preferencias alimentarias, evaluación antropométrica, visitas domiciliarias y dinámicas educativas. Conclusión: la escuela es un territorio para la educación para la salud y la lucha contra el sobrepeso y la obesidad en la infancia y la adolescencia. En este sentido, las intervenciones de enfermería en el ámbito escolar deben basarse en métodos eficaces, de forma sistemática, para desarrollar en los alumnos la comprensión del autocuidado en relación con la salud y la nutrición.(AU)
Assuntos
Serviços de Enfermagem Escolar , Educação em Saúde , Obesidade InfantilRESUMO
BACKGROUND: Elevated liver enzyme levels have been associated with metabolic syndrome in both obese and non-obese pediatric populations. This study aims to compare the serum liver enzyme levels in obese adolescents with and without insulin resistance (IR). METHODS: A cross-sectional analysis was conducted involving obese adolescents aged 10-18. We assessed somatometry, serum insulin levels, lipid profiles, and liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and gamma-glutamyl transferase [GGT]). Statistical differences between groups were evaluated using Student's t-test or the Chi-squared test, with IR (wIR) status matched by propensity scores based on body mass index (BMI) z-scores. RESULTS: The study included 365 adolescents with obesity, 229 wIR, and 136 without (woIR). Before matching, the wIR group had a significantly higher BMI z-score (2.21 vs. 2.14, p = 0.032). After matching for BMI z-scores (n = 122 each group), the wIR group displayed significantly higher levels of AST (32.3 vs. 24.7, p < 0.001) and ALT (42.4 vs. 30.9, p < 0.001), but no significant differences were observed in GGT levels (37.4 vs. 32.5, p = 0.855). CONCLUSION: Obese adolescent's wIR exhibit higher serum ALT and AST levels, suggesting that altered AST is a potential risk factor for IR.
INTRODUCCIÓN: Se ha observado asociación entre niveles elevados de enzimas hepáticas y síndrome metabólico en población pediátrica con y sin obesidad. El objetivo del estudio fue comparar los niveles séricos de enzimas hepáticas entre adolescentes con obesidad con y sin resistencia a la insulina (RI). MÉTODOS: Se realizó un estudio transversal en adolescentes con obesidad entre 10 y 18 años. Se analizaron los datos somatometricos, insulina sérica, perfil lipídico y niveles de enzimas hepáticas (aspartato aminotransferasa [AST], alanina aminotransferasa [ALT] y gamma-glutamil transferasa [GGT]). Análisis estadístico: se utilizó t de Student o la prueba de Chi-cuadrado para evaluar diferencias entre grupos. Los pacientes con RI se emparejaron con pacientes sin RI utilizando puntuaciones de propensión basadas en la puntuación z del IMC. RESULTADOS: Se incluyeron un total de 365 adolescentes con obesidad (229 con RI y 136 sin RI). El grupo con RI tuvo un IMC mayor (con RI 2.21 vs sin RI 2.14 p = 0.032). Después de emparejar los grupos según el IMCz (n = 122 por grupo), el grupo con RI tuvo niveles de AST (24.7 vs., 32.3, p < 0.001) y ALT (30.9 vs., 42.4, p < 0.001) significativamente más altos en comparación al grupo sin RI. Sin embargo, no hubo diferencia en los niveles de GTT (37.4 vs 32.5, p = 0.855). CONCLUSIONES: Los niveles séricos de ALT y AST en adolescents con obesidad y RI fueron mayores. La AST alterada fue un factor de riesgo para presentar RI.