The association between obesity and academic performance in youth: a systematic review

Bidirectional longitudinal associations of mental health with academic performance in adolescents: DADOS study

BACKGROUND

The dual-factor model of mental health (i.e., the presence of psychological well-being along with the absence of distress) and its association with academic performance over time has been barely studied in the adolescent population, as most of the prior research focuses on psychological well-being or distress indicators in isolation. The current study analyzed the bidirectional longitudinal association between the dual-factor model of mental health and academic performance in adolescents, comprising a longitudinal assessment 2 years apart.

METHODS

A total of 266 secondary school students (13.9 ± 0.3 years at baseline) from Deporte, ADOlescencia y Salud study were assessed. Mental health was assessed through the Behavior Assessment System for Children and Adolescents. Academic performance was assessed through academic grades and the Test of Educational Abilities. A cross-lagged modeling approach was used to examine the bidirectional longitudinal association between mental health and academic performance.

RESULTS

Higher academic performance at baseline was associated with better mental health over time, but not vice versa, since this association was not bidirectional.

CONCLUSION

Results suggest that academic performance is an important target for developing educational interventions, as it shapes adolescents' mental health at 2 years of follow-up.

IMPACT

The overall picture of students' mental health and academic performance was analyzed. Academic performance may be a predictor of adolescents' mental health status. Mental health may not be a predictor of adolescents' academic performance. Good mental health should be promoted among youth with low academic performance.

Higher adherence to the Mediterranean Diet is associated with better academic achievement in Spanish university students: A multicenter cross-sectional study

The objective was to assess the association of the overall score and different items of the Mediterranean Diet Adherence Screener (MEDAS) questionnaire with academic achievement in Spanish university students. We hypothesized that university students with greater adherence to the Mediterranean Diet (MedDiet) would have better academic achievement. A cross-sectional study was performed involving 266 first-year students from the University of Castilla-La Mancha, Spain, during the 2017-2018 academic year. Adherence to the Mediterranean diet was evaluated with the 14-item MEDAS questionnaire. As an indicator variable for academic achievement, the average marks of the examinations required for access to Spanish universities were used. A total of 63 participants (23.6%) adhered to MedDiet recommendations. Analysis of covariance models showed that participants with higher adherence to the MedDiet had significantly higher scores on academic achievement than their peers with low adherence (P < .001) after controlling for potential confounders. Additionally, the evaluation of each item of the MEDAS questionnaire showed that a diet rich in olive oil, vegetables, fruits, legumes, fish and shellfish, and a low consumption of sweets and carbonated beverages were positively associated with academic achievement; nevertheless, wine intake was inversely associated. This study showed that Spanish university students had a low prevalence of good adherence to the MedDiet. Additionally, our results suggested that higher adherence to the MedDiet is associated with better academic achievement in Spanish university students. From a public health perspective and because of low adherence, it is important to continue to focus on promoting adherence to the MedDiet as part of a healthy lifestyle pattern to improve the academic performance of young university students.

Associations of Body Mass Index with Self-Rated Health and Weight Perceptions Among Rural Appalachian Adolescent Students

BACKGROUND

Adolescents with overweight or obesity are at greater risk of having physical and psychosocial consequences. With increased disparities and inadequate literature on prevalence of adolescent weight status in rural Appalachia, there is potential for further complications. Unfortunately, adolescent obesity treatment options are often limited, especially in medically underserved regions.

METHODS

This cross-sectional study of adolescents at eight rural Appalachian schools examined weight status among and associations between body mass index percentile (BMIp) categories and health-related perceptions and weight-control intentions. Previously validated instruments were utilized. Analyses included independent samples t-tests, ANOVA tests, and chi-squared tests.

RESULTS

Of 814 adolescents (ages 11-13; 55.0% girls), BMIp revealed 20.8% overweight, 22.7% obese, and 10.6% severely obese. Adolescents with higher BMIp categories reported poorer self-rated health, inaccurate weight perceptions, and greater weight loss intentions (all p < .05).

CONCLUSIONS

Findings, including high prevalence of adolescents with overweight and obesity, emphasize the need for more obesity prevention and treatment options. Schools may be an ideal setting to reach at-risk adolescents and provide obesity prevention and treatment options, especially in medically underserved regions such as rural Appalachia. Opportunities and challenges to apply findings, including school-based obesity programs, are discussed.

Childhood Obesity: An Updated Review

BACKGROUND

Childhood obesity is an important and serious public health problem worldwide.

OBJECTIVE

This article aims to familiarize physicians with the evaluation, management, and prevention of childhood.

METHODS

A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article.

RESULTS

Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition.

CONCLUSION

Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.

Does Physical Fitness Relate to Academic Achievement in High School Students?

BACKGROUND

Academic achievement (AA) is an important issue not only during the school period since it is a strong predictor of long-term professional and social success. Physical fitness (PF) components are associated with AA, and previous studies were conducted with relatively small samples, lack of statistical power, and the conclusions are based on simple correlational analyses. The objective of this study was to analyze the association between PF (single and clustered) with AA in a large and representative sample of high school students.

METHODS

Cross-sectional design study conducted with 911 students, aged 13-15 years (38.52% boys) enrolled in the first year of high school. Cardiorespiratory fitness (20-m shuttle run test), muscular strength (dynamometer), and body composition (skinfolds) were measured. PF components were clustered (Z-cardiorespiratory fitness + Z-muscular strength - Z-body fatness). AA was analyzed through standard math tests. Hierarchical linear regression analysis was applied to verify the independent contribution of each single component and PF's cluster on AA. Age, screen time, maternal education, race, and type of residence were used as covariates.

RESULTS

Among boys, cardiorespiratory fitness was negatively associated with AA (β = -0.137; P = .041), while strength was positively associated with AA (β = 0.188; P = .004). There was no association between clustered PF indicators and AA (β = 0.064; P = .297). There was a negative association between age and AA in girls (β = -0.151; P = .003) and in boys (β = -0.128; P = .045).

CONCLUSIONS

These results support current literature, indicating an association between PF's component, namely muscular strength and AA (mathematics) in adolescents, even when controlled for several covariates.

The moderating role of recreational substance use in the association of Mediterranean diet with academic performance among adolescents

No study has examined the potential moderating role of recreational substance use in the relationship between the Mediterranean diet (MedDiet) and academic performance. The aim of this study was to test the potential moderating role of recreational substance use (i.e., alcohol, tobacco, and cannabis) in the association of adherence to the MedDiet with academic performance among adolescents. This cross-sectional study included a sample of 757 adolescents (55.6% girls) aged 12-17 years from the Valle de Ricote (Region of Murcia). The Region of Murcia is an autonomous community of Spain located in the southeast of the Iberian Peninsula, along the coast of the Mediterranean Sea. Adherence to the MedDiet was assessed by the Mediterranean Diet Quality Index for Children and Teenagers (KIDMED). Recreational substance use (i.e., tobacco, alcohol, cannabis) was self-reported by adolescents. Academic performance was assessed by the school records at the end of the academic year. The relationship between adherence to the MedDiet and academic performance was moderated by both tobacco and alcohol use (for grade point average and all school records). In conclusion, higher adherence to the MedDiet was related to greater academic performance in adolescents, but recreational substance use could moderate this association.

Umbrella systematic review finds limited evidence that school absence explains the association between chronic health conditions and lower academic attainment

Introduction

Absence from school is more frequent for children with chronic health conditions (CHCs) than their peers and may be one reason why average academic attainment scores are lower among children with CHCs.

Methods

We determined whether school absence explains the association between CHCs and academic attainment through a systematic review of systematic reviews of comparative studies involving children with or without CHCs and academic attainment. We extracted results from any studies that tested whether school absence mediated the association between CHCs and academic attainment.

Results

We identified 27 systematic reviews which included 441 unique studies of 7, 549, 267 children from 47 jurisdictions. Reviews either covered CHCs generally or were condition-specific (e.g., chronic pain, depression, or asthma). Whereas reviews found an association between a range of CHCs (CHCs generally, cystic fibrosis, hemophilia A, end-stage renal disease (pre-transplant), end-stage kidney disease (pre-transplant), spina bifida, congenital heart disease, orofacial clefts, mental disorders, depression, and chronic pain) and academic attainment, and though it was widely hypothesized that absence was a mediator in these associations, only 7 of 441 studies tested this, and all findings show no evidence of absence mediation.

Conclusion

CHCs are associated with lower academic attainment, but we found limited evidence of whether school absence mediates this association. Policies that focus solely on reducing school absence, without adequate additional support, are unlikely to benefit children with CHCs.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285031, identifier: CRD42021285031.

Correlation of Physical Activity to Mental Health State and Grade Point Average Among Medical Students in Saudi Arabia: A Cross-Sectional Study

INTRODUCTION

Physical activity (PA) significantly impacts mental health. However, studies addressing the influence of PA on the mental health and academic performance of medical students are scarce.

MATERIALS AND METHODS

A cross-sectional study was carried out among 2,819 students pursuing their medical degrees in Saudi Arabia. PA was measured using the Global Physical Activity Questionnaire, and the state of their mental health was recorded using the Hospital Anxiety and Depression Scale. A multi-logistic regression was performed to predict the risk factor of poor academic performance.

RESULTS

The prevalence of abnormal anxiety and depression levels were found to be 45.3% and 31.6%, respectively, which were comparatively more prevalent among students of younger age (p < 0.001). Students with abnormal anxiety levels had significantly lower grade point average (GPA) levels than others (p < 0.001). Those who were aged < 21 years, female gender, with chronic disease presence, low PA levels, and abnormal anxiety levels were independently associated with lower GPA levels (p < 0.05).

CONCLUSION

Low PA and high anxiety and depression levels were found to affect the academic performance of medical students in Saudi Arabia. Hence, health education about the importance of PA should be directed to those students.

Longitudinal weight status and academic achievement in elementary schoolchildren in the United States

BACKGROUND/OBJECTIVES

Childhood overweight and obesity have a well-established negative impact on children's health. Overweight and obesity might also negatively impact children's academic performance, but existing literature on this association is inconclusive. This study uses a longitudinal design in a large, diverse elementary school sample to rigorously test the association between longitudinal weight status and academic achievement. Analyses also investigate modification by sex, race/ethnicity, and cardiorespiratory fitness (CRF).

SUBJECTS/METHODS

In a large suburban school district in the United States, 4936 Grade 4 students were recruited. Demographic, course grade, and standardized test data were collected from school records for Grades 3-5, and body mass index and CRF were assessed each year. Students wore accelerometers during the school day for up to 15 days across three semesters (Grade 4 Fall and Spring, Grade 5 Fall) to objectively measure physical activity. Multiple imputation addressed missing data and multilevel analyses controlled for student demographics and clustering within schools.

RESULTS

Unadjusted multilevel models found small negative associations between persistent obesity and course grades and standardized test scores, but these associations largely disappeared when controlling for demographic characteristics. Residual associations for math and writing course grades were attenuated when controlling for CRF, though some marginal negative associations for math and writing remained for students who developed obesity during follow-up. There was also evidence of marginal negative associations with course grades for students who developed overweight/obesity. There was no evidence of modification by sex or race/ethnicity.

CONCLUSIONS

Results suggest very small associations between weight status and academic achievement that were largely explained by sociodemographic factors and CRF. Evidence of an association between weight status and achievement was stronger among students who developed overweight/obesity. Interventions promoting healthy weight and high CRF remain critical for schools given the link between student health and achievement.

Longitudinal associations between weight status and academic achievement in primary school children

BACKGROUND

Evidence for longitudinal associations between childhood weight status and academic achievement remains unclear due to considerable heterogeneity in study design, measures of academic achievement and appropriate categorization of weight status.

OBJECTIVE

To examine longitudinal associations between childhood weight status (underweight, healthy weight, overweight/obese) and academic achievement in the transition from preschool to primary (elementary) school among Australian school children.

METHODS

Data were from the Healthy Active Preschool and Primary Years study. Height and weight, for calculating BMI were measured at baseline (preschool age 3-5 years; 2008/9) and follow-up (primary school age 6-8 years; 2011/12). Academic achievement was measured at age 9 years.

RESULTS

No associations between BMI z-score or weight category in the preschool years and later NAPLAN scores were found for boys. For girls, having a higher BMI z-score (B = -13.68, 95%CI: -26.61, -0.76) and being affected by overweight (B = -33.57, 95%CI: -61.50, -5.24) in preschool was associated with lower language scores. Remaining affected by overweight from preschool to primary school was associated with lower numeracy (B = -25.03, 95%CI: -49.74, -0.33), spelling (B = -33.5, 95%CI: -63.43, -3.58), language (B = -37.89, 95%CI: -72.75, -3.03) and total achievement scores (B = -24.24, 95%CI: -44.85, -3.63) among girls. For boys, becoming affected by overweight was associated with lower spelling (B = -38.76, 95%CI: -73.59, -3.93) and total achievement scores (B = -27.70, 95%CI: -54.81, -0.58).

CONCLUSIONS

Associations between being affected by overweight/obesity and poorer academic achievement were more pronounced in girls than boys, indicating potentially inequitable impacts of excess weight and highlighting the greater need for intervention among girls. However, stronger study designs are needed to confirm our findings.

An International Study of Correlates of Women's Positive Body Image

Positive body image (PBI) has received attention in the recent research literature. Despite this, its role in daily functioning in different cultural contexts, particularly its potential relationship with academic outcomes, is still lacking. This study aimed to offer an international perspective on the association between PBI and body mass index (BMI), perceived academic achievement, and educational aspirations, as well as the mediating role of self-esteem. A cross-national study was conducted in eight European countries with a total of 2653 female university students. Participants completed an online survey measuring PBI (conceptualized as body appreciation), self-esteem, perceived academic achievement and aspirations, and body mass index (BMI). Results revealed differences in PBI between countries (low magnitude). PBI correlated negatively with BMI in all national groups (low-to-moderate magnitude). Mediation analysis showed that self-esteem mediated the association between PBI and academic variables. Findings from this study suggest that building students’ self-esteem and PBI can be a suitable way to boost academic success.

Association of Weight Perception, Body Satisfaction, and Weight Loss Intention With Patterns of Health Risk Behaviors in Adolescents With Overweight and Obesity

Obesity is a public health issue and childhood is a critical window in which to establish healthy eating patterns and modify risk factors for overweight. This study aims to verify the association of weight perception, body satisfaction, and weight loss intention with patterns of health risk behaviors in adolescents with overweight and obesity. We analyzed health risk behavior from a school-based national survey conducted in 2015 in Brazil (n = 2,703 students with overweight or obesity, aged 13-17 years). We performed latent class analysis of alcohol consumption, tobacco use, physical activity, screen time, and eating habits for adolescents with overweight and identified four distinct health behavior patterns. The association of these patterns with weight perception, body satisfaction, and weight loss intention was analyzed through multinomial logistic regression. Adolescents who perceived themselves as "fat" or "very fat" were more likely to have a sedentary lifestyle and low consumption of fruit and vegetables. Body satisfaction was a protective factor against sedentary lifestyle. Students who reported weight loss intention were less likely to be in high-health-risk behavior groups (low consumption of fruit and vegetables; sedentary lifestyle; tobacco and alcohol use). Self-perception as overweight had detrimental associations, while body satisfaction was a protective factor for a healthy lifestyle. Weight loss intention still requires rigorous analysis due to inconsistencies in the literature. The complexity of the relationship between body image and obesity needs to be highlighted. Multicomponent strategies are required to control the global obesity pandemic.

Differences in Health-Related Physical Fitness and Academic School Performance in Male Middle-School Students in Qatar: A Preliminary Study

This study examined the differences in the level of physical fitness and academic performance among male middle-school children based on different body status categories. A total of 69 male children [age: 12.4 ± 0.7 years; body mass: 58.5 ± 7.2 kg; height: 1.62 ± 0.09 m; and body mass index (BMI): 22.4 ± 3.3 kg/m²] participated and were divided into BMI age-adjusted groups (i.e., lowest, middle, and highest BMI). Height, mass, BMI, stork test of static balance, 10 and 15 m sprint as an indicator for speed, hand-grip strength test, agility T-half test, medicine ball throw (MBT), and the Yo-Yo Intermittent Recovery Test level 1 (Yo-Yo IR1) were assessed. School records were retrieved for grade point averages (GPA) of mathematics, science, and Arabic. We found significant group differences regarding anthropometric (height: ηp2 = 0.24, mass: ηp2 = 0.33, and BMI: ηp2 = 0.66), physical (sprint 10 m: ηp2 = 0.26), and academic (mathematics: ηp2 = 0.19 and science: ηp2 = 0.15) performance parameters. The largest difference (p < 0.001) was observed between the lowest and highest group for the 10 m sprint. All pairwise differences were between the lowest and highest BMI group or the lowest and middle BMI group. No relevant (r > 0.5) correlation between parameters of different dimensions (e.g., anthropometric vs. physical performance parameters) was found. In conclusion, the highest BMI group exhibited similar physical and academic performances than the lowest group. Thus, these data emphasize the importance and appropriateness to engage young Qatari schoolchildren in physical activity as it associates with superior academic performance.

Academic performance and psychosocial functioning in European schoolchildren: The role of cardiorespiratory fitness and weight status

BACKGROUND

Whether a high cardiorespiratory fitness (CRF) can attenuate the potential detrimental effect of childhood obesity on academic performance and particularly psychosocial functioning remains unclear.

OBJECTIVES

To analyse the academic performance/psychosocial functioning of schoolchildren attending to their CRF and weight status.

METHODS

470 schoolchildren (46% girls, 7 ± 0 years) from 20 schools in five European countries were categorized as (i) having overweight/obesity (n = 113) or normal weight (n = 357) attending to body mass index and (ii) 'fit' (n = 282) or 'unfit' (n = 188) based on 20-meter shuttle-run performance (CRF ≥ or <42 ml·kg^-1 ·min^-1 [boys] and 35 ml·kg^-1 ·min^-1 [girls], respectively). Academic performance and psychosocial functioning were assessed using the grades attained in school subjects and the Strengths and Difficulties Questionnaire (SDQ) for parents, respectively.

RESULTS

Independent of their weight status, fit children showed a greater academic performance and psychosocial functioning than their peers who were unfit and overweight/obese. In fit children, academic performance and psychosocial functioning did not differ between the two weight status categories (normal weight or overweight/obesity).

CONCLUSIONS

Children with a higher CRF show a greater performance achievement and psychosocial functioning regardless of their weight status, thereby supporting the 'fat but fit' paradox and reinforcing the importance of improving CRF in this population.

Association of Academic Performance With Obesity and Unhealthy Lifestyle Among Female University Students

Aim

This study aims to examine the relationship between obesity and academic performance and to investigate the relevance between an unhealthy lifestyle and academic performance, which may exist among obese and non-obese female students in the College of Science and College of Medicine of Imam Mohammad Ibn Saud Islamic University.

Method

The study is observational, descriptive, and cross-sectional in nature and covers a sample of 328 female students aged 19 to 23 years. They were randomly selected from the College of Science and College of Medicine. Sample collection was conducted from December 12, 2020 to June 15, 2021.

Results

The result indicates that obesity did not influence academic performance. The association between obesity and academic performance was non-significant (p = 0.335). In the College of Science, grades in physics and math were analyzed, which reflected a weak association with obesity (p = 0.893 and p = 0.872, respectively). Various factors exerted a positive impact on academic performance, such as eating yogurt at least 1-5 times per week (p < 0.05) and spending less than 4 hours on social media or watching TV (p < 0.05).

Conclusion

Academic performance is influenced by many factors. Eating yogurt more frequently and watching TV and less time for social media are the factors with the largest influence on academic performance. However, obesity does not influence academic performance. In summary, physical activity and a healthy diet exerted no direct effect on academic performance.

Does sleep-disordered breathing add to impairments in academic performance and brain structure usually observed in children with overweight/obesity?

Approximately 4-11% of children suffer from sleep-disordered breathing (SDB), and children with obesity are at increased risk. Both obesity and SDB have been separately associated with poorer brain health, yet whether SDB severity affects brain health in children with obesity remains unanswered. This study aimed to examine associations of SDB severity with academic performance and brain structure (i.e., total brain and gray and white matter volumes and gray matter volume in the hippocampus) in children with overweight/obesity. One hundred nine children aged 8-12 years with overweight/obesity were included. SDB severity and its subscales (i.e., snoring, daytime sleepiness, and inattention/hyperactivity) were evaluated via the Pediatric Sleep Questionnaire (PSQ), and academic performance was evaluated with the Woodcock-Muñoz standardized test and school grades. Brain structure was assessed by magnetic resonance imaging. SDB severity was not associated with academic performance measured by the standardized test (all |β|> 0.160, P > 0.076), yet it was associated with the school grade point average (β = -0.226, P = 0.007) and natural and social science grades (β = -0.269, P = 0.024). Intention/hyperactivity seemed to drive these associations. No associations were found between SDB severity and the remaining school grades (all β < -0.188, P > 0.065) or brain volumes (all P > 0.05).

CONCLUSION

Our study shows that SDB severity was associated with lower school grades, yet it was not associated with the standardized measurement of academic performance or with brain volumes in children with overweight/obesity. SDB severity may add to academic problems in children beyond the effects contributed by overweight/obesity status alone.

WHAT IS KNOWN

• Sleep-disordered breathing (SDB) may affect brain structure and academic performance in children. • Children with overweight/obesity are at higher risk for the development of SDB, yet the comorbid obesity-SDB relationship with brain health has not been investigated thus far.

WHAT IS NEW

• To our knowledge, this is the first study examining the associations of comorbid obesity-SDB severity with brain volumes and academic performance in children. • SDB symptoms may adversely affect academic performance at school in children with overweight/obesity, beyond the effects of weight status alone.

Impact of Adenotonsillectomy on Homework Performance in Children With Obstructive Sleep-Disordered Breathing

OBJECTIVE

As a first line treatment for pediatric obstructive sleep-disordered breathing (SDB), adenotonsillectomy (AT) has been shown to confer physiologic and neurocognitive benefits to a child. However, there is a scarcity of data on how homework performance is affected postoperatively. Our objective was to evaluate the impact of AT on homework performance in children with SDB.

METHODS

Children in grades 1 to 8 undergoing AT for SDB based on clinical criteria with or without preoperative polysomnography along with a control group of children undergoing surgery unrelated to the treatment of SDB were recruited. The primary outcome of interest was the differential change in homework performance between the study group and control at follow-up as measured by the validated Homework Performance Questionnaire (HPQ-P). Adjustments were made for demographics and Pediatric Sleep Questionnaire (PSQ) scores.

RESULTS

116 AT and 47 control subjects were recruited, and follow-up data was obtained in 99 AT and 35 control subjects. There were no significant differences between the general (total) HPQ-P scores and subscale scores between the AT and control subjects at entry and there were no significant differences in the change scores (follow-up minus initial scores) between the groups. Regression modeling also demonstrated that there were no group (AT vs control) by time interactions that predicted differential improvements in the HPQ-P (P > .10 for each model) although initial PSQ score was a significant predictor of lower HPQ-P scores for all models.

CONCLUSIONS

Children with SDB experienced improvement in HPQ-P scores postoperatively, but the degree of change was not significant when compared to controls. Further studies incorporating additional educational metrics are encouraged to assess the true scholastic impact of AT in children with SDB.

The Role of Chronic Physical Activity in Alleviating the Detrimental Relationship of Childhood Obesity on Brain and Cognition

Childhood obesity and its negative relation with children’s brain health has become a growing health concern. Over the last decade, literature has indicated that physical activity attenuates cognitive impairment associated with obesity and excess adiposity in children. However, there is no comprehensive review that considers the extent to which these factors affect different domains of cognition. This narrative review comprehensively summarizes behavioral, neuroimaging, and neuroelectric findings associated with chronic physical activity and fitness on brain and cognition in childhood obesity. Based on the literature reviewed, increased adiposity has a demonstrated relationship with neurocognitive health via mechanisms triggered by central inflammation and insulin resistance, with the most pronounced decrements observed for cognitive domains that are prefrontal- and hippocampal-dependent. Fortunately, physical activity, especially interventions enhancing aerobic fitness and motor coordination, have demonstrated efficacy for attenuating the negative effects of obesity across different subdomains of structural and functional brain imaging, cognition, and multiple academic outcomes in children with overweight or obesity. Such mitigating effects may be accounted for by attenuated central inflammation, improved insulin sensitivity, and increased expression of neurotrophic factors. Lastly, individual differences appear to play a role in this relationship, as the manipulation of physical activity characteristics, the employment of a wide array of cognitive and academic measures, the inclusion of different adiposity measures that are sensitive to neurocognitive function, and the utilization of an inter-disciplinary approach have been found to influence the relationship between physical activity and excess adiposity on brain and cognition.

Factors associated with school achievement of children aged 8-10 years in rural Bangladesh: Findings from a post hoc analysis of a community-based study

Background

Education is one of the most important human capitals. Investment in education at early age returns best. A lot of factors influence children’s educational achievement. Studies in developed countries well established the relation of school achievement with its associated variables. But information is lack on what factors play important role for school achievement at early age in low resource settings like Bangladesh. We aimed to find factors associated with school achievement in rural Bangladesh.

Method

The data were acquired from a long-term follow up study, conducted in 8–10 years old children (n = 372). We used a locally developed school achievement tool based on Wide Range Achievement Test-4 to measure reading, spelling and math computation, Wechsler abbreviated scale of intelligence to measure intelligence Quotient (IQ), Digit span forward and backward for short term memory, and locally available Strength and Difficulties Questionnaire to measure behaviour. Socioeconomic and anthropometric information of the mothers and children were also collected. Multicollinearity of the data was checked. Unadjusted and adjusted multiple linear regression analysis was performed.

Findings

Years of schooling and short-term memory were positively related to reading, spelling and math computation. For years of schooling it was-reading B = 8.09 (CI 5.84, 10.31), spelling 4.43 (4.33, 8.53) and math computation 5.23 (3.60, 6.87) and for short term memory- reading 3.56 (2.01,5.05), spelling 4.01 (2.56, 5.46) and math computation 2.49 (1.37, 3.62). Older children had lower scores of reading -0.48 (-0.94, -0.02), spelling -0.41 (-0.88, -0.02) and math computation -0.47 (-0.80, -0.14). Children’s IQ predicted reading 0.48 (0.14, 0.81) and spelling 0.50 (0.18, 0.82) skills. Mother and father’s education predicted Spelling 0.82 (0.16, 1.48) and reading 0.68 (0.06, 1.30) capacity respectively. Children enrolled in private schools had higher reading 10.28 (5.05, 15.51) and spelling 6.22 (1.31, 11.13) than those in the government schools. Children with more difficult behaviour tended to have lower scores in reading -0.51 (-0.96, -0.05).

Conclusion

Children’s school achievement is influenced by their IQ, years of schooling, type of school and parents’ education. Therefore, intervention should be made to focus specifically on these variables and establish the effect of this intervention through robust research design.

Factors associated with grip strength among adolescents: An observational study

STUDY DESIGN

Cross-sectional.

INTRODUCTION

The muscle strength has been studied in different populations in relation with individual and other factors.

PURPOSE OF THE STUDY

The purpose of this study was to determine values of grip strength in adolescents and to examine its association with sex, age, weight, height, nutritional status, handedness, and academic performance.

METHODS

A total of 452 adolescents (246 men and 206 women) aged 12 to 17 years were included in the study. Grip strength was measured using a Takei dynamometer.

RESULTS

Boys were significantly stronger than girls with both the dominant hand (33.1 kgf vs 25.0 kgf; mean difference = 8.1 kgf; P < .001) and the nondominant hand (30.9 kgf vs 23.1 kgf; mean difference = 7.8 kgf; P < .001), and there was a significant increase in strength values as the age rises in both sexes (P < .001). The dominant hand was stronger than the nondominant one (29.4 kgf vs 27.3 kgf; mean difference = 2.1 kgf; P < .001), except for left-handed subjects who were significantly stronger than right-handed ones in their nondominant hand. Furthermore, strength was positively associated with nutritional status and negatively associated with academic performance in men.

CONCLUSIONS

Sex, age, handedness, nutritional status, and academic performance have a significant influence on the grip strength values. There seems to be a sexual dimorphism in the relationship between strength and both nutritional status and academic performance.

Kindergarten Obesity and Academic Achievement: The Mediating Role of Weight Bias

This study draws the attention towards the importance of reducing weight discrimination against children for their educational success, as an issue of social justice. We investigate the consequences of early-onset obesity identifying the mediating mechanisms in the relationship between childhood obesity and academic achievement. To do so, we employ the Early Childhood Longitudinal Study-Kindergarten Cohort (kindergarten to fifth grade) in the US (ECLS-K: 2011) and apply a parallel process latent growth model with a combination of quasi-experiments and econometrics. The results of this study suggest that teachers may serve as a significant source of weight bias, especially for girls (B = -0.09, 95% BC CI [-2.37 to -0.46]).

Common health conditions in childhood and adolescence, school absence, and educational attainment: Mendelian randomization study

Good health is positively related to children's educational outcomes, but relationships may not be causal. Demonstrating a causal influence would strongly support childhood and adolescent health as important for education policy. We applied genetic causal inference methods to assess the causal relationship of common health conditions at age 10 (primary/elementary school) and 13 (mid-secondary/mid-high school) with educational attainment at 16 and school absence at 14-16. Participants were 6113 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). Exposures were symptoms of attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), depression, asthma, migraines and BMI. Genetic liability for these conditions and BMI was indexed by polygenic scores. In non-genetic, multivariate-adjusted models, all health conditions except asthma and migraines were associated with poorer attainment and greater school absence. School absence substantially mediated effects of BMI (39.9% for BMI at 13) and migraines (72.0% at 10), on attainment with more modest mediation for emotional and neurodevelopmental conditions. In genetic models, a unit increase in standardized BMI at 10 predicted a 0.19 S.D. decrease (95% CI: 0.11, 0.28) in attainment at 16, equivalent to around a 1/3 grade lower in all subjects, and 8.7% more school absence (95% CI:1.8%,16.1%). Associations were similar at 13. Genetic liability for ADHD predicted lower attainment but not more absence. Triangulation across multiple approaches supports a causal, negative influence on educational outcomes of BMI and ADHD, but not of ASD, depression, asthma or migraine. Higher BMI in childhood and adolescence may causally impair educational outcomes.

A SINGLE PHYSICAL EDUCATION SESSION IMPROVES SUBSEQUENT ACADEMIC PERFORMANCE IN RURAL SCHOOL STUDENTS

ABSTRACT Introduction: Activity breaks or physical exercise interventions in schools are linked to better cognitive function in adolescents. However, few studies have evaluated the relationship between physical exercise and cognition in rural schools, where drop-out levels tend to be higher and academic achievement lower. Objective: To analyze the effects of a physical exercise class (PE) on subsequent academic performance of students, and how they felt during mathematics (MATH) and Portuguese language (PL) tests. Methods: Thirty-six students (14.9 ± 1.5 years) randomly carried out 30 min of PE, performed at 74.3 ± 11.8%HRmax, while a control group (CON) remained seated watching a movie, prior to the tests (PE-MATH; PE-PL; CON-MATH; CON-PL). Results: The PE-MATH group presented higher scores (5.3 ± 2.2) than the CON-MATH group (4.0 ± 2.2). The tests were completed more quickly in PE-PL (7.8 ± 3.3 minutes) than in CON-PL (10.5 ± 4.2 minutes). The number of correct answer per minute was higher in PE-MATH and PE-PL (0.52 ± 0.25; 0.64 ± 0.51) than in CON-MATH and CON-PL (0.35 ± 0.19; 0.41 ± 0.41). Furthermore, 38.9% of PE-MATH felt more focused during the test, while only 16.7% of CON-MATH felt more focused. During the Portuguese language test, 27.8% of CON-PL complained of greater apprehensiveness, compared to 8.3% for PE-PL. Also, 36.1% reported feeling fatigued during PL after PE, compared to 8.3% in the CON-PL group. Conclusions: PE improved the adolescents' academic performance. Despite feeling fatigue, more students who performed physical exercise felt less apprehensive and more focused during the tests after PE. Level of evidence I; STARD: studies of diagnostic accuracy.

Differences in educational attainment between obese and non-obese Kuwaiti female university students

Individuals with obesity tend to perform less well than their non-obese peers in tertiary education, but there is little evidence from non-Western countries and recent studies. The present study aimed to test whether academic attainment differed between female undergraduates with obesity (defined by body mass index (BMI)), and those who were non-obese in Kuwait, a country with very high obesity prevalence. In 400 female Kuwaiti first- and second-year Social Science students (mean age 18⋅0, sd 0⋅6 years), educational attainment was defined as the Grade Point Average (GPA) across all subjects (from 1⋅00 to 4⋅00). The mean GPA (2⋅51, sd 0⋅53) among students defined as obese by the BMI (n 163) was significantly lower than among the students defined as non-obese by the BMI (n 237; 2⋅80, sd 0⋅63; P < 0⋅001), and those defined as obese were more likely to be in the lowest quartile for the GPA (OR 3⋅03; 95% CI 1⋅90, 4⋅85), independent of socio-economic status. Similar differences were observed between students defined as having high versus normal body fatness. Female undergraduates in Kuwait with obesity have lower academic attainment than their non-obese peers, and universities should consider measures to mitigate reduced attainment among their female undergraduates.

The "Fat but Fit" paradox in the academic context: relationship between physical fitness and weight status with adolescents' academic achievement

The present study aimed to analyze the relationship between obesity and different physical fitness markers with academic achievement in adolescents, as well as to check if the "Fat but Fit paradox" is applicable in this context. A total of 188 participants (83 boys) ranging from 12 to 18 years (14.51 ± 1.29 years) underwent a series of fitness tests, and were categorized as "fit" or "unfit" attending to their estimated cardiorespiratory fitness (above or below 42 and 35 ml·kg^-1·min^-1 for boys and girls, respectively). Participants were also categorized according to their body mass index as having overweight/obesity or not. A variety of fitness markers (i.e., cardiorespiratory fitness, lower-body power, sprint time, and flexibility) were positively associated with academic achievement (all p < 0.05), but no associations were found for upper-body power, upper-limb coordination or agility. Both being fit (β = 0.652, 95% confidence interval: 0.001-1.302) and normoweight (β = 1.085, 0.171-1.999) were positively associated with academic achievement. A higher academic achievement (p = 0.021) was found for fit and normoweight individuals compared to unfit and overweight/obese ones, but no differences were found for the remaining subgroups. These findings suggest that an optimal physical fitness might attenuate the negative consequences induced by obesity on academic achievement.

The Associations between Childhood Obesity, Academic Performance, and Perception of Teachers: From Kindergarten to Fifth Grade

Background: Obesity is weakly associated with negative academic achievement among school-aged children. The purpose of this study is to demonstrate the relationships between reading/mathematics scores (objective) and teachers' perception of learning ability (subjective) and childhood obesity-from kindergarten to fifth grade. Methods: This study examined a longitudinal study of a nationally representative sample of 18,174 children who were enrolled in kindergarten in 2010 in the United States (ECLS-K:2011). Weighted multiple logistic regression models were used to examine the associations between objective scores, subjective scores, and obesity (vs. healthy-weight children). Results: In the crude analyses, obesity was negatively associated with achieving above-median reading and mathematics scores. After adjusting for sex, race/ethnicity, age, and socioeconomic status (SES), the association weakened but was still present. Children with obesity were less likely to achieve above-median reading and mathematics scores than their healthy-weight peers (odds ratio [OR] 0.77 and 0.86 for reading; OR 0.85, 0.67, 0.79, 0.82, and 0.75 for mathematics). Similarly, teachers reported that children with obesity did not have Approaches to Learning and Attentional Focusing as good as their healthy-weight peers regardless of their objective test scores and SES (OR 0.82, 0.80, 0.78, 0.69, and 0.77 for Approaches to Learning; OR 0.80, 0.81, 0.83, 0.82, 0.80, and 0.74 for Attentional Focusing). Conclusions: Obesity during elementary school years is negatively associated with both objective and subjective measures of academic performance. Further studies are needed to understand if the connection is stemming from behavioral issues of children, weight-based bias of teachers, or both.

Overweight and Obesity Impair Academic Performance in Adolescence: A National Cohort Study of 10,279 Adolescents in China

OBJECTIVE

This study aimed to examine the associations of overweight and obesity (ov/ob) and changes in weight status with academic performance among Chinese adolescents.

METHODS

Self-reported weight and height were collected from adolescents (n = 10,279) each year from seventh grade (baseline, 2013-2014) to ninth grade (2015-2016). Academic performance included standardized scores on math, Chinese, and English examinations and responses to a school-life experience scale.

RESULTS

All adolescents with ov/ob had lower academic performance than their counterparts without overweight (β = -0.46 to -0.08; P < 0.05), except for school-life experience for boys. All adolescents with obesity had lower academic performance than their counterparts without obesity (β = -0.46 to -0.17; P < 0.01), except for English test scores for boys. Changes in weight status between grades 7 and 9 impacted academic performance at grade 9. Adolescents with ov/ob throughout grades 7 to 9 and those who developed ov/ob from normal weight had lower test scores (β = -0.80 to -0.25; P < 0.05) than those who maintained normal weight. Those who developed ov/ob after having normal weight had poorer school-life experiences (β = -0.55 to -0.25; P < 0.05).

CONCLUSIONS

Ov/ob and maintaining and developing ov/ob had adverse academic impacts on adolescents. Relevant stakeholders should consider detrimental impacts of obesity on academic outcomes.

Stress and its association with academic performance among dental undergraduate students in Fujian, China: a cross-sectional online questionnaire survey

BACKGROUND

The aim of this study was to investigate the amount and sources of stress in dental undergraduate students in Fujian, China, and the factors associated with stress.

METHODS

This cross-sectional study was conducted during the second semester of the 2017-2018 academic year at the School of Stomatology, Fujian Medical University, China. A total of 396 students were surveyed with the Dental Environment Stress Questionnaire (DES) and the Perceived Stress Scale (PSS) using an online survey system. The participants' demographic information, including sex, age, year of study, and grade point average (GPA) was also collected. One-way analysis of variance (ANOVA) was performed to compare the stress scores. Pearson correlation and multiple linear regression analyses were conducted to explore the associated factors of stress and academic performance. All statistical analyses were performed at a significance level of 5%.

RESULTS

A total of 347 undergraduate students participated in the present study, for a response rate of 87.6%. There were no significant differences in the DES and PSS total scores among students of different grades and sexes. Significant differences were found in the DES "workload" and "self-efficacy beliefs" scores among students from different study years (all P < 0.05). The Multiple linear regression showed that DES and PSS scores were negatively correlated with GPA, while sex was positively correlated with GPA (all P < 0.05). Female students had significantly higher GPAs than male students.

CONCLUSIONS

Dental undergraduates in Fujian, China experienced moderate levels of stress. While the amount of stress did not differ by year of study, the sources of stress did differ. Stress scores and sex were negatively correlated with academic performance.

Associations among Body Mass Index, sedentary behavior, physical activity, and academic performance in schoolchildren

BACKGROUND

Physical inactivity and sedentary behavior are common among middle and high school grade children. This study aimed to determine the relationship among Body Mass Index (BMI), sedentary behavior, physical activity (PA), and overall academic performance of students.

METHODS

This is a cross sectional study; 357 students of mean age 12.65±1.68 years were enrolled. PA was subjectively assessed using the Physical Activity Questionnaire for Children (PAQ-C) and Godin Leisure-Time Exercise Questionnaire (GLTEQ). Sedentary behavior was assessed as hours spent on watching television, playing video games, computer use, and homework. Grade point average (GPA) was calculated to determine their overall academic performance. Participants were divided into two groups based on their GPA. Independent t-test was used to analyze BMI, sedentary time, and PA between the groups. Correlation analysis was performed to determine the associations among BMI, sedentary time, physical activity, and academic grades.

RESULTS

There was no significant difference in BMI and the level of PA between the two groups. However, significant differences were observed in sedentary time (ST) spent watching television (P=0.04), total screen time (P=0.02), and total ST (P=0.002). There were weak negative correlations among BMI (r=-0.14, P<0.05), total screen time (r=-0.12, P<0.05), and academic scores; however, there was no association with any PA measures.

CONCLUSIONS

A weak correlation was noted between BMI and sedentary characteristics, with respect to academic performance. As academic performance is negatively associated with body mass index and screen time, public health interventions are needed to reduce their time spent on leisure time sedentary activity, watching television, and computer use.

What is good mental health? A scoping review

Promotion of good mental health in young people with and without mental disorders has received little empirical research attention and interventions for improving mental health in young people are not well established. This situation could be explained among other reasons due to the difficulties to define and operationalise what good mental health is. The current manuscript, produced by the European College of Neuropsychopharmacology Thematic Working Group on the Prevention of Mental Disorders and Mental Health Promotion (ECNP TWG PMD-MHP), presents a critical review of the available operationalizations for good mental health. A pragmatic conceptual operationalisation of good mental health is a much-needed step towards more standardised research in this field. Good mental health can be defined as a state of well-being that allows individuals to cope with the normal stresses of life and function productively. Universal and selective interventions are suitable to promote mental health. Core domains that define good mental health encompass: (i) mental health literacy, (ii) attitude towards mental disorders, (iii) self-perceptions and values, (iv) cognitive skills, (v) academic/ occupational performance, (vi) emotions, (vii) behaviours, (viii) self-management strategies, (ix) social skills, (x) family and significant relationships (xi) physical health, (xii) sexual health, (xiii) meaning of life, (xiv) and quality of life. These domains should be widely traceable in the literature and can be used to conduct further empirical research in the field of good mental health. Such data can lead to more robust evidence to identify and establish the pathways to follow in order to improve mental health.

Do changes in weight status affect cognitive function in children and adolescents with obesity? A secondary analysis of a clinical trial

OBJECTIVES

It is unclear whether an association exists between obesity in children/adolescents and cognitive function, and whether the latter can be altered by body mass index (BMI) standard deviation score (SDS) reductions. We aimed to determine whether an association exists between BMI SDS and cognitive function in children/adolescents with obesity engaged in an obesity intervention. Second, we sought to determine if BMI SDS reduction at 12 months was associated with improved cognitive function.

DESIGN

Secondary analysis of a clinical trial.

PARTICIPANTS

Participants (n=69) were recruited from an obesity intervention. Eligible participants (recruited June 2013 to June 2015) were aged 6-16 years, with a BMI ≥98th centile or BMI >91st centile with weight-related comorbidities.

OUTCOME MEASURES

Primary outcome measure was change in BMI SDS from baseline at 12 months. Dependent variables of cognitive functioning and school achievement were assessed at baseline and 12 months, using dependent variables of cognitive functioning (elements of Ravens Standard Progressive Matrices, Wide Range Achievement Test-fourth edition and Wechsler Intelligence Scale for Children-fourth edition).

RESULTS

At baseline, BMI SDS was not associated with all aspects of cognitive function tested (n=69). Reductions in BMI SDS over time did not alter cognitive function overall. However, there was a greater reduction in comprehension standard scores in participants who increased their BMI SDS (adjusted estimated difference -6.1, 95% CI -11.6 to -0.6; p=0.03).

CONCLUSIONS

There were no observed associations between BMI SDS and cognitive function in participants, apart from comprehension in the exploratory analyses, which may have been a random finding. Further studies need to include larger longitudinal cohorts incorporating a wider BMI range at entry to determine whether our findings persist.

TRIAL REGISTRATION NUMBER

ANZCTR12611000862943; Pre-results.