Overweight and obesity: The serious challenge faced by Chinese children and adolescents

Metabolic risk factors, blood pressure and atherogenic indices of cardiovascular disease across different quartiles of dietary sodium to potassium ratio among young semi-professional athletes with overweight or obesity

BACKGROUND

Previous studies have revealed the role of the dietary sodium-to-potassium ratio in predicting cardiovascular and total mortality. However, a limited number of studies have investigated the association between the dietary sodium-to-potassium ratio and individual biomarkers of metabolic disease in athletes. In this study, we aimed to compare metabolic, atherogenic, and anthropometric risk factors for cardiovascular disease across different quartiles of the dietary sodium-to-potassium ratio among young semi-professional athletes with overweight or obesity.

METHODS

In this cross-sectional study, 637 young semi-professional athletes, aged 20-40 years, were selected from active athletic and fitness clubs. Anthropometric measurements were performed, and fasting blood sugar, serum lipids, and lipoprotein (a) [Lp(a)] were measured. Atherogenic indices, including the atherogenic index of plasma (AIP), Castelli risk index (CRI)-I, CRI-II, and lipid tetrad index (LTI), were calculated.

RESULTS

Participants in the highest quartile of the dietary sodium-to-potassium ratio were younger and had a higher waist-to-hip ratio (WHR) compared to those in the lowest quartile. Additionally, those in the highest quartile showed significantly higher serum total cholesterol and Lp(a) concentrations after adjusting for confounding factors (P < 0.05).

CONCLUSION

Our findings suggest that individuals in the higher quartiles of the dietary sodium-to-potassium ratio exhibit less favorable serum lipid profiles. Further longitudinal and interventional studies are needed to clarify the potential therapeutic role of reducing the dietary sodium-to-potassium ratio in managing cardiovascular disease risk factors.

The effect of Internet use on adolescent nutritional outcomes: evidence from China

BACKGROUND

The increasing prevalence of adolescent overweight and obesity poses significant public health challenges, particularly in China. With the rapid adoption of the Internet, adolescents' lifestyles, including dietary habits and physical activity levels, have undergone substantial changes. However, the causal relationship between Internet use and adolescent nutritional outcomes, especially in transitional economies, remains underexplored.

METHODS

This study employs longitudinal data from the China Health and Nutrition Survey (CHNS) and China Family Panel Studies (CFPS) to investigate the impact of Internet use on adolescents' BMI-for-age z-scores and overweight status. An endogenous switching regression (ESR) model addresses potential self-selection bias. Heterogeneity analyses examine urban-rural and gender differences, while mechanism analyses identify dietary pathways influencing outcomes.

RESULTS

Internet use increases BMI-for-age z-scores and the likelihood of being overweight among adolescents, with more intensive Internet use further amplifying these effects. These effects hold across urban and rural areas as well as for both boys and girls, though the magnitude may vary. Mechanism analyses suggest that Internet use enhances protein intake while also leading to higher consumption of fast food and soft drinks.

CONCLUSION

Internet use increases BMI-for-age z-scores and overweight risks among adolescents, reinforcing the need for targeted interventions to mitigate its negative health impacts. Policies promoting healthier online behaviors and better access to nutritional education are essential to ensuring that adolescents develop healthy lifestyle habits in the digital age. Addressing these challenges can help policymakers develop equitable health strategies for adolescents in transitional economies.

Global Trends and Cross-Country Inequalities in Stroke and Subtypes Attributable to High Body Mass Index From 1990 to 2021

BACKGROUND

Stroke is a major global cause of death and disability, with high body mass index (HBMI) as a key modifiable risk factor. Understanding HBMI-attributable stroke burden is crucial for effective prevention.

METHODS AND RESULTS

Using Global Burden of Disease 2021 data, we analyzed disability-adjusted life years and mortality from stroke and its subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) attributable to HBMI at global, regional, and national levels from 1990 to 2021. We conducted decomposition, frontier, inequality, and predictive analyses to assess epidemiological trends and future projections up to 2035. Despite country-specific variations in disability-adjusted life years and mortality, the global burden of stroke and its subtypes attributable to HBMI has increased from 1990 to 2021. Frontier analysis indicated that countries with higher sociodemographic index were expected to own lower age-standardized rates for stroke and its subtypes attributable to HBMI. Decomposition analysis revealed that population growth and aging were the primary contributors to the rise. Significant cross-country disparities remained, although inequality analysis showed a decline in SDI-related differences over time. The projected annual rise in disability-adjusted life years and mortality from 2021 to 2035 suggested ongoing significant challenges in stroke control and management in the coming decades.

CONCLUSION

The global health challenge posed by the increasing burden of stroke and its subtypes attributable to HBMI remains significant, especially in low- and middle-sociodemographic index regions. Targeted lifestyle modifications and policy interventions are crucial for reducing HBMI and mitigating stroke burden, warranting special attention from policymakers in high-burden regions.

Movement behaviours and eating habits in children: a cross-sectional study

OBJECTIVE

It is well-established that adherence to 24-h movement guidelines affects various health outcomes. However, few studies have explored its impacts on eating habits in children comprehensively, with most focusing on small or non-representative samples, and neglecting the combined effects of movement behaviours. Therefore, this study aims to investigate the relationship between adherence to 24-h movement guidelines and eating habits in Chinese children.

METHODS

School-aged students were included for analysis. Physical activity and screen time were assessed using items from the Health Behaviour in School-aged Children questionnaire (the Chinese version). Sleep duration was assessed using the items from the Pittsburgh Sleep Quality Index (PSQI). Multivariable ordinal logistic regression models were used to explore the relationship between adherence to 24-h movement guidelines and eating habits.

RESULTS

Overall, only 1.4 % of children adhered to 24-h movement guidelines. Regression analysis showed that children adhering to one (OR = 1.35, CI: 1.05-1.73) or two recommendations (OR = 1.52, CI = 1.17-1.97) were more inclined to consume fruits compared to those who did not adhere to any recommendations. Those who adhered to two recommendations exhibited reduced likelihoods of consuming soft drinks (OR = 0.62, CI: 0.46-0.81) and junk food (OR = 0.48, CI: 0.35-0.66), whereas adherence to one recommendation displayed a diminished likelihood of consuming junk food.

CONCLUSION

Although no significant association between adherence to all 24-hour movement guidelines and better eating habits was discerned, it was worth noting that adherence to both the recommendations for moderate-to-vigorous physical activity and screen time may have positive effects of improving eating habits.

Ultra-processed food consumption and obesity among children and adolescents in China-Findings from China Health and Nutrition Survey

BACKGROUND

Children and adolescents are increasingly exposed to processed food in China, however, its association with obesity has not been investigated.

OBJECTIVES

To assess the consumption of ultra-processed food (UPF) and its association with overweight/obesity among children and adolescents in China.

METHODS

A total of 3437 children and adolescents aged 6-18 years, participating at least twice in the China Nutrition and Health Survey, were included. Food intake was collected using a 3-day 24-h dietary recall method at home visits. Body weight, height and waist circumference (WC) were measured during the survey. UPF was defined by food process levels using NOVA classification. Overweight/obesity was defined by the international age- and sex-specific BMI and WC cut-offs. The association between UPF consumption and overweight/obesity was assessed using mixed effect logistic regression analyses adjusted for socio-demographic, economic, behavioural, dietary and health factors.

RESULTS

The mean daily UPF consumption of the study population (mean age 9.3 years) increased from 9.7 in 1997 to 60.0 grams in 2011. The adjusted odds ratios (OR) (95% CI) for overweight/obesity (using BMI) for UPF consumption of 0, 1-49, 50-99 and ≥ 100 g/day were 1.00, 1.38 (0.98-1.94), 2.01 (1.25-3.24) and 1.53 (0.82-2.86), respectively (p-trend =0.013). Similarly, the corresponding adjusted ORs (95% CI) for central obesity (using WC) were 1.00, 1.84 (1.30-2.60), 2.13 (1.30-3.48) and 2.15 (1.14-4.05) (p-trend<0.001).

CONCLUSIONS

Higher long-term UPF consumption was associated with an increased risk of overweight/obesity among children and adolescents in China.

Prevalence of childhood overweight and obesity in Malaysia: a systematic review and meta-analysis

The incidence of childhood obesity is increasing worldwide. National surveys in Malaysia have shown similar trends. This review aimed to increase our understanding of the prevalence and associated factors of childhood overweight, obesity, and excess weight in Malaysia. A systematic review and meta-analysis were conducted of studies reporting the prevalence of overweight and obesity in Malaysian children aged <18 years. Systematic searches were conducted in October 2023 and repeated in March 2024 of the PubMed, Scopus, and Web of Science databases. The grey literature was also included. Study selection, data extraction, and quality assessments were conducted by paired independent researchers. A metaanalysis of prevalence and 95% confidence interval (CI) using a random-effects model and heterogeneity (I2) was calculated. Publication bias was investigated using Egger's test. This review included 33 studies (N=273,710) conducted between 1996 and 2022. Overall, the childhood overweight, obesity and excess weight prevalence was 13.9% (95% CI, 13.0%-14.8%), 11.8% (95% CI, 10.9%-12.8%), and 24.0% (95% CI, 22.3%-25.7%), respectively. Boys had a significantly higher proportion of obesity (12.5% [95% CI, 11.1%-14.1%] vs. 9.1% [95% CI, 8.1%-10.1%]) and excess weight (25.7% [95% CI, 23.5%-28.1%] vs. 20.7% [95% CI, 18.8%-22.8%]) than girls. Sarawak natives had a higher prevalence of obesity (17.7% [95% CI, 16.0%-19.5%]). Annually, the obesity prevalence increased by 0.3% (95% CI, 0.1%-0.6%; P=0.006) and excess weight prevalence increased by 0.6% (95% CI, 0.3%-1.0%; P=0.002). Heterogeneity was high (I2>90%), and publication bias was possible (P<0.001). Variability was not significantly affected by the critical appraisal score or sample size. In conclusion, the prevalence of childhood overweight, obesity, and excess weight in Malaysia doubled over 26 years. Future studies of the prevalence of childhood excess weight should follow a standardized reference for body mass index by age to ease interstudy comparisons.

Control of childhood obesity and implications for policy in China

Prevention and control of childhood obesity in China is complex. Despite numerous existing policy endeavours, particularly Healthy China 2030, accompanied by multiministerial initiatives, childhood obesity persists and even exacerbates. In this paper, we review current national policies, assess progress of the existing system managing childhood weight, and identify implementation challenges. Leveraging insights from existing literature and guided by a PEDALS (ie, problem, evidence-based practice, determinants, actions, long term, and scalability) framework, we propose a strategy to refine and integrate current policies, interventions, and research into a policy framework, embedding evidence-based practices into practical solutions for childhood obesity prevention and control in China.

Depression, anxiety, and development of obesity from childhood to young adulthood in China

OBJECTIVE

To examine the cross-sectional and longitudinal bidirectional associations of depression and anxiety symptoms with the development of obesity over time among children and adolescents in different age groups from childhood to young adulthood.

METHODS

This is a three-wave longitudinal study that included >200,000 school-aged children between 5 and 18 years. Participants were assessed at baseline, 6 months, and 12 months. Depression and anxiety symptoms, as well as participants' weight and height, were collected at each assessment. The cross-sectional associations between obesity and depression or anxiety were examined through ANOVA and Chi-square tests. Multivariable logistic regression analyses were performed to investigate their longitudinal bidirectional associations.

RESULTS

The prevalence of obesity reached a peak in the age group between 12 and 14 years. Concurrently, higher mean BMI and obesity prevalence were associated with more severe symptoms of depression and anxiety in each age group (ps < 0.001). Longitudinally, depression and anxiety significantly increased the risk of development of obesity over time (odds ratios [ORs] = 1.08 to 1.77). Moreover, obesity significantly aggravated the risk of development of depression (ORs = 1.17 to 1.68) and anxiety (ORs = 1.25 to 1.71) over time and hindered the alleviation of depressive (ORs = 0.68 to 0.79) and anxiety symptoms (ORs = 0.73 to 0.74).

CONCLUSION

Findings suggest that there were bidirectional associations between obesity and psychological distress. It may be important to continuously track BMI and psychological conditions for children and adolescents over time to avoid the reinforcement of their negative reciprocal interactions.

BMI, Dental Caries, and Risk Factors among Elementary School Children: A Cross-Sectional Study

Background/Objectives: Obesity and dental caries are multifactorial diseases with high prevalence amongst Saudi children. The aim of the study was to determine their association with common risk factors. Methods: This cross-sectional study examined 300 children attending elementary schools. After taking their height and weight, their body mass indices (BMIs) were calculated. Oral examination was performed to record the decayed, missed, and filled scores (dmft/DMFT). A thorough questionnaire was compiled and validated to gather information on diet and physical activity (PA). The KIDMED score was calculated from a 16-item questionnaire to assess diet. Junk food and PA scores were also calculated based on relevant questions. Nonparametric tests were used to assess the associations between the scores and health outcomes (dmft/DMFT and BMI). Results: Fifty-eight of the children had poor diets, which was associated with higher dmft/DMFT (p = 0.012). PA levels were very low, and the average PA score was 2.12 ± 0.61. No association was found between BMI percentiles and PA level, nor between BMI percentiles and diet quality. Older children had lower BMI percentiles compared with younger children (coefficient = -9.35, 95% CI: -17.05, -1.65), and a borderline significant negative association was observed between dmft/DMFT and BMI percentile. Conclusions: Poor diets and chips consumption were related to dental caries. Obesity was not related to diet quality nor PA level.

Factors influencing the bariatric surgery treatment of bariatric surgery candidates in underdeveloped areas of China

BACKGROUND

From year to year, the proportion of people living with overweight and obesity in China rises, along with the prevalence of diseases linked to obesity. Although bariatric surgery is gaining popularity, there are still several issues with its promotion compared to Western nations. Since less developed places in China are more widespread due to disparities in the development of different regions, there has been little exploration of the factors that might be related to acceptance of bariatric surgery in these regions.

METHODS

Patients who visited the Department of Gastrointestinal Surgery at the North Sichuan Medical College Affiliated Hospital from 2018 to 2022 and had obesity or other relevant metabolic problems were surveyed using a questionnaire. The relationship between demographic factors, socioeconomic status, and acceptance of bariatric surgery was analyzed.

RESULTS

Of 334 patients, 171 had bariatric surgery. BMI, education level, marriage history, medical insurance, family support, and a history of type 2 diabetes were all linked to having bariatric surgery, according to a univariate analysis. In a multivariate analysis, BMI (P = 0.02), education (P = 0.02), family support (P<0.001), medical insurance coverage (P<0.001), and history of type 2 diabetes (P = 0.004) were all positively associated with a willingness to have bariatric surgery. Among 163 non-bariatric patients with obesity, 15.3% were not opposed to surgery but preferred trying medication first, 54.6% leaned towards medical therapy, and 30% were hesitant. Additionally, a majority of patients (48.55%) often lacked adequate knowledge about weight reduction therapy. Age, height, gender, smoking, drinking, family history of type 2 diabetes, education, and marital status did not significantly differ (P > 0.05).

CONCLUSIONS

Many patients are concerned about the safety of surgical treatment and the possibility of regaining weight. Due to the relatively high cost of bariatric surgery, they tend to choose medical treatment. To enhance the acceptance of bariatric surgery in underdeveloped regions of China, it is crucial to focus on disseminating knowledge about bariatric surgery, offer pertinent health education to the community, and foster support from patients' families. The government should pay more attention to obesity and provide support in the form of medical insurance.