Screen time and childhood overweight/obesity: A systematic review and meta-analysis

A recent update on childhood obesity: aetiology, treatment and complications

Obesity is a complex, chronic condition characterised by excess adiposity. Rates of obesity in childhood and adolescence are increasing worldwide, with a corresponding increase in adulthood. The aetiology of obesity is multifactorial and results from a combination of endocrine, genetic, environmental and societal factors. Population level approaches to reduce the prevalence of childhood obesity worldwide are urgently needed. There are wide-ranging complications from excess weight affecting every system in the body, which lead to significant morbidity and reduced life expectancy. Treatment of obesity and its complications requires a multi-faceted, biopsychosocial approach incorporating dietary, exercise and psychological treatments. Pharmacological treatments for treating childhood obesity have recently become available, and there is further development of new anti-obesity medications in the pipeline. In addition, bariatric surgery is being increasingly recognised as a treatment option for obesity in adolescence providing the potential to reverse complications related to excess weight. In this review, we present an update on the prevalence, aetiology, complications and treatment of childhood obesity.

Understanding the association of longitudinal body mass index patterns in children and their parents: A data-driven study from the TARGet Kids! cohort

BACKGROUND

Obesity remains a persistent global health issue across generations. Targeting family-level factors may help improve child and adolescent body mass index (BMI) outcomes. While associations between parental and offspring BMI are well-documented, the temporal patterns and risk factors driving these relationships remain unclear. This study aimed to identify longitudinal family-level BMI patterns incorporating child, maternal, and paternal BMI and apply interpretable machine learning (ML) methods to uncover key predictors.

METHODS

This longitudinal study included 6092 children and their parents from the TARGet Kids! cohort, with BMI measurements collected from birth to 150 months. Group-based multi-trajectory modeling identified joint trajectories of child BMI-for-age Z-scores (zBMI) and parental BMI. Five ML classifiers predicted group membership using 78 predictors spanning sociodemographic, dietary, parental health, and child lifestyle variables. To explore the modifying effect of parental overweight/obesity (OW/OB) on the relationship between child age and BMI, Bayesian generalized additive mixed models (GAMMs) with smoothed term interactions were applied.

RESULTS

Five distinct joint trajectory groups were identified. Children in the highest BMI trajectory group typically had both parents following similar high BMI trajectories. Parental OW/OB status emerged as the strongest predictor of child OW/OB (37 % classification probability), followed by breastfeeding duration (17 %) and child physical activity (15 %). The influence of parental OW/OB was particularly pronounced in early childhood (0-60 months). Bayesian GAMMs confirmed the robust, longitudinal association between child and parental BMI trajectories.

CONCLUSIONS

Parental BMI patterns strongly influence child BMI development, with age-dependent effects. These findings highlight the importance of early family-based interventions.

Independent and Combined Associations of Physical Activity and Screen Time With Biomarkers of Inflammation in Children and Adolescents With Overweight/Obesity

PURPOSE

Inflammation regulation is important for obesity management and prevention of obesity-related diseases. This cross-sectional study aimed to analyze the independent and combined associations of physical activity and screen time with biomarkers of inflammation in children and adolescents with overweight/obesity.

METHOD

A total of 1289 children and adolescents with overweight/obesity were included from the 2015 to 2018 National Health and Nutrition Examination Survey. Multivariable linear regressions were conducted for the association analyses.

RESULTS

For the independent associations, a negative dose-dependent relationship was demonstrated between physical activity and inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) in adolescents with overweight/obesity (P < .001) but not children; screen time was not associated with hsCRP in both children and adolescents. No significant association was found between physical activity or screen time with other inflammatory biomarkers. For the combined associations, there was an interaction between physical activity and screen time on hsCRP in adolescents with overweight/obesity (P = .014). In addition, the negative association between physical activity and hsCRP was greater in boys compared with girls and in Hispanic and non-Hispanic Black individuals compared with non-Hispanic White individuals.

CONCLUSION

This study demonstrated a combined association of physical activity and screen time with inflammatory biomarker hsCRP in adolescents with overweight/obesity.

Development and psychometric validation of a clinical instrument for infant feeding and lifestyle evaluation

OBJECTIVE

There is an absence of a comprehensive clinical instrument to assess and track the development of non-ideal feeding practices and lifestyle behaviours in early childhood. Our primary aim was to develop and validate an assessment instrument, called Feeding, Lifestyle, Activity Goals (FLAGs), designed to serve as a feeding, lifestyle and activity behaviour checklist for children aged 0-2 years.

METHODS

This study took place between January and May 2023. Experts evaluated content validity using the criteria of relevance, clarity, simplicity and ambiguity, to calculate the item content validity index (I-CVI) and scale CVI (S-CVI) (acceptable cutoff ≥ 0.80). Face validity was assessed by caregivers. Repeated assessments were also performed to determine test-retest reliability based on intra-class correlation (ICC) (acceptable cutoff > 0.75). Construct validity was established through principal component analysis (PCA), and internal consistency was measured using Cronbach's α coefficient (acceptable cutoff ≥ 0.70).

RESULTS

FLAGs consists of 19 items, with a I-CVI of 1.00 in 12 out of 19 items, and S-CVI average of >0.90 for relevance, simplicity and clarity. Among 198 caregivers, 99.0% responded 'agree' and 'strongly agree' in the criteria of clarity and ambiguity; 99.5% in criterion of relevance, and 100% in criterion of simplicity. PCA showed a two-component structure (55.9% variance). Overall Cronbach's α was 0.71. Participants repeated FLAGs assessment on an average of 9 days apart, with ICC of 0.861 (p < 0.001) for the total FLAGs scores.

CONCLUSIONS

We have developed an instrument which assesses an infant's feeding and lifestyle behaviour from 0 to 2 years, and this has been assessed to have acceptable validity and reliability.

Salivary Physicochemical Parameters in Relation to Dental Caries and Adiposity Status

OBJECTIVES

The objective of this study was to investigate the correlations between salivary physicochemical parameters, adiposity, and caries indices in Hong Kong adolescents.

METHODS

A total of 921 adolescents aged 12-15 years from four randomly selected local secondary schools were invited to participate in this cross-sectional study. Dental examinations including the number of decayed, missing, and filled teeth (DMFT), salivary physicochemical parameters, and anthropometric measurements were performed. The Mann-Whitney U test was used to examine the differences in salivary parameters and adiposity indices between participants with different levels of caries experience. Correlations between adiposity indices, salivary parameters, and caries indices were examined using Spearman's correlation coefficients.

RESULTS

The participation rate was 83.6%. After exclusion, data from 695 adolescents were analysed. Adolescents with high caries experience (DMFT ≥ Significant Caries Index [SiC Index]) had significantly higher weight-to-height ratio (W/H) and waist circumference (WC) z-scores and lower unstimulated and stimulated salivary flow rates and buffering capacity than those with DMFT < SiC Index. Except for body mass index z-score, the other adiposity indices were negatively correlated with at least one salivary physicochemical parameter (stimulated salivary flow rate or salivary buffering capacity) (rs ranged from -0.078 to -0.132). After adjusting for age and sex, decreased stimulated salivary flow rate was associated with higher body fat percentages, WC, and waist-to-height ratio z-scores, whereas low salivary buffering capacity was associated with higher W/H and WC z-scores.

CONCLUSION

There is a potential link between adiposity indices and certain salivary physicochemical parameters that are implicated in the aetiology of dental caries.

Global prevalence of myopia in children using digital devices: a systematic review and meta-analysis

BACKGROUND

The global prevalence of myopia among children has considerably increased over the past few decades, affecting the children's eye health and quality of life. According to the inconsistent reports of myopia among children, the purpose of this systematic review and meta-analysis study was to determine the global prevalence of myopia in children using digital devices.

METHODS

Various databases (PubMed, ScienceDirect, Embase, Web of Science, Scopus, and Google Scholar) were searched systematically (No time limit until September 2023, last updated in May 2024) using keywords of "Myopia Prevalence", "Children", "TV", "Computer", "Video games", and "Smartphone". PRISMA guideline was also used for paper collection based on the Inclusion/Exclusion criteria. The quality of articles was determined based on the STROBE checklist. Data analysis, heterogeneity assessment, publication bias, and all factors influencing heterogeneity were executed using the CMA software (v.2).

RESULTS

Initially, 828 articles were identified through database assessment. 563 and 133 papers were evaluated using primary and secondary assessments, respectively. Ultimately, 17 eligible articles were selected for meta-analysis following paper exclusion. In this era, the global prevalence of myopia among children using computer and video games was reported 28.8% (95%CI:21.1-38), using TV (TV watching) was 35.4% (95%CI:20.6-53.7), and smartphone usage was 31.4% (95%CI:13.5-57.3).

CONCLUSION

Myopia is now recognized as a critical global issue with a daily increasing rate. Technology, along with various digital devices, causes several issues in this era. It is suggested that the application of all digital screens and smart devices can potentially increase the risk of myopia among children. Thus, the reduction of these smart device applications in children can alleviate the potential risk of myopia. The results of this study can be a guide for health policymakers and a useful advertisement for society and families in paying attention to this problem in children, as well as increasing health interventions such as early screening and timely diagnosis for treatment. In this regard, it can be effective in both prevention and increasing the quality of life of children.

How Screen Time Affects Greek Schoolchildren's Eating Habits and Functional Food Consumption?-A Cross-Sectional Study

BACKGROUND

Television (TV), video games, PC and devices such as tablets and smart phones have become part of everyday life at an ever-younger age. Increased screen time correlates with unhealthy eating habits among children.

METHODS

374 children aged 9-12 years and their parents (n = 159), from 3 schools in Lemnos and 5 schools in Thessaloniki, Greece, took part in this cross-sectional study. The children completed the KIDMED score and a questionnaire about their physical activity, time spent watching TV, PC and playing electronic games, the frequency of cooking or shopping with their parents, the frequency of eating fast food, soft drinks and Functional Foods (FFs). Statistical analysis was performed with SPSS-29.0, using One Way ANOVA and Pearson chi-square.

RESULTS

As the hours of TV viewing increased, so did the percentage of children who consumed soft drinks (p = 0.03). A statistically significant association detected between television (p = 0.024), video games (p = 0.028), all screen categories (p = 0.011) and fast-food consumption. Increased screen time is associated with a higher weekly consumption of fast food (p = 0.011). The more hours children spent in front of screens, the less adherence they had to the Mediterranean Diet (p = 0.001) and less natural FFs consumption (p = 0.001).

CONCLUSIONS

The results suggest that screen time seems to affect children's eating behaviors. The study concluded that the longer the screen time, the unhealthier the dietary habits of schoolchildren become. Future research should focus on reducing screen time, as a means of improving dietary patterns and potentially reducing childhood obesity.

The association between screen time trajectories and the comorbidity of depression and anxiety

Depression and anxiety are often comorbid among adolescents. Adolescent screen time changes over time. This study investigates the association between screen time trajectories and the comorbidity of depression and anxiety from a longitudinal perspective. The data were collected from an ongoing prospective puberty cohort which was established in 2014 from Chongqing, China. 838 participants (52.03 % female; wave 1 mean age = 8.62, SD = 1.15) were followed up from 2014 to 2020. Questions about screen time were administered every six months. Trajectories of screen time were identified using latent class growth analysis. Children's Depression Inventory (CDI) and Screen for Child Anxiety Related Disorders (SCARED) were used to measure depression and anxiety. Latent profile analysis was used to identify the subtypes of comorbidity of depression and anxiety. Logistic regression was used to explore the association between screen time trajectory and the comorbidity of depression and anxiety. Three distinct trajectories of screen time were identified: Group Low (68.26 %) had consistently low screen time, Group High (26.37 %) had high screen time and Group Increasing (5.37 %) was characterized by an increasing screen time. Four subtypes of the comorbidity of depression and anxiety were fitted ("High comorbidity", "Low comorbidity", "Low depression symptoms" and "No symptoms"). Group Increasing and Group High were associated with "Low comorbidity" and "Low depression symptoms". Group Increasing was more likely to be the "high comorbidity" both boys and girls. However, Group High was associated with "high comorbidity" only in girls. The results of this study may inform future research and provide possible intervention targets.

The role of lifestyle in the impact of constant phthalate exposure on overweight and obesity: A longitudinal cohort study in China

BACKGROUND AND OBJECTIVES

To explore the relationship between constant exposure to phthalates (PAEs) and overweight/obesity and the role of lifestyle in children.

METHODS

This study conducted five repeated follow-up visits with 829 children and analysed data from 740 children. Logistic regression models were used to evaluate the association between constant PAE exposure, lifestyle and overweight/obesity.

RESULTS

The study found that constant high levels of PAEs exposure may increase the risk of obesity in girls, and the risk is higher in girls with an unhealthy lifestyle. In the unhealthy lifestyle group of girls, compared with the constant low (CL) exposure group of PAEs, the odds ratios (ORs) for overweight/obesity and obesity in the constant high (CH) exposure group were 2.99 (1.11, 8.05) and 11.58 (1.38, 96.87), respectively. In addition, an interaction effect between constant exposure to PAEs and lifestyle was observed on obesity in girls.

CONCLUSION

These results suggest the importance of reducing constant exposure to high levels of PAEs to reduce the risk of obesity, especially in individuals with unhealthy lifestyles. The government should strengthen the formulation of regulations and standards for PAEs while guiding parents to use fewer plastic products.

Caregiver feeding practices for infants and toddlers and their eating behaviors in Singapore

Introduction

Research on early childhood caregiver feeding practices and eating behaviors is limited, especially within Asian populations. This study examined these practices across key feeding domains of variety, autonomy, and mealtime setting and timing, stratified by three age groups: 0 to <7 months, 7 to <13 months, and 13 to <36 months.

Methods

A cross-sectional survey of 1,307 caregivers from a multi-ethnic population in Singapore captured demographic data, feeding practices, child eating behaviors, and caregivers' knowledge, attitudes, and practices. One-way analysis of variance (ANOVA), independent T-tests and the chi-square test were used to assess feeding practices and eating behaviors across age groups.

Results

Regarding dietary variety, 14.8 and 6.1% of infants aged 7 to <13 months were offered three or fewer food groups frequently and daily, respectively. Additionally, 11.9% of infants were receiving processed foods often. At this age, only 1.0% of infants were consuming sugar-sweetened beverages (SSBs) often, while 2.0% consumed them daily. Among older children (aged 13 to <36 months), 8.1% were offered a limited variety of three food groups, while 4.5% were offered fewer than three. In contrast, a significantly higher proportion frequently consumed processed foods (24.0%) and sugar-sweetened beverages (25.2%; p < 0.05). In terms of autonomy, only 75.4% of infants (7- < 13 months) and 89.5% of older children (13- < 36 months) were able to self-feed. Caregivers of older children (13- < 36 months) were less likely to recognize hunger and satiety cues compared to those of infants (0-< 13 months; p < 0.05). Older children (13- < 36 months) also more frequently required special mealtime settings (36.6%), viewed screens during meals (29.9%), and were less likely to be offered post-midnight meals nightly (22.6% compared to infants; 70.3%; 0-< 13 months; p < 0.05).

Conclusion

These findings underscore the need for culturally tailored educational interventions to improve suboptimal feeding practices in children under three in Singapore's multiethnic population.

Impact of the COVID-19 Pandemic on Children's Physical Activity As Perceived by Their Parents

Background Since the outbreak and global spread of COVID-19, countries rapidly introduced a range of preventative measures and isolation protocols to ensure safety, which ultimately led to the implementation of total lockdowns. As a result, children lost access to spaces where they typically engage in physical activity and were required to stay indoors. Objective The objective of this study is to assess the impact of the COVID-19 pandemic on children's physical activity levels and analyze the factors influencing their physical activity during this period. Methods Parents from various Emirates participated in an online survey to evaluate changes in their children's physical activity during the COVID-19 lockdown compared to the pre-lockdown period. The survey included questions about time spent on sedentary activities, general physical activity, and specific play behaviors before and during the lockdown. It also assessed the parents' own physical activity and their involvement in their children's activities. The relationships between these behaviors, as well as demographic and environmental factors, were analyzed. Results The study included 272 parents who completed an online survey about their child's physical activity during the COVID-19 lockdown. Many parents reported significant changes in their children's physical activity and screen time. Specifically, 89 (32.7%) observed a major decrease in physical activity, while 77 (28.3%) noted a minor decrease. Regarding screen time, 79 (29.0%) of parents reported a major increase, and 87 (32.0%) saw a minor increase. Key factors influencing children's physical activity were identified. Most notably, parents' own activity levels had a significant impact on their children's activity (p < 0.001). Additionally, children living in villas were more active than those living in apartments or traditional houses (p = 0.007), and UAE national children were slightly more active than non-nationals (p = 0.023). Conclusion This study demonstrated the significant impact of the COVID-19 lockdown on children's activity and emphasized the importance of parental involvement in supporting their children's activity levels. It highlights the need for increased attention during the recovery phase from this crisis and calls for the development of strategies and guidelines to prevent similar challenges in future pandemics or similar emergencies.

From Surviving to Thriving: A Roadmap for Reinventing Cardiac Rehabilitation in Pediatric Congenital Heart Disease

Exercise is an essential component of the cardiac care of children with congenital heart disease (CHD), and safe and effective exercise counselling by the medical team is important early in life to develop positive physical activity and exercise habits. Without it, children are at risk for sedentariness and related comorbidities in childhood and adulthood. Pediatric cardiologists can guide patients to a cycle of positive fitness through exercise counselling, promotion, prescription, and/or supervised exercise training similar to adult cardiac rehabilitation (ACR). ACR has improved exercise capacity, mortality, and quality of life in adults with acquired heart disease. Similar outcomes have been shown in exercise training for adult and pediatric CHD. Exercise training specific to pediatric CHD is not widely available but is expanding in response to growing need and increasing demand. Although ACR provides a framework for structured exercise training, approaches to pediatric exercise training must be individualized and innovated upon to be successful for children. I propose that the ACR model must be reinvented for children with CHD by integrating 6 missing pieces. First, the underlying goal should be to optimize fitness, not rehabilitate to a previous state of health. Second and third are training mental skills and motor skills. Fourth, play-based exercise training is needed to foster a positive relationship with exercise. Fifth, family-focused exercise interventions can address root causes of sedentariness. Finally, building communities in which positive fitness is a priority will be essential to long-term sustainability.

Learning apps at home prepare children for school

The usage of high-quality learning applications (apps) at home may increase children's mathematical and literacy competencies. This approach was tested in a family intervention study. Intervention families (n = 302) in two German cohorts (N = 500; M (SD)age = 61.0 (4.6) months; n♀ = 302) received tablets with newly developed learning apps focusing either on mathematical or literacy learning for every-day usage at home across half a kindergarten year. Compared with two control groups with and without tablets, children in the intervention groups significantly enhanced their specific competencies (η2 = .03-.10). Higher app usage was associated with greater gains (ΔR2 = .01-.02). Consequently, an easy-to-apply app-based intervention supports children's development of cognitive competencies and helps prepare them for school.

Tendency to overeat predicts an elevated body mass index trajectory across school-age years

Overeating is a complex appetite trait, cross-sectionally linked to an elevated weight in children. However, little is known about longitudinal associations. Therefore, we studied how a tendency towards overeating predicts weight development between 8 and 16 years of age. In this study among 4517 children from the Finnish Health in Teens cohort, parents reported their child's tendency to overeat when children were on average 11.2 (SD 0.8) years old. Children were then categorised as overeating, possibly overeating, or not overeating. Height and weight measurements from two data collection periods were combined with growth data from a national health register, and age- and sex-standardised body mass index z-scores (BMIz) were calculated using the International Obesity Task Force reference. Children also reported their lifestyle factors, including food consumption, physical activity, screen time, and sleep patterns. We examined the association between overeating and BMIz using a linear mixed model, adjusting for age, sex, specific food consumption frequencies, physical activity, screen time, and sleep duration. We further analysed whether associations differed by age, food consumption frequencies, or physical activity. The average BMIz in the overeating group was 1.18 (95% CI 1.10─1.26) units higher compared with those without overeating, but remained stable as age increased. Among those without overeating, BMIz increased 0.043 units per year of age (p < 0.001). Physical activity, but not food consumption, modified the association between overeating and BMIz (p for interaction = 0.038). In the lowest third of physical activity (≤ 5 h/week), BMIz was 1.28 units higher (95% CI 1.15─1.41) in the overeating compared with the no overeating group, while in the highest third (≥ 9 h/week) the effect size was 1.08 (95% CI 0.93─1.24). In conclusion, children with a parent-reported tendency to overeat exhibited an elevated, but stable mean BMIz across adolescence. Public health programmes tackling the obesity epidemic should consider the differences in appetite self-regulation among children.

Outdoor playing during preschool was associated with a reduced risk of school-age obesity in Japan

AIM

This study investigated the association between outdoor play habits during preschool and school-age obesity.

METHODS

We conducted a longitudinal cohort study of all children born in Japan during 2 weeks in January and July 2001. We defined outdoor play habits at age 2.5 years (third survey) as exposure, while parent-reported height and weight at age 7 years (seventh survey) were defined as overweight and obesity status using the WHO reference. Logistic regression models were used to estimate odds ratios (ORs) for associations between preschool outdoor play habits and school-age obesity, adjusting for parental and child factors.

RESULTS

Of 53 575 children born, 42 812 had data on outdoor play habits at age 2.5 years, with 91% (38 970) having such habits. At age 7 years, 31 743/42 812 (74%) children had height and weight data, with 3249/31 743 (10%) classified as overweight or obesity (BMI SD score ≥1.0). Outdoor play habits were negatively associated with obesity (adjusted OR 0.85, 95% confidence interval (CI): 0.74-0.97).

CONCLUSION

Outdoor play habits in early preschool years are associated with a reduced risk of school-age obesity. Parents and caregivers may consider encouraging their children to outdoor play habits at an early age to help prevent obesity later in life.

Prospective relationship between family screen time rules, obesogenic behaviours, and childhood obesity

Family screen use rules (FSRs) could plausibly protect against the development of childhood obesity, although the mechanisms underlying these protective effects remain largely unexplored. This research aimed to investigate prospectively the associations between exposure to FSRs at age 24 months, obesogenic behaviours (excessive screen time and short sleep duration) at age 45 months, and obesity at age 54 months. Additionally, a model proposing the mediating role of obesogenic behaviours in the association between FSRs and childhood obesity was tested. Data were obtained from 5733 children and their mothers participating in the 'Growing Up in New Zealand' study. Logistic regressions examined the association between three FSRs (rules on quality, quantity and timing of screen time, and different numbers of FSRs), obesogenic behaviours, and childhood obesity. Structural equation modelling (SEM) was applied to assess the potential mediating roles of obesogenic behaviours in the association between FSRs and zBMI. Neither exposure to individual nor all three FSRs was significantly associated with lower odds of obesity. However, protective effects of FSRs were observed concerning obesogenic behaviours. Exposure to individual or all three FSRs correlated with reduced odds of not meeting screen time and sleep duration recommendations. SEM analysis indicated no direct association between FSRs and zBMI; nevertheless, a significant indirect association was identified through the mediation of obesogenic behaviours. These findings suggest the potential benefits of promoting the adoption of FSRs as a promising population-based strategy to enhance child health behaviours and mitigate the risk of childhood obesity.

Analysis of risk factors for the development of obesity in preschool children: a logistic model analysis

Introduction

Obesity, characterized by abnormal fat accumulation, has become a significant global health concern. The prevalence of obesity in preschool children is rising across regions, highlighting the need for a thorough analysis of risk factors and effective interventions to address this growing epidemic. The aim of this study was to identify and analyze the main risk factors for the development of obesity in preschool children and explore effective interventions.

Methods

We collected clinical data from 910 preschool children who underwent a physical examination at our hospital from January 2023 to December 2023. Based on specific inclusion and exclusion criteria, we categorized the children into two groups: the obesity group (149 cases) and the non-obesity group (761 cases). Using univariate analysis and logistic regression modeling, we identified risk factors associated with obesity development.

Results

Out of the 910 children, 149 were diagnosed as obese, representing 16.37% of the total. High birth weight, high parental body mass index (BMI), picky eating habits, preference for meat, frequent consumption of junk food, and binge eating were found to be significant risk factors for obesity in preschool children. Meanwhile, higher parental education levels and longer daily outdoor activity times were considered protective factors against obesity.

Discussion

Effective interventions targeting the above risk factors are necessary to minimize the incidence of obesity and promote the healthy development of children.

Screen time and allostatic load among youth: findings from the National Health and Nutrition Examination Survey, 2015-2018

BACKGROUND

More screen time (ST) is associated with dysregulation of the individual biological systems (cardiovascular, immune, metabolic, and neuroendocrine) involved in the stress response in youth. However, its relationship with allostatic load (AL), a measure of the cumulative physiological stress response, is unclear in youth.

PURPOSE

To investigate the associations between ST types and AL outcomes in youth and to explore sociodemographic and behavioral moderators of these relationships.

METHODS

Cross-sectional data were from 1053 US youth aged 12-17 years (Mage = 14.20; 54% male; 21% Hispanic) in the 2015-2018 National Health and Nutrition Examination Survey (NHANES). ST was assessed as watching TV/videos and computer use/playing computer games. AL was measured using 7 biomarkers across 3 systems: cardiovascular (systolic and diastolic blood pressure, heart rate), immune (C-reactive protein), and metabolic (body mass index, glycohemoglobin, and high-density lipoprotein). Weighted multivariable regression models assessed whether ST predicted AL composite and subsystem (cardiovascular, immune, and metabolic) scores. Moderation by age, sex, income, race/ethnicity, and physical activity was explored.

RESULTS

A 1-hour/day increase in watching TV/videos was associated with a 4% increase in mean AL composite score (incident rate ratio = 1.040; 95% CI = 1.008, 1.073; P = .015), while computer use/gaming showed no significant associations (P's > .05). Age moderated the TV/videos-AL cardiovascular association (P = .009), with older youth having higher AL cardiovascular scores.

CONCLUSIONS

More time spent watching TV/videos was associated with higher cumulative physiological stress in youth. Prospective studies are needed to determine causal pathways and potential intervention targets in youth.

The healthy habits questionnaire (HHQ): Validation of a measure designed to assess problematic influential behaviours amongst families of children living with obesity or a risk of developing obesity

The 48-item Healthy Habits Questionnaire (HHQ-48) was developed to (1) monitor positive changes in family lifestyles following engagement in the Parents Plus Healthy Families (PP-HF) parent training programme and (2) be utilised as a standalone measure in clinical settings to identify and track problematic influential behaviours amongst families of children in weight-management services. This study aimed to develop and validate a brief version of the HHQ-48. The scale was administered to a cross-sectional community sample (n = 480), and on two occasions to a control sample (n = 50) and an experimental sample (n = 40) from a randomised controlled trial (RCT) of the PP-HF programme to assess test-retest reliability and sensitivity to change respectively. Exploratory and confirmatory factor analysis showed that a 23-item, 4-factor version of the HHQ (i.e., the HHQ-23) best fit the data. The scale and factor subscales had good internal consistency and test-retest reliability. They also had good concurrent and construct validity shown by significant correlations with another scale that assessed lifestyle issues, and scales that assessed parenting satisfaction, family functioning, and children's strengths and difficulties. The HHQ-23 was sensitive to change following parents completing the PP-HF programme. The HHQ-23 may, therefore, be used to monitor positive changes in family lifestyles following engagement in the PP-HF parent training programme. The HHQ-23 also shows promising potential as a standalone screening measure or as part of a larger battery of screening assessments in paediatric weight-management services.

Relationship of work-related and leisure-based screen time with obesity: a cross-sectional study on adults including older adults

PURPOSE

The relationship between screen time (ST) and obesity has been demonstrated; however, few studies have differentiated between work-related and leisure-based use in Japanese adults, including older adults. This study aimed to examine the relationship between both work-related and leisure-based ST and obesity in adults.

METHODS

This cross-sectional study was based on a questionnaire survey conducted in 2018. Overall, 9947 adults were invited; 3161 participants (31.8%) returned the questionnaire. Finally, 2488 participants (597 younger men (YM), 792 younger women (YW), 542 older men (OM), 557 older women (OW)) were included. The main exposures were work-related, leisure-based, and total ST. The outcome was obesity (body mass index ≥ 25 kg/m2). Log-binomial regression analysis was used to calculate prevalence ratios (PRs) and confidence intervals (CIs) for obesity with 1-h increments of each ST. Analyses were conducted in all participants and subgroups comprising YM, YW, OM, and OW.

RESULTS

Total ST was significantly associated with obesity in all participants (PR (95% CI) 1.07 (1.04-1.10), YM (1.05 (1.01-1.10)), OM (1.13 (1.05-1.22)), and OW (1.13 (1.02-1.26)). Work-related ST was significantly associated with obesity in all participants (1.08 (1.04-1.12)), YM (1.06 (1.00-1.12)), and OM (1.24 (1.08-1.42)). Leisure-based ST was significantly associated with obesity in all participants (1.09 (1.04-1.14)), YM (1.09 (1.00-1.18)), and YW (1.10 (1.01-1.20)).

CONCLUSION

ST is associated with obesity in Japanese adults including older adults; particularly, work-related ST is associated with obesity in men, and leisure-based ST, in younger individuals.

Early life factors that affect obesity and the need for complex solutions

The prevalence of obesity increases with age but is apparent even in early life. Early childhood is a critical period for development that is known to influence future health. Even so, the focus on obesity in this phase, and the factors that affect the development of obesity, has only emerged over the past two decades. Furthermore, there is a paucity of iterative work in this area that would move the field forward. Obesity is a complex condition involving the interplay of multiple influences at different levels: the individual and biological level, the sociocultural level, and the environmental and system levels. This Review provides a brief overview of the evidence for these factors with a focus on aspects specific to early life. By spotlighting the complex web of interactions between the broad range of influences, both causal and risk markers, we highlight the complex nature of the condition. Much work in the early life field remains observational and many of the intervention studies are limited by a focus on single influences and a disjointed approach to solutions. Yet the complexity of obesity necessitates coordinated multi-focused solutions and joined-up action across the first 2,000 days from conception, and beyond.

Association Between Television Viewing and Sensory Reactivity in Childhood: The Cross-Sectional InProS Study

BACKGROUND

Current evidence suggests a potential detrimental effect of increased television viewing on children's health, including sensory processing issues. Therefore, this study examined the association between television viewing time and atypical sensory reactivity (SR) in children aged from three to seven years.

METHODS

We evaluated data from the InProS cross-sectional study (n = 545). Daily television viewing was categorized into tertiles: ≤1.5, 1.5 to 2.5, and ≥2.5 hours. SR was evaluated using the Short Sensory Profile (SSP). Children with atypical SR were those with a global SSP score below 155, 30 for tactile sensitivity, 15 for taste/olfactory sensitivity, 13 for movement sensitivity, 27 for under-responsive/seeks sensation, 23 for auditory filtering, 26 for low energy/weak, and 19 for visual/auditory sensitivity. We used multiple Poisson regression models with robust variance to explore associations.

RESULTS

After adjusting for covariates, children who watched television 1.5 to 2.5 and ≥2.5 hours/day showed a higher prevalence of atypical global SR (prevalence ratio [PR]: 1.54; 95% confidence interval [CI]: 1.03 to 2.30; PR: 1.81; 95% CI: 1.19 to 2.76, respectively) and auditory filtering (PR: 1.50; 95% CI: 1.15 to 1.96; PR: 1.36; 95% CI: 1.01 to 1.83, respectively), compared with children who watched ≤1.5 hours/day. In addition, watching television ≥2.5 hours/day, compared with watching ≤1.5 hours/day, was associated with having atypical SR in movement sensitivity (PR: 1.73; 95% CI: 1.06 to 2.83), under-responsive/seeks sensation (PR: 1.31; 95% CI: 1.02 to1.69), and low energy/weak (PR: 2.02; 95% CI: 1.01 to 4.06).

CONCLUSIONS

The findings showed that television viewing ≥1.5 hours/day was associated with a higher prevalence of atypical SR in childhood. However, further longitudinal studies are required to confirm these results.

Smartphone and tablet use pattern in children up to 5 years old in Spain: a cross-sectional study

to characterize the smartphones and tablets use pattern in a sample of children up to 5 years old and assess with which variables it is associated.

cross-sectional study of 410 parents of children up to 5 years of age. Data were obtained from an online questionnaire. Questions about the time and pattern of daily use of smartphones and tablets were collected. We calculated the overall percentage (and 95% confidence interval) and median (and interquartile range) of each device's use time and according to the variables associated with the child, and the respondent's characteristics.

an estimated 44.7% (95% CI: 37; 51) of children used both smartphones and/or tablets daily. The median use time for smartphones and tablets separately was 30 minutes per day for smartphones (8.6-38.6) and 30 (17.1- 60.0) for tablet. In children who have free access to the devices, 11.6% (95% CI: 6; 16) use these devices up to 30 minutes after waking up on weekdays, 15.4% (95% CI: 10; 21) during weekends and 14.0% (95% CI: 8; 19) use smartphone and/or tablet up to 1 hour before going to bed.

more than 4 out of 10 children in our sample used smartphones and/or tablets daily. Community nursing may be a viable avenue for implementing educational programs focused on promoting healthy practices in children's electronic device usage given the pattern of excessive screen use in the pediatric population.

Association between insulin-like growth factor-1 and ocular surface parameters in obese prepubertal boys

The study aimed to investigate the correlation between insulin-like growth factor 1 (IGF-1) and ocular surface parameters in obese prepubertal boys. Thirty obese prepubertal boys and 30 age- and gender-matched healthy controls underwent physical measurements, laboratory tests, and ocular surface assessments. The obese group showed lower IGF-1 levels (P = 0.001), reduced Schirmer I tear test (SIT) (P <0.001), and higher meibomian gland scores (meiboscore) compared to controls (P = 0.015). Bivariate analysis revealed a positive association between IGF-1 and SIT (r = 0.677, P < 0.001), and a negative association with between IGF-1 and meiboscore (r =  - 0.487, P < 0.001). Multiple regression analysis indicated that IGF-1 (P < 0.001) and triglycerides (P = 0.028) independently influenced SIT. Logistic analysis showed a significant association between decreased IGF-1 and higher meiboscore values (OR 0.994, 95% confidence interval 0.988-1.000; P = 0.033).

CONCLUSION

The findings suggest that reduced IGF-1 in obese prepubertal boys is independently linked to decreased SIT and increased meiboscore, irrespective of obesity and traditional cardiovascular risk factors. This implies that monitoring ocular surface parameters in obese children might provide a new perspective for clinical practice to focus on.

WHAT IS KNOWN

• Obese children exhibit decreased levels of IGF-1, and this reduction in IGF-1 is associated with cardiovascular metabolic complications related to obesity. • Ocular surface tissues might act as targets for hormones, might experience local effects of these hormone.

WHAT IS NEW

• In prepubertal obese boys, the decrease in IGF-1 is independently linked to decreased SIT and increased meiboscore, irrespective of obesity and traditional cardiovascular risk factors. • This finding implies that monitoring ocular surface parameters in obese children might provide a new perspective for clinical practice to focus on.

Behavioral Counseling for Weight Management by Pediatric Nurse Practitioners: A Quantitative Cross-Sectional Study

INTRODUCTION

This study assessed counseling by pediatric nurse practitioners (PNPs) for management of overweight and obesity.

METHOD

Using a cross-sectional design, 1,058 PNPs completed a one-time survey regarding counseling for healthy body weight, physical activity, and consumption of protein, fruits and vegetables.

RESULTS

Study findings suggest PNPs are using behavioral counseling for weight management in pediatric patients. Counseling was more frequent for healthy body weight, fruit and vegetable intake, and physical activity than for protein consumption and muscle strengthening. Furthermore, when PNPs counseled for healthy body weight they were also more likely to counsel for physical activity (OR = 25.99 [95% CI: 19.25, 35.11]), fruit and vegetable intake (OR = 22.35 [95% CI: 16.71, 29.88]), protein intake (OR = 9.82 [95% CI: 7.60, 12.69]), and muscle strengthening (OR = 6.41 [95% CI: 4.98, 8.24]).

DISCUSSION

PNPs are counseling for healthy body weight and necessary behavioral tools, but increased emphasis on muscle strengthening may benefit overweight and obese youth.

Multidimensional School-Based and Family-Involved Interventions to Promote a Healthy and Sustainable Lifestyle (LIVELY) for Childhood Obesity Prevention: Study Protocol

BACKGROUND

Childhood obesity has become a significant public health concern over the past 2 decades, posing multifactorial challenges, including modifiable factors like dietary habits, physical activity, screen time, and sleeping habits. Prevention efforts require a comprehensive approach comprising educational interventions, collaboration among multidisciplinary teams, and community engagement. Since schools play a central role in children's lives, they are the ideal setting for promoting healthy habits.

OBJECTIVE

The LIVELY (Multidimensional School-Based and Family-Involved Interventions to Promote a Healthy and Sustainable Lifestyle) study will assess the prevalence of overweight and obesity in primary school children and identify contributing factors within families. Additionally, it aims to implement and evaluate a multidimensional, multidisciplinary intervention to foster a sustainable and healthy lifestyle, ultimately working toward preventing obesity in school-aged children.

METHODS

During the school year, each class will be individually involved in a multidimensional educational intervention covering the topics of healthy, sustainable nutrition and lifestyle. Children will also participate in a multimedia lab where they will create an animated cartoon. The lectures will engage them through various methods, including direct instructions, games, and drawing activities, to stimulate and enhance their learning and involvement.

RESULTS

Data collection began in October 2023 and will last until the end of October 2024. A sample of 227 children from 14 classes was included in the study. The mean age was 8.9 (SD 1.2) years, and 48% (n=110) were males. Among the overall sample, 18.1% (n=41; 95% CI 13.7%-23.7%) were overweight, while 5.3% (n=12; 95% CI 3%-9%) had obesity. Males had a higher prevalence of obesity than females (9.1%, n=10 vs 1.7%, n=3, P=.03, respectively). Otherwise, the prevalence of central obesity was similar between the two (P=.329). Data analysis and the presentation of the complete results will be available after the end of 2024.

CONCLUSIONS

The study could lead to the structuring of an educational intervention model in school settings aimed at preventing childhood obesity. Moreover, it could help raise awareness of childhood obesity and help prevent this public health issue.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05966051; https://clinicaltrials.gov/study/NCT05966051.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57509.

Dietary and Physical Activity Habits of Children and Adolescents before and after the Implementation of a Personalized, Intervention Program for the Management of Obesity

BACKGROUND

Obesity in childhood and adolescence represents a major public health problem, mostly attributed to dietary and physical activity factors. We aimed to determine the dietary and physical activity habits of participants before and after the implementation of a personalized, multidisciplinary, lifestyle intervention program for the management of obesity in the context of the Horizon Research Project 'BigO: Big Data against Childhood Obesity'.

METHODS

Three hundred and eighty-six (n = 386) children and adolescents (mean age ± SD: 12.495 ± 1.988 years, 199 males and 187 females) participated in the study prospectively. Based on body mass index (BMI), subjects were classified as having obesity (n = 293, 75.9%) and overweight (n = 93, 24.1%) according to the International Obesity Task Force (IOTF) cut-off points. We implemented a personalized, multidisciplinary, lifestyle intervention program providing guidance on diet, sleep, and exercise, and utilized the BigO technology platform to objectively record data collected via a Smartphone and Smartwatch for each patient.

RESULTS

Following the intervention, a statistically significant decrease was noted in the consumption of cheese, cereal with added sugar, savory snacks, pasta, and fried potatoes across both BMI categories. Also, there was an increase in daily water intake between meals among all participants (p = 0.001) and a reduction in the consumption of evening snack or dinner while watching television (p < 0.05). Boys showed a decrease in the consumption of savory snacks, fried potato products, and pasta (p < 0.05), an increase in the consumption of sugar-free breakfast cereal (p < 0.05), and drank more water between meals daily (p < 0.001).

CONCLUSIONS

Our findings suggest that a personalized, multidisciplinary, lifestyle intervention improves the dietary habits of children and adolescents.

Association between eating rate and childhood overweight/obesity: a systematic review and meta-analysis

Many studies have reported the relationship between eating rate and childhood overweight/obesity, while results remain inconclusive. The present study was done to estimate the association between eating rate and childhood overweight/obesity through a systematic review of prevalence studies. Relevant studies were searched by two independent researchers in databases including PubMed, Embase, Cochrane Library, and Web of Science, and data were collected from relevant studies published through June 2023 using predefined inclusion/exclusion criteria. A summary estimate was calculated using a random-effect model, and subgroup analysis was performed to explore sources of heterogeneity. Data from 16 published studies were eligible for inclusion. Fast eating was associated with a higher risk of overweight/obesity compared with a medium eating rate (OR = 1.80; 95% CI: 1.49, 2.18), and slow eating showed a declined overweight/obesity risk among children and adolescents (OR = 0.65; 95% CI: 0.52, 0.81). Subgroup analysis performed according to age showed that in all age groups, eating fast was positively correlated with overweight/obesity, while eating slowly was negatively associated with overweight/obesity. According to our study, eating rate was closely related to childhood overweight/obesity, and eating fast was associated with an increased likelihood of being overweight/obesity. In the future, it will be necessary to understand the factors that influence fast eating and develop methods to slow down the eating rate in children and adolescents.

Prevalence and Correlates of Double and Triple Burden of Malnutrition Among Children and Adolescents in India: The Comprehensive National Nutrition Survey

BACKGROUND

Limited information on the co-prevalence of undernutrition, micronutrient deficiencies, overnutrition, and abnormal levels of noncommunicable disease biomarkers at the same time in children and adolescents in India hinders efforts to comprehensively address their health.

OBJECTIVES

This study aimed to examine the prevalence and correlates of double burden of malnutrition (DBM) and triple burden of malnutrition (TBM) among children and adolescents (5-19 y) to inform policies and programs.

METHODS

A total of 17,599 children (5-9 y) and 16,184 adolescents (10-19 y) with available biomarker data from the Comprehensive National Nutrition Survey were included. Malnutrition was defined based on either undernutrition based on anthropometry, overnutrition/abnormal metabolic markers, and anemia/micronutrient deficiency. DBM was defined as the coexistence of any 2 forms of malnutrition. DBM+ was defined as the coexistence of undernutrition and/or micronutrient deficiency along with overnutrition. TBM was defined as having the coexistence of all 3 forms of malnutrition. The prevalence of DBM, DBM+, and TBM was estimated accounting for probabilistic selection. We used mixed-effect binomial regression to determine correlates of DBM/TBM in children and adolescents separately.

RESULTS

The prevalence of DBM, DBM+, and TBM was 50.8%, 37.2%, and 14.4%, respectively, in children and 53.4%, 36.1%, and 12.7%, respectively, in adolescents. The prevalence of DBM+ was significantly higher in girls compared to in boys in the 5-9 y age group. In children, being in a disadvantaged caste group, having a lower wealth index, having inadequate diet diversity, having no maternal schooling, and having a recent history of acute illness were associated with DBM. In adolescents, being in a disadvantaged caste group, maternal occupation, and lower paternal age were correlated with DBM. A similar set of variables was associated with TBM in both age groups.

CONCLUSIONS

The prevalence of DBM and TBM is substantial in children and adolescents in India and varies across states. Socioeconomic factors and acute illness were the main correlates for DBM and TBM.

Do Children's Health Behaviors Buffer the Impact of Cumulative Environmental Stress on Emerging Cardiometabolic Risk?

BACKGROUND

Previous studies have found that exposure to childhood environmental stress is associated with cardiometabolic risk. However, it is not known whether individual health behaviors disrupt this relationship. This study prospectively evaluated the relationship between cumulative environmental stress in a low-income sample and cardiometabolic risk in middle childhood and examined whether child health behaviors attenuated this relationship.

METHODS AND RESULTS

In a cohort of children (n=338; 57% Hispanic children; 25% Black children), environmental stressors (family and neighborhood factors representing disadvantage/deprivation) and child health behaviors (accelerometry measured physical activity; parent-reported screen time and diet recalls) were measured over 5 time points beginning when children were aged 2 to 4 years and ending when they were aged 7 to 11 years. Children's cardiometabolic risk factors (body mass index, blood pressure, triglyceride/high-density lipoprotein ratio, glucose, hemoglobin A1c, C-reactive protein) were measured at 7 to 11 years. Emerging cardiometabolic risk was defined as having ≥1 elevations that exceeded clinical thresholds. In adjusted path analyses, greater cumulative environmental stress was associated with higher likelihood of emerging cardiometabolic risk in middle childhood (P<0.001). Higher levels of moderate to vigorous physical activity and fewer sedentary minutes attenuated the positive relationship between stress and cardiometabolic risk (P<0.05). Children with >2 hours of average daily screen time had a higher likelihood of elevated cardiometabolic risk (P<0.01), but screen time did not moderate the stress-cardiometabolic risk relationship. Dietary intake was not related to cardiometabolic risk.

CONCLUSIONS

Interventions that promote moderate to vigorous physical activity and limit sedentary behavior may have particular importance for the cardiometabolic health of children exposed to high levels of cumulative environmental stress.

Racial/Ethnic Differences in the Age-Varying Association Between Adherence to 8-5-2-1-0 Guidelines in Adolescents with High BMI

PURPOSE

To examine the association between adherence to sleep, dietary, screen time, and physical activity (PA) (8-5-2-1-0) guidelines and risk of high body mass index (BMI ≥ 85 percentile) among U.S. adolescents and to assess for racial inequities and age-varying effects in these associations.

METHODS

Data from the 2019 Youth Risk Behavior Surveillance System survey were used to conduct multivariable logistic regression models and moderation analysis by race/ethnicity and age using time-varying varying effect models (TVEM) and estimate associations of interest.

RESULTS

Of the 13,518 adolescents aged ≥ 14 years, only 0.5% met all guidelines. Adolescents adhering to sleep guidelines had a 21% reduction in their odds of having a high BMI (OR 0.79, 95% CI 0.67-0.93). Those adhering to PA guidelines had a 34% reduction in their odds of having a high BMI (OR 0.66, 95% CI 0.56-0.79), and those adhering to screen time guidelines had a 17% reduction in their odds of having a high BMI (OR 0.83, 95% CI 0.72-0.95). TVEM showed associations between adherence to sleep and screen time guidelines with high BMI fluctuate and are at specific ages. TVEM revealed substantial racial/ethnic differences in the age-varying association between adherence to 8-5-2-1-0 guidelines and high BMI throughout adolescence.

CONCLUSIONS

Associations between adherence to sleep and screen time guidelines and high BMI fluctuate with age, highlighting the need for nuanced interventions targeting 24-h movement guidelines (sleep, PA, and screen time) across adolescence, particularly given racial/ethnic disparities.

Impact of Soccer-Based Training Interventions on Anthropometric Measures Among Children and Adolescents With Overweight/Obesity: A Systematic Review, Meta-Analysis, and Assessment of Certainty of Evidence

PURPOSE

This systematic review and meta-analysis aimed to systematically examine and summarize recent evidence on the effects of soccer-based training (SBT) on anthropometric measures in children and adolescents with overweight/obesity.

METHODS

Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines, a thorough literature search across 7 electronic databases was conducted on October 11, 2023. The studies' methodological quality was evaluated using the QualSyst tool, followed by conducting a meta-analysis with a random-effects model, and the certainty of evidence was assessed.

RESULTS

Six studies were included, with 4 studies of strong methodological quality and 2 studies of moderate methodological quality. The results of the meta-analysis revealed SBT decreases fat mass percentage (effect size [ES] = 0.47 [small]; P = .002), with no significant effect of SBT on body mass index (ES = 0.180 [small]; P = .275), body mass (ES = 0.183 [trivial]; P = .212), fat-free mass (ES = 0.074 [trivial]; P = .635), or waist circumference (ES = 0.358 [small]; P = .053). The certainty of evidence was moderate for all outcomes.

CONCLUSIONS

SBT appears to decrease fat mass percentage, without affecting body mass, body mass index, fat-free mass, or waist circumference in obese/overweight children and adolescents. These findings require further investigation given the moderate certainty of evidence.

REGISTRATION

The protocol of this review was registered in the Open Science Framework database (https://doi.org/10.17605/OSF.IO/8P4V2).

Effects of outdoor activity time, screen time, and family socioeconomic status on physical health of preschool children

Objective

Experienced 3 years of pandemic-induced home life, in the post-epidemic period, preschoolers in China are falling short of the World Health Organization's standards for screen time and outdoor activities. This notably impacts their physical well-being. The study aims to probe the associations between screen time, outdoor activities, and the physical health of preschoolers, offering insights to shape interventions targeting myopia and obesity prevention in children.

Methods

A cross-sectional study was conducted in Guangdong Province, involving a representative sample of 23,992 preschoolers and their caregivers recruited through proportional stratified cluster sampling. Data collection utilized the Chinese Early Human Capability Index (CHeHCI, eHCi), a questionnaire on children's media use in daily family life, and Body Mass Index (BMI). Linear regression and binary logistic regression models were employed to analyze the impact of screen time and outdoor activity duration on the physical health of preschoolers.

Results

In the high family socioeconomic status (SES) group, children had significantly less screen time compared to those in the medium and low SES groups. Outdoor activity time varied significantly based on SES, with higher SES linked to extended outdoor engagement. Additionally, children's eHCi health dimension score exhibited significant SES-related differences, showcasing higher scores for children in higher SES groups. In terms of gender differences, boys dedicated significantly more time to outdoor activities than girls, yet boys had a notably higher overweight rate. Furthermore, girls demonstrated better health outcomes based on eHCi health scores. A significant association emerged between overweight and screen time in children with high SES, indicating that prolonged screen time was linked to a higher likelihood of overweight based on BMI. Additionally, a substantial negative correlation was observed between children's eHCi health dimension score and screen time. Furthermore, children's outdoor activity time exhibited a significant positive correlation with eHCi health dimension score. Regression analysis revealed that screen time could significantly negatively predict children's physical health score, while outdoor activity time could significantly positively predict children's eHCi physical health score.

Conclusion

The current study highlights that family SES, age, and gender play pivotal roles in influencing preschoolers' screen time and outdoor activity duration, with family SES being particularly influential. Higher family SES correlates with reduced screen time, increased outdoor activity, and elevated health levels among children. Importantly, children's screen time negatively predicts their health status, while outdoor time positively predicts their health status.

Exploring the Self-Reported Physical and Psychological Effects in a Population Exposed to a Regional Conflict

BACKGROUND

Conflict profoundly impacts community health and well-being. While post-conflict research exists, little is known about initial effects during active hostilities.

OBJECTIVE

To assess self-reported changes in health behaviors, distress, and care access within one month of regional warfare onset in a conflict-affected community.

METHODS

An online survey was conducted in November 2023 among 501 residents (mean age 40.5 years) of a community where war began October 7th. Measures evaluated physical health, mental health, diet, substance use, sleep, weight changes, and healthcare access before and after the declaration of war.

RESULTS

Relative to pre-war, respondents reported significantly increased rates of tobacco (56%) and alcohol (15%) consumption, worsening sleep quality (63%), elevated distress (18% sought help; 14% needed but didn't receive it), and postponed medical care (36%). Over a third reported weight changes. Distress was higher among females and those endorsing maladaptive coping.

CONCLUSION

Within one month, substantial impacts on community psychosocial and behavioral health emerged. Unmet mental health needs and risk-taking behaviors were early indicators of conflict's health consequences. Continuous monitoring of conflict-affected communities is needed to inform tailored interventions promoting resilience and prevent entrenchment of harms over time.

Strategies to Overcome Barriers to Physical Activity Participation in Children and Adults Living With Congenital Heart Disease: A Narrative Review

Physical activity participation is critical for optimal physical, psychological, and cognitive health in children and adults living with congenital heart disease (CHD). Majority of the general population are not sufficiently active, and with the added psychological, physical, and socioeconomic barriers faced by individuals with CHD, it is unsurprising that many people living with CHD do not meet the recommendations for physical activity either. The aim of this review is to outline lifelong physical activity barriers faced by individuals living with CHD and provide age-appropriate strategies that can be used to ensure the development of long-term positive physical activity behaviours. Barriers to physical activity include safety fears, lack of encouragement, low exercise self-efficacy, body image concerns, limited education, socioeconomic status, reduced access to resources, and cardiac diagnosis and severity. These barriers are multifaceted and often begin in early childhood and continue to develop well into adulthood. Therefore, it is important for children to participate in physical activity from early stages of life as it has been shown to improve cardiorespiratory fitness, muscular endurance, and quality of life. Current literature demonstrates that participation in physical activity and higher intensity exercise after appropriate screening is safe and should be encouraged rather than dissuaded in people born with a congenital heart condition.

Screen time in the development of type 2 diabetes mellitus (T2DM) : a two-sample Mendelian randomization study

OBJECTIVE

This study aimed to investigate the potential causal relationship between screen time and the risk of developing type 2 diabetes mellitus (T2DM) using Mendelian randomization.

METHODS

Two-sample Mendelian randomization was conducted, utilizing genetic variants associated with different types of screen time as instrumental variables. Single nucleotide polymorphisms (SNPs) were used to assess the primary outcome, which was the risk of developing T2DM.

RESULTS

The analysis revealed a significant positive causal association between television viewing time and the risk of T2DM. Specifically, excessive television viewing time was found to increase the risk of developing T2DM (OR: 2.39, 95% CI: 1.90 to 3.00, P < 0.01). However, no significant causal relationship was observed between computer usage time and the risk of T2DM. Additionally, mobile phone use time showed a positive correlation with the risk of T2DM (OR: 1.31, 95% CI: 1.04 to 1.64, P = 0.02), albeit to a lesser extent than television viewing time.

CONCLUSION

The findings of this study indicate a significant causal association between certain types of screen time, specifically television viewing and mobile phone use, and an increased risk of T2DM.

The prevalence and prevention strategies of pediatric obesity: a narrative review

Pediatric obesity has rapidly increased globally over the past few decades, including in Korea. We aimed to discuss trends in the prevalence of pediatric obesity and effective prevention strategies. Its prevalence has markedly increased in most high-income nations. According to recent reports, this increase has slowed in developed countries, but the levels remain alarmingly high. In Korea, the rate of pediatric obesity has surged notably since the 1990s; however, since the 2000s, this increase has become more gradual. According to recently published 2017 growth charts, the prevalence of pediatric obesity in Korea varies slightly depending on the data source. The National School Health Examination data showed that pediatric obesity gradually increase from 11.5% in 2014 to 15.1% in 2019, and after the coronavirus disease 2019 pandemic, it sharply increased to 19% in 2021. Based on data from the Korea National Health and Nutrition Examination Survey, the prevalence of pediatric obesity gradually increased from 10.8% in 2017 to 13.6% in 2019. This trend, which accelerated sharply to 15.9% in 2020 and 19.3% in 2021, was especially severe in boys and older children. Pediatric obesity not only affects health during childhood but also increases the risk of developing obesity and associated health conditions in adulthood. Despite ongoing research on treatment options, obesity prevention and control remain challenging. Hence, prioritizing early intervention and prevention of pediatric obesity through healthy eating habits and lifestyles is crucial. This requires intervention at the individual, family, school, and community levels.

Early Lifestyle Determinants of Adiposity Trajectories from Childhood into Late Adolescence

Objective: The aim of this study was to examine associations of childhood physical activity, sedentary behavior, and dietary intake with adiposity trajectories from childhood to adolescence. Methods: Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) cohort (n = 630) data from 3 time points (8-10, 10-12, and 15-17 years) for 377 Caucasian children with parental obesity were analyzed. Height and weight, physical activity and sedentary behavior (7-day accelerometry), screen time (self-reported), and dietary intake (three 24-hour diet recalls) were measured. Group-based trajectory modeling identified longitudinal trajectories of body-mass index z-scores (zBMIs). Inverse probability of exposure-weighted multinomial logistic regressions examined associations between baseline lifestyles and zBMI trajectory groups. Results: Six trajectory groups were identified: Stable-Low-Normal-Weight (two groups, 5.7% and 33.0%, which were combined), Stable-High-Normal-Weight (24.8%), Stable-Overweight (19.8%), Stable-Obesity (8.8%), and Overweight-Decreasers (7.9%). For every additional portion of fruits and vegetables, the likelihood of being in the group of Overweight-Decreasers increased by 29% (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.09-1.55) compared with the reference group (Stable-Low-Normal-Weight). For every additional hour of sedentary behavior, the likelihood of belonging to the group of Overweight-Decreasers increased 2-fold (OR: 1.99, 95% CI: 1.28-3.21) and Stable-Obesity increased 1.5-fold (OR: 1.56, 95% CI: 1.08-2.23), compared with the reference. Every additional 10 minutes of moderate-to-vigorous physical activity was associated with a lower likelihood of belonging to the Stable-Obesity group (OR: 0.75, 95% CI: 0.61-0.89) and to the group of Overweight-Decreasers (OR: 0.79, 95% CI: 0.64-0.95) compared with the reference. Finally, children were more likely to belong to the Stable-Obesity group with each additional hour/day of screen time (OR: 1.23, 95% CI: 1.01-1.58). Conclusions: Trajectories of zBMIs from childhood to late adolescence were stable, except for one group which decreased from overweight in childhood to normal weight in adolescence. The latter had more favorable baseline dietary intake of fruits and vegetables. ClinicalTrials.org no. NCT03356262.

The association between screen time exposure and myopia in children and adolescents: a meta-analysis

OBJECTIVE

This study aimed to systematically review epidemiological evidence on associations between screen time exposure and myopia in children and adolescents, and to quantitatively evaluate summary effect estimates from existing literature.

METHOD

There were three online databases including PubMed, Embase, and Web of Science, for epidemiological studies on screen time exposure and myopia published before June 1, 2023. The risk of bias was assessed by the Newcastle Ottawa Scale (NOS) checklist. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the correlation between screen time exposure and myopia using random or fixed-effect models by exposure type (categorical/continuous). We also performed subgroup analysis by screen device type, study quality, geographic region, and research period.

RESULTS

We searched 7,571 records from three databases and identified 19 eligible studies, including 14 high-quality studies and 5 moderate-quality studies. Meta-analyses suggested that there was a statistically significant correlation between screen time (high vs. low) and myopia. The pooled ORs with 95%CIs were respectively 2.24 (1.47-3.42) for cross-sectional studies, and 2.39 (2.07-2.76) for cohort studies. We also found a significant association between continuous exposure to screen time (per 1 h/d increase) and myopia in cohort studies. The pooled ORs with 95%CIs were 1.07 (1.01-1.13). In subgroup analysis stratified by screen device type in cross-sectional studies, screen time exposures from computers (categorical: OR = 8.19, 95%CI: 4.78-14.04; continuous: OR = 1.22, 95%CI: 1.10-1.35) and televisions (categorical: OR = 1.46, 95%CI: 1.02-2.10) were associated with myopia, while smartphones were not. Although publication bias was detected, the pooled results did not show significant changes after adjustment using the trim and fill method.

CONCLUSION

Our findings support that screen time exposure was significantly associated with myopia in children and adolescents. Notably, screen time exposure from computers may have the most significant impact on myopia.

Examining the growth in willingness to pay for digital wellbeing services on social media: A comparative analysis

In recent years, there has been a growing need for social media platforms to offer services that preserve and promote users' digital wellbeing, including better protection of personal data and balanced technology usage. However, the current business model of social media is often seen as in conflict with users' digital wellbeing. In 2020, a study investigated users' willingness to pay monetary fees for social media digital wellbeing services. In the present work, we replicated this study in Q4 of 2022, aiming to explore any changes in interest and willingness to pay for these services. In addition, we extended the replication by conducting qualitative analysis on participants' comments to gain deeper insight and identify reasons for payment and reasons for rejecting to pay. Data were collected from 262 participants through an online questionnaire. The survey focused on four services: better data protection, less use of data for marketing, aiding users in controlling their prolonged usage, and reducing fake news and radicalisation on social media. The results showed that the willingness to pay for these services was significantly higher in 2022 compared to the results published in 2020. Participants expressed concerns about the feasibility and fairness of the alternative business model, which requires users to pay for safety and support. Our findings suggest a growing interest in digital wellbeing services, emphasizing the need for social media platforms to assess the feasibility of alternative business models, identify user segments, and take measures to enhance consumers' trust, accordingly.

Association of physical activity and screen time with cardiovascular disease risk in the Adolescent Brain Cognitive Development Study

BACKGROUND

According to the Physical Activity Guidelines Advisory Committee Scientific Report, limited evidence is available on sedentary behaviors (screen time) and their joint associations with physical activity (steps) for cardiovascular health in adolescence. The objective of this study was to identify joint associations of screen time and physical activity categories with cardiovascular disease (CVD) risk factors (blood pressure, hemoglobin A1c, cholesterol) in adolescence.

METHODS

This study analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, comprising a diverse sample of 4,718 U.S. adolescents aged 10-15 years between 2018 and 2021. Steps were measured by a Fitbit wearable device and levels were categorized as low (1,000-6,000), medium (> 6,000-12,000), and high (> 12,000) averaged daily step counts. Self-reported recreational screen time hours per day were classified as low (0-4), medium (> 4-8), and high (> 8) hours per day. CVD risk factors including blood pressure, hemoglobin A1c, and cholesterol (total and HDL) were measured.

RESULTS

The analytical sample averaged 6.6 h of screen time per day and 9,722 steps per day. In models including both screen time and steps, the high screen time category was associated with a 4.27 higher diastolic blood pressure percentile (95% CI 1.83-6.73) and lower HDL cholesterol (B= -2.85, 95% CI -4.77 to -0.94 mg/dL) compared to the low screen time category. Medium (B = 3.68, 95% CI 1.24-6.11) and low (B = 7.64, 95% CI 4.07-11.20) step categories were associated with higher diastolic blood pressure percentile compared to the high step category. The medium step category was associated with lower HDL cholesterol (B= -1.99, 95% CI -3.80 to -0.19 mg/dL) compared to the high step category. Findings were similar when screen time and step counts were analyzed as continuous variables; higher continuous step count was additionally associated with lower total cholesterol (mg/dL).

CONCLUSIONS

Combinations of low screen time and high steps were generally associated with favorable cardiovascular health markers including lower diastolic blood pressure and higher HDL cholesterol, which can inform future adolescent health guidelines.

Relationships among Sleep Time, Physical Activity Time, Screen Time, and Nutrition Literacy of Adolescents: A Cross-Sectional Study in Chongqing, China

Background: Unhealthy lifestyles among adolescents are reaching alarming levels and have become a major public health problem. This study aimed to assess the relationship between sleep time, physical activity (PA) time, screen time (ST), and nutritional literacy (NL). Methods: This cross-sectional online study involving adolescents aged 10-18 years was conducted in September 2020 in 239 schools in Chongqing, China. NL was measured using the "Nutrition Literacy Scale for middle school students in Chongqing (CM-NLS)". According to the recommended by the Chinese dietary guidelines (2022), we divided the sleep time of junior high school students into <9 h and ≥9 h, high school students into <8 h and ≥8 h, divided the workdays into weekend PA time < 1 h and ≥1 h, and divided the workdays into weekend ST < 2 h and ≥2 h. The multinomial logistic regression model was used to examine the association. Results: A total of 18,660 adolescents (50.2% males) were included. The proportion of participants that were junior high school students and attended boarding schools was 57.2% and 65.3%, respectively. Compared with senior high school students, junior high school students had a higher level of NL. Whether on workdays or weekends, participants with sleep time ≥ 8/9 h, PA time ≥ 1 h, and ST < 2 h per day had higher levels of NL. On weekdays, participants who met the sleep time ≥ 8 h/9 h (OR = 1.48, 95% CI: 1.36, 1.62) and PA time ≥ 1 h (OR = 1.69, 95% CI: 1.59, 1.81) had higher reporting of NL levels. Conclusions: Sleep time, PA time, and ST were positively correlated with NL among adolescents, especially junior high school students.

Association between watching eating broadcast "Mukbang and Cookbang" and body mass index status in South Korean adolescents stratified by gender

BACKGROUND

It has been suggested that Mukbang and Cookbang, a type of eating broadcast originating from Korea and gaining popularity, may contribute to obesity. However, despite suggestions that Mukbang might contribute to obesity, studies investigating the impact of watching Mukbang on obesity is lacking. The goal of this study is to analyze the relationship between watching Mukbang and Cookbang and body mass index (BMI) status in Korean adolescents. All analyses were stratified by gender.

METHODS

This study utilized data from the 2022 Korea Youth Risk Behavior Web-based Surveys. The anonymous online survey was conducted with 56,213 students, and 51,850 students (92.2%) who participated in the survey were analyzed. Participants reported the frequency of watching Mukbang and Cookbang per week over the previous 12 months. BMI was categorized into four subgroups based on percentiles: underweight (< 5th percentile), normal (5th - 85th percentiles), overweight (85th - 95th percentiles), and obese (> 95th percentile). This study used multinomial logistic regression for analysis.

RESULTS

The likelihood of being obese was significantly higher in Mukbang-watching boys compared to those who never watched Mukbang and Cookbang (adjusted odds ratio [aOR]: 1.22, 95% confidence interval [CI]: 1.12-1.32). A dose-dependent association was found between the frequency of Mukbang and Cookbang watching and the likelihood of obesity among boys (p-for-trend < 0.0001). Subgroups that currently smoke, currently drink alcohol, frequently consume fast food, or drink sweetened beverages showed significantly higher odds of being obese in the "Ever" group than those in the "Never" group.

CONCLUSION

This study found a relationship between watching Mukbang and Cookbang and obesity in boys. Appropriate interventions should be considered for boys watching Mukbang and Cookbang.

Association between Screen Time and Sociodemographic Factors, Physical Activity, and BMI among Children in Six European Countries (Feel4Diabetes): A Cross-Sectional Study

Screen time among children in most European countries is notably high and is influenced by various sociodemographic and other factors. Our study aimed to explore the associations between parents' sociodemographic characteristics, socioeconomic status, body mass index (BMI), physical activity, risk status for type 2 diabetes, and their children's BMI, physical activity, and screen time. The data were sourced from the 2016 Feel4Diabetes study, involving 12,280 parents and 12,211 children aged 6-9 years (average age 8.21 years) in a cross-sectional study design. We used a logistic regression model to identify potential factors associated with children's screen time. The results showed that mothers with tertiary education (OR = 0.64; 95%CI = 0.49-0.82; p < 0.001), the middle age group (45-54 years) (OR = 0.81 95%CI = 0.66-0.98; p = 0.033), and families with higher incomes (middle-OR = 0.85; 95%CI = 0.75-0.97; p = 0.014; high-OR = 0.8; 95%CI = 0.69-0.93; p = 0.003) were associated with a decreased chance of children spending more than 2 h/day in front of the screen. In contrast, maternal overweight/obesity (OR = 1.15; 95%CI = 1.03-1.29; p = 0.013) and lower physical activity in children were linked to an increased likelihood of more than 2 h of screen time per day. Our findings suggest that targeted interventions should be developed to mitigate excessive screen time, particularly focusing on low-income families and mothers with low educational levels.

Longitudinal associations of screen time, physical activity, and sleep duration with body mass index in U.S. youth

BACKGROUND

Youth use different forms of screen time (e.g., streaming, gaming) that may be related to body mass index (BMI). Screen time is non-independent from other behaviors, including physical activity and sleep duration. Statistical approaches such as isotemporal substitution or compositional data analysis (CoDA) can model associations between these non-independent behaviors and health outcomes. Few studies have examined different types of screen time, physical activity, and sleep duration simultaneously in relation to BMI.

METHODS

Data were baseline (2017-2018) and one-year follow-up (2018-2019) from the Adolescent Brain Cognitive Development Study, a multi-site study of a nationally representative sample of U.S. youth (N = 10,544, mean [SE] baseline age = 9.9 [0.03] years, 48.9% female, 45.4% non-White). Participants reported daily minutes of screen time (streaming, gaming, socializing), physical activity, and sleep. Sex-stratified models estimated the association between baseline behaviors and follow-up BMI z-score, controlling for demographic characteristics, internalizing symptoms, and BMI z-score at baseline.

RESULTS

In females, isotemporal substitution models estimated that replacing 30 min of socializing (β [95% CI] = -0.03 [-0.05, -0.002]), streaming (-0.03 [-0.05, -0.01]), or gaming (-0.03 [-0.06, -0.01]) with 30 min of physical activity was associated with a lower follow-up BMI z-score. In males, replacing 30 min of socializing (-0.03 [-0.05, -0.01]), streaming (-0.02 [-0.03, -0.01]), or gaming (-0.02 [-0.03, -0.01]) with 30 min of sleep was associated with a lower follow-up BMI z-score. In males, replacing 30 min of socializing with 30 min of gaming was associated with a lower follow-up BMI z-score (-0.01 [-0.03, -0.0001]). CoDA estimated that in males, a greater proportion of time spent in baseline socializing, relative to the remaining behaviors, was associated with a higher follow-up BMI z-score (0.05 [0.02, 0.08]). In females, no associations between screen time and BMI were observed using CoDA.

CONCLUSIONS

One-year longitudinal associations between screen time and BMI may depend on form of screen time, what behavior it replaces (physical activity or sleep), and participant sex. The alternative statistical approaches yielded somewhat different results. Experimental manipulation of screen time and investigation of biopsychosocial mechanisms underlying the observed sex differences will allow for causal inference and can inform interventions.

Trends in childhood obesity in Japan: A nationwide observational study from 2012 to 2021

The persistent ascension of childhood obesity on a global scale constitutes a significant quandary. The prevalence of childhood obesity in Japan peaked in the early 2000s and has been reported to have declined since then, but recent data and its trend including the novel coronavirus disease 2019 (COVID-19) pandemic era are not available. Moreover, there is a dearth of studies examining the correlation between the trend in childhood obesity and exercise habits over the past decade. This study aims to examine the changes in the prevalence of obesity, physical fitness, and exercise habits over the past 10 years in Japanese children. We investigated the prevalence of childhood obesity in Japan, using the School Health Statistics Survey data from 2012 to 2021. The dataset has a sample size representative of children nationwide and includes variables for obesity, such as height, weight, and age. Data were classified into groups by sex and age (6-8, 9-11, and 12-14 years age). Children weighing 20% or more of the standard body weight are classified as obese. The annual percentage changes and average annual percentage changes were estimated using the joinpoint regression model. We also examined the trends in the physical fitness test score and exercise time. Average annual percentage changes of boys increased, especially in the 6- to 8-year age group (3.4%-4.6%). For girls, average annual percentage changes had increased in 6- to 8-year (2.5%-4.0%) and 9- to 11-year (0.9%-2.2%) age groups. Since the late 2010s, significantly increasing annual percentage changes were observed in 12- to 14-year age boys (6.7%-8.9%) and girls of many age groups (2.6%-8.6%). The physical fitness test score and exercise time showed decreasing trends since the late 2010s. Childhood obesity may have generally risen in Japan, in the last decade. Encouraging healthy eating and physical activity through school policies and curricula is necessary.

Healthy lifestyle interventions within the curriculum in school-age children: systematic review and meta-analysis

Childhood obesity is a major public health challenge. Previous research has identified the impact of school-based interventions for preventing and treating obesity; we hypothesized that when curricular changes are integrated, results could be exponentiated. This study aimed to systematically review and conduct a meta-analysis of the published literature analyzing information about school-based interventions inserted in the curriculum. The Cochrane Handbook methodology was followed. An electronic search was conducted in five databases, with a specific design strategy per database. Randomized controlled trials or quasi-experimental studies of children with nutrition and physical activity (PA) interventions inserted into the school curricula were included. The risk of bias was assessed with the Risk of Bias tool. The mean differences were pooled using a fixed-effects model for the meta-analysis. The certainty of the evidence was evaluated according to the guidelines of the Grading of the Recommendations, Assessment, Development, and Evaluations working group (Protocol ID: CRD42021270557). After the screening and selection process, 12 studies were included. The interventions identified, based on the school curricula, include classroom activities and homework, among others. A meta-analysis with five intervention groups presented an overall mean difference of -0.14 body mass index (BMI) Z-score (95% CI: -0.25, -0.03) after this intervention with high certainty of the evidence. This systematic review and meta-analysis suggest that nutrition and PA lessons inserted into the curricula and supported with additional activities (i.e. homework, workshops, etc.) could increase nutrition knowledge and improve attitudes toward fruit, vegetables, and water consumption, and BMI Z-score reduction.

Mediation of the association between screen time and suicidality by overweight/obesity and perceived overweight: results from the youth risk behavior surveillance system of the United States

Aim

Adolescent suicide is a major public health concern, and modifiable risk factors associated with adolescent suicide remain poorly understood. This study aimed to assess the association between screen time and overweight/obesity and self-perceived overweigh and suicidality in adolescents.

Methods

Adolescents from the United States Youth Risk Behavior Surveillance System (YRBSS) between 2013 and 2019 were included in this cross-sectional study. The outcome was suicidality, including considered suicide, made a suicide plan, attempted suicide, and injurious suicide attempt. Multivariable logistic regression model was used to investigate the associations between screen time, overweight/obesity, self-perceived overweight, and suicidality, and expressed as odds ratio (OR) and 95% confidence interval (CI). Mediation analysis was used to explore the role of overweight/obesity and self-perceived overweight on the association between screen time and suicidality.

Results

A total of 30,731 adolescents were included, of which 6,350 (20.65%) had suicidality, including 5,361 (17.45%) with considered suicide, 4,432 (14.42%) with made a suicide plan, 2,300 (7.45%) with attempted suicide, and 677 (2.21%) with injurious suicide attempt. Adolescents with screen time ≥3h were related to higher odds of suicidality (OR=1.35, 95%CI: 1.23-1.46), overweight/obesity (OR=1.27, 95%CI: 1.19-1.38), and self-perceived overweight (OR=1.38, 95%CI: 1.30-1.48) after adjusting confounders. Adolescents with overweight/obesity (OR=1.30, 95%CI: 1.19-1.43) and self-perceived overweight (OR=1.54, 95%CI: 1.39-1.70) were associated with higher odds of suicidality. The association between screen time and suicidality was 4.67% mediated by overweight/obesity and 9.66% mediated by self-perceived overweight. Moreover, the mediating role of overweight/obesity was observed only in females, whereas there were no sex differences in the mediating effect of self-perceived overweight.

Conclusion

Both overweight/obesity and self-perceived overweight mediated the association between screen time and suicidality.

Factors associated with consuming unhealthy food in school children: A population-based study from Hong Kong

Background and Aims

Unhealthy diets were found to be the main contributor to the overweight problem among adolescents. In this study, we aim to identify the factors causing unhealthy eating habits in adolescents.

Methods

School-aged children and adolescents participated in this cross-sectional observational study with additional school and parental consent. A self-administered survey was conducted by 30 primary schools and 25 secondary schools. Participants were asked about the frequency of consuming unhealthy food and the types of unhealthy food consumed. A descriptive analysis was performed to demonstrate the proportions of characteristics. The prevalence of the outcome among participants of various factors was also analyzed using separate binary regression models.

Results

A total of 4884 responses were collected. Among primary school students (grade 4, mean age: 10.06), people who (1) were actively gaining weight (aOR: 1.651, 95% CI 1.006-2.708, p = 0.047), (2) went to bed after 11 p.m. (aOR: 1.652, 95% CI 1.065-2.563, p = 0.025), (3) had more than 2 h of gaming (aOR: 2.833, 95% CI 1.913-4.195, p < 0.001), (4) suffered from self-report depressive symptoms (aOR: 1.753, 95% CI 1.233-2.493, p = 0.002) was more likely to consume unhealthy food. As for secondary school students (grade 3, mean age: 15.28), (1) males (aOR: 1.266, 95% CI 1.0004-1.601, p = 0.0496), (2) average-to-high socioeconomic status (Average: aOR: 1.471, 95% CI 1.115-1.941, p = 0.006; High: aOR: 2.253, 95% CI 1.585-3.202. p < 0.001), (3) having more than 2 h of gaming (aOR: 1.342, 95% CI 1.069-1.685, p = 0.011), (4) suffering from psychological distress (aOR: 1.395, 95% CI 1.051-1.852, p = 0.021) were associated with the increased odds of consuming unhealthy food.

Conclusion

Several lifestyle and health factors were significantly associated with unhealthy eating behaviors in school-aged children and adolescents in Hong Kong, sharing similarities with many other countries. In conjunction with implementing a policy that addresses factors for unhealthy eating habits, further research should investigate potential interventions targeting these factors to ultimately tackle the overweight and obesity concern for children and adolescents in Hong Kong.