Total energy expenditure measured by doubly labeled water method in children and adolescents: a systematic review

Total energy expenditure (TEE) is essential for understanding the growth, development, and physical activity of children and adolescents. This study aimed to summarize the existing evidence on TEE measured using the doubly labeled water (DLW) technique in children and adolescents aged 1-18 years. Furthermore, this review compared TEE between obese and normal-weight participants. This systematic review used the PubMed, ScienceDirect, Web of Science, and EBSCO databases. These studies were limited to those published in English between January 2000 and December 2021. Articles presenting objectively measured data on the TEE of children and adolescents aged 1-18 years measured using the DLW method were included. Physical activity level (PAL; TEE/basal metabolic rate [BMR]) and BMR data were also obtained. The search strategy identified 2,351 articles, of which 63 (n=4,283 children and adolescents; 45.4% male) met the selection criteria. The participants in the 10 studies were overweight or obese (n=413). In our study, TEE increased in male and female participants aged 1-18 years. PAL increased with age in males (y=0.0272x+1.3887, r2=0.511) and females (y=0.0199x+1.401, r2=0.335), and the slope of PAL with age did not differ between males and females. The TEE of obese and overweight participants was higher than that of normal-weight participants, but the slope of TEE did not differ between normal-weight (y=132.99x+702.24, r2=0.877) and obese individuals (y=136.18x+1,037.9, r2=0.842). In conclusion, this review provides convincing evidence that daily TEE progressively increases with growth in males and females aged 1-18 years.

Movement Behaviour and Health Outcomes in Rural Children: A Systematic Review

BACKGROUND

Studies with rural children are limited, and results are divergent regarding the information on movement behaviours.

PURPOSE

to (i) describe the physical activity and sedentary behaviour in children; (ii) synthetize the year and place of publication, methodological quality, and instruments used to measure physical activity and sedentary behaviour; and (iii) to analyse the relationship between physical activity, sedentary behaviour, and health outcomes in these children.

METHODS

We use the databases PubMed, Web of Science, SPORTDiscus, Scopus, Virtual Health Library, and SciELO, considering papers published until October 2021. A total of 12,196 studies were identified, and after the exclusion of duplicate, title and abstract screening, and the full-text assessment, a total of 68 were included in the study.

RESULTS

A cross-sectional design was dominant among the studies, with sample sizes ranging from 23 to 44,631 children of both sexes. One-third of the studies were conducted in North America and Europe, and most of them used device-based measurements. Inequalities were observed regarding sex, age, economic level, race, and physical activity domains within and between the places of residence. Sociodemographic characteristics were also related to health outcomes for children living in rural and urban areas.

CONCLUSION

It is necessary to increase the evidence on movement behaviours among children living in the countries of South America and Oceania, as well as to increase the level of evidence on the role of school for physical activity in children in rural areas, given the inconsistent findings.

Influence of commuting methods on low back pain and musculoskeletal function of the lower limbs in elementary school children: A cross-sectional study

BACKGROUND

Lower limb flexibility is known to be decreased in those living in mountainous areas, and musculoskeletal growth is often influenced by lifestyle factors. The purpose of this study was to determine the relationship between the means of transportation to school and lower limb musculoskeletal function and low back pain.

METHODS

During routine medical examinations conducted in two cities in a prefecture in 2016, a questionnaire was administered. The parents of 15,259 students who attended elementary school answered questions evaluating the following parameters: (1) anteflexion limit in the standing posture, (2) crouching failure, (3) one leg standing failure, (4) low back pain during lumbar extension, (5) lower limb alignment abnormalities, and (6) flat foot. Students were divided into a walking commuting group (13,569 students) and a vehicle commuting group (1690 students), and findings were compared between the two groups using chi-square tests.

RESULTS

In the walking and vehicle commuting groups, anteflexion limit in the standing posture was present in 23.3% and 26.1% of students, respectively (p = 0.013). Crouching failure was present in 4.6% and 7.3% of students (p < 0.001); one leg standing failure in 5.3% and 8.5% of students (p < 0.001); low back pain in 5.0% and 7.1% of students (p < 0.001); positive leg alignment abnormalities in 7.3% and 8.0% of students (p = 0.260); and flat foot in 7.4% and 8.7% of students (p = 0.067), respectively. Significant differences were observed in all four of the failure measures. No significant differences were observed in the two methods evaluating morphological abnormalities.

CONCLUSIONS

The decreased walking duration and increased sitting duration associated with vehicle commuting had little effect on lower limb morphology but could induce lower limb dysfunction and low-back pain in children. Thus, supplemental walking should be instated for children who commute by car.

Association of Neighborhood Food Environment and Physical Activity Environment With Obesity: A Large-Scale Cross-Sectional Study of Fifth- to Ninth-Grade Children in Japan

Objective: This study examined the relationship between neighborhood food and physical activity environment, and obesity among elementary and junior high school students in Japan. Methods: The participants were fifth- to ninth-grade children (n=7277), who were attending municipal schools in Japan. Percent overweight (POW) was calculated using their age, gender, height, and weight, which were collected through a questionnaire. A POW of < 20% was considered non-obese, while ≥ 20% was considered obese. Furthermore, using a geographic information system, we investigated the density of convenience stores, fast-food stores, casual restaurants, supermarkets and department stores, parks, sports facilities, stations, and intersections in the school district. Additionally, from the census, we obtained information regarding the population density of the municipality where the participants' schools were located. Multiple logistic regression analysis was used to examine the relationship between obesity and food environment (the food environment model), between obesity and physical activity environment (the physical activity environment model), and among obesity, food, and physical activity environment (the food and physical activity environment model). Results: In the food environment model and the food and physical activity environment model, the density of convenience stores showed a significant positive association. In the physical activity environment model, the density of stations showed a significant negative association. Conclusion: This study's findings can contribute to the development of appropriate community interventions for improving children's health in Japan and similar areas.

Total Energy Expenditure, Body Composition, Physical Activity, and Step Count in Japanese Preschool Children: A Study Based on Doubly Labeled Water

Adequate energy intake is essential for the healthy development of children, and the estimated energy requirement of children is determined by total daily energy expenditure (TDEE) and energy deposition for growth. A previous study in Japanese tweens indicated that TDEE could be estimated by fat-free mass (FFM) and step count. The aims of this study were to measure TDEE in Japanese preschool children and to confirm whether TDEE can be estimated by FFM and step count in preschool children. Twenty-one children aged 4-6 years old (11 girls and 10 boys; age, 5.1 (0.9) years; height, 107.2 (6.6) cm; weight, 17.5 (1.7) kg; BMI, 15.3 (1.3); mean (SD)) participated in this study. FFM and 7-day TDEE were obtained by doubly labeled water (DLW). Participants wore accelerometers during the DLW measurement period. No significant differences were observed in age-adjusted height, weight, BMI, FFM (13.0 (1.5) kg), or TDEE (1300 (174) kcal/day) between girls and boys. Girls had significantly higher percent fat and a lower daily step count than boys. Stepwise regression analysis revealed that FFM and step count were significant predictors of TDEE; TDEE (kcal/day) = 85.0 × FFM (kg) + 0.0135 × step count (steps/day). This accounted for 74% of TDEE variance. The current study confirmed that FFM and step count are major determinants of TDEE in Japanese preschool children as well as adolescents, although further research is needed to obtain precise equations.

Assessment of body weight, maternal dietary knowledge and lifestyle practices among children and adolescents in north Jordan

OBJECTIVE

To estimate the prevalence of overweight and obesity among children and adolescents in north Jordan and to evaluate the dietary knowledge of their mothers.

DESIGN

Cross-sectional study.SettingsSchools, Irbid, Jordan.

SUBJECTS

Male and female participants (n 516) aged 6-18 years.

RESULTS

Thirty per cent of our sample population was overweight or obese, and about 11 % was underweight. Males tend to have a higher BMI and waist circumference than females except in the age group ≥15 years. Children who ate in front of the television tended to have higher BMI and waist circumference. Forty per cent of the mothers answered four or more questions correctly out of six, which indicated a sufficient level of nutritional knowledge.

CONCLUSIONS

The study revealed that obesity is a growing health problem in children and adolescents in north Jordan. This finding is considered a serious concern for public health and calls for the creation of new prevention programmes at the individual, family and community level.

Use of Mobile Devices to Measure Outcomes in Clinical Research, 2010-2016: A Systematic Literature Review

Background

The use of mobile devices in clinical research has advanced substantially in recent years due to the rapid pace of technology development. With an overall aim of informing the future use of mobile devices in interventional clinical research to measure primary outcomes, we conducted a systematic review of the use of and clinical outcomes measured by mobile devices (mobile outcomes) in observational and interventional clinical research.

Method

We conducted a PubMed search using a range of search terms to retrieve peer-reviewed articles on clinical research published between January 2010 and May 2016 in which mobile devices were used to measure study outcomes. We screened each publication for specific inclusion and exclusion criteria. We then identified and qualitatively summarized the use of mobile outcome assessments in clinical research, including the type and design of the study, therapeutic focus, type of mobile device(s) used, and specific mobile outcomes reported.

Results

The search retrieved 2,530 potential articles of interest. After screening, 88 publications remained. Twenty-five percent of the publications (n = 22) described mobile outcomes used in interventional research, and the rest (n = 66) described observational clinical research. Thirteen therapeutic areas were represented. Five categories of mobile devices were identified: (1) inertial sensors, (2) biosensors, (3) pressure sensors and walkways, (4) medication adherence monitors, and (5) location monitors; inertial sensors/accelerometers were most common (reported in 86% of the publications). Among the variety of mobile outcomes, various assessments of physical activity were most common (reported in 74% of the publications). Other mobile outcomes included assessments of sleep, mobility, and pill adherence, as well as biomarkers assessed using a mobile device, including cardiac measures, glucose, gastric reflux, respiratory measures, and intensity of head-related injury.

Conclusion

Mobile devices are being widely used in clinical research to assess outcomes, although their use in interventional research to assess therapeutic effectiveness is limited. For mobile devices to be used more frequently in pivotal interventional research – such as trials informing regulatory decision-making – more focus should be placed on: (1) consolidating the evidence supporting the clinical meaningfulness of specific mobile outcomes, and (2) standardizing the use of mobile devices in clinical research to measure specific mobile outcomes (e.g., data capture frequencies, placement of device). To that aim, this manuscript offers a broad overview of the various mobile outcome assessments currently used in observational and interventional research, and categorizes and consolidates this information for researchers interested in using mobile devices to assess outcomes in interventional research.

The shelf space and strategic placement of healthy and discretionary foods in urban, urban-fringe and rural/non-metropolitan Australian supermarkets

Objective

Supermarkets are a key influence on eating behaviours, but it is unknown if the promotion of food within stores varies on a geographic gradient from urban, to urban-fringe and non-metropolitan areas. The present study aimed to assess the shelf space and strategic placement of healthy and discretionary foods in each of urban, urban-fringe and non-metropolitan Australian supermarkets.

Design/Setting

In-store audits were conducted in stores from one of the two major Australian supermarket chains in urban (n19), urban-fringe (n20) and non-metropolitan (n26) areas of Victoria. These audits examined selected food items (crisps/chips, chocolate, confectionery, soft drinks/sodas, fruits and vegetables) and measured the shelf space and the proportion of end-of-aisle and cash register displays containing these products. Store size was measured as the sum of aisle length. Differences in the supermarket food environment with respect to location were assessed, before and after adjustment for neighbourhood socio-economic position.

Results

The strategic placement of discretionary foods was commonly observed in all supermarkets. Adjusting for store size (larger in urban-fringe and rural areas), urban stores had greater shelf space devoted to fruits and vegetables, and less checkouts with soft drinks, than urban-fringe and rural/non-metropolitan areas. Differences remained following adjustment for neighbourhood socio-economic position. No clear pattern was observed for end-of-aisle displays, or the placement of chocolate and confectionery at checkouts.

Conclusions

The shelf space of healthy and discretionary foods in urban-fringe and rural stores parallels the prevalence of overweight and obesity in these areas. Interventions in urban-fringe and rural stores targeting the shelf space of healthy foods and the placement of soft drinks at key displays may be useful obesity prevention initiatives.

Total energy expenditure of 10- to 12-year-old Japanese children measured using the doubly labeled water method

Background

To establish Japanese children's estimated energy requirements, total energy expenditure (TEE) data measured using the doubly labeled water (DLW) method is needed. This study aimed to 1) obtain basic TEE data from Japanese children measured using DLW (TEE_DLW), 2) compare TEE_DLW with TEE estimated by various estimation formulas to calculate their accuracy, and 3) develop a new equation to estimate TEE using body composition and pedometers.

Methods

TEE was measured using DLW in 56 10- to 12-year-old Japanese children (33 boys, 23 girls). Physical activity level (PAL) was calculated by dividing TEE_DLW by estimated resting energy expenditure. To assess their physical activity, participants wore pedometers during the 7-d DLW period. Total body water was calculated from ²H and ¹⁸O; fat-free mass (FFM) and fat mass (FM) were then determined.

Results

In boys and girls of normal weight, TEE_DLW was 2067 ± 230 kcal/d and 1830 ± 262 kcal/d, respectively. Average PAL was 1.58 ± 0.17. FFM was strongly related to TEE (r = 0.702, p < 0.01). After adjusting for FFM and FM, step count was significantly associated with TEE (r = 0.707, p < 0.01). The TEE estimation formula used in the Dietary Reference Intakes (DRI) for the United States and Canada estimated TEE_DLW with high accuracy (bias: 2.0%) in both sexes. We developed new equations for TEE consisting of FFM and step count, which accounted for 68% and 65% of TEE variance in boys and girls, respectively: boys, 47.1 × FFM (kg) + 0.0568 × step count (steps/d) - 122, and girls, 55.5 × FFM (kg) + 0.0315 × step count (steps/d) - 117.

Conclusions

The TEE in 10- to 12-year-old Japanese children measured using DLW was approximately 7% lower for boys and 12% lower for girls compared to the current Japanese DRI. If PAL can be accurately determined, the equation in the DRI for the United States and Canada may be applicable to Japanese children. In addition, TEE could be predicted using FFM and step count.

Sleep and dietary habits in the urban environment: the role of chrono-nutrition

The urban environment has changed vastly over past decades, which also has had an impact on our sleep and dietary patterns and possibly health outcomes. Some studies have shown that sleep duration and sleep quality has declined over past decades, especially in children. In parallel, our lifestyle and dietary patterns have also changed including more shift work, more meals outside the home or family setting and more irregular eating patterns, including breakfast skipping and late-night eating. This new area of research in nutritional sciences studying the impact of the timing of eating on health outcomes is called chrono-nutrition, and combines elements from nutritional research with chrono-biology. The objectives of this paper were to discuss secular trends in sleep patterns and related dietary patterns, introduce basic concepts and mechanisms of chrono-nutrition and discuss the evidence for the importance of sleep and chrono-nutrition in relation to health outcomes. Overall, chrono-nutrition could mediate the effects between sleep, diet and urbanisation, and more research is needed to elucidate the importance of chrono-nutrition for metabolic health and its impact on public health.

Decline in objective physical activity over a 10-year period in a Japanese elementary school

Background

The purpose of this study was to examine the change in accelerometer-derived daily physical activity (PA) and activity record-derived daily activities over a 10-year period in urban elementary schoolchildren in Japan.

Methods

A total of 233 sixth-grade children (11–12 years old) in a same elementary school in Kyoto participated in the study (n = 125 and 108 in 1999 and 2009, respectively). The participant rate is 91.9 and 98.2 % in 1999 and 2009, respectively. The size and shape of the school district was not changed. The children were instructed to wear an accelerometer for 5 consecutive days of weekday and to keep minute-by-minute 24-h activity records with the assistance of their parents. The school-day scheduling was similar between 1999 and 2009 (29 and 27 sessions of 45-min class per week, respectively).

Results

From 1999 to 2009, step counts considerably decreased (20,832 vs. 12,237 steps per day in boys and 16,087 vs. 10,748 steps per day in girls; P < 0.001) with concomitant significant decreases in total energy expenditure (P = 0.011), activity energy expenditure (P < 0.001), and physical activity level (P < 0.001). Time spent playing outdoors and walking to school were also significantly less in 2009 than 1999 (P < 0.001). Accelerometer-measured PA was significantly associated with the amount of time spent playing outdoors and walking to school.

Conclusions

These results indicate that elementary schoolchildren in 2009 spend less time playing outdoors and walking to school, perform less PA, and take fewer steps than children of a decade ago.

Ellagic acid suppresses lipid accumulation by suppressing early adipogenic events and cell cycle arrest

Ellagic acid (EA) is a natural polyphenol found in various fruits and vegetables. In this study, we examined the inhibitory effect of EA on fat accumulation in 3T3-L1 cells during adipogenesis. Our data showed that EA reduced fat accumulation by down-regulating adipogenic markers such as peroxisome proliferator activated receptor γ (PPARγ) and the CCAAT/enhancer binding protein α (C/EBPα) at the mRNA and protein levels in a dose-dependent manner. We found that the decrease in adipogenic markers resulted from reduced expression of some early adipogenic transcription factors such as KLF4, KLF5, Krox20, and C/EBPβ within 24 h. Also, these inhibitions were correlated with down-regulation of TG synthetic enzymes, causing inhibition of triglyceride (TG) levels in 3T3-L1 cells investigated by ORO staining and in zebrafish investigated by TG assay. Additionally, the cell cycle analysis showed that EA inhibited cell cycle progression by arresting cells at the G0/G1 phase.

Etiology of Obesity Over the Life Span: Ecological and Genetic Highlights from Asian Countries

Obesity is a worldwide pandemic, and the prevalence rate has doubled since the 1980s. Asian countries are also experiencing the global epidemic of obesity with its related health consequences. The prevalence of overweight and obesity are increasing at an alarming rate across all age groups in Asia. These increases are mainly attributed to rapid economic growth, which leads to socio-economic, nutrition and lifestyle transitions, resulting in a positive energy balance. In addition, fat mass and obesity-associated gene variants, copy number variants in chromosomes and epigenetic modifications have shown positive associations with the risk of obesity among Asians. In this review highlights of prevalence and related ecological and genetic factors that could influence the rapid rise in obesity among Asian populations are discussed.