Wiley

Pediatric Obesity

Published by Wiley and World Obesity

Online ISSN: 2047-6310

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Print ISSN: 2047-6302

Disciplines: Endocrinology

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Effectiveness of behavioural and psychological interventions for managing obesity in children and adolescents: A systematic review and meta‐analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline

January 2025

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56 Reads

M. Henderson

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S. A. Moore

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C. S. Birken

Objective Conduct a systematic review and meta‐analysis of randomized controlled trials (RCTs) of behavioural and psychological interventions for managing paediatric obesity. Methods Eligible studies, published between 1985 and 2022, included 0 to 18 year olds with outcomes reported ≥3 months post‐baseline, including patient‐reported outcome measures (PROMs), cardiometabolic and anthropometric outcomes, and adverse events (AEs). We pooled data using a random effects model and assessed certainty of evidence (CoE) related to minimally important difference estimates for outcomes using GRADE. Results We included 73 unique RCTs (n = 6305 participants, 53% female). Intervention types included physical activity (n = 1437), nutrition (n = 447), psychological (n = 1336), technology‐based (n = 901) or multicomponent (≥2 intervention types, n = 2184). Physical activity had a small effect on health‐related quality of life (HRQoL), varying effects ranging from moderate to very large on blood pressure, lipids and insulin resistance, and a small effect on BMIz. Nutrition had a small effect on lipids, insulin resistance and BMIz. Psychological interventions showed a small effect on HRQoL and triglycerides and moderate benefits on depressive symptoms, while technology interventions showed small benefits on blood pressure and BMIz. Multicomponent interventions had a large benefit on anxiety, small benefit on depressive symptoms, with large to very large benefits on lipids, and small benefits for diastolic blood pressure, insulin resistance and BMIz. AEs were reported infrequently, and when reported, were described as mild. Conclusion Physical activity and multicomponent interventions showed improvements in PROMs, cardiometabolic and anthropometric outcomes. Future trials should consistently measure PROMs, evaluate outcomes beyond the intervention period, and study children <6 years of age.

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CONSORT flow diagram. BMI, body mass index; GDM, gestational diabetes mellitus; HE, healthy eating intervention; OGTT, oral glucose tolerance test; PA, physical activity intervention; UC, usual care.
Fetal growth trajectories from 32 weeks of gestation onwards per randomisation group. Predicted mean growth trajectories of EFW (estimated fetal weight; in grams), HC (head circumference; in millimetre), AC (abdominal circumference; in millimetre) and FL (femur length; in millimetre) stratified by randomisation group: UC (usual care), PA (physical activity intervention), HE (healthy eating intervention) and PA + HE (physical activity and healthy eating intervention) from 32 weeks of gestation onwards. Growth trajectories were estimated using multilevel natural cubic spline models with 2 knots containing an interaction term between gestational age at measurement (continuous; weeks) and randomisation group (categorical; UC, PA, HE, PA + HE). Study site (categorical; Austria, Belgium, Denmark [Copenhagen, Odense], Ireland, Italy [Pisa, Padua], Netherlands, Poland, Spain, United Kingdom) was added to all models as covariate with Spain set as reference category.
Intervention effect on fetal size across gestation. Predicted mean differences in mean EFW (estimated fetal weight; in grams), HC (head circumference; in millimetre), AC (abdominal circumference; in millimetre) and FL (femur length; in millimetre) comparing the interventions PA (physical activity), HE (healthy eating) and PA + HE (physical activity and healthy eating) to UC (usual care; reference group) across gestation. Mean differences were estimated using multilevel natural cubic spline models with 2 knots containing an interaction term between gestational age at measurement (continuous; weeks) and randomisation group (categorical; UC, PA, HE, PA + HE). Study site (categorical; Austria, Belgium, Denmark [Copenhagen, Odense], Ireland, Italy [Pisa, Padua], Netherlands, Poland, Spain, United Kingdom) was added to all models as covariate.
Effect of a physical activity and healthy eating lifestyle intervention in pregnancy on fetal growth trajectories: The DALI randomised controlled trial

January 2025

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47 Reads

Aims and scope


Pediatric Obesity is devoted to research into obesity during childhood and adolescence. This topic is currently at the centre of intense interest in the scientific community and is of increasing concern to health policymakers and the public at large. We have established ourselves as the leading journal for high quality papers in this field, covering all areas of pediatric obesity.
Pediatric Obesity is owned by the World Obesity Federation, a not-for-profit charitable body linking over 50 regional and national associations with over 10,000 professional members in scientific, medical and research organisations.

Recent articles


Flowcharts for inclusion and exclusion of children with obesity aged 5–10 living followed for a minimum of 3 years living in Aarhus Municipality, Denmark between 1 January 2010 and 17 March 2018, and not invited to participate in the lifestyle intervention.
Logistic regression models, including 467 children aged 5–10 years living with obesity and a minimum of 3 years of follow‐up not receiving a lifestyle intervention, present the OR of normalizing weight at the end of follow‐up with having overweight or persistent obesity as the reference group. For each co‐variable, we present univariable, unweighted multivariable, and weighted multivariable OR. The included co‐variables are sex (boys as reference), BMI z‐score (per unit increase in SD), and age (per unit increase in a year). The weighted multivariable model was weighted by the ratio of follow‐up of each individual relative to the maximum follow‐up observed in the cohort.
Logistic regression models, including 467 children aged 5–10 years living with obesity and a minimum of 3 years of follow‐up not receiving a lifestyle intervention, and presenting the odds ratio of being in the obesity remission group (212 children) at the end of follow‐up with the persistence of obesity group as the reference. For each co‐variable, we present univariable, unweighted multivariable, and weighted multivariable odds ratios. The included co‐variables are sex (boys as reference), BMI z‐score (per unit increase in SD), age (per unit increase in a year) highest completed household education (low as reference), family type (two‐adult family as reference), immigration status (Danish origin as reference), psychiatric diagnosis at the child (no diagnosis as reference) or family history of mental illness (no disposition as reference). The weighted multivariable model was weighted by the ratio of follow‐up of each individual relative to the maximum follow‐up observed in the cohort.
Logistic regression models, including 467 children aged 5–10 years living with obesity and a minimum of 3 years of follow‐up not receiving a lifestyle intervention, and presenting the odds ratio of being above 80th percentile for change in BMI z‐score with being below the 80th percentile for change in BMI z‐score (375 children) as reference. For each co‐variable, we present an univariable, unweighted multivariable, and weighted multivariable odds ratio. The included co‐variables are sex (boys as reference), BMI z‐score (per unit increase in SD), age (per unit increase in a year) highest completed household education (low as reference), family type (two‐adult family as reference), immigration status (Danish origin as reference), psychiatric diagnosis at the child (no diagnosis as reference) or family history of mental illness (no disposition as reference). The weighted multivariable model was weighted by the ratio of follow‐up of each individual relative to the maximum follow‐up observed in the cohort.
Weight development in children with obesity without treatment: A Danish cohort study with long‐term follow‐up
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February 2025

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Introduction Limited insight exists into the weight development in children with obesity not receiving obesity treatment. Methods This cohort study included 467 Danish children aged 5–10 years with obesity (iso‐BMI >30 kg/m²) not receiving treatment. Data from mandatory health check‐ups on school‐children's height and weight (converted to BMI z‐scores) were merged with the Danish National Registries. A multivariable logistic regression weighted for the duration of follow‐up was used to estimate odds ratios (OR) for normalization of BMI (iso‐BMI 18.5–25 kg/m²) and obesity remission (iso‐BMI 18.5–30 kg/m²). Results During a median follow‐up of more than 6 years, 7.9% of the children normalized their BMI, while 45.4% obtained obesity remission. BMI z‐score at inclusion acted as a strong inverse predictor for normalizing BMI (OR 0.14 per one‐unit SD, CI: 0.03–0.53) and for obesity remission (OR 0.17 per one‐unit SD, CI: 0.08–0.37). No other significant predictors were observed in the weighted multivariable models. Conclusion Higher BMI z‐scores inversely predict normalizing BMI and achieving obesity remission in untreated children. Given that many children naturally achieve obesity remission or weight normalization, resources should focus on understanding barriers of obesity maintenance and to develop effective strategies for those who do not experience improvement.


Childhood obesity trajectories and adolescent mental health: A UK cohort study

January 2025

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23 Reads

Background There is limited evidence on how changes in obesity from childhood to adolescence are associated with adolescent mental health. We examined the associations between childhood obesity trajectories, obesity episodes, and mental health at age 17. Methods Data were from the UK Millennium Cohort Study. Obesity trajectory groups at ages 7 and 17 (n = 8306) and previous obesity episodes (number of sweeps with obesity) at ages 7, 11 and 14 (n = 7246) were examined. Caregiver and self‐reported internalising and externalising symptoms at age 17 were used to measure mental health. Linear regression models were used. Results Relative to never developing obesity, obesity development (β = 1.01; 95% CI = 0.71, 1.32) and persistence (β = 1.18; 95% CI = 0.74, 1.61) were associated with higher internalising symptoms at age 17 and worsening (increase in scores) of these symptoms between ages 7 and 17 (β = 0.87; 95% CI = 0.57, 1.17 and β = 0.86; 95% CI = 0.56, 1.26 for development and persistence, respectively). Obesity development was associated with higher externalising symptoms at age 17 (β = 0.52; 95% CI = 0.25, 0.80) and worsening of these symptoms over time (β = 0.30; 95% CI = 0.07, 0.53). Having multiple past obesity episodes was not associated with worsening mental health independent of follow‐up weight status. There were no differences in mental health outcomes between children who reversed versus never developed obesity. Conclusions Obesity development or persistence from ages 7 to 17 are associated with worsening mental health. If childhood obesity is reversed, there appears to be no evidence of a negative association between previous obesity and mental health at age 17.


Flow chart of the study sample selection. SES, socioeconomic status; BMI, body mass index; FMI, fat mass index; WC, waist circumference.
Interaction model between breastfeeding duration and obesity GRS for z‐BMI (2A), z‐FMI (2B) and z‐WC (2C). Model adjusted by FAS, DQI and MVPA. X axis: beta coefficients of obesity GRS; Y axis: unstandardized predicted values of adiposity indices in z‐scores. Coloured lines represent different breastfeeding duration categories: Never Breastfed (blue), 1–3 months (green), ≥4 months (fuchsia). Crossed lines suggest breastfeeding x GRS effect. Z‐BMI, body mass index z‐score; z‐FMI, fat mass index z‐score; z‐WC, waist circumference z‐score; GRS, genetic risk score; FAS, family affluence scale; DQI, Diet Quality Index; MVPA, Moderate to Vigorous Physical Activity.
Mean z‐BMI (3A), z‐FMI (3B) and z‐WC (3C) across breastfeeding categories according to genetic risk, adjusted by FAS, DQI and MVPA. Significant mean differences are presented as p < 0.05* and p < 0.001**. X axis: Mean low and high genetic risk; Y axis: mean adiposity indices in z‐scores. Colour intensity of bars represents different breastfeeding duration categories: Never Breastfed (light grey), 1–3 months (grey) and ≥4 months (black). Z‐BMI, body mass index z‐score; z‐FMI, fat mass index z‐score; z‐WC, waist circumference z‐score; GRS, genetic risk score; FAS, family affluence scale; DQI, Diet Quality Index; MVPA, Moderate to Vigorous Physical Activity.
Interaction between breastfeeding duration and an obesity genetic risk score to predict body fat composition in European adolescents: The HELENA study

January 2025

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39 Reads

Background Although the genetic interplay with the environment has a major impact on obesity development, little is known on whether breastfeeding could modulate the genetic predisposition to obesity. Objectives To investigate whether breastfeeding attenuates the effect of an obesity genetic risk score (GRS) on adiposity in European adolescents. Methods Totally 751 adolescents from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross‐sectional study were included, divided according to breastfeeding status into never breastfed, 1–3 months and ≥4 months. Adjusting by socioeconomic status and lifestyle factors multiple linear regression models were used to assess (1) the main effect of breastfeeding duration and (2) its interaction effect with an obesity GRS, to predict different adiposity measures. Results A significant negative association between ≥4 months of breastfeeding and waist circumference (WC) z‐score was observed [β (95% confidence interval), p‐value] = [β = −0.189 (−0.37, −0.00), p = 0.044]. Also, significant interaction effects were observed for 1–3 and ≥4 months of breastfeeding and obesity GRS regarding body mass index (BMI) z‐score [β = 0.155 (0.06, 0.24), p = 0.001] and [β = 0.108 (0.01, 0.18), p = 0.020, respectively] and fat mass index (FMI) z‐score [β = 0.134 (0.04, 0.22), p = 0.003] and [β = 0.100 (0.01, 0.18), p = 0.026, respectively]. Conclusions Breastfeeding modulates the association between the obesity GRS and body composition in adolescents.


Graphical representation of the regression slopes between sleep‐disordered breathing scale and C‐reactive protein by levels of cardiorespiratory fitness. High/low cardiorespiratory fitness groups were classified based on the Ruiz et al.³⁹ cut‐off points (i.e., 35 mL/kg/min for girls and 42 mL/kg/min for boys) for cardiorespiratory fitness. Orange colour represents the high cardiorespiratory fitness group, while black colour refers to those children grouped in the low cardiorespiratory fitness category. The regression model was adjusted for fat mass index. ‡Blom's normalized values were used in the analysis. β = standardized regression coefficient.
Sleep‐disordered breathing and cardiometabolic and inflammatory markers in children with overweight/obesity: The role of cardiorespiratory fitness

Objectives To investigate the association of sleep‐disordered breathing (SDB) severity with cardiometabolic and inflammatory markers independently of the adiposity levels; and to explore the role of cardiorespiratory fitness in these associations in children with overweight/obesity. Methods A total of 109 children aged 8–11 years with overweight/obesity were included in this cross‐sectional study. SDB was assessed using a scale of the reduce version of the Paediatric Sleep Questionnaire. Cardiometabolic markers included fasting blood lipids biomarkers (i.e., low‐ and high‐density lipoprotein cholesterol, and triglycerides), blood pressure, insulin, glucose, and the homeostatic model assessment index. Inflammatory markers (i.e., interleukin‐6, interleukin‐1β, C‐reactive protein [CRP], and tumour necrosis factor alpha) were analysed. Cardiorespiratory fitness was assessed by the 20 m shuttle‐run test. Results No significant associations were found between SDB severity and most of the cardiometabolic markers after correcting for adiposity and multiple comparisons (all p's >0.05). SDB severity was positively related to CRP (β = 0.352, p = 0.002), yet not with the remaining inflammatory markers analysed. The interaction effect of cardiorespiratory fitness presented a positive trend in the association of SDB with CRP (p = 0.1). When stratified analyses by cardiorespiratory fitness levels were conducted, a positive relation was found between SDB and CRP in the low cardiorespiratory fitness group (β = 0.465, p = 0.014), but not in the high cardiorespiratory fitness group (β = 0.236, p = 0.108). Conclusion SDB severity was positively associated with CRP independently of the adiposity levels, but not with other inflammatory or cardiometabolic risk factors in children with overweight/obesity. Moreover, our results suggest that higher levels of cardiorespiratory fitness may attenuate the adverse effect of SDB severity on systematic inflammation in children with overweight/obesity.


CONSORT flow diagram. BMI, body mass index; GDM, gestational diabetes mellitus; HE, healthy eating intervention; OGTT, oral glucose tolerance test; PA, physical activity intervention; UC, usual care.
Fetal growth trajectories from 32 weeks of gestation onwards per randomisation group. Predicted mean growth trajectories of EFW (estimated fetal weight; in grams), HC (head circumference; in millimetre), AC (abdominal circumference; in millimetre) and FL (femur length; in millimetre) stratified by randomisation group: UC (usual care), PA (physical activity intervention), HE (healthy eating intervention) and PA + HE (physical activity and healthy eating intervention) from 32 weeks of gestation onwards. Growth trajectories were estimated using multilevel natural cubic spline models with 2 knots containing an interaction term between gestational age at measurement (continuous; weeks) and randomisation group (categorical; UC, PA, HE, PA + HE). Study site (categorical; Austria, Belgium, Denmark [Copenhagen, Odense], Ireland, Italy [Pisa, Padua], Netherlands, Poland, Spain, United Kingdom) was added to all models as covariate with Spain set as reference category.
Intervention effect on fetal size across gestation. Predicted mean differences in mean EFW (estimated fetal weight; in grams), HC (head circumference; in millimetre), AC (abdominal circumference; in millimetre) and FL (femur length; in millimetre) comparing the interventions PA (physical activity), HE (healthy eating) and PA + HE (physical activity and healthy eating) to UC (usual care; reference group) across gestation. Mean differences were estimated using multilevel natural cubic spline models with 2 knots containing an interaction term between gestational age at measurement (continuous; weeks) and randomisation group (categorical; UC, PA, HE, PA + HE). Study site (categorical; Austria, Belgium, Denmark [Copenhagen, Odense], Ireland, Italy [Pisa, Padua], Netherlands, Poland, Spain, United Kingdom) was added to all models as covariate.
Effect of a physical activity and healthy eating lifestyle intervention in pregnancy on fetal growth trajectories: The DALI randomised controlled trial

January 2025

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47 Reads

Background Obesity during pregnancy is related to fetal overgrowth. Effective interventions that can mitigate this risk are needed. Objectives This study aimed to investigate the effect of a lifestyle intervention for pregnant women with obesity on fetal growth trajectories. Methods In the DALI trial, pregnant women with a body mass index ≥29.0 kg/m² and without gestational diabetes at baseline were randomized to counselling on physical activity (PA), healthy eating (HE) or a combination (PA + HE), or to usual care (UC). Fetal growth trajectories were modelled based on a combination of estimated fetal weight (EFW) from repeated ultrasound scans and weight measured at birth. Differences in fetal growth trajectories between groups were assessed. Results Three hundred eighty‐four women were included. Those in the PA + HE intervention had slower EFW gain from 32 weeks onwards, with differences (PA + HE vs. UC) at 32, 36 and 40 weeks of −54.1 g (−146.7 to 38.9 g), −84.9 g (−194.0 to 24.7 g), and −99.8 g (−227.1 to 28.1 g), respectively. Effects appeared stronger in males, with a difference at 40 weeks of −185.8 g (−362.5 g to −9.2 g) versus −23.4 g (−190.4 g to 143.5 g) in females. Conclusions A lifestyle intervention for pregnant women with obesity resulted in attenuated fetal growth, which only reached significance in male offspring. Future larger trials are needed to confirm these findings and elucidate underlying pathways.


CONSORT flow diagram from original intervention through to 11 year follow‐up for BMI z‐score.
BMI z‐scores from birth to 11 years of age in each of the four original groups.
Long‐term follow‐up of the impact of brief sleep and lifestyle interventions in infancy on BMI z‐score at 11 years of age: The POI randomized controlled trial

Objective To determine whether BMI differences observed at 5 years of age, from early intervention in infancy, remained apparent at 11 years. Methods Participants (n = 734) from the original randomized controlled trial (n = 802) underwent measures of body mass index (BMI), body composition (DXA), sleep and physical activity (24‐h accelerometry, questionnaire), diet (repeated 24‐h recalls), screen time (daily diaries), wellbeing (CHU‐9D, WHO‐5), and family functioning (McMaster FAD) around their 11th birthday. Following multiple imputation, regression models explored the effects of two interventions (‘Sleep’ vs. ‘Food, Activity and Breastfeeding’ [FAB]) using a 2 × 2 factorial design. Results Five hundred twelve children (48% female, mean [SD] age 11.1 [0.1] years) returned for the 11‐year assessment (63% of original sample). Significant differences in BMI z‐score (mean difference; 95% CI: −0.16; −0.41, 0.08) or the risk of overweight (including obesity) (odds ratio; 95% CI: 0.85; 0.56, 1.29) were no longer observed between children who had received the sleep intervention compared with those who had not. By contrast, children who had received the FAB intervention had greater BMI z‐scores (0.24; 0.01, 0.47) and a higher risk of obesity (1.56; 1.03, 2.36) than children not enrolled in FAB. No significant differences were observed in any lifestyle variables nor wellbeing measures across all groups. Conclusions Sustained reductions in BMI and obesity risk from an early sleep intervention were not apparent 9 years later, whereas a more traditional lifestyle intervention resulted in increased rates of obesity, not explained by any differences in lifestyle behaviours measured. Clinical Trial Registry ClinicalTrials.gov number NCT00892983, https://clinicaltrials.gov/study/NCT00892983.


Effectiveness of behavioural and psychological interventions for managing obesity in children and adolescents: A systematic review and meta‐analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline

January 2025

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56 Reads

Objective Conduct a systematic review and meta‐analysis of randomized controlled trials (RCTs) of behavioural and psychological interventions for managing paediatric obesity. Methods Eligible studies, published between 1985 and 2022, included 0 to 18 year olds with outcomes reported ≥3 months post‐baseline, including patient‐reported outcome measures (PROMs), cardiometabolic and anthropometric outcomes, and adverse events (AEs). We pooled data using a random effects model and assessed certainty of evidence (CoE) related to minimally important difference estimates for outcomes using GRADE. Results We included 73 unique RCTs (n = 6305 participants, 53% female). Intervention types included physical activity (n = 1437), nutrition (n = 447), psychological (n = 1336), technology‐based (n = 901) or multicomponent (≥2 intervention types, n = 2184). Physical activity had a small effect on health‐related quality of life (HRQoL), varying effects ranging from moderate to very large on blood pressure, lipids and insulin resistance, and a small effect on BMIz. Nutrition had a small effect on lipids, insulin resistance and BMIz. Psychological interventions showed a small effect on HRQoL and triglycerides and moderate benefits on depressive symptoms, while technology interventions showed small benefits on blood pressure and BMIz. Multicomponent interventions had a large benefit on anxiety, small benefit on depressive symptoms, with large to very large benefits on lipids, and small benefits for diastolic blood pressure, insulin resistance and BMIz. AEs were reported infrequently, and when reported, were described as mild. Conclusion Physical activity and multicomponent interventions showed improvements in PROMs, cardiometabolic and anthropometric outcomes. Future trials should consistently measure PROMs, evaluate outcomes beyond the intervention period, and study children <6 years of age.


Flow diagram of the study participants.
Analysis of the relationship between BMI z‐score at birth of preterm infants and health outcomes using restricted cubic spline (RCS) model. This figure displays the relationships between BMI at the birth of preterm infants and various health outcomes using a restricted quintic spline (RCS) model. Compared to the normal group, the values shown are adjusted odds ratios and 95% confidence intervals, adjusted for factors such as gestational age, birth weight, birth length and mode of delivery. Adjusted odds ratios are depicted as solid lines, while the 95% confidence intervals are indicated by shaded areas. Health outcomes illustrated include the following: (A) RDS (respiratory distress syndrome); (B) NHB (neonatal hyperbilirubinemia); (C) BPD (bronchopulmonary dysplasia); (D) ROP (retinopathy of prematurity); (E) NEC (necrotizing enterocolitis); (F) PDA (patent ductus arteriosus); (G) IVH (intraventricular haemorrhage); (H) LOS (late‐onset sepsis).
Association between body mass index at birth and neonatal health outcomes in preterm infants: A retrospective analysis

Background Studies on how birth body mass index (BMI) affects health outcomes in preterm infants are relatively limited. Aim To analyze the association between BMI at birth and neonatal health outcomes in extremely low and very low birth weight preterm infants in China. Methods Used data from the Chinese Premature Infant Informatization Platform (2022–2023). Preterm infants were categorized based on their birth BMI z‐scores into three groups: low BMI group (< −2), normal BMI group (−2 to 2) and high BMI group (>2). The relationship between BMI and neonatal health outcomes was then analyzed. Results The final analysis included 1662 extremely low and very low birth weight preterm infants. The results indicated that low BMI was significantly associated with an increased risk of respiratory distress syndrome (RDS) (AOR 1.61, 95% CI 1.31–2.30), bronchopulmonary dysplasia (BPD) (AOR 1.34, 95% CI 1.00–1.80) and necrotizing enterocolitis (NEC) (AOR 1.57, 95% CI 1.01–2.42). High BMI was significantly associated with an increased risk of RDS (AOR 1.60, 95% CI 1.05–2.45). Conclusions BMI at birth is significantly associated with the risks of RDS, BPD and NEC in ELBW and VLBW, highlighting the importance of monitoring BMI as an additional risk predictor in a population of neonates already at high risk for adverse outcomes.


Prenatal exposure to particulates and anthropometry through 9 years of age in a birth cohort

January 2025

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5 Reads

Background Previous research observed links between prenatal air pollution and risk of childhood obesity but the timing of the exposure is understudied. Aim: We examined prenatal particulate matter (PM10, PM2.5) exposure and child anthropometry. Materials & Methods Children's body mass index z‐scores (zBMI) at 0–3 (N = 4370) and 7–9 (n = 1191) years were derived from reported anthropometry at paediatric visits. We ran linear mixed models for six windows, adjusting for maternal, child, and neighbourhood factors. Results PM10 exposure across pregnancy and at multiple windows was associated with higher zBMI in both early and middle childhood. For instance, one interquartile range increase in PM10 exposure during the first 2 weeks of pregnancy was associated with higher zBMI at 0–3 (0.05, 95% CI: 0.01, 0.10) and 7–9 (0.14, 95% CI: 0.02, 0.23). PM2.5 exposure during the final 2 weeks of gestation was associated with higher zBMI at 7–9 years (B: 0.12, 95% CI: 0.04, 0.22). Conclusion Even at low levels of air pollution, prenatal PM10 exposure was associated with higher zBMI in childhood.


Moderator effects of parent group (Parents as Coaches [PAC] and parent weight loss [PWL]) on the relationship between parent and adolescent BMI (kg/m²) change during (A) treatment (0–4 months) and (B) maintenance (4–7 months).
Associations between parent and adolescent weight outcomes within two parent approaches to family‐based adolescent obesity treatment: Secondary analyses from the TEENS+ pilot trial

January 2025

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11 Reads

Objective To examine associations between parent and adolescent weight change within two parent approaches to adolescent obesity treatment. Methods Adolescent (Mage = 13.7 ± 1.2 years; MBMI = 34.9 ± 7.0 kg/m²) and parent (MBMI = 36.4 ± 7.3 kg/m²) dyads (N = 82) were randomized to TEENS+Parents as Coaches (PAC) or TEENS+parent weight loss (PWL). Anthropometrics were assessed at baseline (0‐month), 4 months (post) and 7 months (after 3‐month maintenance period). Regression analyses examined associations between parent and adolescent ΔBMI0‐4m and ΔBMI4‐7m, with parent group as a moderator. Results Post‐treatment, parent and adolescent ∆BMI0‐4m were positively related (β = 0.68, p < 0.001), with no group interaction. Parent and adolescent ΔBMI4‐7m were related (β = 0.48, p = 0.012) during maintenance, moderated by parent group (β = −0.49, p = 0.010): positive relationships persisted in PAC (β = 0.39, p = 0.011), but not PWL (β = −0.19, p = 0.211). Discussion Parent and adolescent weight changes were positively related during treatment in both parent groups. During maintenance, weight change associations persisted only in PAC. These patterns prompt further exploration of parent factors driving weight change relationships.


Study design to evaluate the long‐term impact of “Lekker Fit.”
Flow diagram.
The long‐term effects of a school‐based intervention on preventing childhood overweight: Propensity score matching analysis within the Generation R Study cohort

January 2025

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17 Reads

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1 Citation

Background This study investigated the long‐term impact of the primary school‐based multicomponent lifestyle intervention “Lekker Fit!” (LF) on obesity‐related outcomes, and studied whether the impact differed between population subgroups. Methods Children from the Generation R Study (Rotterdam, the Netherlands) were categorized into the LF group (6 years exposure, between the ages 6/7 to 12/13 years) or regular school group (no exposure). BMI and DXA‐derived fat mass were assessed after 4 years of intervention (age 10 years), and 1.5 years post‐intervention (age 14 years). A propensity score matching model was fitted to examine the intervention effect on BMI‐z‐score and percent fat mass, and we tested for differences by sex, pre‐intervention weight status, ethnic background, and income. Results We found no effect on BMI‐z‐score [0.06 (95% confidence interval [CI]: −0.04 to 0.17)] and percent fat mass (0.4%‐point [95% CI: −0.2 to 1.1]) after 4 years of intervention. 1.5 years post‐intervention and after 6 years of exposure, BMI‐z‐score (0.11 [95% CI: 0.00–0.22]) and percent fat mass (1.1%‐point [95% CI: 0.2–1.9]) were significantly higher for children in the LF group. No subgroup differences were found. Conclusion Findings suggest the need for obesity prevention programs that extend beyond primary education.


Relationship between OUES and body size parameters in non‐obese and obese participants. Relationship between OUES and body size parameters in non‐obese (black dots) and obese (grey dots) participants. (A) Relationship between OUES and BSA, (B) Relationship between OUES and weight (kg), (C) relationship between OUES and body mass index (BMI m²/kg).
The use of submaximal parameters in the assessment of exercise capacity in children with obesity

Background Peak oxygen uptake (VO2) is considered the most important indicator of aerobic exercise capacity during cardiopulmonary exercise testing (CPET). However, its accuracy is compromised when maximal effort is not achieved. In such cases, submaximal parameters can serve as surrogates for assessing exercise performance. Objectives To compare the differences in maximal and submaximal exercise parameters between children with obesity and normal weight. Methods A prospective study evaluating CPET using a treadmill completed by children with and without obesity. Results A total of 153 children (50.9% females) were divided into two groups: obese (n = 87) and non‐obese (n = 66). Children with obesity achieved lower exercise capacity (peakVO2 of 68% ± 16% vs. 89% ± 15%; p < 0.0001) with fewer achieving maximal effort (26.4% vs. 78.7%, respectively). VO2‐derived submaximal parameters showed a significantly lower oxygen uptake efficiency slope per body weight (OUES/kg) (30.5 ± 6.1 vs. 39.0 ± 9.5; p < 0.0001) and lower VO2 at ventilatory threshold (VO2@AT) (21.2 ± 4.6 vs. 26.4 ± 5.3, p = 0.0001) in the obese group, with no significant differences in the CO2‐derived parameters. Conclusions Maximal exercise data in children with obesity is frequently unavailable due to failure to achieve maximal effort. Submaximal parameters, such as OUES and VO2@AT, may be useful substitute options for assessing the health and functional level of this population.


Design of the study. BW + 0%: body weight; BW + 5%: condition with simulated 5% weight gain; BW + 10%: condition with simulated 10% weight gain; RPE: rate of perceived exertion.
Evolution of the gross and net energy cost of walking during the graded walking test, in absolute (A and B), relative to instant body weight (C and D) and fat‐free mass (E and F), during the three experimental BW‐conditions. BW + 0%: body weight; BW + 5%: condition with simulated 5% weight gain; BW + 10%: condition with simulated 10% weight gain; *p < 0.05 BW + 0% vs. BW + 5%; **p < 0.01 BW + 0% vs. BW + 5%; ***p < 0.001 BW + 0% vs. BW + 5%; $ p < 0.05 BW + 5% vs. BW + 10%; $$ p < 0.01 BW + 5% vs. BW + 10%; $$$ p < 0.001 BW + 5% vs. BW + 10%; £p < 0.05 BW + 0% vs. BW + 10%; ££p < 0.01 BW + 0% vs. BW + 10%; £££p < 0.001 BW + 0% vs. BW + 10%; C: condition effect; S: speed effect; X: interaction effect (CxS). Data are presented as means, and for the clarity of the figure, the standard deviations are not represented.
Heatmap representing the correlations between the degree of simulated weight gain and Cw at each speed for each BW‐condition. BW + 0%: body weight; BW + 5%: condition with simulated 5% weight gain; BW + 10%: condition with simulated 10% weight gain; Δ: variations; *p < 0.05; **p < 0.01; ***p < 0.001.
Acute simulated weight gain might not increase the energy cost of walking in adolescents with obesity

December 2024

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66 Reads

Introduction This work aims at evaluating the adaptations of the energy cost of walking (Cw) to simulated weight gain at different walking speeds in adolescents with obesity. Methods Substrate use and Cw were evaluated during a graded walking exercise (4 × 5min at 0.75, 1, 1.25, 1.5 m.s⁻¹) performed under three randomized body weight conditions (BW‐conditions): (i) at the adolescents' body weight (BW + 0%) or with a simulated weight gain of (ii) 5%(BW + 5%) and (iii) 10%(BW + 10%), in 18 adolescents with obesity (14.2 ± 1.4 years, BMI:33.86 ± 2.55 kg.m‐²). Body composition was assessed by absorptiometry and perceived exertion rated after every walking speed stage. Results EE in absolute or relative to BW and FFM was different between BW‐conditions (p = 0.017, 0.006 and 0.007, respectively) being lower on BW + 5% than BW + 10%. Gross Cw (absolute, relative to BW and fat‐free mass) showed overall speed (p < 0.001) and BW‐conditions effects, being lower on BW + 5% compared with BW + 10% (p < 0.001). Net Cw (absolute, relative to BW and fat‐free mass) showed a significant speed effect (<0.001) but no BW‐conditions nor interaction effect. Conclusion While EE and Cw have been shown to decrease in response to weight loss, potentially as a way to save stored energy and limit further weight loss, inverse adaptations do not seem to occur with increased acute simulated weight gain in weight stable adolescents with obesity.


Adolescent experiences of weight‐related communication: Sociodemographic differences and the role of parents

Background Weight‐related conversations are common between adolescents and parents. However, there is limited understanding of how these conversations vary across sociodemographic groups, such as sex, sexual orientation, race/ethnicity, or parents' level of education. This study assessed the prevalence of weight‐related communication among adolescents and parents across sociodemographic characteristics, and identified adolescents' preferred sources for these discussions. Methods Quantitative data were collected through online surveys from two independent U.S. samples: adolescents aged 10–17 years of age (N = 2032), and parents of children aged 10–17 years of age (N = 1936). Frequency and sources of weight‐related communication were assessed. Sociodemographic factors were analysed for their associations with these communication patterns. Results While few differences emerged based on race/ethnicity or grade level, significant variation was observed for sex, sexual orientation, and parental education. Girls, sexual minority youth, high school students, and those with college‐educated parents were more likely to communicate about their own weight, whereas boys were more likely to comment on others' weight. Most adolescents preferred healthcare professionals (71%) and parents (69%) for these conversations, although sexual minority youth preferred mental health professionals considerably more than parents. Among parents, 77% discussed their child's weight, with fathers and Latinx parents engaging more frequently in these conversations, and Black parents engaging least frequently. Conclusion Weight‐related communication is prevalent among adolescents and parents, with variation across sociodemographic characteristics. As healthcare professionals and parents were identified as the preferred sources for weight‐related communication by adolescents across sociodemographic groups, it is important that paediatricians and parents are equipped to engage in these conversations without imparting stigma.


Timeline of State Government imposed lockdown periods of the 12 local government areas.
COVID‐19‐related lockdowns and changes in overweight and obesity, movement behaviours, diet quality, and health‐related quality of life among regional Australian primary school children: A repeat cross‐sectional study

December 2024

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3 Reads

Background During the coronavirus disease 2019 (COVID‐19) pandemic, the Australian state of Victoria (in particular, its capital, Melbourne) experienced some of the longest lockdowns in the world. Objective This repeated cross‐sectional study examined changes between March to June 2019 (pre‐pandemic) and April to August 2022 (6 to 11 months following pandemic‐related lockdowns) in overweight and obesity prevalence, physical activity, sedentary behaviour, sleep, diet quality, and health‐related quality of life (HRQoL) among primary school children in north‐east Victoria, Australia. Methods Height and weight were measured for Grade 2, 4, and 6 students in 2019 (3889 children) and 2022 (1816 children). Grade 4 and 6 students self‐reported on their movement behaviours, diet quality, and HRQoL. Results Participation declined among schools (2019:56%, 2022:34%) and students (2019:87%, 2022:75%). Compared to children in 2019, children in 2022 had a higher prevalence of overweight and obesity; were less likely to have met guidelines for moderate‐to‐vigorous physical activity, recreational screen time, and vegetable consumption; had higher intakes of takeaway food, energy‐dense nutrient‐poor snacks, and sugar‐sweetened beverages; and had lower HRQoL. Conclusion Children's health‐related behaviours and outcomes seemed not to have returned to pre‐pandemic levels 6 to 11 months after the final lockdowns lifted for their communities. Continued monitoring and interventions targeting the drivers of childhood obesity are urgently needed.


BMI z‐score trajectories among children with prenatal exposure to Δ9‐THC (n = 15) and children with no prenatal exposure to Δ9‐THC (n = 125). The rate of growth in BMI z‐score was more rapid among Δ9‐THC‐exposed offspring, as compared to unexposed offspring (0.42 per square root year; 95% CI: 0.12, 0.72; p < 0.01). Δ9‐THC, delta 9‐tetrahydrocannabinol; BMI, body mass index; CI, confidence interval.
BMI z‐score trajectories according to prenatal exposure to Δ9‐THC and breastfeeding. There was evidence of effect modification by breastfeeding (p‐value for Δ9‐THC × breastfed × age interaction = 0.04), such that Δ9‐THC did not appear to influence growth among those breastfed for 5 months whereas a shorter duration of breastfeeding was associated with 1.1 higher BMI z‐score at 36 months (95% CI: 0.21, 2.05). Δ9‐THC, delta 9‐tetrahydrocannabinol; BMI, body mass index; CI, confidence interval.
Impact of prenatal exposure to delta 9‐tetrahydrocannabinol and cannabidiol on birth size and postnatal growth trajectories

December 2024

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41 Reads

Background Prenatal exposure to cannabis (or more specifically, delta 9‐tetrahydrocannabinol [Δ9‐THC]) has been consistently linked to low birthweight. Animal models further show that Δ9‐THC is associated with rapid postnatal growth. Whether this association is modified by breastfeeding is unknown. Methods In this exploratory study, we followed 128 mother–child pairs through 3 years. Urinary Δ9‐THC and cannabidiol (CBD) were measured mid‐gestation. Generalized linear models estimated the associations between Δ9‐THC and neonatal body composition. A mixed‐effects model estimated the association between Δ9‐THC and body mass index (BMI) z‐score trajectories. Interaction was assessed by a three‐way product term (Δ9‐THC × breastmilk months × age). Results Fifteen children (12%) had Δ9‐THC exposure; three had concomitant CBD exposure. Prenatal exposure to Δ9‐THC alone was associated with lower fat mass (−95 g, 95% confidence interval [CI]: −174, −14) and neonatal adiposity (−2.1%; 95% CI: −4.2, −0.4) followed by rapid postnatal growth (0.42 increase in BMI z‐score per square root year; 95% CI: 0.12, 0.72). Breastfeeding modified this association (p = 0.04), such that growth was similar for those breastfed for 5 months whereas a shorter duration of breastfeeding was associated with 1.1 higher BMI z‐score at 3 years (95% CI: 0.21, 2.05). Conclusions Our study suggests that prenatal exposure to Δ9‐THC may alter early‐life growth. Breastfeeding may stabilize rapid postnatal growth, but the impact of lactational exposure requires further investigation.


Total and oxidized concentrations of high (HDL) and low (LDL) density lipoprotein cholesterol. (A) HDL‐C, (B) LDL‐C, (C) oxHDL, (D) oxLDL, (E) oxLDL/LDL, (F) oxHDL/HDL. Study groups are adolescents classified as controls with normal‐weight (NW), controls with obesity (Ob) and participants with obesity and metabolic dysfunction‐associated steatotic liver disease (MASLD), respectively. Boxes show the median (centre line) and interquartile range (IQR) for each group. Whiskers show the range of values within 1.5× of the IQR. Black circles are outlier values outside of the IQR. Between‐group comparisons are shown as adjusted p‐values from Tukey's or Dunn's multiple comparison tests.
Correlations with oxidized lipids. Open circles: control group with normal weight; grey circles: control group with obesity; black circles: metabolic dysfunction‐associated steatotic liver disease (MASLD) group. Regression lines (solid line), 95% confidence intervals (dashed lines), Spearman's correlation coefficient (r) and p‐values in panels A‐D are for the line of best fit for the whole cohort. No regression lines are shown for panels E and F because there were no significant relationships between fibrosis and oxLDL or oxHDL, respectively. The values for fibrosis stages 1A and 1B are pooled because there was only one case classified as 1B.
Oxidized high‐density lipoprotein and low‐density lipoprotein in adolescents with obesity and metabolic dysfunction‐associated steatotic liver disease

Background Metabolic dysfunction‐associated steatotic liver disease (MASLD) is increasingly common in the pediatric population and may increase risk for developing cardiovascular disease (CVD) in people with MASLD. Oxidized high‐density lipoprotein (oxHDL) and oxidized low‐density lipoprotein (oxLDL) are modified, pro‐atherosclerotic lipoproteins that are increased in adults with MASLD and CVD but have not been reported in adolescents with MASLD. Purpose To determine if oxLDL and oxHDL are increased in adolescents with MASLD. Methods Fasting oxHDL and oxLDL were measured in adolescents (11–20 years) with obesity and biopsy‐confirmed MASLD (n = 47), and peers without MASLD but with obesity (Ob; n = 28), or normal weight (NW; n = 29). Results oxHDL was 27% higher (p < 0.05) in the MASLD group (mean ± SD: 11.9 ± 4.7 ng/mL) compared to the Ob group (9.3 ± 3.7 ng/mL, p < 0.05) but only 7% higher than the NW group (11.1 ± 3.8 ng/mL, p > 0.05). However, HDL‐C was 19% and 32% lower in the MASLD group than in the Ob and NW groups, respectively. Thus, oxHDL/HDL‐C ratio was 55% and 66% higher in MASLD compared to the Ob group (p < 0.004) and the NW group (p < 0.001), respectively. oxLDL (52.4 ± 16.0, 46.7 ± 10.1 and 47.1 ± 15.2 U/L for MASLD, Ob and NW, respectively), LDL‐C and the oxLDL/LDL‐C ratio did not differ among groups. Conclusions The elevated oxHDL and oxHDL/HDL‐C in adolescents with MASLD compared to peers with Ob or NW suggests that there is some oxidative stress in MASLD independent of obesity and potential for increased CVD risk in the future.


Model 1 longitudinal associations between sleep hours, diet quality and body mass index z‐score. zBMI, body mass index z‐score. Data shown are coefficients, and all associated p values are above 0.05. T1 (enrolment), T2 (6‐month follow‐up) and T3 (18‐month follow‐up).
Model 2 longitudinal associations between sleep efficiency, diet quality and body mass index z‐score. zBMI, body mass index z‐score. Data shown are coefficients, and all associated p values are above 0.05. T1 (enrolment), T2 (6‐month follow‐up) and T3 (18‐month follow‐up).
Assessing the longitudinal association between sleep, diet quality and BMI z‐score among Black adolescent girls

December 2024

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21 Reads

Background Cross‐sectional research has suggested associations between diet, sleep and obesity, with sparse longitudinal research. Objectives To identify longitudinal mechanistic associations between sleep, diet and obesity. Methods We used longitudinal data from a sample of Black adolescent girls. At T1 (enrolment), 6 months (T2) and 18 months (T3), we estimated sleep duration and quality (7‐day accelerometry), diet quality (Healthy Eating Index [HEI‐2020]) and body mass z‐scores (zBMI) from measured height and weight. Longitudinal mediation using structural equation models examined the mechanistic roles of sleep, diet quality and zBMI. Results At enrolment, girls (n = 441) were mean age 12.2 years (±0.71), 48.3% had overweight/obesity, and mean HEI 55.8 (±7.49). The association between sleep and diet quality did not vary over time. Sleep duration at T1 was not associated with diet quality at T2 nor was diet associated with zBMI at T3. The bootstrapped indirect effect was not significant. Sleep quality at T1 was not associated with diet quality at T2 nor was diet associated with zBMI at T3. The bootstrapped indirect effect was not significant. Conclusions Diet was not a mediator between sleep and obesity. Study strengths are the longitudinal design and direct measures of sleep and zBMI among a homogeneous sample.


Flowchart. HPLGI—high‐protein low‐glycaemic‐index; MPMGI—moderate‐protein moderate‐glycaemic‐index.
Distribution of BMI‐for‐age z‐scores at birth, 6 months, 18 months, 3 years and 5 years of age in the HPLGI and MPMGI maternal diet groups. HPLGI, high‐protein low‐glycaemic‐index; MPMGI, moderate‐protein moderate‐glycaemic‐index.
Effect of a high‐protein and low‐glycaemic index diet during pregnancy in women with overweight or obesity on offspring metabolic health—A randomized controlled trial

December 2024

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10 Reads

Background Maternal obesity and excessive weight gain during pregnancy are associated with higher birth weight and increased risk of childhood obesity. Objective This study investigated the effect of a high‐protein and low‐glycaemic‐index (HPLGI) diet during pregnancy on offspring body composition and metabolic health. Methods We conducted a dietary intervention study in pregnant women with a pre‐pregnancy BMI of 28–45 kg/m² who were randomly assigned to an HPLGI diet or a moderate‐protein moderate‐glycaemic‐index (MPMGI) diet. A total of 208 offspring born to these women were followed‐up from birth to 5 years of age. Results No differences were found on BMI z‐scores at different ages; however, offspring born to women on the HPLGI diet exhibited 0.43 mmol/L higher glucose levels (p = 0.017) at birth compared with the MPMGI diet. At 3 years of age, HPLGI offspring had 0.09 mmol/L lower levels of HDL‐cholesterol (p = 0.018) and 16% higher levels of triglycerides (p = 0.044). At 5 years of age, they had 0.25 mmol/L higher total cholesterol levels (p = 0.027) and 0.27 mmol/L higher LDL‐cholesterol levels (p = 0.003) compared with the MPMGI diet. Conclusion An HPLGI diet during pregnancy may lead to adverse metabolic outcomes in the offspring, necessitating further investigation into long‐term health implications.


Weight trends from children and adolescents (age 9–16 years) to young adults (age 23–31 years) and related UPF consumption.
Ultra‐processed food consumption and overweight in children, adolescents and young adults: Long‐term data from the Kiel Obesity Prevention Study (KOPS)

December 2024

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60 Reads

Objective The aim was to assess ultra‐processed food (UPF) consumption, its impact on overweight and its association with weight trends from childhood and adolescence to young adulthood. Methods Long‐term UPF consumption (13.3 years) by NOVA was analysed (children/adolescents and adults, n = 182) in the Kiel Obesity Prevention Study (KOPS, n = 10 750). Results In children/adolescents (13.1 ± 1.9 years), a UPF‐based dietary pattern showed an inverse association with BMI‐SDS and fat mass index (males: r = −0.301, p = 0.01; r = −0.376, p = 0.001; females: r = −0.315, p < 0.001; r = −0.282, p = 0.003). Longitudinal analysis indicated that UPF consumption in childhood and adolescence was correlated with UPF consumption in adulthood among females (r = 0.272; p = 0.004) but not among males. In young adults (26.7 ± 2.2 years), UPF consumption accounted for nearly 50% of daily energy intake and was higher with overweight compared to normal weight and in incident overweight compared to persistent normal weight (both p < 0.05). High UPF consumption was associated with markers of poor diet quality (lower intake of fibre, higher intake of salt and energy‐dense food, all p < 0.05). Conclusions High UPF consumption in young adults was associated with both prevalence and incidence of overweight from childhood and adolescence to adulthood.


Countries with available data for prevalence estimates of cardiovascular risk factors.
Estimated prevalence for health behaviours. (A) Diet; (B) Physical activity; (C) Smoking; (D) Sleep duration. Forest plot for prevalence (%) and 95% Confidence Interval of each risk factor among children and adolescents (up to 19 years old). Risk factors were the following: insufficient physical activity (less than 1 h a day), diet (not daily fruit nor vegetable consumption), smoking (current use of cigarettes or inhaled nicotine), sleep (not meeting recommended daily hours according to the American Academy of Pediatrics). The Clopper‐Pearson method was used to determine 95% CIs for prevalence from the individual studies. A Freeman‐Tukey double arcsine transformation was conducted to stabilize the variances before calculating the pooled prevalence. CI, confidence interval; ES, effect size (prevalence); I², Higgins' I².
Estimated prevalence for health factors. (A) Obesity; (B) Dyslipidaemia; (C) Diabetes; (D) Elevated blood pressure. Forest plot for prevalence (%) and 95% Confidence Interval of each risk factor among children and adolescents (up to 19 years old). Risk factors were the following: obesity (body mass index in the 95th percentile according to their reference population), dyslipidaemia (one or more abnormal levels of any lipid profile according to the pediatric guidelines), diabetes (fasting blood glucose 126 mg/dL), blood pressure (systolic blood pressure and/or diastolic blood pressure according to the 95th percentile of their reference population). The Clopper‐Pearson method was used to determine 95% CIs for prevalence from the individual studies. A Freeman‐Tukey double arcsine transformation was conducted to stabilize the variances before calculating the pooled prevalence. CI, confidence interval; ES, effect size (prevalence); I², Higgins' I².
Prevalence of cardiovascular risk factors according to Life's Essential 8 in children and adolescents during the COVID‐19 pandemic: A systematic review and meta‐analysis including 1 526 173 participants from 42 countries

Introduction Cardiovascular health is a crucial aspect of overall health. The aim of this study was to estimate the prevalence of cardiovascular risk factors among children and adolescents during the COVID‐19 pandemic based on the Life's Essential 8 domains. Methods PubMed, Scopus and Web of Science were systematically searched until 24 February 2023. Studies had to meet the following criteria: (1) observational studies, (2) studies reporting proportion of selected risk factors, (3) studies involving children or adolescents, (4) studies that collected data during the COVID‐19 pandemic and (5) studies with representative samples. The outcomes included were diet, physical activity, nicotine exposure, sleep health, obesity, dyslipidaemia, diabetes and elevated blood pressure. Results Sixty‐two studies with 1 526 173 participants from 42 countries were included. Of these, 41 studies were used in the meta‐analyses. The overall pooled prevalence of risk factors in the behavioural domain was as follows: poor quality diet 26.69% (95% CI 0.00%–85.64%), inadequate physical activity 70.81% (95% CI 64.41%–76.83%), nicotine exposure 9.24% (95% CI 5.53%–13.77%) and sleep disorders 33.49% (95% CI 25.24%–42.28%). The overall pooled prevalence of risk factors in the health domain was as follows: obesity 16.21% (95% CI 12.71%–20.04%), dyslipidaemia 1.87% (95% CI 1.73%–2.01%), diabetes 1.17% (95% CI 0.83%–1.58%) and elevated blood pressure 11.87% (95% CI 0.26%–36.50%). Conclusions These results highlight the need for prevention strategies to maintain better cardiovascular health from an early age, particularly by increasing physical activity levels, sleep time and promoting the consumption of more fruits and vegetables.


Mendelian randomization (MR) analysis for early life BMI (31 SNPs) in relation to colorectal cancer (CRC) in GECCO, Finngen and Asia Colorectal Cancer Consortium (ACCC). The x axis corresponds to an OR change per 1 standard deviation increase in BMI. The MR result corresponds to a random effects model. OR, odds ratio (black filled square); 95% CI, 95% confidence interval (black line); SNP, single nucleotide polymorphism.
Mendelian randomization (MR) analysis for BMI at birth (8 SNPs) as well as in specific time periods (transient: 17 SNPs, early rise: 10 SNPs, late rise: 4 SNPs) in relation to colorectal cancer (CRC) in GECCO, Finngen and Asia Colorectal Cancer Consortium (ACCC). The x axis corresponds to an OR change per 1 standard deviation increase in BMI. The MR result corresponds to a random effects model. OR, odds ratio (black filled square); 95% CI, 95% confidence interval (black line); SNP,‐ single nucleotide polymorphism.
Body mass index at birth and early life and colorectal cancer: A two‐sample Mendelian randomization analysis in European and East Asian genetic similarity populations

November 2024

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16 Reads

Background Varying obesogenic inherited predisposition in early to later life may differentially impact colorectal cancer (CRC) development. Previous Mendelian randomization (MR) studies, conducted in populations of European genetic similarity, have not observed any significant associations between early life body weight with CRC risk. However, it remains unclear whether body mass index (BMI) at different early lifetime points is causally related with CRC risk in both Europeans and East Asian populations. Objectives We conducted a two‐sample MR study to investigate potential causal relationships between genetically predicted BMI during early life (birth to 8 years old) and at specific periods (birth, transient, early rise and late rise) and CRC risk. Methods Summary data were obtained from genome‐wide association study (GWAS) of BMI in 28 681 children from the Norwegian Mother, Father and Child Cohort Study (MoBa) study and applied to CRC GWAS data from European and East Asian descent populations (102 893 cases and 485 083 non‐cases). Results There were no significant associations observed between early life BMI and CRC risk in European or East Asian populations. The effect estimates were similar in European studies (odds ratio [OR] per a 1‐standard deviation [SD] increase: 1.01, 95% confidence interval [CI]: 0.95, 1.07) and in East Asians (OR per a 1‐SD increase: 1.02, 95% CI: 0.91, 1.14). Similar nonsignificant associations were found between time of BMI measurement during childhood and cancer‐site‐specific analyses. Conclusions We found little evidence of any associations between early life adiposity on later life CRC risk.


Associations between gestational exposure to neighbourhood socioeconomic deprivation and early childhood weight status

November 2024

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14 Reads

Objective This study aimed to examine associations between prenatal neighbourhood socioeconomic deprivation (NSD) with early offspring weight status and to assess potential modification by race and ethnicity. Methods We used data from the Newborn Epigenetics STudy (NEST) cohort. Gestational NSD was assessed as neighbourhood deprivation index (NDI) tertiles. Offspring height and weight were assessed at 6 months (N = 1023), 1 year (N = 1268), 2 years (N = 1033) and 3 years (N = 1038). Multilevel logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) for the relationship of NDI with overweight or obesity and rapid infant weight gain, adjusting for gestational parent age, race/ethnicity, marital status and educational attainment. Models were estimated in the total sample and also stratified by race and ethnicity. Results Children exposed to NDI in the highest (compared to the lowest) tertile had increased odds of having overweight/obesity at 1 year (OR = 1.53, 95%CI = 1.09–2.15). In stratified models, children of NH Black gestational parents residing in the highest tertile of NDI (compared to the lowest) had increased odds of having overweight/obesity at 1 year (OR = 1.67, 95%CI = 1.00–2.77). Conclusions This findings suggest that higher gestational exposure to NSD may play a role in early childhood weight status, which has important implications for later development and health.


Association between total, regional and organ fat and type 2 diabetes risk factors among Latino youth: A longitudinal study

Introduction To examine whether within‐person changes in total, regional and organ fat were associated with within‐person changes in type 2 diabetes (T2D)‐related biomarkers following interventions. Methods A secondary analysis from a randomised trial among Latino youth (30 males, 25 females) aged 12–16 years with obesity. The study sample combined participants randomised to either lifestyle intervention (N = 39) or usual care (N = 16). Total body composition was assessed by DEXA. Hepatic and pancreatic fat fractions were assessed using MRI. T2D risk factors included insulin sensitivity, beta‐cell function and post‐challenge glucose. Results Significant changes in %body fat, lean mass, insulin sensitivity and 2‐h glucose were observed. Changes in fat mass were associated with changes in insulin sensitivity (β = −0.45, p < 0.001), while changes in lean mass were associated with changes in 2‐h glucose concentrations (β = −0.50, p = 0.02). No association between changes in total, regional, or organ fat and beta cell function were noted. Conclusions Our study revealed that within‐person changes in fat mass and lean mass were associated with increased insulin sensitivity and reduced 2‐h glucose concentrations, respectively, among high‐risk Latino youth. The impact of reductions in regional and organ fat deposition on T2D risk factors warrants further examination.


Adolescents' chronotype and its association with obesity‐related outcomes: The EHDLA study

October 2024

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116 Reads

Objective This study aimed to assess associations between chronotype and obesity‐related indicators in a sample of Spanish adolescents. Methods This cross‐sectional study used data from The Eating Healthy and Daily Life Activities (EHDLA) Study, which included a representative sample of adolescents from Spain. A total of 820 adolescents (54.7% girls) aged 12–17 years were included in the analyses. The adolescents' chronotype was determined using the Morningness/Eveningness Scale in Children. Obesity‐related indicators included body mass index, waist circumference, waist‐to‐height ratio, triceps and medial calf skinfolds, sum of skinfolds, and body fat percentage. Generalized linear models were used to examine the relationship between the Morningness‐Eveningness score and chronotype status and the above‐mentioned obesity‐related indicators in adolescents. All analyses were adjusted for sex, age, socioeconomic status, sleep duration, physical activity, sedentary behaviour, adherence to the Mediterranean diet, and energy intake. Results The morningness chronotype was associated with higher abdominal obesity (odds ratio [OR] = 1.67, 95% confidence interval (CI) 1.12 to 2.50; p = 0.001), waist‐to‐height ratio (unstandardized beta coefficient [B] = 0.01, 95% CI 0.01 to 0.05; p = 0.029) and skinfold calves (B = 1.04 95% CI 0.24 to 1.94; p = 0.011), compared with the intermediate chronotype. Conclusion Adolescents with a morningness chronotype may be more prone to abdominal obesity than their counterparts with an intermediate chronotype. Effective intervention‐related approaches can be applied to those with a morningness chronotype.


Journal metrics


2.7 (2023)

Journal Impact Factor™


22%

Acceptance rate


7.3 (2023)

CiteScore™


19 days

Submission to first decision


$4,650 / £3,090 / €3,840

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