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Introduction: Understanding the underlying factors that influence the approach to overweight and obesity in children is basic to best support families searching a solution to this important public health problem. Objective: To assess attitudes and feelings of paediatric staff in addressing overweight and childhood obesity to parents, exploring perceived barriers and facilitators, for an effective care. Participants and method: Qualitative study by means of individual semi-structured questionnaires of paediatric staff (paediatricians and paediatrician nurses; n = 57; 68% female) of primary health care centres and hospitals in Mallorca. Thematic analysis was done. Results: Three themes emerged from the data: “Parents’ attitude in childhood obesity” (sub-themes “The conscience of parents”, “The parents ask for help”), “Paediatric staff and childhood obesity” (sub-themes “Approaching to the problem: The interview with parents”, “Looking together for the solution”), and “System barriers” (sub-themes “Improving teamwork and health policy”, “Family participation in addressing childhood obesity”). Conclusions: Paediatric staffs know how to treat childhood obesity, but demand training on motivation. Effectivity on therapy of childhood obesity will be obtained after parents/carers recognize the problem and establish a trustful relationship with paediatric staff. The health system is still a barrier to the activity of paediatric personnel. Resumen: Introducción: Comprender los factores que influyen en el tratamiento del sobrepeso y la obesidad infantil es crucial para ofrecer el mejor apoyo a las familias y solucionar este grave problema de salud pública. Objetivo: Describir las actitudes y sentimientos del personal de pediatría al tratar con los padres el sobrepeso y la obesidad de sus hijos, explorando los facilitadores y las barreras percibidas, a fin de realizar una atención efectiva. Sujetos y método: Estudio cualitativo por cuestionarios individuales semiestructurados de personal pediátrico (pediatras y enfermeras pediatras; n = 57; 68% mujeres) de centros de atención primaria y hospitales de la isla de Mallorca, sobre las que se aplicó un análisis temático. Resultados: Se identificaron 3 temas: “La actitud de los padres en la obesidad infantil” (subtemas “La conciencia de los padres”, “Los padres piden ayuda”), “El personal pediátrico y la obesidad infantil” (subtemas “Aproximación al problema: La entrevista con los padres”, “Buscando juntos la solución”) y “Barreras del Sistema” (subtemas “Mejorar el trabajo en equipo y la política de salud”, “Participación familiar al abordar y estudiar la obesidad infantile”). Conclusiones: El personal pediátrico sabe tratar la obesidad infantil, pero demanda entrenamiento en motivación. La terapia de la obesidad infantil será efectiva cuando los padres/cuidadores reconocen el problema y establecen confianza con los equipos pediátricos. El sistema de salud aún es una barrera a la actividad del personal pediátrico.

Background The prevalence of childhood obesity in the U.S. has tripled over the last three decades. However, fewer than 1% of children with severe obesity undergo surgical weight loss interventions each year. Materials and methods All patients age 10 to 19 years old who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2015 through 2018 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database were included in this retrospective cohort analysis. The primary outcomes were mortality and overall complications. Procedural trends, readmission and reoperation rates were also examined using a multivariate regression model. Results Patients had a mean BMI of 47.3 kg/m2 and 80.0% were either 18 or 19 years old (n = 4,051). There were two reported deaths. Reoperation within 30 days occurred in 1.1% of patients, readmission in 3.5%, and complications in 1.2%. Among all readmissions, primary reasons included nausea/vomiting or nutritional depletion (41.3%) and abdominal pain (16.3%). RYGB was associated with higher odds for readmission (p = 0.006) and complications (p = 0.005). Higher BMI and younger age were not associated with an increased likelihood to experience poorer outcomes. The proportion of patients undergoing SG increased yearly over RYGB from 73.9% in 2015 to 84.3% in 2018. Conclusions Bariatric surgery appears to be low risk for adolescents and SG has become the operation of choice. More research on early consideration of surgical therapy in adolescents with severe obesity is needed given the safety profile. Level of Evidence III

Childhood obesity is a public health challenge. Between 1999 and 2012, the prevalence in Mexico of overweight and obesity in schoolchildren went from 25.5 to 32 %.To report current prevalence of overweight and obesity in schoolchildren from the municipality of Durango, Mexico.Cross-sectional survey conducted between January 2017 and December 2018. A total of 24,600 children aged between six and 11 years from 138 schools of the municipality of Durango were included. The body mass index reference values established by the World Health Organization were used to determine the presence of overweight and obesity.The prevalence of overweight was 19.7 %, of obesity, 16 %, and of overweight and obesity combined, 35.7 %. In the six-year-old group, a prevalence of overweight-obesity of 25.4 % was found, and in the 11-year-old group, 41.1 %.The prevalence of overweight-obesity in children aged from 6 to 11 years in the municipality of Durango is higher than those reported in the national survey by states in 2012 and in the 2016 national survey; a trend towards an increase with age was observed.La obesidad infantil es un reto de salud pública. Entre 1999 y 2012, en México la prevalencia de sobrepeso y obesidad (SO) en niños escolares pasó de 25.5 a 32 %.Reportar la prevalencia actual de SO en niños escolares del municipio de Durango, México.Encuesta transversal realizada entre enero de 2017 y diciembre de 2018. Se incluyeron 24 600 niños de seis a 11 años, de 138 escuelas del municipio de Durango. Se utilizaron los valores de referencia del índice de masa corporal establecidos por la Organización Mundial de la Salud para determinar la presencia de SO.La prevalencia de sobrepeso fue de 19.7 %, la de obesidad de 16 % y la de SO de 35.7 %. En el grupo de seis años se encontró una prevalencia de SO de 25.4 % y en el de 11 años, de 41.1 %.La prevalencia de SO en niños de seis a 11 años del municipio de Durango es más elevada que la reportada en la encuesta nacional por entidad federativa en 2012 y la nacional en 2016; se observó tendencia al incremento en la prevalencia conforme aumenta la edad.

Childhood obesity is a costly, yet preventable, public health concern. Strengthening the parent–child relationship and teaching parents strategies to manage children’s general and health-related behaviors has the potential to reduce childhood obesity risk. Selective prevention interventions may help parents of young children establish positive parenting and feeding practices to actively reduce risk factors. We review the existing literature on childhood obesity interventions and describe an adaptation to a behavioral parent training program—parent–child interaction therapy (PCIT)—to address children’s behaviors in obesity-salient (e.g., mealtime, screen time, bedtime) contexts. In a case example, we describe how PCIT-Health can be effectively implemented.

Background: The growing prevalence of overweight and/or obese children is an important public health problem in both developed and developing countries. Although the association of obesity between parents and their children is well known, its underlying mechanisms are not well established.Purpose: This meta-analysis examined parent-child (PC) relationships in obesity and identified factors such as world region and country income level that may influence this relationship.Methods: We identified all related studies published between January 1, 2015 and May 31, 2020 by conducting a literature search using the MeSH terms “obesity,” “overweight,” “body mass index,” “parent,” “child,” “associate,” and “relate” in the PubMed database in English.Results: The meta-analysis of 23 studies that reported an odds ratio (OR) for parent and child obesity associations found a significant association between parents and children who were overweight or obese (pooled OR, 1.97; 95% confidence interval, 1.85–2.10). A meta-regression analysis was used to examine the sources of interstudy heterogeneity. The association between parent and child obesity was higher in Asia than in Europe and the Middle East and higher in high-income countries than in middle-or low-income countries. In addition, a higher association between parent and child obesity was found when both parents were obese than when only the father or mother was obese. This study from multiple countries indicates a significant PC relationship in weight status that varies according to PC pair type, parent and child weight statuses, world region, and country income level.Conclusion: These results demonstrate that the risk of childhood obesity is greatly influenced by parental weight status and indicate that parents could play an important role in preventing child obesity.

Interest in and research on hidradenitis suppurativa (HS) have increased during the past decade, resulting in expanded knowledge about associated comorbidities and treatment efficacy. Knowledge about pediatric-onset HS is still limited, based on case studies, small case series, and extrapolation from adult studies. With increasing prevalence of childhood obesity, decreasing pubertal age, and increasing awareness of HS, physicians may start encountering younger HS patients. This review presents an updated discussion on the epidemiology, pathophysiology, and associated comorbidities in HS, with a focus on pediatric and adolescent patients. It also suggests recommendations for investigation and treatment based on current evidence.

Introduction. Recently, many studies have been devoted to the study of type 2 diabetes mellitus (DM2) worldwide. In most countries of the world, the increase in the prevalence of DM2 among children and adolescents is accompanied by an increase in childhood obesity. The presence of obesity or overweight in children can complicate the diagnosis of various types of DM. Detection and treatment of DM2 is extremely important for the society due to the wide range of severe diabetes complications.The aim of this work was to analyze the frequency of DM2 according to the Register of patients with DM, and to determine the state of glycemic control in children with DM2. Materials and methods. An analysis of glycemic control in children with DM2 who received various treatment regimens: with diet and lifestyle modifications, or with additional oral hypoglycemic agents (metformin monotherapy, or combination with insulin therapy). The glycemic control was assessed by measurement of glycated hemoglobin (HbA1c) level. Results. According to the data Register in Ukraine, the prevalence of DM among children has a tendency to rise — from 8.6 per 10 thousand children in 2005, to 13.14 — in 2019 year. The prevalence of DM2 in 2019 was 0.47 % of all cases of DM, and its prevalence contained 0.062 per 10 thousand children under 19 years of age with significant differences in the frequency of its diagnosis in different regions of Ukraine. We analyzed the state of glycemic control in children with DM2 aged from 9 up to 19 years old (Me 16.2 [15.5; 18.0]), with a disease duration 0.5—12 years (Me 4.5 [1.0] ; 7.5]). The age of diagnosis of DM2 was 2-17 years old (Me 11.7 [8.5; 15.0]), and 91.3 % of patients had obesity. Diet and lifestyle modifications were used in 34.8 % of patients, metformin monotherapy in 52.2 %, and metformin and insulin combination therapy in 13 % of patients. HbA1c values ​​ranged from 5.0 to 11.4 % (Me 7.2 % [5,8; 8,0]). The proportion of children who had ideal or optimal glycemic control (HbA1c 7.0—7.5 %) was 52.2 %, suboptimal (HbA1c 7.6—9.0 %) — 39.1 %, high-risk glycemic control (HbA1c> 9.1 %) — 8.7 % of children. The most unsatisfactory HbA1c levels ​​were registered in children who received metformin in combination with insulin (Me 10.6 % [10,15; 11,4]). Chronic complications of DM2 have not been reported.Conclusions. We found a low prevalence of DM2 among the pediatric population in Ukraine, more likely due to the low quality of its detection among children diagnosed with DM, as well as among children among high risk groups. Most children with DM 2 were obese. The majority of patients with DM2 (52.2 %) received metformin monotherapy, more than a third did not receive oral hypoglycemic agents. In most children with DM2 (52,2 %), the state of glycemic control corresponded to the optimal (

Background Obesity constitutes a critical risk for adolescent health. This study aimed at identifying youth‐friendly components of obesity treatment. Methods In this feasibility study, an adolescent obesity treatment platform was implemented at two Pediatric outpatient clinics in Sweden. Body mass index (BMI), BMI z‐score, and the category of obesity (International Obesity Task Force) were compared before and after the intervention and with data on standard care from the Swedish Childhood Obesity Treatment Register. Results The study included 99 participants (49 females) aged 13–18 years from 1 September 2014, to 31 December 2016. A pediatric nurse met the participants on average 6.5 times in the average inclusion period of 15 months. Physical activity sessions attracted 63 participants. Acceptance Commitment Therapy and In Real Life groups attracted 24 participants. At inclusion, 62 participants had obesity and 37 severe obesity, and 71/99 (72%) remained in the same category. The mean BMI increased from 32.0 to 33.4 kg/m2 (p

Objective: This study assessed the effectiveness of a school‐based intervention in reducing adolescents’ sugar‐sweetened beverage (SSB) consumption and percentage of energy from SSBs. Secondary outcomes were SSB consumption within school, average daily energy intake, and body mass index z‐scores. Methods: Six secondary schools located in New South Wales, Australia were recruited to participate in a six‐month pilot randomised controlled trial (1:1). The intervention included components targeting the school nutrition environment, curricula and community. Outcomes were collected via online surveys, observations, anthropometric measurements and project records. Between‐group differences were assessed via linear mixed models. Results: At the six‐month intervention endpoint (n=862) there were no statistically significant differences between students in intervention or control schools for mean daily intake of SSBs (8.55mL; CI −26.77, 43.87; p=0.63), percentage daily energy from SSBs (0.12% kJ; CI −0.55, 0.80; p=0.72), or for secondary outcomes. Acceptability of the school‐based strategies were high, however intervention fidelity varied across schools. Conclusion: While acceptable, improving fidelity of implementation and increasing the duration or intensity of the intervention may be required to reduce SSB intake. Implications for public health: Engaging parents and education stakeholders in the development phase to co‐design interventions may prove beneficial in improving intervention fidelity and enhance behavioural outcomes.

Objective This study examined whether the efficacy of a standard‐of‐care pediatric obesity treatment was affected by the COVID‐19 pandemic. Methods Analyses leveraged data from an ongoing pediatric obesity treatment trial involving 230 lower‐income, urban children aged 6 to 12 years. Mixed‐effects regression models compared children who participated in a 12‐month weight‐management intervention before versus during the COVID‐19 pandemic on change from baseline in BMI z score (ΔzBMI) at 3, 6, 9, and 12 months. Results The observed pattern of ΔzBMI was significantly different before versus during the pandemic (χ2 = 22.73, p < 0.0001). Children treated before the pandemic maintained an average weight loss of −0.06 ΔzBMI at 12 months, whereas children treated during the pandemic steadily gained weight over time, averaging a net gain of 0.11 ΔzBMI at 12 months (χ2 = 34.99, p < 0.0001). Treatment session completion did not differ before versus during the pandemic (60.4% vs. 55.7%, respectively; p = 0.30) or account for differences in ΔzBMI. Conclusions Similar reductions in intervention efficacy may be anticipated in other pediatric obesity treatment trials conducted during the COVID‐19 pandemic. Many families that have struggled with managing their child’s weight during this period may need encouragement to continue engaging in structured weight management as society renormalizes.

This study examined the association between breastfeeding, type of childbirth, and family structure with childhood obesity. During 2014-2016, 1728 Greek students attending primary schools and their parents were enrolled. Children's weight status was measured and classified according to the International Obesity Task Force criteria. A self-administered questionnaire assessing the type of childbirth, the family structure, and several perinatal and demographic characteristics was used. Factors associated with higher breastfeeding rates were the type of childbirth, high maternal educational level, and nuclear family structure. No association was found between childhood obesity and type of childbirth (p = 0.64) and family structure (p = 0.26). Although the short-term beneficial effects of breastfeeding on childhood obesity are undeniable and it is of great importance to all health professionals to promote breastfeeding, no significant long-term effects on obesity in adolescence were observed. More studies are needed in order to elucidate the role of breastfeeding in obesity status in adolescence.

AIM The purpose of this study was to assess for an association between higher body mass index and disease severity, morbidity and mortality in children admitted for an acute respiratory distress and failure. METHODS A single-institution retrospective cross-sectional study performed in the United States evaluating paediatric patients, 2-20 years of age, admitted for diagnoses related to acute respiratory distress and acute respiratory failure. Main outcomes include disease severity as assessed using the respiratory component of the Paediatric Early Warning Score (PEWS) with adjustment for altered mental status (Resp-PEWS + AMS), hospital or intensive care length of stay (LOS) and death. RESULTS Children with obesity made up 42/334 (13%) of the cohort. There was no significant difference in Resp-PEWS + AMS between obese and non-obese cohorts (mean of 0.93, {standard deviation 1.11} vs. 1.13 {1.35}, range 0-6, rank sum p = 0.46). There was no significant difference in overall hospital LOS or intensive care LOS. Multivariate analysis including diagnosis as a control variable did not change the results. CONCLUSION We found that body habitus was not an independent factor for illness severity or clinical outcomes.

Obesity is becoming increasingly prevalent in paediatric populations worldwide. In addition to increasing prevalence, the severity of obesity is also continuing to rise. Taken together, these findings demonstrate a worrying trend and highlight one of the most significant challenges to public health. Childhood obesity affects multiple organs in the body and is associated with both significant morbidity and ultimately premature mortality. The prevalence of complications associated with obesity, including dyslipidaemia, hypertension, fatty liver disease and psychosocial complications are becoming increasingly prevalent within the paediatric populations. Treatment guidelines currently focus on intervention with lifestyle and behavioural modifications, with pharmacotherapy and surgery reserved for patients who are refractory to such treatment. Research into adult obesity has established pharmacological novel therapies, which have been approved and established in clinical practice; however, the research and implementation of such therapies in paediatric populations have been lagging behind. Despite the relative lack of widespread research in comparison to the adult population, newer therapies are being trialled, which should allow a greater availability of treatment options for childhood obesity in the future. This review summarizes the current evidence for the management of obesity in terms of medical and surgical options. Both future therapeutic agents and those which cause weight loss but have an alternative indication are also included and discussed as part of the review. The review summarizes the most recent research for each intervention and demonstrates the potential efficacy and limitations of each treatment option.

Background: Childhood obesity has been growing steadily, at an earlier age, and currently comprises a public health issue. A number of studies have pointed to perinatal factors as possible determinants in the development of childhood obesity. Objective: To evaluate the influence of perinatal factors on the development of obesity in children and adolescents in southern Brazil. Design: Retrospective cohort study in which a linkage was made between anthropometric data of children and adolescents aged 0 to 15 years who had been registered in the Food and Nutrition Surveillance System (SISVAN) from 2008 to 2016 and their perinatal data registered in the Live Birth Information System (SINASC) from 2000 to 2014. The SINASC was used to extract maternal covariables (age, schooling, marital status), prenatal variables (parity and number of prenatal visits), and perinatal variables (type of delivery, sex, and birth weight). Variables such as age, inclusion in the Bolsa Família income transfer program, and the number of anthropometric evaluations were extracted from SISVAN. Results: The sample comprised 537 children and adolescents. The median age was 8 years (interquartile range: 2-11 years). The prevalence of obesity was 15.1%. Poisson regression revealed a higher risk of obesity in children born via cesarean delivery (relative risk [RR] = 1.48; 95% CI: 1.01-2.17), children of primiparous mothers (RR = 1.72; 95% CI: 1.16-2.53), girls (RR = 1.77; 95% CI:1.21-2.60), and those aged between 5 and 9 years (RR = 26.8; 95% CI: 3.75-191.55) and older than 10 years (RR = 20.74; 95% CI: 2.89-148.61). Conclusions: The linkage between SINASC and SISVAN allowed identification of prenatal and perinatal risk factors for the development of childhood obesity. These findings should contribute to the development of health promotion and prevention policies.

Extensive evidence shows that risk factors for cardiovascular disease (CVD) begin to develop early in life. Childhood obesity and elevated blood pressure (BP) have become overwhelmingly challenging, with 57% of today's children predicted to be obese by the age of 35 years, and global rates of hypertension in children and adolescents increasing by 75% from 2000 to 2015. Thus, there is an urgent need for tools that can assess early CVD risk in youth, which may lead to better risk stratification, preventative intervention, and personalised medicine. Vascular ageing (the deterioration in vascular structure and function) is a pivotal progenitor of health degeneration associated with elevated BP. Exposure to adverse environmental and genetic factors from fetal life promotes the development and accumulation of subclinical vascular changes that direct an individual towards a trajectory of early vascular ageing (EVA)-an independent predictor of target organ damage in the heart, brain, and kidneys. Therefore, characterising vascular ageing from youth may provide a window into cardiovascular risk later in life. However, vascular ageing measurements only have value when techniques are accurate/validated and when reliable thresholds are available for defining normal ranges and ranges that signal increased risk of disease. The aim of this paper is to summarise current evidence on the importance of vascular ageing assessment in youth and the impact of interventions to prevent or delay EVA, to highlight the need for standardisation and validation of measurement techniques in children and adolescents, and the importance of establishing reference values for vascular ageing measures in this population.

Background A technology-based intervention, such as a mobile application, was a growing interest and potentially effective modality for treating obesity. The study aimed to evaluate the effectiveness of the OBEST, a new mobile/tablet-based application in reducing weight and encouraging healthy eating behaviors and quality of life in children with obesity. The application could assist healthcare professionals to treat children and adolescents with obesity. Methods A randomized controlled trial was conducted in the hospital and school settings in Chiang Mai, Thailand. Seventy-seven children and adolescents with obesity were randomized into two groups; one received standard care combined with the OBEST application, and the other received only standard care. The outcomes were changes in weight, healthy eating behaviors, and quality of life assessed by the Pediatric Quality of Life Inventory (PedsQL) from baseline to six-month follow-up between the two groups. Results The results showed that the intervention group reduced more body mass index (BMI) and had a higher number of participants engaging in healthy eating behaviors than the standard care group but did not reach a statistically significant level, except for less frequent consumption of fast food. The participants in the intervention group had 4.5 times higher odds of decreased engaging in fast-food consumption than the standard care group at 6 months follow-up (odds ratio, 4.5 [95% CI, 1.41 to 14.35]). There were no statistically significant changes in PedsQL scores over 6 months in between groups. Conclusions The current study was unable to detect a significant effect of the OBEST application as an adjunct tool to the standard treatment on reducing weight in obese children and adolescents. However, the mobile application might help to increase engaging in healthy eating behaviors. Further studies with a larger sample are needed to confirm our findings. Trial registration The trial was retrospectively registered at the Thai Clinical Trials Registry (trial registration number: TCTR20200604008, on June 4, 2020).

Background Genetic correlations, causalities and pathways between large-scale complex exposures and ovarian and breast cancers need systematic exploration. Methods Mendelian randomisation (MR) and genetic correlation (GC) were used to identify causal biomarkers from 95 cancer-related exposures for risk of breast cancer [BC: oestrogen receptor-positive (ER + BC) and oestrogen receptor-negative (ER - BC) subtypes] and ovarian cancer [OC: high-grade serous (HGSOC), low-grade serous, invasive mucinous (IMOC), endometrioid (EOC) and clear cell (CCOC) subtypes]. Results Of 31 identified robust risk factors, 16 were new causal biomarkers for BC and OC. Body mass index (BMI), body fat mass (BFM), comparative body size at age 10 (CBS-10), waist circumference (WC) and education attainment were shared risk factors for overall BC and OC. Childhood obesity, BMI, CBS-10, WC, schizophrenia and age at menopause were significantly associated with ER + BC and ER - BC. Omega-6:omega-3 fatty acids, body fat-free mass and basal metabolic rate were positively associated with CCOC and EOC; BFM, linoleic acid, omega-6 fatty acids, CBS-10 and birth weight were significantly associated with IMOC; and body fat percentage, BFM and adiponectin were significantly associated with HGSOC. Both GC and MR identified 13 shared factors. Factors were stratified into five priority levels, and visual causal networks were constructed for future interventions. Conclusions With analysis of large-scale exposures for breast and ovarian cancers, causalities, genetic correlations, shared or specific factors, risk factor priority and causal pathways and networks were identified.

Objectives The later achievement of gross motor milestones during infancy is associated with adiposity in early childhood. However, the associations between gross motor development and adiposity after entering primary school are unclear. This study examined the associations between the ages at which six gross motor milestones were achieved and adiposity during early school years. Methods This retrospective study was conducted in 2012 and 2013. Data were collected from 225 first-grade primary school children (mean age, 6.9 years; 39% girls). Adiposity was assessed using dual-energy X-ray absorptiometry and expressed as body fat percentage. Data describing the ages of achieving six gross motor milestones (holding head up, sitting, crawling, standing supported, walking supported, and independent walking) were obtained from the Maternal and Child Health Handbooks. Results Mean body fat percentage was 21.7%. Multiple linear regression analyses revealed that later ages of achieving crawling (p Conclusions Achieving crawling, standing supported, and walking supported later predict increased body fat when aged 6–7 years. The practice of observing gross motor milestone achievements may allow early targeted interventions to optimize body composition before beginning school and thereby, potentially prevent childhood obesity.

Globally, Childhood obesity is one of the most serious public health challenges in the 21st century. In 2017, the Commission on Ending Childhood Obesity (ECHO) reported that worldwide obesity increased 10-fold among children and adolescents during the last 40 years. According to World Health Organization (WHO) & Childhood Obesity Surveillance Initiative (COSI) data, childhood obesity rates are highest in the Southern European Countries in the World. Childhood obesity is one of the most important public concerns due to increased incidence with a high morbidity rate. This study was intended to identify the parent's attitude on causes and its prevention of childhood obesity in Jazan province. With the Stratified Random sampling method, 100 obese children's parents were selected. Initially, personal information was obtained about a child and mother, and then "Google Form" 5-point Likert's scale was administered to assess parents' attitude on obesity and its prevention. It has four domains (General information on obesity - 2 questions, causes of obesity - 14, consequences of obesity - 4, and prevention of obesity - 10) with 30 questions. The results of the study are expressed as mean and standard deviation (mean percentage). The parent’s attitude score was expressed in terms of obesity 5.86 ± 1.27 (58.6%), causes 38.75 ± 6.52 (55.36%), consequences 11.65 ± 2.36 (58.25%) and prevention 29 ± 5.15 (58%). The overall mean score and standard deviation were 86.67 ± 13.81 (54.84%). The parents had an average attitude score (64.57%) on the causes and prevention of childhood obesity. There was no association between attitude scores with the demographic variables, except the variable age associated with attitude scores. Obesity prevention requires effective intervention measures. The research study proposed that family education and impulse are essential for treating childhood obesity. Schools play a significant role in promoting healthy eating habits and physical activity.

Objectives To examine perceptions of Sugar-sweetened beverage (SSB) policies and programs focused on the first 1000 days—gestation through age 2 years—among community stakeholders in Washington Heights and the South Bronx, two neighborhoods in New York City with disproportionately high prevalence of childhood obesity. Methods A multilevel framework informed interview guide development. Using purposeful sampling, we recruited study participants who were (1) able to speak English or Spanish and (2) resided or employed in Washington Heights or the South Bronx. Participants included community leaders (local government officials, community board members, and employees from community- and faith-based organizations) as well as community members. Trained research staff conducted semi-structured in-depth interviews. Using immersion/crystallization and template style coding, the study team performed thematic analysis until no new relevant themes emerged. Results Among the 19 female study participants, perceived facilitators to SSB policy and program implementation included sustained partnerships with broad coalitions; continual education and clear messaging; and increased accessibility to healthier beverages. Perceived barriers included systems-level challenges accessing programs that support healthy beverage options, and individual-level lack of access to affordable healthy beverages. Acceptable potential intervention strategies included messaging that emphasizes health in pregnancy and infancy; policies that require healthy beverages as the default option in restaurants; and policies that remove SSBs from childcare settings. Some strongly favored SSB excise taxes while others opposed them, but all participants supported reinvestment of SSB tax revenue into health resources among marginalized communities. Conclusions A multi-pronged approach that incorporates engagement, access, equitable reinvestment of revenue, and continual clear messaging may facilitate implementation of policies and programs to reduce SSB consumption in the first 1000 days.

CD36 glycoprotein is a candidate receptor involved in the gustatory detection of lipids and emerging evidence has suggested that genetic variations in CD36 may modulate the oral perception threshold to fatty acids. Here, we analyzed the association of -31118 G > A polymorphism in CD36 gene with nutritional status and preferences for fatty foods in Mexican children. Genotyping of SNP rs1761667 was performed in school-age children (n = 63) in addition to sensory tests evaluating the preference and satisfaction score assigned to oil-based sauces of different fatty acid composition. The G allele was associated with high BMI z-score in children (OR = 2.43, 95% (CI 1.02–5.99); p = 0.02) but CD36 genotypes (AA, GA, and GG) did not show significant association with the preference and satisfaction scores assigned to oil-based sauces. The BMI z-score showed no association with the preference to oil-based sauces; however, children with normal weight gave higher satisfaction scores to sauces with a high content of unsaturated fatty acids than to sauces rich in saturated fatty acids (0.56 ± 1.26 vs. 0.06 ± 1.22; p = 0.02). Therefore, the G allele of -31118 G > A SNP in CD36 gene is associated with overweight and obesity in Mexican children but do not appear to modulate the preferences and satisfaction scores to fat. info:eu-repo/semantics/acceptedVersion

Background: in the United Kingdom, rates of childhood obesity are high and inequalities in obesity have widened in recent years. Children with obesity face heightened risks of living with obesity as adults and suffering from associated morbidities. Addressing population prevalence and inequalities in childhood obesity is a key priority for public health policymakers in the United Kingdom and elsewhere. Where randomized controlled trials are not possible, potential policy actions can be simulated using causal modeling techniques. Objectives: using data from the Southampton Women's Survey (SWS), a cohort with high quality dietary and lifestyle data, the potential impact of policy-relevant calorie-reduction interventions on population prevalence and inequalities of childhood obesity was investigated. Methods: predicted probabilities of obesity (using UK90 cut-offs) at age 6–7 years were estimated from logistic marginal structural models adjusting for observed calorie consumption at age 3 years (using food diaries) and confounding. A series of policy-relevant intervention scenarios were modeled to simulate reductions in energy intake (differing in effectiveness, the targeting mechanisms, and level of uptake). Results: at age 6–7 years, 8.3% of children were living with obesity, after accounting for observed energy intake and confounding. A universal intervention to lower median energy intake to the estimated average requirement (a 13% decrease), with an uptake of 75%, reduced obesity prevalence by 1% but relative and absolute inequalities remained broadly unchanged. Conclusions: simulated interventions substantially reduced population prevalence of obesity, which may be useful in informing policymakers.

OBJECTIVE This study examines relations between food insecurity, inhibitory control, and body mass index (BMI) in early childhood. METHOD The sample comes from an evaluation of a state-funded prekindergarten program and includes 126 children (mean age = 4.73 yrs, female = 42%) from families with low incomes. Parents reported on their child's food insecurity. Child inhibitory control was assessed using a performance-based task, and children's height and weight were objectively collected at the same time as the inhibitory control assessment. A regression model was used to test whether inhibitory control moderated the association between food insecurity and BMI. The model included a large battery of covariates and adjusted for clustering at the classroom level. Ad hoc analyses were conducted to examine the robustness of findings to different conceptualizations of food insecurity based on the US Department of Agriculture's categories for severity. RESULTS A significant interaction revealed that inhibitory control moderated the association between food insecurity and children's BMI percentile. Investigation of the simple slopes suggested that greater food insecurity was related to a higher BMI percentile among children who demonstrated stronger inhibitory control. In addition, results from ad hoc analyses examining categories of food insecurity indicated that experiencing very low food security was also related to a higher BMI among children with average and strong inhibitory control. CONCLUSION This study makes a unique contribution to the existing literature by examining relations among food insecurity, inhibitory control, and BMI during a critical period in children's physical and brain development. Findings have implications for public health efforts to address childhood obesity among populations with low incomes.

“Childhood Obesity and its co-morbidities is considered as a prime health hitch that lay up consideration among the public health society. Obesity and above the over weight has bagged the fifth position in the global risk for mortality. The obesity shows a very early onset in life which has laid the utmost importance in the prevention of it among the children. Neck circumference is being considered as the marker of upper body subcutaneous tissue distribution. Aim: The main objective is to evaluate the association between neck circumference and obesity among the children. Methodology: This is a cross sectional study conducted between the periods of august 2019 - September 2019, among 150 male + 129 female students, aged 11 to 18 years. Anthropometric markers of obesity- body mass index (BMI), waist circumference (WC), Hip circumference (HC), waist hip ratio (WHR), neck circumference (NC) were collected. Pearson’s correlation coefficient was used to compute the neck circumference with other obesity indices. Results: The mean BMI was 27.70±1.27 kg/m² and 27.72±2.12 kg/m², mean neck circumference was 35.42±2.26 cm and 32.85±1.92 in above the over weight /obesity boys + girls respectively. The hip circumference in boys was found to be greater than girls, which is higher in above the over weight /obesity students with P

Ожиріння є однією з актуальних медико-соціальних проблем сучасності. Відзначається збільшення поширеності ожиріння серед дітей. Кількість дітей у світі віком до 5 років із надлишковою масою тіла та ожирінням становить 44 мільйони. Ожиріння в дитячому віці є фактором ризику для розвитку тяжкої супутньої патології. Дитяче ожиріння — тяжкий прогностичний фактор ожиріння в дорослих. Реєструється підвищений рівень передчасної смерті в дорослих, які страждали від ожиріння в дитинстві. Заходи профілактики та лікування дитячого ожиріння повинні бути спрямовані на всю родину, а не тільки на хвору дитину. З метою профілактики ожиріння слід обмежувати надлишкове вживання калорій. Для підвищення ефективності профілактики ожиріння в дітей вживання енергії потрібно поєднувати з підвищенням фізичної активності. Основним методом лікування ожиріння в дітей є модифікація способу життя, що включає корекцію харчування, призначення фізичних навантажень та поведінкову терапію. Впровадження шкільних програм, що передбачають збільшення фізичної активності та оптимізацію харчування школярів, підвищує ефективність боротьби з дитячим ожирінням. Фармакотерапія при ожирінні в дітей призначається при неефективності програм з модифікації способу життя. Для медикаментозного лікування ожиріння в дітей застосовується орлістат. Ефективність фармакотерапії підвищується при її поєднанні з комплексними програмами з модифікації способу життя. За кордоном при морбідному ожирінні в підлітків у разі неефективності нехірургічного лікування використовується баріатрична хірургія. У результаті оперативного втручання знижується індекс маси тіла, покращується перебіг супутніх захворювань, підвищується якість життя пацієнтів. Баріатрична хірургія пов’язана з ризиком розвитку побічних ефектів, що потребує проведення безперервного моніторингу ускладнень. Для лікування та профілактики ожиріння в дітей необхідним є мультидисциплінарний підхід із залученням спеціалістів різного профілю.

RATIONALE Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset. OBJECTIVES To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association. METHODS We studied 8,716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7,299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years). MEASUREMENTS AND MAIN RESULTS We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23). CONCLUSIONS This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.

Childhood obesity prevalence is increasing worldwide. The most common cause of obesity in children is a positive energy balance due to excess caloric intake in contrast to caloric expenditure combined with a genetic predisposition for weight gain. Obesity causes type 2 diabetes mellitus, hypertension, cardiovascular diseases, osteoporosis and some cancers. There is limited information on the efficacy and safety of medications for weight loss in children. In this paper, definition, etiopathogenesis, differential diagnosis, co-morbidities, and treatment of obesity in children will be reviewed.

The analysis of the prevalence and morbidity of obesity in children and adolescents in Ukraine for a period of 2010–2013 was conducted. Obesity reaches 17.2 % among endocrine diseases, which take 4th place in the structure of prevalence according to the disease classes for children and adolescents. Analysis of time series in terms of obesity prevalence in the pediatric age group showed that the indicator has positive dynamics and, according to constructed mathematical models, was prone to the relative increase in the nearest future. A mathematical model is characterized by a high rate of approximation (R2 = 0.9659), which determines the increase in the prevalence of obesity in children and adolescents till 2017. The following preventive measures should be considered as important ones: expertise of microenvironment (living conditions, kindergartens, schools); study of morbidity according to official statistics; medical examinations of the child population with an analysis of health (physical development, resistance, morbidity); selection of risk groups of developing pathology; organization of follow-up; introduction of modern medical technology.

Objective Puberty-induced insulin resistance is considered critical in the pathogenesis of type 2 diabetes (T2D) in youth. The development of T2D before puberty suggests distinct risk factors and pathophysiology but, because of its rarity, this has not been well studied. We aimed to describe the clinical characteristics of children with T2D diagnosed before the onset of puberty. Research design and methods We retrospectively studied all children with autoantibody-negative T2D and available pubertal development assessment seen at our center between July 2016 and July 2019, and compared characteristics of those at Tanner stage I (prepubertal, n = 35) versus those at Tanner II-V of pubertal development (n = 341). Results At T2D diagnosis, prepubertal children compared with those at Tanner II-V had higher body mass index z-score (p = 0.003) and higher C-peptide (p = 0.003) (while glucose levels were not significantly different), with differences retaining significance after adjustment for glucose, race/ethnicity and sex. Dyslipidemia occurred in 100% of prepubertal children versus 89.7% of those diagnosed later (p = 0.036). Of the prepubertal children diagnosed under age 10 (n = 13), 69.2% were female, 100% racial/ethnic minority, 100% had obesity with history of dyslipidemia and none with diabetic ketoacidosis. Conclusions T2D, although rarely, can develop before puberty. Children with T2D diagnosed in the prepubertal period have more severe obesity, greater insulin resistance, and more frequent dyslipidemia than older youth. These findings suggest that children with prepubertal T2D are at increased risk for associated morbidity compared with older youth and underscore the significance of interventions to prevent and treat obesity in early childhood.

[Purpose] Exercise is a key factor in preventing obesity and metabolic syndrome. Sumo wrestlers increase their body size from childhood for athletic advantage; however, the risk of metabolic syndrome in junior sumo wrestlers is undetermined. Preventive measures against pediatric obesity should be initiated during childhood to prevent obesity in adulthood, considering its high global incidence. We comparatively evaluated the risk factors for metabolic syndrome in junior sumo wrestlers and children with obesity.[Methods] We enrolled 70 male children (age 9–17 years [sumo group, n = 14] and 9–14 years [other sports and non-exercise groups, n = 28 each]) and evaluated their anthropometric parameters (height, weight, body mass index z-score, obesity rate, waist circumference, waist to height ratio) and hematological parameters (total, low-density, high-density, and non-high-density lipoprotein-cholesterol; triglycerides; plasma glucose, and glycated hemoglobin levels).[Results] The BMI z-score, obesity rate, waist circumference (p < 0.05, along with the non-exercise group), and systolic blood pressure were significantly higher and the high-density cholesterol level was lower in the sumo group than in the other sports group (p < 0.05). The waist to height ratio was significantly higher in the non-exercise group than in the other sports group (p < 0.05). No significant difference was found in other blood lipid, plasma glucose (significantly lower level than the reference range in the sumo group, p < 0.05), and glycated hemoglobin (within the reference range in all groups) levels among the three groups.[Conclusion] Junior sumo wrestlers had a larger body size and higher blood pressure than children with obesity who exercised regularly. This provides direction for future research into targeted preventive interventions against metabolic syndrome for junior sumo wrestlers with large body size.

BACKGROUND: Infants and young children with high weight-for-length are at increased risk for obesity in later life. This study describes prevalence of high weight-for-length and examines changes during 2010–2018 among 11,366,755 infants and young children 3–23 months of age in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: Children’s weights and lengths were measured. High weight-for-length was defined as ≥2 standard deviations above sex and age-specific median on World Health Organization growth charts. Adjusted prevalence differences (APDs) between years were calculated as 100 times marginal effects from logistic regression models. APD was statistically significant if 95% confidence interval did not include 0. RESULTS: Adjusted prevalence of high weight-for-length decreased from 2010 to 2014, and leveled off through 2018 overall, in boys and girls, those 6–11 and 18–23 months of age, and non-Hispanic whites, non-Hispanic blacks, Hispanics, and Asians/Pacific Islanders. For 12–17 months old and American Indian/Alaska Native infants and young children, adjusted prevalence decreased from 2010 to 2014, and then increased slightly through 2018. Among 56 WIC state or territorial agencies, 33 had significant decreases between 2010 and 2018, whereas 8 had significant increases. Between 2014 and 2018, prevalence decreased significantly in 12 agencies and increased significantly in 23. CONCLUSIONS: The results indicate overall declines in prevalence of high weight-for-length from 2010 to 2018, with a prevalence stabilization since 2014. Continued surveillance is needed. Obesity prevention strategies in WIC and multiple settings are important for ensuring healthy child growth.

Objective: To quantify the potential population-wide costs, number of individuals reached, and impact on obesity of five effective interventions to reduce children's television viewing if implemented nationally. Study Design: Utilizing evidence from systematic reviews, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) microsimulation model estimated the cost, population reach, and impact on childhood obesity from 2020 to 2030 of five hypothetical policy strategies to reduce the negative impact of children's TV exposure: (1) eliminating the tax deductibility of food and beverage advertising; (2) targeting TV reduction during home visiting programs; (3) motivational interviewing to reduce home television time at Women, Infants, and Children (WIC) clinic visits; (4) adoption of a television-reduction curriculum in child care; and (5) limiting noneducational television in licensed child care settings. Results: Eliminating the tax deductibility of food advertising could reach the most children [106 million, 95% uncertainty interval (UI): 105–107 million], prevent the most cases of obesity (78,700, 95% UI: 30,200–130,000), and save more in health care costs than it costs to implement. Strategies targeting young children in child care and WIC also cost little to implement (between $0.19 and $32.73 per child reached), and, although reaching fewer children because of the restricted age range, were estimated to prevent between 25,500 (95% UI: 4600–59,300) and 35,400 (95% UI: 13,200–62,100) cases of obesity. Home visiting to reduce television viewing had high costs and a low reach. Conclusions: Interventions to reduce television exposure across a range of settings, if implemented widely, could help prevent childhood obesity in the population at relatively low cost.

Background Given the increasing rates of childhood obesity in Alaska Native children and the understanding that the most effective interventions are informed by and reflect the cultural knowledge of the community in which they are implemented, this project sought to gather the wisdom of local Yup’ik and Cup’ik Elders in the Yukon-Kuskokwim region of Alaska around how to maintain a healthy diet and active lifestyle. Methods Perspectives were sought through the use of semi-structured focus groups, which were completed in person in twelve communities. All conversations were recorded, translated, transcribed, and analyzed using a qualitative approach, where key themes were identified. Results Elders provided a clear and consistent recollection of what their life looked like when they were young and expressed their perspectives related to maintaining a healthy and traditional lifestyle. The key themes the Elders discussed included an emphasis on the nutritional and cultural benefits of traditional foods; concerns around changing dietary patterns such as the consumption of processed foods and sugar sweetened beverages; and concerns on the time and use of screens. Elders also expressed a desire to help younger generations learn traditional subsistence practices. Conclusions The risk of obesity in Alaska Native children is high and intervention efforts should be grounded in local knowledge and values. The perspectives from Yup’ik and Cup’ik Elders in the Yukon-Kuskokwim Delta area of Alaska provide a better understanding on local views of how to maintain a healthy diet, physical activities, and traditional values.

Introduction: Sleep apnoea-hypopnoea syndrome (SAHS) and childhood obesity are two high prevalence conditions that represent a public health challenge. Objective: To analyse the association between both and comparing child groups that had or did not have both conditions. Patients and methods: A prospective study in children (3–14 years), referred to the “Multidisciplinary Sleep Unit” due to suspected SAHS, between 1 November 2015 and 1 August 2017. The following parameters were evaluated: anthropometry, symptoms, blood pressure, ear, nose, and throat examination, polysomnography (nocturnal PSG) and laboratory tests. Results: A total of 67 children were evaluated (64% non-obese (NOb) and 36% obese (Ob). It was observed that the Ob were older (P

Background Reducing sugar-sweetened beverage (SSB) consumption is a promising dietary target for childhood obesity prevention. This paper describes the design and methods of a cluster randomized trial of H2GO!, a youth empowerment intervention to prevent childhood obesity through reducing SSB consumption among a low-income, ethnically diverse sample of youth. Methods This cluster randomized controlled trial is an academic-community partnership with the Massachusetts Alliance of Boys and Girls Clubs (BGC). Ten BGC sites will be randomly assigned to the H2GO! intervention or a wait-list, usual care control. Eligible study participants will be N = 450 parent-child pairs (youth ages 9–12 years and their parents/caregivers) recruited from participating BGCs. The 6-week in-person H2GO! intervention consists of 12 group-based sessions delivered by BGC staff and youth-led activities. An innovative feature of the intervention is the development of youth-produced narratives as a strategy to facilitate youth empowerment and parental engagement. Child outcomes include measured body mass index z scores (zBMI), beverage intake, and youth empowerment. Parent outcomes include beverage intake and availability of SSBs at home. Outcomes will be measured at baseline and at 2, 6, and 12 months. With a 75% retention rate, the study is powered to detect a minimum group difference of 0.1 zBMI units over 12 months. Discussion Empowering youth may be a promising intervention approach to prevent childhood obesity through reducing SSB consumption. This intervention was designed to be delivered through BGCs and is hypothesized to be efficacious, relevant, and acceptable for the target population of low-income and ethnically diverse youth. Trial registration ClinicalTrials.gov NCT04265794. Registered 11 February 2020.

IntroductionSleep disordered breathing (SDB) represents common comorbidities of childhood obesity leading to interrupted sleep and sleep deprivation. Sleep deprivation alters secretion of brain-derived neurotrophic factor (BDNF), which is an appetite regulator. However, little is known about the relation between BDNF and central obesity in children with SDB. The aim of the study was to evaluate BDNF level and anthropometric indices in relation to SDB in children with obesityMaterial and methodsA prospective case-control study was conducted on 30 children with obesity (BMI > 95th percentile) and 30 healthy lean children (BMI 5th-85th percentile). Polysomnographic, anthropometric data and BDNF serum level were obtained from all included children. Serum level of BDNF and anthropometric indices of obesity were assessed in relation to SDB in children with obesity. Regression analysis was done to determine predictors for SDB in children with obesity.ResultsIn comparison to healthy controls, anthropometric indices of central obesity were significantly higher while BDNF was significantly lower in obese children, especially those with SDB. Respiratory disturbance index has a significant positive correlation with anthropometric indices of central obesity and a significant negative correlation with BDNF level. Central obesity and decreased BDNF were associated with 2-fold increased risk for SDB. Waist circumference/height ratio and neck circumference/height ratio have 89.5%, 75% sensitivity and 81.23%, 84.62% specificity at a cutoff point > 0.62, > 0.24 respectively for prediction of SDB in children with obesity.ConclusionsCentral obesity and decreased BDNF represent independent predictors for SDB in children with obesity. Anthropometric indices adjusted to height are a simple screening tool for SDB in obese children.

Childhood overweight and obesity in Indian children and adolescents is a relatively new but widespread epidemic. Hence, it is necessary to evaluate and identify these children to prevent long-term complications. The most important evaluation to identify and assess obesity-related risks in these children involves anthropometric assessment and using appropriate growth charts. Overweight and obesity are defined using weight-for-length or -height parameters (World Health Organization 2006 charts) in Indian children less than 5 y and body mass index (Indian Academy of Pediatric 2015 charts) in Indian children aged 5-18 y. Waist circumference is another important predictor of pediatric obesity-related comorbidities and is also a component to define metabolic syndrome. Tall and obese children usually have primary obesity, and short and obese children require further evaluation for endocrine disease or syndromic causes. The presence of developmental delay, hearing or vision impairment, genital and digit abnormalities or dysmorphism should warrant a genetic evaluation. It is important to document social and dietary history as well as time spent in physical activity and usage of electronic screen. Finally, comorbidities associated with childhood obesity are common, which can result in long-term complications; hence, these comorbidities should be screened and managed to prevent long-term cardiometabolic risks.

Purpose: To compare choroidal thickness (CT) and ocular pulse amplitude (OPA) in childhood obesity with insulin resistance (IR) and without IR. Methods: Seventy-three childhood obesity and 62 healthy children, who were both age-matched and gender-matched, comprised the study population in this prospective study. Obesity was determined as having a body mass index (BMI) – standard deviation (SD) score that was > 2 SD. Intraocular pressure (IOP) and OPA were measured using a dynamic contour tonometer. The CT measurements were performed using enhanced depth imaging optical coherence tomography at three locations, comprising at the fovea, at a position 500 µm nasal, and also at a position 500 µm temporal to the fovea. Results: Mean BMI value was 28.72 ± 4.85 in the patients with childhood obesity and 21.47 ± 1.14 in the control group. The mean IOP and OPA values were determined 15.90 ± 2.30 and 14.10 ± 2.16 mm Hg, 1.50 ± 0.28 and 1.74 ± 0.32 mm Hg in the patients with childhood obesity and the control group, respectively ( p 0.005). Conclusions: Our results showed that both OPA and CT values were significantly decreased in childhood obesity patients. We suggest further studies to verify longitudinal changes in OPA and CT, as also the evaluation of these parameters in other populations.

Introduction Observational studies suggest earlier puberty is associated with higher adulthood blood pressure (BP), but these findings have not been replicated using Mendelian randomization (MR). We examined this question sex-specifically using larger genome-wide association studies (GWAS) with more extensive measures of pubertal timing. Methods We obtained genetic instruments proxying pubertal maturation (age at menarche [AAM] or voice breaking [AVB]) from the largest published GWAS. We applied them to summary sex-specific genetic associations with systolic and diastolic BP z-scores, and self-reported hypertension in women (n = 194 174) and men (n = 167 020) from the UK Biobank, using inverse-variance weighted meta-analysis. We conducted sensitivity analyses using other MR methods, including multivariable MR adjusted for childhood obesity proxied by body mass index (BMI). We used late pubertal growth as a validation outcome. Results AAM (beta per 1-year later = -0.030 [95% confidence interval, -0.055 to -0.005] and AVB (beta -0.058 [95% CI, -0.100 to -0.015]) were inversely associated with systolic BP independent of childhood BMI, as were diastolic BP (-0.035 [95% CI, -0.060 to -0.009] for AAM and -0.046 [95% CI, -0.089 to -0.004] for AVB) and self-reported hypertension (odds ratio 0.89 [95% CI, 0.84-0.95] for AAM and 0.87 [95% CI, 0.79-0.96] for AVB). AAM and AVB were positively associated with late pubertal growth, as expected. The results were robust to sensitivity analysis using other MR methods. Conclusion Timing of pubertal maturation was associated with adulthood BP independent of childhood BMI, highlighting the role of pubertal maturation timing in midlife BP.

Objetivos: Determinar a prevalência de baixo peso, peso normal, excesso de peso e obesidade na população em idade escolar numa Unidade de Saúde Familiar (USF) do concelho de Portalegre e determinar se existe diferença estatisticamente significativa entre o género e o peso e entre a idade e o peso. Tipo de estudo: Estudo observacional transversal, descritivo e analítico. Local: USF Portus Alacer, concelho de Portalegre. População: Utentes da USF Portus Alacer [6-17 anos]. Métodos: Determinação do índice de massa corporal (IMC) de 448 crianças e adolescentes [6-17 anos] vigiadas na USF Portus Alacer, entre janeiro de 2017 e outubro de 2018 [intervalo de confiança (IC) 95%, margem de erro 3,64%]. Os participantes foram classificados em quatro categorias de acordo com os pontos de corte de IMC estabelecidos pela OMS para a idade e género. O software usado no tratamento de dados foi o SPSS® v. 25.0, o Microsoft Office Excel® e o Sample Size Calculator by Raosoft®. As ferramentas estatísticas utilizadas foram o teste de Qui-quadrado e o teste do t-Student. A normalidade foi testada através do teste Kolmogorov-Smirnov. Resultados: Das crianças avaliadas 52,7% eram do sexo masculino. A mediana etária foi de 12 anos. Verificou-se uma prevalência de peso excessivo de 37,4%. A prevalência do excesso de peso foi de 16,7%, superior no sexo feminino, e a da obesidade foi de 10,7%, ligeiramente superior no sexo masculino. A maior prevalência de peso excessivo verificou-se aos sete anos. Não foram encontradas diferenças estatisticamente significativas entre o género e a categoria de peso, nem entre as idades relativamente ao peso excessivo. Conclusões: Apesar da diminuição da prevalência da obesidade infantil e excesso de peso verificada em Portugal nos últimos anos, estas entidades representam um grave problema de saúde pública. No concelho de Portalegre, a prevalência do peso excessivo nos menores de 10 anos foi superior aos dados disponíveis na literatura. Dos 10 aos 17 anos a prevalência foi inferior.

Graphical abstract, Highlights • MetS occurs in a 1 out of 4 obese children and increases the future risk of serious health complications. • The serum level of adiponectin decreases while leptin increases as body weight increases, in the understudy children group. • The serum level of the inflammatory marker CRP increases significantly as body weight increases in the understudy population. • Adipokines and CRP can distinguish the children with Metabolic Syndrome as compared to children with no Metabolic Syndrome., Background Metabolic syndrome (MetS) occurs in a proportion of overweight and obese children and increases their future risk of serious health complications, even in adolescence and young adulthood. We aimed to explore the role of certain adipokines and inflammatory markers in identifying children with MetS. Methods This study is a secondary analysis of data coming from the Healthy Growth Study, a cross-sectional study conducted with schoolchildren in Greece. The present study included data from a representative sample of 1376 schoolchildren (mean age: 11.19 ± 0.66 years), recruited from 77 primary schools in four large regions in Greece. Anthropometric, clinical and biochemical data were recorded. Children’s body weight status and the presence of MetS were determined and their correlation with the serum levels of leptin, adiponectin and C-reactive protein (CRP) was explored. Results The prevalence of the MetS was 21.7 % and 3.7 % in obese and overweight children, respectively. The balance of adipokines was disturbed in obesity, as the serum level of adiponectin decreased as body weight increased, while the serum level of leptin increased. The serum level of the inflammatory marker CRP increased significantly as body weight increased. Discriminant analysis showed that these factors could distinguish the children with MetS as compared to children with no MetS. Conclusions In the under study Mediterranean childhood population, monitoring of the levels of adipokines and CRP could identify the overweight and obese children with MetS. Appropriate individualized dietary and lifestyle interventions can be applied in these children to prevent health complications associated with MetS.

Background Childhood obesity is an emerging public health problem globally. Although previously a problem of high-income countries, overweight and obesity is on the rise in low- and middle-income countries. This paper explores the factors associated with childhood obesity and overweight in Uganda using data from the Uganda Demographic and Health Survey (UDHS) of 2016. Methods We used Uganda Demographic and Health Survey (UDHS) 2016 data of 4338 children less than 5 years. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Overweight and obesity were combined as the primary outcome. Children whose BMI z score was over two were considered as overweight while those with a BMI z score greater than three were considered as obese. We used multivariable logistic regression to determine factors associated with obesity and overweight among children under 5 years of age in Uganda. Results The prevalence of overweight and obesity was 5.0% (217/4338) (95% CI: 4.3–5.6), with overweight at 3.9% (168/4338: 95% CI: 3.2–4.3) and obesity at 1.1% (49/4338: 95% CI: 0.8–1.5). Mother’s nutritional status, sex of the child, and child’s age were associated with childhood obesity and overweight. Boys were more likely to be overweight or obese (aOR = 1.81; 95% CI 1.24 to 2.64) compared to girls. Children who were younger (36 months and below) and those with mothers who were overweight or obese were more likely to have obesity or overweight compared to those aged 49–59 months and those with underweight mothers respectively. Children from the western region were more likely to be overweight or obese compared to those that were from the North. Conclusion The present study showed male sex, older age of the children, nutritional status of the mothers and region of residence were associated with obesity and overweight among children under 5 years of age.

WalczykTeresa. Anthropometric indicators associated with childhood obesity. Is it time for a BMI successor?Journal of Education, Health and Sport. 2021;11(8):134-147. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2021.11.08.014 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2021.11.08.014 https://zenodo.org/record/5201537 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2021; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 01.08.2021. Revised: 10.08.2021. Accepted: 14.08.2021. Anthropometric indicators associated with childhood obesity. Is it time for a BMI successor? Antropometryczne wskaźniki wiązane z otyłością u dzieci. Czy nadszedł czas na następcę BMI? Teresa Walczyk1https://orcid.org/0000-0003-4945-0654 teresakarpiniakwalczyk@gmail.com 1Józef Piłsudski University of Physical Education in Warsaw, Department of Human Biology, St Marymoncka 34, 00-968 Warszawa, Poland Abstract Childhood obesity and overweight have a wide impact on physical and mental health, and affect adulthood. In the last decade, scientists have been looking with concern at the increasingly frequent excess body weight in children and adolescents. Therefore, it is crucial to estimate the scale of the problem, and thus to correctly assess the level of adipose tissue. In assessing the nutritional status of the young, anthropometric measurements and indicators are used. Despite the widespread use of BMI (body mass index), this indicator is often criticized. BMI is frequently recognized as an imprecise tool and its use often results in misleading classification. Therefore, the aim of this study is to present selected, non-invasive anthropometric indicators related to overweight/obesity in children. Anthropometric indicators are relatively simple tools used in public health. However, the search for a simple and useful indicator is still ongoing, which will enable the assessment of the nutritional status both in clinical practice and in population studies. The paper presents the most frequently described anthropometric indicators in the literature: body mass index (BMI) and BMIz score, relative fat mass pediatric (RFMp), tri-ponderal mass index (TMI), pediatric body adiposity fat index (BAIp) and the mid-upper arm circumference (MUCA). The possibilities of application and their effectiveness for the estimation of adipose tissue content and the risk of coexisting diseases are presented. Although there is no consensus on the best tool, it is known that BMI will remain the main parameter in assessing nutritional status. Nevertheless, the authors suggest the usefulness of tools such as RFMp, TMI and MUAC as a good complement to the imperfections ascribed to BMI. Key words:children, Body Mass Index (BMI), Relative Fat Mass pediatric (RFMp), Tri-Ponderal Mass Index (TMI), Pediatric Body Adiposity Index (BAIp), Mid-Upper Arm Circumference (MUAC) Streszczenie Dziecięca otyłość i nadwaga wywierają szeroki wpływ na zdrowie fizyczne ipsychiczne, ale także odciskają piętno na dorosłym życiu. W ostatniej dekadzie naukowcy zniepokojem przyglądają się coraz częściej notowanej nadmiernej masie ciała u dzieci imłodzieży. Dlatego też kluczowe jest oszacowanie skali problemu, co wiąże się z prawidłową oceną poziomu tkanki tłuszczowej. W diagnozie stanu odżywienia młodego pokolenia stosuje się pomiary i wskaźniki antropometryczne. Mimo powszechnego wykorzystania BMI (body mass index) często jest krytykowany i został uznany za narzędzie nieprecyzyjne, a jego użycie często powoduje błędną klasyfikację. Dlatego też, celem tej pracy jest przedstawienie wybranych, nieinwazyjnych wskaźników antropometrycznych służących do oceny stanu odżywienia u dzieci. Wskaźniki antropometryczne są względnie prostymi narzędziami używanymi wzdrowiu publicznym. Jednak cały czas trwa poszukiwanie prostego i użytecznego wskaźnika, który umożliwi ocenę stanu odżywienia zarówno w praktyce klinicznej jak i w badaniach populacyjnych. W pracy przedstawiono najczęściej opisywane wskaźniki antropometryczne: wskaźnik masy ciała (BMI) i BMIz score, wskaźnik relatywnej tkanki tłuszczowej (RFMp), TMI (Tri-Ponderal Mass Index), wskaźnik otłuszczenia ciała pediatryczny (BAIp) oraz obwód środkowy ramienia (MUCA). Przedstawiono możliwości zastosowania i ich skuteczność do szacowania zawartości tkanki tłuszczowej oraz ryzyka występowania chorób współistniejących. Mimo iż nie ma konsensusu w sprawie najlepszego narzędzia, wiadomo, że wskaźnik BMI pozostanie głównym parametrem w ocenie stanu odżywienia. Niemniej jednak badacze dostrzegają potencjał narzędzi takich jak: RFMp, TMI i MUAC stanowiących dobre uzupełnienie niedoskonałości przypisywanych BMI. Słowa kluczowe:dzieci, wskaźnik masy ciała (BMI), wskaźnik relatywnej tkanki tłuszczowej (RFMp), TMI (Tri-Ponderal Mass Index), wskaźnik otłuszczenia ciała pediatryczny (BAIp), obwód środkowy ramienia (MUCA)

Introduction: Women who have a GDM diagnosis, on the other hand, are more likely to develop type 2 diabetes later in life. Many risk factors, such as obesity and obesity, were shown to be shared by GDM and type 2 diabetes, and GDM is believed to be the second most prevalent type of diabetes mellitus. Human risk tests are used to determine the proportion of GDM cases that may have been eliminated if all overweight or obese women had a GDM risk similar to that of average weight women. To better understand the possible effect of weight loss on GDM cases, we calculated the number of children with GDM and the proportion of GDM cases caused by obesity and obesity-related diseases. Aim: Effects of relationship between gestational diabetes mellitus and children's obesity Materials and Methods: The full texts of 32 publications were retrieved for those whose abstracts listed a connection between maternal gestational diabetes and childhood obesity.to the Observed Treatment in the Departments of Medicine and Respiratory, Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Conclusion: While the association between diabetes and weight loss is reduced after the pre-pregnancy obesity adjustment, there is a positive relationship, according to this recent research study. Only two of the 12 previous studies of maternal obesity were found to be 12, and both showed that organizations were no longer purposeful after the correction. To better define and differentiate the roles of prenatal obesity and gestational diabetes, further research is needed to look at the functioning of common genes and / or shared substances, such as postpartum diet and physical activity. Regardless of genetics, animal studies have shown that maternal hypernlymemia and fatal hyperinsulinism can cause infertility in adolescence, lower glucose tolerance, hyperinsulinemia, and insulin resistance

Childhood obesity is a major health concern. The associated health risks dramatically reduce lifespan and increase healthcare costs. The goal was to develop methodology to identify as early in life as possible whether or not a child would become obese at age five. This diagnostic tool would facilitate clinical monitoring to prevent and or minimize obesity. Obesity is measured by Body Mass Index (BMI), but an improved metric, the ratio of weight to height (or length) (WOH), is proposed from this research for detecting early obesity. Results of this research demonstrate that WOH performs better than BMI for early detection of obesity in individuals using a longitudinal decision analysis (LDA), which is essentially an individuals type control chart analysis about a trend line. Utilizing LDA, the odds of obesity of a child at age five is indicated before the second birthday with 95% sensitivity and 97% specificity. Further, obesity at age five is indicated with 75% specificity before two months and with 84% specificity before three months of age. These results warrant expanding this study to larger cohorts of normal, overweight, and obese children at age five from different healthcare facilities to test the applicability of this novel diagnostic tool.

Background Despite the widespread use of caffeine including consumption during pregnancy, the effect of prenatal caffeine exposure on child brain development and behavior is unclear. Methods To address this, we used data from the Adolescent Brain and Cognitive Development Study (n = 11,875 children aged 9-11 years from 22 sites across the United States). We explored the associations between prenatal caffeine exposure and various developmental outcomes including birth outcomes, physical health, behavior problems, cognition, substance use and brain structure in children, and evaluated dose effects. Results Among 9,978 children (4,745 females) who had valid data for prenatal caffeine exposure and whose mothers did not use drugs of abuse after knowing of pregnancy, 4,170 (41.79%) had no prenatal caffeine exposure, 2,292 (22.97%) had daily, 1,933 (19.37%) had weekly, and 1,583 (15.86%) had less than weekly exposures. Prenatal caffeine exposure including the widely recommended 'safe' dose was associated with greater externalizing problems, whereas greater BMI and soda consumption were only observed in children with high dose exposures (3+ per day). Notably, the effect size for association of externalizing problems with prenatal caffeine exposure was comparable with that reported for prenatal alcohol (The American Journal of Psychiatry, 177, 2020 and 1060) and prenatal cannabis (JAMA Psychiatry, 78, 2020 and 64) exposures from previous ABCD publications. Additionally, prenatal caffeine exposure was associated with brain structural changes that included greater posterior and lower frontal cortical thickness and altered parietooccipital sulcal depth. Conclusions The recommended 'safe' dose of caffeine during pregnancy should be carefully studied to assess whether the behavioral and brain correlates observed here are clinically relevant and determine whether it needs adjustment. Because of the high prevalence of caffeine use in the general population, studies on prenatal exposure to drugs of abuse should include prenatal caffeine use as a covariate.

Addressing Latino childhood obesity requires effective health promotion programs and culturally resonant health professionals. The current profiles of public health professionals and registered dietitians point to the need to increase the number of Latino students trained in community-based participatory research and engagement of underserved populations. To address this workforce gap, the Center for Latino Community Health, Evaluation, and Leadership Training developed the Sanos y Fuertes: Healthy & Strong Graduate Research Fellowship to provide Latino graduate students with research training, professional development, and mentorship. Five cohorts of seven graduate students participated in a yearlong experiential learning program. Graduate research fellows received monthly research and professional development training from faculty, staff, and community health workers. Furthermore, fellows engaged in mentored research through the development and implementation of a Latino childhood obesity prevention curriculum and intervention. A mixed-method evaluation approach was used to assess the effectiveness of the program. Fellows completed baseline, posttraining, and follow-up assessments. Assessment surveys measured training experiences (e.g., research methods, community engagement), confidence (e.g., research methods, health education), and knowledge and skills (e.g., community health program skills). The training resulted in significant increases in skills and confidence between pre- and postassessments that were sustained at follow-up. Based on these findings, we recommend that student training programs include research as experiential learning with multidisciplinary, interprofessional teams and that community-based, community-engaged, or translational research teams include community health workers as integral members for research with marginalized, underserved populations.

BACKGROUND: Adolescent overweight and obesity are well documented in high-income countries (HICs). They are also emerging as a global public health concern in low-and middle-income countries (LMICs), yet there is a lack of reliable, national-level data to inform policies and interventions. This study aimed to estimate the prevalence of overweight and obesity and assess associated lifestyle risk factors amongst school-going adolescents in LMICs as well as HICs. METHODS: A total of 282,213 samples were drawn from 89 LMICs and HICs in the 'latest Global School-based Student Health Survey' of school children, aged 11-17 years, during 2003 to 2015, in the six World Health Organisation (WHO) regions. The prevalence of adolescent overweight and obesity were estimated using the WHO BMI-for-age growth standards. A multinomial logistic regression model was employed to estimate the adjusted (age and sex) association of food patterns, physical activity, and sedentary behaviours with adolescent overweight and obesity. RESULTS: The pooled prevalence of overweight and obesity amongst adolescents was 10.12%, and 4.96%, respectively, ranging from 2.40% in Sri Lanka to 29.08% in Niue for overweight and 0.40% in Sri Lanka to 34.66% in the Cook Islands for obesity. Overweight and obesity were associated with unhealthy dietary intake and lifestyles including respectively fast-food intake (adjusted relative risk ratio, RRR = 1.09; 95% CI: 1.05-1.12 and RRR = 1.32; 95% CI: 1.26-1.38), a high level of carbonated soft drinks consumption (RRR = 1.19; 1.12-1.24 and RRR = 1.28; 1.18-1.38), a low level of physical activity (RRR = 1.11; 1.06-1.17 and 1.20; 1.12-1.28), and high level of sedentary behaviours (RRR = 1.33; 1.27-1.39 and RRR = 1.73; 1.63-1.84). Adolescents who consumed vegetables at least two times per day had a lower risk of overweight (22%) and obesity (17%) than those who did not consume vegetables per day. CONCLUSIONS: Adolescent overweight and obesity represent a global public health problem and can possibly track into adult weight status and morbidity. School-based obesity prevention that promotes environmental and policy changes related to healthy dietary practices and active living are urgently needed to curb the trend.

International audience; Background and Aim: Childhood obesity is associated with vitamin D (VD) deficiency and vascular dysfunction. Considering evidence indicates that VD may improve vascular function, this study, for the first time, assessed the effect of VD supplementation on microvascular reactivity in obese adolescents (OA).Methods and Results: This randomized controlled trial included 26 OA, receiving fruit juice with (n=13) or without VD (4000 IU/d; n=13) over a 3-month lifestyle program, as well as 23 normal-weight adolescents (controls). The primary outcome was the pre-to-post-program change in microvascular reactivity determined by laser speckle contrast imaging with acetylcholine and sodium nitroprusside iontophoresis. Changes in 25 hydroxyvitamin D (25(OH)D), flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), insulin resistance (HOMA-IR) and inflammatory markers (C-reactive protein [CRP]) were monitored. At inclusion, in comparison to controls, OA exhibited lower total and free 25(OH)D, impaired microvascular responses, and impaired FMD, but similar NMD. After the lifestyle program, total and free 25(OH)D increased in all OA, with a greater increase in those receiving VD supplements. HOMA-IR and CRP decreased in all OA. Neither FMD nor NMD were altered in either group. Endothelium-dependent microvascular reactivity only increased in the VD-supplemented group, reaching values comparable to that of controls. Similar results were found when analyzing only OA with a VD deficiency at baseline.Conclusion: VD supplementation during a lifestyle program attenuated microvascular dysfunction in OA without altering macrovascular function.Registration number for clinical trial: NCT02400151.