Association between Obesity and Parental Weight Status in Children and Adolescents

Socioeconomic inequalities in childhood and adolescent obesity in Australia: The role of behavioral and biological factors

BACKGROUND

Obesity among children and adolescents is a significant public health concern, influenced by a complex interplay of biological and behavioral factors. However, the extent to which these factors contribute to socioeconomic disparities in obesity remains inadequately understood. Therefore, this study aimed to elucidate the roles of behavioral factors -such as dietary habits, physical activity levels, and outdoor activities-alongside biological factors, including parental body weight, in shaping socioeconomic inequalities in obesity among Australian children and adolescents.

METHODS

This study utilized data from the Birth Cohort (n=5101) and Kindergarten Cohort (n=4983) of the Longitudinal Study of Australian Children (LSAC). LSAC data have been collected biannually since 2004 for the B cohort and since 2000 for the K cohort. The study employed Concentration Index and Decomposition Index analyses to assess the magnitude and to identify the relative contributions of socioeconomic inequalities in obesity, focusing on the contributions of behavioral and biological factors.

RESULTS

The analysis revealed that socioeconomic disparities in obesity among children and adolescents were significantly influenced by both biological and behavioral factors, as well as household income. Biological factors were found to account for 28.96% of these disparities, while household income contributed 49.17%, and behavioral factors explained 10.36% of the inequalities. Moreover, non-consumption of fatty foods and outdoor activities were found to be associated with a decrease in obesity by [Formula: see text] [Formula: see text] respectively. However, non-consumption of fruits and vegetables and maternal BMI were significantly correlated with an increased risk of obesity in children ([Formula: see text]) and adolescents ([Formula: see text]) respectively.

CONCLUSION

These findings provide critical insights into the distribution of obesity across different socioeconomic groups in Australia, highlighting the substantial role of household income and the combined impact of biological and behavioral factors. The results emphasize the importance of developing targeted public health interventions that support families from lower socioeconomic backgrounds to reduce obesity-related disparities.

Exploring the multifaceted factors influencing overweight and obesity: a scoping review

Introduction

Obesity and overweight problems in public health have substantial impacts which affect the health status of individuals and community well-being and healthcare service provision worldwide. This scoping review aims to identify and classify factors from social, technological, environmental, economic and political domains which influence obesity and overweight conditions. The systematic analysis of determinants in this study generates usable information to guide public health intervention design and obesity epidemic management strategies.

Methods

The study utilized the ProQuest, ISI Web of Science, PubMed, and Scopus databases, and it also included grey literature in its analysis. The research objectives focused on identifying factors that contribute to overweight or obesity issues. The researchers used framework analysis to examine the qualitative data collected from these studies.

Results

The synthesis incorporated 121 research studies which satisfied the established criteria. This comprised 98 studies from 46 different countries, 17 studies conducted at the international level, and 6 studies involving multiple countries. Eighty-two factors influencing overweight and obesity were identified as determinants and categorized into five main categories: sociocultural, economic, technological, environmental, and political. Most of the identified determinants belong to the socio-cultural category, which demonstrates their substantial impact on lifestyle and health behaviors.

Conclusion

The implementation of public health prevention and intervention programs depends on complete knowledge of all factors that affect overweight and obesity rates. This issue needs a comprehensive approach which analyzes sociocultural aspects together with economic, technological, environmental, and political factors, as well as other policy goals within defined societal challenges. Effective solutions to resolve this situation depend on multi-sectoral collaboration to tackle obesity and promote health-enhancing factors for the entire community.

Addressing childhood obesity in Iran: exploring a multifaceted conceptual model in a low/middle income country through stakeholder lens

BACKGROUND

Despite significant global efforts to control childhood obesity (CO), its prevalence continues to rise, particularly in low- and middle-income countries. This study aims to identify the determinants of CO in Iran.

METHODS

This qualitative study employed a purposive snowball sampling method to interview 30 stakeholders from various specialities and disciplines. They included scientists, government and industry authorities, representatives from international organizations, and members of civil society. The data analysis was conducted using MAXQDA 2020, employing inductive content analysis. The credibility and dependability of the data were ensured by using Lincoln and Guba's criteria. We used the consolidating criteria for reporting qualitative studies.

RESULTS

The main determinants of childhood obesity control in Iran can be categorized into three levels: local, national, and international. At the local level, home and school environments are influential in shaping unhealthy lifestyles and energy imbalances. The national determinants are the triad of governance, dominant social structure, and national policies/regulations. Governance factors such as inappropriate policy-making processes, Low responsiveness and accountability, and Low collaboration and parallel working between stakeholders; impact childhood obesity control. Dominant social structures including cultural norms, urban design, air pollution, social transitions, and inequalities also contribute to the issue. National policies and regulations exhibit shortcomings in fiscal and food promotion aspects. At the international level, the World Health Organization's approach to Ending Childhood Obesity (ECHO), trade policies, political sanctions, climate change, and the COVID-19 pandemic have significant implications for childhood obesity control.

CONCLUSION

This study provides valuable insights into the determinants of childhood obesity (CO) in Iran. It can inform evidence-based policymaking not only in Iran but also in other countries with similar socio-economic statuses.

Prevalence and Predictors of Overweight and Obesity Among School-Aged Children in the Country of Georgia: A Cross-Sectional Study, 2022

BACKGROUND

Childhood overweight and obesity are significant global public health challenges that affect approximately 340 million children worldwide. In Georgia, the prevalence of childhood obesity is alarming, with approximately 28% of 7-year-old children classified as overweight or obese in 2019. This study aimed to investigate the key factors associated with overweight and obesity among school-age children in Georgia.

METHODS

Data from the Childhood Obesity Surveillance Initiative Survey (COSI), which was conducted in 2022, was analyzed. The study involved 3,334 children from 245 schools across the region. Anthropometric measurements and a structured questionnaire were utilized to evaluate body weight, dietary behaviors, physical activity behaviors, parental education, household socioeconomic status, and body mass index (BMI).

RESULTS

Among second-grade school children in Georgia, 17.2% were overweight and 11.0% were obese, with higher percentages of boys (30.0%) than girls (26.3%). The prevalence of overweight/obesity was greater in urban-dwelling children (30.3%) than in rural children (23.6%). Significant associations were found between BMI and living area (p < 0.001), playing outside (p = 0.01), passive modes of transportation (e.g., cars) for school travel (p < 0.05), parental education (p = 0.03) and parental body weight (p < 0.05). However, no significant differences were observed in the prevalence of various dietary behaviors or screen time between normal-weight and overweight/obese children.

CONCLUSIONS

This study revealed significant associations between body weight status and certain demographic and lifestyle factors, highlighting the critical role of promoting physical activity, encouraging active transportation (e.g., walking or cycling to school) and raising parental awareness to address childhood overweight and obesity. Future interventions should prioritize creating a supportive environment for healthy behaviors and implementing early screening measures to prevent potential complications and improve overall health outcomes in children.

Adolescent Metabolic Screening

This article explores metabolic syndrome (MetS) in children and adolescents, shedding light on its significant influence on long-term cardiovascular health outcomes. We navigate the complex landscape of MetS, where there is no universally accepted definition, and explore its roots in factors like obesity and insulin resistance. We also discuss the challenges of diagnosing and understanding its relevance in pediatric populations. The article also discussed the impact of the COVID-19 pandemic on the metabolic well-being of adolescents. Also, we discuss the importance of addressing associated comorbidities and risk factors in the context of MetS.

Effect of virtual education on health responsibility of overweight students during the COVID-19 pandemic

BACKGROUND

The global prevalence of obesity is increasing not only in adults but also in children and adolescents. In addition to the role of genetic and biological factors, policies such as the need for quarantine during the coronavirus epidemic and the family's behavioral and socioeconomic status in causing obesity cannot be ignored. The current research aimed to investigate the effect of virtual education programs on the health responsibility of overweight students during the outbreak of the Coronavirus.

METHODS

This was a semi-experimental study with a pre-test-post-test design and a randomized control group, which was conducted in three stages)pre-intervention, intervention, and post-intervention) during 2021-22 in Tehran Province, Iran. The samples were 60 adolescent girls aged 12-18 with a body mass index higher than 25 and placed in two test and control groups through random cluster sampling. Data was collected using the demographic information profile and the 12-item health responsibility questionnaire from HPLPII. The intervention was implemented as 6 virtual training sessions of 1.5 h for the test group. After 1.5 months, BMI was measured and a post-test was done. SPSS version 22 software was used for data analysis.

RESULTS

There was no significant change in the BMI of students after the intervention in the control group (p = 0.476), but it decreased significantly in the test group (p < 0.001). Before the intervention, there was no statistically significant difference between the average score of health responsibility in the test group (54.63± 6.93 ) and the control group (53.03± 6.79) (P = 0.370). After the intervention, the mean difference between the test group (62.56) and the control group (55.10) was statistically significant (P < 0.001). Before the intervention, about 70% of the students in both the test and control groups were at a relatively favorable health responsibility level. After the study, the number of students in the test group who were placed at a completely favorable level was almost twice as before, and a statistically significant difference was observed between the two groups(P = 0.035).

CONCLUSIONS

The results of the present study showed that virtual education during the outbreak of COVID-19 has led to an increase in the responsibility for the health of overweight and obese students (in terms of improving health behaviors, increasing the hours of physical activity, and modifying the eating pattern) and reducing the body mass index of students.

Association between rs4994 variant in β3-Adrenergic receptor and obesity in Vietnamese preschool-age children, independent of eating behaviors

BACKGROUND

The Arg64 allele of the rs4994 (Trp64Arg) variant in the β3-adrenergic receptor (ADRB3) gene is involved in the control of energy balance by altering lipolysis and thermogenesis in adipocytes, ultimately contributing to the development of obesity. The objective of our study was to investigate the association between the rs4994 variant of the ADRB3 gene and obesity in Hanoi preschool-age children, adjusting for their eating behaviors.

METHODS

A cross-sectional study was performed involving 708 children with normal weight and 304 children with obesity aged 3-5 years from 36 kindergartens in Hanoi, Vietnam. Cheek mucosa cell samples were used for DNA extraction, and genotyping at the ADRB3-rs4994 locus was performed using the polymerase chain reaction-restriction fragment length polymorphism method (PCR-RFLP). Eating behaviors were assessed using the Children's Eating Behaviour Questionnaire (CEBQ). Binary logistic regression analysis was employed to examine the association between the rs4994 variant and obesity, adjusting for confounding factors such as age, sex, residence, birth weight, and eating behaviors.

RESULTS

The frequency of the C allele in the group with obesity was 16.4%, which was higher than in the control group (11.7%, P = 0.003). Children with the CC genotype exhibited significantly greater weight and weight-for-age Z-score compared to those with the TT and TC genotypes (P = 0.004 and 0.03, respectively). Following univariate and multivariate analyses adjusted for age, sex, residence, birth weight, and eating behaviors, a significant association between the rs4994 variant and obesity was observed (P < 0.05).

CONCLUSIONS

This study indicated that the ADRB3-rs4994 variant can be considered as an independent risk factor for obesity in Vietnamese preschool children.

Effectiveness of an mHealth App That Uses Financial Incentives and Gamification to Promote Health Behavior Change in Adolescents and Caregivers: Protocol for a Clinic-Based Randomized Controlled Trial

BACKGROUND

Adolescent and adult obesity continues to be a public health epidemic in the United States. Despite the popularity of mHealth apps with gamification among adolescents, there are insufficient studies to evaluate the efficacy of gamified mHealth apps and financial incentives to motivate sustained health behavior change in adolescents or their adult caregivers.

OBJECTIVE

This study aims to evaluate the effectiveness of gamification techniques and financial incentives used in the novel "CommitFit" mHealth app to motivate health behavior change and improve various mental and physical health metrics in adolescents and their caregivers.

METHODS

This study is a 3-month randomized controlled trial (RCT) with 30 adolescents (aged 13-15 years) and their adult caregivers (N=60). It evaluates "CommitFit," which uses gamification including points and leaderboards to motivate logging and achievement of self-selected health behavior goals (eg, more water, sleep, physical activity, fruits, or vegetables or fewer sugary beverages). The RCT had three arms, each with 10 dyads: (1) CommitFit-only users; (2) CommitFit$, where adolescents were paid US $0.05 for each point they earned; and (3) waitlist control. Intervention dyads used the app for 3 months and had the option to use it for the fourth month without prompts or extra financial incentives. User analytic software was used to evaluate the frequency of user logs and goal achievement. Monthly surveys evaluated self-reported change in the 5 CommitFit health behaviors. Changes in BMI and blood pressure were evaluated for all participants at 3 clinical visits. Mental health, gamification, and behavior economics surveys were completed during the clinical visits.

RESULTS

Recruitment began in August 2023 and was completed in 10 weeks. The research team successfully recruited and enrolled 30 dyads. Researchers emailed and called 89 caregivers on a physician-approved adolescent patient list, a 33% recruitment rate. Data collection and analysis will be conducted in the spring and summer of 2024. The results of this study are anticipated to be published between late 2024 and early 2025.

CONCLUSIONS

This RCT will expand knowledge of the effectiveness of gamification techniques, financial incentives, and mHealth apps to motivate sustained health behavior change among adolescents and caregivers. These results may offer new opportunities to caregivers, health insurers, health care systems, and clinicians to motivate health behavior change in adolescents and caregivers, with the ultimate goal of preventing or reducing obesity and obesity-related diseases. Additional gamification, mental health surveys, and app user analytics included in the study may provide further insight into the characteristics of adolescents or caregivers who would benefit the most from using a gamified mHealth app like CommitFit.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63505.

Corticotropin-releasing hormone and obesity: From fetal life to adulthood

Obesity is among the most common chronic disorders, worldwide. It is a complex disease that reflects the interactions between environmental influences, multiple genetic allelic variants, and behavioral factors. Recent developments have also shown that biological conditions in utero play an important role in the programming of energy homeostasis systems and might have an impact on obesity and metabolic disease risk. The corticotropin-releasing hormone (CRH) family of neuropeptides, as a central element of energy homeostasis, has been evaluated for its role in the pathophysiology of obesity. This review aims to summarize the relevance and effects of the CRH family of peptides in the pathophysiology of obesity spanning from fetal life to adulthood.

Postpartum Obesity Is Associated With Increases in Child Adiposity in Midchildhood in a Cohort of Black and Dominican Youth

Background

Obesity disproportionately affects marginalized and low-income populations. Birth parent obesity from the prenatal period and childhood has been associated with child obesity. It is unknown whether prenatal or postnatal birth parent obesity has differential effects on subsequent changes in adiposity and metabolic health in children.

Objectives

We evaluated how birth parent obesity 7 y after delivery was associated with child body composition changes and cardiometabolic health in midchildhood and further assessed the influence of the perinatal and postpartum period on associations.

Methods

Black and Dominican pregnant individuals were enrolled, and dyads (n = 319) were followed up at child age 7 and 9 y. Measures included, height, weight, waist circumference (WC), and percent body fat (BF%). Multiple linear regression was used to relate postpartum weight status with child outcomes accounting for attrition, and a series of secondary analyses were conducted with additional adjustment for perinatal weight status, gestational weight gain (GWG), and/or long-term weight retention to evaluate how these factors influenced associations.

Results

Almost one-quarter (23%) of birth parents and 24.1% children were classified with obesity at child age 7 y, while at 9 y, 30% of children had obesity. Birth parent obesity at child age 7 y was associated with greater changes, from ages 7 to 9 y, in child BMI z-score (β: 0.13; 95% CI: 0.02, 0.24) and BF% (β: 1.15; 95% CI: 0.22, 2.09) but not obesity at age 9 y. All observed associations crossed the null after additional adjustment for prenatal factors.

Conclusions

Birth parent obesity at 7-y postpartum is associated with greater gains in child BMI z-score and BF% in midchildhood. These associations diminish after accounting for prenatal size, suggesting a lasting impact of the perinatal environment and that interventions supporting families from the prenatal period through childhood are needed.

Parental obesity predisposes to exacerbated metabolic and inflammatory disturbances in childhood obesity within the framework of an altered profile of trace elements

BACKGROUND

Family history of obesity is known to increase the odds of developing childhood obesity in the offspring, but its influence in underlying molecular complications remains unexplored.

SUBJECTS/METHODS

Here, we investigated a population-based cohort comprising children with obesity, with and without parental obesity (PO+, N = 20; PO-, N = 29), and lean healthy children as controls (N = 30), from whom plasma and erythrocyte samples were collected to characterize their multi-elemental profile, inflammatory status, as well as carbohydrate and lipid metabolisms.

RESULTS

We found parental obesity to be associated with unhealthier outcomes in children, as reflected in increased blood insulin levels and reduced insulin sensitivity, unfavorable lipid profile, and pro-inflammatory milieu. This was accompanied by moderate alterations in the content of trace elements, including increased copper-to-zinc ratios and iron deficiency in circulation, as well as metal accumulation within erythrocytes.

CONCLUSIONS

Therefore, we hypothesize that family history of obesity could be an important risk factor in modulating the characteristic multi-elemental alterations behind childhood obesity, which in turn could predispose to boost related comorbidities and metabolic complications.

Association of Body Mass Index between Adolescents and their Parents in Mumbai and Kolkata: A Population-based Study

Introduction

Adolescent overweight and obesity as measured by body mass index (BMI) seem to be increasing at an alarming rate in urban populations. Parental BMI plays an important role in their adolescent's BMI. Overweight and obesity coexisting with undernutrition in adolescents is an important public health challenge in low- and middle-income countries (LMICs). We present results from a population-based study on adolescents' prevalence of BMI and its association with their parents' BMI in Mumbai and Kolkata, India.

Methods and materials

Multistage random sampling of households was used to select adolescents aged 12-14 years and one of their parents in 2019-2020. In Mumbai, 843 adolescents, and in Kolkata, 913 adolescents and one of their parents were interviewed independently by trained field investigators. Height and weight were measured using standardized procedures. Adolescents' BMI categories were defined using Centers for Disease Control and Prevention (CDC) recommendations. For parents, the BMI was categorized using Asian cut-off categories into underweight (BMI < 18.5), normal weight (BMI: 18.5-22.9), overweight (BMI: 23.0-27.0), and obese (BMI > 27.0). Multivariate logistic regression was used to determine the relationship between parental BMI and adolescents' BMI.

Results

In Mumbai, 15.7% and in Kolkata, 21.1% of adolescents were overweight or obese. Nearly 80% of mothers and 70% of other parents were either overweight or obese. The mothers of adolescents who were overweight or obese showed a high risk of their adolescent being overweight [odds ratio (OR): 4.16 (1.36-12.73)] or obese [OR: 18.53 (2.02-170.44)] in Mumbai and [OR: 4.45 (1.25-15.80)] and [OR: 8.81 (1.40-55.33)] in Kolkata respectively after adjusting for adolescent's gender and head of the household's highest level of educational attainment.

Conclusion

Adolescents' overweight/obesity status is strongly associated with their mothers' BMI in urban India. This association may reflect both genetic and environmental effects. The present study highlights the high prevalence of adolescent overweight and obesity in these urban populations and underscores how important it is to identify effective public health strategies for the primary prevention of childhood obesity.

The Influence of Parent’s Education, Birth order and Number of Siblings on Adolescents’ BMI.. [DOI: 10.21203/rs.3.rs-2879484/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Obesity in adolescents show high prevalence specially in developing countries. Although birth order and sib size have been mathematically coupled and in spite of their respective effect on both overweight and obesity, they have not been estimated before separately. Moreover, the educational achievement of parents might have impact on their children’s nutritional status. Objective This study aims to assess how birth order and number of siblings affect adolescent obesity risk and to examine the impact of parent’s education on adolescent obesity, the results will indicate which family members may be prioritized for inclusion in adolescent obesity prevention programs. Methodology A self-administered questionnaire was used to collect data on individuals aged 10 to 18 years old, including sex, age, birth weight, birth order, number of siblings, lifestyle, and parents' educational level by a self-administered questionnaire completed by an adult member of the family, while measurements of subjects’ height and weight were done in the clinic of nutrition and immunity. The CDC's BMI cut-off points were used to classify the subjects as normal (5–84th percentile) and obese (≥ 95th percentile). Results Distribution of the number of siblings was different in both groups as regards BMI but statistically insignificant, we found no statistically significant difference on correlating birth order and number of siblings. Conclusion Adolescent’s BMI were driven by neither the sibling was (younger or older) nor number of their siblings. There was no significant association between parental education and the development of obesity.

Examining the Association Between Parental Factors and Childhood Obesity

PURPOSE

To examine associations between parent's diet and BMI (body mass index) and child's sedentary behavior and physical activity (PA) with child's BMI.

DESIGN

A descriptive design.

METHODS

Study participants were a parent-child dyad in a subsample of families enrolled in Chicago Heights Early Childhood Center.

FINDINGS

Approximately 80% of parents had a BMI classifying as overweight or obese. Associations between children's sedentary behavior, PA, and BMI were insignificant.

CONCLUSIONS

Findings highlight the importance of including parents when developing strategies for promoting healthy behavior of children.

CLINICAL EVIDENCE

Community health nurses are well-positioned to promote healthy behaviors.

Association between specific types of parent stressors and fast-food consumption among parents and children

INTRODUCTION

Although stress has been associated with eating behaviors, such as overeating and eating less healthy foods, the relationships between specific types of parent stressors and fast-food consumption in parents and young children have not been well studied. We hypothesized that parent perceived stress, parenting stress, and household chaos would be positively associated with fast-food consumption for parents and their young children.

METHODS

Parents of 2-5 year olds and with Body Mass Index >27 kg/m2 (N = 234, parent mean age: 34.3 (±5.7); child age: 44.9 (±13.8) months; 65.8 % from two parent households) completed surveys on parent perceived stress, parenting stress, household chaos, and their fast-food intake and that of their child.

RESULTS

In separate regression models, controlling for covariates, parent perceived stress (β = 0.21, p < 0.01; R2 = 0.10, p < 0.01), parenting stress (β = 0.26, p < 0.01; R2 = 0.13, p < 0.01), and household chaos (β = 0.25, p < 0.01; R2 = 0.12, p < 0.01) were each significantly associated with parent fast-food consumption, and separately with child fast-food consumption [Parent perceived stress (β = 0.05, p = 0.02; R2 = 0.14, p < 0.01); parenting stress (β = 0.14, p = 0.03; R2 = 0.14, p < 0.01); parent fast-food consumption (β = 0.40, p < 0.01; R2 = 0.27, p < 0.01)]. However, combined final models showed parenting stress (p < 0.01) as the only significant predictor of parent fast-food consumption, which in turn was the only significant predictor of child fast-food consumption (p < 0.01).

DISCUSSION

The findings support the inclusion of parenting stress interventions that target fast-food eating behaviors in parents, which may in turn, reduce fast-food intake in their young children.

Father's weight could contribute to large babies in overweight and obese mothers with and without gestational diabetes

We evaluated whether there was an association between fathers' nutritional status and children's birth weight (BW) considering weight-matched mothers with and without gestational diabetes mellitus (GDM). In total, 86 trios of women, infants, and fathers were evaluated. BW was not different between the groups of obese and non-obese parents, frequency of maternal obesity, or GDM. The percentage of infants who were large for gestational age (LGA) was 25% in the obese group and 14% in the non-obese group (p = 0.44). There was a borderline significance for higher body mass index (p = 0.09) of the father in the LGA group compared with the adequate for gestational age group. These results corroborate the hypothesis that the father's weight can also be relevant for the occurrence of LGA.

Sedentary lifestyle with increased risk of obesity in urban adult academic professionals: an epidemiological study in West Bengal, India

Ectopic fat deposition is more strongly associated with obesity-related health problems including type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), hypothyroidism, arthritis, etc. Our study aimed at identifying the cumulative role of several risk factors in developing obesity and the role of ectopic fat (visceral fat) in predicting cardiovascular disease risk in varied age groups among urban adult academic professionals in West Bengal. 650 adults (Male = 456; Female = 194) associated with the academic job (age 20-65 years) in urban West Bengal were randomly selected for anthropometric, blood biochemical, and questionnaire-based analyses. Body Mass Index and Visceral Fat% exhibited comparable association with all the other anthropometric parameters (e.g. Whole body Subcutaneous fat%: male-Linear Regression Comparison: F = 11.68; P < 0.001; female-F = 6.11; P < 0.01). Therefore, VF% acts as a risk factor alongside BMI in instances where BMI fails alone. The presence of T2DM, hypertension, and hypothyroidism in the case groups confirmed their obesity-associated longitudinal pattern of inheritance. Unhealthy diet pattern indicates improper liver function, vitamin D deficiency, and increased erythrocytic inflammation. An overall sedentary lifestyle with parental history of obesity was found to be significant in the longitudinal transmission of the disease.

Paternal preconception modifiable risk factors for adverse pregnancy and offspring outcomes: a review of contemporary evidence from observational studies

BACKGROUND

The preconception period represents transgenerational opportunities to optimize modifiable risk factors associated with both short and long-term adverse health outcomes for women, men, and children. As such, preconception care is recommended to couples during this time to enable them to optimise their health in preparation for pregnancy. Historically, preconception research predominately focuses on maternal modifiable risks and health behaviours associated with pregnancy and offspring outcomes; limited attention has been given to inform paternal preconception health risks and outcomes. This systematic review aims to advance paternal preconception research by synthesising the current evidence on modifiable paternal preconception health behaviours and risk factors to identify associations with pregnancy and/or offspring outcomes.

METHODS

Medline, Embase, Maternity and Infant care, CINAHL, PsycINFO, Scopus, and ISI Proceedings were searched on the 5^th of January 2023, a date limit was set [2012-2023] in each database. A Google Scholar search was also conducted identifying all other relevant papers. Studies were included if they were observational, reporting associations of modifiable risk factors in the preconception period among males (e.g., identified as reproductive partners of pregnant women and/or fathers of offspring for which outcomes were reported) with adverse pregnancy and offspring outcomes. Study quality was assessed using the Newcastle-Ottawa Scale. Exposure and outcome heterogeneity precluded meta-analysis, and results were summarised in tables.

RESULTS

This review identified 56 cohort and nine case control studies. Studies reported on a range of risk factors and/or health behaviours including paternal body composition (n = 25), alcohol intake (n = 6), cannabis use (n = 5), physical activity (n = 2), smoking (n = 20), stress (n = 3) and nutrition (n = 13). Outcomes included fecundability, IVF/ISCI live birth, offspring weight, body composition/BMI, asthma, lung function, leukemia, preterm birth, and behavioural issues. Despite the limited number of studies and substantial heterogeneity in reporting, results of studies assessed as good quality showed that paternal smoking may increase the risk of birth defects and higher paternal BMI was associated with higher offspring birthweight.

CONCLUSION

The current evidence demonstrates a role of paternal preconception health in influencing outcomes related to pregnancy success and offspring health. The evidence is however limited and heterogenous, and further high-quality research is needed to inform clinical preconception care guidelines to support men and couples to prepare for a health pregnancy and child.

Epidemiology of obesity and high blood pressure among school-age children from military families: the largest report from our region

BACKGROUND

For the first time, we aimed to determine the epidemiology and associated factors of obesity and hypertension among children of military families in our region.

METHODS

In this multi-centered study, children between the ages of 5 to 12 years old, entered the study. Data on baseline and clinical characteristics, history of disease and anthropometric measurements, were collected.

RESULTS

Among 504 children, 44.2% were males. Mean (SD) age of participants was 7.9 ± 1.9 years. Overall, 5% were obese and 9.9% were overweight. In total, 16.3% had elevated BP, 12.5% had stage one and 0.2% had stage two hypertension. Age (beta = 0.306, OR = 1.35, 95% CI:1.14-1.61), obesity/overweight (OR = 5.58, 95% CI:2.59-12.0), history of hypertension in mother (OR = 43.24, 95% CI:5.99-312.11), low birth weight (OR = 7.96, 95% CI:2.59-12.0), physical activity (OR = 0.27, 95% CI:0.10-0.72), and consumption of fast food more than once a week (OR = 3.36, 95% CI:1.82-6.19), were associated with risk of hypertension. Furthermore, age (beta = 0.346, OR = 1.41, 95% CI:1.21-1.64), history of childhood obesity in the father (OR = 3.78, 95% CI: 1.77-8.06) and mother (OR = 2.44, 95% CI:1.07-5.56), and physical activity (OR = 0.27, 95% CI:0.11-0.66), were associated with obesity.

CONCLUSION

Age, obesity/overweight, history of hypertension in the mother, birth weight, physical activity, and consumption of fast food, were associated with risk of hypertension. Moreover, age, history of childhood obesity in parents, and physical activity, were associated with obesity. Furthermore, we found that school-age children in military families have higher rates of hypertension and overweight compared to other reports from our region.

Families' expectations of an eHealth family-based cardiovascular disease-risk reduction programme

AIM

Research has shown that families' participation in a cardiovascular disease (CVD) prevention programme could boost early adoption of healthy lifestyle behaviours in families. Behaviour-based, eHealth interventions are a potential means of achieving this. This study aimed to explore expectations of families-parents and children-at risk of CVD towards the design and functionality of an eHealth family-based CVD-risk reduction programme 'Health-e-Hearts'.

METHODS AND RESULTS

Three online focus groups were conducted with six families comprising at least one parent at risk of CVD and at least one child aged 5-17 years. The focus groups were video and audio recorded and transcribed. Content analysis was used to synthesize and identify key categories and subcategories regarding development of and engagement with an eHealth programme. Three categories emerged: experiences of health apps and devices; eHealth application needs of family members; and motivators for using an eHealth programme. Experiences included using health apps individually and inconsistently. Needs included personalization, free and easy-to-use, time efficient, and multiple content formats. Motivators for engaging with the programme included goal setting, rewards, and competition.

CONCLUSION

Families' expectations of an eHealth family-based CVD-risk reduction programme include the incorporation of personalized, easy-to-use design features and motivators for engaging with the programme. Family involvement in the development of an eHealth programme such as 'Health-e-Hearts' has the potential to boost early adoption of healthy lifestyle behaviours among all family members.

Knock knee deformity and body mass index among the male school students of 9 to 13 years old of chandigarh, India

Study aim: To study knock knee deformity and the body mass index among male school students of Chandigarh, India. The study also intended to evaluate the association of knock knee deformity with BMI.

Material and method: In total, 900 school students were selected, and out of these 300 each were from private, government model and government schools in slum areas. Convenient sampling was employed. The age of the subjects ranged from 9 to 13 years. Height, weight, BMI and intermalleolar distance of selected subjects were assessed. Descriptive statistics, ANOVA and correlation were employed.

Results: The highest percentages of obese (11.3%) and overweight (15.3%) students were found in the private schools. The highest percentages of severe knock knee deformity (10.7%) were found in the students of the private schools, whereas 16.7% of students in the government model schools had moderate knock knee deformity. Height, weight and BMI were significantly correlated with knock knee deformity.

Conclusion: Body weight among the school students might be associated with the school type, as the problem of obesity and underweight was pervasive in private and government schools. Knock knee deformity was related to the school type and body weight status.

Household Food Insecurity, Anemia, Malnutrition and Unfavorable Dietary Diversity among Adolescents: Quadruple Whammies in the Era of Escalating Crises in Lebanon

Adolescence is a transitional period between childhood and adulthood. Nowadays, adolescents in Lebanon are growing during a time of unprecedented health crises and political instability. This study aimed to determine the prevalence and correlates of malnutrition, dietary diversity in adolescents' households, and adolescents' self-reported food insecurity in Lebanon. A national representative sample of 450 parent-adolescent dyads (parents: mean age ± standard deviation (SD) = 46.0 ± 7.0, mothers: 59.0%; adolescents: mean age ± SD = 15.0 ± 3.0, girls: 54.6%) were interviewed. Anthropometric and blood hemoglobin measurements were performed for adolescents. The Food Consumption Score, the Arab Family Food Security Scale and the Adolescent-Level Food-Security Scale were used. The overall prevalence of adolescent stunting, thinness, overweight, obesity and anemia was 6.7%, 4.7%, 19.3%, 12.9% and 16.7%, respectively. Almost 40.4% and 68% of adolescent's households consumed undiversified diets and were food insecure, respectively. Food insecurity (FI) affected 54.0% of adolescents. Adolescents attending schools (vs. university) were eight times more likely to be stunted (p = 0.04). Boys had a 4.3 times higher thinness risk (p = 0.005) compared to girls. Households reporting an income decline since the start of the Lebanese economic crisis were three times more likely to have a thin adolescent (p = 0.01). Parental overweight/obesity (p = 0.002) and lower education level (p = 0.04) nearly doubled the risk of adolescent overweight or obesity. At a time when escalating crises in Lebanon are shifting diets for the youngest generations, the development of adolescent-responsive nutritional policies becomes a must.

Factors of Obesity and Metabolically Healthy Obesity in Asia

The East Asian region (China, Japan, and South Korea) is comprised of almost 1.5 billion people and recent industrialization has brought with it a pandemic of rising obesity, even in children. As these countries are rapidly aging and functioning at sub-replacement birthrates, the burgeoning costs of obesity-related care may threaten socialized healthcare systems and quality of life. However, a condition called metabolically healthy obesity (MHO) has been found to be without immediate cardiopulmonary or diabetic risk. Thus, maintenance of the MHO condition for the obese in East Asia could buffer the burden of long-term obesity care on medical systems and knowledge of the biochemical, genetic, and physiological milieu associated with it could also provide new targets for intervention. Diverse physiological, psychological, environmental, and social factors play a role in obesogenesis and the transition of MHO to a metabolically unhealthy obesity. This review will give a broad survey of the various causes of obesity and MHO, with special emphasis on the East Asian population and studies from that region.

Exclusive Breastfeeding for at Least Four Months Is Associated with a Lower Prevalence of Overweight and Obesity in Mothers and Their Children after 2-5 Years from Delivery

Introduction: Obesity is a current public health concern. Higher body weight is influenced by genetic and environmental parameters, and their interplay and is associated with a greater risk for several chronic diseases. Breastfeeding has been suggested as a preventive measure against obesity, which can further reduce long-term negative health outcomes for both women and children. Aim: The aim of the present study was to evaluate the role of breastfeeding on maternal and childhood overweight and obesity. Materials and Methods: This is a cross-sectional study conducted on 2515 healthy mothers and their children, aged 2−5 years, enrolled from nine different Greek rural and urban regions. Validated, standardized questionnaires were administrated that included anthropometric indices, socio-demographic characteristics of mothers and children, as well as breastfeeding practices. Results: Overall, 68% of participated women exclusively breastfed their children for at least 4 months. Mothers that exclusively breastfed showed a significantly lower prevalence of overweight and obesity after 2−5 years from delivery (p < 0.0001). Children that had exclusively been breastfed showed a significantly lower prevalence of overweight and obesity at the age of 2−5 years (p < 0.0001). Using multivariate regression analysis, exclusive breastfeeding for at least 4 months was associated with a two-fold lower risk for maternal and childhood overweight and obesity after 2−5 years from delivery, independent from maternal age, educational and economic status, and smoking habits (p < 0.0001). Conclusion: Exclusive breastfeeding for at least 4 months had a positive effect on childhood overweight and obesity, also contributing beneficially to post-natal maternal weight control. The beneficial effects of breastfeeding should be communicated to future and new mothers, while supportive actions for all mothers to initiate and continue breastfeeding their offspring should be implemented.

The association of changes in body mass index and metabolic parameters between adults with overweight or obesity and their children in a family-based randomized trial (DiOGenes)

BACKGROUND

Family-based approaches have been reported to be effective in improving overweight or obesity in children.

OBJECTIVES

To investigate the relationship of changes in body mass index and metabolic parameters between adults with overweight or obesity and their children during a weight-maintenance family-based dietary intervention.

METHODS

In a multicentre randomized controlled trial, families with at least one parent with overweight or obesity and one healthy child aged between 5 and 18 years, of which the parents completed an 8-week weight-loss phase successfully, were randomized into five different dietary intervention groups to achieve weight maintenance for 6 months. Anthropometric parameters and body composition were measured and blood samples were collected before and after the dietary intervention. Data were analysed using Pearson correlation coefficient analyses and multiple linear regression analysis adjusted for diet group, centre, child's sex and age.

RESULTS

A positive association was found between the change in body mass index (BMI) of the mother and change in BMI-for-age Z-score of first and second child (std β = 0.248, p = 0.000; std β = 0.326, p = 0.000, respectively). The change in BMI of the father was only significantly associated with the change in BMI-for-age Z-score of first child (std β = 0.186, p = 0.031). No consistent pattern of associations between parents and children was found for homeostatic model assessment for insulin resistance, fasting glucose and fasting insulin.

CONCLUSION

This study supports the inclusion of parents into family-based dietary approaches for weight management of their children regardless of the child's weight status in eight different countries throughout Europe.

Dietary Counseling Aimed at Reducing Sugar Intake Yields the Greatest Improvement in Management of Weight and Metabolic Dysfunction in Children with Obesity

Pediatric obesity is a significant public health problem, the negative outcomes of which will challenge individual well-being and societal resources for decades to come. The objective of this study was to determine the effects of dietary counseling on weight management and metabolic abnormalities in children with obesity. One hundred and sixty-five patients aged 2−18 years old were studied over a two and a half year period. Data collected included demographic information, anthropometric assessment, laboratory measurements, and self-reported eating behaviors. Dietary counseling was provided at each visit. The data was analyzed from the first and last visits and the subjects were retrospectively divided into responders and non-responders based on a decrease in their BMI. After receiving dietary guidance, BMI decreased in 44% of the children, and these participants were classified as responders (BMI-R; n = 72). However, BMI did not improve in 56% of the participants, and these were classified as non-responders (BMI-NR; n = 93). At the initial visit, anthropometric measurements and dietary habits were similar between the groups. At the time of the last visit, mean change in BMI was −1.47 (SD 1.31) for BMI-R and +2.40 (SD 9.79) for BMI-NR. Analysis of food intake revealed that BMI-R significantly improved their dietary habits (p = 0.002) by reducing the intake of sugar-sweetened beverages (p = 0.019), processed foods (p = 0.002), sweets (p < 0.001), and unhealthy snacks (p = 0.009), as compared with BMI-NR. There was no change in the intake of second helpings, portion sizes, skipping meals, frequency of meals eaten at school, condiment use, intake of fruits and vegetables and consumption of whole grains between the groups. BMI-R also achieved an improvement in fasted glucose (p = 0.021), triglycerides (p < 0.001), and total cholesterol (p = 0.023), as compared to BMI-NR. In conclusion, children with obesity who were able to decrease their BMI implemented a significant reduction in consumption of foods with high sugar content. Focusing on reducing sugar intake may yield the biggest impact in terms of weight management and the improvement of metabolic abnormalities.

"GENYAL" Study to Childhood Obesity Prevention: Methodology and Preliminary Results

Objective

This article describes the methodology and summarizes some preliminary results of the GENYAL study aiming to design and validate a predictive model, considering both environmental and genetic factors, that identifies children who would benefit most from actions aimed at reducing the risk of obesity and its complications.

Design

The study is a cluster randomized clinical trial with 5-year follow-up. The initial evaluation was carried out in 2017. The schools were randomly split into intervention (nutritional education) and control schools. Anthropometric measurements, social and health as well as dietary and physical activity data of schoolchildren and their families are annually collected. A total of 26 single nucleotide polymorphisms (SNPs) were assessed. Machine Learning models are being designed to predict obesity phenotypes after the 5-year follow-up.

Settings

Six schools in Madrid.

Participants

A total of 221 schoolchildren (6-8 years old).

Results

Collected results show that the prevalence of excess weight was 19.0, 25.4, and 32.2% (according to World Health Organization, International Obesity Task Force and Orbegozo Foundation criteria, respectively). Associations between the nutritional state of children with mother BMI [β = 0.21 (0.13-0.3), p (adjusted) <0.001], geographical location of the school [OR = 2.74 (1.24-6.22), p (adjusted) = 0.06], dairy servings per day [OR = 0.48 (0.29-0.75), p (adjusted) = 0.05] and 8 SNPs [rs1260326, rs780094, rs10913469, rs328, rs7647305, rs3101336, rs2568958, rs925946; p (not adjusted) <0.05] were found.

Conclusions

These baseline data support the evidence that environmental and genetic factors play a role in the development of childhood obesity. After 5-year follow-up, the GENYAL study pretends to validate the predictive model as a new strategy to fight against obesity.

Clinical Trial Registration

This study has been registered in ClinicalTrials.gov with the identifier NCT03419520, https://clinicaltrials.gov/ct2/show/NCT03419520.

Digital Intervention Strategies for Increasing Physical Activity Among Preschoolers: Systematic Review

Background

Digital interventions are increasingly used to improve health behaviors. Improved access and lower costs (relative to in-person interventions) make such interventions appealing. Specifically, digital platforms may be a promising approach for increasing physical activity (PA) in young children.

Objective

The goal of this systematic review was three-pronged: (1) to determine the quality of studies using digital PA intervention strategies with preschool-aged children (ie, 3 to 5 years old); (2) to assess the efficacy of digital interventions and approaches designed to improve PA in preschool-aged children; and (3) to examine theoretical application and implementation outcomes with current approaches to digital PA interventions.

Methods

This review identified and summarized studies on digitally supported interventions for promoting PA in preschool-aged children. We generated 3 lists of relevant search terms that included technology-related terms, PA-related terms, and weight-related terms. The search included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Study selection was led by a single author and verified by a second; the same 2 authors assessed study quality using a standardized tool, and 3 authors completed data extraction on PA outcomes, theory application, and implementation outcomes.

Results

In total, 601 studies were identified; 8 met the inclusion criteria. For study quality, only 2 studies received an overall rating of strong quality and low risk of bias. All but 1 study had a small sample size (<100). Positive and significant changes in child PA outcomes were reported in only 2 studies with weak overall quality, both of which used child-directed approaches. In total, 5 studies applied a behavioral theory for designing the intervention; no patterns of effectiveness were identified based on the application of theory. Finally, no studies reported on the implementation outcomes of adoption, cost, penetration, or sustainability; 1 study did not assess any implementation outcomes, and no single study reported on more than 2 implementation outcomes. Studies measured the implementation outcome of acceptability most frequently (n=4), and researchers assessed fidelity in 3 studies.

Conclusions

The interventions with a significant effect on PA used child-centered activities; parent-directed digital interventions alone were ineffective for improving PA. Future research with rigorous designs, monitoring of implementation outcomes, and testing of the contributions of digital components will advance understanding of the effectiveness of digital interventions for increasing PA in children.

Association between parental unhealthy behaviors and offspring's cardiovascular health status: Results from a cross-sectional analysis of parent-offspring pairs in China

BACKGROUND

Cardiovascular health (CVH) in children and adolescents, which might be largely influenced by parental behaviors, may affect the incidence of cardiovascular diseases in adulthood. However, few studies have been conducted to explore the associations between parental behaviors and CVH status of offspring in China.

METHODS

Data were obtained from a cross-sectional survey conducted in Chinese children and adolescents aged 7-18 years old, with a total of 10,043 parent-offspring pairs included. Parental behaviors included moderate to vigorous physical activity (MVPA), dietary behaviors, and weight status. The CVH status of offspring was consulted by The American Heart Association, including seven factors. The associations between parental behaviors and CVH status of offspring were evaluated by multilevel logistic regression. Stratified analyses were conducted to explore the potential modifying influence of sociodemographic factors.

RESULTS

Most of the offspring had five ideal CVH factors; only 21.04% had six to seven ideal CVH factors. Parental unhealthy behaviors were associated with high odds of nonideal CVH status of offspring. Parental overweight/obesity, insufficient MVPA, and unhealthy dietary behaviors could increase the odds of owning one to three ideal CVH factors in offspring, with corresponding odds ratios (ORs) (95% confidence interval) of 1.61 (1.32-1.96), 1.31 (1.10-1.56), and 2.05 (1.43-2.94), respectively. There was a dose-response relationship between parental single unhealthy behavior and the odds of nonideal CVH status in offspring (P-trend < 0.001). Offspring with overweight parents had ORs of 1.25 for nonideal CVH status, compared to offspring with normal-weight parents. Among offspring who had the same number of ideal CVH factors, the cumulative association between unhealthy behaviors of parents and offspring's nonideal CVH status increased if parents had more unhealthy behaviors (P-trend < 0.001).

CONCLUSIONS

Parental overweight/obesity, insufficient MVPA, and unhealthy dietary behaviors were strongly associated with CVH status in offspring. With a cumulative association, more unhealthy parental behaviors were associated with higher odds of offspring's nonideal CVH status, suggesting that targeting parental behaviors might facilitate attainment of improving CVH status of children and adolescents.

A Comparative Analysis of Rural versus Urban Preschool Children's Sugar-Sweetened Beverage Consumption, Body Mass Index and Parent's Weight Status

Background

Childhood overweight and obesity continues to be a major public health concern, especially in minority, low-income, and rural populations. In order to develop health promotion interventions aimed at reducing obesity rates, there is a need to identify which populations have the highest rates of obesity and the risk factors associated with these high rates.

Methods

Data collected from low-income, preschool children and their parents in an urban community and a rural community in Alabama were analyzed and compared. Body Mass Index (BMI) was collected during school based health screenings, and information regarding parent's BMI and child's consumption of sugar-sweetened beverages (SSBs) were collected by parent report.

Results

Of the 363 children screened, 12.8% (15.2% rural and 11.9% urban) were considered overweight, and 15.8% (20.2% rural and 14.2% urban) of the sample was classified as obese. Rates of overweight and obesity for mothers were 27.6% (25.3% rural and 28.4% urban) and 48% (56.3% rural and 44.8% urban) respectively and 39.6% (53.3% rural and 34.4% urban) and 34.6% (28.3% rural and 36.9% urban) for fathers. Parents reported their child consumed 3.82 SSBs per day. Overall, mother's BMI, father's BMI and sugar-sweetened beverage consumption was positively associated with child's BMI. However, there were no significant interactions between the rural and urban groups.

Conclusion

Rates of overweight and obesity remain high in low-income, predominantly minority preschool children and their parents in two communities in Alabama. Consumption of SSBs, mother's BMI, and father's BMI are three factors impacting the weight status of low-income preschool children. These factors are significant in both rural and urban children.

Empowerment Approaches in Childhood Weight Management: A Systematic Review

Empowerment interventions facilitate individuals, organizations, and communities to gain better control over their health. They are distinctly different from traditional behavior change models and encourage participants to set their own health priorities and agenda. Current evidence suggests empowerment interventions are efficacious for smoking, sexual, and mental health outcomes. However, empowerment in childhood obesity (which remains a global public health challenge) is underresearched. This review systematically analyzed the evidence for empowerment approaches in childhood weight management. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A search strategy was applied to six databases from inception to May 25, 2021. Evidence was appraised using The Academy of Nutrition and Dietetics Quality Criteria Checklist and National Health and Medical Research Council Levels of Evidence. Of the 9274 articles identified, 29 articles describing 14 programs met the inclusion criteria. Twenty-five studies rated positive and four rated neutral. Overall, the evidence body rated "B." Seventy-two percent of the 3318 participants were from priority populations, highlighting the unique ability of empowerment interventions to engage those most in need. Results demonstrate small to large improvements in participant body mass index with effect sizes ranging from 0.08 to 1.13. Throughout the literature, empowerment was measured inconsistently and usually with a surrogate marker. All studies were set in America or Canada. This review suggests empowerment should be further investigated in childhood weight management. Empowerment interventions represent a unique opportunity to meaningfully integrate self-determination to clinical childhood weight management practice and overcome current barriers related to priority population engagement.

Global relationship between parent and child obesity: a systematic review and meta-analysis

BACKGROUND

The growing prevalence of overweight and/or obese children is an important public health problem in both developed and developing countries. Although the association of obesity between parents and their children is well known, its underlying mechanisms are not well established.

PURPOSE

This meta-analysis examined parent-child (PC) relationships in obesity and identified factors such as world region and country income level that may influence this relationship.

METHODS

We identified all related studies published between January 1, 2015 and May 31, 2020 by conducting a literature search using the MeSH terms "obesity," "overweight," "body mass index," "parent," "child," "associate," and "relate" in the PubMed database in English.

RESULTS

The meta-analysis of 23 studies that reported an odds ratio (OR) for parent and child obesity associations found a significant association between parents and children who were overweight or obese (pooled OR, 1.97; 95% confidence interval, 1.85-2.10). A meta-regression analysis was used to examine the sources of interstudy heterogeneity. The association between parent and child obesity was higher in Asia than in Europe and the Middle East and higher in high-income countries than in middle-or low-income countries. In addition, a higher association between parent and child obesity was found when both parents were obese than when only the father or mother was obese. This study from multiple countries indicates a significant PC relationship in weight status that varies according to PC pair type, parent and child weight statuses, world region, and country income level.

CONCLUSION

These results demonstrate that the risk of childhood obesity is greatly influenced by parental weight status and indicate that parents could play an important role in preventing child obesity.

How beliefs about weight malleability and risk perceptions for obesity influence parents' information seeking and feeding

This study surveyed 185 parents to determine whether their perceived risk of their child developing obesity and their implicit theories about the malleability of weight independently and/or interactively predict their child-feeding and pursuit of child-related obesity risk information. Higher risk perceptions were associated with healthier feeding intentions and more information seeking. More incremental (malleable) beliefs predicted healthier feeding intentions and greater pursuit of environmental, but not genetic, information. Contrary to hypotheses, the influence of implicit theories and risk perceptions were primarily independent; however, more incremental beliefs predicted less "junk food" feeding among only parents with lower perceived risk.

Hispanic Parents' Views of Family Physical Activity: Results from a Multisite Focus Group Investigation

Understanding parental views regarding family physical activity is essential to the development of family-focused physical activity interventions. Using a qualitative methodology with thematic analysis and a socio-demographic questionnaire, this study aimed to examine Mexican American and Puerto Rican parental views on child and family physical activity. Sixty-one parents (56 mothers, five fathers) from four sites (California, Illinois, Texas, and Puerto Rico) each participated in a single one-hour focus group session, which included an average of five parents. The findings of this study indicated that parents perceived themselves and their families to be physically active, while some parents believed their children were getting enough physical activity at school and afterschool programs. Walking, bicycling, and playing soccer were the most common physical activities that parents reported engaging in as a family. In addition, some parents shared their preference for exercising without their children. Time constraints along with unsafe neighborhood streets and parks were identified as the major barriers to being physically active as a family. Mothers reported that fathers’ involvement in physical activity and combining a healthy diet with exercise were useful strategies for physical activity promotion. This study provides valuable information regarding Hispanic parental views concerning family physical activity relevant to the design of culturally family-based physical activity interventions for this population.

Classification of psychiatric symptoms using deep interaction networks: the CASPIAN-IV study

Identifying the possible factors of psychiatric symptoms among children can reduce the risk of adverse psychosocial outcomes in adulthood. We designed a classification tool to examine the association between modifiable risk factors and psychiatric symptoms, defined based on the Persian version of the WHO-GSHS questionnaire in a developing country. Ten thousand three hundred fifty students, aged 6–18 years from all Iran provinces, participated in this study. We used feature discretization and encoding, stability selection, and regularized group method of data handling (GMDH) to classify the a priori specific factors (e.g., demographic, sleeping-time, life satisfaction, and birth-weight) to psychiatric symptoms. Self-rated health was the most critical feature. The selected modifiable factors were eating breakfast, screentime, salty snack for depression symptom, physical activity, salty snack for worriedness symptom, (abdominal) obesity, sweetened beverage, and sleep-hour for mild-to-moderate emotional symptoms. The area under the ROC curve of the GMDH was 0.75 (CI 95% 0.73–0.76) for the analyzed psychiatric symptoms using threefold cross-validation. It significantly outperformed the state-of-the-art (adjusted p < 0.05; McNemar's test). In this study, the association of psychiatric risk factors and the importance of modifiable nutrition and lifestyle factors were emphasized. However, as a cross-sectional study, no causality can be inferred.

Effectiveness of family-based eHealth interventions in cardiovascular disease risk reduction: A systematic review

Family-based eHealth interventions to reduce cardiovascular disease risk have potential as a primary prevention strategy to improve the health of parents and their children. This systematic review evaluated the effectiveness of such interventions in modifying parent and child/adolescent risk factors such as body mass index, physical activity, dietary intakes and alcohol use. Five electronic databases were searched up to April 2020. Of 2193 articles identified, seven randomised controlled trials met inclusion criteria and were reviewed. Data were extracted regarding study setting, design, methods, eHealth technology used, intervention and control group components, retention rates, outcome measures, incentives and limitations. Risk of bias and quality assessment were carried out using Cochrane methods. A qualitative narrative data synthesis of the studies was conducted. Our review found that three studies showed an improvement in alcohol use among parents and adolescents as a result of the eHealth intervention. Among children/adolescents, two studies showed an improvement in dietary intake, one study showed an improvement in physical activity, and one study showed an improvement in body mass index as a result of the eHealth intervention. Interventions appeared more likely to be effective if they were theory-based, had longer follow-up periods, were incentivised and included regular interaction. Our findings suggest that, despite a paucity of high-quality trials, there is some evidence that family-based eHealth interventions have potential to reduce cardiovascular disease risk. However, more sufficiently powered, higher-quality trials with theory driven, clearly described interventions and unambiguous outcomes are needed.

Sex differences in the impact of parental obesity on offspring cardiac SIRT3 expression, mitochondrial efficiency, and diastolic function early in life

Previous studies suggest that parental obesity may adversely impact long-term metabolic health of the offspring. We tested the hypothesis that parental (paternal + maternal) obesity impairs cardiac function in the offspring early in life. Within 1-3 days after weaning, offspring from obese rats fed a high-fat diet (HFD-Offs) and age-matched offspring from lean rats (ND-Offs) were submitted to echocardiography and cardiac catheterization for assessment of pressure-volume relationships. Then, hearts were digested and isolated cardiomyocytes were used to determine contractile function, calcium transients, proteins related to calcium signaling, and mitochondrial bioenergetics. Female and male HFD-Offs were heavier (72 ± 2 and 61 ± 4 g vs. 57 ± 2 and 49 ± 1 g), hyperglycemic (112 ± 8 and 115 ± 12 mg/dL vs. 92 ± 10 and 96 ± 8 mg/dL) with higher plasma insulin and leptin concentrations compared with female and male ND-Offs. When compared with male controls, male HFD-Offs exhibited similar systolic function but impaired diastolic function as indicated by increased IVRT (22 ± 1 vs. 17 ± 1 ms), E/E' ratio (29 ± 2 vs. 23 ± 1), and tau (5.7 ± 0.2 vs. 4.8 ± 0.2). The impaired diastolic function was associated with reduced resting free Ca²⁺ levels and phospholamban protein expression, increased activated matrix metalloproteinase 2, and reduced SIRT3 protein expression, mitochondrial ATP reserve, and ATP-linked respiration. These results indicate that male and female Offs from obese parents have multiple metabolic abnormalities early in life (1-3 days after weaning) and that male, but not female, Offs have impaired diastolic function as well as reductions in cardiac SIRT3, resting free Ca²⁺ levels, and mitochondrial biogenesis.NEW & NOTEWORTHY Parental obesity contributes to diastolic dysfunction in young offspring (1-3 days after weaning) in a sex-dependent manner, as well as reduced cardiac SIRT3 expression and altered mitochondrial bioenergetics, resting Ca²⁺ levels, and reduced phospholamban protein levels.

Is the Prospective Link between Parental Stress and Adolescent Snack Intake or Weight Outcome Mediated by Food Parenting Practices?

Parental stress may influence adolescents’ food intake and weight development over time, however, it is largely unknown why this is the case. This study examines whether the link between parental stress and adolescents’ snack intake and weight outcome is mediated by food parenting practices (FPPs). Participants included 400 parents and their adolescent children (aged 12–16) who completed questionnaires. The Perceived Stress Scale (PSS) was used to assess parental general stress levels and the Adolescent Food Parenting Questionnaire (AFPQ) to assess FPPs. Multiple mediation analyses with parallel mediators were performed, with parental general stress as an independent variable and adolescent snack intake and zBMI as dependent variables. FPPs (autonomy support, coercive control, modeling, healthy structure, snack structure) were entered as mediators in the model, adjusted for covariates. Autonomy support mediated the link between parental general stress and adolescent savory snack and sweet snack intake at follow-up. Parents who reported higher stress levels provided less autonomy support, which resulted in more adolescent snacking. None of the other FPPs mediated any link between parental stress and intake or weight outcome, and no significant indirect effects were observed with zBMI as an outcome variable. Further research should replicate this finding and may further examine underlying mechanisms.

Nutritional status and high adherence to the Mediterranean diet in Colombian school children and teenagers during the COVID-19 pandemic according to sex

The current COVID-19 pandemic has generated a series of changes in the daily routines of people, including children and teenagers, in an unprecedented way, which constitutes a global challenge in public health. Social isolation has been a prophylactic measure to prevent the spread of the virus; however, it has generated negative impacts on the physical and emotional health of parents, caregivers, children and teenagers around the world. The objective of the present study was to evaluate the effects of confinement caused by the COVID-19 pandemic at the level of nutritional status, dietary and behavioural patterns of elementary school children and teenagers in a small town of Colombia. Anthropometric parameters such as BMI Z-score, waist circumference and waist/height ratio were evaluated in 266 school children and teenagers. A questionnaire with socio-demographic, clinical and lifestyle characteristics and the KIDMED were applied to learn about nutritional aspects. A total of 102 students (38⋅3 %) were classified as having altered nutritional status, being 39 (14⋅7 %) classified as overweight and 36 (13⋅5 %) with obesity. The prevalence of high adherence to the Mediterranean diet was 12 %, 95 % CI (0⋅08, 0⋅16). Overweight was more prevalent in women (26/39, 66⋅7 %; P = 0⋅0439), and obesity was discreetly more frequent in men (19/36, 52⋅7 %; P = 0⋅7193). We observed a worrying nutritional, dietary and behavioural situation in the children and teenagers studied during the confinement associated with the COVID-19 pandemic. This unveils the need to establish strategies and/or public policies in our town that help to promote an adequate biopsychosocial development of the paediatric patient and their family group.

Policy and Food Consumption: What Nutrition Guidelines Are Swiss Children Meeting and What Determines Adherence?

Objectives: To describe the adherence of the children to the Swiss Society for Nutrition (SSN) dietary guidelines, assess determinants of adherence, and compare these findings with a previous study in the same population.

Methods: Data from 312 children ages 5–12 were collected through a survey and a 2-day food record. The associations of children- and parent-related factors with adherence of the children to guidelines were assessed by logistic regression analyses.

Results: SSN guidelines were not met for any food category, although there were improvements: vegetables (4.5% in this study vs. 0% in the previous study), sweets, snacks, and soft drinks (SSD) (12.5 vs. 9.5%), and fruit (45.5 vs. 10.4%). Higher Body Mass Index (BMI) in children was associated with higher adherence to guidelines for protein intake. Higher parental BMI was associated with higher adherence to vegetables. Parental lower educational level was associated with higher adherence for cereal.

Conclusion: Despite improvements since the last eating behavior assessment in this population, children consume too little fruit, vegetables, cereal, and milk and dairy products, and too much SSD and proteins. Further efforts are needed to promote healthy eating to children and achieve adherence to guidelines.

Evaluation of mothers' opinions on appetite and body shape perception of their children

OBJECTIVES

In this study, we aimed to evaluate how mothers perceived the appetite and body shape of their children using gender- and age-specific development sketches.

STUDY DESIGN

The study design used in the study is a single-centred descriptive study.

METHODS

We included 153 children aged 2-14 years and their mothers who attended family medicine polyclinic outpatient services, for any reason, at the University of Health Sciences, Şişli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey, between February 2019 and April 2019. Weight and height measurements of both the children and their mothers were taken. In addition, the mothers completed the sociodemographic data form and were asked to select an image from the gender- and age-specific development sketches that best represented their child's body shape. Participants were divided into four groups by their body mass index (BMI) in accordance with criteria from the Centres for Disease Control and Prevention. Results were compared using appropriate statistical procedures.

RESULTS

A significant weak positive correlation was observed between maternal BMI and child BMI (r = 0.166, P = 0.041). When the maternally perceived BMI (determined by the age-specific development sketches) was compared with the actual BMI values of children, mothers perceived their underweight children to be in higher BMI groups, whereas the overweight and obese children were perceived to be in lower BMI groups. The results were similar when the same comparison was made for the mother's expectation (i.e. the body shape the mother desired for their child).

CONCLUSIONS

When mothers were asked to visually evaluate the body shape of their children, their responses were inaccurate compared with both the actual data and the researcher's evaluation. Obtaining verbal assessments from mothers about their children (e.g. an assessment of the child's bodily appearance) is important for physicians to make correct referrals and also for public health policies. It is valuable for mothers to correctly interpret the weight status of their children, thus enabling early diagnosis and treatment, and preventing future health consequences.

Paternal obesity and its transgenerational effects on gastrointestinal function in male rat offspring

The interplay between obesity and gastrointestinal (GI) motility is contradictory, and the transgenerational influence on this parameter is unknown. We aimed to evaluate the GI function in a model of paternal obesity and two subsequent generations of their male offspring. Newborn male rats were treated with monosodium glutamate (MSG) and composed the F1 generation, while control rats (CONT) received saline. At 90 days, male F1 were mated with non-obese females to obtain male offspring (F2), which later mated with non-obese females for obtaining male offspring of F3 generation. Lee Index analysis was adopted to set up the obesity groups. Alternating current biosusceptometry (ACB) technique was employed to calculate GI transit parameters: mean gastric emptying time (MGET), mean cecum arrival time (MCAT), mean small intestinal transit time (MSITT), and gastric frequency and amplitude of contractions. Glucose, insulin, and leptin levels and duodenal morphometry were measured. F1 obese rats showed a decrease in the frequency and amplitude of gastric contractions, while obese rats from the F2 generation showed accelerated MGET and delayed MCAT and MSITT. Glucose and leptin levels were increased in F1 and F2 generations. Insulin levels decreased in F1, F2, and F3 generations. Duodenal morphometry was altered in all three generations. Obesity may have paternal transgenerational transmission, and it provoked disturbances in the gastrointestinal function of three generations.

The relationship between socioeconomic status and childhood overweight/obesity is linked through paternal obesity and dietary intake: a cross-sectional study in Chongqing, China

Background

The prevalence of obesity and overweight in childhood has increased dramatically over the past decades globally. Thus, the risk factors of overweight and obesity in children and adolescents must be studied.

Objectives

This study aimed to reveal the prevalence of childhood obesity and examine the relationship between socioeconomic status (SES) and z-body mass index (z-BMI) via parental obesity and dietary intake using path analysis.

Methods

Stratified cluster sampling was used to select 17,007 participants aged 6–12 years on two avenues per region in urban, suburban, and rural areas. Path analysis was conducted to examine the mediators between SES and z-BMI.

Results

The prevalence rates of overweight and obesity were 13.36% and 8.60%, respectively, and were positively correlated with the father’s education level, family income, a birth weight > 3000g, a parental obesity history, vegetable intake and red meat intake (all P < 0.05). Four mediators (paternal obesity history, red meat intake, vegetable intake, and nutritional supplements) were observed, and the four path analyses were significant (all P < 0.05). The adjusted total effects on z-BMI were significant for income (βTot = 0.03; P < 0.01), father’s education (βTot = 0.05; P < 0.001), and region (βTot = 0.11; P<0.001), and the total mediation effects were 20.69%, 16.67%, and 5.36%, respectively. All the variables accounted for 12.60% of the z-BMI variance.

Conclusions

The prevalence of overweight/obesity in children was notable, and the relationship between SES and z-BMI was mediated by paternal obesity history and dietary intake.

The relationship between socioeconomic status and childhood overweight/obesity is linked through paternal obesity and dietary intake: a cross-sectional study in Chongqing, China

BACKGROUND

The prevalence of obesity and overweight in childhood has increased dramatically over the past decades globally. Thus, the risk factors of overweight and obesity in children and adolescents must be studied.

OBJECTIVES

This study aimed to reveal the prevalence of childhood obesity and examine the relationship between socioeconomic status (SES) and z-body mass index (z-BMI) via parental obesity and dietary intake using path analysis.

METHODS

Stratified cluster sampling was used to select 17,007 participants aged 6-12 years on two avenues per region in urban, suburban, and rural areas. Path analysis was conducted to examine the mediators between SES and z-BMI.

RESULTS

The prevalence rates of overweight and obesity were 13.36% and 8.60%, respectively, and were positively correlated with the father's education level, family income, a birth weight > 3000g, a parental obesity history, vegetable intake and red meat intake (all P < 0.05). Four mediators (paternal obesity history, red meat intake, vegetable intake, and nutritional supplements) were observed, and the four path analyses were significant (all P < 0.05). The adjusted total effects on z-BMI were significant for income (βTot = 0.03; P < 0.01), father's education (βTot = 0.05; P < 0.001), and region (βTot = 0.11; P<0.001), and the total mediation effects were 20.69%, 16.67%, and 5.36%, respectively. All the variables accounted for 12.60% of the z-BMI variance.

CONCLUSIONS

The prevalence of overweight/obesity in children was notable, and the relationship between SES and z-BMI was mediated by paternal obesity history and dietary intake.

Adult attachment styles and mothers' life satisfaction in relation to eating behaviors in the families with overweight and obese children

Family plays a significant role in shaping children's eating behaviors. The aim of the study was to assess whether mothers' attachment style, their life satisfaction and their own body weight can be associated with family eating behaviors. The results from 52 dyads (mothers/children) covered by the Metabolic Disease Clinic were analyzed. A targeted sample selection was used, taking into account the weight (overweight/obesity) and age (≥11 years) criteria of the child. The results have shown that the mother's body weight is a significant determinant of her child's body weight. The anxiety-ambivalent attachment style in mothers is a significant predictor of behaviors aimed at regulating and controlling affective states by food. A decrease in the knowledge of nutrition is associated with an increase in the level of anxiety-ambivalent and avoidant style. The avoidant attachment style is significantly associated with the nutrition organisation and control. Dysfunctional eating behaviors predominate among mothers with a lower level of life satisfaction. The lower the level of life satisfaction, the greater the tendency to regulate affective states and family relationships through nutrition, and to manifest improper organisation of nutrition. Mothers with obesity, compared to mothers with overweight and with normal body weight show a higher level of regulating emotions through food, improper organisation of nutrition and lower control in this area. The research results indicateshow significant relationships between insecure attachment styles, life satisfaction, and the mother's weight with eating behaviors unfavorable to health. It is therefore necessary to include family factors in the process of creating effective intervention strategies.

Food addiction: A key factor contributing to obesity?

Background:

People may develop addiction to hyperpalatable foods, which may be a cause of obesity. This study aimed to determine the prevalence of obesity among adolescents and the effect of food addiction on obesity.

Materials and Methods:

In this cross-sectional study, food addiction and obesity status of high school students were investigated. Among 17,000 10^th and 11^th grade students, assuming the design effect as 2.0, with obesity prevalence of 10%, with 3% error, and 95% confidence interval, at least 752 participants were included. Obesity was the dependent variable, whereas sociodemographic characteristics, body image, eating habits, and food addiction were the independent variables. Food addiction was assessed using the Yale Food Addiction Scale. Obesity was determined by age- and sex-specific body mass index (BMI) percentiles for adolescents < 18 years of age and BMI ≥ 30.0 for those aged ≥ 18. Data were collected through face-to-face interviews. Statistical analyses were performed using SPSS 25.0. After adjustment for age, sex, and other variables, the effect of food addiction on obesity was determined through logistic regression. P <0.05 was deemed statistically significant.

Results:

Among adolescents (n = 874), 18.9% were food addict, 25.1% were overweight, and 12.1% were obese. After adjusted for age, sex, and other variables, food addiction significantly increased the risk of obesity (odds ratio: 1.9; 95% confidence interval: 1.167–3.335). Having a fragmented family, working mother, overweight father, and participants not knowing their weight correctly significantly increased obesity.

Conclusion:

While quarter of the adolescents had weight problems, one-fifth suffered from food addiction. After adjusting for confounders, food addiction significantly increased obesity. Identifying individuals with food addiction, providing treatment to overcome that, paying special attention to adolescents with obese parents or living in fragmented families, and providing support to both parents and adolescents could be useful in tackling obesity.

Overweight and obesity among Vietnamese school-aged children: National prevalence estimates based on the World Health Organization and International Obesity Task Force definition

Background

Overweight and obesity is a severe global health issue in both developed and developing nations. This study aims to estimate the national prevalence of overweight and obesity among school-aged children in Vietnam.

Method

We conducted a national cross-sectional study on 2788 children aged from 11–14 years old from September to November 2018. We applied the WHO 2007 and IOTF criteria to estimate the prevalence of overweight and obesity among participants. Poison regression analysis with cluster sampling adjustment was employed to assess associated factors with obesity and overweight. Metadata on sociodemographic characteristics, physical measurements, and lifestyle behaviors were also extracted to investigate these factors in association with overweight and obesity prevalence.

Results

The prevalences of overweight and obesity in Vietnamese children were 17.4% and 8.6%, respectively by WHO Z-score criteria, and 17.1% and 5.4%, according to the IOTF reference. Using WHO Z-score yielded a higher prevalence of obesity than the IOTF and CDC criteria of all ages and both sexes. The proportions of overweight and obesity were substantially higher among boys than girls across ages. Parental BMI was shown to be a significant factor associated with overweight/obesity status in both girls and boys. Only for boys, age (PR = 0.83, 95% CI 0.76–0.90) and belonging to ethnic minorities (PR = 0.43, 95% CI 0.24–0.76) were significant risk factors for overweight/obesity.

Conclusion

Our findings indicate a high prevalence of childhood overweight and obesity in Vietnam, especially in boys.

Psychometric testing on two weight stigma instruments in Iran: Weight Self-Stigma Questionnaire and Weight Bias Internalized Scale

PURPOSE

This study aimed to comprehensively and thoroughly examine the psychometric properties of two commonly used weight-related self-stigma instruments on Iranian adolescents with overweight or obesity: Weight Self-Stigma Questionnaire [WSSQ] and Weight Bias Internalization Scale [WBIS].

METHODS

After ensuring the linguistic validity of both the WSSQ and WBIS in their Persian versions, 737 Iranian adolescents with overweight or obesity (male = 354; mean age = 15.8 ± 1.3 years; body mass index = 30.0 ± 4.8 kg/m²) completed both questionnaires and other relevant measures regarding their depression, anxiety, stress, dietary self-efficacy, weight efficacy lifestyle, quality of life, body fat, self-esteem, body shape preoccupation, and sleepiness.

RESULTS

In the scale level, the confirmatory factory analysis verified the two-factor structure for the WSSQ and the single-factor structure for the WBIS. The factorial structures were further found to be invariant across gender (male vs. female) and across weight status (overweight vs. obesity). Additionally, both the WSSQ and WBIS had promising properties in internal consistency, test-retest reliability, separation reliability, and separation index. In the item level, all items but WBIS item 1 (infit mean square = 1.68; outfit mean square = 1.60) had satisfactory properties in factor loadings, corrected item-total correlation, test-retest reliability, and infit and outfit mean square. Moreover, all the items did not display substantial differential item functioning (DIF) across gender and across weight status.

CONCLUSION

Both the WSSQ and WBIS were valid instruments to assess the internalization of weight bias for Iranian adolescents with overweight or obesity.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Development and Validation of a Self-Determination Theory-Based Measure of Motivation to Exercise and Diet in Children

Objective: To develop and test the factorial structure of a new self-determination theory–based measure of behavioral regulation in children.

Methods: Five hundred ninety 590 (F = 51.7%) children aged 7 to 11 years completed the Motivation to Exercise and Diet (MED-C) questionnaire, which comprises 16 items (eight for exercise and eight for diet) grouped into eight factors (five motivations and three needs). Psychometric testing included confirmatory factor analysis and internal consistency. Measurement invariance analyses were also performed to evaluate whether the factorial structure of the MED-C was equivalent for gender (male vs. female), age (≤9 vs. ≥10 years), and the perception of having at least one parent with overweight or obesity (yes vs. no).

Results: Factorial analysis confirmed an acceptable factors solution for the MED-C and a good fit to the data for both the exercise and the diet subscales assessed independently. The maximal reliability coefficient revealed good reliability for the exercise and the diet subscales. Moreover, the MED-C factor structure was invariant across group comparisons.

Discussion: Findings support the construct validity and reliability of the MED-C. Therefore, it represents the first validated instrument simultaneously measuring motivational regulation and psychological need satisfaction in the context of children’s exercise and diet. Considering the goodness of these results, scale percentile ranks of the total score distribution as well as the z score and the T score were provided for clinical and research purposes.

Conclusion: The MED-C might support the understanding of motivations and needs of children with weight problems and assist their process of behavioral change in primary and secondary prevention programs. Psychological factors represent, in fact, potential targets for interventions to increase children’s motivation to exercise and diet.