Television watching and soft drink consumption: associations with obesity in 11- to 13-year-old schoolchildren

Residence-based inequalities in overweight/obesity in sub-Saharan Africa: a multivariate non-linear decomposition analysis

BACKGROUND

Overweight/obesity remains a major risk factor for non-communicable diseases and their associated morbidities and mortalities. Yet, limited studies have comprehensively examined factors contributing to the rural-urban disparities in overweight/obesity among women in sub-Saharan Africa. Thus, our study sought to decompose the rural-urban disparities in overweight/obesity among women in sub-Saharan Africa (SSA) using nationally representative datasets.

METHODS

We performed a cross-sectional analysis of data from the Demographic and Health Surveys of 23 sub-Saharan African countries conducted from 2015 to 2022. A sample of 177,329 women was included in the analysis. Percentages with confidence intervals (CIs) were used to summarize the prevalence of overweight/obesity per rural-urban strata and pooled level. A multivariate non-linear decomposition analysis was used to identify the factors contributing to the rural-urban disparities in overweight/obesity. The results were presented using coefficients and percentages.

RESULTS

The pooled prevalence of overweight/obesity among the women was higher in urban areas (38.9%; 95% CI = 38.2-39.6) than rural areas (19.1%; 95% CI = 18.7-19.6). This pattern was observed in all the countries surveyed, except in South Africa, where women in rural areas (53.1%; 95% CI = 50.0-56.4) had a higher prevalence of overweight/obesity than those in urban areas (46.0%; 95% CI = 43.2-48.9). Approximately 54% of the rural-urban disparities in overweight/obesity was attributable to the differences in the women's characteristics or explanatory variables. More than half of the rural-urban disparities in overweight/obesity would be reduced if the disparities in women's characteristics were levelled. Among the women's characteristics, frequency of watching television (29.03%), wealth index (26.59%), and level of education (9.40%) explained approximately 65% of the rural-urban differences in overweight/obesity.

CONCLUSION

The prevalence of overweight/obesity among women in SSA remains high and skewed towards women in urban areas. Increased frequency of watching television, high wealth index, and higher educational attainment contributed largely to the rural-urban disparities in overweight/obesity among women in SSA. Thus, interventions aimed at reducing overweight/obesity among women in SSA could be targeted at reducing the frequency of television watching as well as promoting physical activities among wealthy women and those with higher education, particularly in urban areas.

The relationship between children's oral health behaviours and oral health-related quality of life: a cross-sectional study

BACKGROUND

Understanding oral health behaviour s and their impact on Oral Health-Related Quality of Life (OHRQoL) may serve as an instrument to articulate the conventional oral health policy framework, thereby ameliorating the overall health of young individuals in the long term.

OBJECTIVE

The aim of this study was to investigate the relationship between children's oral health behaviour s and Oral Health-Related Quality of Life in the capital governorate, Kuwait.

METHODS

A cross-sectional study involving 607 children aged 12-14 years, randomly selected from schools in Kuwait Capital Region. A validated Oral Health Behaviour s and OHRQoL Child Perception Questionnaires (CPQ12-14) was used to collect the data. Chi-square, t-tests, and ANOVA were used to examine the association between oral behaviour s and children's OHRQoL.

RESULTS

About 52.2% of participants were males and the overall response rate was 93.8%. The mean ± SD for total OHRQoL impact was 3.1 ± 0.58, while the total mean for individual domains- for oral symptoms, functional limitations, emotional well-being and social well-being were 2.89 ± 0.63, 2.89 ± 0.72, 3.1 ± 0.91 and 3.4 ± 0.61, respectively. There was no significant difference in total OHRQoL impact score by frequency of last dental visit, flossing, use of mouth rinse or chewing gum (p > 0.05) but for the overall OHRQoL, frequency of soft drink intake was the only significant predictor associated with 0.2-unit decrease (B = -0.207, 95% CI, p = 0.002) in total OHRQoL scores.

CONCLUSIONS

High frequency of soft drink consumption was related to poorer OHRQoL. Behaviour changing interventions based on OHRQoL inferences coupled with clinical intervention are needed.

Effects of Nonnutritive Sweeteners on Body Composition Changes during Pubertal Growth

The effects of consuming specific types of nonnutritive sweeteners (NNSs) on adiposity changes in children have remained inconsistent. In this study, we aimed to investigate the effects of the intake of different kinds of NNSs on long-term adiposity changes during pubertal growth. Furthermore, we examined the above relationships among different sexes, pubertal stages, and levels of obesity. A total of 1893 6-15-year-old adults were recruited and followed-up every 3 months. The NNS-FFQ (Food Frequency Questionnaire) was conducted and urine samples were collected to investigate the effects of the selected sweeteners, which included acesulfame potassium, aspartame, sucralose, glycyrrhizin, steviol glycosides, and sorbitol. Multivariate linear mixed-effects models were used to examine the relationship between NNS intake and body composition. The consumption of aspartame, sucralose, glycyrrhizin, stevioside, and sorbitol was associated with decreased fat mass and increased fat-free mass. In the highest tertile group, the effects of NNS consumption on fat mass corresponded to values of -1.21 (95% CI: -2.04 to -0.38) for aspartame, -0.62 (95% CI: -1.42 to 0.19) for sucralose, -1.26 (95% CI: -2.05 to -0.47) for glycyrrhizin, -0.90 (95% CI: -2.28 to 0.48) for stevioside, and -0.87 (95% CI: -1.67 to -0.08) for sorbitol, while the effects on fat-free mass corresponded to values of 1.20 (95% CI: 0.36 to -0.38) for aspartame, 0.62 (95% CI: -0.19 to 1.43) for sucralose, 1.27 (95% CI: 0.48 to 2.06) for glycyrrhizin, 0.85 (95% CI: -0.53 to 2.23) for stevioside, and 0.87 (95% CI: 0.08 to 1.67) for sorbitol. Particularly, aspartame and sorbitol revealed a dose-responsiveness effect. The above finding was more prominent among girls than boys. Moreover, fat mass was significantly reduced in normal-weight children who consumed a moderate amount of aspartame and a large amount of glycyrrhizin and sorbitol compared with obese children. In conclusion, the NNS-specific and sex-specific effects of long-term NNS consumption revealed associations of decreasing fat mass and increasing fat-free mass for children undergoing pubertal growth.

Intake of Artificial Sweeteners by Children: Boon or Bane?

BACKGROUND

Sugar is the main culprit in many health dysfunctions. Excessive sugar intake can negatively affect oral health, precipitate diabetes, and lead to weight gain and obesity. Sucrose is the primary form of sugar, and is strongly correlated with dental caries. Artificial sweeteners are chemically synthesized sugar substitutes that are generally regarded as being low-calorie.

OBJECTIVE

This review examines the current evidence in the literature for the need for artificial sweeteners and outlines its implications for the health of children. We briefly outline its adverse effects, and concerns regarding their safety.

REVIEW RESULTS

Artificial sweeteners are a widely used food additive. Six main artificial sweeteners are approved by the food and drug administration (FDA). The conflicting results and divergent regulatory norms of each sweetener are a constant cause of concern and debate. However, most studies have spotlighted the beneficial effects of artificial sweeteners. Dental caries diminish with the increase in sweetener intake. An increase in appetite and eventually weight gain is observed in individuals consuming artificial sweeteners.

CONCLUSION

Artificial sweeteners are indeed a bane according to present studies, although more research on recently discovered non-nutritive artificial sweeteners is required. It also has a positive effect on overall health disorders. If one curbs the onset of dental caries, then the eventual rise is highly unlikely.

CLINICAL SIGNIFICANCE

Artificial sweeteners' effect on lowering dental caries will help to reduce the caries index in general. Oral hygiene is maintained, and the growth of oral bacterium is depressed. Research on novel sweeteners will help to compare their efficacy in caries prevention compared to existing ones. It is necessary to educate people on artificial sweeteners and its implication as one can use them by being aware of their properties.

Association of Household Type and Fast-Food Consumption in Korean Adolescents

Background: Due to changing household types and weakening of family functions, children have fewer opportunities to develop healthy lifestyle patterns from contact with family members compared to the past. In this paper, we evaluate the association between household type and adolescents’ fast-food consumption, focusing on whether they were living with their parents or not, and determine their reasons for not living with their parents. Methods: This cross-sectional study analyzed data from the Korea Youth Risk Behavior web-based survey between 2017 and 2020. The subjects were students in grades 7–12. The outcome variable was a frequency of fast-food intake of ≥5 times per week. The main independent variable was the type of household: (1) living with both parents; (2) living with a single parent (one of father, mother, stepfather, stepmother); (3) not living together, but having parents; and (4) having no parents. Results: Participants without parents were more likely to eat fast food frequently than those living with both parents. Among boys, not having parents and living in a dorm or boarding house or living with other family members or relatives were significantly associated with frequent fast-food intake; among girls, not having parents and living in a dorm or boarding house were significantly associated with frequent fast-food intake. Conclusion: Adolescents having no parents have a higher risk of frequent fast-food intake than those living with both parents. Further studies are needed to address household types in greater detail.

Outdoor light at night, overweight, and obesity in school-aged children and adolescents

Previous studies have indicated that outdoor light at night (LAN) is associated with a higher prevalence of overweight or obesity in adults. However, the association of LAN levels with overweight or obesity in children is still unknown. This study utilized data from the Seven Northeastern Cities study, which included 47,990 school-aged children and adolescents (ages 6-18 years). Outdoor LAN levels were measured using satellite imaging data. Weight and height were used to calculate age-sex-specific body mass index (BMI) Z-scores based on the World Health Organization (WHO) growth standards. Overweight status and obesity were defined using the Chinese standard. Information regarding socioeconomic status, sleep-related characteristics, and obesogenic factors were obtained using a questionnaire. A generalized linear mixed model examined the associations of outdoor LAN levels (in quartiles) with the outcomes of interest. Compared to children in the lowest quartile of outdoor LAN levels, children exposed to higher outdoor LAN levels had larger BMI Z-scores and higher odds of being overweight (including obesity) or obese, with the largest estimates in the third quartile [BMI Z-score: β = 0.26, 95% CI: 0.18-0.33; overweight (including obesity): OR = 1.40, 95% CI: 1.25-1.56; obesity: OR = 1.46, 95% CI: 1.29-1.65]. There was a significant sex difference (P_interaction<0.001) in the association of outdoor LAN levels with BMI Z-scores, and the association was stronger in males. Results remained robust following multiple sensitivity analyses and the adjustment of sleep-related characteristics, obesogenic factors, and environmental exposures. Our findings suggest that higher outdoor LAN levels are associated with larger BMI Z-scores and greater odds of overweight (including obesity) and obesity in school-aged children and adolescents. Further, the association between outdoor LAN levels and BMI Z-scores is stronger in males. Future studies with exposure assessments that consider both outdoor and indoor LAN exposures are needed.

Parent-adolescent agreement in reported moderate-to-vigorous intensity physical activity during the COVID-19 pandemic

PURPOSE

To describe the agreement between parent- and adolescent- reports of adolescent moderate-to-vigorous intensity physical activity (MVPA) and to determine sociodemographic factors associated with MVPA reporting differences during the COVID-19 pandemic.

METHODS

We analyzed data collected in May 2020 from the Adolescent Brain Cognitive Development Study (ABCD, N = 4841), a U.S. prospective cohort study. We quantified past weekly adolescent MVPA levels as reported by the parent and adolescent (referent). Intra-class correlation coefficients (ICC) and Bland-Altman plots were used to examine the degree of agreement between parent- and adolescent- reports.

RESULTS

When quantifying adolescent MVPA during the same recall period, median (p25, p75) MVPA (h∙wk.- 1) was 2.17 (0.00, 6.00) as reported by adolescents and 1.52 (0.29, 4.75) by parents with a mean difference of 4.89. Statistically significant differences in reports of MVPA were found in households with income > $75,000: on average, adolescents reported higher MVPA levels than their parents. Bland-Altman plots illustrated that, among adolescents reporting no or little MVPA, there was higher parent-adolescent agreement. However, among adolescents reporting high levels of MVPA, there was less agreement between the parent- and adolescent- reports.

CONCLUSIONS

Despite more time spent together at home during the pandemic, there was generally low agreement between parent- and adolescent- reports of adolescent MVPA. Future research could examine parent-adolescent agreement of MVPA within the context of device-based measures (e.g., accelerometers), determine reasons for differences in parent-adolescent reporting of MVPA, and inform interventions for improved parental involvement and monitoring of MVPA.

Sugar-sweetened beverage consumption and breast composition in a longitudinal study of Chilean girls

Background

Frequent sugar-sweetened beverage (SSB) intake has been associated with indirect markers of breast cancer risk, such as weight gain in adolescents and early menarche. How SSB intake relates to breast composition in adolescent girls has not been explored.

Methods

We evaluated the association between prospective intake of SSB and breast density in a cohort of 374 adolescent girls participating in the Growth and Obesity Cohort Study in Santiago, Chile. Multivariable linear regression models were used to analyze the association between average daily SSB intake quartiles and breast composition (absolute fibroglandular volume [aFGV], percent fibroglandular volume [%FGV], total breast volume [tBV]). Models were adjusted for potential confounding by BMI Z-score, age, daily energy intake (g/day), maternal education, hours of daily television watching after school, dairy intake (g/day), meat intake (g/day), waist circumference, and menarche. To examine the sensitivity of the association to the number of dietary recalls for each girl, analyses were further stratified by girls with one dietary recall and girls with > one dietary recall.

Results

A total of 881 dietary recalls were available for 374 girls prior to the breast density assessment. More than 60% of the cohort had > one dietary recall available. In multivariable analyses, we found no association between SSB intake quartile and aFGV (Q2 vs Q1 β: − 5.4, 95% CI − 15.1, 4.4; Q3 vs Q1 β: 1.3, 95% CI − 8.6, 11.3; Q4 vs Q1 β: 3.0, 95% CI − 7.1, 13). No associations were noted for %FGV and tBV. Among girls with at least one dietary recall, we found no significant associations between SSB intake quartiles and %FGV, aFGV, or tBV.

Conclusion

Overall, we observed no evidence that SSB intake was associated with breast density in adolescent Chilean girls.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13058-021-01495-8.

Racial Disparities in Obesity Treatment Among Children and Adolescents

PURPOSE OF REVIEW

With the growing obesity epidemic among children and adolescents, the evaluation of disease origin to slow disease progression is necessary. Racial disparities which are evident amid prevalence and treatment must be studied to counteract disease propagation.

RECENT FINDINGS

Disparities are pronounced among Black and Hispanic pediatric patients prior to conception and birth due to genetic composition and fetal environment. Postnatal environment and psychosocial influences can further increase a child/adolescent's propensity to increased weight. Current treatment options including nutrition, physical activity, behavior modification, pharmacotherapy, and surgery are underutilized in communities of color due to limited access to care and cost. Data is limited to demonstrate disparities among treatment of obesity in children and adolescents. The reviewed studies show the role of race on disease treatment. Increased research efforts, especially in pharmacotherapy and metabolic and bariatric surgery (MBS), will help combat obesity in pediatric communities of color.

Low-energy sweeteners and body weight: a citation network analysis

OBJECTIVE

Reviews on the relationship of low-energy sweeteners (LES) with body weight (BW) have reached widely differing conclusions. To assess possible citation bias, citation analysis was used to quantify the relevant characteristics of cited articles, and explore citation patterns in relation to review conclusions.

DESIGN

A systematic search identified reviews published from January 2010 to March 2020. Different characteristics (for example, type of review or research, journal impact factor, conclusions) were extracted from the reviews and cited articles. Logistic regression was used to estimate likelihood of articles with particular characteristics being cited in reviews. A qualitative network analysis linked reviews sub-grouped by conclusions with the types of articles they cited.

MAIN OUTCOME MEASURES

(OR; 95% CI) for likelihood that articles with particular characteristics were cited as evidence in reviews.

RESULTS

From 33 reviews identified, 183 different articles were cited (including other reviews). Narrative reviews were 62% less likely to be cited than systematic reviews with meta-analysis (OR 0.38; 0.16 to 0.86; p=0.03). Likelihood of being cited was higher for evidence on children than adults (OR 2.27; 1.59 to 3.25; p<0.0001), and with increased journal impact factor (OR 1.15; 1.00 to 1.31; p=0.04). No other factors were statistically significant in the main analysis, and few factors were significant in subgroup analyses. Network analysis showed that reviews concluding a beneficial relationship of LES with BW cited mainly randomised controlled trials, whereas reviews concluding an adverse relationship cited mainly observational studies.

CONCLUSIONS

Overall reference to the available evidence across reviews appears largely arbitrary, making citation bias likely. Differences in the conclusions of individual reviews map onto different types of evidence cited. Overall, inconsistent and selective use of the available evidence may account for the diversity of conclusions in reviews on LES and BW.

TRIAL REGISTRATION NUMBER

Prior to data analysis, the protocol was registered with the Open Science Framework (https://osf.io/9ghws).

Effects of therapeutic horse-riding program on the walking ability of students with intellectual disabilities

The purpose of this study was to determine if an 8-week therapeutic riding (TR) program was effective in improving the walking ability of students with intellectual disabilities. Thirteen students diagnosed with intellectual disabilities participated in the TR program. TR sessions were conducted twice a week (30 min per session), with a total of 16 rides taking place over an 8-week period. A gait measurement analyzer was used to measure progress based on a turn test (6-m walking and turning test), walk test (10-m walking), and timed up and go (TUG) test. Measurements were made three times: before horse-riding (P0), after 4 weeks (8 rides) of horse-riding (P1), and after 8 weeks (16 rides) of horse-riding (P2). Data analysis was conducted using SPSS software (ver. 22.0). Descriptive statistics were generated on the general characteristics of the subjects, and the Kolmogorov-Smirnov test was used to verify the normality of the data. Because of the lack of normality, the data were analyzed using a nonparametric method and the significance level was set to 0.05. Measurements of the duration of the forward gait cycle (s) in the turn test and the forward gait speed (m/s) in the walk test indicated improved walking ability after the TR program (p < 0.001); the stride length (% height) also increased significantly (p < 0.05). The walk test revealed a significant effect of the program on the duration of the forward gait cycle (p < 0.05), while there were significant improvements on the left and right of the elaborated strides (p < 0.001). No significant improvement in TUG test performance was observed after the TR program. In this study, an 8-week TR program had positive results on gait. Therefore, further research is merited, where TR programs are likely to improve the walking ability of individuals with intellectual disabilities.

Lifestyle Behaviors Associated With Body Fat Percent in 9- to 11-Year-Old Children

PURPOSE

To examine (1) associations between body fat percent (BF) and lifestyle behaviors in children aged 9-11 years and (2) the consistency of these associations over a 10-year period.

METHODS

In this repeat, cross-sectional study, 15,977 children aged 9-11 years completed an anthropometric assessment and the SportsLinx Lifestyle survey between 2004 and 2013. Body fat was estimated according to the sum of the triceps and subscapular skinfold measurements. Multilevel models were utilized to examine associations between BF and responses to the lifestyle survey while controlling for known covariates.

RESULTS

Lifestyle behaviors explained 8.6% of the total variance in body fat. Specifically, negative associations were found between BF and active transport to school ( β = -0.99 [0.19], P < .001), full-fat milk (-0.07 [0.15], P < .001), and sweetened beverage consumption (-0.40 [0.15], P = .007). Relative to the reference group of ≤8:00 PM, later bedtime was positively associated with BF: 8:00 to 8:59 PM ( β = 1.60 [0.26], P < .001); 9:00 to 10:00 PM ( β = 1.04 [0.24], P < .001); ≥10:00 PM ( β = 1.18 [0.30], P < .001). Two-way interactions revealed opposing associations between BF and the consumption of low-calorie beverages for boys ( β = 0.95 [0.25], P < .001) and girls ( β = -0.85 [0.37], P = .021). There was no significant change in these associations over a 10-year period.

CONCLUSIONS

In this population-level study covering a decade of data collection, lifestyle behaviors were associated with BF. Policies and interventions targeting population-level behavior change, such as active transport to school, sleep time, and consumption of full-fat milk, may offer an opportunity for improvements in BF.

The Effects of Non-Nutritive Sweetener Consumption in the Pediatric Populations: What We Know, What We Don't, and What We Need to Learn

Childhood obesity is increasing at an alarming rate in the United States. This trend carries serious risk of children developing obesity-related diseases including Type 2 diabetes and cardiovascular disease. Non-nutritive sweeteners (NNS) are used as substitution for table sugar as a way to prevent weight gain. Their consumption is ubiquitous in adults and children; however the long-term health outcomes of chronic NNS consumption in children are unclear. Conflicting observational studies suggest that children consuming NNS are at risk of obesity and development of type 2 diabetes, while others concluded some benefits in weight reduction. Here, we review the physiological mechanisms that can contribute to the negative metabolic effects of NNS. We will focus on how NNS alters the sweet perception leading to increase caloric consumption, how NNs alters the gut microbiota, and how NNS may disrupt glucose homeostasis and initiate a vicious cycle of pancreatic endocrine dysfunction. Studies focused on the pediatric population are limited but necessary to determine whether the potential weight loss benefits outweigh the potential negative metabolic outcomes during this critical development period.

Consumption of acidic drinks, knowledge and concern about dental erosive wear in Norwegian high school students

OBJECTIVES

The objectives of the present study were to assess the consumption of acidic beverages, knowledge and concern about preventing dental erosive wear, and to examine potential associations between these variables, in a sample of high school students.

MATERIALS AND METHODS

A survey measuring acidic beverage consumption, knowledge and concern about erosive tooth wear was conducted at 13 high schools in Rogaland county, Norway.

RESULTS

Of the 850 students who completed the questionnaire, 26% reported that they drink acidic beverages every day. There were significant gender differences for the consumption of acidic drinks. The survey also demonstrated that a high proportion of students lacks basic knowledge of what erosive tooth wear is, and that this lack of knowledge is associated with a more frequent intake of acidic beverages. However, students who responded that they are concerned about preventing dental erosive wear reported that they drink soft drinks and energy drinks less frequently than students who are not concerned about this.

CONCLUSIONS

Results from this study support assumptions about a lack of knowledge about dental erosive wear in youth, and that this lack of knowledge is associated with a more frequent intake of acidic drinks.

Children's Body Mass Index Depending on Dietary Patterns, the Use of Technological Devices, the Internet and Sleep on BMI in Children

Due to the increase in overweight as well as obesity in children, the researchers undertook the studies to determine the occurrence of these irregularities and identify the factors leading to them. The study aimed to assess the body mass index of the children subcategorized and compared depending on the dietary patterns, the use of technical devices, the Internet, and sleeping habits. The study group consisted of 376 children (189 girls and 187 boys) aged 6 to 15. The body composition estimates were obtained with the use of a foot-to-foot bioelectrical impedance analysis, the body height was measured by means of a stadiometer, and blood pressure was monitored. The research questionnaire was distributed among the surveyed and included the question concerning the children’s lifestyle, eating and sleeping habits, the use of electronic devices, the Internet, and socio-demographic data. As indicated, the number of sleeping hours per day significantly negatively correlated with body mass index (BMI), whereas the frequency of using the smartphone had a positive correlation with BMI. The children who sleep less and spend more time using the smartphone had higher BMI values. Bearing in mind the conditions that may have an influence on the BMI of early-school age children, the emphasis must be placed on healthy lifestyle education among children and parents alike.

Consumption of non-nutritive sweeteners during pregnancy

In an effort to reduce sugar consumption to prevent diabetes mellitus and cardiovascular diseases, "sugar-free" or "no added sugar" products that substitute sugar with non-nutritive sweeteners (NNSs) (eg, Splenda, Sweet'N Low, and Stevia) have become increasingly popular. The use of these products during pregnancy has also increased, with approximately 30% of pregnant women reporting intentional NNS consumption. In clinical studies with nonpregnant participants and animal models, NNSs were shown to alter gut hormonal secretion, glucose absorption, appetite, kidney function, in vitro insulin secretion, adipogenesis, and microbiome dysbiosis of gut bacteria. In pregnant animal models, NNS consumption has been associated with altered sweet taste preference later in life and metabolic dysregulations in the offspring (eg, elevated body mass index, increased risk of obesity, microbiome dysbiosis, and abnormal liver function tests). Despite the accumulating evidence, no specific guidelines for NNS consumption are available for pregnant women. Furthermore, there are limited clinical studies on the effects of NNS consumption during pregnancy and postpartum and long-term outcomes in the offspring.

The relationship between obesity and dental caries according to life style factors in schoolchildren: a case-control study

Objectives: To evaluate the association between obesity and dental caries in terms of life-style habits and socio-economic status in Turkish school children.Materials and methods: This case-control study was undertaken with 178 children aged 6-11 years in a Turkish government children's hospital. The case group consisted of 86 obese children who were categorized in ≥95 percentile according to the BMI. The control group consisted of 90 non-obese children that would not raise any doubts about the teeth disease. Data of demographic features and life-style habits were obtained by a questionnaire at the dental examination. Caries experience was measured with DMFT and dmft indices.Results: No difference was found between obesity and caries prevalence in primary dentition (p = .957); however, there was a statistically significant association in the permanent dentition (p = .002). Also, no differences were found in children with healthy natural teeth between the study groups according to education level, family income and food consumption during TV viewing in primary dentition (p = .297; p = .652; p = .023).Conclusions: It can be concluded that obesity appears to be not a possible risk factor for dental caries in primary dentition, but would be a probable endangerment in the permanent dentition.

Determinants of Sugar-Sweetened Beverage Consumption among Indian Adults: Findings from the National Family Health Survey-4

Background

Sugar-sweetened beverages (SSBs) are associated with obesity, and various other noncommunicable diseases (NCDs). The aim of the study was to study the patterns of consumption of SSBs and association of SSB consumption with various socioeconomic factors and fried food consumption.

Methodology

We used data of the 4^th round of National Family Health Survey. We used multiple logistic regression to estimate the extent of the relationship between consumption of aerated drinks and various predictors. Furthermore, generalized structural equation modeling (GSEM) was used to derive a path diagram that showed a significant linkage between aerated drinks and observed variables.

Results

Our study showed a clear association between consumption of aerated drinks with socioeconomic variables age, sex, marital status, and wealth index. The consumption of aerated drinks was also significantly associated with watching television and eating fried foods.

Conclusion

Aerated drinks are a popular source of added sugar in the Indian diet. Limiting such factors can prove to be beneficial in reducing their consumption and further help in reducing the burden of NCDs.

In, out, and fluctuating: obesity from adolescence to adulthood

PURPOSE

While high levels of obesity prevalence and incidence have been well documented, there is less research on obesity dynamics over time. In this article, we sought to understand the body mass index (BMI) trajectories in and out of obesity from adolescence to adulthood.

METHODS

We used the National Longitudinal Study of Adolescent to Adult Health to explore American obesity dynamics from mean ages 15-28 years. We analyzed six BMI trajectories from 1994 to 2008 and examined their contextual sociodemographic correlates using ordinal logistic regression models.

RESULTS

More than 50% of adolescents with normal BMI moved to overweight/obesity by adulthood; only 8% of overweight and 2% of obese adolescents achieved normal BMI in adulthood. While some sociodemographic characteristics such as sex, race/ethnicity, place of residence, and parents' education were associated with being in certain BMI trajectories among adolescents with normal BMI, they were not so associated among adolescents starting at obesity.

CONCLUSIONS

Transitioning to higher BMI categories was common, whereas the opposite direction was rare. Pathways to obesity prevention might be easier to identify than those to reversal, as contextual factors had more explanatory power for youths with normal BMI than for those with obese BMI.

The Use of Nonnutritive Sweeteners in Children

The prevalence of nonnutritive sweeteners (NNSs) in the food supply has increased over time. Not only are more children and adolescents consuming NNSs, but they are also consuming a larger quantity of NNSs in the absence of strong scientific evidence to refute or support the safety of these agents. This policy statement from the American Academy of Pediatrics is intended to provide the pediatric provider with a review of (1) previous steps taken for approved use of NNSs, (2) existing data regarding the safety of NNS use in the general pediatric population, (3) what is known regarding the potential benefits and/or adverse effects of NNS use in children and adolescents, (4) identified gaps in existing knowledge and potential areas of future research, and (5) suggested talking points that pediatricians may use when discussing NNS use with families.

Low-calorie sweetener use, weight, and metabolic health among children: A mini-review

A reduction in the consumption of added sugars and sugar-sweetened beverages (SSBs) is a key focus of public health recommendations for a healthy diet among children. One approach to lower added sugar intake is to instead use low-calorie sweeteners (LCSs), which contain no or few calories. Consumption of LCSs is increasing worldwide, with the most marked rise observed among children and adolescents. However, the extent to which LCS consumption is helpful or harmful for weight management is controversial, particularly when LCS consumption begins in childhood. Herein, we summarize the limited existing literature examining effects of paediatric LCS consumption on appetite, energy intake, and body weight. While positive associations between LCS consumption and weight gain are reported in observational analyses, the majority of intervention studies, some of which blinded children to the contents of the drinks, report benefits of LCSs for reducing excessive child weight gain. Several potential mechanisms have been proposed to explain LCS effects on body weight, including LCS-induced promotion of appetite and energy intake. Yet studies assessing effects of beverages with LCSs (LCSBs) compared with SSBs on child appetite report mixed findings. Some demonstrate that children completely compensate for the diluted energy content of LCSBs by eating more solid food calories at subsequent meals compared with children administered SSBs, while others report a reduction in total energy intake with LCSB ingestion. Given the limited studies and resulting uncertainty as to whether LCSs benefit or worsen weight and metabolic health in children is integral that effects of LCS use during childhood continue to be investigated in future prospective studies.

Artificial sweeteners in food and beverage products at school

Objective

Experts recommend that products containing artificial sweeteners are not marketed to children or sold at schools. The present study aimed to provide a baseline assessment of the extent to which state laws and local school district wellness policies (LWP) address restrictions on the use of artificial sweeteners in competitive foods and beverages (CF&B) sold at schools.

Design

A descriptive, cross-sectional study of policies in place for the 2014–15 school year.

Setting

Data were collected on laws in all fifty states and Washington, DC. LWP were compiled for 496/518 school food authorities (SFA) for which data were collected as part of the US Department of Agriculture’s School Nutrition and Meal Cost Study.

Subjects

State laws and LWP respectively were coded on a 0–3 ordinal scale for the strength of their restrictions on artificial sweeteners in CF&B sold in each of five CF&B venues, separately by grade level. Prevalence of state laws and LWP for SFA nationwide was computed.

Results

Thirteen states addressed the use of artificial sweeteners. Six states addressed the use of artificial sweeteners in both CF&B. District-level artificial sweetener policies were most frequently addressed for beverages in elementary schools’ vending machines. District policies also were more likely to address artificial sweeteners in states with laws addressing artificial sweeteners.

Conclusions

Most state laws and LWP do not address artificial sweeteners in CF&B. This is not surprising given the Food and Drug Administration has approved eight artificial sweeteners for consumption and the Smart Snacks regulation does not limit artificial sweeteners for CF&B.

Non-Nutritive Sweeteners and Metabolic Health Outcomes in Children: A Systematic Review and Meta-Analysis

OBJECTIVE

To systematically assess and quantitatively synthesize the literature regarding the association of consumption of non-nutritive sweeteners (NNS) during childhood with negative metabolic health outcomes.

STUDY DESIGN

Following the PRISMA guidelines, published literature was systematically reviewed. Eligible studies (N = 13) were identified through the screening of over 2500 publications. Random-effects meta-analyses were conducted on the association of NNS consumption with body mass index (BMI) increase. Sensitivity and subgroup analyses by sex were also undertaken.

RESULTS

Consumption of NNS during childhood and adolescence was associated with an increase in BMI (OR 1.15, 95% CI 1.06-1.25); the OR was similar in sensitivity analyses. The associations were positive but marginally significant in subanalyses by sex. The qualitative assessment of existing literature showed nonsignificant associations with other components of metabolic disease, such as waist circumference, fat mass accumulation, and type 2 diabetes.

CONCLUSIONS

Systematic assessment of observational studies showed no association of NNS intake during childhood with fat mass accumulation and waist circumference and a small, but statistically significant association with BMI increase. Inherent methodological weaknesses of to-date published investigations, including mainly underpowered size to explore the hypothesis, call for more research.

Impact of dietary nutrient intake and physical activity on body composition and growth in Indian children

BackgroundTo investigate interrelationships of dietary composition and physical activity (PA) with growth and body composition (BC) in urban Indian school children.MethodsA cross-sectional study was performed in 4,747 Indian school children (2,623 boys) aged 3-18 years. Weight, height, BC by body impedance analyzer, PA and dietary food intakes by questionnaire method were recorded.ResultsMean daily energy and protein intakes as recommended dietary allowance were significantly lower in both boys and girls (P<0.01) above 6 years, with 55% reduction in micronutrient intakes in older children. When compared with World Health Organization references, lower heights in pubertal boys and girls were related to dietary energy and protein intake. Multiple regression analysis showed positive association of height for age z-scores (HAZ) with midparental height z-scores (β=0.45, P=0.0001) and protein density (β=0.103, P=0.014). HAZ was negatively associated with inactivity (β=-0.0001, P=0.049) in boys and girls (R²=0.104, P<0.01). Further, body fat percentage was negatively correlated with moderate or light activity and antioxidant intakes (P<0.01) but not with dietary fat intake. Percentage muscle mass was positively correlated with moderate activity and negatively with inactivity (P<0.05).ConclusionAdequacy of protein and antioxidant intakes, reducing inactivity and increasing moderate activity are essential for optimal growth and body composition in Indian children.

Early-Life Exposure to Non-Nutritive Sweeteners and the Developmental Origins of Childhood Obesity: Global Evidence from Human and Rodent Studies

Non-nutritive sweeteners (NNS) are increasingly consumed by children and pregnant women around the world, yet their long-term health impact is unclear. Here, we review an emerging body of evidence suggesting that early-life exposure to NNS may adversely affect body composition and cardio-metabolic health. Some observational studies suggest that children consuming NNS are at increased risk for obesity-related outcomes; however, others find no association or provide evidence of confounding. Fewer studies have examined prenatal NNS exposure, with mixed results from different analytical approaches. There is a paucity of RCTs evaluating NNS in children, yielding inconsistent results that can be difficult to interpret due to study design limitations (e.g., choice of comparator, multifaceted interventions). The majority of this research has been conducted in high-income countries. Some rodent studies demonstrate adverse metabolic effects from NNS, but most have used extreme doses that are not relevant to humans, and few have distinguished prenatal from postnatal exposure. Most studies focus on synthetic NNS in beverages, with few examining plant-derived NNS or NNS in foods. Overall, there is limited and inconsistent evidence regarding the impact of early-life NNS exposure on the developmental programming of obesity and cardio-metabolic health. Further research and mechanistic studies are needed to elucidate these effects and inform dietary recommendations for expectant mothers and children worldwide.

Adverse eating behavior and its association with obesity in Indian adolescents: Evidence from a nonmetropolitan city in India

INTRODUCTION

With the so-called modernization, the epidemiological and sociocultural context of adolescents in developing countries is rapidly changing and is affecting their eating behavior and dietary choices. The objective of our study is twofold. First, our study seeks to find whether there is a prevalence of the adverse eating behaviors among the adolescents. Second, our study seeks to examine whether the prevalence of the adverse eating behavior is related to obesity and quantifies their association of with body mass index (BMI) status.

MATERIALS AND METHODS

A cross-sectional school-based study was conducted in 13-15-year-old adolescents from schools of Aligarh, India, with prevalidated study tools and standardized anthropometric measures. The Z-scores were found by the WHO recommended AnthroPlus.

RESULTS

The results indicate a high prevalence of different adverse eating behaviors. The dietary behavior was found to be poor in 19.3%, fair in 54.4%, and good in only 26.3% of the study population. The mean BMI for age Z-score was found to be 0.87 and 0.02 in poor and fair dietary behavior. The odds of being overweight and obese were high (1.82 [1.20-2.78]) in those with poor dietary behavior.

CONCLUSIONS

Our findings suggest that more research and timely intervention in adverse eating behaviors are much needed in India before this widely neglected problem acquires even more alarming and gigantic proportions.

"I only watch for the commercials": Messages about weight, eating and race in Super Bowl advertisements

OBJECTIVE

Health experts and communication experts assert that the media influence individuals' health. Yet, incongruously, the public, policy-makers and the media themselves appear reticent to accept that the media could have extensive negative influence on health.

METHODS

The current study examined all ads that aired from Super Bowl XLVI through Super Bowl XLIX (N = 241) using a detailed, multistep coding process.

RESULTS

Ads had similar racial/ethnic diversity in the full sample and food/beverage ads. A minority (14.5%) of advertisements contained actors with overweight/obesity, who were more likely to be White and less likely to be Hispanic compared with race/ethnicity in all ads. Humour and tone were similarly present whether or not the ads included actors with overweight/obesity.

CONCLUSIONS

Findings are striking given the high prevalence of overweight/obesity in the USA, particularly among Black and Hispanic populations, and the comparatively low representation of actors with overweight/obesity in Super Bowl advertisements. Surprising weight findings may signal a change in how the media portray body-size norms (away from exclusively thin), although representations remain disproportionate from actual body-size distributions in the USA.

Differences in the Protective Effect of Exclusive Breastfeeding on Child Overweight and Obesity by Mother's Race

Objectives To examine the relationship between infant feeding and risk of child overweight and obesity across race and ethnicity in a diverse community-based cohort. Methods 2172 mother baby dyads were drawn from a prospective cohort constructed using data from electronic medical records linked to birth records. The primary exposure was exclusive breastfeeding at 2 months of age; outcome was BMI Z-score and BMI ≥ 85th percentile (overweight and obese) at 4 years of age. Regression models were adjusted for confounding using covariance balanced propensity score and inverse probability weighting. Results At age 4, exclusively breast fed children had lower BMI Z-score (-0.109, SE = 0.048) and a decreased odds of a BMI ≥ 85th percentile (0.832; 95 % CI 0.792, 0.994), when compared to those exclusively formula-fed or had mixed feeding. Race and ethnicity significantly moderated these associations. Sub-population analysis showed the effect was significant for BMI Z-score (p = 0.0002) and BMI ≥ 85th percentile (p < 0.0001) only for children of NH white mothers. For children of NH black mothers exclusive breastfeeding was not associated with a significant difference in BMI Z-score, however there was an increased odds of overweight or obesity (p = 0.0145). Conclusions The protective effect of breastfeeding against early childhood overweight and obesity may differ by race and ethnicity. This suggests that programs aiming to reduce obesity by increasing rates of breastfeeding may have limited impact for some groups and should be coupled with other racially and ethnically focused efforts to encourage healthy feeding practices in infancy and early childhood.

Using appreciative inquiry methodology to develop a weight management program for obese children in New Zealand

OBJECTIVES

Paediatric obesity predicts adult obesity, and alarming new data in New Zealand reveals that obesity among the young continues to rise. In this study, we used a novel solution-focused paradigm, or appreciative inquiry perspective, to explore the factors that influence not just obese but non-obese states (that is, healthy weight as well as obesity), in Pacific adolescents (aged 13-17) living in socioeconomically deprived neighbourhoods.

METHODS

Sixty-eight parents and adolescents from 30 families were recruited and interviewed, resulting in 15 obese and 15 healthy weight adolescents participating in the study.

RESULTS

Our findings showed that, despite living in low socioeconomic circumstances, parents were able to alter their micro-environments to prevent obesity in their children. Parents with healthy weight adolescents had food rules in the home and monitored their children's eating and television viewing time.

CONCLUSIONS

An appreciative inquiry approach to obesity research can uncover resiliency factors within families that can be applied to obesity prevention and treatment programs. Implications for public health: Appreciative inquiry methodology is a promising alternative qualitative research strategy for developing health interventions for low-income ethnic minority communities.

Health outcomes of non-nutritive sweeteners: analysis of the research landscape

BACKGROUND

Food products containing non-nutritive sweeteners (NNSs) instead of sugar have become increasingly popular in the last decades. Their appeal is obviously related to their calorie-free sweet taste. However, with the dramatic increase in their consumption, it is reasonable and timely to evaluate their potential health benefits and, more importantly, potential adverse effects. The main aim of this scoping review was to map the evidence about health outcomes possibly associated with regular NNS consumption by examining the extent, range, and nature of research activity in this area.

METHODS

We systematically searched Ovid MEDLINE, EMBASE and the Cochrane CENTRAL databases for studies on NNSs (artificial sweeteners or natural, non-caloric sweeteners, either used individually or in combination) using text terms with appropriate truncation and relevant indexing terms. All human studies investigating any health outcomes of a NNS intervention or exposure were eligible for inclusion. No studies were excluded based on language, study design or methodological quality. Data for each health outcome were summarized in tabular form and were discussed narratively.

RESULTS

Finally, we included 372 studies in our scoping review, comprising 15 systematic reviews, 155 randomized controlled trials (RCTs), 23 non-randomized controlled trials, 57 cohort studies, 52 case-control studies, 28 cross sectional studies and 42 case series/case reports. In healthy subjects, appetite and short term food intake, risk of cancer, risk of diabetes, risk of dental caries, weight gain and risk of obesity are the most investigated health outcomes. Overall there is no conclusive evidence for beneficial and harmful effects on those outcomes. Numerous health outcomes including headaches, depression, behavioral and cognitive effects, neurological effects, risk of preterm delivery, cardiovascular effects or risk of chronic kidney disease were investigated in fewer studies and further research is needed. In subjects with diabetes and hypertension, the evidence regarding health outcomes of NNS use is also inconsistent.

CONCLUSIONS

This scoping review identifies the needs for future research to address the numerous evidence gaps related to health effects of NNSs use.It also specifies the research questions and areas where a systematic review with meta-analyses is required for the proper evaluation of health outcomes associated to regular NNSs consumption.

Hispanic Youth Visits to Food and Beverage Company Websites

Purpose: To measure disparities in exposure to food/beverage websites by Hispanic youth.

Methods: Observational study using market research panel data compared frequency and time spent visiting food/beverage websites and the Internet overall for Hispanic and non-Hispanic children (6–11 years) and youth (6–17 years).

Results: Hispanic children and youth, particularly Spanish-speaking youth, were less likely to visit the Internet overall, but more likely to visit food/beverages websites, compared with their non-Hispanic peers.

Conclusions: Food and beverage company websites disproportionately appeal to Hispanic youth. Public health advocates and companies should take action to reduce Hispanic youth exposure to unhealthy food marketing online.

[Systematic review on the physical activity level and nutritional status of Brazilian children]

Objective To systematically review the literature on the prevalence and the factors associated with physical activity level and nutritional status of Brazilian children. Methods The electronic database MEDLINE (via PubMed), SciELO, SCOPUS and Web of Science were selected. The search strategy included the descriptors proposed in the Medical Subject Headings (MeSH): "Motor Activity", "Activities", "Nutritional Status", "Overweight", "Obesity", "Body Mass Index", "Child", "Brazil". Results The search allowed the identification of 141 articles, of which 16 studies were considered potentially relevant and were included in the review. Conclusions Studies about nutritional status and physical activity levels in Brazilian children are still scarce, but the work on this has increased in recent years, especially those that use cross designs, as well as questionnaires to measure physical activity; BMI for nutritional status is still widely used. Furthermore, studies that analyzed the amount of hours designated to sedentary behaviors such as watching TV, playing video-games and using the computer, found that these activities took more than two hours every day.

Knowledge, Attitude, Frequency and Level of Consumption Regarding Non-alcoholic Carbonated Soft Drinks among Students from Two High Schools in Hanoi, Vietnam in 2015

Objective

This article aims to describe the knowledge, attitude, frequency and level of consumption regarding non-alcoholic carbonated soft drinks (NCSD) among students from two high schools in Hanoi.

Materials and Methods

A cross-sectional survey including a semi-quantitative food frequency were conducted with 620 students from two high schools, one in the urban area and the other in the rural area of Hanoi city.

Results

Data on knowledge of health risk associated with the consumption of NCSD showed neagtive results (only 11.9% of the students were able to identify all the contents of NCSD correctly, and 2.7% knew all eight health risks due to consumption of NCSD). Besides, 31.4% of all students did not have the intention to quit NCSD despite being aware of health risks associated with the consumption of NCSD. Students who reported consuming NCSD within one month prior to the study constituted 83.1%, and those who consumed NCSD 1–2 times/week accounted for the highest proportion, being 21.3%. On average, each student consumed 2,094 ml NCSD within one month prior to the study. Suburban students and male students consumed more than urban and female ones, respectively (p < 0.01).

Recommendations

Students should be equipped with information about NCSD related health risks and encouraged to consume less NCSD.

A Cross-sectional Study of the Prevalence of Dental Caries among 12- to 15-year-old Overweight Schoolchildren

INTRODUCTION

Overweight and obesity are growing health-related problems worldwide, and it is currently the most prevalent nutritional disorder among children and adolescents. The objective of this study was to assess the association between overweight and dental caries among 12- to 15-year-old schoolchildren in Mangaluru district, Karnataka, India.

MATERIALS AND METHODS

Data were obtained from 2000 school-going children aged 12 to 15 years. The children were categorized as overweight and normal-weight group by assessing the body mass index (BMI). Body mass index was categorized using the classification system given by the International Obesity Task Force (IOTF) and obtained in units of kg/m². The dental caries was assessed by detection and was performed according to decayed, missing, and filled teeth (DMFT) index.

RESULTS

Of the 2000 children examined, the mean BMI recorded was 26.87 ± 2.26 for the overweight children and 20.82 ± 1.48 for the normal-weight children. Even though the DMFT (3.90 ± 2.95) in the overweight children was slightly higher than the control group (3.36 ± 2.73), it was not statistically significant.

CONCLUSION

Within the confines of the present study, it can be concluded that there is no significant association between overweight and dental caries among the schoolchildren of Mangaluru district in Karnataka. Longitudinal studies are necessary to substantiate the possible relationships between dental caries and overweight in children. Knowledge of these relationships could lead to preventive health measures designed to reduce the prevalence of both obesity and dental caries.

Effects of TV in the Bedroom on Young Hispanic Children

Purpose.

The main purposes of this study were to assess TV viewing among Hispanic young children and to examine effects of having a TV in the child's bedroom (TVIB).

Design and Setting.

A quasi-experimental design was used to evaluate an intervention program that is collecting longitudinal data in West Texas. However, the current report uses only the baseline data of the ongoing study.

Subjects.

Predominantly low-income and Hispanic parents/guardians (N = 315) and their children of 5 to 9 years (N = 597).

Measures.

Children's anthropometric measures were obtained. Their overweight status was determined based on age- and gender-adjusted body mass index. A demographic questionnaire, acculturation scale (brief version of Acculturation Rating Scale for Mexican Americans II), and family survey were used among parents.

Analysis.

Descriptive statistics, t-tests, X2 tests, and logistic regressions were used.

Results.

Most children (70%) have TVIB; more than 30% were or were at risk of overweight. Demographic characteristics did not significantly predict TVIB. Children with TVIB spent .93 hours more daily watching TV/DVD (t = 3.07; df = 283; p = .003), and children (at one site) ate more fast food (X2 = 5.46; df = 1; p = .019), compared with children without TVIB whose parents better supported physical activity (t = 2.11; df = 275; p = .039).

Conclusion.

Most children in this low-income and Hispanic sample have TVIB, which is associated with unhealthy behaviors. (Am J Health Promot 2011;25[5]:310-318.)

A 4 year prospective longitudinal study of progression of dental erosion associated to lifestyle in 13-14 year-old Swedish adolescents

OBJECTIVES

To evaluate the progression of dental erosion in 13-14 year-olds after 4 years, and its association with lifestyle and oral health.

METHODS

227 randomly selected 13-14 year-olds from a Public Dental Clinic, Örebro, Sweden, were investigated. A clinical examination was performed which included dental caries/gingival/plaque status, as well as grading of dental erosion at the tooth surface and participant levels in "marker teeth", including buccal/palatal surfaces of 6 maxillary anterior teeth (13-23), and occlusal surfaces of first molars. An interview and a questionnaire regarding drinking habits and other lifestyle factors were completed. All investigations were repeated at follow-up. The participants were divided into high and low progression erosion groups and logistic regression statistics were applied.

RESULTS

175 individuals participated at follow-up. Progression occurred in 35% of the 2566 tooth surfaces. 32% of the surfaces had deteriorated by one severity grade (n=51 individuals) and 3% by two grades (n=2 individuals). Boys showed more severe erosion than girls at the follow-up. Among the variables predicting greater progression, a lower severity of erosive wear at baseline had the highest OR (13.3), followed in descending order by a "retaining" drinking technique, more frequent intake of drinks between meals, low GBI and lesser sour milk intake, with reference to the baseline recording. Using these five variables, sensitivity and specificity were 87% and 67% respectively, for predicting progression of erosion.

CONCLUSIONS

Progression of erosive lesions in Swedish adolescents aged 13-14 years followed up to age 17-18 years was common and related to certain lifestyle factors.

CLINICAL SIGNIFICANCE

In permanent teeth, dental erosion may develop early in life and its progression is common. Dental health workers should be made aware of this fact and regular screenings for erosion and recording of associated lifestyle factors should be performed.

Structural equation modeling of the associations between the home environment and obesity-related cardiovascular fitness and insulin resistance among Hispanic children

Hispanic children are disproportionally affected by obesity-related risk of metabolic disease. We used the structural equation modeling to examine the associations between specific diet and physical activity (PA) behaviors at home and Hispanic children's metabolic health. A total of 187 Hispanic children and their parents from an urban community in Wisconsin participated in the study. Exposure variables included, children's daily intake of sugar-sweetened beverages (SSB) and PA; home availability of SSB and PA areas/equipment; and parents' intake of SSB and PA, assessed through self-administered questionnaires. Outcome variables for children's metabolic health included, measured anthropometrics; cardiovascular fitness assessed using the Progressive Aerobic Cardiovascular Endurance Run (PACER); and insulin resistance determined with the homeostasis model assessment of insulin resistance (HOMAIR). We found that children's daily intake of SSB was positively associated with BMI z-score, which in turn, was positively associated with HOMAIR (P < 0.05). Specific diet behaviors at home associated with children's intake of SSB, included home availability of SSB, which mediated the association between parents' and children's intake of SSB (P < 0.05). Children's PA was positively associated with PACER z-score, which in turn, was inversely associated with HOMAIR (P < 0.05). Specific PA behaviors at home associated with children's PA, included home availability of PA areas/equipment, which mediated the association between parents' and children's PA (P < 0.05). The structural equation model indices suggested a satisfactory model fit (Chi-square, X(2) = 53.1, comparative fix index = 0.92, root-mean-squared error associated = 0.04). The findings confirm the need for interventions at the family level that promotes healthier home environments by targeting poor diet and low levels of PA in all family members.

Familial and individual predictors of obesity and insulin resistance in urban Hispanic children

BACKGROUND

High intake of sugar-sweetened beverages (SSB) has been suggested to contribute to the pediatric obesity epidemic, however, how the home food environment influence children's intake of SSB among Hispanic families is still poorly understood.

OBJECTIVES

To evaluate the relationships between the home food environment and Hispanic children's diet in relation to weight status and insulin resistance (IR).

METHODS

A food frequency questionnaire was administered to 187 Hispanic children (ages 10 to 14 years) and anthropometrics were measured. IR was estimated from fasting insulin and glucose levels using the homeostasis model assessment of insulin resistance (HOMAIR ). Parents reported on family demographics and the home food environment. A structural equation modelling approach was applied to examine the hypothesized relationships among variables.

RESULTS

The prevalence of childhood overweight and obesity was 52.8% and it was positively associated with HOMAIR (β = 0.687, P < .0001). Children's SSB consumption was positively associated with children's body mass index z-score (β = 0.151, P < 0.05) and subsequently to HOMAIR . Children's SSB consumption was predicted by home availability (β = 0.191) and parental intake of SSB (β = 0.419) (P < 0.05). The model fit indices [χ(2)  = 45.821 (d.f. = 30, P > 0.01 and < 0.05), χ(2) /d.f. = 1.53, root mean square error of approximation = 0.053 (90% confidence interval = 0.016, 0.082), comparative fit index = 0.904] suggested a satisfactory goodness-of-fit.

CONCLUSIONS

The home food environment and parental diet seem to play an important role in the children's access to and intake of SSB, which in turn predicted children's weight status.

Predictors of Weight Loss in Young Adults

BACKGROUND

Increased understanding of weight loss among healthy young people in naturalistic settings could inform the development of effective weight control programs. The aim of this study was to describe loss in BMI over 7 years in a population-based sample of healthy young adolescents (mean age 17 years at beginning of follow-up) and identify determinants of BMI loss.

DESIGN AND METHOD

Data were available for 681 participants in the Nicotine Dependence in Teens Study (1999-2012), a longitudinal investigation of adolescents in Montreal (Canada). Loss in BMI was assessed between age 17 and 24 years. Potential predictors of BMI loss including age, sex, mother's education, worry about weight, physical activity, screen time, and cigarette smoking were studied in multivariable logistic regression.

RESULTS

Males and females gained 2.0 and 1.4 BMI units, respectively, on average, between age 17 and 24 years. However, 9% of males and 14% of females experienced a loss in BMI ≥1.0 unit. Female sex and a higher BMI at age 17 were associated with a higher probability of BMI loss, but none of age, mother's education, physical activity, screen time, or cigarette smoking were associated with BMI loss between ages 17 and 24.

CONCLUSIONS

Whereas BMI increased on average between age 17 and 24 years in a population-based sample of healthy young people, 12% of participants experienced a loss in BMI ≥1 unit. Weight loss was highest among the heaviest persons and did not affect the prevalence of underweight. No single behavior at age 17 stands out as associated with predicting BMI loss.

Is the relationship between sedentary behaviour and cardiometabolic health in adolescents independent of dietary intake? A systematic review

Screen time, but not overall sedentary behaviour, is consistently related to cardiometabolic health in adolescents. Because of the associations screen time has with dietary intake, diet may be an important factor in the screen time and health relationship; however, evidence has not previously been synthesized. Thus, the aim of this systematic review was to explore whether the associations between various sedentary behaviours and cardiometabolic risk markers are independent of dietary intake in adolescents. Online databases and personal libraries were searched for peer-reviewed original research articles published in English before March 2014. Included studies assessed associations between sedentary behaviour and cardiometabolic markers in 12- to 18-year-olds and adjusted for dietary intake. Twenty-five studies met the inclusion criteria. From the 21 studies examining sedentary behaviour and adiposity, the majority found significant positive associations between television viewing, screen time and self-reported overall sedentary behaviour with markers of adiposity, independent of dietary intake. No significant associations between screen time with blood pressure and cholesterol were reported. Sedentary behaviour appears to be associated with adiposity in adolescents, irrespective of dietary intake. However, the variability of dietary variables between studies suggests further work is needed to understand the role of dietary intake when examining these associations in youth.

Television viewing habits and their influence on physical activity and childhood overweight

OBJECTIVES

To assess the prevalence of television (TV) viewing habits and their association with childhood sedentary lifestyle and overweight in 8-year-old children, from a cohort in a city in Southern Brazil.

METHODS

A prospective cohort study with hospital screening of all births that occurred from September of 2002 to May of 2003. This study refers to a cross-sectional analysis of data collected during the cohort's follow-up conducted at 8 years of age. To evaluate the level of physical activity, a physical activity questionnaire for children and adolescents was used (PAQ-C), during the consultation at 8 years of age.

RESULTS

Of the 616 interviewed children, a prevalence of sedentary lifestyle>70% was found, as well as the habit of watching TV for more than two hours a day in 60% of the sample, regardless of gender (p=0.30), income (p=0.57), or family socioeconomic level (p=0.90). The daily time spent watching TV was inversely associated with physical activity (p<0.05) and positively associated with excess weight (p<0.01). Regarding physical activity, running was the most frequently practiced sports modality among the population.

CONCLUSIONS

Considering the high prevalence of sedentary lifestyle and children who watch TV for an excessive period of time, it is necessary to motivate such individuals to perform interactive activities, as well as promote a more active lifestyle, by decreasing the time children spend in front of the TV.

Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood

Clinical manifestations of cardiometabolic risk (CMR) may be set early in childhood due to unfavorable behaviors or lifestyle patterns related to diet and physical activity. Several factors may determine the adoption of such lifestyle-related behaviors, which researchers have tried to cluster under certain frameworks or models. In this context, the framework developed and proposed by this review gathers all the present knowledge regarding these determining factors to date and groups them into three main categories related to personal characteristics and the social and physical environment. Based on the proposed framework, a large variety of personal, social and physical environmental factors can positively or negatively influence CMR-related behaviors (either directly or indirectly via their interrelations), thus leading to decreased or increased risk, respectively. This framework could be of great value to public health policy makers and legislators for designing and implementing interventional programs tailored to the needs of susceptible population groups who are most in need for such initiatives. Targeting the correlates as potential determinants of CMR-related behaviors, and not just on the behaviors themselves, has been shown previously to be the most effective approach for tackling health issues related to CMR starting from early life stages.

Racial Differences in Obesity-Related Risk Factors Between 2-Year-Old Children Born of Overweight Mothers

OBJECTIVE

Investigate racial differences in a range of obesity-related socio-behavioral risk factors in children born of obese mothers.

METHODS

142 Black and 151 White 2-year-old children and their parents were surveyed on their physical activity environment, food environment, parental role modeling, eating behaviors, feeding practices, child physical activity, dietary intake, and eating behaviors; body mass index (BMI) for parents and children (BMI z-score) were calculated.

RESULTS

In bivariate analyses, Black families reported significantly more risk factors for early-childhood obesity than White families, including greater availability of soda, more television viewing, and poorer dietary intake. In multivariate analyses adjusting for maternal and socioeconomic factors, the differences between Black and White families on factors including television watching and dietary intake remained significant.

CONCLUSION

These data show a greater number of risk factors for obesity among Black children and their families compared with White children even after adjustment for maternal BMI and socioeconomic status.

Risk factors of overweight and obesity in childhood and adolescence in South Asian countries: a systematic review of the evidence

OBJECTIVE

To assess and synthesize the published evidence on risk factors of overweight and obesity in childhood and adolescence in South Asia.

STUDY DESIGN

A systematically conducted narrative review.

METHODS

A systematic review was conducted of all primary studies published between January 1990 and June 2013 from India, Pakistan, Nepal, Bangladesh, Sri Lanka, Bhutan, and Maldives located through the following data bases: PubMed, PubMed central, EMBASE, MEDLINE, BioMed central, Directory of Open Access Journals (DOAJ) and electronic libraries of the authors' institutions. Data extraction and quality appraisal of included studies was done independently by two authors and findings were synthesized in a narrative manner as meta-analysis was found to be inappropriate due to heterogeneity of the included studies.

RESULTS

Eleven primary studies were included in the final review, all of which were conducted in school settings in India, Pakistan and Bangladesh. Prevalence of overweight and obesity showed wide variations in the included studies. The key individual risk factors with statistically significant associations to overweight and obesity included: lack of physical activities reported in six studies; prolonged TV watching/playing computer games reported in four studies; frequent consumption of fast food/junk food reported in four studies; and frequent consumption of calorie dense food items reported in two studies. Family level risk factors included higher socioeconomic status reported in four studies and family history of obesity reported in three studies.

CONCLUSION

This review provides evidence of key contributors to the increasing burden of obesity and overweight among children and adolescents in South Asia, and demonstrates the nutritional transition that characterizes other developing countries and regions around the world. The findings have implications for policy, practice and the development of interventions at various levels to promote healthy eating and physical activity among children and adolescents in the region as well as more globally.

Do weight status and television viewing influence children's subsequent dietary changes? A National Longitudinal Study in the United States

Objective

It is unknown how children’s dietary changes would vary by overweight/obese status and length of TV-viewing. This study examined whether US children’s weight status and TV-viewing duration influenced their subsequent dietary behavioral changes.

Methods

A national representative sample of the Early Childhood Longitudinal Study – Kindergarten Cohort were followed between 5^th and 8^th grades during 2004–2007 (N=7,720). Children’s daily TV-viewing hour and weight status were measured at 5^th grade. Children reported their dietary behaviors at the 5^th and 8^th grades, including fruit/vegetable consumption ≥5 times/day (five-a-day), daily fast food and soft drink consumption. Logistic models were used to estimate the odds ratio (OR) of dietary behavioral changes by children’s baseline weight status and TV-viewing duration. Gender and race/ethnicity differences in the ORs were examined. Sampling weight and design effect were considered for the analysis.

Results

Among those without five-a-day at 5^th grade, overweight/obese children were more likely to develop the five-a-day behavior at 8^th grade than normal weight children (for overweight: OR=1.65, 95% CI=1.14-2.39; obese: OR=1.35, 95% CI=0.81-2.23). Among girls, overweight group was more likely to develop eating vegetable ≥3 times/day than normal weight group, but 1 more hour/day of TV-viewing at baseline was associated with lower odds of developing eating vegetable ≥3 times/day. Overweight/obese black and Hispanic children were significantly more likely to develop five-a-day than their normal weight counterparts. TV-viewing did not show modification effect on the association between weight status and subsequent dietary changes.

Conclusions

Overweight/obese children were more likely to improve their subsequent FV consumption than normal weight children, but TV-viewing’s independent relationship with dietary changes may counteract the weight status-associated dietary improvement.