1
|
Saintila J, Carranza-Cubas SP, Santamaria-Acosta OFA, Serpa-Barrientos A, Ramos-Vera C, López-López E, Geraldo-Campos LA, Calizaya-Milla YE. Breakfast consumption, saturated fat intake, and body mass index among medical and non-medical students: a cross-sectional analysis. Sci Rep 2024; 14:12608. [PMID: 38824182 PMCID: PMC11144192 DOI: 10.1038/s41598-024-63440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024] Open
Abstract
Changes in dietary patterns and body weight have become a focus of research in undergraduate students. This study compared breakfast consumption, intake of foods high in saturated fat, and BMI between medical and non-medical students. A comparative cross-sectional study was conducted in 4,561 Peruvian university students, of whom 1,464 (32.1%) were from the medical field and 3,097 (67.9%) from the non-medical field. We compared the frequency of breakfast consumption (categorized as regular: 6 to 7 days/week; occasional: 3 to 5 days/week; and rarely or never: 0 to 2 days/week) and the frequency of consumption of foods high in saturated fat. We created simple and multiple linear and Poisson regression models with robust variance to evaluate the association of the mentioned variables with academic fields. Non-medical students (Adjusted Prevalence Ratio [PR] = 0.92, 95% CI 0.86-0.99; p = 0.008) were less likely to eat breakfast regularly compared to medical students. Likewise, consumption of foods high in saturated fats was higher in non-medical students (B = 1.47, 95% CI 0.91-2.04; p < 0.001) compared to medical students. Similarly, the mean BMI of these students was significantly higher than that of medical students (B = 0.33, 95% CI 0.12-0.53; p = 0.002). Although medical students reported relatively healthy eating habits and a lower BMI, there is a widespread need to promote improved diet and lifestyle among the entire university population to reduce the risks of communicable diseases and improve quality of life.
Collapse
Affiliation(s)
- Jacksaint Saintila
- Research Group for Nutrition and Healthy Behaviors, School of Medicine, Universidad Señor de Sipán, Carretera a Pimentel Km 5, Chiclayo, Lambayeque, 14001, Peru.
| | - Sandra P Carranza-Cubas
- Research Group for Nutrition and Healthy Behaviors, School of Medicine, Universidad Señor de Sipán, Carretera a Pimentel Km 5, Chiclayo, Lambayeque, 14001, Peru
| | - Omar F A Santamaria-Acosta
- Research Group for Nutrition and Healthy Behaviors, School of Medicine, Universidad Señor de Sipán, Carretera a Pimentel Km 5, Chiclayo, Lambayeque, 14001, Peru
| | | | | | - Elmer López-López
- Research Group for Nutrition and Healthy Behaviors, School of Medicine, Universidad Señor de Sipán, Carretera a Pimentel Km 5, Chiclayo, Lambayeque, 14001, Peru
| | | | - Yaquelin E Calizaya-Milla
- Research Group for Nutrition and Lifestyle, School of Human Nutrition, Universidad Peruana Unión, Lima 15, Peru.
| |
Collapse
|
2
|
Garcidueñas-Fimbres TE, Gómez-Martínez C, Pascual-Compte M, Jurado-Castro JM, Leis R, Moreno LA, Navas-Carretero S, Codoñer-Franch P, Echeverria AM, Pastor-Villaescusa B, López-Rubio A, García SM, De Miguel-Etayo P, Martínez JA, Aguayo IV, Vázquez-Cobela R, Escribano J, Miguel-Berges ML, De La Torre-Aguilar MJ, Gil-Campos M, Salas-Salvadó J, Babio N. Adherence to a healthy lifestyle behavior composite score and cardiometabolic risk factors in Spanish children from the CORALS cohort. Eur J Pediatr 2024; 183:1819-1830. [PMID: 38260993 PMCID: PMC11001667 DOI: 10.1007/s00431-023-05389-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024]
Abstract
To assess the associations between the adherence to a composite score comprised of 6 healthy lifestyle behaviors and its individual components with several cardiometabolic risk factors in Spanish preschool children. Cross-sectional analyses were conducted in 938 participants included in the CORALS cohort aged 3-6 years. Six recognized healthy lifestyle behaviors (breastfeeding, sleep duration, physical activity, screentime, adherence to the Mediterranean diet, and eating speed) were assessed in a composite score. Multiple linear and logistic regression models were fitted to assess the associations with cardiometabolic risk factors (weight status, waist circumference, fat mass index, blood pressure, fasting plasma glucose, and lipid profile). In the adjusted multiple linear and logistic regression models, compared with the reference category of adherence to the healthy lifestyle behavior composite score, those participants in the category of the highest adherence showed significant decreased prevalence risk of overweight or obesity [OR (95% CI), 0.4 (0.2, 0.6)] as well as significant lower waist circumference, fat mass index (FMI), systolic blood pressure and fasting plasma glucose concentration [β (95% CI), - 1.4 cm (- 2.5, - 0.4); - 0.3 kg/m2 (- 0.5, - 0.1); and - 3.0 mmHg (- 5.2, - 0.9); - 1.9 mg/dL (- 3.5, - 0.4), respectively]. Slow eating speed was individually associated with most of the cardiometabolic risk factors. Conclusions: Higher adherence to the healthy lifestyle behavior composite score was associated with lower waist circumference, FMI, other cardiometabolic risk factors, and risk of overweight or obesity in Spanish preschool children. Further studies are required to confirm these associations. What is Known: • Lifestyle is a well-recognized etiologic factor of obesity and its comorbidities. • Certain healthy behaviors such as adhering to a healthy diet, increasing physical activity, and decreasing screentime are strategies for prevention and treatment of childhood obesity. What is New: • Higher adherence to the healthy lifestyle behavior composite score to 6 healthy behaviors (breastfeeding, sleep duration, physical activity, screentime, eating speed, and adherence to the Mediterranean diet) was associated with decreased adiposity, including prevalence risk of overweight or obesity, and cardiometabolic risk in preschool children. • Slow eating and greater adherence to the Mediterranean diet were mainly associated to lower fasting plasma and serum triglycerides concentration, respectively.
Collapse
Affiliation(s)
- Tany E Garcidueñas-Fimbres
- Departament de Bioquímica i Biotecnologia. Unitat de Nutrició Humana, Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Carlos Gómez-Martínez
- Departament de Bioquímica i Biotecnologia. Unitat de Nutrició Humana, Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria Pascual-Compte
- Departament de Bioquímica i Biotecnologia. Unitat de Nutrició Humana, Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Jose Manuel Jurado-Castro
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, 14004, Córdoba, Spain
| | - Rosaura Leis
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Service, Hospital Clínico Universitario de Santiago, 15706, Santiago de Compostela, Spain
- Pediatric Nutrition Research Group, Unit of Investigation in Nutrition, Growth and Human Development of Galicia-USC, Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
| | - Luis A Moreno
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
| | - Santiago Navas-Carretero
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Center for Nutrition Research, University of Navarra, 31008, Pamplona, Spain
- Fac Pharm & Nutr, Dept Nutr Food Sci & Physiol, University of Navarra, 31008, Pamplona, Spain
- IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Pilar Codoñer-Franch
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Dr. Peset University Hospital, University of Valencia, Valencia, Spain
| | | | - Belén Pastor-Villaescusa
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, 14004, Córdoba, Spain
| | - Alicia López-Rubio
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Service, Hospital Clínico Universitario de Santiago, 15706, Santiago de Compostela, Spain
- Pediatric Nutrition Research Group, Unit of Investigation in Nutrition, Growth and Human Development of Galicia-USC, Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
| | | | - Pilar De Miguel-Etayo
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
| | - J Alfredo Martínez
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Center for Nutrition Research, University of Navarra, 31008, Pamplona, Spain
| | - Inmaculada Velasco Aguayo
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, 14004, Córdoba, Spain
| | - Rocío Vázquez-Cobela
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Service, Hospital Clínico Universitario de Santiago, 15706, Santiago de Compostela, Spain
- Pediatric Nutrition Research Group, Unit of Investigation in Nutrition, Growth and Human Development of Galicia-USC, Health Research Institute of Santiago de Compostela (IDIS), 15706, Santiago de Compostela, Spain
| | - Joaquín Escribano
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Paediatrics, Nutrition, and, Development Research Unit, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Reus, Spain
| | - María Luisa Miguel-Berges
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
| | - María José De La Torre-Aguilar
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, 14004, Córdoba, Spain
| | - Mercedes Gil-Campos
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, 14004, Córdoba, Spain
| | - Jordi Salas-Salvadó
- Departament de Bioquímica i Biotecnologia. Unitat de Nutrició Humana, Universitat Rovira i Virgili, Reus, Spain.
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Nancy Babio
- Departament de Bioquímica i Biotecnologia. Unitat de Nutrició Humana, Universitat Rovira i Virgili, Reus, Spain.
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| |
Collapse
|
3
|
Prieto-Latorre C, Lopez-Agudo LA, Marcenaro-Gutierrez OD. Influence of body mass index on health complains and life satisfaction. Qual Life Res 2024; 33:705-719. [PMID: 38038808 PMCID: PMC10894113 DOI: 10.1007/s11136-023-03557-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE This research work investigates the influence of children's weight status on well-being and school context in a sample of Spanish adolescences. METHODS The Spanish records from the 2013-14 Health Behaviour in School-Aged Children Survey are used, which gathers 9,565 adolescences aged 11, 13 and 15. Studies do not usually address the endogeneity of body mass index when analysing their effect on life satisfaction and health complaints, thus resulting in biased estimates. Considering the endogeneity of body mass index, we use the frequency of alcohol consumption as an instrumental variable in order to obtain consistent estimates of its influence. RESULTS The two-stage least squares estimation shows that children's body mass index has a significant negative influence on health complaints and it conditions the way children relate to each other at school. Likewise, results report significant influence on children's subjective well-being and their self-assessment of general health. CONCLUSIONS The results of this study provide compelling evidence that BMI plays a crucial role in shaping adolescents' well-being and their interactions with peers at school. These findings underscore the importance of addressing childhood overweight and promoting healthy body mass index levels. Furthermore, the study highlights the need for targeted policy interventions to combat the social stigma associated with being overweight, fostering a more inclusive and supportive school environment for all students.
Collapse
Affiliation(s)
- Claudia Prieto-Latorre
- Departamento de Economía Aplicada (Estadística y Econometría), Facultad de Ciencias Económicas y Empresariales, Universidad de Málaga, Plaza de El Ejido s/n, 29013, Málaga, Spain.
| | - Luis Alejandro Lopez-Agudo
- Departamento de Economía Aplicada (Estadística y Econometría), Facultad de Ciencias Económicas y Empresariales, Universidad de Málaga, Plaza de El Ejido s/n, 29013, Málaga, Spain
| | - Oscar David Marcenaro-Gutierrez
- Departamento de Economía Aplicada (Estadística y Econometría), Facultad de Ciencias Económicas y Empresariales, Universidad de Málaga, Plaza de El Ejido s/n, 29013, Málaga, Spain
| |
Collapse
|
4
|
Luo Y, Xiao M. Early Weight Status and Human Capital in Adulthood: A 32-Year Follow-Up of the 1970 British Cohort Study. Int J Public Health 2024; 69:1606829. [PMID: 38414532 PMCID: PMC10896887 DOI: 10.3389/ijph.2024.1606829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/05/2024] [Indexed: 02/29/2024] Open
Abstract
Objectives: To prospectively evaluate the effects of early weight status (childhood and adolescence) and changes in obesity status on human capital in adulthood. Methods: We employed data from the 1970 Birth Cohort Study in the United Kingdom. Data on height and weight during childhood and adolescence, human capital variables in adulthood were collected from 2,444 participants. Human capital includes cognitive ability, non-cognitive skill, educational attainment and health status. Data were analyzed through linear regression and logistic regression models. Results: Our results showed that obesity during adolescence was negatively associated with cognitive ability (β = -0.83, p < 0.01), educational attainment (β = -0.49, p < 0.01), and some health outcomes; and that underweight in childhood also adversely affected educational attainment in females (β = -0.66, p < 0.05). In terms of changes in obesity status, becoming obese in adolescence negatively affected cognitive ability (β = -1.18, p < 0.01), educational attainment (β = -0.62, p < 0.05) and some health outcomes, remaining obese was associated with all adverse health outcomes. Conclusion: Our results suggest that obesity during adolescence negatively affects a range of human capital outcomes in adulthood, and adolescence is a critical period during which early obesity affects adult human capital.
Collapse
Affiliation(s)
- Yi Luo
- Research Center for Medical and Social Development, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Mimi Xiao
- Research Center for Medical and Social Development, School of Public Health, Chongqing Medical University, Chongqing, China
| |
Collapse
|
5
|
Waldrop SW, Wang D, Kancherla D, Stanford FC. Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk. Curr Opin Pediatr 2024; 36:42-48. [PMID: 37965910 PMCID: PMC10873084 DOI: 10.1097/mop.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Obesity is one of the most common pediatric chronic conditions in the United States, affecting approximately 20% of American youth and is more common amongst Black, Latino, and Indigenous and low socioeconomic populations. The condition places children and adolescents at increased risk of physical and mental health conditions partly mediated by the weight bias and stigmatization experienced during the potentially vulnerable periods of childhood and adolescence. RECENT FINDINGS Weight bias and the resulting stigma are pervasive in society. Children have been shown to internalize this bias and its devaluation, which have been shown to contribute to worsening metabolic and mental health outcomes independently. Studies suggest weight stigmatization more adversely affects Black, Latino, and Indigenous children, suggesting the potential for adverse synergistic effects of these historical biases on such youth. SUMMARY Addressing childhood obesity successfully across all racial, ethnic, and socioeconomic lines requires addressing weight bias and stigma. Steps toward this end include collaborative efforts to promote cross-cultural competence and upstander bias education and training for those who care for children, person-centered communication, and a culture of inclusivity across governmental, healthcare, educational, entertainment, and advertising sectors.
Collapse
Affiliation(s)
- Stephanie W. Waldrop
- Section on Nutrition Department of Pediatrics, University of Colorado School of Medicine, Nutrition Obesity Research Center at the University of Colorado, Aurora, CO, USA
| | - Daisy Wang
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Fatima Cody Stanford
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA
| |
Collapse
|
6
|
Ma G, Meyer CL, Jackson-Morris A, Chang S, Narayan A, Zhang M, Wu D, Wang Y, Yang Z, Wang H, Zhao L, Nugent R. The return on investment for the prevention and treatment of childhood and adolescent overweight and obesity in China: a modelling study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100977. [PMID: 38456086 PMCID: PMC10920044 DOI: 10.1016/j.lanwpc.2023.100977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/05/2023] [Accepted: 11/08/2023] [Indexed: 03/09/2024]
Abstract
Background The rapid increase in child and adolescent overweight and obesity (OAO) in China has a significant health and economic impact. This study undertook an investment case analysis to evaluate the health and economic impacts of child and adolescent OAO in China and the potential health and economic returns from implementing specific policies and interventions. Methods The analysis estimates the reduction in mortality and morbidity from implementing a set of evidence-based interventions across China between 2025 and 2092 using a deterministic Markov cohort model. Modelled interventions were identified by literature review and expert recommendation and include fiscal and regulatory policies, eHealth breastfeeding promotion, school-based interventions, and nutritional counselling by physicians. The study applies a societal costing perspective to model the economic impact on healthcare cost savings, wages, and productivity during adulthood. By projecting and comparing the costs between a status quo scenario and an intervention scenario, the study estimates the return on investment (ROI) for interventions separately and in combination. Findings Without intervention China will experience 3.3 billion disability-adjusted life years (DALYs) due its current levels of child and adolescent OAO and a lifetime economic impact of CNY 218 trillion (USD 31.6 trillion), or a lifetime CNY 2.5 million loss per affected child or adolescent (USD 350 thousand). National implementation of all five interventions would avert 179.4 million DALYs and result in CNY 13.1 trillion of benefits over the model cohort's lifetime. Implementing fiscal and regulatory policies had the strongest ROI, with benefits accruing at least 10 years after implementation. Scaling up China's current school-based interventions offers China significant health and economic gains, however, the ROI is lower than other modelled interventions. Interpretation Effective prevention and treatment of child and adolescent OAO is critical to China's health and economic development. Multiple interventions offer a comprehensive approach to address the various factors that increase risk of child and adolescent OAO. Nonetheless, fiscal and regulatory policies offer the strongest health and economic gains. Funding Funding was provided by UNICEF China.
Collapse
Affiliation(s)
- Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Christina L. Meyer
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | | | | | | | - Man Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Daphne Wu
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Youfa Wang
- International Obesity and Metabolic Disease Research Center, Global Health Institute, School of Public Health, Xi’an Jiaotong University, Xi’an, Shannxi, China
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| |
Collapse
|
7
|
Onyimadu O, Violato M, Astbury NM, Hüls H, Heath L, Shipley A, Taylor H, Wilkins LE, Abhari RE, Jebb SA, Petrou S. A systematic review of economic evaluations of interventions targeting childhood overweight and obesity. Obes Rev 2023; 24:e13597. [PMID: 37463862 DOI: 10.1111/obr.13597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 05/03/2023] [Accepted: 05/29/2023] [Indexed: 07/20/2023]
Abstract
This systematic review critically appraised and synthesized evidence from economic evaluations of interventions targeting childhood excess weight. We conducted systematic searches in 11 databases from inception to April 19, 2023. Studies were eligible if they evaluated interventions targeting children up to 18 years and the study intervention(s) targeted childhood excess weight or sought to improve diet or physical activity, regardless of the type of economic evaluation or the underpinning study design. We synthesized evidence using narrative synthesis methods. One-hundred fifty-one studies met the eligibility criteria and were classified into three groups based on the intervention approach: prevention-only (13 studies), prevention and treatment (100 studies), and treatment-only (38 studies). The predominant setting and study design differed considerably between the three groups of studies. However, compared with usual care, most interventions were deemed cost-effective. The study participants' ages, sex, and socioeconomic status were crucial to intervention cost-effectiveness. Interventions whose effects were projected beyond childhood, such as bariatric surgery, lower protein infant formula, and home-based general practitioner consultations, tended to be cost-effective. However, cost-effectiveness was sensitive to the assumptions underlying the persistence and intensity of such effects. Our findings can inform future recommendations on the conduct of economic evaluations of interventions targeting childhood overweight and obesity, as well as practice and policy recommendations.
Collapse
Affiliation(s)
- Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hannah Hüls
- The TUM School of Medicine, Technical University Munich, Munich, Germany
- The TUM School of Management, Technical University Munich, Munich, Germany
| | - Laura Heath
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alexandra Shipley
- Level 3, John Radcliffe Hospital, Oxford University Medical School, Oxford, UK
| | - Harriet Taylor
- Level 3, John Radcliffe Hospital, Oxford University Medical School, Oxford, UK
| | | | - Roxanna E Abhari
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
8
|
Brero M, Meyer CL, Jackson-Morris A, Spencer G, Ludwig-Borycz E, Wu D, Espinosa De Candido AF, Ferre Eguiluz MI, Bonvecchio Arenas A, Jewell J, Nugent R. Investment case for the prevention and reduction of childhood and adolescent overweight and obesity in Mexico. Obes Rev 2023; 24:e13595. [PMID: 37464960 DOI: 10.1111/obr.13595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/11/2023] [Accepted: 05/21/2023] [Indexed: 07/20/2023]
Abstract
Despite efforts to curb the rise in Mexico's child and adolescent overweight and obesity rates, prevalence in Mexico has grown by 120% since 1990 to 43.3% in 2022. This investment case identifies policies that will produce the largest returns for Mexico. The investment case model builds beyond a cost-of-illness analysis by predicting the health and societal economic impact of implementing child and adolescent overweight and obesity interventions in a cohort aged 0-19 from 2025 to 2090. The Markov model's impacts include healthcare expenditures, years of life lost, and reduced wages and productivity. We projected and compared costs in a status quo scenario to an intervention scenario to estimate cost savings and calculate return-on-investment (ROI). Total lifetime health and economic costs amount to USD 1.8 trillion-USD 30 billion on average per year. Implementing five interventions can reduce lifetime costs by approximately 7%. Each intervention has a low cost per disability-adjusted life year averted over 30-year, 50-year, and lifetime horizons. The findings demonstrate that a package of interventions mitigating child and adolescent overweight and obesity offers a strong ROI. The novel investment case methods should be applied to other countries, particularly low- and middle-income countries.
Collapse
Affiliation(s)
| | - Christina L Meyer
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
| | - Angela Jackson-Morris
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
| | - Garrison Spencer
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
| | | | - Daphne Wu
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
| | | | | | - Anabelle Bonvecchio Arenas
- Directora de Investigación en Políticas y Programas de Nutrición, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
| |
Collapse
|
9
|
Yu B, Zachrisson HD, Cheesman R, Ystrom E, Nes RB. Boys with overweight status lagged behind girls with overweight status in reading: evidence from mendelian randomization. J Clin Epidemiol 2023; 159:199-205. [PMID: 37156340 DOI: 10.1016/j.jclinepi.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/05/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES We investigated the relationship between childhood weight status and academic achievement across sexes and different school subjects in Norway. STUDY DESIGN AND SETTING We used data from the Norwegian Mother, Father and Child Cohort Study (MoBa), which includes genetic data (N = 13,648, 8-year-old children). We employed within-family mendelian randomization, using a body mass index (BMI) polygenic risk score as an instrument to address unobserved heterogeneity. RESULTS Contrary to most previous findings, we observed that overweight status (including obesity) has more detrimental effects on reading achievement in boys than in girls; the test scores of boys with overweight were about a standard deviation lower than those of normal weight boys, and the negative effects on reading achievement became stronger in the later grade. CONCLUSION Previous obesity prevention studies have mainly targeted girls, based on the assumption that the obesity penalty is greater for girls. Our findings highlight that particular attention to boys with overweight may help reduce the existing gender gap in academic achievement.
Collapse
Affiliation(s)
- Baeksan Yu
- Department of Education, Gwangju National University of Education, Gwangju, South Korea.
| | | | - Rosa Cheesman
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Eivind Ystrom
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Ragnhild Bang Nes
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway; Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway; Department of Philosophy, Classics, and History of Arts and Ideas, University of Oslo, Oslo, Norway
| |
Collapse
|
10
|
Jay MA, Sanders-Ellis D, Blackburn R, Deighton J, Gilbert R. Umbrella systematic review finds limited evidence that school absence explains the association between chronic health conditions and lower academic attainment. Front Public Health 2023; 11:1122769. [PMID: 37361156 PMCID: PMC10288991 DOI: 10.3389/fpubh.2023.1122769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/12/2023] [Indexed: 06/28/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Matthew A. Jay
- UCL GOS Institute of Child Health, Population, Policy and Practice Research and Teaching Department, University College London, London, United Kingdom
| | - David Sanders-Ellis
- UCL Institute of Education, Social Research Institute, University College London, London, United Kingdom
| | - Ruth Blackburn
- UCL Institute of Health Informatics, University College London, London, United Kingdom
| | - Jessica Deighton
- The Evidence Based Practice Unit, University College London and Anna Freud Centre for Children and Families, London, United Kingdom
| | - Ruth Gilbert
- UCL GOS Institute of Child Health, Population, Policy and Practice Research and Teaching Department, University College London, London, United Kingdom
| |
Collapse
|
11
|
Bowman K, Cadman T, Goncalves Soares A, Robinson O, Hughes A, Heron J, Segal AB, Huerta MC, Howe LD. Mediators of the association between childhood body mass index and educational attainment: Analysis of a UK prospective cohort study. Pediatr Obes 2023; 18:e13014. [PMID: 36823984 PMCID: PMC10909521 DOI: 10.1111/ijpo.13014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 12/15/2022] [Accepted: 01/25/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Higher body mass index (BMI) in childhood is associated with lower academic achievement. OBJECTIVE To explore potential pathways linking childhood BMI with educational attainment. METHODS Using data from the Avon Longitudinal Study of Parents and Children prospective cohort study (N = 6949), we assessed the association between BMI z-scores at 11.7 years and educational attainment at 16 (General Certificate of Secondary Education [GCSE] results). Depressive symptoms, externalizing behaviours, bullying and school enjoyment were considered as potential mediators. Mediators were examined individually and jointly using sequential causal mediation. RESULTS Higher BMI z-scores were associated with lower GCSE scores (females β = -3.47 95% CI -5.54, -1.41 males β = -4.33 95% CI -6.73, -1.94). Together, bullying, externalizing symptoms, depressive symptoms and school enjoyment mediated 41.9% of this association in females, and 23.3% in males. In males, evidence for mediation was weak (confidence intervals for all indirect effects spanned the null). In both females and males, most of the mediation was driven by externalizing symptoms. CONCLUSIONS The detrimental effect of higher BMI on educational attainment appears to be partly explained by externalizing behaviours, particularly in females. Interventions to support behavioural problems may help the academic achievement of children with a higher body weight.
Collapse
Affiliation(s)
- Kirsty Bowman
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
- Population Health SciencesUniversity of BristolBristolUK
| | - Tim Cadman
- Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Ana Goncalves Soares
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
- Population Health SciencesUniversity of BristolBristolUK
| | - Oliver Robinson
- MRC Centre for Environment and HealthSchool of Public Health, Imperial College LondonLondonUK
| | - Amanda Hughes
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
- Population Health SciencesUniversity of BristolBristolUK
| | - Jon Heron
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
- Population Health SciencesUniversity of BristolBristolUK
| | - Alexa Blair Segal
- Centre for Health Economics & Policy InnovationImperial College Business SchoolLondonUK
| | - Maria Carmen Huerta
- Centre for Health Economics & Policy InnovationImperial College Business SchoolLondonUK
| | - Laura D. Howe
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
- Population Health SciencesUniversity of BristolBristolUK
| |
Collapse
|
12
|
Carrello J, Hayes A, Baur LA, Lung T. Potential cost-effectiveness of e-health interventions for treating overweight and obesity in Australian adolescents. Pediatr Obes 2023; 18:e13003. [PMID: 36649693 PMCID: PMC10909552 DOI: 10.1111/ijpo.13003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/04/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND E-health, defined as the use of information and communication technologies to improve healthcare delivery and health outcomes, has been promoted as a cost-effective strategy to treat adolescent overweight and obesity. However, evidence supporting this claim is lacking. OBJECTIVES Assess the potential cost-effectiveness of a hypothetical e-health intervention for adolescents with overweight and obesity. METHODS The costs and effect size (BMI reduction) of the hypothetical intervention were sourced from recent systematic reviews. Using a micro-simulation model with a lifetime time horizon, we conducted a modelled cost-utility analysis of the intervention compared to a 'do-nothing' approach. To explore uncertainty, we conducted bootstrapping on individual-level costs and quality-adjusted life years (QALYs) and performed multiple one-way sensitivity analyses. RESULTS The incremental cost-effectiveness ratio (ICER) for the e-health intervention was dominant (cheaper and more effective), with a 96% probability of being cost-effective at a willingness-to-pay (WTP) of $50 000/QALY. The ICER remained dominant in all sensitivity analyses except when using the lower bounds of the hypothetical intervention effect size, which reduced the probability of cost-effectiveness at a WTP of $50 000/QALY to 51%. CONCLUSION E-health interventions for treatment of adolescent overweight and obesity demonstrate very good cost-effectiveness potential and should be considered by healthcare decision makers. However, further research on the efficacy of such interventions is warranted to strengthen the case for investment.
Collapse
Affiliation(s)
- Joseph Carrello
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alison Hayes
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Louise A. Baur
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- Weight Management Services, The Children's Hospital at WestmeadWestmeadAustralia
| | - Thomas Lung
- School of Public Health, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| |
Collapse
|
13
|
Lioret S, Harrar F, Boccia D, Hesketh KD, Kuswara K, Van Baaren C, Maritano S, Charles MA, Heude B, Laws R. The effectiveness of interventions during the first 1,000 days to improve energy balance-related behaviors or prevent overweight/obesity in children from socio-economically disadvantaged families of high-income countries: a systematic review. Obes Rev 2023; 24:e13524. [PMID: 36394375 PMCID: PMC10078443 DOI: 10.1111/obr.13524] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/26/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022]
Abstract
This narrative systematic review examined effectiveness of interventions during pregnancy and up to 2 years of age in improving energy balance-related behaviors or prevent overweight/obesity in children from families experiencing socio-economic disadvantage. We identified 24 interventions, from 33 articles, since 1990. Overall, despite their heterogeneity and variability in internal and external validity, there was some evidence of beneficial impact of interventions on obesity risk (4/15), and associated behaviors, e.g.: breastfeeding (9/18), responsive feeding (11/16), diet (7/8), sedentary (1/3) and movement (4/7) behaviors, and sleep (1/2). The most effective interventions aimed at promoting breastfeeding commenced antenatally; this was similar for the prevention of obesity, provided the intervention continued for at least 2 years postnatally and was multi-behavioral. Effective interventions were more likely to target first-time mothers and involve professional delivery agents, multidisciplinary teams and peer groups. Among ethnic/racial minorities, interventions delivered by lay agents had some impact on dietary behavior but not weight outcomes. Co-creation with stakeholders, including parents, and adherence to theoretical frameworks were additional ingredients for more pragmatic, inclusive, non-judgmental, and effective programs. The growing body of evidence on obesity prevention interventions targeting families experiencing socio-economic disadvantage is promising for reducing early inequalities in obesity risk.
Collapse
Affiliation(s)
| | - Faryal Harrar
- Université Paris Cité, INSERM, INRAE, CRESS, Paris, France
| | - Delia Boccia
- Faculty of Public Health and Policy, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - Konsita Kuswara
- Department of Medical Sciences, Università di Torino, Cancer Epidemiology Unit, Turin, Italy
| | | | - Silvia Maritano
- Department of Medical Sciences, Università di Torino, Cancer Epidemiology Unit, Turin, Italy
| | | | - Barbara Heude
- Université Paris Cité, INSERM, INRAE, CRESS, Paris, France
| | - Rachel Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| |
Collapse
|
14
|
Vega-Salas MJ, Murray C, Nunes R, Hidalgo-Arestegui A, Curi-Quinto K, Penny ME, Cueto S, Lovegrove JA, Sánchez A, Vimaleswaran KS. School environments and obesity: a systematic review of interventions and policies among school-age students in Latin America and the Caribbean. Int J Obes (Lond) 2023; 47:5-16. [PMID: 36216909 PMCID: PMC9549440 DOI: 10.1038/s41366-022-01226-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The rapid rise in obesity rates among school children in Latin America and the Caribbean (LAC) could have a direct impact on the region's physical and mental health, disability, and mortality. This review presents the available interventions likely to reduce, mitigate and/or prevent obesity among school children in LAC by modifying the food and built environments within and around schools. METHODS Two independent reviewers searched five databases: MEDLINE, Web of Science, Cochrane Library, Scopus and Latin American and Caribbean Health Sciences Literature for peer-reviewed literature published from 1 January 2000 to September 2021; searching and screening prospective studies published in English, Spanish and Portuguese. This was followed by data extraction and quality assessment using the Cochrane risk-of-bias tool (RoB 2) and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I), adopting also the PRISMA 2020 guidelines. Due to the heterogeneity of the intervention's characteristics and obesity-related measurements across studies, a narrative synthesis was conducted. RESULTS A total of 1342 research papers were screened, and 9 studies were included; 4 in Mexico, and 1 each in Argentina, Brazil, Chile, Colombia, and Ecuador. Four studies reported strategies for modifying food provision; four other targeted the built environment, (modifying school premises and providing materials for physical activity); a final study included both food and built environment intervention components. Overall, two studies reported that the intervention was significantly associated with a lower increase over time in BMI/obesity in the intervention against the control group. The remaining studies were non-significant. CONCLUSIONS Data suggest that school environmental interventions, complementing nutritional and physical education can contribute to reduce incremental childhood obesity trends. However, evidence of the extent to which food and built environment components factor into obesogenic environments, within and around school grounds is inconclusive. Insufficient data hindered any urban/rural comparisons. Further school environmental intervention studies to inform policies for preventing/reducing childhood obesity in LAC are needed.
Collapse
Affiliation(s)
- María Jesús Vega-Salas
- Carrera de Nutrición y Dietética, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, 7820436, Chile.
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6DZ, UK.
| | - Claudia Murray
- Department of Real Estate and Planning, Henley Business School, University of Reading, Reading, RG6 6UD, UK.
| | - Richard Nunes
- Department of Real Estate and Planning, Henley Business School, University of Reading, Reading, RG6 6UD, UK
| | - Alessandra Hidalgo-Arestegui
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6DZ, UK
| | | | - Mary E Penny
- Instituto de Investigación Nutricional (IIN), Lima, 15024, Peru
| | - Santiago Cueto
- Grupo de Análisis para el Desarrollo (GRADE), Lima, 15063, Peru
- Departamento de Psicología, Pontificia Universidad Católica del Peru, Lima, 15088, Peru
| | - Julie Anne Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6DZ, UK
- Institute for Food, Nutrition and Health (IFNH), University of Reading, Reading, RG6 6AH, UK
| | - Alan Sánchez
- Grupo de Análisis para el Desarrollo (GRADE), Lima, 15063, Peru
| | - Karani Santhanakrishnan Vimaleswaran
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6DZ, UK
- Institute for Food, Nutrition and Health (IFNH), University of Reading, Reading, RG6 6AH, UK
| |
Collapse
|
15
|
Sarrias M, Blanco A. Bodyweight and human capital development: Assessing the impact of obesity on socioemotional skills during childhood in Chile. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101190. [PMID: 36306701 DOI: 10.1016/j.ehb.2022.101190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
This article analyzes the effect of bodyweight on socioemotional skills for children aged two to 12 years in Chile. Using an instrumental variable approach and a representative survey, we show that both BMI and obesity are causality related to children's socioemotional development, even after assuming that our instrument is imperfect. Although we did not find significant differences between boys and girls, we do identify heterogeneous effects by age: the weight penalty for girls starts earlier than for boys. Our findings suggest that early interventions for childhood obesity not only might generate positive impacts on children's health, but also a greater accumulation of non-cognitive human capital in the future.
Collapse
Affiliation(s)
- Mauricio Sarrias
- Facultad de Economía y Negocios, Universidad de Talca, Talca, Chile.
| | - Alejandra Blanco
- IDEAR, Department of Economics, Universidad Católica del Norte, Antofagasta, Chile.
| |
Collapse
|
16
|
The Impact of the 'Planning Health in School' Programme on a Pair of Twins with Obesity. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121866. [PMID: 36553309 PMCID: PMC9777452 DOI: 10.3390/children9121866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
This case study describes the impact of the 'Planning Health in School' programme (PHS-pro) on the nutritional status and lifestyle behaviours of two twins with obesity. As part of a larger research project involving 449 adolescents in grade-6, PHS-pro aims at preventing obesity and guiding children towards healthy behaviours. Twins were evaluated for anthropometric measurements-height, weight, body mass index (BMI), waist circumference (WC), and lifestyle behaviours before (baseline) and after (8 months) PHS-pro and at a follow-up (one-year later). At the baseline, both twins were obese according to the international cut-off points of Cole. After PHS-pro, improvements in anthropometric parameters were found: the boy decreased his BMI by 10% and lost 9.0 cm in WC, while remaining obese; the girl decreased her BMI by 8% and lost 8.7 cm in WC, changing to the overweight category. At the follow-up, a slight increase in the anthropometric parameters was found in both twins; however, they did not return to the baseline values. The programme successfully promoted positive changes in behaviours and improved nutritional status, showing the long-term effects of the PHS-pro. Although it is a school-based intervention to prevent obesity, the PHS-pro is helpful in weight reduction even in children already with obesity.
Collapse
|
17
|
Handakas E, Xu Y, Segal AB, Huerta MC, Bowman K, Howe LD, Sassi F, Robinson O. Molecular mediators of the association between child obesity and mental health. Front Genet 2022; 13:947591. [PMID: 36118877 PMCID: PMC9473726 DOI: 10.3389/fgene.2022.947591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Biological mechanisms underlying the association between obesity and depression remain unclear. We investigated the role of metabolites and DNA methylation as mediators of the relationship between childhood obesity and subsequent poor mental health in the English Avon Longitudinal Study of Parents and Children. Obesity was defined according to United Kingdom Growth charts at age 7 years and mental health through the Short Mood and Feelings Questionnaire (SMFQ) completed at age 11 years. Metabolites and DNA methylation were measured by nuclear magnetic resonance spectroscopy and Illumina array in blood at the age of 7 years. The associations between obesity and SMFQ score, as continuous count data or using cut-offs to define depressive symptoms (SMFQ >7) or depression (SMFQ >11), were tested using adjusted Poisson and logistic regression. Candidate metabolite mediators were identified through metabolome-wide association scans for obesity and SMFQ score, correcting for false-discovery rate. Candidate DNA methylation mediators were identified through testing the association of putative BMI-associated CpG sites with SMFQ scores, correcting for look-up false-discovery rate. Mediation by candidate molecular markers was tested. Two-sample Mendelian randomization (MR) analyses were additionally applied to test causal associations of metabolites with depression in independent adult samples. 4,018 and 768 children were included for metabolomics and epigenetics analyses, respectively. Obesity at 7 years was associated with a 14% increase in SMFQ score (95% CI: 1.04, 1.25) and greater odds of depression (OR: 1.46 (95% CI: 0.78, 2.38) at 11 years. Natural indirect effects (mediating pathways) between obesity and depression for tyrosine, leucine and conjugated linoleic acid were 1.06 (95% CI: 1.00, 1.13, proportion mediated (PM): 15%), 1.04 (95% CI: 0.99, 1.10, PM: 9.6%) and 1.06 (95% CI: 1.00, 1.12, PM: 13.9%) respectively. In MR analysis, one unit increase in tyrosine was associated with 0.13 higher log odds of depression (p = 0.1). Methylation at cg17128312, located in the FBXW9 gene, had a natural indirect effect of 1.05 (95% CI: 1.01,1.13, PM: 27%) as a mediator of obesity and SMFQ score. Potential biologically plausible mechanisms involving these identified molecular features include neurotransmitter regulation, inflammation, and gut microbiome modulation. These results require replication in further observational and mechanistic studies.
Collapse
Affiliation(s)
- Evangelos Handakas
- Μedical Research Council Centre for Environment and Health, Imperial College London, London, United Kingdom
| | - Yiwen Xu
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
| | - Alexa Blair Segal
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
| | - Maria Carmen Huerta
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
| | - Kirsty Bowman
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Laura D. Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Franco Sassi
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
| | - Oliver Robinson
- Μedical Research Council Centre for Environment and Health, Imperial College London, London, United Kingdom
| |
Collapse
|
18
|
Brown V, Moodie M, Sultana M, Hunter KE, Byrne R, Zarnowiecki D, Seidler AL, Golley R, Taylor RW, Hesketh KD, Matvienko-Sikar K. A scoping review of outcomes commonly reported in obesity prevention interventions aiming to improve obesity-related health behaviors in children to age 5 years. Obes Rev 2022; 23:e13427. [PMID: 35122457 DOI: 10.1111/obr.13427] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 12/18/2022]
Abstract
This scoping review was undertaken as the first stage of development of the Core Outcome Sets for Early Prevention of Obesity in CHildhood (COS-EPOCH). The aim of this review is to identify the outcomes collected and reported in randomized controlled trials of early childhood obesity prevention interventions. A systematic scoping review was undertaken following published guidelines. Trial registries and Medline were searched, and records retrieved were screened by two reviewers. Included trials aimed to prevent childhood obesity in the first 5 years of life and were randomized. Data were extracted using a standardized form. Outcomes were assigned to outcome domains, and similar definitions within each domain were merged, based on key literature and expert consensus. Outcome and domain frequencies were estimated and presented in outcome matrices. Eighteen outcome domains were identified from 161 included studies: "anthropometry," "dietary intake," "physical activity," "sedentary behaviour," "emotional functioning/wellbeing," "feeding," "cognitive/executive functioning," "sleep," "other," "study-related," "parenting practices," "motor skill development," "environmental," "blood and lymphatic system," "perceptions and preferences," "quality of life," and "economic," "oral health." The most frequently reported outcome domain was anthropometry (92% of studies), followed by dietary intake (77%) and physical activity (60%). 221 unique outcomes were identified, indicating a high degree of heterogeneity. Body mass index was the only outcome reported in >50% of studies. The considerable heterogeneity in outcomes supports the need for the development of COS-EPOCH.
Collapse
Affiliation(s)
- Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia.,Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia.,Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia
| | - Marufa Sultana
- Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Kylie E Hunter
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Rebecca Byrne
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
| | - Dorota Zarnowiecki
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Anna Lene Seidler
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Rebecca Golley
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Rachael W Taylor
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Kylie D Hesketh
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | | |
Collapse
|
19
|
Onyimadu O, Violato M, Astbury NM, Jebb SA, Petrou S. Health Economic Aspects of Childhood Excess Weight: A Structured Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:461. [PMID: 35455505 PMCID: PMC9028108 DOI: 10.3390/children9040461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted.
Collapse
Affiliation(s)
- Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK;
| | - Nerys M. Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| |
Collapse
|
20
|
Chia A, Ong J, Bundele A, Lim YW. Social entrepreneurship in obesity prevention: A scoping review. Obes Rev 2022; 23:e13378. [PMID: 34841626 PMCID: PMC9285950 DOI: 10.1111/obr.13378] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
We conducted a scoping review of social ventures in obesity and developed a taxonomy of their interventions and business models. Sources included PubMed, Business Source Premier, ABI Inform, Factiva, Google, Facebook, Twitter, social entrepreneurship networks (Ashoka, Skoll, and Schwab), and social entrepreneurship competitions. Our review identified 512 social ventures in 32 countries; 93% originated from developed countries. Their areas of intervention included diet and nutrition, urban farming, physical activity, access to healthy food, and health literacy. They addressed factors beyond health such as education, affordability, employment, and the built and natural environments. To support their programs of work, social ventures developed various business models with multiple revenue or resource streams. Social ventures designed double-duty interventions that were aligned with additional meaningful social or environmental objectives. This "bundling" of objectives allowed social ventures to appeal to a wider target audience. Most of the social ventures were initiated, supported, or sustained by local communities. Social ventures offer financially self-sufficient approaches to obesity reduction and could potentially relieve the burden on healthcare systems. Policymakers should consider social entrepreneurs as partners in obesity prevention.
Collapse
Affiliation(s)
- Audrey Chia
- NUS Business School, National University of Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Junyu Ong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | - Yee Wei Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
21
|
Langford R, Davies A, Howe L, Cabral C. Links between obesity, weight stigma and learning in adolescence: a qualitative study. BMC Public Health 2022; 22:109. [PMID: 35033056 PMCID: PMC8761050 DOI: 10.1186/s12889-022-12538-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Educational attainment is a key social determinant of health. Health and education are linked by multiple pathways, many of which are not well understood. One such pathway is the association between being above a healthy weight and lower academic achievement. While various explanations have been put forward to explain this relationship, evidence for causal pathways is sparse and unclear. This study addresses that evidence gap. METHODS We interviewed 19 adults (late 20s; 14 female, 5 male) and one young person (14 years, male) from the UK in 2019/2020. Participants were recruited from the ALSPAC 1990s birth cohort, sampled to ensure diversity in socio-economic status and educational attainment, and a community-based weight management group for young people. Interviews focused on experiences of being above a healthy weight during secondary school and how this may have affected their learning and achievement. Interviews were face-to-face, digitally recorded, and transcribed verbatim. We analysed the data thematically. RESULTS We identified key pathways through which higher body weight may negatively impact educational performance and showed how these are linked within a novel theoretical model. Because larger body size is highly stigmatised, participants engaged in different strategies to minimise their exposure to negative attention. Participants sought to increase their social acceptance or become less socially visible (or a combination of both). A minority navigated this successfully; they often had many friends (or the 'right' friends), experienced little or no bullying at school and weight appeared to have little effect on their achievement at school. For most however, the behaviours resulting from these strategies (e.g. disruptive behaviour, truanting, not working hard) or the physical, social or mental impacts of their school experiences (e.g. hungry, tired, self-conscious, depressed) made it difficult to concentrate and/or participate in class, which in turn affected how teachers viewed them. CONCLUSIONS Action to combat weight stigma, both within schools and in wider society, is urgently required to help address these educational disparities that in turn can impact health in later life.
Collapse
Affiliation(s)
- Rebecca Langford
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Alisha Davies
- Research and Evaluation Division, Public Health Wales, Floor 5, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ UK
| | - Laura Howe
- Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Christie Cabral
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Rd, Bristol, BS8 2PS UK
| |
Collapse
|
22
|
Mazhar U, Rehman F. Productivity, obesity, and human capital: Panel data evidence. ECONOMICS AND HUMAN BIOLOGY 2022; 44:101096. [PMID: 34920362 DOI: 10.1016/j.ehb.2021.101096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/21/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
The consequences of obesity for adults and children are well documented in the extant literature. We use panel data of 105 countries from 1990 to 2019 to estimate the effect of obesity on economic performance. We predict obesity using lagged values of child obesity as instruments. Predicted obesity has a negative and significant effect on productivity. This effect is independent of the effect of human capital and other macroeconomic determinants of economic performance. There is only weak evidence that this effect operates through the deterioration of human capital formation caused by childhood obesity.
Collapse
Affiliation(s)
- Ummad Mazhar
- Suleman Dawood School of Business (SDSB), Lahore University of Management Sciences (LUMS), Lahore, Pakistan.
| | - Fahd Rehman
- Suleman Dawood School of Business (SDSB), Lahore University of Management Sciences (LUMS), Lahore, Pakistan.
| |
Collapse
|
23
|
Wang X, Long Y, Yang L, Huang J, Du L. Results Reporting and Early Termination of Childhood Obesity Trials Registered on ClinicalTrials.gov. Front Pediatr 2022; 10:860610. [PMID: 35402346 PMCID: PMC8987712 DOI: 10.3389/fped.2022.860610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Childhood obesity is one of the most severe challenges of public health in the twenty-first century and may increase the risk of various physical and psychological diseases in adulthood. The prevalence and predictors of unreported results and premature termination in pediatric obesity research are not clear. We aimed to characterize childhood obesity trials registered on ClinicalTrials.gov and identify features associated with early termination and lack of results reporting. METHODS Records were downloaded and screened for all childhood obesity trials from the inception of ClinicalTrials.gov to July 29, 2021. We performed descriptive analyses of characteristics, Cox regression for early termination, and logistic regression for lack of results reporting. RESULTS We identified 1,312 trials registered at ClinicalTrials.gov. Among clinicalTrials.gov registered childhood obesity-related intervention trials, trial unreported results were 88.5 and 4.3% of trials were prematurely terminated. Additionally, the factors that reduced the risk of unreported outcomes were US-registered clinical studies and drug intervention trials. Factors associated with a reduced risk of early termination are National Institutes of Health (NIH) or other federal agency funding and large trials. CONCLUSION The problem of unreported results in clinical trials of childhood obesity is serious. Therefore, timely bulletin of the results and reasons for termination remain urgent aims for childhood obesity trials.
Collapse
Affiliation(s)
- Xinyi Wang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Youlin Long
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Liu Yang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Huang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Du
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China.,West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
24
|
Handakas E, Keski-Rahkonen P, Chatzi L, Alfano R, Roumeliotaki T, Plusquin M, Maitre L, Richiardi L, Brescianini S, Scalbert A, Robinot N, Nawrot T, Sassi F, Vrijheid M, Vineis P, Robinson O. Cord blood metabolic signatures predictive of childhood overweight and rapid growth. Int J Obes (Lond) 2021; 45:2252-2260. [PMID: 34253844 PMCID: PMC8455328 DOI: 10.1038/s41366-021-00888-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/30/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Metabolomics may identify biological pathways predisposing children to the risk of overweight and obesity. In this study, we have investigated the cord blood metabolic signatures of rapid growth in infancy and overweight in early childhood in four European birth cohorts. METHODS Untargeted liquid chromatography-mass spectrometry metabolomic profiles were measured in cord blood from 399 newborns from four European cohorts (ENVIRONAGE, Rhea, INMA and Piccolipiu). Rapid growth in the first year of life and overweight in childhood was defined with reference to WHO growth charts. Metabolome-wide association scans for rapid growth and overweight on over 4500 metabolic features were performed using multiple adjusted logistic mixed-effect models and controlling the false discovery rate (FDR) at 5%. In addition, we performed a look-up analysis of 43 pre-annotated metabolites, previously associated with birthweight or rapid growth. RESULTS In the Metabolome-Wide Association Study analysis, we identified three and eight metabolites associated with rapid growth and overweight, respectively, after FDR correction. Higher levels of cholestenone, a cholesterol derivative produced by microbial catabolism, were predictive of rapid growth (p = 1.6 × 10-3). Lower levels of the branched-chain amino acid (BCAA) valine (p = 8.6 × 10-6) were predictive of overweight in childhood. The area under the receiver operator curve for multivariate prediction models including these metabolites and traditional risk factors was 0.77 for rapid growth and 0.82 for overweight, compared with 0.69 and 0.69, respectively, for models using traditional risk factors alone. Among the 43 pre-annotated metabolites, seven and five metabolites were nominally associated (P < 0.05) with rapid growth and overweight, respectively. The BCAA leucine, remained associated (1.6 × 10-3) with overweight after FDR correction. CONCLUSION The metabolites identified here may assist in the identification of children at risk of developing obesity and improve understanding of mechanisms involved in postnatal growth. Cholestenone and BCAAs are suggestive of a role of the gut microbiome and nutrient signalling respectively in child growth trajectories.
Collapse
Affiliation(s)
- Evangelos Handakas
- Μedical Research Council Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Pekka Keski-Rahkonen
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Lida Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rossella Alfano
- Μedical Research Council Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Theano Roumeliotaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Léa Maitre
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO-Piemonte, Torino, Italy
| | - Sonia Brescianini
- Centre for Behavioural Science and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Augustin Scalbert
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Nivonirina Robinot
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Tim Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, South Kensington Campus, London, UK
| | - Martine Vrijheid
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Paolo Vineis
- Μedical Research Council Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Oliver Robinson
- Μedical Research Council Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
| |
Collapse
|
25
|
Okunogbe A, Nugent R, Spencer G, Ralston J, Wilding J. Economic impacts of overweight and obesity: current and future estimates for eight countries. BMJ Glob Health 2021; 6:e006351. [PMID: 34737167 PMCID: PMC8487190 DOI: 10.1136/bmjgh-2021-006351] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Obesity is a growing public health challenge worldwide with significant health and economic impacts. However, much of what is known about the economic impacts of obesity comes from high-income countries and studies are not readily comparable due to methodological differences. Our objective is to demonstrate a method for estimating current and future national economic impacts of obesity and apply it across a sample of heterogeneous contexts globally. METHODS We estimated economic impacts of overweight and obesity for eight countries using a cost-of-illness approach. Direct and indirect costs of obesity from 2019 to 2060 were estimated from a societal perspective as well as the effect of two hypothetical scenarios of obesity prevalence projections. Country-specific data were sourced from published studies and global databases. RESULTS In per capita terms, costs of obesity in 2019 ranged from US$17 in India to US$940 in Australia. These economic costs are comparable to 1.8% of gross domestic product (GDP) on average across the eight countries, ranging from 0.8% of GDP in India to 2.4% in Saudi Arabia. By 2060, with no significant changes to the status quo, the economic impacts from obesity are projected to grow to 3.6% of GDP on average ranging from 2.4% of GDP in Spain to 4.9% of GDP in Thailand. Reducing obesity prevalence by 5% from projected levels or keeping it at 2019 levels will translate into an average annual reduction of 5.2% and 13.2% in economic costs, respectively, between 2020 and 2060 across the eight countries. CONCLUSION Our findings demonstrate that the economic impacts of obesity are substantial across countries, irrespective of economic or geographical context and will increase over time if current trends continue. These findings strongly point to the need for advocacy to increase awareness of the societal impacts of obesity, and for policy actions to address the systemic roots of obesity.
Collapse
Affiliation(s)
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, USA
| | - Garrison Spencer
- Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, USA
| | | | | |
Collapse
|
26
|
Chen T, Lin J, Lin Y, Xu L, Lu D, Li F, Hou L, Yu CCW. Effects of aerobic exercise and resistance exercise on physical indexes and cardiovascular risk factors in obese and overweight school-age children: A systematic review and meta-analysis. PLoS One 2021; 16:e0257150. [PMID: 34543302 PMCID: PMC8452003 DOI: 10.1371/journal.pone.0257150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background Obesity is a serious social and public health problem in the world, especially in children and adolescents. For school-age children with obesity, this stage is in the transition from childhood to adolescence, and both physical, psychological, and external environments will be full of challenges. Studies have showed that school-age children are the largest proportion of people who continue to be obese in adulthood. Physical exercise is considered as an effective way to control weight. Therefore, we focus on this point to study which factors will be improved to reduce childhood obesity. Objective To assess the effects of aerobic and resistance exercise on physical indexes, such as body mass index (BMI) and body fat percentage, and cardiovascular risk factors such as VO2peak, triglycerides (TG) and low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), insulin and insulin resistance in school-age children who are overweight or obese. Method PubMed, SPORTDiscus, Medline, Cochrane-Library, Scopus, Ovid and Web of Science were searched to locate studies published between 2000 and 2021 in obese and overweight school-age children between 6–12 years old. The articles are all randomized controlled trials (RCTs) and in English. Data were synthesized using a random-effect or a fixed-effect model to analyze the effects of aerobic and resistance exercise on six elements in in school-age children with overweight or obese. The primary outcome measures were set for BMI. Results A total of 13 RCTs (504 participants) were identified. Analysis of the between-group showed that aerobic and resistance exercise were effective in improving BMI (MD = -0.66; p < 0.00001), body fat percentage (MD = -1.29; p = 0.02), TG (std.MD = -1.14; p = 0.005), LDL (std.MD = -1.38; p = 0.003), TC (std.MD = -0.77; p = 0.002), VO2peak (std.MD = 1.25; p = 0.001). However, aerobic and resistance exercise were not significant in improving HDL (std.MD = 0.13; p = 0.27). Conclusions Aerobic exercise and resistance exercise are associated with improvement in BMI, body fat percentage, VO2peak, TG, LDL, TC, while not in HDL in school-age children with obesity or overweight. Insulin and insulin resistance were not able to be analyzed in our review. However, there are only two articles related to resistance exercise in children with obesity and overweight at school age, which is far less than the number of 12 articles about aerobic exercise, so we cannot compare the effects of the two types of exercises.
Collapse
Affiliation(s)
- Tianhao Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Jingxia Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Yuzhe Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Lin Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Dian Lu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Fangping Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Lihao Hou
- Department of Rehabilitation, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Clare Chung Wah Yu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- * E-mail:
| |
Collapse
|
27
|
Baek Y, Ademi Z, Paudel S, Fisher J, Tran T, Romero L, Owen A. Economic Evaluations of Child Nutrition Interventions in Low- and Middle-Income Countries: Systematic Review and Quality Appraisal. Adv Nutr 2021; 13:282-317. [PMID: 34510178 PMCID: PMC8803532 DOI: 10.1093/advances/nmab097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/24/2021] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Economic evaluation is crucial for cost-effective resource allocation to improve child nutrition in low and middle-income countries (LMICs). However, the quality of published economic evaluations in these settings is not well understood. This systematic review aimed to assess the quality of existing economic evaluations of child nutrition interventions in LMICs and synthesize the study characteristics and economic evidence. We searched 9 electronic databases, including MEDLINE, with the following concepts: economic evaluation, children, nutrition, and LMICs. All types of interventions addressing malnutrition, including stunting, wasting, micronutrient deficiency, and overweight, were identified. We included economic evaluations that examined both costs and effects published in English peer-reviewed journals and used the Drummond checklist for quality appraisal. We present findings through a narrative synthesis. Sixty-nine studies with diverse settings, perspectives, time horizons, and outcome measures were included. Most studies used data from sub-Saharan Africa and South Asia and addressed undernutrition. The mortality rate, intervention effect, intervention coverage, cost, and discount rate were reported as predictors among studies that performed sensitivity analyses. Despite the heterogeneity of included studies and the possibility of publication bias, 81% of included studies concluded that nutrition interventions were cost-effective or cost-beneficial, mostly based on a country's cost-effectiveness thresholds. Regarding quality assessment, the studies published after 2016 met more criteria than studies published before 2016. Most studies had well-stated research questions, forms of economic evaluation, interventions, and conclusions. However, reporting the perspective of the analyses, justification of discount rates, and describing the role of funders and ethics approval were identified as areas needing improvement. The gaps in the quality of reporting could be improved by consolidated guidance on the publication of economic evaluations and the use of appropriate quality appraisal checklists. Strengthening the evidence base for child malnutrition across different regions is necessary to inform cost-effective investment in LMICs. Trial registration: PROSPERO CRD42020194445.
Collapse
Affiliation(s)
- Yeji Baek
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan Paudel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | | |
Collapse
|
28
|
Hughes A, Wade KH, Dickson M, Rice F, Davies A, Davies NM, Howe LD. Common health conditions in childhood and adolescence, school absence, and educational attainment: Mendelian randomization study. NPJ SCIENCE OF LEARNING 2021; 6:1. [PMID: 33398003 PMCID: PMC7782810 DOI: 10.1038/s41539-020-00080-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/19/2020] [Indexed: 05/30/2023]
Abstract
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.
Collapse
Affiliation(s)
- Amanda Hughes
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK.
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Kaitlin H Wade
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Matt Dickson
- Institute for Policy Research, University of Bath, Bath, UK
| | | | | | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Laura D Howe
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
| |
Collapse
|