Effects of COVID-19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitudinal Study

Gestational diabetes mellitus and adverse pregnancy outcomes increased on pandemic lockdown: a retrospective analysis

OBJECTIVES

Adverse social contexts, such as lockdowns and disasters during pregnancy, can significantly impact maternal and neonatal outcomes. However, the specific effects on different populations remain unclear. This study aimed to investigate the variations in pregnancy outcomes resulting from the pandemic lockdown and to identify distinct populations in need of targeted intervention.

METHODS

Women who delivered at our institution spanning from 2017 to 2019 (pre-pandemic) and from 2020 to 2022 (during the pandemic lockdown) were included in this study. A comparison was conducted on maternal and neonatal outcomes across a total of 19,382 singleton pregnancies, with a specific focus on those affected by gestational diabetes mellitus (GDM).

RESULTS

As a total of 19,382 singleton pregnant women were included, this study found a significant increase in the incidence rates of GDM with an odds ratio of 1.194 (95%CI: 1.109-1.286, p < .001). Additionally, following the pandemic lockdown, there was an increase in rates of premature birth, premature rupture of membranes, and intrahepatic cholestasis of pregnancy. Further analysis of the GDM cohort revealed a notable rise in the risk of Group B Streptococcus infection and neonatal small for gestational age (SGA). Specifically, GDM patients with a body mass index (BMI) less than 18.5 kg/m2 exhibited an increased risk of fetal growth restriction and SGA.

CONCLUSIONS

The pandemic lockdown adversely affected pregnancy outcomes. Therefore, targeted screening and clinical management for specific populations should be prioritized.

Leveraging Social Media Data to Understand the Impact of COVID-19 on Residents' Dietary Behaviors: Observational Study

BACKGROUND

The COVID-19 pandemic has inflicted global devastation, infecting over 750 million and causing 6 million deaths. In an effort to control the spread of the virus, governments around the world implemented a variety of measures, including stay-at-home orders, school closures, and mask mandates. These measures had a substantial impact on dietary behavior, with individuals discussing more home-cooked meals and snacking on social media.

OBJECTIVE

The study explores pandemic-induced dietary behavior changes using Twitter images and text, particularly in relation to obesity, to inform interventions and understand societal influences on eating habits. Additionally, the study investigates the impact of COVID-19 on emotions and eating patterns.

METHODS

In this study, we collected approximately 200,000 tweets related to food between May and July in 2019, 2020, and 2021. We used transfer learning and a pretrained ResNet-101 neural network to classify images into 4 health categories: definitely healthy, healthy, unhealthy, and definitely unhealthy. We then used the state obesity rates from the Behavioral Risk Factor Surveillance System (BRFSS) to assess the correlation between state obesity rates and dietary images on Twitter. The study further investigates the effects of COVID-19 on emotional changes and their relation to eating patterns via sentiment analysis. Furthermore, we illustrated how the popularity of meal terms and health categories changed over time, considering varying time zones by incorporating geolocation data.

RESULTS

A significant correlation was observed between state obesity rates and the percentages of definitely healthy (r=-0.360, P=.01) and definitely unhealthy (r=0.306, P=.03) food images in 2019. However, no trend was observed in 2020 and 2021, despite higher obesity rates. A significant (P<.001) increase in the percentage of healthy food consumption was observed during (39.99% in 2020) and after the shutdown (39.32% in 2021), as compared with the preshutdown period (37.69% in 2019). Sentiment analysis from 2019, 2020, and 2021 revealed a more positive sentiment associated with dietary posts from 2019. This was the case regardless of the healthiness of the food mentioned in the tweet. Last, we found a shift in consumption time and an increase in snack consumption during and after the pandemic. People ate breakfast later (ie, from 7 AM to 8 AM in 2019 to 8 AM to 9 AM in 2020 and 2021) and dinner earlier (ie, from 6 PM to 7 PM in 2019, to 5 PM to 6 PM in 2020). Snacking frequency also increased. Taken together, dietary behavior shifted toward healthier choices at the population level during and after the COVID-19 shutdown, with potential for long-term health consequences.

CONCLUSIONS

We were able to observe people's eating habits using social media data to investigate the effects of COVID-19 on dietary behaviors. Deep learning for image classification and text analysis was applied, revealing a decline in users' emotions and a change in dietary patterns and attitudes during and after the lockdown period. The findings of this study suggest the need for further investigations into the factors that influence dietary behaviors and the pandemic's implications of these changes for long-term health outcomes.

Oral Health and Dietary Habits Before and After COVID-19 Restrictions in a Portuguese Adult Population: An Observational Study

Background: The declaration of COVID-19 as a pandemic by the World Health Organization in 2020 led to the widespread suspension of clinical practices, including dentistry. This study aims to evaluate the impact of these restrictions on oral health and dietary habits. Methods: A retrospective cross-sectional study was conducted at Egas Moniz University Clinic (Lisbon Metropolitan Area), covering from June 2019 to June 2021. A total of 3380 participants were included and categorized into two cohorts: pre- and post-COVID-19 restrictions. Data were collected through a structured questionnaire assessing oral health behaviors and dietary habits. Results: Of 3469 incoming patients, 3380 met the inclusion criteria. Statistically significant post-lockdown changes were observed, including increased smoking prevalence, higher coffee with sugar consumption, reduced use of dental floss and mouthwash, and redistribution in tooth brushing frequency, with fewer individuals brushing 2-3 times daily. Conclusions: COVID-19-related restrictions had a heterogeneous impact on oral health and dietary behaviors. While some individuals reported improved hygiene routines, others showed negative changes, such as increased tobacco use or decreased use of oral hygiene products. These contrasting effects call for targeted public health strategies to reduce inequalities and support vulnerable groups during crises.

From Childhood Obesity to Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Hyperlipidemia Through Oxidative Stress During Childhood

BACKGROUND/OBJECTIVES

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is rapidly becoming the most prevalent form of chronic liver disease in both pediatric and adult populations. It encompasses a wide spectrum of liver abnormalities, ranging from simple fat accumulation to severe conditions such as inflammation, fibrosis, cirrhosis, and liver cancer. Major risk factors for MASLD include obesity, insulin resistance, type 2 diabetes, and hypertriglyceridemia.

METHODS

This narrative review employed a comprehensive search of recent literature to identify the latest studies on the relationship between MAFLD and obesity, the health consequences and the latest treatment options to prevent long-term damage to the liver and other organs. Additionally, the article presents perspectives on diagnostic biomarkers.

RESULTS

Childhood obesity is linked to a multitude of comorbid conditions and remains a primary risk factor for adult obesity. This abnormal fat accumulation is known to have long-term detrimental effects into adulthood. Scientific evidence unequivocally demonstrates the role of obesity-related conditions, such as insulin resistance, dyslipidemia, and hyperglycemia, in the development and progression of MASLD. Oxidative stress, stemming from mitochondrial dysfunction, is a leading factor in MASLD. This review discusses the interconnections between oxidative stress, obesity, dyslipidemia, and MASLD.

CONCLUSIONS

Atherogenic dyslipidemia, oxidative stress, inflammation, insulin resistance, endothelial dysfunction, and cytokines collectively contribute to the development of MASLD. Potential treatment targets for MASLD are focused on prevention and the use of drugs to address obesity and elevated blood lipid levels.

Childhood obesity: The threatening apprentice of the adiposity empire

Childhood obesity is a global health problem, with its prevalence having tripled since 1975. The increase in its prevalence has been predominantly in developing countries, but also in those with high economic status. Nowadays, there are multiple obesity definitions, however, one of the most accurate is the one which defines obesity as the accumulation of excessive body adiposity and not as an body weight excess. Nevertheless, the body mass index (BMI) is the most frequently used tool for its classification, according to the cut-off points established by the Center for Disease Control and World Health Organization tables. In children and adolescents an adiposity excess is related to the appearance of cardiovascular disease in adulthood and with many comorbidities such as metabolic syndrome, insulin resistance, type 2 diabetes, hypertension and metabolic dysfunction-associated steatotic liver disease, among others. Currently, there is still controversy about which is the ideal indicator for measuring overweight and obesity. BMI is still used as a standardized measure but may miss cases in which body composition is pathological despite a BMI within the normal-weight category. An adequate knowledge of the impact on health of dysfunctional adiposity as well as its accurate diagnosis will allow health professionals to address this condition in a more precise and comprehensive manner, and substantially improve the associated cardiometabolic risk and prognosis.

Handgrip Strength in Children and Adolescents Aged 3 to 16 Years and Residing in Spain: New Reference Values

Introduction: Handgrip strength, measured by dynamometry (HGD), is a key measure in assessing physical condition and nutritional status. Its correlation with anthropometric measures and body composition makes it an accessible method for the evaluation of cardiovascular health. This study aimed to develop a new reference for right-hand dynamometry in the Spanish population and compare it with previous references. Material and Methods: A total of 3281 subjects aged 3 to 16 years (1608 females) from the PESCA, PASOS, and ASOMAD projects were included. Handgrip strength was measured using the same methodology in all cases. Data on age, weight, height, and BMI were collected, and the handgrip strength per kilogram of body weight was calculated. Sexual dimorphism in the temporal development of strength was analyzed, and multiple correlations were established between dynamometry and anthropometric variables. Results: Percentile curves and tables for dynamometry are presented for each sex, including data from as early as 3 years old, for the first time. Conclusions: Sexual dimorphism in strength development is confirmed, becoming more pronounced with puberty. In absolute terms, our study shows a decrease in handgrip strength among adolescents, occurring earlier and more markedly in females. When compared to the previous literature, the 16-year-old male adolescents in our study exhibited lower strength than those from 40 and 16 years ago.

Psychological Impact of COVID-19 on Children and Adolescents: A Narrative Review of Mental Health Challenges, Interventions, and Long-Term Trajectories

The COVID-19 pandemic has significantly impacted the mental health and well-being of children and adolescents globally. This comprehensive narrative review synthesizes current research on the pandemic's psychological effects on young people, examining emotional distress, behavioral changes, sleep disturbances, educational disruptions, and the exacerbation of pre-existing mental health conditions. A systematic literature search was conducted using PubMed, MEDLINE, PsycINFO, CINAHL, and Web of Science, covering articles published from January 2020 to December 2024. Studies focusing on children and adolescents (aged 0-18 years) that examined mental health outcomes related to the COVID-19 pandemic were included. Data extraction was performed using a standardized form, and a narrative synthesis approach was employed to analyze and integrate the findings. Key findings reveal a substantial increase in anxiety, depression, and post-traumatic stress disorder among children and adolescents during the pandemic. School closures, social isolation, and disrupted routines have contributed to these mental health challenges. Sleep patterns have been notably affected, with delayed bedtimes, increased sleep disturbances, and a higher prevalence of insomnia and nightmares. The pandemic has widened educational disparities, particularly affecting children from disadvantaged backgrounds. Individuals with pre-existing mental health conditions have experienced exacerbated symptoms and faced challenges in accessing care. Various interventions, including cognitive behavioral therapy, social-emotional learning programs, and digital mental health support, have shown promise in mitigating the pandemic's psychological impact on young people. Children were more affected, as they faced a global crisis for the first time with limited coping skills. Disruptions in routine, social isolation, and family stressors heightened anxiety, depression, and behavioral issues, making them more affected. This review emphasizes the need for continued research, targeted interventions, and policy development to address the long-term mental health consequences of the COVID-19 pandemic on children and adolescents.

The impact of COVID-19 pandemic on sarcopenic obesity among children between 6 and 10 years of age: a prospective study

This study aims to examine the effects of physical activity, eating habits, sleep patterns, and media use on children's body composition during the COVID-19 pandemic, as well as the relationship of these factors with sarcopenic obesity (SO). This prospective cross-sectional study has involved 431 healthy male and female child participants aged between 6 and 10 years during the COVID-19 pandemic lockdown period. The daily routines of participants, including their dietary habits, levels of physical activity, and media usage patterns, have been assessed. The anthropometric measurements taken included body weight, height, body mass index (BMI), and skinfold thickness assessments. Body composition analyses have been conducted using the bioelectrical impedance (BIA) method to determine the total body fat and muscle mass as well as the fat percentage. It has identified obesity in 25.2% and SO in 9.5%. Children with SO have had mean BMI SDS of 2.67 ± 0.4 and mean waist circumference of 78.5 ± 9 cm. Fruit consumption OR = 2.68, 95% CI (1.13-6.31), the number of household members OR = 0.54, 95% CI (0.35-0.84), the duration of sitting time OR = 1.17, 95% CI (1.02-1.36)], and junk food consumption OR = 1.27, 95% CI (1.03-1.57)] have been found to be effective in the development of SO.

CONCLUSION

The COVID-19 pandemic has had a significant impact on the body composition of children, resulting in an increased prevalence of obesity and sarcopenic obesity. This research highlights the critical importance of engaging in regular physical activity, consuming a balanced diet, and obtaining sufficient sleep, particularly during times of crisis.

WHAT IS KNOWN

• Sarcopenic obesity is a complex metabolic condition characterized by reduced muscle mass and increased adipose tissue. • COVID-19 pandemic-related physical inactivity potentially has led to adverse effects on muscle mass composition.

WHAT IS NEW

• First comprehensive assessment of sarcopenic obesity development in children during the COVID-19 pandemic, utilizing advanced bioelectrical impedance analysis (BIA) to evaluate changes in muscle mass and adipose tissue. • Systematic evaluation of the impact of sedentary lifestyle and dietary habits on sarcopenic obesity during the unprecedented lockdown period.

The Impact of the COVID-19 Pandemic on the Development of Motor Skills of German 5- to 6-Year-Old Children

The closure of educational institutions, playgrounds, and sports facilities has had a significant impact on children's levels of physical activity during the COVID-19 pandemic. Currently, there are only a few studies available that address the consequences of these pandemic-related restrictions on the development of motor skills in younger children. The aim of the present study was to gain insights into the impact of the COVID-19 pandemic on the development of children's fine and gross motor skills by comparing cohorts of German preschoolers. For this purpose, data from annual (years 2015 to 2018 and 2020 to 2024) routine examinations of children's (n = 1426; mean age: 5.46 ± 0.29 years) motor development conducted in the child daycare centers of the SportService des Landessportbund Brandenburg e.V. [Federal Sports Association of Brandenburg, Germany] were subjected to a secondary analysis. While no effects on overall motor performance as measured by the MOT 4-6, a standardized motor skills test, were found for the groups of preschoolers, a more detailed analysis revealed that the cohorts of children differed with respect to certain motor domains, i.e., jumping performance and fine motor skills. The findings are relevant for designing targeted remedial measures for children affected by the pandemic-related restrictions.

An Evaluation of the Relationship between Body Mass Index (BMI), Dietary Habits, and the Prevalence of Dental Caries in Children Aged 4 to 12

AIM

To evaluate the relationship between body mass index (BMI) and dental caries in children aged 4-12 years.

MATERIALS AND METHODS

367 children referred to the pedodontics clinic were included in our study. In this two-stage study, firstly the decayed, missing, and filled teeth index (DMFT) or dental caries index (dft) scores of the children were recorded by oral examination, and their weight and height measured. Secondly, the children's parents or legal representatives were asked to complete a questionnaire assessing sociodemographic data and their children's nutritional habits. The data obtained were analysed statistically. In multiple comparisons of variables showing continuous variation with normal distribution, ANO-VA post-hoc analysis and Tukey's tests were used. For variables not showing normal distribution, Kruskal-Wallis post-hoc analysis and Mann-Whitney U tests were used.

RESULTS

Considering their BMI, 34.1% children were underweight, 30.8% were of normal weight, 14.4% were overweight, and 20.7% were obese. A significant relationship was found between the children's BMI and age groups (P = 0.000) and BMI increased as age decreased. Both BMI and dental caries incidence increased as the consumption of carbohydrates and sugar products increased. The mean DMFT score was higher for children with overweight BMI. The mean dft score was higher among children in the obese BMI category.

CONCLUSION

High BMI and dental caries are multifactorial disorders with similar risk factors, and the relationship between both is still not fully clear in the literature. Although cross-sectional studies provide the infrastructure for future studies by revealing the prevalence of the disorder, risk factors, and possible consequences, they are inadequate to examine the cause-effect relationship. More detailed and longer-term studies are needed to establish the causal relationship between BMI and dental caries.

Exercise-related self-perception, physical activity and intention to in-person and virtual activities among adolescent girls

This study aimed (1) to describe the experience of adolescents and adults using FitSpirit asynchronous virtual (V) exercise videos that target adolescent girls, (2) to compare physical activity (PA) levels and exercise-related self-perception variables among groups (2019 in-person [IP], 2021 IP, and 2021 V) of adolescent girls, and (3) to assess the association between the adolescents' PA levels and their exercise-related self-perception in response to IP (pre-pandemic and during pandemic) and V (during pandemic) FitSpirit exercise modes. Regarding the first aim, 28 adolescent girls ([15.5 ​± ​0.8] years old) and 29 adult women ([33.0 ​± ​10.3] years old) experienced the V exercise mode. For the second and third aims, 376 girls ([15.3 ​± ​1.7] years old) participated IP in 2019 (pre-pandemic), 339 girls ([14.9 ​± ​1.6] years old) participated IP in 2021 (during the pandemic), and 27 girls ([15.5 ​± ​0.8] years old) watched V FitSpirit exercise videos in 2021 (during the pandemic). Data was collected using online questionnaires. Chi-square (χ 2 ) and Pearson tests were performed. Adults (76%) had a significantly higher intention to use FitSpirit exercise videos again than adolescents (14%) (p ​< ​0.001). For IP exercise mode, we observed significant correlations between PA levels and being proud (r ​= ​0.08, p ​= ​0.046), feeling good (r ​= ​0.14, p ​< ​0.001), and being disappointed (r ​= ​-0.12, p ​< ​0.001). For the V exercise mode, there were no significant correlations. In conclusion, better exercise-related self-perception was only correlated to PA levels when IP training was offered. These first findings support IP training for adolescent girls when the pandemic situation allows it.

Perceived Changes in Physical Activity, Sedentary Behavior, and Stress During the Pandemic Predict Current Levels of These Same Variables

The COVID-19 pandemic and its associated restrictions placed on daily life may have negatively impacted overall physical and psychological health as well as health behaviors such as decreased physical activity and increased sedentary behavior. It is important to understand if these potential changes during the pandemic may be predictive of current health behaviors where pandemic-related restrictions are no longer being implemented. This study aimed to assess the relationships between perceived changes in physical activity, sitting, and stress during the COVID-19 pandemic to current measures of these same variables. In April 2022, participants (N = 208) completed a survey in which they indicated perceived changes in physical activity, sitting, and stress during the pandemic. Participants then self-reported their current total physical activity, daily sitting, and anxiety. Multiple Pearson correlation analyses were performed to assess the relationships between perceived measures of physical activity, sitting, and stress during the pandemic to current measures of these same variables. Greater perceived inactivity (i.e., reduced physical activity) during the pandemic was associated with lower current total physical activity (r = -0.28, p < 0.001) and greater daily sitting (r = 0.19, p = 0.007). Greater perceived sitting during the pandemic was associated with lower current total physical activity (r = -0.26, p < 0.001). Lastly, greater perceived stress during the pandemic was associated with greater current anxiety (r = 0.35, p < 0.001). This suggests that individuals who perceived negative health-related changes during the pandemic may still be impacted by persisting effects.

The Rising Burden of Childhood Obesity: Prevention Should Start in Primary School

Background: The increasing rates of childhood obesity (CO) are an ongoing problem. We focused on the adherence to the Mediterranean diet (MD), physical activity, and sleep habits of preschool children in order to investigate the relationship between lifestyle habits and health outcomes through parental perception. Methods: In the context of "EpPOI: Education to prevent CO", we investigated physical activity (PA) and sleep hygiene using an online survey for caregivers. Parents also completed the Mediterranean Diet Quality Index for children and adolescents (Kid-Med) questionnaire. Results: A total of 5.3% of the interviewees achieved a score indicating an adequate adherence to the MD. Additionally, 50.5% of children ate sweets every day, and 80% skipped breakfast. We also found that the parents' perceptions of their children's PA were a predictor of MD adherence, and PA was also positively correlated with fruit consumption [p < 0.034], vegetable consumption [p < 0.015], and fish consumption [p < 0.005]. Conclusions: Parents seem to be oriented towards a healthy lifestyle, but the children's level of adherence to the Mediterranean diet is poor. CO prevention requires a synergic effort that includes an adherence to healthy eating patterns such as the MD and a greater awareness of parents on the importance of adopting a healthy lifestyle at an early age.

Botulinum toxin-A in acute acquired comitant esotropia during COVID pandemic in children and young adolescents

PURPOSE

To study the effectiveness of botulinum toxin A (BTX-A) in the treatment of patients with acute acquired comitant esotropia (AACE) due to excessive use of mobile and laptops in the COVID era in the pediatric population and adolescents.

METHODS

This was a retrospective, interventional study of pediatric patients and young adults who presented with AACE and received unilateral or bilateral BTX-A. All the patients complained of binocular diplopia and sudden onset of esotropia with a history of mobile or laptop usage during the COVID era (2020-2023). Twenty-seven patients with acute-onset esotropia in 3 years (2020-2023) were included. All patients were administered 2.5-7.5 units of BTX-A (Botox, Allergan, India) into the unilateral or bilateral medial rectus muscle of the deviating eye under short general anesthesia or local anesthesia. The main outcome measures were pre- and post-injection angle of deviation, pre- and post-injection stereopsis, final level of stereopsis achieved, recurrence, and whether strabismus surgery was later required.

RESULTS

The mean age of patients was 12.85 ± 7.15 years (range: 4-25 years). The mean dosage of Botox was 6 U (2.5-7.5 U). The mean follow-up was 6 months (6 months-2 years). The mean preoperative angle of deviation (AOD) was 41.11 ± 10.9 prism diopters (PD) for distance and 41.67 ± 10.9 PD for near. The maximum effect of BTX-A was seen at 1 month; post-injection AOD was 13.65 ± 14.7 PD for distance and 14.87 ± 15.8 PD for near ( P < 0.001). Over half of the patients achieved optimal outcomes, with improvements in stereopsis and sensory fusion. Early intervention (within 3 months of symptom onset) significantly correlated with treatment success.

CONCLUSION

While BTX-A therapy for acute-onset esotropia demonstrates efficacy, patient-specific considerations are essential. This study highlights the evolving nature in the digital age and early administration of BTX-A along with close follow-up to monitor residual and recurrence of esotropia. The surgical intervention can increase the final success rate.

Nutritional guidance through digital media for glycemic control of women with gestational diabetes mellitus: a randomized clinical trial

OBJECTIVES

To compare the effectiveness of outpatient nutritional guidance supplemented by digital media with exclusively standard outpatient nutritional guidance in pregnant women with gestational diabetes mellitus (GDM).

METHODS

This was a randomized, patient-blinded clinical trial conducted at the Diabetes and Pregnancy outpatient clinic from February 2021 to January 2023. Pregnant women with GDM were randomly allocated into two groups: the control group received exclusively outpatient nutritional guidance, and the Intervention Group received outpatient nutritional guidance along with reminders via WhatsApp. Dietary intake (calories, carbohydrates, lipids, proteins, and fibers) was evaluated using 24 h dietary recalls. Glycemic control and the need for pharmacological treatment were also assessed.

RESULTS

A total of 81 women were included, 34 allocated to the control group, and 47 to the intervention group. Patients were followed for a period of 4-8 weeks. Significant differences were observed in some points of glycemic control between the two groups over the follow-up period. There were no statistical differences in pharmacological therapy (p=0.498); 188 24 h dietary recall were conducted in the control group and 290 in the intervention group. A statistically significant increase in lipid intake was observed in the intervention group over the follow-up period compared to the control group (p<0.001). No changes in calorie intake, other macronutrients, or fiber consumption were noted.

CONCLUSIONS

Glycemic control was significantly improved with the addition of frequent text reminders about dietary choices, and a significant increase in lipid intake was seen in all women, more so in the reminder group.

Trends of Overweight and Obesity Among Chinese Rural Children and Adolescents Aged 6 to 15 Years - the Central and Western Regions, China, 2012-2023

What is already known about this topic?

Childhood overweight and obesity pose significant risks to physical and mental health. The Nutrition Improvement Programme for Rural Compulsory Education Students (NIPRCES) has demonstrated effectiveness in reducing malnutrition.

What is added by this report?

From 2012 to 2023, obesity prevalence increased more rapidly (AAPC=10.6%) than overweight prevalence (AAPC=2.0%) among children aged 6-15 years in central and western rural China. A quicker increase in the trends of overweight and obesity was observed in rural western China (AAPC for overweight=3.0%, AAPC for obesity=11.8%), among males (AAPC for overweight=2.1%, AAPC for obesity=10.8%). Additionally, while the prevalence of overweight/obesity was lower in older age groups of children, these cohorts showed more rapid increases.

What are the implications for public health practice?

Continuous monitoring of prevalence and implementation of targeted interventions are essential to prevent and control the expansion of overweight and obesity.

Comparative Analysis of Dietary Behavior in Children and Parents During COVID-19 Lockdowns in Greece: Insights from a Non-Representative Sample

BACKGROUND/OBJECTIVES

Home isolation measures during the COVID-19 lockdown periods may have influenced individuals' lifestyles. The COVEAT study aimed to identify differences in children's and their parents' dietary behavior, children's body weight and parental body mass index (BMI) between two lockdown periods implemented in Greece.

METHODS

In total, 61 participants (children 2-18 years and their parents) completed questionnaires about their lifestyle, body weight and height, and family socio-demographic data, during both lockdown periods (LDs) implemented in Greece (LD1 in March-May 2020; LD2 in December 2020-January 2021).

RESULTS

No significant differences in parents' BMI and fluctuations in children's/adolescents' body weight and BMI were observed in LD2 compared to LD1. Regarding dietary behavior, in LD2 fewer parents were found to have dinner and prepared home meals and more families reported to order fast food. Furthermore, a significant decrease in the consumption of fresh and prepacked juices and an increase in fast-food consumption were observed for children/adolescents in LD2 compared to LD1.

CONCLUSIONS

The findings of the COVEAT study indicate that each lockdown period had a different impact on children's/adolescents' and their parents' dietary behavior, with less favorable changes observed in LD2, suggesting that the implementation of additional lockdowns may have had a negative impact on individuals' lifestyles.

Adiposity and body fat distribution based on skinfold thicknesses and body circumferences in Czech preschool children, secular changes

Background

The long-standing widespread prevalence of obesity includes issues of its evaluation. Nutritional status may be assessed using various tools and methods; among others simple anthropometric measurements are well established. Widely used body mass index (BMI), presents an obstacle of needing to calculate a standard deviation score (SD) for correct use in the child population. As BMI overlooks body composition, it is necessary to evaluate fat and muscle mass with different methods. Established skinfolds and circumferences are used in many variations and equations to accomplish that goal; however, the parameters used in these methods also undergo secular changes. Furthermore, secular changes have been documented in fat mass distribution. The aim of the study is to assess secular changes of skinfolds thickness and body circumferences and evaluate their validity for use in clinical practice and population research.

Methods and sample

Our database consisted of a recent (2016-2022) sample with 594 participants (298 males) and a reference sample (from 1990) with 2,910 participants (1,207 males). Both cohorts comprised Czech preschool children, aged 4.00 to 6.99 years. With standard methodology, anthropometric parameters were obtained for 13 skinfolds and eight circumferences, by trained staff. The equations of Slaughter, Durnin and Deurenberg were correspondingly calculated. Statistical evaluation was conducted in the R programming language, using Welch's test, Cohen's d and the Bland-Altman method.

Results

Our study found significant increases in skinfold thickness on the abdomen, chest I. and forearm, with high clinical relevance (p ≥ 0.01; d = range from 0.20 to 0.70). Contrastingly, apart from the abdominal area, a decrease of circumferences was observed. The body fat percentage estimation equations were tested for bias in the recent sample in the context of bioimpedance analysis with the Bland-Altman method. All equations are suitable for application in clinical use.

Discussion

Documented secular changes in fat mass distribution are only part of a contemporary accelerating trend of obesity prevalence. Our findings support the trend of a decline of circumferences and rise of skinfold thickness in corresponding areas, especially on the limbs, that is evidenced by the trend of latent obesity. The results of the study show the need to complement established diagnostic procedures in childhood obesitology with abdominal and midthigh circumferences and optionally even the maximal circumference of the forearm. These circumferences should always be measured alongside the skinfold thickness of the region. Only in this way can the overall adiposity of an individual with regard to secular changes, including the detection of latent obesity, be objectively evaluated.

The impact of COVID-19-induced distance learning on physical activity and dietary habits of female students in the Qassim Region

Background

The COVID-19 pandemic has profoundly affected the physical activity (PA) levels and dietary habits of individuals, particularly children and adolescents in Saudi Arabia, owing to widespread closures and social distancing measures, including school closures.

Methods

A cross-sectional study was conducted to assess the impact of distance learning (DL) on PA and dietary habits among public middle school girls during the pandemic. The Arab Teens Lifestyle Questionnaire (ATLS) was used to assess habitual PA, sedentary behavior, and dietary habits.

Results

A total of 300 middle school female students, with an average age of 14 years, participated in the study. The results indicated a generally low level of PA among students during DL and after school reopening, with a significant decrease in specific types of PA, such as walking and stair climbing during DL. However, after schools reopened, there was a significant increase in students' participation in activities such as swimming, dancing, and housework (P < 0.05). Moreover, sleep hours and TV-watching time increased compared to the DL period. Despite the prevalence of students frequently consuming soft drinks, sugary treats, fried and fast foods, as well as sweets and chocolates during the lockdown, middle school girls also consumed a lot of fruits and vegetables.

Conclusion

Assessing students' habitual PA and dietary habits during the lockdown may provide insights into their future health and well-being post-pandemic. This assessment can help in identifying strategies to redirect current PA levels to maintain health and prevent potential long-term health implications.

Effects of school closure on lifestyle behaviours and health outcomes in children during the COVID-19 pandemic in Chile: A time-matched analysis

BACKGROUND

The COVID-19 pandemic led to school closures, potentially impairing children's behaviours and health. We aimed to explore the effects of school closure on lifestyle behaviours (dietary habits, physical activity) and health outcomes (adiposity, fitness, self-esteem, self-concept) in children.

METHODS

We measured 247 children before school closure (October-November 2019) and after school reopening (October-November 2021) (COVID-19 group). To distinguish the changes due to school closure from changes due to growth, we included 655 age-matched children with cross-sectional measurements in October-November 2019 (control group). The response of this group (i.e., differences between children with 2 years of difference) was considered the expected response to growth. Two-way ANOVA was used to test age-by-group interactions, indicating an effect of school closure.

RESULTS

In 7-to-9-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.4 points), resulting in higher physical inactivity prevalence (by 19 percent points) at 9 years. This was accompanied by larger-than-expected increases in fat percentage (by 6.1 percent point). In 8-to-10-year-old children, the COVID-19 group had higher physical inactivity prevalence at 10 years (by 20 percent points). This was accompanied by larger-than-expected increases in fat percentage (by 8.3 percent points), z-score BMI (by 0.90 units), and waist circumference (by 6.1 cm). In 9-to-11-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.3 points) and increases in self-concept (by 0.2 points). The response in dietary habits, fitness, or self-esteem was not different between groups.

CONCLUSION

Overall, school closure negatively impacted physical activity and adiposity, particularly in the youngest children.

Prevalence of overweight and obesity in 6-15-year-old boys and girls before the COVID-19 pandemic: results from anthropological research 2001-2019 in the Czech Republic

OBJECTIVE

Childhood overweight and obesity has been a major global problem for a long time, with a steadily increasing prevalence of obesity and a growing number of cases of serious health complications associated with childhood obesity. The main objective of the study is to assess the prevalence of overweight and obesity in boys and girls before the COVID-19 pandemic in the Czech Republic.

METHODS

Body height, weight, BMI, and body composition (fat free mass, skeletal muscle mass, body fat, visceral fat area) were assessed in a cohort of 4,475 subjects (2,180 boys and 2,295 girls) aged 6-15 years. Somatic status was assessed by standardized anthropometry and body composition was determined by bioelectrical impedance. The subjects were classified according to BMI in percentile bands (up to 3rd percentile, P3-10, P25-75, P75-90, P90-97, above 97th percentile). Statistical analysis was performed using the software TIBCO Statistica 14.0.015.

RESULTS

During growth, statistical differences in the proportion of fat-free mass and fat fractions were found between boys and girls. In boys, there is an increase in muscle mass, in girls, there is an increase in the proportion of fat fraction. Sexual differentiation is pronounced during pubertal growth. By their BMI, 10.32% of the boys and 7.36% of the girls were categorized as overweight, and 8.12% of the boys and 7.71% of the girls were categorized as obese. Using bioelectrical impedance analysis and the percentage of fat fraction, 21.61% of the boys and 21.87% of the girls were categorized as obese; 5.96% of the boys and 8.19% of the girls were found to have visceral adipose tissue posing a health risk (more than 100 cm2). From 2002 to 2019, there was a significant increase of 3.72% in the overweight category for boys and 1.36% for girls, while the obesity category showed an increase of 3.62% for boys and 4.91% for girls.

CONCLUSION

The results confirm the increasing negative trend of overweight and obesity in the BMI and the relative body fat categories in children aged 6-15 years. Greater attention and monitoring of the effectiveness of preventive measures is needed to slow and stop the obesity epidemic which has health, social and economic impacts on the entire society.

How did previously obese children and adolescents behave during the SARS-CoV-2 pandemic in relation to weight gain?

OBJECTIVE

The objective of this study was to analyze the implications of social contingency measures and interruption of outpatient follow-up on weight gain in children and adolescents with a previous diagnosis of obesity.

METHODS

This is an observational study with data from electronic medical records of children and adolescents followed up at a specialized outpatient clinic from 2019 to 2023. Weight gain, height, BMI variation, BMI z-score, laboratory tests, and associated comorbidities were analyzed. The data were computed and analyzed using the Statistical Package for the Social Sciences (SPSS), and the results were considered statistically significant when p<0.05.

RESULTS

There was a weight gain of approximately 17.66% in the total set of participants, corresponding to a median increase of 14 kg. When analyzing between genders, we observed an approximate increase of 21.38% in body weight for men, while for women, it was 21.45%.

CONCLUSIONS

The COVID-19 pandemic has led to significant weight gain among previously obese children and adolescents in follow-up at a specialized outpatient clinic.

Prevalence of Overweight and Obesity and Association with Risk Factors in Secondary School Children in Croatia

BACKGROUND

Childhood and adolescent overweight and obesity represent significant global health concerns. The primary objective of this study was to assess the prevalence and associations of some potential risk factors with overweight and obesity among Croatian adolescents aged 15 to 18.

METHODS

This cross-sectional study included 344 secondary school students from Croatia's Mediterranean region, with data collected through an anonymous questionnaire. The questionnaire gathered sociodemographic information, adherence to the Mediterranean diet of both children and their parents, and the children's dietary habits and physical activity levels.

RESULTS

Weight status data revealed that 2.6% of participants were underweight, 82% had normal weight, 11% were overweight, and 4.4% were classified as obese. The results indicated that boys (p < 0.001), children who skip breakfast (p = 0.031), those with less active lifestyles compared to their peers (p = 0.001), children whose mothers have a higher BMI (p < 0.001), and children from smaller families (p = 0.034) are at greater risk of being overweight or obese.

CONCLUSIONS

This study provides valuable insights into the risk factors associated with overweight and obesity in this age group, which can support the development of targeted strategies for this population.

Children's and Adolescents' Use of Nature During the COVID-19 Pandemic in a Very Green Country

Play, physical activity, and social interaction with other children in nature are important for healthy and social development in childhood and adolescence. The extent to which lockdown policies during the COVID-19 pandemic impacted the way children engaged in outdoor activities remains unclear, especially in a country with free access to abundant nature during the pandemic. We performed a national survey of parents (n = 1002) in Norway in January 2021 to uncover changes in outdoor play for children (6-12 years, n = 396) and adolescents (13-19 years, n = 606) compared with the situation before the lockdown on 12 March 2020. Ten months after the start of the COVID-19 lockdown, 38% of the parents reported that their children played and spent time outside 'less than usual' in their neighborhood, compared with 15% who reported 'more than usual' time spent outside. Parents indicated that the children's play activities were highly organized and institutionalized, and when the activities ceased, their children had less motivation to spend time outdoors and tended to engage more in screen-based activities indoors. We conclude that while children and adolescents had many opportunities to be outdoors in natural settings during the COVID-19 pandemic restrictions, they did so much less than before the lockdown.

The Effects of Physical Activity and the Consequences of Physical Inactivity in Adult Patients with Congenital Heart Disease During the COVID-19 Pandemic

BACKGROUND

The ongoing COVID-19 pandemic has infected more than 500 million people worldwide. Several measures have been taken to reduce the spread of the virus and the saturation of intensive care units: among them, a lockdown (LD) was declared in Italy on 9 March 2020. As a result, gyms, public parks, sports fields, outdoor play areas, schools, and multiple commercial activities have been closed. The consequences of physical inactivity can be dramatic in adult patients with congenital heart disease (ACHD), in which the benefit of regular exercise is well known. In this study, we investigated the effects of reduced physical activity during the COVID-19 pandemic on ACHD's exercise capacity.

MATERIALS AND METHODS

Patients who performed exercise or cardiopulmonary exercise tests from October 2019 to February 2020 and one year after lockdown with the same protocol were retrospectively enrolled in our database.

INCLUSION CRITERIA

ACHD patients aged ≥ 18 years old under regular follow-up.

EXCLUSION CRITERIA

significant clinical and/or therapeutic changes between the two tests; significant illness occurred between the two tests, including COVID-19 infection; interruption of one of the tests for reasons other than muscle exhaustion.

RESULTS

Thirty-eight patients (55.6% males) met the inclusion criteria. Before the lockdown, 17 patients (group A) were engaged in regular physical activity (RPA), and 20 patients (group B) had a sedentary lifestyle. After LD, in group A, (a) the weekly amount of physical activity reduced with statistical significance from 115 ± 46 min/week to 91 ± 64 min/week (-21%, p = 0.03); (b) the BMI did not change; (c) the duration of exercise test and VO2 max at cardiopulmonary exercise test showed a significant reduction after the LD. In group B, BMI and exercise parameters did not show any difference.

CONCLUSIONS

The COVID-19 pandemic dramatically changed the habits of ACHD patients, significantly reducing their possibility to exercise. Our data analyzed in this extraordinary situation again demonstrated that physical inactivity in ACHD worsens functional capacity, as highlighted by VO2 max. Regular exercise should be encouraged in ACHD patients to preserve functional capacity.

Impact of the COVID-19 lockdown on the oral health behaviour of young children

AIM

Children up to the age of 10 are dependant primarily on their caregivers for oral care; COVID-19 lockdowns may have disrupted this care. We therefore assessed whether the COVID-19 lockdown affected routine parental oral care for their children.

METHODS

A short online survey regarding oral health behaviour and changes in the home setting during the COVID-19 lockdown was emailed to parents (n = 782, response 15%) participating in an existing study 'Healthy Teeth All Aboard (HTAA)'.

RESULTS

During the lockdown, 29% of parents reported that they skipped their children's toothbrushing more often than before the lockdown, and 49% of the children were allowed to consume sugary snacks or drinks more often. These behaviours were not significantly associated with socio-economic status, country of birth of the mother, work situation of the parents, school attendance patterns or HTAA participation status.

CONCLUSION

The COVID-19 lockdown affected the daily oral hygiene routines of children, potentially increasing caries risk.

CLINICAL RELEVANCE

Dental professionals should be aware of the potential impacts on oral health in children in the circumstance of a new lockdown. Parents should be made aware of the oral health consequences of a lockdown.

Comparison of central precocious puberty frequency before and during COVID-19: a systematic review and meta-analysis

OBJECTIVE

The current systematic review and meta-analysis assessed the prevalence of central precocious puberty (CPP) throughout the novel coronavirus disease 2019 (COVID-19) pandemic.

DESIGN

A systematic review and meta-analysis were carried out following the principles outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2020).

DATA SOURCES

PubMed, Embase, Web of Science, and WANFANG databases were searched from January 1, 2019, to March 30, 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

(1) children and adolescents ≤ 15 years; (2) studies with the outcome of frequency of central precocious puberty, measured prior to and throughout the COVID-19 pandemic; (3) a novel CPP diagnosis was created depending on all of the following criteria: girls with a chronological age < 8 years and boys with a chronological age < 9 years at the onset of symptoms, basal luteinizing hormone (LH) levels > 0.3 UI/L, and/or GnRH-stimulated peak LH levels > 5 IU/L.

DATA EXTRACTION AND SYNTHESIS

The process of extracting data and evaluating the likelihood of bias was carried out by two independent reviewers. The data were pooled employing the generic inverse-variance method and presented as mean differences (MDs) with 95% CIs. The evaluation of heterogeneity was conducted employing the Cochran Q statistic, and the degree of heterogeneity was measured employing the I2 statistic.

RESULTS

This meta-analysis included 17 studies. In contrast to the same period prior to the COVID-19 pandemic, the occurrence of CPP elevated (OR = 2.57; 95% CI, 1.85-3.56). Moreover, body mass index standard deviation score (BMI SDS) differences between CPP patients prior to COVID-19 and throughout the pandemic follow-up was 0.12 (95% CI - 0.01 to 0.25 P = 0.06).

CONCLUSION

Overall, CPP frequency significantly elevated throughout the COVID-19 pandemic. Given the restricted number of cohort investigations in this meta-analysis, additional research may be conducted on larger groups of children in order to establish a correlation between the observed rise in precocious puberty and specific pathogenic factors.

Comparative study on health behaviors among adolescents with chronic allergic disease before and during COVID-19 using data from the Korean Youth Health Panel Surveys

BACKGROUND

This study aimed to investigate the changes in the health behaviors and subjective health perception of adolescents with chronic allergic disease, including atopic dermatitis, asthma, and allergic rhinitis, amidst the coronavirus disease 2019 (COVID-19) pandemic in South Korea.

METHODS

This study used the 15th (2019) and 17th (2021) raw data obtained from the Korea Youth Risk Behavior Web-based Survey (KYRBWS), conducted by the Ministry of Health and Welfare of South Korea. Data were analyzed using multiple logistic regression with complex sampling using weighted values. Odds ratios with 95% confidence intervals for six health behaviors and subjective health perception were used as the major variables.

RESULTS

Six health behaviors (dietary habits, weight gain, smoking, alcohol consumption, sleep time, and physical activity) changed substantially during COVID-19. There was an increase in the duration of sedentary activities, a slight increase in BMI, and improvements in mental health. Concurrently, there was a decrease in alcohol consumption, sleep duration, and the consumption of sweetened beverages. Despite these improvements in big six health behaviors, adolescents with chronic illnesses continue to perceive themselves as unhealthy.

CONCLUSIONS

These findings suggest that the follow-up and monitoring of health behaviors and subjective health perception in adolescents with chronic allergic diseases during the COVID-19 pandemic are necessary. Understanding the mechanisms underlying sustained behavioral change can inform the development of interventions to promote healthy behavior after the pandemic has passed.

Central Precocious Puberty During the COVID-19 Pandemic Period: A Systematic Review of Literature

Central precocious puberty (CPP) is a condition where the hypothalamus-pituitary-gonadal axis is activated earlier than normal, leading to premature development of secondary sexual characteristics before eight years of age in girls and nine years of age in boys. The purpose of this study was to critically and systematically evaluate the literature regarding CPP rise during the COVID-19 pandemic. We searched PubMed and Google Scholar for relevant articles using the following MeSH terms: "COVID-19, "precocious puberty," "early puberty," "pediatric endocrinology," and "pandemic effects." We included studies calculating the risk of CPP before and during the COVID-19 pandemic. We excluded studies looking at patients with an identifiable cause for CPP or with peripheral precocious puberty. The primary outcome was the prevalence of central precocious puberty during the pandemic compared to the pre-pandemic period. We analyzed data regarding anthropometric, biochemical, and pelvic ultrasound data between the two groups. Overall, 16 studies with 2.175 subjects were included, of which 1.818 were diagnosed with CPP. There was a rise in the number of new diagnoses of CPP during the COVID-19 pandemic (985 subjects) compared with the pre-pandemic period (833 subjects). The mean age of diagnosis in the first group was 7.42 years versus 7.54 years in the second group. Notably, CPP during the pandemic was associated with a higher body mass index (BMI) compared with the group of the pre-pandemic period (17.50 versus 17.08). The pandemic and lockdowns led to changes in lifestyle habits, social isolation, sleep disturbance, excess screen time, and increased stress levels. We hypothesize that these alterations influenced the increase in CPP frequency.

A critical review of health and financial implications of obesity during the COVID-19 pandemic

The COVID-19 was reported in Wuhan, China, in December 2019. There is a link between increased mortality and obese individuals with the disease. The disease has been claimed to have disproportionately affected non-Hispanic blacks and Hispanics. The rise in food accessibility and the drop in the relative cost of junk food items are the two most significant changes in dietary patterns. Around the world, 2.8 million people die from being overweight or obese, and those with more body fat also have a higher risk of diabetes (44%) and heart disease (23%). Obesity weakens the immune system because adipose cells infiltrate the bone marrow, spleen, and thymus. Obesity was substantially more common among COVID-19 patients who were hospitalized than those who were not hospitalized. Over 900 000 adults in the United States are hospitalized due to a COVID-19 infection. Hospitalizations in 271 700 (30.2%) cases have been attributed to obesity. Obese patients may be experiencing reduced thoracic expansion following bariatric surgery. Less tracheal collapse and air-trapping at end-expiration chest computed tomography (CT) were observed post-surgery, and patients reported reduced dyspnea. COVID-19 is estimated to cost the European Union €13.9 billion in secondary care, with 76% of that cost attributed to treatment for overweight and obese individuals. The average price per hospitalized patient also increased with increasing BMI. Screening for obesity, preventive measures, and recommendations for healthy lifestyle changes should be of the utmost importance to decrease both the health and financial implications of COVID-19.

The effect of the COVID-19 pandemic lockdown on the distribution of fat tissue and skinfold thickness in adolescents from Kraków (Poland)

BACKGROUND

The COVID-19 pandemic has significantly changed the lifestyle and dietary habits of societies worldwide. The aim of the study was to assess changes in the distribution of fat tissue and skinfold thickness in adolescents (aged 11-15) from Kraków during the COVID-19 pandemic period.

METHODS

Two cross-sectional studies conducted in 2020 and 2022 (before and after the pandemic) involved 1662 adolescents from the Kraków population. Skinfold thickness measurements were taken. The trunk adiposity index, limbs-to-trunk fat ratio and limbs-to-total skinfold ratio were calculated. Statistical analysis employed a two-way ANOVA, Tukey's HSD test and the Kruskal-Wallis test, depending on the normality of the distribution.

RESULTS

Higher skinfold thicknesses were observed in the majority of age groups in both sexes from the 2022 cohort in comparison with the 2020 cohort. Additionally, higher values of the trunk adiposity index and the limbs-to-total skinfold ratio in most age groups were observed. However, an inverse trend was observed in the limbs-to-trunk fat radio.

CONCLUSIONS

The introduced restrictions such as lockdown, remote learning, reduced physical activity and changes in dietary habits could have influenced the distribution of fat tissue and skinfold thickness amongst adolescents from Kraków.

Obesity Influences T CD4 Lymphocytes Subsets Profiles in Children and Adolescent's Immune Response

BACKGROUND

Evidence shows that CD4+ T cells are altered in obesity and play a significant role in the systemic inflammation in adults with the disease.

OBJECTIVES

Because the profile of these cells is poorly understood in the pediatric population, this study aims to investigate the profile of CD4+ T lymphocytes and the plasma levels of cytokines in this population.

METHODS

Using flow cytometry, we compared the expression profile of lymphocyte markers, master transcription factors, cytokines, and molecules involved in the regulation of the immune response in CD4+ T cells from children and adolescents with obesity (OB group, n = 20) with those with eutrophy group (EU group, n = 16). Plasma levels of cytokines in both groups were determined by cytometric bead array (CBA).

RESULTS

The OB group presents a lower frequency of CD3+ T cells, as well as a decreased frequency of CD4+ T cells expressing CD28, IL-4, and FOXP3, but an increased frequency of CD4+IL-17A+ cells compared with the EU group. The frequency of CD28 is increased in Th2 and Treg cells in the OB group, whereas CTLA-4 is decreased in all subpopulations compared with the EU group. Furthermore, Th2, Th17, and Treg profiles can differentiate the EU and OB groups. IL-10 plasma levels are reduced in the OB group and negatively correlated with adiposity and inflammatory parameters.

CONCLUSIONS

CD4+ T cells have an altered pattern of expression in children and adolescents with obesity, contributing to the inflammatory state and clinical characteristics of these patients.

Eating attitudes, physical activity, and sleep quality levels of adolescents during the pandemic process

PURPOSE

The present study was conducted to determine the eating attitude, physical activity, and sleep quality levels of adolescents during the pandemic process.

METHOD

This descriptive study was completed by 987 adolescents. Data were collected by using the Adolescent Descriptive Characteristics Form, the Dutch Eating Behavior Questionnaire (DEBQ), the International Physical Activity Evaluation Questionnaire (IPAQ-Short Form), and the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

It was found that the mean age of the adolescents who participated in the study was 16.30 ± 1.30 and 23.1 % of them were male. During the pandemic process, adolescents consumed pastries, sugary foods and beverages, french fries, chips, etc. consumption was found to increase (41.7 %, 42.2 %, 45.2 %, respectively). It was also found that the mean DEBQ score of the adolescents was 75.13 ± 19.65 and the mean PSQI score was 10.99 ± 4.22. In the IPAQ, 29.9 % of the adolescents were found to be inactive, 44.7 % minimally active, and 25.4 % very active. It was determined that BMI, PSQI, gender, pastry, and sugary food consumption were important predictors of eating behavior. When the increase in consumption of pastries and sugary foods was added, it was seen that BMI, PSQI, and gender explained 7 % of the change in DEBQ and when the increase in pastry and sugary foods was added, it explained 11 % of the change in DEBQ. It was found that BMI, PSQI (p < 0.001), and gender (p = 0.001) had significant effects on students' eating behavior scores.

CONCLUSION

Adolescents' eating out, emotional eating, and restrictive eating scores were found to be high during the COVID-19 pandemic. Adolescents were also found to have inadequate physical activity levels and poor sleep quality. It is recommended that projects and intervention studies be performed to help adolescents with these matters.

COVID-19 lockdown and lifestyles: A narrative review

Background

The primary objective worldwide during the coronavirus disease 2019 (COVID-19) pandemic had been controlling disease transmission. However, lockdown measures used to mitigate transmission affected human behavior and altered lifestyles, with a likely impact on chronic non-communicable diseases. More than a year into the pandemic, substantial peer-reviewed literature emerged on altered lifestyles following the varying lockdown measures imposed globally to control the virus spread. We explored the impact of lockdown measures on six lifestyle factors, namely diet, physical activity, sleep, stress, social connectedness, and the use of tobacco, alcohol, or other harmful substances.

Methods

We comprehensively searched PubMed and the World Health Organization's global literature database on COVID-19 and retrieved 649 relevant articles for the narrative review. A critical interpretative synthesis of the articles was performed.

Results

Most of the articles included in the review identified the negative effect of lockdown measures on each of the lifestyle factors in many parts of the world. Encouraging lifestyle trends were also highlighted in a few articles. Such trends can positively influence the outcome of lifestyle-related chronic diseases, such as obesity and diabetes.

Conclusions

The lockdown associated with COVID-19 has largely had a negative impact on the lifestyles of individuals and communities across many countries and cultures. However, some individuals and communities also initiated positive lifestyle-related behavioral changes. If the knowledge generated by studying the impact of COVID-19-related lockdowns on the six lifestyle factors is further consolidated, it could improve chronic disease outcomes. This will help better understand lifestyle behaviors amidst crises and assist in redesigning extreme public health measures such as lockdowns.. It is up to governments, communities, and healthcare/academic entities to derive benefit from lessons learned from the pandemic, with the ultimate objective of better educating and promoting healthy lifestyles among communities.

Effects of COVID-19 lockdown on children´s sleep quality, physical activity, screen time, and diet

Introduction

Background: this study aimed to assess how the COVID-19 lockdown (March to June 2020) affected children's sleep quality, physical activity, screen time, and nutrition. Material and methods: the survey consisted of 479 children from the SENDO project, a pediatric cohort in Spain, aged 4-5 years. The BEAR questionnaire was used to evaluate sleep quality. Hierarchical models with two-level clustering were used to account for intra-cluster correlation between siblings, and the difference regression method was used to study the association between changes in screen consumption and physical activity and changes in sleep quality. Results: the results showed an increase in the consumption of homemade pastries and snacks. Sleep quality worsened significantly during confinement, with a mean score on the BEAR scale of 0.52 before, 1.43 during, and 1.07 after confinement. Although sleep quality improved significantly after the end of confinement, it remained worse than before. The average daily screen time increased from 1.13 hours before confinement to 2.65 hours during confinement. Physical activity decreased during confinement, with the mean number of hours per day decreasing from 1.27 to 0.79. Children who spent more time on screens during confinement had worse sleep quality, as indicated by their higher scores on the BEAR scale. We used the difference regression method to identify a statistically significant association between the increased screen time for leisure hours and the worsening of children's sleep quality during confinement. Conclusion: we observed a significant relationship between confinement and reduced sleep quality. Although the end of the lockdown led to a slight improvement, the average BEAR scale score remained higher post-confinement, suggesting that the consequences of the lockdown may persist over time.

Validity and Reliability of a Questionnaire Assessing Changes in Dietary Behaviors Among School Children Amid the COVID-19 Pandemic in Jordan

OBJECTIVE

This study aimed to develop and validate a questionnaire to assess changes in dietary behaviors among school children in Jordan during the COVID-19 pandemic.

METHODS

A cross-sectional study used a convenience sample of 253 school-aged children from public schools across Jordan. The dietary and lifestyle behavior inventory (DLBI) was developed, incorporating cultural and regional dietary preferences. The questionnaire's validity and reliability were assessed using the content validity index (CVI) and Cronbach's alpha for internal consistency. Exploratory factor analysis (EFA) was conducted to evaluate the underlying factor structure.

RESULTS

The DLBI demonstrated excellent content validity with a scale content validity index (S-CVI) of 0.997 and a high level of agreement among expert reviewers (total agreement = 116). Reliability analysis showed high internal consistency for dietary behavior scales, with Cronbach's alpha values exceeding 0.9 for fruit (0.869) and vegetable (0.916) consumption scales. Factor analysis revealed strong associations between dietary behavior variables, with factor loadings ranging from 0.688 to 0.889. The study identified significant reductions in physical activity levels among children, with an average Cronbach's alpha of 0.835 for physical activity-related items. The average time to complete the questionnaire was 15 minutes (SD = 5 minutes), with a completion rate of 45.6%.

CONCLUSIONS

The validated DLBI is a robust tool for assessing changes in dietary behaviors among school-aged children in Jordan during the COVID-19 pandemic. The findings highlight significant dietary patterns and physical activity shifts, emphasizing the need for targeted nutritional interventions.

Obesity: Post-Pandemic Weight Management

Societal changes secondary to the coronavirus disease 2019 pandemic led to increased prevalence of adolescents with obesity and heightened awareness of weight stigma and size bias. During this time the American Academy of Pediatrics published its first clinical practice guidelines, and the Food and Drug Administration approved new weight loss drugs for adolescents, but insurance coverage is largely unavailable.

Impact of COVID-19 pandemic on children overweight in Japan in 2020

OBJECTIVES

This study aimed to explore the association between the coronavirus disease (COVID-19) pandemic and overweight incidence among preadolescent elementary school children in Japan.

METHODS

A population-based longitudinal study was conducted in Adachi City, Tokyo, Japan, using data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study. The control group (2016-2018) comprised 434 children, and the COVID-19 exposure group (2018-2020) included 3500 children. Overweight was defined as a body mass index (BMI) z-score of 1 SD or more according to the World Health Organization standards. The study design involved comparing BMI z-scores before and after exposure to the pandemic, considering the associated lifestyle changes and potential consequences on physical activity, parental employment status and income.

RESULTS

By 6th grade, the prevalence of overweight increased from 17.7% to 19.2% in the control group and 22.5% to 29.5% in the COVID-19 exposure group. Difference-in-differences analysis revealed that children's exposure to COVID-19 significantly increased BMI z-scores (coefficient 0.22, 95% confidence interval (CI) 0.14-0.29) and a higher odds ratio of overweight (odds ratio 2.51, 95% CI 1.12-5.62), even after adjusting for time-varying covariates.

CONCLUSION

The COVID-19 pandemic has been associated with an increased prevalence of overweight among elementary school children in Japan.

Body weight in relation to hours of sleep, and physical activity in Latin American university students during the Covid-19 pandemic

Introduction: Short sleep, physical inactivity, and being locked up are risk factors for weight gain. Objective: We evaluated weight gain according to sex, age, hours of sleep and physical activity in university students from 10 Latin American countries during the COVID-19 pandemic. Methods: Cross-sectional and multicenter study (n = 4880). Results: The average age was 22.5 ± 4.4 years. 60.2% were currently locked up. 73.6% were women, 48.2% increased their body weight, 66% reported insufficient sleep hours, and 65.9% were inactive. Women gained more weight than men (73.2%) and younger students gained more weight (85.1%). Those who had insufficient sleep hours gained most weight (67.6%). Inactive participants gained most weight (74.7%). Students who have insufficient sleep are 21% more likely to have changes in body weight compared to students who have optimal sleep. Conclusion: The increase in body weight and its risk factors during confinement should be considered as emerging from public health.

Long-term effects of the COVID-19 lockdown on weight status, eating habits, and lifestyle changes related to school-aged children in Bandar Abbas, Iran

BACKGROUND

Despite the end of the COVID-19 lockdown and reopening of schools, the long-term effects of quarantine on the weight status, eating habits, and lifestyle of children and adolescents remain unknown. This study aimed to determine the long-term effects of the lockdown on the weight status, eating habits, and lifestyle changes of children and adolescents in Iran.

METHOD

This descriptive cross-sectional study was conducted from April to May 2022. The target population comprised one hundred students aged between 10 and 16 years old. Our study obtained students' weight and height data from records maintained by school principals or physical education instructors before and after the quarantine period. The BMI z-score (zBMI) was calculated for each time point. The researchers also provided a questionnaire to collect the students' demographic and lifestyle status changes during school closures.

RESULTS

We found that the zBMI increased significantly from - 0.02 ± 1.64 to 0.36 ± 1.12, and the number of individuals with overweight and obesity increased by 3% during quarantine (P ≤ 0.05). These changes were more pronounced in males and students aged 14-16 years old. We also found that eating habits, sleeping time, sleeping patterns, screen time (time spent on social media per day), and physical activity had significant negative changes during quarantine, and a significant increase in zBMI was observed among students who experienced negative eating behaviors, altered sleeping patterns, and decreased physical activity during school closures.

CONCLUSION

As prolonged school closures due to the COVID-19 lockdown aggravated students' health and lifestyle status, our findings can aid in proper planning to establish an appropriate framework for the diet, physical activity, and sleeping quality of students during extended school closures.

Nutritional status of schoolchildren before and after confinement by COVID-19 (2019-2021) in Jujuy, Argentina

An increase in the prevalence of obesity due to lockdown and confinement linked to COVID-19 is observed. Variations in the nutritional status of schoolchildren from Jujuy are analyzed in relation to confinement due to COVID-19 (2019-2021) and its relationship with socio-demographic variables and the school environment. This is an observational, descriptive study. Data from 56,695 schoolchildren aged 6-18 years old is analyzed based on two temporary cuts (2019 pre-confinement and 2021 post-confinement). The nutritional status of schoolchildren (underweight, overweight, and obese) was established using the IOTF (International Obesity Task Force) criterion. The prevalence of each nutritional phenotype was estimated by sex and age group, considering the following independent variables: setting (rural/urban), school management system (public/private), geographic altitude, and percentage of households with unmet basic needs (UBN) in the place where they attend school. Multiple proportions contrast was performed using Fisher's test, a transition matrix ws produced and a statistical model of proportional odds was fitted. It was observed that between 2019 and 2021, the prevalence of underweight decreased and the prevalence of overweight and obesity increased significantly. In 2021, 67% of schoolchildren maintained the same nutritional category that they had in 2019, 21% gained weight and 12% lost weight. The model explains about 52% of the total variability observed. The factors that are significantly correlated in the model are school cycle, age, geographic altitude, school setting, and % of households with UBN. The results indicate that during the COVID-19 pandemic, there was a shift to the right in the distribution of the nutritional status categories of the schoolchildren population in Jujuy, with a decrease in the prevalence of underweight and an increase in the prevalence of overweight and obesity with variations related to age, school location, geographic altitude, and socioeconomic characteristics of the households in the place where the children attended school.

Association between increased screen time, sedentary behavior, and insomnia among Indian adults: A cross-sectional nationwide online survey

Context

During the "coronavirus disease 2019 (COVID-19)" pandemic, screen time saw a notable increase, ranging from 2.5 to 7.5 hours per day. Scientific evidence has demonstrated a strong correlation between heightened digital media usage and heightened levels of stress, anxiety, and depression. Research indicates that engaging in screen time for four hours or more daily can elevate the likelihood of experiencing symptoms of depression among children and adolescents by 46-80%. Despite this, there remains a paucity of medical evidence elucidating the intricate interplay between screen time, physical inactivity, and insomnia in adults.

Aim

The aim of the study was to estimate the prevalence of increased screen time, insomnia, and physical inactivity among adults and their association during the COVID-19 pandemic.

Settings and Design

A cross-sectional study through an online Google Form questionnaire was conducted among the Indian population.

Methods and Materials

The study was conducted between June and August 2020 and comprised 658 participants aged 18 and above. Participants were recruited using a chain sampling procedure, with the majority being female, accounting for 54% (355 individuals).

Statistical Analysis

The mean and standard deviation were calculated for numerical variables, while percentages and proportions were determined for categorical variables. The Chi-square test was employed to examine associations between variables. For assessing the predictors of screen time, a multivariate logistic regression analysis was conducted.

Results

The majority of participants reported screen time exceeding 2 hours per day (85%), clinical insomnia symptoms (59%), moderate to high physical activity levels (92.8%), and low levels of sedentary behavior (60.5%). Variables such as gender, age, and screen time demonstrated significant associations with insomnia and physical activity. The odds ratio for insomnia in relation to screen time was 2.84 (95% confidence interval: 1.78-4.58) with a P value of 0.001. Multivariate logistic regression analysis indicated that increasing age was significantly associated with lower levels of screen time.

Conclusions

Screen time showed a significant association with insomnia. Less screen time was reported with increased age.

Change in BMI in Children Over the First 30 Months After the Start of the SARS-CoV-2 Pandemic

Our study aim was to assess body mass index (BMI) change in children in the immediate 6 months of the pandemic, to follow longitudinal BMI change up to 30 months after the pandemic start, and to identify sociodemographic factors associated with these changes. Our study included a retrospective chart review of 1298 children 2 to 18 years old with office visits at an Indianapolis primary care clinic. Body mass index and sociodemographic information were collected at visits during 3 time periods: Prepandemic (March 1, 2019-February 28, 2020), Early Pandemic (June 1, 2020-November 30, 2020), and Late Pandemic (December 1, 2020-September 30, 2022). Data analysis indicated statistically significant increases in BMI monthly rate of change from Prepandemic to Early Pandemic periods. Interestingly, BMI rate of change stabilized from Early Pandemic to Late Pandemic periods but remained positive, suggesting children had slower, but persistent, continued BMI increase after the pandemic initiation.

Bored, afraid, alone: What can we learn from children with paediatric obesity about the impact of the COVID-19 pandemic for future pandemics, care practices and policies?

PURPOSE

The aim of this study was to gain insight into the perspectives of children with paediatric obesity themselves, during the pandemic and afterwards, regarding their wellbeing and health, and to solicit their advice on tailoring obesity care to match their daily realities.

DESIGN AND METHODS

We used a 'draw, write and tell' interview technique, conducted walk-alongs, participant observations and a group session with children with paediatric obesity from seldom-heard communities in Amsterdam, the Netherlands. Data was analysed using reflexive thematic analysis.

RESULTS

Children reported that during lockdowns they were confined to the house, causing them to feel bored and alone. This triggered them to fall into previous unhealthy patterns, such as an increase in sitting on the couch or lying in bed, gaming or watching TV, feeling hungry a lot and eating more. Some children experienced major events, such as mourning the death of a loved one or taking care of other family members, and thus felt they had to grow up fast.

CONCLUSION

Our study adds to our understanding of the mechanisms of the impact of the COVID-19 pandemic from the perspectives of children with paediatric obesity from seldom-heard communities and emphasizes the importance of considering how the pandemic (and related measures) affected the daily - as well as future - lives of children in vulnerable circumstances.

PRACTICAL IMPLICATIONS

The recommendations children gave could be explored as pathways for more child-centred, successful and tailored obesity care practices and policies in order to support their (mental) wellbeing and health.

Nutrition and public health in Georgia: reviewing the current status and inspiring improvements: a joint event of the Georgian Nutrition Society, The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, October 2023

Georgia lies to the northeast of Türkiye, having a western border on the Black Sea. With a population of some 3·73 million, Georgia has a tradition of gastronomic excellence dating back millennia. However, changing lifestyles and external influences have, as elsewhere, led to problems of suboptimal nutrition, and lifestyle-related diseases and disorders prevail. There is considerable scope for improving the focus on public health (PH) and nutrition in Georgia. With this in mind, the Georgian Nutrition Society teamed up with The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, a PH charity based in Istanbul, Türkiye, to host a conference and workshops in Tbilisi, Georgia. The primary purpose was to review the current status of PH and nutrition in Georgia with reference to the situation elsewhere, to share examples of best practice and to identify opportunities for improvement. A particular highlight was the presentation of a programme of nutrition education for family physicians recently implemented in Türkiye. This summary of the proceedings is intended as a blueprint for action in Georgia and also to inspire others to consider how PH might be improved via a focus on balanced nutrition.

Impact of the COVID-19 pandemic lockdown on Body Mass Index: a three-year follow up study in 6,156 Chinese college students

Background

The novel coronavirus disease 2019 as the most pervasive and consequential pandemic in recent years, has exerted significant impacts on human health, including aspects related to body weight. Objectives: This study aims to assess the influence of the lockdown measures implemented during the COVID-19 pandemic on Chinese college students' Body Mass Index (BMI) through a three-year cohort study.

Methods

We recruited 6156 college students (n = 4,248, 69% male, and n = 1,908, 31% female, with an average age of 18.68 ± 0.86 yr.) from a University in China to participate in this three-year cohort study. All of the subjects took the same physical fitness tests from 2019 to 2021 (pre-lockdown, during lockdown and post-lockdown). Participants' height and weight data were objectively measured by Tongfang Health Fitness Testing Products 5000 series. A paired t-test was performed in the analysis.

Results

During the lockdown, there is 4.2% increase of BMI among the college student (p<0.001). Moreover, males had a greater overall mean BMI rate increase of 4.74% (p<0.001) than females (2.86%, p<0.001). After the lockdown, there is 0.94% increase of BMI among the college student (p<0.001). However, females had a greater overall mean BMI rate increase of 1.49% (p<0.001) than males (0.72%, p<0.001). During this period, the obese and overweight group's growth rate from 2019 to 2020 was smaller than the normal and underweight group, which were 2.94% (p<0.001), 3.90% (p<0.001), 4.44% (p<0.001) and 5.25% (p<0.001), respectively.

Conclusion

BMI increased both during and post-lockdown periods among Chinese college students. However, during the lockdown, participants with higher BMI groups appeared to have a diminished BMI growth rate compared to those with lower BMI. After the lockdown, participants with higher BMI levels appeared to have an augmented BMI growth rate. Public policy action is needed to increase the level of physical activity of Chinese college students and take action to improve students' physical fitness performance after the lockdown.

Changes to Secondary School Physical Activity Programs and Policy after Emerging from COVID-19 Lockdowns

The purpose of this study was to explore the adaptations that schools made to physical activity programs and facilities, and disparities by area urbanicity and income, during the first school year after the emergence of the COVID-19 pandemic. In a convenience sample of 132 secondary schools in Canada, school contacts responded to an annual survey in the 2020-2021 school year on changes to physical activity programs and facilities, and related staff training. Content analysis categorized open-ended text responses, and schools were compared based on area urbanicity and median income. Most schools canceled all interschool sports (88.9%) and intramurals (65.9%). New programs were added by 12.6% of schools, and about half (49%) of schools reported some continuing programs, most of which were sports programs, followed by facility and equipment access. Physical activity facilities were closed in 18.1% of schools, while 15.7% had new facilities added, and 11% temporarily converted facilities into learning spaces. Large/medium urban schools were at greater odds of having made any change to their facilities compared to schools in rural/small urban areas (odds ratio (95% confidence interval): 2.3 (1.1, 4.8)). The results demonstrate the considerable scale and nature of the restrictions in school provisions of physical activity opportunities during this period, as well as the resourcefulness of some schools in adding new programs and facilities.

Unveiling the lockdown effects: exploring behavior, dietary habits and weight changes in rural Egypt during COVID-19 lockdown: a cross-sectional retrospective study

BACKGROUND

The COVID-19 lockdown significantly impacted dietary habits and body weights globally, particularly in Egypt, where 57.03% of the population resides in rural areas, despite lack of information. The study examines the impact of COVID-19 lockdown on the weight changes of the rural Egyptian population through behavioral, physical, and dietary changes.

METHODS

A cross-sectional online survey using Microsoft Forms was distributed in Delta regions in Egypt. The questionnaire used a modified version of the validated 14- items PREDIMED MedDiet Adherence Screener (MEDAS). The first part of the questionnaire addressed sociodemographic variables whereas the second one included questions related to dietary, behavioral and weight changes of participants. These changes were statistically tested for significance in relation to BMI, gender, home living, current job and family history of obesity.

RESULTS

A total of 306 participated in the study (70% females, 13% obese, 95% living with family, 56% university students, and 36% with family history of obesity). Obese showed a significant increase in sweet intake whereas underweight and normal weight people displayed a significant decrease in eating desire. Both females and males showed significant increase in consumption of fruits and vegetables with significant decrease in soft drink. However, women showed a significant decrease in sport activity relative to men. Participants living with family showed an increase in sweet intake while those living alone explored an increase in meal frequency. Employers revealed a significant decrease in sport activities and people with family history of obesity reported more sleeping times than those without family history of obesity.

CONCLUSION

During Covid-19 quarantine, Egyptians' eating habits improved, but daily routines were disrupted. Raising awareness about obesity and providing guidance on maintaining activity, energy, and mood is crucial for future quarantine situations.

Assessment of Adolescents' Overweight and Obesity Risk Factors Among Alabnaa Schools in Tabuk City, Saudi Arabia

BACKGROUND

The prevalence of overweight and obesity among adolescents in Saudi Arabia has been progressively increasing. Obesity is associated with an increased risk of various morbidities and mortality. Identifying the factors that contribute to obesity in this age group is crucial for implementing targeted prevention measures.

AIM

The aim of this study was to identify risk factors for overweight and obesity among adolescents aged nine to 17 years residing in Tabuk City, Saudi Arabia.

METHODS

A case-control study was conducted during the 2021-2022 academic year at Alabnaa Schools in Tabuk City, Saudi Arabia. The study included overweight/obese individuals (cases, n = 125) and normal-weight individuals (controls, n = 201) who were selected based on their body mass index and classified according to the World Health Organization's reference for defining overweight and obesity in individuals aged five to 19 years. Data were collected from both groups using a self-administered questionnaire.

RESULTS

The study analyzed 125 overweight/obese students and 201 normal-weight students who were matched for sex and age (p > 0.05). Logistic regression analysis identified several risk factors for overweight or obesity among adolescents. A family history of obesity was found to be associated with a 5.735 times increased likelihood of obesity (95% CI: 3.318-9.912, p < 0.001). Another significant contributing risk factor for obesity was frequent consumption of four or more meals per day (adjusted odds ratio: 3.091, 95% CI: 1.094-8.736, p = 0.033). Students who used electronic devices for more than five hours were 2.422 times more likely to exhibit obesity (p = 0.006).

CONCLUSIONS

Certain factors may increase the risk of overweight or obesity in adolescents aged nine to 17 years. These factors include frequent eating, prolonged use of electronic devices, family history of obesity, and the misconception that obesity is not an illness. Tailored school health programs are needed to improve students' healthy lifestyles and eating behaviors, minimize sedentary entertainment and use of electronic devices, and engage children in physical activity.

COVID-19 lockdowns weigh heavily on youth: an analysis of the impact on BMI for Age Z scores in children and adolescents

BACKGROUND

The COVID-19 pandemic has significantly impacted the lifestyle and health of children and adolescents. This study aimed to assess the lifestyle changes brought about by COVID-19-related school closures and their impact on the Body Mass Index for Age Z (BAZ) scores of governmental school students in Qatar.

METHODS

An analytical cross-sectional study was conducted between June and August 2022 targeting students aged 8-15 years. Data on lifestyle behaviors were gathered through telephone interviews with parents of selected students. The BAZ scores before and after school closures that were automatically calculated by the electronic health records system were extracted.

RESULTS

We completed 1546 interviews. We found a significant increase in unhealthy food categories, a reduction in physical activity and an increase in the screen time over the period of schools' closure. The BAZ increased significantly by 0.30 (95% CI 0.26-0.35). The increase in BAZ scores was significantly higher among male students and the younger age group compared to females and older counterparts, respectively. The student's age group, sex, nationality and change in physical activity were significant predictors of the change in BAZ scores.

CONCLUSIONS

School closures during the COVID-19 pandemic negatively impacted the lifestyle of students in Qatar and resulted in a significant increase in the BAZ scores.