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Cuda S. Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024. OBESITY PILLARS 2024; 11:100113. [PMID: 38953014 PMCID: PMC11216014 DOI: 10.1016/j.obpill.2024.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 07/03/2024]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details assessment and management of the child with overweight or obesity. The term "child" is defined as the child between 2 and 12 years of age. Because children are in a continual state of development during this age range, we will specify when our discussion applies to subsets within this age range. For the purposes of this CPS, we will use the following definitions: overweight in the child is a body mass index (BMI) ≥ 85th and <95th percentile, obesity in the child is a BMI ≥95th percentile, and severe obesity is a BMI ≥120% of the 95th percentile. Methods The information and clinical guidance in this OMA Clinical Practice Statement are based on scientific evidence, supported by medical literature, and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement provides an overview of prevalence of disease in this population, reviews precocious puberty in the child with obesity, discusses the current and evolving landscape of the use of anti-obesity medications in children in this age range, discusses the child with obesity and special health care needs, and reviews hypothalamic obesity in the child. Conclusions This OMA Clinical Practice Statement on the child with obesity is an evidence based review of the literature and an overview of current recommendations. This CPS is intended to provide a roadmap to the improvement of the health of children with obesity, especially those with metabolic, physiological, psychological complications and/or special healthcare needs. This CPS addresses treatment recommendations and is designed to help the clinician with clinical decision making.
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Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
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Kang E, Hong YH, Kim J, Chung S, Kim KK, Haam JH, Kim BT, Kim EM, Park JH, Rhee SY, Kang JH, Rhie YJ. Obesity in Children and Adolescents: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr 2024; 33:11-19. [PMID: 38193204 PMCID: PMC11000513 DOI: 10.7570/jomes23060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/12/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
The prevalence of obesity in children and adolescents has been gradually increasing in recent years and has become a major health problem. Childhood obesity can readily progress to adult obesity. It is associated with obesity-related comorbidities, such as type 2 diabetes mellitus, hypertension, obstructive sleep apnea, non-alcoholic fatty liver disease, and the risk factor for cardiovascular disease. It is important to make an accurate assessment of overweight and obesity in children and adolescents with consideration of growth and development. Childhood obesity can then be prevented and treated using an appropriate treatment goal and safe and effective treatment strategies. This article summarizes the clinical practice guidelines for obesity in children and adolescents that are included in the 8th edition of the Clinical Practice Guidelines for Obesity of the Korean Society for the Study of Obesity.
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Affiliation(s)
- Eungu Kang
- Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyoung-Kon Kim
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Ji-Hee Haam
- Deptartment of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Bom Taeck Kim
- Department of Family Practice & Community Health, Ajou University School of Medicine, Suwon, Korea
| | - Eun Mi Kim
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Jee-Hyun Kang
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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McCarty G, Wyeth EH, Sullivan T, Crengle S, Nelson V, Derrett S. Health-related quality of life measures used with Indigenous children/youth in the Pacific Rim: a scoping review. BMJ Open 2023; 13:e070156. [PMID: 36997253 PMCID: PMC10069609 DOI: 10.1136/bmjopen-2022-070156] [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: 03/31/2023] Open
Abstract
OBJECTIVE To identify and describe (1) which health-related quality of life (HRQoL) measures have been used with Indigenous children/youth (aged 8-17 years) within the Pacific Rim; and (2) studies that refer to Indigenous health concepts in the use of child/youth HRQoL measures. DESIGN A scoping review. DATA SOURCES Ovid (Medline), PubMed, Scopus, Web of Science and CINAHL were searched up until 25 June 2020. ELIGIBILITY CRITERIA Eligible papers were identified by two independent reviewers. Eligible papers were written in English, published between January 1990 and June 2020 and included an HRQoL measure used in research with Indigenous child/youth populations (aged between 8 and 17 years) in the Pacific Rim region. DATA EXTRACTION AND SYNTHESIS Data extracted included study characteristics (year, country, Indigenous population, Indigenous sample size, age group), HRQoL measure characteristics (generic or condition-specific measure, child or adult measure, who completed the measure(s), dimensions, items and response scale of measure) and consideration of Indigenous concepts (created for Indigenous population, modified for Indigenous population, validated for Indigenous population, reliability in Indigenous populations, Indigenous involvement, reference to Indigenous theories/models/frameworks). RESULTS After removing duplicates, 1393 paper titles and abstracts were screened, and 543 had full-text review for eligibility. Of these, 40 full-text papers were eligible, reporting on 32 unique studies. Twenty-nine HRQoL measures were used across eight countries. Thirty-three papers did not acknowledge Indigenous concepts of health, and only two measures were specifically created for use with Indigenous populations. CONCLUSIONS There is a paucity of research investigating HRQoL measures used with Indigenous children/youth and a lack of involvement of Indigenous peoples in the development and use of HRQoL measures. We strongly recommend explicit consideration of Indigenous concepts when developing, validating, assessing and using HRQoL measures with Indigenous populations.
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Affiliation(s)
- Georgia McCarty
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Emma H Wyeth
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Trudy Sullivan
- Preventive and Social Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Vicky Nelson
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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Han B, Du G, Yang Y, Chen J, Sun G. Relationships between physical activity, body image, BMI, depression and anxiety in Chinese college students during the COVID-19 pandemic. BMC Public Health 2023; 23:24. [PMID: 36604631 PMCID: PMC9813468 DOI: 10.1186/s12889-022-14917-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Both depression and anxiety are worldwide burden that is not being abated with our current knowledge and treatment of the condition. Numerous clinical trials have supported that physical activity (PA) can reduce the depression and anxiety in adolescents, but little is known about its mechanism of action. Therefore, the study objectives were to explore the potential relationship between physical activity and depression and anxiety from the perspective of body image and body mass index (BMI), and to provide an important reference for future self-esteem education and health promotion intervention. METHODS The participants in this study were 251 Chinese college students between 17 and 22 years old. Participants completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the Body Image Questionnaire (BIQ), the Self-rating Depression Scale (SDS) and the Self-rating Anxiety Scale (SAS). A descriptive and correlational approach was used, using the PROCESS macro for Statistical Package for the Social Sciences (SPSS). RESULTS (1) Physical activity was significantly negatively correlated with both depression and anxiety (t = -0.216, p < 0.001; t = -0.184, p < 0.01). (2) Body image had a significant moderating effect on the relationship between physical activity and anxiety among college students, but there was no moderating effect between depression and physical activity. BMI has no moderating effect on the two interrelationships. CONCLUSION There is only body image that moderates the relationship between anxiety and physical activity.
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Affiliation(s)
- Bing Han
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, Shandong China
| | - Guoli Du
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, Shandong China
| | - Yashu Yang
- grid.27255.370000 0004 1761 1174School of Philosophy and Social Development, Shandong University, Jinan, Shandong China
| | - Jiping Chen
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, Shandong China
| | - Guoxiao Sun
- grid.27255.370000 0004 1761 1174School of Physical Education, Shandong University, Jinan, Shandong China
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de la Rie S, Washbrook E, Perinetti Casoni V, Waldfogel J, Kwon SJ, Dräger J, Schneider T, Olczyk M, Boinet C, Keizer R. The role of energy balance related behaviors in socioeconomic inequalities in childhood body mass index: A comparative analysis of Germany, the Netherlands, the United Kingdom, and the United States. Soc Sci Med 2023; 317:115575. [PMID: 36470056 DOI: 10.1016/j.socscimed.2022.115575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 11/09/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022]
Abstract
Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries-Germany, the Netherlands, the United Kingdom (UK), and the United States (US)-to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors-physical activity, screen time, and breakfast consumption-in explaining these inequalities. Children were aged 5-7 at our first timepoint and were followed up at age 8-11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families.
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Affiliation(s)
- Sanneke de la Rie
- Department of Public Administration & Sociology, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR, Rotterdam, Netherlands.
| | - Elizabeth Washbrook
- School of Education, University of Bristol, 35 Berkeley Square, Bristol, BS8 1JA, United Kingdom
| | | | - Jane Waldfogel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Sarah Jiyoon Kwon
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Jascha Dräger
- School of Education, University of Strathclyde, 141 St James Road, Glasgow, G4 0LT, United Kingdom
| | | | - Melanie Olczyk
- Martin-Luther-Universität Halle-Wittenberg, Paracelsusstr. 22, 06114, Halle (Saale), Germany
| | - Césarine Boinet
- Department of Economics, University of Strathclyde, 199 Cathedral Street, Glasgow, G4 0QU, United Kingdom; French Institute for Demographic Studies (INED), 9 Cours des Humanités CS 50004, 93322, Aubervilliers Cedex, Aubervilliers, France
| | - Renske Keizer
- Department of Public Administration & Sociology, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR, Rotterdam, Netherlands
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Nussbaum BM, Mathew MS, Atem F, Barlow SE, Gupta OT, Messiah SE. Distribution of comorbidities as primary diagnoses by obesity class among patients in a large US paediatric healthcare system. Clin Obes 2021; 11:e12478. [PMID: 34250735 DOI: 10.1111/cob.12478] [Citation(s) in RCA: 6] [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: 05/05/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
There is little documentation of the distribution of specific health conditions across obesity classes (I, II, III), especially for paediatric populations who are seen for routine care in large United States US healthcare systems. The aim of this study was to assess the odds of presenting ≥2 obesity-related comorbidities as well as assess the overall distribution of these co-morbidities in children by class I/II/III obesity status controlling for key sociodemographic characteristics. This retrospective (2015-2019) electronic health record review analysed 49 276 patients from the Children's Health System of Texas diagnosed with obesity-related health conditions by obesity status (no obesity, class I, II, III). Crude and adjusted logistic regression models examined the association between obesity class and the likelihood of ≥2 comorbidities as primary diagnoses. Patients with class I obesity were 22% more likely (OR 1.22, 95% CI, 1.16, 1.27), patients with class II obesity were almost 50% more likely (OR 1.44, 95% CI, 1.35, 1.53) and those with class III obesity twice as likely (OR 2.04, 95% CI 1.91, 2.18) to be diagnosed with ≥2 comorbidities as primary diagnoses, compared with patients classified with no obesity. Children with obesity, particularly severe obesity, should be monitored closely by paediatricians for possible diagnoses of risk factors that could lead to adult chronic disease.
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Affiliation(s)
- Brandon M Nussbaum
- University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas, USA
| | - Matthew Sunil Mathew
- Center for Pediatric Population Health, UTHealth School of Public Health, Children's Health System of Texas, Dallas, Texas, USA
| | - Folefac Atem
- Center for Pediatric Population Health, UTHealth School of Public Health, Children's Health System of Texas, Dallas, Texas, USA
| | - Sarah E Barlow
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Olga T Gupta
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas, USA
- Center for Pediatric Population Health, UTHealth School of Public Health, Children's Health System of Texas, Dallas, Texas, USA
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7
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Corbett BA, Muscatello RA, Horrocks BK, Klemencic ME, Tanguturi Y. Differences in Body Mass Index (BMI) in Early Adolescents with Autism Spectrum Disorder Compared to Youth with Typical Development. J Autism Dev Disord 2021; 51:2790-2799. [PMID: 33051783 PMCID: PMC8041918 DOI: 10.1007/s10803-020-04749-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 12/19/2022]
Abstract
Adolescence is a time of exceptional physical health juxtaposed against significant psychosocial and weight-related problems. The study included 241, 10-to-13-year-old youth with autism spectrum disorder (ASD, N = 138) or typical development (TD, N = 103). Standardized exams measured pubertal development, height (HT), weight (WT), heart rate (HR), blood pressure (BP) and Body Mass Index (BMI). Analysis of Variance showed no significant between-group differences for HT, WT, HR, or BP (all p > 0.05). There was a significant difference in BMI-percentile between the groups (F(1,234) = 6.05, p = 0.01). Using hierarchical linear regression, significant predictors of BMI-percentile included diagnosis, pubertal stage and socioeconomic status. Pre-to-early pubescent children with ASD evidence higher BMI percentiles compared to youth with TD suggesting they may be at heightened risk for weight-related health concerns.
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Affiliation(s)
- Blythe A Corbett
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Village at Vanderbilt, Suite 2200, 1500 21st Avenue South, Nashville, TN, 37212, USA.
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Rachael A Muscatello
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Village at Vanderbilt, Suite 2200, 1500 21st Avenue South, Nashville, TN, 37212, USA
| | - Briana K Horrocks
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Village at Vanderbilt, Suite 2200, 1500 21st Avenue South, Nashville, TN, 37212, USA
| | - Mark E Klemencic
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Village at Vanderbilt, Suite 2200, 1500 21st Avenue South, Nashville, TN, 37212, USA
| | - Yasas Tanguturi
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Village at Vanderbilt, Suite 2200, 1500 21st Avenue South, Nashville, TN, 37212, USA
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Koutaki D, Michos A, Bacopoulou F, Charmandari E. The Emerging Role of Sfrp5 and Wnt5a in the Pathogenesis of Obesity: Implications for a Healthy Diet and Lifestyle. Nutrients 2021; 13:nu13072459. [PMID: 34371968 PMCID: PMC8308727 DOI: 10.3390/nu13072459] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 01/03/2023] Open
Abstract
In recent decades, the prevalence of obesity has risen dramatically worldwide among all age groups. Obesity is characterized by excess fat accumulation and chronic low-grade inflammation. The adipose tissue functions as a metabolically active endocrine organ secreting adipokines. A novel duo of adipokines, the anti-inflammatory secreted frizzled-related protein 5 (Sfrp5) and the proinflammatory wingless type mouse mammary tumor virus (MMTV) integration site family member 5A (Wnt5a), signal via the non-canonical Wnt pathway. Recent evidence suggests that Sfpr5 and Wnt5a play a key role in the pathogenesis of obesity and its metabolic complications. This review summarizes the current knowledge on the novel regulatory system of anti-inflammatory Sfrp5 and pro-inflammatory Wnt5a, and their relation to obesity and obesity-related complications. Future studies are required to investigate the potential role of Sfrp5 and Wnt5a as biomarkers for monitoring the response to lifestyle interventions and for predicting the development of cardiometabolic risk factors. These adipokines may also serve as novel therapeutic targets for obesity-related disorders.
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Affiliation(s)
- Diamanto Koutaki
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Athanasios Michos
- Division of Infectious Diseases, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health & Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
- Correspondence: ; Tel./Fax: +30-213-2013-384
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Rossman H, Shilo S, Barbash-Hazan S, Artzi NS, Hadar E, Balicer RD, Feldman B, Wiznitzer A, Segal E. Prediction of Childhood Obesity from Nationwide Health Records. J Pediatr 2021; 233:132-140.e1. [PMID: 33581105 DOI: 10.1016/j.jpeds.2021.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate body mass index (BMI) acceleration patterns in children and to develop a prediction model targeted to identify children at high risk for obesity before the critical time window in which the largest increase in BMI percentile occurs. STUDY DESIGN We analyzed electronic health records of children from Israel's largest healthcare provider from 2002 to 2018. Data included demographics, anthropometric measurements, medications, diagnoses, and laboratory tests of children and their families. Obesity was defined as BMI ≥95th percentile for age and sex. To identify the time window in which the largest annual increases in BMI z score occurs during early childhood, we first analyzed childhood BMI acceleration patterns among 417 915 adolescents. Next, we devised a model targeted to identify children at high risk before this time window, predicting obesity at 5-6 years of age based on data from the first 2 years of life of 132 262 children. RESULTS Retrospective BMI analysis revealed that among adolescents with obesity, the greatest acceleration in BMI z score occurred between 2 and 4 years of age. Our model, validated temporally and geographically, accurately predicted obesity at 5-6 years old (area under the receiver operating characteristic curve of 0.803). Discrimination results on subpopulations demonstrated its robustness across the pediatric population. The model's most influential predictors included anthropometric measurements of the child and family. Other impactful predictors included ancestry and pregnancy glucose. CONCLUSIONS Rapid rise in the prevalence of childhood obesity warrant the development of better prevention strategies. Our model may allow an accurate identification of children at high risk of obesity.
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Affiliation(s)
- Hagai Rossman
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Smadar Shilo
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel; Pediatric Diabetes Unit, Ruth Rappaport Children's Hospital of Haifa, Rambam Healthcare Campus, Haifa, Israel
| | - Shiri Barbash-Hazan
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nitzan Shalom Artzi
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran D Balicer
- Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel; Department of Public Health, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Becca Feldman
- Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
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10
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Lundgren O, Henriksson P, Delisle Nyström C, Silfvernagel K, Löf M. Hyperactivity is associated with higher fat-free mass and physical activity in Swedish preschoolers: A cross-sectional study. Acta Paediatr 2021; 110:1273-1280. [PMID: 33020960 PMCID: PMC7984399 DOI: 10.1111/apa.15608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/11/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022]
Abstract
Aim We investigated psychological strengths and difficulties in a Swedish population of preschool children and analysed how these behavioural variables were related to body composition, cardiorespiratory fitness, physical activity levels, sedentary behaviour and diet. Methods Three hundred and fifteen boys and girls were recruited during 2014‐2015. Body composition was measured using air‐displacement plethysmography, and anthropometric measures were taken. Parents responded to questions about age, sex and educational attainment, diet, physical activity levels and smoking habits, as well as the Strengths and Difficulties Questionnaire (SDQ). Regression models were created to analyse associations between psychological variables, body composition and health behaviours. Results Hyperactivity scores were positively related to fat‐free mass (β = 0.20, P = .001) and moderate‐to‐vigorous physical activity (β = 0.16, P = .003) and negatively associated with sedentary behaviours (β = 0.18, P = .001), but showed no statistically significant associations with fat mass. Conclusion Our findings suggest that the adverse health consequences of hyperactivity on obesity and obesity‐related health behaviours may be established after the preschool period. Questions about the time frame of contributing and modulating factors in obesity development are discussed.
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Affiliation(s)
- Oskar Lundgren
- Crown Princess Victoria Children's Hospital Linköping University Hospital Linköping Sweden
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | | | - Kristin Silfvernagel
- Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
- Department of Biosciences and Nutrition Karolinska Institutet Solna Sweden
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11
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Fernández CR, Lee J, Duroseau N, Vargas-Rodriguez I, Rieder J. Child Health Behaviour and Parent Priorities for a School-Based Healthy Lifestyle Programme. HEALTH EDUCATION JOURNAL 2021; 80:361-372. [PMID: 35747426 PMCID: PMC9217183 DOI: 10.1177/0017896920972152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The purpose of this study was to characterise parents' concerns for their children's health behaviours and perceptions of motivators and barriers to positive child health behaviour change, and to determine associations between motivators and barriers and parents' priorities for a school-based healthy lifestyle programme. DESIGN Cross-sectional study of 46 parents who had completed an un-validated survey distributed during school-wide events. SETTING School for children aged 5-14 years in The Bronx, New York City, USA. METHODS Wilcoxon Rank Sum tests compared motivators and barriers to positive child health behaviour change by heath behaviour concern; Spearman's correlation measured associations between motivators and barriers and programme priorities. RESULTS Parents concerned about child weight significantly ranked keeping up with others and decreasing clothing size as motivators, while parents concerned about child food choices significantly ranked improving food choices and decreasing BMI and clothing size as motivators. Food-, play-, and self-esteem-related motivators were associated with nutrition education (rs ≥ .41, p ≤ .01), physical activity classes (rs ≥ .29, p ≤ .04) and child involvement in programme decision-making (rs ≥ .43, p ≤ .01) priorities. Consistency-, child resistance-, and home rules-related barriers were associated with nutrition education (rs ≥ .37, p=.02), physical activity classes (rs ≥ .32, p = .02), and child involvement (rs ≥ .40, p ≤ .02) priorities. CONCLUSIONS Despite the study sample size, selection bias, and generalisability limitations, prioritising nutrition, physical activity and child involvement in programme decision-making may enhance parent support for school-based healthy lifestyle programmes.
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Affiliation(s)
- Cristina R Fernández
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Janet Lee
- Department of Pediatrics, Mount Sinai Health System, New York, NY, USA
| | - Nathalie Duroseau
- Adolescent Medicine Fellow, Department of Pediatrics, Mount Sinai Health System, New York, NY, USA
| | | | - Jessica Rieder
- Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, NY, USA
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12
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Nguyen CD, Carlin JB, Lee KJ. Practical strategies for handling breakdown of multiple imputation procedures. Emerg Themes Epidemiol 2021; 18:5. [PMID: 33794933 PMCID: PMC8017730 DOI: 10.1186/s12982-021-00095-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 03/20/2021] [Indexed: 01/11/2023] Open
Abstract
Multiple imputation is a recommended method for handling incomplete data problems. One of the barriers to its successful use is the breakdown of the multiple imputation procedure, often due to numerical problems with the algorithms used within the imputation process. These problems frequently occur when imputation models contain large numbers of variables, especially with the popular approach of multivariate imputation by chained equations. This paper describes common causes of failure of the imputation procedure including perfect prediction and collinearity, focusing on issues when using Stata software. We outline a number of strategies for addressing these issues, including imputation of composite variables instead of individual components, introducing prior information and changing the form of the imputation model. These strategies are illustrated using a case study based on data from the Longitudinal Study of Australian Children.
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Affiliation(s)
- Cattram D Nguyen
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia.
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia.
| | - John B Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Katherine J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
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13
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Fan H, Zhang X. Prevalence of and Trends in the Co-Existence of Obesogenic Behaviors in Adolescents From 15 Countries. Front Pediatr 2021; 9:664828. [PMID: 33968860 PMCID: PMC8100235 DOI: 10.3389/fped.2021.664828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/26/2021] [Indexed: 12/22/2022] Open
Abstract
Background: The global epidemic of pediatric obesity is well-known, but data on co-existence of obesogenic behaviors are limited. We aim to report the prevalence of and trends in the co-existence of obesogenic behaviors in adolescents from 15 countries. Methods: This study was based on the Global School-based Student Health Survey 2003-2017 and included 121,963 adolescents aged 12-15 years from 15 countries where at least 2 cross-sectional surveys were conducted. We used sampling weights and calculated the country-level prevalence of and trends in the co-existence of obesogenic behaviors (low fruit and vegetable intake, anxiety-induced insomnia, no physical activity, and sedentary behavior) during survey years. Pooled prevalence and trend estimates were calculated with random-effects models. Results: Pooled prevalence of exposure ≥ 1, ≥2, and ≥3 obesogenic behaviors was 88.2, 44.9, and 9.8% in the first survey and 88.4, 46.4, and 10.2% in the last survey, respectively. Plateauing, increasing, and decreasing trends in the co-existence of obesogenic behaviors were observed in different countries. Specifically, we identified a plateauing pooled trend in the exposure ≥ 1, ≥2, and ≥3 obesogenic behaviors [odds ratios (95% confidence intervals): 1.03 (0.93, 1.14), 1.05 (0.97, 1.13), and 1.06 (0.95, 1.18), respectively]. Conclusion: Trends in the prevalence of the co-existence of obesogenic behaviors varied significantly across different countries, but the prevalence remained high in most countries. These findings suggest the need for behavioral interventions to mitigate obesogenic behaviors in adolescents for overweight and obesity prevention.
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Affiliation(s)
- Hui Fan
- Department of Preventive Medicine, North Sichuan Medical College, Nanchong, China
| | - Xingyu Zhang
- Applied Biostatistics Laboratory, University of Michigan School of Nursing, Ann Arbor, MI, United States
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14
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Rashid R, Condon L, Gluud C, Jakobsen JC, Lindschou J, Lissau I. Psychotherapy versus treatment as usual and other control interventions in children and adolescents with overweight and obesity: a protocol for systematic review with meta-analysis and Trial Sequential Analysis. BMJ Open 2020; 10:e036058. [PMID: 33154043 PMCID: PMC7646330 DOI: 10.1136/bmjopen-2019-036058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The prevalence of children with overweight and obesity is increasing worldwide. Multicomponent interventions incorporating diet, physical activity and behavioural change have shown limited improvement to body mass index (BMI). However, the impact of psychotherapy is poorly explored. This systematic review aims to assess the effects of psychotherapeutic approaches for children with all degrees of overweight. METHODS AND ANALYSIS We will include randomised clinical trials involving children and adolescents between 0 and 18 years with overweight and obesity, irrespective of publication type, year, status or language up to April 2020. Psychotherapy will be compared with no intervention; wait list control; treatment as usual; sham psychotherapy or pharmaceutical placebo. The following databases will be searched: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, Embase, PsycINFO, PubMed, Web of Science, CINAHL and LILACS. Primary outcomes will be BMI z-score, quality of life measured by a validated scale and proportion of patients with serious adverse events. Secondary outcomes will be body weight, self-esteem, anxiety, depression and proportion of patients with non-serious adverse events. Exploratory outcomes will be body fat, muscle mass and serious adverse events. Study inclusion, data extraction and bias risk assessments will be conducted independently by at least two authors. We will assess risk of bias according to Cochrane guidelines and the Cochrane Effective Practice and Organisation of Care guidance. We will use meta-analysis and control risks of random errors with Trial Sequential Analysis. The quality of the evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation Tool. The systematic review will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines. ETHICS AND DISSEMINATION As individual patient data will not be included, we do not require ethics approval. This review will be published in a peer review journal. PROSPERO REGISTRATION NUMBER CRD42018086458.
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Affiliation(s)
- Rajeeb Rashid
- Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Laura Condon
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janus C Jakobsen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbaek Sygehus, Holbaek, Sjaelland, Denmark
| | - Jane Lindschou
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Inge Lissau
- Clinical Research Centre, University Hospital Copenhagen, Copenhagen, Hvidovre, Denmark
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15
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Sünnetçi Silistre E, Hatipoğl HU. Increased serum circulating asprosin levels in children with obesity. Pediatr Int 2020; 62:467-476. [PMID: 32003085 DOI: 10.1111/ped.14176] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/15/2019] [Accepted: 01/15/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Childhood obesity is a growing and significant problem worldwide. Asprosin is a novel adipokine that is significantly associated with glucose and insulin production in the liver during fasting. In the present study, we aimed to demonstrate whether there would be differences between obese, overweight, and normal weight children in terms of serum asprosin levels. METHODS Forty-four children with obesity, 54 overweight children, and 60 normal weight children were compared in terms of serum asprosin levels and other anthropometric, biochemical, and hormonal parameters that are associated with being overweight and with obesity. RESULTS Serum asprosin levels were found to be significantly different between groups: 70.903 ± 17.49 ng/mL, 79.744 ± 29.54 ng/mL, and 106.293 ± 122.69 ng/mL in normal weight, overweight, and obese children respectively. Post-hoc analysis revealed that the asprosin level was significantly higher in obese children compared with normal weight children (P = 0.009). Additionally, asprosin was found to be a predictor of obesity in multiple regression analysis. CONCLUSION Our study is the first to demonstrate increased levels of asprosin in obese children compared with normal weight children. Further studies are needed to demonstrate the role of asprosin in the etiology of childhood obesity, as well as other diseases that might be associated with effects of asprosin.
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Affiliation(s)
- Eda Sünnetçi Silistre
- Department of Pediatrics, Istanbul Training and Education Hospital, İstanbul, Turkey
| | - Halil Uğur Hatipoğl
- Department of Pediatrics, Istanbul Training and Education Hospital, İstanbul, Turkey
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16
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Rashid R, Perego P, Condon L, Jakobsen JC, Lindschou J, Gluud C, Andreoni G, Lissau I. Health apps targeting children with overweight-a protocol for a systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials. Syst Rev 2020; 9:28. [PMID: 32046781 PMCID: PMC7014738 DOI: 10.1186/s13643-020-1269-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The prevalence of overweight is increasing worldwide in children. Multi-component interventions incorporating diet, physical activity, and behavioural change have been shown to reduce body mass index (BMI). Whilst many children have their own smartphone, the clinical effects of using smartphone applications (apps) for overweight are unknown. This systematic review aims to ascertain the effects of mHealth apps in children with overweight. METHODS We will include randomised clinical trials irrespective of publication type, year, status, or language. Children between 0 and 18 years with overweight will be included. We will compare apps targeting overweight versus sham app, no app, or usual intervention. No distinction about operative system will be considered (i.e. Android, iOS, and Window Mobile will be included). The following databases will be searched: The Cochrane Library, Excerpta Medica database (Embase), PsycINFO, PubMed, IEEE Explore, Web of Science, CINAHL, and LILACS. Primary outcomes will be body weight, quality of life, and serious adverse event. Secondary outcomes will be self-efficacy, anxiety, depression, and adverse event not considered serious. Trial inclusion, data extraction, and bias risk assessment will be conducted independently by at least two authors. We will assess risk of bias through eight domains and control risks of random errors with Trial Sequential Analysis. The quality of the evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation Tool (GRADE). DISCUSSION We will provide evidence of the beneficial and harmful effects of smartphone apps for children with overweight and highlight any gaps in the evidence in order to shape future potential interventions. By only including randomised clinical trials, we know that we bias our review towards benefits. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019120210.
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Affiliation(s)
- Rajeeb Rashid
- Paediatric Unit, Department of Child Health, University of Edinburgh, St John’s Hospital, Livingston, EH54 6PP UK
| | - Paolo Perego
- Department of Design, Politecnico di Milano, via Durando 38/a, 20158 Milan, Italy
| | - Laura Condon
- School of Medicine, University of Nottingham, Medical School, Nottingham, NG7 2RD UK
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
- Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Giuseppe Andreoni
- Department of Design, Politecnico di Milano, via Durando 38/a, 20158 Milan, Italy
| | - Inge Lissau
- Clinical Research Centre, University Hospital Copenhagen, Kettegard Alle 30, 2650 Hvidovre, Denmark
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17
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Kang NR, Kwack YS. An Update on Mental Health Problems and Cognitive Behavioral Therapy in Pediatric Obesity. Pediatr Gastroenterol Hepatol Nutr 2020; 23:15-25. [PMID: 31988872 PMCID: PMC6966224 DOI: 10.5223/pghn.2020.23.1.15] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/17/2022] Open
Abstract
Prevalence of pediatric obesity has increased worldwide in the last 20 years. Obese children suffer not only physical complications but also mental health problems such as depression, attention deficit hyperactivity disorder (ADHD), and eating disorders, as well as psychosocial impairments, such as school adjustment problems, bullying, and low self-esteem. Recently, there have been some studies on the association of mental health problems and pediatric obesity. In the treatment of pediatric obesity, many previous studies suggest multidisciplinary treatment. However, cognitive behavioral therapy (CBT) has attracted attention because obese children are accompanied by body image distortion, emotion dysregulation, and difficulties in stimulus control. This review is a narrative summary of the recent studies on mental health problems and CBT in pediatric obesity. The relationship between depression/anxiety and pediatric obesity is still inconsistent but recent studies have revealed a bidirectional relation between depression and obesity. Additionally, some studies suggest that obese children may have eating disorder symptoms, like loss of control eating, and require therapeutic intervention for pediatric obesity treatment. Furthermore, impulsivity and inattention of ADHD symptom is thought to increase the risk of obesity. It has also been suggested that CBT can be very effective for mental health problems such as depression, impulsivity, and body image distortion, that may coexist with pediatric obesity, and use of multimedia and application can be useful in CBT.
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Affiliation(s)
- Na Ri Kang
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Korea
| | - Young Sook Kwack
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Korea
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18
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Christensen KG, Nielsen SG, Olsen NJ, Dalgård C, Heitmann BL, Larsen SC. Child behaviour and subsequent changes in body weight, composition and shape. PLoS One 2019; 14:e0226003. [PMID: 31856169 PMCID: PMC6922444 DOI: 10.1371/journal.pone.0226003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/17/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Studies have found an association between child behavioural problems and overweight, but the existing evidence for this relationship is inconsistent, and results from longitudinal studies are sparse. Thus, we examined the association between behavioural problems and subsequent changes in body mass index (BMI) and anthropometry over a follow-up period of 1.3 years among children aged 2–6 years. Design The study was based on a total of 345 children from The Healthy Start Study; all children were healthy weight but predisposed to develop overweight. The Danish version of the Strengths and Difficulties Questionnaire (SDQ), classified as SDQ Total Difficulties (SDQ-TD) and SDQ Prosocial Behaviour (SDQ-PSB), was used to assess child behaviour. Linear regression analyses were used to examine associations between SDQ scores and subsequent change in BMI z-score, body fat percentage, waist circumference and waist-hip ratio, while taking possible confounding factors into account. Results We found an association between SDQ-PSB and subsequent change in BMI z-score (β: 0.040 [95% CI: 0.010; 0.071, p = 0.009]). However, there was no evidence of an association between SDQ-PSB and measures of body composition or body shape. Conclusions Among 2 to 6 years old children predisposed to overweight, the association between SDQ-scores and weight gain is either absent or marginal. The SDQ-PSB score may be associated with subsequent increases in BMI z-score, but this association does not seem driven by an increased relative fat accumulation.
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Affiliation(s)
- Katrine G. Christensen
- Research Unit for Dietary Studies at The Parker Institute and Institute of Preventive Medicine, The Capital Region, Copenhagen, Denmark
| | - Sidse G. Nielsen
- Research Unit for Dietary Studies at The Parker Institute and Institute of Preventive Medicine, The Capital Region, Copenhagen, Denmark
| | - Nanna J. Olsen
- Research Unit for Dietary Studies at The Parker Institute and Institute of Preventive Medicine, The Capital Region, Copenhagen, Denmark
| | - Christine Dalgård
- Department of Public Health, Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Berit L. Heitmann
- Research Unit for Dietary Studies at The Parker Institute and Institute of Preventive Medicine, The Capital Region, Copenhagen, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sofus C. Larsen
- Research Unit for Dietary Studies at The Parker Institute and Institute of Preventive Medicine, The Capital Region, Copenhagen, Denmark
- * E-mail:
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19
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Ortiz-Pinto MA, Ortiz-Marrón H, Rodríguez-Rodríguez A, Casado-Sánchez L, Cuadrado-Gamarra JI, Galán I. Parental perception of child health status and quality of life associated with overweight and obesity in early childhood. Qual Life Res 2019; 29:163-170. [PMID: 31583617 DOI: 10.1007/s11136-019-02313-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE The aim was to assess perceived health status and health-related quality of life (HRQL) according to persistence of and variation in weight status among children from the age of 4 to 6 years. METHODS Longitudinal study of 1883 participants in the ELOIN cohort (Madrid Region, Spain), with physical examination at ages 4 and 6 years. Perceived health status and HRQL were assessed using parent-reported Kidscreen-10 scores, with excess weight being defined on the basis of body mass index (BMI) using the WHO reference tables (z-BMI > 1 standard deviation), and abdominal obesity being defined on the basis of waist circumference (percentile ≥ 90) using the tables proposed by Fernández et al. Variation in these two parameters at age 6 years was associated with incident cases of suboptimal health by logistic regression, and with HRQL by linear regression. RESULTS Compared to children without excess weight or abdominal obesity in both periods, incident cases of excess weight or abdominal obesity had odds ratios (ORs) of suboptimal health of 2.41 (95% CI 1.21 to 4.80) and 2.99 (95% CI 1.31 to 6.84) respectively. In terms of HRQL, children with remission of excess weight had a higher Kidscreen-10 score: β coefficient = 2.02 (95% CI 0.36 to 3.68), whereas new cases of abdominal obesity had a lower Kidscreen-10 score: β = - 2.22 (95% CI - 4.40 to - 0.03). CONCLUSIONS Incident cases of excess weight and abdominal obesity had a higher risk of suboptimal health. Incident cases of abdominal obesity were also associated with worse HRQL.
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Affiliation(s)
- Maira Alejandra Ortiz-Pinto
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, c/Monforte de Lemos 5, 28029, Madrid, Spain.,Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz, Madrid, Spain.,Departamento de Salud Pública, Universidad del Norte, Barranquilla, Colombia
| | | | | | | | | | - Iñaki Galán
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, c/Monforte de Lemos 5, 28029, Madrid, Spain. .,Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz, Madrid, Spain.
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20
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Noonan RJ, Fairclough SJ. Cross-sectional associations between body mass index and social-emotional wellbeing among differentially active children. Eur J Public Health 2019; 29:303-307. [PMID: 30299479 DOI: 10.1093/eurpub/cky208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND This study assessed gender-specific associations between body mass index (BMI) and social-emotional wellbeing (SEW) among differentially active seven-year-old children. METHODS Data are from wave four of the UK Millennium Cohort Study, collected in 2007-08. Children wore an ActiGraph accelerometer for seven consecutive days and measures of stature and body mass were taken. BMI was calculated from stature and body mass (kg/m2). Parents/carers completed the strengths and difficulties questionnaire (SDQ). A total of 6011 children (3073 girls) had completed data. Mean minutes per day spent in moderate-to-vigorous intensity physical activity (MVPA) were calculated for each child. Gender-specific MVPA quartile cut-off values categorized boys and girls separately into four graded groups representing the least (Q1) through to the most active (Q4) children. Adjusted linear regression analyses examined associations between BMI and SDQ scores. Gender-specific analyses were conducted separately for MVPA quartiles. RESULTS BMI was positively associated with peer problems for Q1 and Q2 boys and girls, conduct problems for Q2 and Q4 boys, emotional problems and prosocial behaviour for Q2 boys and total difficulty scores for Q1 girls and Q2 boys (P < 0.05). CONCLUSIONS Our results revealed that BMI was positively associated with SEW difficulties among the low active children but not the high active children. Further research examining the concurrent effect of diet and MVPA on child weight status and SEW is needed.
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Affiliation(s)
- Robert J Noonan
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Stuart J Fairclough
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK.,Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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21
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Abera M, Tesfaye M, Hanlon C, Admassu B, Girma T, Wells JC, Kæstel P, Ritz C, Wibaek R, Michaelsen KF, Friis H, Andersen GS. Body Composition during Early Infancy and Mental Health Outcomes at 5 Years of Age: A Prospective Cohort Study of Ethiopian Children. J Pediatr 2018; 200:225-231. [PMID: 30060887 DOI: 10.1016/j.jpeds.2018.04.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/31/2018] [Accepted: 04/23/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the relationship between body composition-specifically fat mass (FM) and fat-free mass (FFM)-in early infancy, and mental health outcomes in early childhood. STUDY DESIGN In the Infant Anthropometry and Body Composition birth cohort study from Ethiopia, body composition was measured at birth and 1.5, 2.5, 3.5, 4.5, and 6 months of age. Mental health was assessed at 5 years of age using the approved Amharic version of the Strengths and Difficulties Questionnaire (SDQ), a parent report scale covering 4 different domains providing a total difficulties score. The associations of FM or FFM at birth as well as during early infancy, with SDQ score at 5 years of age were examined using multiple linear regression analyses. RESULTS At 5 years of age, the mean ± SD for SDQ score was 10.4 ± 5.8. FM at birth was positively and FFM negatively associated with SDQ score. For each kg increase in FM at birth, the SDQ score at 5 years was 5.7 points higher (β = 5.7; 95% CI, 1.4-10.0). In contrast, for each kilogram increase in FFM at birth, the SDQ score was 3.9 points lower (β = -3.9; 95% CI, -7.0 to -0.8). Neither FM nor FFM accretion rate during early infancy were associated with SDQ score at 5 years of age. CONCLUSIONS Fetal rather than infant body composition was associated with SDQ score at 5 years of age. Greater FFM accretion during fetal life may have contributed to more optimal neurobehavioral development during early life. However, the potential mechanisms underlying the observed associations need further investigation.
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Affiliation(s)
- Mubarek Abera
- Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia; Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Bitiya Admassu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark; Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Jonathan C Wells
- Childhood Nutrition Research Center UCL Institute of Child Health, London, United Kingdom
| | - Pernille Kæstel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Rasmus Wibaek
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark; Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
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Hayes M, Baxter H, Müller-Nordhorn J, Hohls JK, Muckelbauer R. The longitudinal association between weight change and health-related quality of life in adults and children: a systematic review. Obes Rev 2017; 18:1398-1411. [PMID: 28975765 DOI: 10.1111/obr.12595] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/15/2017] [Accepted: 07/07/2017] [Indexed: 12/19/2022]
Abstract
This systematic review examined longitudinal associations between weight change (weight gain and loss) and both physical and mental aspects of health-related quality of life (HRQOL) compared with stable weight in adults and children of the general population. MEDLINE, EMBASE, PsycINFO and PubMed databases were searched. Longitudinal observational studies measuring HRQOL with six predefined instruments were synthesized according to type of association: weight change and change in HRQOL (change-on-change association) and weight change and HRQOL at follow-up (predictive association). Twenty studies of adults (n = 15) or children (n = 5) were included. Fifteen studies used the SF-12 or SF-36. Results of nine studies in adults examining the change-on-change association were combined through a tallying of 606 analyses. Weight gain was most often associated with reduced physical, but not mental HRQOL, across all baseline body mass index categories and in both men and women. Weight loss may be associated with improved physical, but not mental HRQOL, among adults with overweight and obesity. Weight gain was more strongly associated with HRQOL than weight loss, implicating a greater need for preventative strategies to tackle obesity. Results in children and for the predictive association generally reflected these findings but require further research.
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Affiliation(s)
- M Hayes
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - H Baxter
- Austin Health Sciences Library, Austin Health, Heidelberg, Victoria, Australia
| | - J Müller-Nordhorn
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J K Hohls
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - R Muckelbauer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Michels N, Susi K, Marques-Vidal PM, Nydegger A, Puder JJ. Psychosocial Quality-of-Life, Lifestyle and Adiposity: A Longitudinal Study in Pre-schoolers (Ballabeina Study). Int J Behav Med 2017; 23:383-392. [PMID: 26809517 DOI: 10.1007/s12529-016-9537-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE In obesity prevention, understanding psychosocial influences in early life is pivotal. Reviews reported contradictory results and a lack of longitudinal studies focusing on underlying lifestyle factors. This study tested whether psychosocial Quality-Of-Life (QOL) was associated with pre-schoolers' lifestyle and adiposity changes over one school year and whether lifestyle moderated the latter. It was hypothesised that QOL might not impact adiposity in everybody but that this might depend on preceding lifestyle. METHOD Longitudinal data from 291 Swiss pre-schoolers (initially 3.9-6.3 years) was available. The following measures were used in longitudinal regressions: psychosocial QOL by PedsQL, adiposity (BMI z-score, waist, fat%), diet (food frequency), sedentary time and accelerometer-based activity. RESULTS Concerning lifestyle, low psychosocial QOL was only related to unfavourable changes in diet (less fruit β = 0.21 and more fat intake β = -0.28) and lower physical activity (β = 0.21). Longitudinal QOL-adiposity relations appeared only after moderation by lifestyle factors (beta-range 0.13-0.67). Low psychosocial QOL was associated with increased adiposity in children with an unhealthy diet intake or high sedentary time. By contrast, low psychosocial QOL was associated with decreasing adiposity in high fruit consumers or more physically active pre-schoolers. CONCLUSION Results emphasise the need for testing moderation in the QOL-adiposity relation. An unhealthy diet can be a vulnerability factor and high physical activity a protective factor in QOL-related adiposity. Consequently, QOL and lifestyle should be targeted concurrently in multi-factorial obesity prevention. The environment should be an 'activity encouraging, healthy food zone' that minimises opportunities for stress-induced eating. In addition, appropriate stress coping skills should be acquired.
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Affiliation(s)
- Nathalie Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 4K3, Ghent, B-9000, Belgium.
| | - Kriemler Susi
- Institute for Social and Preventive Medicine, University of Zürich, Zürich, Switzerland
| | - Pedro M Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Andreas Nydegger
- Department of Pediatrics, Pediatric Gastroenterology Unit, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Jardena J Puder
- Diabetes and Metabolism & Division of Pediatric Endocrinology, Service of Endocrinology, Diabetes and Obesity, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
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Implementation of an Outcome Measure in Pediatric Behavioral Health: A Process Improvement Initiative. Pediatr Qual Saf 2017; 2:e043. [PMID: 30229179 PMCID: PMC6132892 DOI: 10.1097/pq9.0000000000000043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/29/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction Efforts to monitor outcomes in pediatric behavioral health are becoming a quality, financial, and regulatory imperative. The implementation of a broad-based measure to assess patient functioning at the start of pediatric psychology services, as well as at subsequent visits, has not been demonstrated. This article describes the systematic implementation of a measure of health-related quality of life (HRQOL) to assess functional impairment across an entire clinic population using quality improvement science and methodologies. Methods The Pediatric Quality of Life Inventory Generic Core 4.0 (PedsQL) was administered at initial and subsequent visits for all patients seeking treatment at a large, tertiary care pediatric psychology clinic in an academic pediatric medical center (Nationwide Children's Hospital, Columbus, Ohio). The goal of this project was to design a process change to support a 90% completion rate of this measurement tool by all clinicians. Results Within 16 months, the completion rate of the PedsQL increased from a baseline of 39% to the identified goal of 90%. This process change was within control limits (over 80%) for over 12 months. Conclusion This study demonstrates the implementation of a systematic process for collection of outcome measures in a pediatric behavioral health care setting. Successful administration of an outcome measure at multiple time points during the care of children and adolescents in a large psychology clinic can allow for quantitative assessment of treatment progress and identify a pathway for administration of additional measures.
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da Fonseca ACP, Mastronardi C, Johar A, Arcos-Burgos M, Paz-Filho G. Genetics of non-syndromic childhood obesity and the use of high-throughput DNA sequencing technologies. J Diabetes Complications 2017; 31:1549-1561. [PMID: 28735903 DOI: 10.1016/j.jdiacomp.2017.04.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Childhood obesity is a serious public health problem associated with the development of several chronic diseases, such as type 2 diabetes mellitus, dyslipidemia, and hypertension. The elevated prevalence of obesity is mostly due to inadequate diet and lifestyle, but it is also influenced by genetic factors. OBJECTIVES To review recent advances in the field of the genetics of obesity. We summarize the list of genes associated with the rare non-syndromic forms of obesity, and explain their function. Furthermore, we discuss the technologies that are available for the genetic diagnosis of obesity. RESULTS Several studies reported that single gene variants cause Mendelian forms of obesity, determined by mutations of major effect in single genes. Rare, non-syndromic forms of obesity are a result of loss-of-function mutations in genes that act on the development and function of the hypothalamus or the leptin-melanocortin pathway. These variants disrupt enzymes and receptors that play a role in energy homeostasis, resulting in severe early-onset obesity and endocrine dysfunctions. Different approaches and technologies have been used to understand the genetic background of obesity. Currently, whole genome and whole exome sequencing are important diagnostic tools to identify new genes and variants associated with severe obesity, but other approaches are also useful at individual or population levels, such as linkage analysis, candidate gene sequencing, chromosomal microarray analysis, and genome-wide association studies. CONCLUSIONS The understanding of the genetic causes of obesity and the usefulness and limitations of the genetic diagnostic approaches can contribute to the development of new personalized therapeutic targets against obesity.
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Affiliation(s)
| | - Claudio Mastronardi
- Institute of Translational Medicine, Universidad del Rosario, Bogota, Colombia
| | - Angad Johar
- Department of Genome Sciences, John Curtin School of Medical Research, The Australian National University, Australia.
| | | | - Gilberto Paz-Filho
- Department of Genome Sciences, John Curtin School of Medical Research, The Australian National University, Australia.
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Guardabassi V, Mirisola A, Tomasetto C. How is weight stigma related to children's health-related quality of life? A model comparison approach. Qual Life Res 2017; 27:173-183. [PMID: 28884265 DOI: 10.1007/s11136-017-1701-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Obesity is a highly stigmatizing condition for both adults and children, and both obesity and stigma experiences are negatively related with health-related quality of life (HRQoL). However, the relations among these constructs have been modeled in different and sometimes inconsistent terms in past research, and have been the object of surprisingly few studies in pediatric populations. The present study addresses this gap by comparing, in a sample of preadolescent children, four competing models (i.e., additive, mediation, moderation, and moderated mediation models) accounting for the role of stigma experiences in the concurrent relation between body weight and HRQoL. METHODS A community sample of 600 children aged 8-11 years completed the Perception of Teasing Scale to assess weight-based teasing experiences and the PedsQL 4.0 to assess HRQoL. Parent-reported height and weight were used to calculate age- and gender-adjusted zBMI. Log-likelihood test, BIC difference, and Wald test were used for model comparisons. RESULTS The mediation model outperformed both additive and moderation models and was found to be equally informative (but more parsimonious) as compared to the moderated mediation account. The same pattern of results was replicated for both global HRQoL and domain-specific quality of life domains (i.e., physical, emotional, social, and scholastic). CONCLUSIONS The mediation model provided the best fitting and more parsimonious representation of the relations between body weight, stigma experiences, and HRQoL, meaning that an increased likelihood of experiencing weight-based teasing episodes, rather than excess weight per se, is associated with reduced quality of life in middle childhood.
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Affiliation(s)
- Veronica Guardabassi
- Department of Psychology, University of Bologna, Piazza Aldo Moro, 90, 47521, Cesena, FC, Italy.
| | - Alberto Mirisola
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Piazza Marina, 61, 90133, Palermo, Italy
| | - Carlo Tomasetto
- Department of Psychology, University of Bologna, Piazza Aldo Moro, 90, 47521, Cesena, FC, Italy
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Mallan KM, Daniels LA, Nicholson JM. Obesogenic eating behaviors mediate the relationships between psychological problems and BMI in children. Obesity (Silver Spring) 2017; 25:928-934. [PMID: 28371313 PMCID: PMC5427629 DOI: 10.1002/oby.21823] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/04/2017] [Accepted: 02/15/2017] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To examine the association between psychological problems and weight status in children aged 3.5 to 4 years and test whether obesogenic eating behaviors mediate this relationship. METHODS This study is a cross-sectional secondary analysis of data from first-time mothers (N = 194) in the control arm of the NOURISH randomized controlled trial. At child age 3.5 to 4 years, maternal-reported child eating behaviors and psychological problems were collected via valid tools, and child weight and height data were collected by trained study staff. Pearson's correlations and linear regressions examined associations between eating behaviors, psychological problems, and BMI z score. Multiple mediation models were tested by assessing indirect effects of psychological problems on BMI z score via obesogenic eating behaviors. RESULTS Peer problems were associated with both higher food responsiveness and emotional overeating and directly with higher BMI z score. This relationship was partially mediated by emotional overeating. Both emotional overeating and food responsiveness fully mediated the association between emotional problems and BMI z score, and food responsiveness fully mediated the association between conduct problems and BMI z score. CONCLUSIONS The findings suggest that children with psychological problems may also display obesogenic eating behaviors, which may result in higher BMI. This needs to be considered in the clinical management of both pediatric overweight/obesity and psychological problems.
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Affiliation(s)
- Kimberley M. Mallan
- School of Psychology Australian Catholic UniversityBrisbaneAustralia
- School of Exercise and Nutrition SciencesQueensland University of TechnologyBrisbaneAustralia
| | - Lynne A. Daniels
- School of Exercise and Nutrition SciencesQueensland University of TechnologyBrisbaneAustralia
- Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
| | - Jan M. Nicholson
- Judith Lumley Centre, La Trobe UniversityMelbourneAustralia
- School of Early ChildhoodQueensland University of TechnologyBrisbaneAustralia
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VELLA STEWARTA, SWANN CHRISTIAN, ALLEN MARKS, SCHWEICKLE MATTHEWJ, MAGEE CHRISTOPHERA. Bidirectional Associations between Sport Involvement and Mental Health in Adolescence. Med Sci Sports Exerc 2017; 49:687-694. [DOI: 10.1249/mss.0000000000001142] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kumar S, Kelly AS. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clin Proc 2017; 92:251-265. [PMID: 28065514 DOI: 10.1016/j.mayocp.2016.09.017] [Citation(s) in RCA: 794] [Impact Index Per Article: 113.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/12/2016] [Accepted: 09/21/2016] [Indexed: 12/11/2022]
Abstract
Childhood obesity has emerged as an important public health problem in the United States and other countries in the world. Currently 1 in 3 children in the United States is afflicted with overweight or obesity. The increasing prevalence of childhood obesity is associated with emergence of comorbidities previously considered to be "adult" diseases including type 2 diabetes mellitus, hypertension, nonalcoholic fatty liver disease, obstructive sleep apnea, and dyslipidemia. The most common cause of obesity in children is a positive energy balance due to caloric intake in excess of caloric expenditure combined with a genetic predisposition for weight gain. Most obese children do not have an underlying endocrine or single genetic cause for their weight gain. Evaluation of children with obesity is aimed at determining the cause of weight gain and assessing for comorbidities resulting from excess weight. Family-based lifestyle interventions, including dietary modifications and increased physical activity, are the cornerstone of weight management in children. A staged approach to pediatric weight management is recommended with consideration of the age of the child, severity of obesity, and presence of obesity-related comorbidities in determining the initial stage of treatment. Lifestyle interventions have shown only modest effect on weight loss, particularly in children with severe obesity. There is limited information on the efficacy and safety of medications for weight loss in children. Bariatric surgery has been found to be effective in decreasing excess weight and improving comorbidities in adolescents with severe obesity. However, there are limited data on the long-term efficacy and safety of bariatric surgery in adolescents. For this comprehensive review, the literature was scanned from 1994 to 2016 using PubMed using the following search terms: childhood obesity, pediatric obesity, childhood overweight, bariatric surgery, and adolescents.
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Affiliation(s)
- Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN.
| | - Aaron S Kelly
- Department of Pediatrics and Department of Medicine, University of Minnesota, Minneapolis
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Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, Baker JS. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther 2016; 7:125-146. [PMID: 27881930 PMCID: PMC5115694 DOI: 10.2147/ahmt.s101631] [Citation(s) in RCA: 311] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Childhood obesity is one of the most serious public health challenges of the 21st century with far-reaching and enduring adverse consequences for health outcomes. Over 42 million children <5 years worldwide are estimated to be overweight (OW) or obese (OB), and if current trends continue, then an estimated 70 million children will be OW or OB by 2025. The purpose of this review was to focus on psychiatric, psychological, and psychosocial consequences of childhood obesity (OBy) to include a broad range of international studies. The aim was to establish what has recently changed in relation to the common psychological consequences associated with childhood OBy. A systematic search was conducted in MEDLINE, Web of Science, and the Cochrane Library for articles presenting information on the identification or prevention of psychiatric morbidity in childhood obesity. Relevant data were extracted and narratively reviewed. Findings established childhood OW/OBy was negatively associated with psychological comorbidities, such as depression, poorer perceived lower scores on health-related quality of life, emotional and behavioral disorders, and self-esteem during childhood. Evidence related to the association between attention-deficit/hyperactivity disorder (ADHD) and OBy remains unconvincing because of various findings from studies. OW children were more likely to experience multiple associated psychosocial problems than their healthy-weight peers, which may be adversely influenced by OBy stigma, teasing, and bullying. OBy stigma, teasing, and bullying are pervasive and can have serious consequences for emotional and physical health and performance. It remains unclear as to whether psychiatric disorders and psychological problems are a cause or a consequence of childhood obesity or whether common factors promote both obesity and psychiatric disturbances in susceptible children and adolescents. A cohesive and strategic approach to tackle this current obesity epidemic is necessary to combat this increasing trend which is compromising the health and well-being of the young generation and seriously impinging on resources and economic costs.
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Affiliation(s)
- Jean Rankin
- Department of Maternal and Child Health, University of the West of Scotland, Paisley
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Stephen Cobley
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Ahreum Han
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Ross Sanders
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Huw D Wiltshire
- Cardiff School of Sport/Ysgol Chwaraeon Caerdydd, Cardiff Metropolitan University, Cardiff, UK
| | - Julien S Baker
- School of Science and Sport, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, Scotland
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Arnoldussen IA, Zerbi V, Wiesmann M, Noordman RH, Bolijn S, Mutsaers MP, Dederen PJ, Kleemann R, Kooistra T, van Tol EA, Gross G, Schoemaker MH, Heerschap A, Wielinga PY, Kiliaan AJ. Early intake of long-chain polyunsaturated fatty acids preserves brain structure and function in diet-induced obesity. J Nutr Biochem 2016; 30:177-88. [DOI: 10.1016/j.jnutbio.2015.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/13/2015] [Accepted: 12/16/2015] [Indexed: 12/28/2022]
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Kim JH, Lee C, Sohn W. Urban Natural Environments, Obesity, and Health-Related Quality of Life among Hispanic Children Living in Inner-City Neighborhoods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E121. [PMID: 26771623 PMCID: PMC4730512 DOI: 10.3390/ijerph13010121] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 12/23/2022]
Abstract
Although a substantial body of literature has provided evidence supporting the positive effects of natural environments on well-being, little has been known about the specific spatial patterns of urban nature in promoting health-related quality of life (HRQOL) among children. This study assessed the association that the urban natural environment measured by landscape spatial patterns may have with obesity and HRQOL among Hispanic children. Ninety-two 4th and 5th grade students were recruited from Houston, Texas, and the Pediatric Quality of Life Inventory (PedsQL) was used to capture the children's HRQOL. The quality of urban natural environments was assessed by quantifying the landscape spatial patterns, using landscape indices generated by Geographic Information Systems and remote sensing. From the bivariate analyses, children's body mass index showed a significantly negative association with their HRQOL. After controlling for socio-demographic factors, the results revealed that larger and more tree areas were positively correlated with children's HRQOL. In addition, those children living in areas with tree patches further apart from each other showed higher HRQOL. This research adds to the current multi-disciplinary area of research on environment-health relationships by investigating the roles of urban greeneries and linking their spatial structures with children's HRQOL.
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Affiliation(s)
- Jun-Hyun Kim
- Department of Landscape Architecture and Urban Planning; Texas A&M University, College Station, TX 77843, USA.
| | - Chanam Lee
- Department of Landscape Architecture and Urban Planning; Texas A&M University, College Station, TX 77843, USA.
| | - Wonmin Sohn
- Department of Landscape Architecture and Urban Planning; Texas A&M University, College Station, TX 77843, USA.
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Haber JJ, Atti S, Gerber LM, Waseem M. Promoting an obesity education program among minority patients in a single urban pediatric Emergency Department (ED). Int J Emerg Med 2015; 8:38. [PMID: 26511854 PMCID: PMC4624687 DOI: 10.1186/s12245-015-0086-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/29/2015] [Indexed: 01/13/2023] Open
Abstract
Background The purpose of this study was to assess the feasibility of the Emergency Department (ED) as a place for obesity education and to evaluate its impact on patient’s lifestyle modification. Methods In this study, children between 8 and 18 years of age, who presented to the ED for non-urgent reasons in a single urban hospital, were enrolled. Parents’ perception of their child’s diet and exercise were assessed prior to the intervention. Both parents and children attended a brief audio-visual presentation that provided educational information on age-appropriate diet and exercise. Following the intervention, the participants were asked about their impressions regarding the ED as a place to receive obesity education and whether they plan to make any changes in diet and exercise. Results One hundred children and their parents participated in this study. Of these, 76 were Latino and 21 were African-Americans. The mean age was 14 years, and the mean body mass index (BMI) was 25.6. Following the intervention, 21 (100 %) of the African-American parents and 73 (98.6 %) of the Latino parents felt that the ED should provide obesity education. Eighteen (85.7 %) of the African-American parents and 72 (97.3 %) of the Latino parents planned to make changes in their child’s diet and exercise. Among the children, 21 (100 %) of African-American participants and 76 (100 %) of Latino participants reported that they found the audio-visual useful. Seventeen (81.0 %) of the African-American children and 73 (96.1 %) of Latino children stated learning new information from the intervention program. Conclusions This study suggests the ED may have a role in primary health promotion and obesity prevention. An ED-based intervention may be used to provide education about obesity prevention and has the potential to impact life style modifications, including diet and exercise.
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Affiliation(s)
- Jordana J Haber
- Department of Emergency Medicine, University Medical Center, 1800 W Charleston Blvd, Las Vegas, NV, 89102, USA.
| | - Sukshant Atti
- Department of Emergency Medicine, Lincoln Medical & Mental Health Center, 234 E 149th St, Bronx, NY, 10451, USA.
| | - Linda M Gerber
- Department of Healthcare Policy, Research Weill Cornell Medical College, 402 East 67th Street, New York, NY, 10065, USA.
| | - Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical & Mental Health Center, 234 E 149th St, Bronx, NY, 10451, USA.
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Sanders RH, Han A, Baker JS, Cobley S. Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents. Eur J Pediatr 2015; 174:715-46. [PMID: 25922141 DOI: 10.1007/s00431-015-2551-3] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED Australia is predicted to have the highest overweight/obesity rate in the world by 2022 outranking the USA and UK. The purpose of this systematic review was to evaluate the associations between childhood obesity and physical and psychological health co-morbidities. Therefore, a systematic literature search was conducted from six databases (2004-2014). Studies were included if they investigated obesity-related co-morbidities with participants residing in Australia aged 0-18 years. Forty-seven studies fulfilled selection criteria. Evidence suggests that overweight/obese Australian children and adolescents, compared to normal-weight peers, had more cardio-metabolic risk factors and higher risk factors of non-alcohol fatty liver disease and were experiencing more negative psychological outcomes (depression, low self-esteem and lower scores of health-related quality of life). Many other health consequences have either not been investigated in Australia, or as frequently as in other countries. CONCLUSIONS Given Australia's current overweight/obesity prevalence and trajectory, Australia-based studies are needed to identify the suspected co-morbidities, understand the range of individual, social and environmental mechanisms driving obesity, and help identify policies, interventions and strategies that will change the future trajectory and 'disease burden' both in Australia and internationally. WHAT IS KNOWN • Trend analyses have shown that obesity prevalence in Australia is increasing and will outrank UK and the USA by 2022. • Every third Australian child/adolescent between 5 and 19 years old is predicted to be classified as overweight or obese by 2025. • Childhood obesity is associated with multiple immediate physical and psychological health co-morbidities as well as co-morbidities in adulthood. These have often been identified and examined individually. What is New: • This paper presents a holistic picture of childhood obesity and the associated multiple co-morbidities in Australia. • The extensive health-related outcomes from childhood obesity and those requiring further research are identified. • The findings of this paper will influence the development of local/regional, state and national strategies to change Australia's future trajectory.
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Affiliation(s)
- Ross H Sanders
- Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, Cumberland Campus C42, 75 East Street, Sydney, NSW, 2141, Australia,
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Pérez-Bonaventura I, Granero R, Ezpeleta L. The relationship between weight status and emotional and behavioral problems in Spanish preschool children. J Pediatr Psychol 2014; 40:455-63. [PMID: 25502614 DOI: 10.1093/jpepsy/jsu107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 11/20/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine cross-sectional and longitudinal associations between behavioral problems and weight status, considering body mass index (BMI) z-scores and overweight status, in a community sample of preschoolers. METHODS The Strengths and Difficulties Questionnaire and the Diagnostic Interview for Children and Adolescents were administered to 611 parents. Adjusted general linear models and binary logistic regressions were used. RESULTS Children who were overweight and had a higher BMI were at increased risk of peer problems and attention-deficit/hyperactivity disorder (ADHD) symptoms. Prospective analyses showed that a higher BMI at the age of 3 years was predictive of peer problems at ages 4 and 5 years and hyperactivity and ADHD symptoms at the age of 4 years. CONCLUSION This is the first study using a diagnostic-based instrument that shows a relationship between weight status and ADHD symptoms in preschoolers. Overweight children might benefit from screening for behavioral disorders and peer relationship problems.
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Affiliation(s)
- Iris Pérez-Bonaventura
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Department of Mental Health, Corporació Sanitària Parc Taulí, and Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Department of Mental Health, Corporació Sanitària Parc Taulí, and Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Department of Mental Health, Corporació Sanitària Parc Taulí, and Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona
| | - Roser Granero
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Department of Mental Health, Corporació Sanitària Parc Taulí, and Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Department of Mental Health, Corporació Sanitària Parc Taulí, and Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona
| | - Lourdes Ezpeleta
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Department of Mental Health, Corporació Sanitària Parc Taulí, and Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Department of Mental Health, Corporació Sanitària Parc Taulí, and Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona
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Shrivastava A, Murrin C, Kelleher CC. Preschoolers' parent-rated health disparities are strongly associated with measures of adiposity in the Lifeways cohort study children. BMJ Open 2014; 4:e005328. [PMID: 25052171 PMCID: PMC4120306 DOI: 10.1136/bmjopen-2014-005328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To examine the relationship between lifecourse factors from preschoolers' microecosystem and their parent-reported (mother-reported) health (PRH), following them prospectively from preconception to age 5 years. To investigate if preschoolers' body mass index (BMI) and waist circumference were associated with preschoolers' PRH when controlled for lifecourse predictors. DESIGN Lifeways cross-generation cohort study. SETTING Ireland. PARTICIPANTS Of 1082 families, 62% mothers responded on a health and lifestyle questionnaire at follow-up. Food frequency, BMI and waist circumference were measured. There were 547 family data sets available for analysis of children's PRH. MAIN OUTCOME MEASURE Mother-reported children's PRH at age 5. Associations with child's individual and familial exposures from preconception to age 5 years examined using logistic regression. RESULTS In univariate analysis, relatively positive rating of children's PRH were associated with children's lower intake of fats (OR (95% CI) 2.2 (1.1 to 4.3)), higher intake of fruits/vegetables (OR (95% CI) 2.2 (1.1 to 4.3)); as well as familial socioeconomic characteristics {higher household income (OR (95% CI) 3.0 (1.6 to 5.9)), non-entitlement to means-tested healthcare (OR (95% CI) 2.1 (1.0 to 4.3)), mothers' higher education (OR (95% CI) 1.9 (1.0 to 3.6))}, psychosocial characteristics {father's participation in study (OR (95% CI) 2.1 (1.0 to 4.3)), mothers' perceiving better support from partner (OR (95% CI) 2.3 (1.2 to 4.3)), children (OR (95% CI) 1.9 (1.0 to 3.7)) or relatives (OR (95% CI) 2.2 (1.1 to 4.1))}, parents' lifestyle {mothers' lower intake of energy (OR (95% CI) 2.2 (1.1 to 4.3)), fathers' non-smoking status (OR (95% CI) 2.2 (1.1 to 4.4))} and parents' health {mothers' self-rated health relatively positive (OR (95% CI) 5.1 (2.6 to 9.9)), fathers' self-rated health relatively positive (OR (95% CI) 3.0 (1.5 to 6.0))}. In multivariable analysis (χ(2)=34.2, df=21, N=303, R(2 )= 0.26, p<0.05), one of the two strong predictors of children's relatively positive PRH was child not being obese by International Obesity Task Force classification (OR (95% CI) 5.5 (1.4 to 21.0)), observed also using BMI (kg/m(2); OR (95% CI) 0.73 (0.58 to 0.93)) or waist circumference (cm; OR (95% CI) 0.89 (0.81 to 0.98)) as continuous variables. The other significant predictor was mothers' self-rated health relatively positive (OR (95% CI) 4.2 (1.5 to 12.2)). CONCLUSIONS Preschoolers' health is adversely associated with obesity and this is independent of lifecourse and social and environmental inequalities. The findings suggest that reducing childhood obesity and improving maternal health may be useful ways to improve child's global health.
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Affiliation(s)
- Aakash Shrivastava
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4, Republic of Ireland
| | - Celine Murrin
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4, Republic of Ireland
| | - Cecily C Kelleher
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4, Republic of Ireland
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O'Haver J, Jacobson D, Kelly S, Melnyk BM. Relationships among factors related to body mass index, healthy lifestyle beliefs and behaviors, and mental health indicators for youth in a title 1 school. J Pediatr Health Care 2014; 28:234-40. [PMID: 23623542 DOI: 10.1016/j.pedhc.2013.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 02/04/2013] [Accepted: 02/11/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The effect of being overweight in childhood has both physical and psychological implications. The purpose of this study was to determine the relationships among body mass index (BMI), healthy lifestyle beliefs and behaviors, and mental health indicators for 5th- and 6th-grade children in a Title I school. METHODS This is a cross-sectional, descriptive correlational design on a convenience sample of youth in an urban school. BMI was calculated. Participants completed surveys that assessed healthy beliefs and behaviors, activity and nutrition knowledge, and mental health indicators. RESULTS Children with higher BMIs reported difficulty in living a healthy lifestyle. This perceived difficulty affected their ability to make healthy choices. Belief in the ability to live a healthy lifestyle resulted in reported healthier behaviors. Anxiety and depression symptomatology were not significantly related to healthy lifestyle indicators. DISCUSSION The results demonstrate that the proposed thinking, feeling, behavior triangle model was supported in this population.
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Wittenhagen P, Thiesson HC, Baudier F, Pedersen EB, Neland M. Long-term experience of steroid-free pediatric renal transplantation: effects on graft function, body mass index, and longitudinal growth. Pediatr Transplant 2014; 18:35-41. [PMID: 24384046 DOI: 10.1111/petr.12186] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/28/2022]
Abstract
Increased focus on the potential negative side effects of steroid usage in pediatric transplantation has led to steroid minimization or steroid-free transplantation. In this study, we report results after complete steroid avoidance in renal transplantation in the period 1994-2009. We evaluate the effects of complete steroid avoidance on allograft function, BMI, and linear growth. The majority of transplanted children were induced with antithymocyte globulin and immunosuppressed with a calcineurin inhibitor and mycophenolate mofetil. Steroids were given only when rejection occurred or due to comorbidities. Anthropometric data were collected from 65 transplantations in 60 children. Patient survival was 93%; graft survival was 81% after five yr (N = 42) and 63% after 10 yr (N = 16). Acute rejection within the first year of transplantation was 9%. The distribution of the children's BMI before transplantation was normal; the mean BMI-SDS was 0.21 before transplantation, and this value remained stable during the next five yr. Post-transplantation the children demonstrated significant improved growth as the mean height-SDS increased significantly from -1.7 to -1.1. Catch-up growth was most pronounced in the youngest (< six yr). Steroid-free immunosuppression in pediatric renal transplantation is safe and protects against steroid-induced obesity and short stature.
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Affiliation(s)
- Per Wittenhagen
- Department of Nephrology, Odense University Hospital, Odense, Denmark
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Child behavioural problems and body size among 2-6 year old children predisposed to overweight. results from the "healthy start" study. PLoS One 2013; 8:e78974. [PMID: 24250821 PMCID: PMC3826721 DOI: 10.1371/journal.pone.0078974] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 09/25/2013] [Indexed: 01/15/2023] Open
Abstract
Objective Psychological adversities among young children may be associated with childhood overweight and obesity. We examined if an increased level of child behavioural problems was associated with body size among a selected group of 2-6 year old children, who were all predisposed to develop overweight. Methods Cross-sectional analyses were conducted using baseline data from the “Healthy Start” intervention study. A total of 3058 children were invited to participate, and data from 583 children who were all predisposed for obesity was analyzed. The Danish version of the Strengths and Difficulties Questionnaire (SDQ) was used to assess child stress by the SDQ Total Difficulties (SDQ-TD) score and the Prosocial Behavior (PSB) score. Height and weight were measured, and BMI z-scores were calculated. Results A direct, but non-significant linear trend was found between SDQ-TD score and BMI z-score (β = 0.021, p = 0.11). Having an SDQ-TD score above the 90th percentile was associated with BMI z-score (β = 0.36, p = 0.05). PSB score was not associated with BMI z-score. Analyses were adjusted for parental socioeconomic status, parental BMI, family structure, dietary factors, physical activity, and family stress level. Conclusion The results suggested a threshold effect between SDQ-TD score and BMI z-score, where BMI z-score was associated with childhood behavioural problems only for those with the highest scores of SDQ-TD. No significant association between PSB score and BMI z-score was found.
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Abstract
OBJECTIVE Although hyperactivity would seem to increase energy expenditure, attention-deficit hyperactivity disorder (ADHD) appears to increase the risk for being overweight. This study examined the body mass index (BMI) in children with ADHD and its relationship with age, gender, ADHD and comorbid symptom severity, inhibitory control, developmental coordination disorder, sleep duration, and methylphenidate use. METHOD Participants were 372 Dutch children with ADHD combined type aged 5 to 17 years participating in the International Multicenter ADHD Genetics (IMAGE) study. We categorized BMI according to international age- and gender-specific reference values and calculated BMI-standard deviation scores (BMI-SDS). The control population was matched for age, gender, and ethnicity and originated from the same birth cohort as the ADHD group. Inhibitory control was measured by the computerized Stop-signal task. Prevalence differences of underweight, overweight, and obesity between groups were expressed in odds ratios. We used linear regression analyses with gender, age, parent- and teacher-rated ADHD and comorbid scores, inhibitory control, sleep duration, motor coordination, and methylphenidate use to predict BMI-SDS. RESULTS Boys with ADHD aged 10 to 17 years and girls aged 10 to 12 years were more likely to be overweight than children in the general Dutch population. Younger girls and female teenagers, however, seemed to be at lower risk for being overweight. Higher oppositional behavior and social communication problems related to higher BMI-SDS scores, whereas more stereotyped behaviors related to lower BMI-SDS scores. We found no effects of the other examined associated risk factors on BMI-SDS. CONCLUSIONS Attention-deficit hyperactivity disorder in boys is a risk factor for overweight. In girls with ADHD, the prevalence of overweight is age dependent and most pronounced in girls aged 10 to 12 years. They have a 4-fold risk of being obese. Higher oppositional and social communication problems pose an increased risk for overweight, whereas sleep duration, motor coordination problems, and methylphenidate use do not.
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Trajectories of depressive symptoms from adolescence to young adulthood: the role of self-esteem and body-related predictors. J Youth Adolesc 2013; 43:597-611. [PMID: 23975352 DOI: 10.1007/s10964-013-9995-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022]
Abstract
Although depression is a common issue among youth, it is unclear how important developmental factors, such as body mass index (BMI), self-esteem, and eating-and weight-related disturbances relate to the development of depression across adolescence and into young adulthood. Gender differences in these relationships and the specific nature of these relationships among adolescent boys and young men require further study. Using multilevel growth curve modeling, this study examined the effects of BMI, self-esteem, and eating- and weight-related disturbances (i.e., body dissatisfaction and weight management effort) and their interactive effects with gender on the developmental trajectory of depressive symptoms using the Canadian-based National Longitudinal Survey of Children and Youth (N = 4,359 ages 12-21, 48.7 % female). On average, depressive symptoms decreased slightly at ages 12 through 14, began to increase from ages 14 through 17, and then began to decrease through age 21. Adolescent girls were at increased risk for depressive symptoms throughout adolescence and young adulthood compared to boys. This effect was compounded by low levels of self-esteem across adolescence and young adulthood. Engaging in weight management effort was associated with lower initial levels of depressive symptoms in early adolescence. The study's findings contribute to basic etiologic research regarding the trajectory of depressive symptoms in adolescence and young adulthood suggesting that mid-adolescents may be most vulnerable to depression compared to other adolescent age groups. The findings also underscore the importance of fostering positive self-esteem among adolescent girls and young women to prevent depression and exploring the protective effect of specific weight management strategies in future research.
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van Grieken A, Renders CM, Wijtzes AI, Hirasing RA, Raat H. Overweight, obesity and underweight is associated with adverse psychosocial and physical health outcomes among 7-year-old children: the 'Be active, eat right' study. PLoS One 2013; 8:e67383. [PMID: 23825655 PMCID: PMC3692418 DOI: 10.1371/journal.pone.0067383] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 05/17/2013] [Indexed: 11/30/2022] Open
Abstract
Background Limited studies have reported on associations between overweight, and physical and psychosocial health outcomes among younger children. This study evaluates associations between overweight, obesity and underweight in 5-year-old children, and parent-reported health outcomes at age 7 years. Methods Data were used from the ‘Be active, eat right’ study. Height and weight were measured at 5 and 7 years. Parents reported on child physical and psychosocial health outcomes (e.g. respiratory symptoms, general health, happiness, insecurity and adverse treatment). Regression models, adjusted for potential confounders, were fitted to predict health outcomes at age 7 years. Results The baseline study sample consisted of 2,372 children mean age 5.8 (SD 0.4) years; 6.2% overweight, 1.6% obese and 15.0% underweight. Based on parent-report, overweight, obese and underweight children had an odds ratio (OR) of 5.70 (95% CI: 4.10 to 7.92), 35.34 (95% CI: 19.16; 65.17) and 1.39 (95% CI: 1.05 to 1.84), respectively, for being treated adversely compared to normal weight children. Compared to children with a low stable body mass index (BMI), parents of children with a high stable BMI reported their child to have an OR of 3.87 (95% CI: 1.75 to 8.54) for visiting the general practitioner once or more, an OR of 15.94 (95% CI: 10.75 to 23.64) for being treated adversely, and an OR of 16.35 (95% CI: 11.08 to 24.36) for feeling insecure. Conclusion This study shows that overweight, obesity and underweight at 5 years of age is associated with more parent-reported adverse treatment of the child. Qualitative research examining underlying mechanisms is recommended. Healthcare providers should be aware of the possible adverse effects of childhood overweight and also relative underweight, and provide parents and children with appropriate counseling.
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Affiliation(s)
- Amy van Grieken
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carry M. Renders
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Anne I. Wijtzes
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Remy A. Hirasing
- EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
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Jansen PW, Mensah FK, Clifford SA, Tiemeier H, Nicholson JM, Wake M. Development of mental health problems and overweight between ages 4 and 11 years: a population-based longitudinal study of Australian children. Acad Pediatr 2013; 13:159-67. [PMID: 23356960 DOI: 10.1016/j.acap.2012.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/27/2012] [Accepted: 12/04/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate timing and strength of associations between mental health and overweight in childhood; to investigate how the cumulative burden of each of these problems affects the other. METHODS Participants were 3197 children in the population-based Longitudinal Study of Australian Children. At 4 biennial waves spanning ages 4-5 to 10-11 years, parents and teachers reported child mental health on the Strengths and Difficulties Questionnaire, and researchers measured body mass index (BMI). Outcomes were analyzed both continuously and dichotomized (clinical vs no mental health problems; overweight vs not overweight). RESULTS Approximately 30% of participants had overweight and/or mental health problems at some point between ages 4-5 and 10-11 years. Small positive cross-sectional mental health-BMI associations emerged at 8-9 years and strengthened by 10-11 years. In longitudinal analyses, more episodes of overweight predicted higher Total Difficulties scores by 10-11 years, mainly reflecting greater Peer Problems and, to a lesser degree, Emotional Symptoms than never-overweight children; though modest, these associations were robust to a range of sensitivity analyses. In post hoc analyses, overweight in late childhood was more strongly associated with poorer mental health at 10-11 years than early and fluctuating childhood overweight. Associations were smaller and less robust for mental health problems prospectively predicting higher BMI. CONCLUSIONS Relationships between poorer mental health and higher BMI emerged then strengthened in middle to late childhood. In childhood, it appears that overweight precedes mental health problems, particularly peer problems and-on a lower level-emotional problems, rather than the reverse.
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Bada HS, Bann CM, Whitaker TM, Bauer CR, Shankaran S, LaGasse L, Lester BM, Hammond J, Higgins R. Protective factors can mitigate behavior problems after prenatal cocaine and other drug exposures. Pediatrics 2012; 130. [PMID: 23184114 PMCID: PMC3507246 DOI: 10.1542/peds.2011-3306] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We determined the role of risk and protective factors on the trajectories of behavior problems associated with high prenatal cocaine exposure (PCE)/polydrug exposure. METHODS The Maternal Lifestyle Study enrolled 1388 children with or without PCE, assessed through age 15 years. Because most women using cocaine during pregnancy also used other substances, we analyzed for the effects of 4 categories of prenatal drug exposure: high PCE/other drugs (OD), some PCE/OD, OD/no PCE, and no PCE/no OD. Risks and protective factors at individual, family, and community levels that may be associated with behavior outcomes were entered stepwise into latent growth curve models, then replaced by cumulative risk and protective indexes, and finally by a combination of levels of risk and protective indexes. Main outcome measures were the trajectories of externalizing, internalizing, total behavior, and attention problems scores from the Child Behavior Checklist (parent). RESULTS A total of 1022 (73.6%) children had known outcomes. High PCE/OD significantly predicted externalizing, total, and attention problems when considering the balance between risk and protective indexes. Some PCE/OD predicted externalizing and attention problems. OD/no PCE also predicted behavior outcomes except for internalizing behavior. High level of protective factors was associated with declining trajectories of problem behavior scores over time, independent of drug exposure and risk index scores. CONCLUSIONS High PCE/OD is a significant risk for behavior problems in adolescence; protective factors may attenuate its detrimental effects. Clinical practice and public health policies should consider enhancing protective factors while minimizing risks to improve outcomes of drug-exposed children.
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Affiliation(s)
- Henrietta S. Bada
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Carla M. Bann
- RTI International, Research Triangle Park, North Carolina
| | - Toni M. Whitaker
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Charles R. Bauer
- Department of Pediatrics, University of Miami School of Medicine, Miami, Florida
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Linda LaGasse
- Department of Pediatrics, Brown University Medical School, Providence, Rhode Island; and
| | - Barry M. Lester
- Department of Pediatrics, Brown University Medical School, Providence, Rhode Island; and
| | - Jane Hammond
- RTI International, Research Triangle Park, North Carolina
| | - Rosemary Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
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Höner O, Demetriou Y. Effects of a health-promotion programme in sixth grade German students' physical education. Eur J Sport Sci 2012; 14 Suppl 1:S341-51. [PMID: 24444228 DOI: 10.1080/17461391.2012.704080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of the study was to assess the effects of a school-based health-promotion programme in physical education (PE) on sixth grade German students' motor performance, BMI and health-related quality of life (HRQOL). In a quasi-experimental design, 516 students (54.7% girls) were assigned to either the intervention group (IG) that received eight 90-minute health-promoting PE lessons or the control group (CG), which continued regular PE. Outcome variables were assessed at baseline, immediately after, and three months after the intervention in order to explore significant short- and middle-term intervention effects, respectively. The intervention programme had gender specific effects in motor performance with girls reaching higher levels. Positive short-term intervention effects were found in girls' sideways jumps (η (2)=0.17) and negative effects were measured in the 20-meter sprints (η (2)=0.05) and the standing long jump (η (2)=0.04). Positive middle-term effects were measured on the motor performance score (η (2)=0.05), sideways jumps (η (2)=0.08) and stand-and-reach flexibility (η (2)=0.04). In boys, short-term positive intervention effects were found in 20-meter sprints (η (2)=0.04). In the middle-term, differences in favour of the CG were found in press-ups (η (2)=0.03) and sideways jumps (η (2)=0.06). Concerning BMI the IG had significantly lower levels compared to the CG in the short-term (η (2)=0.04) and in the middle-term (η (2)=0.03), respectively. There were no significant differences between the groups in HRQOL. In conclusion, the results demonstrate the feasibility of promoting health related parameters in PE, but also raise the question whether gender-specific tailored interventions would result in higher intervention effects concerning motor performance especially in boys.
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Affiliation(s)
- Oliver Höner
- a Institute of Sports Science , University of Tübingen , Tübingen , Germany
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