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Introduction: Limited insight exists into the weight development in children with obesity not receiving obesity treatment., Methods: This cohort study included 467 Danish children aged 5-10 years with obesity (iso-BMI >30 kg/m 2 ) not receiving treatment. Data from mandatory health check-ups on school-children's height and weight (converted to BMI z-scores) were merged with the Danish National Registries. A multivariable logistic regression weighted for the duration of follow-up was used to estimate odds ratios (OR) for normalization of BMI (iso-BMI 18.5-25 kg/m 2 ) and obesity remission (iso-BMI 18.5-30 kg/m 2 )., Results: During a median follow-up of more than 6 years, 7.9% of the children normalized their BMI, while 45.4% obtained obesity remission. BMI z-score at inclusion acted as a strong inverse predictor for normalizing BMI (OR 0.14 per one-unit SD, CI: 0.03-0.53) and for obesity remission (OR 0.17 per one-unit SD, CI: 0.08-0.37). No other significant predictors were observed in the weighted multivariable models., Conclusion: Higher BMI z-scores inversely predict normalizing BMI and achieving obesity remission in untreated children. Given that many children naturally achieve obesity remission or weight normalization, resources should focus on understanding barriers of obesity maintenance and to develop effective strategies for those who do not experience improvement., (© 2025 The Author(s). Pediatric Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Accurate and efficient body composition assessment is essential for diagnosing and monitoring childhood obesity in clinical and research settings. This study evaluated the agreement between bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) in assessing body composition and its changes during a long-term lifestyle intervention in children and adolescents with obesity. We hypothesized that BIA is comparable to DXA in tracking longitudinal changes in body composition in this population. The study included 92 children and adolescents 5 to 17 years of age (mean 10.5 ± 2.9 years) classified as obese at the time of measurement (body mass index-standard deviation score ≥ 2 SD). From January 1, 2014, to December 31, 2017, they participated in a lifestyle intervention at Randers Regional Hospital. Body composition was assessed using BIA and DXA at baseline and follow-up (mean 20.5 ± 9.3 months). Bland-Altman plots, correlation- and concordance analyses were used to evaluate the agreement between methods. Bland-Altman plots demonstrated wide limits of agreement without significant bias for longitudinal changes in fat mass (FM), FM%, fat-free mass (FFM), and FFM% (0.39 kg (CI -0.14, 0.93), -0.39% (CI -1.06, 0.26), -0.21 kg (CI -0.73, 0.31), and 0.39% (CI -0.27, 1.05), respectively). Correlations between methods for changes in FM, FM%, FFM, and FFM% were 0.93, 0.83, 0.88, and 0.83, respectively. In cross-sectional assessments, BIA underestimated FM and FM% and overestimated FFM and FFM% compared to DXA. Conclusively, BIA effectively monitors longitudinal changes in body composition at a group level in a pediatric population with obesity. However, caution is needed for individual assessments., Competing Interests: Author declarations RMJ, ETV, and JMB are employed at Steno Diabetes Center Aarhus, a public hospital and research institution in the Central Denmark Region, partly funded by an unrestricted grant from the Novo Nordisk Foundation. CRB has no conflicts of interest to disclose. The Novo Nordisk Foundation had no role in the study's design and conduct., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Several evaluations of lifestyle interventions for childhood obesity exist; however, follow-up beyond 2 years is necessary to validate the effect. The aim of the present study was to investigate long-term weight development following children participating in one of two pragmatic family-centered lifestyle interventions treating childhood obesity., Methods: This real-life observational study included Danish children 4-17 years of age classified as having obesity. Data from 2010 to 2020, from two community-based family-centered lifestyle interventions (designated hereafter as the Aarhus- and the Randers-intervention) were merged with national registers and routine health check-ups, including height and weight. Adjusted mixed effect models were used to model changes in body mass index (BMI) z score. We performed exploratory analyses of the development in BMI z-score within stratified subgroups of children treated in the interventions before investigating potential effect modifications induced by sex, age, family structure, socioeconomic, or immigration status., Results: With a median follow-up of 2.8 years (interquartile range: 1.3; 4.8), 703 children participated in an intervention (445 the Aarhus-intervention; 258 the Randers-intervention) and 2,337 children were not invited to participate (no-intervention). Children in both interventions experienced a comparable reduction in BMI z-scores during the first 6 months compared to the no-intervention group (Aarhus-intervention: -0.12 SD/year and Randers-intervention: -0.25 SD/year). Only children in the Randers-intervention reduced their BMI z-score throughout follow-up (Aarhus-intervention vs. no-intervention: 0.01 SD/year; confidence interval [CI]: -0.01; 0.04; Randers-intervention vs. no-intervention: -0.05 SD/year; CI: -0.08; -0.02). In subgroup comparisons, combining the two interventions, family income below the median (-0.05 SD/year, CI: -0.02; -0.09), immigrant background (0.04 SD/year, CI: 0.00; 0.07), or receiving intervention less than 1 year (0.04 SD/year, CI: 0.00; 0.08) were associated with a yearly increase in BMI z score. In addition, effect modification analyses did not observe any interaction by sex, age, family structure, socioeconomic, or immigration., Conclusions: Although the more dynamic intervention with longer duration obtained and sustained a minor reduction in BMI z score, the clinical impact may only be modest and still not effective enough to induce a long-term beneficial development in BMI in children with obesity., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Children living with obesity are prevalent worldwide. It is an established finding that many children who start a lifestyle intervention tend to leave prematurely. The aim of this study was to identify characteristics in children with obesity who prematurely leave a lifestyle intervention. The cohort study includes children living with obesity aged 4-17, treated in a Danish family-centered lifestyle intervention between 2014 and 2017. Data were collected from patient records. BMI-SDS was calculated using an external Danish reference population and multivariable regression analysis was used to answer the research question. Of the 159 children included, 64 children who left the intervention within the first 1.5 years were older compared to those who stayed in the intervention (10.2 years ± 2.9 vs 11.5 years ± 3.1, p = 0.005). Older participants (> 66.6 th percentile) had a shorter treatment duration (489 days) compared to the youngest (190 days 95% CI: 60; 320, p = 0.005) and middle third (224 days 95% CI: 89; 358, p = 0.001). Additionally, an inverse association was found between duration of treatment and age at baseline (-31 days, 95% CI (-50; -13), p = 0.001).   Conclusion: The risk of leaving a lifestyle intervention prematurely was primarily dependent on the age of the participants, emphasizing the importance of including children early in lifestyle interventions. What is Known: • Lifestyle interventions for childhood obesity that are shorter in duration often lead to short-term weight reductions only. Limited knowledge exists on why some children prematurely leave these interventions. What is New: • This study observes a solid inverse correlation and association between age and time spent in the interventions, when treating childhood obesity. We hereby suggest age as an important determinant for the adherence to lifestyle interventions and emphasize the importance of treatment early in life., (© 2023. The Author(s).)

Background: Childhood obesity is associated with impaired Quality-of-Life (QoL), increased stigmatization and higher risk of development of depression compared to their peers. This report describes the long-term development in QoL for cohort of children with obesity after a sustainable weight reduction., Methods: This pragmatic descriptive intervention study enrolled 120 children with obesity, age 5-17 years, in a multifactorial lifestyle intervention. The intervention was an across sectors collaboration between a department of pediatrics and community health care workers. QoL was assessed yearly throughout the intervention and evaluated by a 6-item Visual Analogue Scale (VAS). For analyzing changes in VAS, as function BMI-SDS, regression models were used, while ANOVA and Wilcoxon test were applied for normal and not-normal distributed data. 95% confidence interval not containing 0 and p-value < 0.05 was considered statistically significant., Results: After 26.4 months (13.9 SD) an overall decrease in bullying (0.6 vs. 0.0 median) and motivation (10.0 vs. 9.6) was observed. QoL increased in children with a BMI-SDS reduction (0.65 (2.49 SD)) opposite children with no-change or increasing BMI-SDS who reported reduced QoL (-0.36 (1.55 SD) and -0.96 (2.27 SD)). A significant inverse relationship was observed for Joy of Life, QoL and body perception as a function of BMI-SDS per year., Conclusion: Weight reduction causes improvement in QoL for children with obesity and an inverse relationship for QoL and changing BMI-SDS / year was establish., (© 2022. The Author(s).)

Introduction: Childhood obesity is an increasing condition associated with continuous obesity into adulthood and development of comorbidities. Adult studies show an association between serum uric acid (SUA) levels and body mass index (BMI). The aim of this retro perspective exploratory study was to investigate SUA in obese children and adolescents and the effects of a subsequent weight reduction. Materials and Methods: One hundred and seventy-one children (age 4-18), with obesity (i.e. BMI-SDS of +2 or higher) were included in a multifactorial lifestyle intervention. The children participating were annually measured for anthropometrics, blood samples and DEXA-scans for up to 3 years. Eighty-nine children were included for follow-up analysis. Results: After a follow-up of 20.7 ± 9.4 months a reduction in BMI-SDS of -0.34 ± 0.53 ( p < 0.01) was observed. SUA was found to be positively associated with changes in BMI-SDS. SUA levels decreased in the 65 children who lost weight during the trial, conversely, SUA increased in the 23 children who gained weight during the trial ( p < 0.01 between groups). Conclusion: SUA was found to correlate with measures of obesity and for the first time, this intervention demonstrates a positive relationship between SUA and weight reduction in children with obesity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jørgensen, Bøttger, Vestergaard, Kremke, Bahnsen, Nielsen and Bruun.)

Natural isolates of the soil-dwelling bacterium Bacillus subtilis form robust biofilms under laboratory conditions and colonize plant roots. B. subtilis biofilm gene expression displays phenotypic heterogeneity that is influenced by a family of Rap-Phr regulatory systems. Most Rap-Phr systems in B. subtilis have been studied independently, in different genetic backgrounds and under distinct conditions, hampering true comparison of the Rap-Phr systems' impact on bacterial cell differentiation. Here, we investigated each of the 12 Rap-Phr systems of B.subtilis NCIB 3610 for their effect on biofilm formation. By studying single ∆rap-phr mutants, we show that despite redundancy between the cell-cell communication systems, deletion of each of the 12 Rap-Phr systems influences matrix gene expression. These Rap-Phr systems therefore enable fine-tuning of the timing and level of matrix production in response to specific conditions. Furthermore, some of the ∆rap-phr mutants demonstrated altered biofilm formation in vitro and colonization of Arabidopsis thaliana roots, but not necessarily similarly in both processes, indicating that the pathways regulating matrix gene expression and other factors important for biofilm formation may be differently regulated under these distinct conditions., (© 2021 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.)

Introduction: Childhood obesity has psychological consequences and increases the risk of continuous obesity into adulthood, associated with development of non-communicable disease (e.g. type 2 diabetes). Short-term weight loss intervention studies show good results but long-term studies are limited., Methods: One hundred ninety-nine obese children (4-18 years of age), with a BMI-SDS (standard deviation score) above + 2 SDS were enrolled into a multifactorial family-centered lifestyle intervention study. The children had yearly visits in the outpatient clinic for anthropometrics, blood samples and DXA-scans, and 6-8 meeting with community health workers between these visits. The children followed the intervention up to 3 years., Results: After a follow-up of 26.7 ± 17.5 months a reduction in BMI-SDS of - 0.25 SDS (p < 0.001) was observed. The 57 children who were adherent to the intervention for ≥ 2 years had significantly reduced BMI-SDS compared to the 142 children with shorter intervention (BMI-SDS: - 0.38 ± 0.67 vs. - 0.20 ± 0.50, p = 0.036). All weight loss was accompanied by decrease in fat mass and increase in muscle mass (p < 0.001)., Conclusion: The intervention was found to induce long-term reduction in BMI-SDS in obese children, with beneficial change in body composition. Children who followed the intervention the longest had the greatest reduction in BMI-SDS., Level of Evidence: Level III, longitudinal cohort study.

Common variable immunodeficiency is the second most common primary immunodeficiency with a prevalence of approx. 1/10.000-50.000. The clinical challenge is early diagnosis and efficient supportive treatment. The purpose of the present article is to focus on the complexity of the disease, including the risk of a long pre-diagnostic period and to focus on the sarcoidosis-like variant and the possible impact of immunoglobulin subclass deficiency.

Encapsulating peritoneal sclerosis (EPS) is a rare but potentially fatal complication to long-term peritoneal dialysis (PD). We describe a case of EPS in a 58-year-old patient who had formerly had PD. The interdisciplinary approach for diagnosis and possible treatments in this condition is discussed.