The association between obesity and secular trend of stature: a nationwide study of 2.8 million adolescents over five decades

Prevalence and predictors of short stature in children aged 3-18 years in Hainan Province, China: a cross-sectional study

Background

Short stature is a global health-related problem and remains to be evaluated in children in Hainan Province. The present study was conducted to investigate the associated factors with short-stature in children.

Methods

This cross-sectional study was conducted using a staged, cluster random sampling method. A total of 26,189 children aged 3-18 years, originating from 18 cities and counties in Hainan Province, to determine the prevalence of short stature. Additionally, these children were selected for a thorough analysis of associated factors.

Results

The crude prevalence of short stature was 2.88%, and the standard prevalence was (after adding weights) 3.01%. Children's short stature was significantly related to seven factors: area, birth weight, body mass index z score (BAZ), maternal education, family income (RMB per year), frequency of bean intake and frequency of egg intake. A nomogram model of factors associated with short stature was constructed. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.698 (95% CI: 0.679-0.716).

Conclusions

Our findings demonstrated that birth weight, BAZ, dietary habits, and family-related factors were strongly correlated with short stature in children in Hainan Province.

Secular trends and urban-rural disparities in height of Chinese adolescents aged 18 years from 1985 to 2019

OBJECTIVES

To examine the secular trends and urban-rural disparities in height of Chinese adolescents aged 18 years from 1985 to 2019.

METHODS

Data were extracted from the Chinese National Surveys on Students' Constitution and Health from 1985 to 2019, and the heights of a total of 76 554 boys and 75 908 girls aged 18 years were measured. The Mann-Kendall trend test was used to analyze the secular trends in height. Changes in different periods and urban-rural disparities were tested by z-tests and calculating the ratios of the coefficient of variation (CV) of height.

RESULTS

The height of Chinese boys and girls aged 18 years increased from 168.21 and 157.10 cm in 1985 to 172.15 cm and 160.11 cm in 2019, respectively, with a larger increase in rural areas. The secular trends in height were the largest for boys from 1995 to 2005 and for girls from 2014 to 2019, and the same results were observed in urban and rural areas. The urban-rural disparities for boys and girls decreased by 1.79 and 0.91 cm, respectively, with significant decreases for boys in all regions and for girls in the eastern region. The overall CVs of height increased by 0.13% and 0.25% for boys and girls, respectively, with the largest increase among rural girls.

CONCLUSIONS

The height of Chinese adolescents aged 18 years continued to increase between 1985 and 2019. The urban-rural disparities narrowed, and inequalities within rural areas for girls increased.

SARS-CoV-2 Omicron Variant: Clinical Presentation and Occupational Implications in Young and Healthy IDF Soldiers

INTRODUCTION

To this date, there is little known about the symptoms, their duration, and occupational implications of Coronavirus disease (COVID-19) in the military population. Decisions regarding implementing precaution measures are based on data deriving from the general population. Moreover, the Omicron variant seems to cause a disease with lesser severity than previous variants. We aimed to describe the clinical presentation and estimate the loss of workdays due to mild COVID-19 during an Omicron predominant wave among a young, healthy, and mostly vaccinated military population.

MATERIALS AND METHODS

A cross-sectional, survey-based study among IDF soldiers who replied to an online questionnaire following recovery from COVID-19. Data included self-reported vaccination status, symptoms presentation and duration, and service-related sick days. Student's t-test and chi-square test of independence were used to compare differences in continuous and categorical variables, respectively. A binary logistic regression analysis was performed to estimate the odds ratio and 95% CIs for prolonged symptom duration (4 days and above) by participants' characteristics. The IDF medical corps institutional review board approved this study.

RESULTS

A total of 199 soldiers, with a mean age of 21.9 years, were included in the study. Upper respiratory tract symptoms, headache, and constitutional symptoms were found to be the most common among symptomatic soldiers. The median reported time for inability to continue the daily routine, including work, was 5 days [Interquartile range (IQR), 0-10]. Median duration of symptoms was 4 days (IQR, 0-10). In addition, women were found to have longer symptomatic disease (odds ratio = 2.34; 95% CI, 1.20-4.52).

CONCLUSIONS

Our findings demonstrate that even among a young and fully vaccinated population, COVID-19 caused by the Omicron variant may result in substantial medical leave from military service, compared to common cold or influenza virus infection. Our study sample was relatively small; however, the response rate was high and our results shed light on the yet-to-be fully characterized Omicron variant-related COVID-19. Despite the current common perception of COVID-19 as a self-limiting mild disease with low burden of symptoms, our findings show the potential occupational burden of infection with COVID-19 on military units and their readiness and could be considered when discussing public health restrictions and further steps taken to minimize outbreaks ramifications.

Rapid Rollout and Initial Uptake of a Booster COVID-19 Vaccine Among Israel Defense Forces Soldiers

The surge of breakthrough COVID-19 among fully vaccinated individuals has raised the prospects of booster dose administration. In Israel, concerns of waning immunity and dominance of the B.1.617.2 (delta) variant resulted in approval of a third-dose (booster) vaccination for the entire eligible population starting on August 29, 2021. This study aims to evaluate vaccine uptake for booster doses among a population of previously vaccinated individuals during a rapid rollout and to analyze socio-demographic characteristics associated with vaccine uptake. A cross-sectional study among Israel Defense Forces soldiers with high access to booster doses of BNT162b2. Subjects eligible for booster doses were voluntarily vaccinated at three vaccine sites constructed within soldiers' bases. We analyzed associations between subjects' socio-demographic characteristics and booster vaccine uptake at the culmination of vaccine rollout using logistic regression models. 1157 soldiers from an IDF brigade were eligible for third dose vaccination (received second dose > 5-months before rollout), with 978 (84.5%) receiving a third, booster dose during the study's timeframe. Subjects' median age was 20.5 (IQR 19.7-21.5) and 791 (68.4%) were male. Notable socio-demographic characteristics associated with increased vaccine uptake in a multivariable model included increased age (OR 1.16, 95% CI 1.02-1.31), high socio-economic status (OR 2.12, 95% CI 1.25-3.59) and female sex (OR 1.87, 95% CI 1.26-2.74). Below-average cognitive function score was associated with decreased vaccine uptake (OR 0.61, 95% CI 0.39-0.95). This study demonstrates that real-world vaccine hesitancy remains a major obstacle, even among a population previously acceptant to COVID-19 vaccines. Decreased uptake for vaccines may be associated with socio-demographic variables in-spite of high-access vaccine rollouts. Reasons for vaccine hesitancy among previously vaccinated individuals, along with the benefits of population-wide booster administration should be further investigated.

Glucose Intolerance in Pregnancy and Offspring Obesity in Late Adolescence

OBJECTIVE

Gestational hyperglycemia is associated with deleterious neonatal outcomes, but long-term risks for offspring obesity are less clear. We estimated the odds for offspring adolescent overweight and obesity among mothers with gestational glucose intolerance.

RESEARCH DESIGN AND METHODS

In a mother-offspring historical cohort, the Israel military conscription data set was linked to a large health maintenance organization. Included were women who were evaluated at adolescence and underwent two-step gestational diabetes screening (mean age, 31 years) with a 50-g glucose challenge test (GCT), followed by a 100-g oral glucose tolerance test (OGTT) if the result was abnormal. Glucose tolerance categories included gestational normoglycemia, abnormal GCT with normal OGTT, impaired glucose tolerance (IGT; one abnormal OGTT value), and gestational diabetes. The primary outcome was offspring overweight/obesity (BMI ≥85th percentile) at adolescence, measured prior to military conscription. Logistic regression models were applied.

RESULTS

Of 33,482 mother-offspring pairs, overweight and obesity were observed in 6,516 offspring. Across increasing categories of pregnancy glycemia, the proportions of offspring with adolescent overweight/obesity increased: normoglycemia, 19%; abnormal GCT with normal OGTT, 22%; gestational IGT, 24%; and gestational diabetes, 25% (P < 0.0001). Corresponding odds ratios after adjustment for the mother's late adolescent characteristics (sociodemographic confounders and BMI) and pregnancy age were 1.2 (95% CI 1.1-1.4), 1.3 (1.2-1.5), and 1.4 (1.3-1.6), respectively. Further adjustment for offspring birth weight percentile and sociodemographic variables did not materially change results. Associations were more pronounced with increasing obesity severity.

CONCLUSIONS

Gestational glucose intolerance, including categories not meeting the gestational diabetes threshold, was associated with increased odds for offspring overweight/obesity at late adolescence.

Short-Term Changes in Mental, Physical, and Social Factors After Metabolic Bariatric Surgery in Adolescents: A Nationwide Prospective Cohort Study

Background

Metabolic bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. However, changes in mental, physical, and social factors, as well as their association with the extent of excess weight loss (%EWL) after MBS, remain controversial.

Methods

We followed 97 adolescents (64% females, aged 17 ± 0.9 years, BMI 46.1 ± 5.9 kg/m2) before and 9 months following MBS in a multi-center, prospective cohort study. Changes in mental, physical, and social factors were assessed by self-reported questionnaires, and associations with %EWL were evaluated after adjustment for potential confounders.

Results

The body mass index (BMI) decreased by 30%, and all physical parameters significantly improved (p ≤ 0.001). Energy level increased by 24%, mood level by 14%, and mental health by 9.5% (p ≤ 0.002). Social parameters were also improved, with a significant decrease in social rejection (p = 0.02), and an increase in participation in after-school social activities (p = 0.008). Mental health improvement was associated with baseline social rejection (r = 0.514, p < 0.001). The improvement in all factors was not related to the extent of %EWL.

Conclusion

Metabolic bariatric surgery MBS in adolescents led to a meaningful decrease in BMI and to an improvement in short-term physical, mental, and social factors that were not related to %EWL. Patients experiencing social rejection may improve their mental health following BS.

Linear growth and puberty in childhood obesity: what is new?

Pediatric obesity is a growing and alarming global health problem and represents an important determinant of morbidity. Since nutrition plays an important role in regulating growth and development, the excess weight gain related to overnutrition can affect growth patterns, bone maturation and pubertal development. The purpose of this review is to summarize the current knowledge about the effect of primary obesity on linear growth and pubertal development in children and adolescents. Evidences about regulatory hormones and adipokines that may be involved in the physiology of childhood growth in the context of obesity were also discussed. The most recent literature confirms previous studies indicating that linear growth is accelerated (mainly due to longer trunks rather than longer legs) and bone age is advanced in prepubertal children with obesity, while there is a reduction of pubertal height gain and attainment of normal adult height. Conflicting results are reported on the timing of puberty, specifically in boys. Indeed, previous studies suggested earlier onset of puberty in obese girls and overweight boys, and a delayed puberty in obese boys. Conversely, the most recent studies show more consistently an earlier onset and completion of pubertal development also in boys with obesity. Considering the false belief of health associated with transient taller stature in children and the adverse outcomes related to early puberty, interventions on diet and physical activity are urgently needed to tackle the epidemics of childhood obesity in public health and clinical setting.

Identification and characterization of factors associated with short stature and pre-shortness in Chinese preschool-aged children

OBJECTIVES

We aimed to identify and characterize potential factors, both individually and jointly as a nomogram, associated with short stature and pre-shortness in Chinese preschool-aged children.

METHODS

Total of 9501 children aged 3-6 years were recruited from 30 kindergartens in Beijing and Tangshan from September to December 2020 using a stratified random sampling method. Effect-size estimates are expressed as odds ratio (OR) and 95% CI.

RESULTS

The prevalence of short stature and pre-shortness in preschool-aged children was 3.9% (n = 375) and 13.1% (n = 1616), respectively. Factors simultaneously associated with the significant risk for short stature, pre-shortness and both included BMI, paternal height, maternal height, birth weight, birth height, latter birth order (≥2) and less parental patience to children. Besides, breastfeeding duration (≥12 months) was exclusively associated with pre-shortness (OR, 95% CI, P: 1.16, 1.01 to 1.33, 0.037), and childhood obesity with both short stature (3.45, 2.62 to 4.54, <0.001) and short stature/pre-shortness (1.37, 1.15 to 1.64, <0.001). Modeling of significant factors in nomograms had descent prediction accuracies, with the C-index being 77.0, 70.1 and 71.2% for short stature, pre-shortness and both, respectively (all P < 0.001).

CONCLUSIONS

Our findings indicate the joint contribution of inherited characteristics, nutrition status from the uterus to childhood, and family psychological environment to short stature and pre-shortness in Chinese preschool-aged children. Further validation in other independent groups is warranted.

Identification of contributing predictors for short stature and pre-shortness among 7310 Chinese preschool-aged children

PURPOSES

We aimed to identify the contributing predictors for short stature and pre-shortness in Chinese preschool-aged children, and further to construct nomogram prediction models.

METHODS

A large cross-sectional, kindergarten-based study was conducted during September-November, 2019 in Beijing. Utilizing a stratified random sampling method, total 20 kindergartens with 7310 children with complete data were eligible for analysis.

RESULTS

The prevalence of short stature and pre-shortness was 3.0% (n = 222) and 11.6% (n = 848), respectively. Six contributing predictors were significantly associated with short stature, including parental height (odds ratio, 95% confidence interval, P: 0.773, 0.69-0.86, <0.001), maternal height (0.723, 0.64-0.82, <0.001), birthweight (0.826, 0.74-0.92, 0.001), birth height (0.831, 0.69-1.00, 0.046), children body mass index (1.204, 1.43-1.82, <0.001), and maternal age at menarche (1.614, 1.43-1.82, <0.001). Seven significant contributing predictors were found for pre-shortness, including parental height (0.805, 0.76-0.85, <0.001), maternal height (0.821, 0.77-0.87, <0.001), birthweight (0.881, 0.83-0.93, <0.001), birth height (0.86, 0.78-0.95, 0.003), gestational weight gain (0.851, 0.77-0.94, 0.002), children body mass index (1.142, 1.05-1.24, 0.002), and chronic disease (4.016, 1.66-9.70, 0.002). The nomogram models for short stature and pre-shortness had descent prediction accuracies.

CONCLUSIONS

Our findings indicate that short stature is predominantly determined by inherited and natal factors, and pre-shortness is additionally by modifiable factors.

Obesity and sleep disorders: A nationwide study of 1.3 million Israeli adolescents

OBJECTIVES

To assess the association between sleep disorders prevalence and obesity in Israeli adolescents.

METHODS

A nationwide, population-based, cross-sectional study of 1,348,817 Israeli adolescents (57% males) who were medically examined prior to military service between 1997 and 2015; height and weight were measured along with assessment of medical status at age 17.3⬰±⬰0.4 years. The diagnosis of a sleep disorder was made based on objective diagnostic criteria. The prevalence and odds ratio (OR) for a sleep disorder were computed across BMI subgroups and were adjusted for socio-demographic confounders.

RESULTS

Overall sleep disorders prevalence was 1.8:1000 (males) and 0.45:1000 (females), with a total of 1601 cases. There was a gradual increase in the odds ratio for sleep disorders with increasing BMI. Multivariable-adjusted ORs for sleep disorders were 1.29 (95% CI 1.10⬜1.52), 1.44 (1.18⬜1.75), 3.03 (2.32⬜3.96) and 3.38 (1.98⬜5.75) for overweight, obese class I, II and III, respectively (5th⬜49th BMI percentile was the reference). Results persisted in extensive sensitivity analyses including limiting the study sample to participants with unimpaired health.

CONCLUSIONS

We found a higher prevalence of sleep disorders in males and a dose-dependent association between sleep disorders and adolescent BMI in both sexes. Our findings warrant clinical awareness among healthcare providers, given the rise in obesity in teenagers, and particularly in light of the obesity epidemic that we are experiencing in this era. Sleep related complaints should be actively screened in adolescents who suffer obesity.