Search

Background: The association between assisted reproductive technologies (ARTs) and the body mass index (BMI) of children remains controversial. Confounding by morbidity and other factors associated with parental infertility may have biased studies comparing children born after ART with children born after no treatment. We investigated the associations between different fertility treatments and BMI in children at age 5 to 8 years, adjusting for and stratifying by causes of parental infertility. Methods and findings: This Danish cohort study included 327,301 children born between 2007 and 2012 (51% males, median age at follow-up 7 years). Of these, 13,675 were born after ART, 7,728 were born after ovulation induction with or without intrauterine insemination [OI/IUI], and 305,898 were born after no fertility treatments. Using the International Obesity Task Force (IOTF) standards, we defined overweight (BMI ≥ IOTF-25) and obesity (BMI ≥ IOTF-30). We compared children born after ART versus OI/IUI; intracytoplasmic sperm injection (ICSI) versus conventional in vitro fertilization (IVF); and frozen-thawed versus fresh embryo transfer and estimated crude and adjusted prevalences of children with overweight or obesity at age 5 to 8 years, prevalence odds ratios (PORs), and differences in mean BMI z-scores. Adjustment was performed using stabilized inverse probability of treatment weights, including parity, year of conception, parental causes of infertility, age, educational level, comorbidities, maternal country of origin, BMI, and smoking as covariates. The crude prevalence of obesity was 1.9% in children born after ART, 2.0% in those born after OI/IUI, and 2.7% in those born after no fertility treatment. After adjustment, children born after ART and OI/IUI had the same prevalence of being overweight (11%; POR 1.00, 95% confidence interval [CI] 0.91 to 1.11; p = 0.95) or obese (1.9%; POR 1.01, 95% CI 0.79 to 1.29; p = 0.94). Comparison of ICSI with conventional IVF yielded similar pattern (POR 0.95, 95% CI 0.83 to 1.07; p = 0.39 for overweight and POR 1.16, 95% CI 0.84 to 1.61; p = 0.36 for obesity). Obesity was more prevalent after frozen-thawed (2.7%) than fresh embryo transfer (1.8%) (POR 1.54, 95% CI 1.09 to 2.17; p = 0.01). The associations between fertility treatments and BMI were only modestly different in subgroups defined by the cause of infertility. Study limitations include potential residual confounding, restriction to live births, and lack of detailed technical information about the IVF procedures. Conclusions: We found no association with BMI at age 5 to 8 years when comparing ART versus OI/IUI or when comparing ICSI versus conventional IVF. However, use of frozen-thawed embryo transfer was associated with a 1.5-fold increased risk of obesity compared to fresh embryo transfer. Despite an elevated relative risk, the absolute risk difference was low. In a population-based cohort study, Kristina Laugesen and colleagues investigate the associations between different fertility treatments and body mass index in children born after assisted reproductive technologies in Denmark. Author summary: Why was this study done?: The number of children born after in vitro fertilization (IVF) is increasing. Information about long-term health of these children is limited, and the association between IVF and body mass index (BMI) of the children remains controversial. Various procedures, such as type of fertilization and embryo transfer, and underlying causes of infertility may influence associations. What did the researchers do and find?: The researchers used Danish national registries to conduct a cohort study on the association between different fertility treatments and BMI in children at age 5 to 8 years, taking into account underlying causes of infertility. Children born after IVF had similar BMI compared with those born after ovulation induction (with or without intrauterine insemination) and compared with those born after no fertility treatment. Children born after frozen-thawed embryo transfer had higher BMI and higher prevalence of obesity compared with those born after fresh embryo transfer, compared with those born after ovulation induction (with or without intrauterine insemination), and compared with those born after no fertility treatment. Findings were consistent across subgroups defined by underlying cause of infertility. What do these findings mean?: Our study provides reassuring results for couples who seek help to conceive. Reasons behind our findings for frozen-thawed embryo transfer need further investigation. Longer follow-up and assessment of other outcomes related to metabolic health is needed. Study limitations include potential residual confounding, inclusion of live births only, and lack of detailed technical information about the IVF procedures. [ABSTRACT FROM AUTHOR]

This qualitative study investigates health care practitioners’ approaches to early childhood obesity in Denmark and their view on their own ability to initiate processes of change in affected families, and it asks the overall question of whether perceived barriers become real through practitioners’ reluctance to intervene in families labelled as ´problematic’. The paper identifies three approaches in the practitioners’ narratives: the socially oriented, the individually oriented, and the mixed. The individually oriented approach was based on a logic resembling individualistic explanatory models of behaviour change, and was related to a positive perspective on their own ability to move families towards healthier habits by health care practitioners. The socially oriented approach borrowed elements from a sociological perspective, which seemed to lead to resigned pessimism in the face of the complexity of the problem of childhood overweight and a reluctance to address early childhood overweight in some families. In practitioners of all three types, widespread cultural essentialism was found. Non-western, ethnic minority background was seen as determining family habits and making preventive action especially difficult. Based on this, the current paper discusses whether individual actions and choices are being ascribed too much explanatory power, and the health system's biased perceptions too little. [ABSTRACT FROM AUTHOR]

In recent years, there has been increased awareness of obesity as a condition that carries a high level of stigma, as well as growing recognition of its prevalence and harm. Despite the increasing body of research on this topic, there is a gap in the literature regarding mechanisms that generate or exacerbate perceptions of weight stigma, especially within families and pediatric healthcare settings. The present study aims to identify potential stigma-generating mechanisms by focusing on inter-relational dynamics within these contexts. We conducted in-depth, semi-structured interviews with 11 families and analyzed the data by applying sociological theories on health identities and authenticity. Our study found four themes that represent potential stigma-generating mechanisms by being explicitly related to familial health identities and healthcare authenticity: (1) negotiating and reconstruction familial self-understanding, (2) between guilt, shame and conflicts, (3) navigating weight perceptions, and (4) the necessity of positivity and relevance. Our study shows the complexities of weight stigma within family and pediatric healthcare settings, emphasizing the need for sensitive and tailored support, as well as the value of working authentically as crucial aspects in preventing and/or reducing stigma. [ABSTRACT FROM AUTHOR]

It is well established that overweight and obesity are often accompanied by stigmatization. However, the influence of stigmatization on interventions for overweight and obesity remains unknown. Stigma may be particularly harmful to children. This study aimed to examine how stigmatization affects efforts to reduce childhood overweight and obesity through family interventions. This research was conducted in a socially disadvantaged area in Denmark. Twenty-seven families and forty professionals participated in in-depth interviews or workshops. The data were analyzed using CMO configurations from a realist evaluation and the theory of stigmatization developed by Link and Phelan. Thus, an abductive approach was employed in the analysis, with its foundation rooted in the empirical data. The study found that the mechanisms of stigmatization could 1. restrain professionals and parents from approaching the problem—thereby challenging family recruitment; 2. prevent parents from working with their children to avoid eating unhealthy food for fear of labeling the child as overweight or obese; and 3. cause children with obesity to experience a separation from other slimmer family members, leading at times to status loss, discrimination, and self-stigmatization. The study showed how the mechanisms of stigmatization may obstruct prevention and treatment of childhood obesity through family interventions. It is suggested that the concept of stigma should be incorporated into the program theories of interventions meant to reduce childhood overweight and obesity. [ABSTRACT FROM AUTHOR]

The family represents the cause of as well as the solution to childhood overweight in many family-based childhood weight management interventions. Involving the family also entails involving the individual family members' experiences with, attitudes towards, and understandings of obesity. This study explores how families with life-long experiences of overweight manage and experience a family-based childhood weight management intervention in Northern Zealand in Denmark. The analysis is focused on family narratives and their temporal character. The families' narratives about overweight and past weight management interventions are crucial to how they understand and manage the present intervention. Additionally, the families expect the focus on weight management to continue to be a constant part of their everyday life. The paper concludes that the understanding of weight management in interventions should take its point of departure in the life-world, which the individual family creates through members' narratives about overweight. [ABSTRACT FROM AUTHOR]

Intersectoral partnerships have the potential to co-produce 'synergistic' solutions to complex public health problems, exceeding what any single organization acting alone might achieve. Synergy requires shared decision-making and equitable co-construction by partners. However, many partnerships struggle to realize such synergistic potential. Building on the Bergen Model of Collaborative Functioning, this study offers insights for optimizing partnership synergy by examining interactions between 'inputs' to the partnership—shared mission, and partner resources. Specifically, we introduce the concept of 'dependency structure' to draw attention to how these input interactions shape the balance of power and hence the potential for shared decision-making and co-construction. Findings are based on qualitative data from 10 intersectoral, health promotion partnerships in Denmark, including 27 interviews, 10 focus groups, partnership documents and meeting observations. We identified eight distinct types of 'input resources', which were important in shaping the potential balance of power between partners in more or less productive ways. However, the dependency structure that materialized—and its synergistic potential—was contingent on how these inputs interacted with the partnership mission. Our findings suggest a well-developed shared mission serves three functions—(i) foregrounding a common purpose, (ii) aligning individual partner's self-interests and (iii) enabling action. The extent to which partnerships developed a shared mission serving all three functions influenced realization of a balanced dependency structure in which collaborators recognized their interdependencies, in turn promoting shared decision-making. To ensure the greatest potential for synergy, early and ongoing discursive processes to co-develop the partnership mission were particularly important. [ABSTRACT FROM AUTHOR]

Objective: Prenatal exposure to excess cortisol can affect postnatal metab olic health by epigenetic mechanisms. We aimed to investigate if prenatal exposure to pharmacological gl ucocorticoids increases the risk of overweight/obesity in childhood. Design: A nationwide population registry-based cohort study. Methods: We identified 383 877 children born in Denmark (2007-2012), who underwent routine anthropometric evaluation at 5-8 years of age. Prenatal exposure to glucocorti coids was divided into systemic and topical glucocorticoids, cumulative systemic dose, and use by trimester. The comparison cohort included children without exposure, born to maternal never-users. Negative control exposu res were used to investigate confounding from an underlying disease or unmeasured characteristics. Such expos ures included children without glucocorticoid exposure born to maternal users of non-steroidal anti-inflammato ry drugs or immunotherapy during pregnancy, maternal former users of glucocorticoids, or paternal users of glucocorticoids during the pregnancy of their partner. We estimated sex-stratified adjusted prevalence ratios (aPR) of overweight/obesity at 5-8 years of age, as epigenetic modifications have shown to be sex-specific. Results: In the study, 21 246 (11%) boys and 27 851 (15%) girls were ov erweight/obese at 5-8 years of age. Overall, neither systemic nor topical glucocorticoids were associated with overweight/obesity. In boys, high-dose systemic glucocorticoids was associated with higher prevalence of overwe ight/obesity vs the comparison cohort (aPR: 1.41 (95% CI: 1.07-1.86), prevalence: 16% vs 11%). Negative control exposures indicated robustness to confounding. Conclusion: Overweight/obesity might be an adverse effect of prenatal expos ure to high-dose systemic glucocorticoids in boys. We found no association for neither prenatal exposure to lower doses of systemic nor topical glucocorticoids. These results merit clinical attention. [ABSTRACT FROM AUTHOR]

The growing rates of childhood obesity constitute a public health challenge worldwide. Therefore it is important to identify effective and widely applicable interventions to prevent it. This study aims to explore children's experience of using a newly developed smartphone application (app) designed to promote healthy eating and evaluate its efficacy on encouraging healthy eating. First, two focus groups were conducted to explore children's experience of using the app. Then, a quasi-experimental design was used to evaluate the app's efficacy. The children were asked to use the app for three months. Afterwards, the effect of the intervention was evaluated. 118 children aged 9 to 13 years (M=10.9, Sd=1.1) participated in the study. The children's experience of using the app was relatively positive, and they found the app easy to use. A significant increase in fruit (η2=.10) and vegetable preferences (η2=.37) and fruit intake (η2=.06) was found in the experimental group. No effects were found for vegetable intake, selfefficacy for healthy eating, or peer norms for healthy and unhealthy eating (p>0.05). The smartphone app-based intervention could potentially serve as an attractive and low-cost intervention to reach a wide population of children for the promotion of healthy eating and prevention of childhood obesity. [ABSTRACT FROM AUTHOR]

Summary: Background: Information on postnatal weight gain is important for predicting later overweight and obesity, but it is unclear whether inclusion of this postnatal predictor improves the predictive performance of a comprehensive model based on prenatal and birth‐related predictors. Objectives: To compare performance of prediction models based on predictors available at birth, with and without information on infancy weight gain during the first year when predicting childhood obesity risk. Methods: A Danish register‐based cohort study including 55.041 term children born between January 2004 and July 2011 with birthweight >2500 g registered in The Children's Database was used to compare model discrimination, reclassification, sensitivity and specificity of two models predicting risk of childhood obesity at school age. Each model consisted of eight predictors available at birth, one additionally including information on weight gain during the first 12 months of life. Results: The area under the receiving operating characteristic curve increased from 0.785 (95% confidence interval (CI) [0.773‐0.798]) to 0.812 (95% CI [0.801‐0.824]) after adding weight gain information when predicting childhood obesity. Adding this information correctly classified 30% more children without obesity and 21% with obesity and improved sensitivity from 0.42 to 0.48. Specificity remained unchanged at 0.91. Conclusion: Adding infancy weight gain information improves discrimination, reclassification and sensitivity of a comprehensive prediction model based on predictors available at birth. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the childhood obesity in U.S., the use of sports and arts activities in the early 1980s in France and the schools sports in Denmark.

Summary: Background: In recent decades, there has been an increase in the prevalence of childhood overweight in most high‐income countries. Within northern Europe, prevalence tends to be higher in the UK compared with the Scandinavian countries. We aimed to study differences in body mass index (BMI) trajectories between large cohorts of children from UK and Scandinavian populations. Methods: We compared BMI trajectories in participants from the English Avon Longitudinal Study of Parents and Children born in 1991–1993 (ALSPAC) (N = 6517), the Northern Finland Birth Cohorts born in 1966 (NFBC1966) (N = 3321) and 1986 (NFBC1986) (N = 4764), and the Danish Aarhus Birth Cohort born in 1990–1992 (ABC) (N = 1920). We used multilevel models to estimate BMI trajectories from 2 to 18 years. We explored whether cohort differences were explained by maternal BMI, height, education or smoking during pregnancy and whether differences were attributable to changes in the degree of skew in the BMI distribution. Results: Differences in mean BMI between the cohorts were small but emerged early and persisted in most cases across childhood. Girls in ALSPAC had a higher BMI than all other cohorts throughout childhood, e.g. compared with the NFBC1986 BMI was 2.2–3.5% higher. For boys, the difference emerging over time (comparing the two NFBC's) exceeded the differences across populations (comparing NFBC1986, ABC and ALSPAC). BMI distribution demonstrated increasing right skew with age. Conclusion: Population‐level differences between cohorts were small, tended to emerge very early, persisted across childhood, and demonstrated an increase in the right‐hand tail of the BMI distribution. [ABSTRACT FROM AUTHOR]

Background/objective: Prenatal exposure to antibacterials may permanently dysregulate fetal metabolic patterns via epigenetic pathways or by altering maternal microbiota. We examined the association of prenatal exposure to systemic antibacterials with overweight and obesity in schoolchildren.Subjects/methods: We conducted a prevalence study among Danish schoolchildren aged 7-16 years using data from routine school anthropometric evaluations conducted during 2002-2013. Prenatal exposure to antibacterials was ascertained by using maternal prescription dispensations and infection-related hospital admissions during pregnancy. We defined overweight and obesity among the children using standard age- and sex-specific cutoffs. We computed sex-specific adjusted prevalence ratios (aPRs) of overweight and obesity associated with exposure to prenatal antibacterials, adjusting for maternal age at delivery, marital status, smoking in pregnancy and multiple gestation; we also stratified the analyses by birth weight.Results: Among 9886 schoolchildren, 3280 (33%) had prenatal exposure to antibacterials. aPRs associated with the exposure were 1.26 (95% confidence interval (CI): 1.10-1.45) for overweight and 1.29 (95% CI: 1.03-1.62) for obesity. Among girls, aPRs were 1.16 (95% CI: 0.95-1.42) for overweight and 1.27 (95% CI: 0.89 to 1.82) for obesity. Among boys, aPRs were 1.37 (95% CI: 1.13-1.66) for overweight and 1.29 (95% CI: 0.96-1.73) for obesity. The aPR for overweight was higher among schoolchildren with birth weight <3500 g (aPR: 1.30, 95% CI: 1.05-1.61) than in schoolchildren with birth weight ⩾3500 g (aPR: 1.18, 95% CI: 0.95-1.46). Inversely, the association for obesity was higher among schoolchildren with birth weight ⩾3500 g (aPR: 1.35, 95% CI: 1.00-1.81) than among those who were <3500 g at birth (aPR: 1.16, 95% CI: 0.82-1.65).Conclusions: Prenatal exposure to systemic antibacterials is associated with an increased risk of overweight and obesity at school age, and this association varies by birth weight. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Understanding peer effect is potentially important for finding ways to combat the obesity epidemic. Nevertheless, it is not clear whether a peer effect exists because of the composition of the peer group, because the group members have similar, unobserved individual characteristics, or because of an endogenous effect. METHODS This issue is addressed here by using a unique longitudinal data set of 573 schoolchildren attending state schools in the Municipality of Aalborg, Denmark, during 2008-2010. To identify the spillover effect of a targeted intervention on peers, we use a difference-in-differences approach. RESULTS A targeted health intervention reduced body mass index (BMI) among overweight, inactive individuals and, more interestingly, that BMI among the nontreated peers was reduced by 1.04%. CONCLUSIONS The analysis suggests that individually targeted health intervention has a health benefit beyond the treated individual, which needs to be included when evaluating targeted policies aiming to combat childhood overweight and inactivity. [ABSTRACT FROM AUTHOR]

Psoriasis is associated with being overweight, but the temporal relationship is not known. This historical cohort study tested whether severe psoriasis resulting in hospitalization in adulthood was preceded by excess increase in age-adjusted body mass index, a known risk factor in childhood for being overweight in adulthood. The study cohort was based on the Copenhagen School Health Records Register, birth years 1930 to 1984 (309,152 schoolchildren). Cases were found through the Danish National Patient Register for the period 1977 to 2001. A total of 1074 (0.36%) of the schoolchildren were identified as having psoriasis, with at least one hospital admission. Multivariate analysis demonstrated an association between excess increase in body mass index and psoriasis in females only. Being overweight in adolescence was the main factor behind this observation. The female group showed a significant association between psoriasis and body mass index at ages 12 (p=0.028) and 13 years (p=0.010). This was not the case for males or for body mass index measured at ages 11 years and below. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to assess the impacts of a family-based childhood obesity treatment on anthropometry and predictors of dropout and successful weight loss.Materials and Methods: The 18-month treatment consisted of a intensive period (IP) including physical exercise, nutritional guidance, family psychotherapy, child group sessions and a 1-year follow-up (FU).Results: One hundred children (10-12 years old, >140% of median weight-for-height) participated. The 81 children completing the IP decreased significantly from 2.9 to 2.6 body mass index (BMI) standard deviation score (SDS) units (p < 0.001). Furthermore, mean body fat percentage decreased significantly from 33.7 to 31.9 during IP. The 49 children completing the FU had a further decrease of 0.2 BMI SDS units (p = 0.003). Weight loss was less in children from immigrant families. Drop-out was higher if the mother had limited education and in immigrant families.Conclusions: This treatment with a psychological approach is feasible and results in significant weight loss during the programme. Future research should focus on how to improve the results of families with limited education and immigrants with non-European origin. [ABSTRACT FROM AUTHOR]

The article discusses a study on trends in childhood obesity in relation to economic development in Denmark between 1930 and 1983. It says that obesogenic environment is believed to be the driving force of the childhood obesity epidemic. Also noted is that the increase in prevalence of obesity in both genders and all ages started before the economic growth. The research found out that economic development could not explain the trends in childhood obesity.