Showing papers in "Pediatric Obesity in 2018"

37 year snacking trends for US children 1977–2014

Abstract: SummaryBackground Previous studies have indicated that snacking is contributing to increased calorie intake of American children and that the energy density of snacks in US diets has increased in recent decades Objective Examine short-term and long-term trends in the energy density and food sources of snacks for US children from 1977 to 2014, and examine whether trends differ between socio-demographic groups Methods We used data collected from eight nationally representative surveys of food intake in 49,952 US children age 2–18 years, between 1977 and 2014 Overall patterns of snacking, trends in energy intake from snacking, trends in food and beverage sources and energy density of snacks across race-ethnic, age, gender, education and income groups were examined Results In all socio-demographic groups, there was a significant increase in per capita energy intake deriving from snacks from 1977 to 2014 (P < 001) Salty snack intake doubled over the study period, and sugar-sweetened beverage intake decreased overall from 1977 to 2014 but increased in Non-Hispanic Blacks Non-Hispanic Blacks had the largest increase in per capita intake from foods as a snack from 1977 to 2014 Children in the lowest poverty level and household education groups had more than 100% increase in calorie intake from snacks from 1977 to 2014 Conclusions We found that snacking behaviour in the USA differs between race-ethnic, household education, gender and income groups, yet snacking remains a significant component of children's diets and the foods consumed at these snacks are not the types of foods recommended by the US dietary guidelines

Home-based exergaming among children with overweight and obesity: a randomized clinical trial.

Abstract: Background Given children's low levels of physical activity and high prevalence of obesity, there is an urgent need to identify innovative physical activity options. Objective This study aims to test the effectiveness of exergaming (video gaming that involves physical activity) to reduce children's adiposity and improve cardiometabolic health. Methods This randomized controlled trial assigned 46 children with overweight/obesity to a 24-week exergaming or control condition. Intervention participants were provided a gaming console with exergames, a gameplay curriculum (1 h per session, three times a week) and video chat sessions with a fitness coach (telehealth coaching). Control participants were provided the exergames following final clinic visit. The primary outcome was body mass index (BMI) z-score. Secondary outcomes were fat mass by dual energy X-ray absorptiometry and cardiometabolic health metrics. Results Half of the participants were girls, and 57% were African-American. Intervention adherence was 94.4%, and children's ratings of acceptability and enjoyment were high. The intervention group significantly reduced BMI z-score excluding one control outlier (intervention [standard error] vs. control [standard error]: -0.06 [0.03] vs. 0.03 [0.03], p = 0.016) with a marginal difference in intent-to-treat analysis (-0.06 [0.03] vs. 0.02 [0.03], p = 0.065). Compared with control, the intervention group improved systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein-cholesterol and moderate-to-vigorous physical activity (all p values Conclusions Exergaming at home elicited high adherence and improved children's BMI z-score, cardiometabolic health and physical activity levels. Exergaming with social support may be promoted as an exercise option for children.

Effects of air pollution exposure on glucose metabolism in Los Angeles minority children.

Abstract: SummaryObjectives Growing evidence indicates that ambient (AAP: NO2, PM2.5 and O3) and traffic-related air pollutants (TRAP) contribute to metabolic disease risk in adults; however, few studies have examined these relationships in children. Methods Metabolic profiling was performed in 429 overweight and obese African-American and Latino youth living in urban Los Angeles, California. This cross-sectional study estimated individual residential air pollution exposure and used linear regression to examine relationships between air pollution and metabolic outcomes. Results AAP and TRAP exposure were associated with adverse effects on glucose metabolism independent of body fat percent. PM2.5 was associated with 25.0% higher fasting insulin (p < 0.001), 8.3% lower insulin sensitivity (p < 0.001), 14.7% higher acute insulin response to glucose (p = 0.001) and 1.7% higher fasting glucose (p < 0.001). Similar associations were observed for increased NO2 exposure. TRAP from non-freeway roads was associated with 12.1% higher insulin (p < 0.001), 6.9% lower insulin sensitivity (p = 0.02), 10.8% higher acute insulin response to glucose (p = 0.003) and 0.7% higher fasting glucose (p = 0.047). Conclusions Elevated air pollution exposure was associated with a metabolic profile that is characteristic of increased risk for type 2 diabetes. These results indicate that increased prior year exposure to air pollution may adversely affect type 2 diabetes-related pathophysiology in overweight and obese minority children.

Composition of gut microbiota in obese and normal-weight Mexican school-age children and its association with metabolic traits.

Abstract: SummaryBackground Childhood obesity is a serious public health problem in Mexico. Adult gut microbiota composition has been linked to obesity, but few studies have addressed the role of gut microbiota in childhood obesity. Objectives The aim of this study is to compare gut microbiota composition in obese and normal-weight children and to associate gut microbiota profiles with amino acid serum levels and obesity-related metabolic traits. Methods Microbial taxa relative abundance was determined by 16S rRNA sequencing in 67 normal-weight and 71 obese children aged 6–12 years. Serum amino acid levels were measured by mass spectrometry. Associations between microbiota composition, metabolic parameters and amino acid serum levels were tested. Results No significant differences in phyla abundances or Firmicutes/Bacteroidetes ratios were observed between normal-weight and obese children. However, Bacteroides eggerthii abundance was significantly higher in obese children and correlated positively with body fat percentage and negatively with insoluble fibre intake. Additionally, Bacteroides plebeius and unclassified Christensenellaceae abundances were significantly higher in normal-weight children. Abundance of both these species correlated negatively with phenylalanine serum levels, a metabolite also found to be associated with obesity in Mexican children. Conclusions The study identified bacterial species associated with obesity, metabolic complications and amino acid serum levels in Mexican children.

Intakes and sources of total and added sugars among 4 to 13-year-old children in China, Mexico and the United States.

Abstract: Background Intakes of dietary sugars is a global concern, and many national and international organizations have set targets to limit consumption However, it is unclear to what extent intakes of total and added sugars vary between geographies Objectives The aim of this study was to assess the differences in intakes of total and added sugars in 4 to 13-year-old children in China, Mexico and the United States The secondary aim was to identify main sources of total and added sugars in the diets of these children Methods Secondary data analysis was conducted using the 2011 China Health and Nutrition Survey, 2012 Mexican National Health and Nutrition Survey, and 2009-2012 US National Health and Nutrition Examination Surveys Total and added sugar intakes were calculated using the US Food Patterns Equivalents Database Results Mean intakes of total and added sugars were 26 and 9 g d-1 among Chinese children, 92 and 55 g d-1 among Mexican children, and 124 and 76 g d-1 among US children, respectively The top food sources of total sugars were fruits among Chinese children, and sugar-sweetened beverages and milk-based beverages among Mexican and US children Conclusions These data highlight the heterogeneity of food patterns worldwide and the need for adapted country-specific public health recommendations on sugars

The adiposity of children is associated with their lifestyle behaviours: a cluster analysis of school-aged children from 12 nations.

Abstract: SummaryBackground The relationship between children's adiposity and lifestyle behaviour patterns is an area of growing interest. Objectives The objectives of this study are to identify clusters of children based on lifestyle behaviours and compare children's adiposity among clusters. Methods Cross-sectional data from the International Study of Childhood Obesity, Lifestyle and the Environment were used. Participants: the participants were children (9–11 years) from 12 nations (n = 5710). Measures: 24-h accelerometry and self-reported diet and screen time were clustering input variables. Objectively measured adiposity indicators were waist-to-height ratio, percent body fat and body mass index z-scores. Analysis: sex-stratified analyses were performed on the global sample and repeated on a site-wise basis. Cluster analysis (using isometric log ratios for compositional data) was used to identify common lifestyle behaviour patterns. Site representation and adiposity were compared across clusters using linear models. Results Four clusters emerged: (1) Junk Food Screenies, (2) Actives, (3) Sitters and (4) All-Rounders. Countries were represented differently among clusters. Chinese children were over-represented in Sitters and Colombian children in Actives. Adiposity varied across clusters, being highest in Sitters and lowest in Actives. Conclusions Children from different sites clustered into groups of similar lifestyle behaviours. Cluster membership was linked with differing adiposity. Findings support the implementation of activity interventions in all countries, targeting both physical activity and sedentary time.

Mechanisms of obesity in Prader-Willi syndrome.

Abstract: Obesity is the most common cause of metabolic complications and poor quality of life in Prader-Willi syndrome (PWS). Hyperphagia and obesity develop after an initial phase of poor feeding and failure to thrive. Several mechanisms for the aetiology of obesity in PWS are proposed, which include disruption in hypothalamic pathways of satiety control resulting in hyperphagia, aberration in hormones regulating food intake, reduced energy expenditure because of hypotonia and altered behaviour with features of autism spectrum disorder. Profound muscular hypotonia prevents PWS patients from becoming physically active, causing reduced muscle movements and hence reduced energy expenditure. In a quest for the aetiology of obesity, recent evidence has focused on several appetite-regulating hormones, growth hormone, thyroid hormones and plasma adipocytokines. However, despite advancement in understanding of the genetic basis of PWS, there are contradictory data on the role of satiety hormones in hyperphagia and data regarding dietary intake are limited. Mechanistic studies on the aetiology of obesity and its relationship with disease pathogenesis in PWS are required. . In this review, we focused on the available evidence regarding mechanisms of obesity and potential new areas that could be explored to help unravel obesity pathogenesis in PWS.

Associations of prenatal and early life dietary inflammatory potential with childhood adiposity and cardiometabolic risk in Project Viva.

Abstract: SummaryBackground Limited information exists regarding the association between early-life diet and cardiometabolic risk. Objectives Examine associations of dietary inflammatory index (DII) in pregnancy and early childhood (3–5 years) with adiposity, blood pressure and metabolic markers in mid-childhood (6–10 years). Methods Among 992 mother–child pairs from Project Viva, a pre-birth cohort, we examined associations of DII scores with outcomes using multivariable linear regression adjusted for child age and sex and maternal age, BMI, education, parity, smoking, race and income. Results Mean (SD) maternal DII in pregnancy was −2.6(1.4) units and in child DII in early childhood was 0.3(0.7). Mean mid-childhood BMI z-score was 0.40(0.98) units. In boys only, DII in early childhood was associated with higher BMIz (adjusted β = 0.16 units per unit DII, 95%CI 0.02, 0.29), waist circumference (0.93 cm; −0.07, 1.92) and skin fold thicknesses (1.12 mm; 0.01, 2.23). Dietary inflammatory index in the highest quartiles during both pregnancy and in early childhood, compared to the lowest quartiles, was associated with higher waist circumference (2.4 cm; 0.14, 4.6) in all children, and BMIz in boys (0.78 units; 0.34, 1.22). Associations with BP and metabolic markers were null. Conclusions A pro-inflammatory diet in pregnancy and early childhood may promote the development of adiposity.

The association between higher maternal pre-pregnancy body mass index and increased birth weight, adiposity and inflammation in the newborn

Abstract: SummaryBackground Excess adiposity and adiposity-related inflammation are known risk factors for cardiovascular disease in adults; however, little is known regarding the determinants of adiposity-related inflammation at birth. Objectives The aim of this study was to investigate the association between maternal pre-pregnancy BMI and newborn adiposity and inflammation. Methods Paired maternal (28-week gestation) and infant (umbilical cord) blood samples were collected from a population-derived birth cohort (Barwon Infant Study, n = 1074). Data on maternal comorbidities and infant birth anthropomorphic measures were compiled, and infant aortic intima-media thickness was measured by trans-abdominal ultrasound. In a selected subgroup of term infants (n = 161), matched maternal and cord lipids, high-sensitivity C-reactive protein (hsCRP) and maternal soluble CD14 were measured. Analysis was completed by using pairwise correlation and linear regression. Because of their non-normal distribution, pathology blood measures were log transformed prior to analysis. Results Maternal pre-pregnancy BMI was positively associated with increased birth weight (mean difference 17.8 g per kg m−2, 95% CI 6.6 to 28.9; p = 0.002), newborn mean skin-fold thickness (mean difference 0.1 mm per kg m−2, 95% CI 0.0 to 0.1; p < 0.001) and cord blood hsCRP (mean difference of 4.2% increase in hsCRP per kg m−2 increase in pre-pregnancy BMI, 95% CI 0.6 to 7.7%, p = 0.02), but not cord blood soluble CD14. Inclusion of maternal hsCRP as a covariate attenuated the associations between pre-pregnancy BMI and both newborn skin-fold thickness and cord blood hsCRP. Conclusion Higher maternal pre-pregnancy BMI is associated with increased newborn adiposity and inflammation. These associations may be partially mediated by maternal inflammation during pregnancy.

Probiotic supplementation increases obesity with no detectable effects on liver fat or gut microbiota in obese Hispanic adolescents: a 16-week, randomized, placebo-controlled trial.

Abstract: BACKGROUND Numerous studies have shown that there are links between obesity, liver fat and the gut microbiome. However, there are mixed results on whether probiotics could impact the gut microbiome and/or help to decrease liver fat and obesity outcomes. OBJECTIVE This study aimed to determine whether a probiotic supplement (VSL#3® ) intervention altered gut microbiota and/or gut hormones associated with appetite regulation. The secondary aim of this study was to determine whether VSL#3® altered body composition and liver fat and fibrosis. METHODS We conducted a double-blind, randomized placebo-controlled trial in 19 obese Latino adolescents. The intervention consisted of three packets per day of VSL#3® or a matched placebo for 16 weeks. Pre-intervention and post-intervention measures included gut microbial abundance, gut appetite regulating hormones, anthropometrics, body composition, liver fat and liver fibrosis. We conducted linear models to determine whether there were any significant differences in the changes in these outcomes following VSL#3® intervention. RESULTS Compared with placebo, adolescents that received VSL#3 had significant increases in total adiposity (%) (+1.7 ± 0.6 vs. -1.3 ± 0.5, p < 0.01) and trunk adiposity (%) (+3.3 ± 0.8 vs. -1.8 ± 0.8, p < 0.01) with no significant effects on liver fat/fibrosis, insulin/glucose, gut microbial abundances or gut hormones. CONCLUSION VSL#3 supplementation may lead to increased adiposity in obese Latino adolescents with no significant detectable changes in gut microbiota, gut appetite-regulating hormones, liver fat and fibrosis and dietary intake. However, it is important to note that recruitment efforts were terminated early and the sample size fell short of what was planned for this trial.

A mHealth randomized controlled trial to reduce sugar-sweetened beverage intake in preschool-aged children.

Abstract: BACKGROUND Sugar-sweetened beverages and maternal weight are strong drivers of child obesity, but few studies have targeted these risk factors as an obesity prevention strategy in children. OBJECTIVE The objective of this study was to test the efficacy of a smartphone-delivered intervention to reduce parent-provided sugar-sweetened beverage and juice (SSB/juice) consumption among children ages 3-5 and maternal weight. METHODS Mothers with overweight or obesity, who had a child ages 3-5 that consumed at least 12 fl. oz./day of SSB/juice (N = 51 dyads) were randomized to the Smart Moms group that received one group session, lessons on a mobile website, and text messages, or to a waitlist control group. Mothers self-monitored their children's beverages in addition to their own beverages, high-calorie foods, and weight. Assessments at baseline, 3, and 6 months included dietary recalls to measure SSB/juice intake and objectively measured maternal weight. RESULTS Using linear mixed models controlling for baseline values, child age and race, there was a greater reduction in child SSB/juice in Smart Moms compared with control at 6 months (-9.7 oz./day vs. 1.7 oz./day, p < .01). Mothers in Smart Moms lost 2.4 kg at 6 months compared with a 0.9-kg gain in the control group (p < .01). CONCLUSIONS An intervention delivered using mHealth technologies can target mothers to change child dietary behaviours and improve maternal weight, which suggests a novel approach to family-based obesity prevention.

Internet use patterns and Internet addiction in children and adolescents with obesity

Abstract: SummaryBackground There are no data regarding the Internet addiction (IA) rates and patterns in youth with obesity. Objective This study aimed to explore the prevalence and patterns of IA in children and adolescents with obesity. The relationship between IA and body mass index (BMI) was also investigated. Methods Study includes 437 children and adolescents with age ranging from 8 to 17 years: 268 with obesity and 169 with healthy controls. The Internet addiction scale (IAS) form was administered to all participants. The obesity group also completed a personal information form including Internet usage habits and goals. Linear regression analysis was utilized to assess the contributions of Internet use habits and goals to BMI in the obesity group and IAS scores to BMI in both groups. Results A total of 24.6% of the obese children and adolescents were diagnosed with IA according to IAS, while 11.2% of healthy peers had IA (p 0.05). The IAS scores (t = 8.719) were also found to be associated with increased BMI in the control group (p < 0.05). Conclusions The present study suggests that obese children and adolescents were found to have higher IA rates than their healthy peers, and the results indicate an association between IA and BMI.

Associations between birthweight and overweight and obesity in school-age children.

Abstract: SummaryBackground Relationships between birthweight and future obesity risk remain unclear. Objective To assess associations between birthweight and later obesity in a nationally representative cohort of early school-aged children. Methods We used linear and logistic regression to evaluate 10 186 term- or preterm children in the Early Childhood Longitudinal Study-Kindergarten Cohort 2011 for relationships between birthweight and later obesity and change in BMI z-score from kindergarten-to-second grade. All analyses were adjusted for sex, race/ethnicity, parental education and household income. Results Compared to children born normal birthweight (NBW), high birthweight (HBW) term children and large-for-gestational-age (LGA) preterm children had significantly greater BMI z-scores from kindergarten-to-second grade (p < 0.001). Term children born HBW had higher odds of obesity by kindergarten (adjusted odds ratios [aOR] 1.91, p < 0.0001). Among preterm children, odds of obesity was higher among LGA children starting in first grade (aOR 2.34, p < 0.05) and among small-for-gestational age children in second grade (aOR 2.26, p < 0.05). Compared to NBW children, HBW children had greater change in BMI z-score between kindergarten-first grade (p < 0.01). Conclusions High birthweight term and LGA preterm children had increased adjusted odds of obesity in school-age compared to their NBW counterparts. Physicians may provide counselling early in life for families of large infants to help prevent future obesity.

Television food advertising viewed by preschoolers, children and adolescents: contributors to differences in exposure for black and white youth in the United States

Abstract: SummaryBackground Public health experts raise concerns about adolescents' and black youth's greater exposure to TV advertising for unhealthy foods and beverages compared with children and white youth. Objectives Examine how television-viewing patterns and rates of advertising during targeted programming contribute to this greater exposure. Methods Nielsen panel data provided viewing times and amount of food advertising viewed on U.S. television in 2008 and 2012. Researchers compared results by network type (black-, child- and youth-targeted), age group (preschoolers, children and adolescents) and race (black and white youth). Results Food advertising exposure increased with age for both black and white youth, but black youth viewed approximately 50% or more ads than did white youth of the same age. Higher rates of food advertising on youth-targeted networks explained greater adolescent exposure. However, greater television viewing and higher rates of advertising on youth- and black-targeted networks both contributed to black youth's greater exposure. From 2008 to 2012, increases in food-ads-per-hour increased exposure for all youth. Conclusions Food advertisers and networks, especially those targeting adolescents and black youth, must do more to reduce advertising that negatively impacts young people's health. Furthermore, reducing commercial-television viewing by black youth may help reduce health disparities affecting their communities.

Relationship of circulating spexin with markers of cardiovascular disease: a pilot study in adolescents with obesity.

Abstract: SummaryPurpose Spexin, a novel peptide, has potential implications in obesity, satiety and energy homeostasis. The current study examined the relationship of spexin with various biomarkers of cardiovascular disease and endothelial function in adolescents with obesity. Methods Nineteen adolescents with obesity (age, 15.8 ± 1.7 years) were studied. Spexin, leptin and various cardiovascular disease biomarkers were measured. Endothelial function was assessed by high-resolution Doppler ultrasonography of the right brachial artery. Results Spexin concentration (median [interquartile range] 0.38 ng/mL [0.29–0.59 ng/mL]) was inversely correlated (r = −0.50, P = 0.03) with leptin. When participants were clustered into two groups (‘high spexin and low leptin’ vs. ‘low spexin and high leptin’), the odds of having ‘low spexin and high leptin’ in participants with higher hs-CRP (≥ 3 mg/L) were 12.25 times (95 per cent CI −1 to139, P = 0.026) higher than those of participants with lower hs-CRP (<3 mg/L). Spexin levels, however, were not associated with measures of endothelial function. Conclusions The inverse association between spexin and leptin and the presence of higher concentrations of hs-CRP in adolescents with obesity in the setting of ‘low spexin and high leptin’ suggest a potential role for spexin in the regulation of satiety and certain cardiovascular risk factors in children with obesity.

Combined use of a wristband and a smartphone to reduce body weight in obese children: randomized controlled trial

Abstract: SummaryBackground Technological instruments may help control paediatric obesity. Objective We tested whether a personalized programme based on the energy expenditure obtained from a wristband (WB) and the energy intake obtained from a smartphone application (APP) is superior to a standard approach at promoting weight loss. Methods We performed a randomized controlled trial in obese children aged 10–17 years. The experimental (EXP) and control (CTR) groups were given a low-energy diet and a prescription for physical activity. The EXP group was equipped with a WB and an APP and given personalized feedback every 7 days. The main outcome was weight loss at 3 months. Results The mean (standard deviation) z-score of body mass index at the enrollment was 2.20 (0.47) in the EXP (n = 16 out of 23) and 2.09 (0.34) in the CTR group (n = 14 out of 20) of children who completed the trial. The mean (95%CI) difference in weight loss at 3 months was 0.07 kg (95%CI: 2.81 to 2.96) for EXP vs. the CTR. Conclusion A personalized lifestyle programme based on a WB and an APP was not superior to a standard lifestyle programme at promoting weight loss in obese children.

Sweetened beverage intake in association to energy and sugar consumption and cardiometabolic markers in children

Abstract: SummaryBackground Artificially sweetened beverages (ASBs) are promoted as healthy alternatives to sugar-sweetened beverages (SSBs) in order to reduce sugar intake, but their effects on weight control and glycaemia have been debated. This study examines associations of SSBs and ASBs with energy and sugar intake and cardiometabolic measures. Methods One thousand six hundred eighty-seven children aged 4–18 participated in the National Diet and Nutrition Survey Rolling Programme (2008/9–2011/12) in the UK. Linear regression was used to examine associations between SSBs and ASBs and energy and sugar, overall and from solid foods and beverages, and body mass index, waist-to-hip ratio and blood analytes. Fixed effects linear regression examined within-person associations with energy and sugar. Results Compared with non-consumption, SSB consumption was associated with higher sugar intake overall (6.1%; 4.2, 8.1) and ASB consumption with higher sugar intake from solid foods (1.7%; 0.5, 2.9) but not overall, mainly among boys. On SSB consumption days, energy and sugar intakes were higher (216 kcal; 163, 269 and 7.0%; 6.2, 7.8), and on ASB consumption days, sugar intake was lower (−1.0%; −1.8, −0.1) compared with those on non-consumption days. SSB and ASB intakes were associated with higher levels of blood glucose (SSB: 0.30 mmol L−1; 0.11, 0.49 and ASB: 0.24 mmol L−1; 0.06, 0.43) and SSB intake with higher triglycerides (0.29 mmol L−1; 0.13, 0.46). No associations were found with other outcomes. Conclusion Sugar-sweetened beverage intake was associated with higher sugar intake and both SSBs and ASBs with a less healthy cardiometabolic profile. These findings add to evidence that health policy should discourage all sweetened beverage consumption.

Emotional eating is learned not inherited in children, regardless of obesity risk.

Abstract: BACKGROUND: Emotional over-eating (EOE) and emotional under-eating (EUE) are common behaviours that develop in early childhood and are hypothesised to play a role in weight status. Data from a British twin cohort demonstrated that environmental, rather than genetic, factors shape individual differences in both behaviours in early childhood. OBJECTIVE: The aim of this current study was to replicate this finding in a subsample (n = 398) of 4-year-old twins selected for high or low risk of obesity from another population-based cohort of British twins (the Twins Early Development Study). METHODS: Parental ratings of child EOE and EUE were analysed using genetic model fitting. RESULTS: Genetic influence was not significant, while shared environmental factors explained 71% (52-79%) of the variance in EOE and 77% (62-85%) in EUE. The two behaviours correlated positively (r = 0.53, 95% CI: 0.44, 0.61), and about two-thirds of the shared environmental factors influencing EOE and EUE were the same (rC = 0.67, 95% CI: 0.51, 0.85). CONCLUSIONS: Emotional eating in childhood is shaped by the home family environment; parents are therefore promising intervention targets.

ADHD symptoms and body composition changes in childhood: a longitudinal study evaluating directionality of associations

Abstract: Background: Attention-deficit/hyperactivity disorder (ADHD) is linked to increased risk of overweight/obesity among children and adults. Studies have also implicated obesity as a risk factor for ADHD. However, no studies have evaluated bidirectional, longitudinal associations between childhood fat mass and ADHD symptom severity. Objectives: We investigate bidirectional associations between ADHD symptoms and measures of body composition between ages 1.5 and 9. We further examine effects of specific eating patterns linked to ADHD on associations between symptom severity and body composition. Methods: The study utilized data from children (N = 3903) participating in the Generation R cohort (Netherlands). Children were enrolled at birth and retained regardless of ADHD symptoms over time. Cross-lagged and change models examined bidirectional associations between body composition (body mass index/dual-energy X-ray absorptiometry) and ADHD symptoms at four time points in childhood. Results: A child with a clinically concerning ADHD symptom z-score two standard deviations above the mean at age 6 would be expected to experience about 0.22 kg greater fat mass gain measured via dual-energy x-ray absorptiometry between ages 6 and 9, even if they displayed healthy eating patterns (95% CI: 0.11 - 0.28, p < 0.001). Conversely, fat mass at any age did not predict worse ADHD symptoms later. Conclusions: Beginning in early childhood, more ADHD symptoms predict higher fat mass at later ages. We did not find evidence of a reverse association. Based on these and prior findings, lifestyle counselling during treatment for children with a diagnosis of ADHD should be considered, even if they are diagnosed in early childhood and do not yet have a body mass index of clinical concern.

Circulating levels of miR‐122 and nonalcoholic fatty liver disease in pre‐pubertal obese children

Abstract: Objectives The liver-specific miR-122 was proposed as biomarker for NAFLD in adults. Here, we investigated the relationship between miR-122 levels, parameters of liver metabolism and NAFLD in pre-pubertal obese children. Methods Parameters of liver metabolism (ALT, AST and GGT) of three European cohorts were included (German cohort [n = 71; age: 11.53 ± 1.29 years; BMI z-score: 2.96 ± 0.64], Italian cohort [n = 45; age: 9.60 ± 2.11 years; BMI z-score: 3.57 ± 1.16], Slovenian cohort [n = 31; age: 7.53 ± 1.47 years; BMI z-score: 3.66 ± 0.88]). MiR-122 levels and CK18 concentrations were measured in fasting blood samples. In the German and Italian cohort, the diagnosis of NAFLD and grading of NAFLD was assessed by ultrasound. Results NAFLD was diagnosed in n = 50 patients of the German cohort (29.6%) and in n = 29 patients (72.5%) of the Italian cohort. In all three cohorts, miR-122 was positively correlated with ALT and AST as well as with CK18 concentrations. MiR-122 levels were higher in children with NAFLD compared with healthy controls. Conclusions MiR-122 levels in pre-pubertal obese children could be a potential biomarker for paediatric NAFLD.

Improving rates of overweight, obesity and extreme obesity in New Zealand 4-year-old children in 2010-2016

Abstract: SummaryBackground Prevalence of childhood obesity is high in developed countries, and there is a growing concern regarding increasing socio-economic disparities. Objectives To assess trends in the prevalence of overweight, obesity and extreme obesity among New Zealand 4-year olds, and whether these differ by socio-economic and ethnic groupings. Methods A national screening programme, the B4 School Check, collected height and weight data for 75–92% of New Zealand 4-year-old children (n = 317 298) between July 2010 and June 2016. Children at, or above, the 85th, 95th and 99.7th percentile for age and sex adjusted body mass index (according to World Health Organization standards) were classified as overweight, obese and extremely obese, respectively. Prevalence rates across 6 years (2010/11 to 2015/16) were examined by sex, across quintiles of socio-economic deprivation, and by ethnicity. Results The prevalence of overweight, obesity and extreme obesity decreased by 2.2 [95% CI, 1.8–2.5], 2.0 [1.8–2.2] and 0.6 [0.4–0.6] percentage points, respectively, between 2010/2011 and 2015/2016. The downward trends in overweight, obesity and extreme obesity in the population persisted after adjustment for sex, ethnicity, deprivation and urban/rural residence. Downward trends were also observed across sex, ethnicity and deprivation groups. Conclusions The prevalence of obesity appears to be declining in 4-year-old children in New Zealand across all socio-economic and ethnic groups.

Increased brain cortical thickness associated with visceral fat in adolescents

Abstract: SummaryBackground There has been a growing amount of evidence indicating that excess visceral fat is associated with alterations in brain structure and function, including brain cortical thinning in adults Objectives This study aims to investigate the relationship between brain cortical thickness with obesity assessments, in adolescents Methods In this study, we measured three different obesity assessments within an adolescent population (aged 15 – 18 years): body mass index (BMI), visceral fat ratio measured with an MRI and hepatorenal gradient measured with an ultrasound Volunteers also underwent an MRI scan to measure brain structure Results Results indicated that there was no relationship of BMI or hepatorenal gradient with brain cortical dimensions However, there was a significant association between visceral fat ratio and an increase of cortical thickness throughout the brain Conclusions These results suggest that visceral fat, but not BMI, is correlated with cortical thickening in adolescence

Prenatal traffic-related air pollution exposures, cord blood adipokines and infant weight.

Abstract: SummaryObjective Studies suggest that prenatal exposure to traffic-related air pollution (TRAP) may contribute to childhood obesity. While exact mechanisms for this association are unknown, circulating adipokines are hypothesized to contribute to early-life weight gain. Methods The Maternal and Child Health Study birth cohort included 136 women from the Los Angeles County + University of Southern California Medical Center. This study estimated prenatal residential TRAP exposure and used linear regression analysis to examine associations between adipokines with TRAP exposure and infant weight change (birth to 6 months). Results A one standard deviation (1-SD: 2 ppb) increase in prenatal non-freeway nitrogen oxides was associated with 33% (P = 0.01) higher leptin and 9% higher high molecular weight adiponectin levels (P = 0.07) in cord blood. Leptin levels were 71% higher in mothers who lived 300 m from major roadways (P = 0.03). A 1-SD (10 ng mL−1) increase in leptin was associated with a significant increase in infant weight change in female infants (0.62 kg, P = 0.02) but not male infants (0.11 kg, P = 0.48). Conclusions Higher TRAP exposures were associated with higher cord blood levels of leptin and high molecular weight adiponectin. These adipokines were associated with increased infant weight change in female infants, which may have implications for future obesity risk.

Waist-to-height ratio as a risk marker for metabolic syndrome in childhood. A meta-analysis.

Abstract: Background Individuals with abdominal obesity have a higher cardiovascular risk, regardless of the degree of global overweight. Objective To estimate the accuracy of the Waist/height ratio (WtHR) as a risk marker for metabolic syndrome (MS) in children or adolescents. Methods Published cohort or cross-sectional studies (Pubmed, Embase-SCOPUS and CINAHL) were searched, with no limits of time. Studies providing Waist/height ratio and clustered criteria of metabolic syndrome were included. Results Thirty-one studies (66,912 subjects) were selected. Overall, a high WtHR (≥0.5) was associated with a four-fold increased risk of clustered criteria of MS (odds ratio [OR] 4.15, 95% confidence interval [95% CI]: 2.69 to 6.42) and two-fold increased risk when adjusted by general obesity (adjusted OR 2.26, 95% CI: 1.29 to 3.98). The WtHR, as a quantitative measure, showed a pooled area under the curve of 0.76 (95% CI: 0.71 to 0.80) and, as a dichotomous measure, with a cut-off point close to 0.5, a sensitivity of 60% (95% CI: 50% to 68.8%) and a specificity of 79% (95% CI: 71.6% to 83.9%). Conclusions Measuring WtHR may be considered in regular health checks of children and adolescents, as it can measure cardiovascular risk regardless of the degree of general obesity.

Adolescent preferences for weight terminology used by health care providers.

Abstract: BACKGROUND In light of high rates of obesity and weight stigma in youth, the American Academy of Paediatrics recommends that paediatric health care professionals use appropriate, sensitive and non-stigmatizing language in communication about weight with youth. For these efforts to be effective, there is a need to identify weight-based language preferences among youth with overweight and obesity, as research in this area is scarce. OBJECTIVES The present study provides a systematic assessment of youth perspectives of weight-based language used by providers. METHODS Adolescents (ages 13-18 years; N = 148) enrolled in a national weight loss camp were surveyed about their preferences for words that health providers use to refer to their body weight. Adolescents completed an online survey and responded to a list of 16 words describing excess body weight, as well as questions assessing demographics, body mass index, and experienced as well as internalized weight stigma. RESULTS Adolescents assigned low ratings to words like 'fat', 'large', 'obese' and 'extremely obese', indicating that they would not want providers to use these words when discussing their body weight. In contrast, words like 'weight problem', 'BMI' and 'plus size' were rated among the most preferred words for providers to use. Word preferences varied across gender, body mass index and extent of internalized weight stigma. CONCLUSIONS These findings underscore the importance of acknowledging different word preferences among youth, and to avoid making assumptions about what words youth will feel most comfortable using in discussions about their body weight.

Intervention for childhood obesity based on parents only or parents and child compared with follow‐up alone

Abstract: SummaryObjectives The study aims to assess the effects of family-based interventions targeted to parents only or to parents-and-child for the prevention and treatment of childhood obesity. Method An open-label randomized study was conducted in 247 children (166 girls, 5–11 years) with body mass index (BMI) in the 85–98th percentile. Participants were allocated to three groups: parents-only (n = 89), parents-and-child (n = 84) and follow-up alone (n = 74). The intervention consisted of 12 once-weekly meetings with a dietician and psychologist. All children were followed for 2 years. Changes in anthropometric, clinical and lifestyle outcomes were assessed. Results The 3-month intervention was completed by 58 (65.2%) in the parents-only, 61 (72.6%) in the parents–child and 49 (66.2%) in the control group (P = .554). BMI-standard deviation score (SDS) decreased from baseline to 3 months in both intervention groups (parents-only: from 1.74 ± 0.31 to 1.66 ± 0.36, P < .001; parents–child, 1.83 ± 0.33 to 1.76 ± 0.36, P = .012), with no significant change in the controls (1.73 ± 0.32 to 1.70 ± 0.31, P = .301). The 2-year follow-up was completed by 45 in each of the intervention groups (50.5% and 53.5%, respectively) and 37 controls (50%) (P = .896). Compared with baseline, only the parents–child group showed a significant decrease in BMI-SDS (1.56 ± 0.46, P = .006). The rate of children who met the criteria for metabolic syndrome tended to drop from 6.0% at baseline (14/232) to 1.5% at 3 months (12/137) (P = .109), with no significant between-group differences in the rate of metabolic syndrome at baseline or at completion of the intervention. Conclusions An intervention programme that focuses on both parents and children was found to have positive short-term and long-term effects on BMI-SDS.

PTPRS and PER3 methylation levels are associated with childhood obesity: results from a genome-wide methylation analysis.

Abstract: SummaryBackground The global prevalence of childhood overweight and obesity has increased in the last years. Epigenetic dysregulation affecting gene expression could be a determinant in early-life obesity onset and accompanying complications. Objective The aim of the present investigation was to analyse the putative association between DNA methylation and childhood obesity. Methods DNA was isolated from white blood cells of 24 children obtained from the GENOI study and was hybridized in a 450K methylation array. Two CpG sites associated with obesity were validated in 91 children by MassArray® EpiTyper™ technology. Results Genome-wide analysis identified 734 CpGs (783 genes) differentially methylated between cases (n = 12) and controls (n = 12). Ingenuity Pathway Analysis showed that these genes were involved in oxidative stress and circadian rhythm signalling pathways. Moreover, the DNA methylation levels of VIPR2, GRIN2D, ADCYAP1R1, PER3 and PTPRS regions correlated with the obesity trait. EpiTyper™ validation also identified significant correlations between methylation levels of CpG sites on PTPRS and PER3 with BMI z-score. Conclusions This study identified several CpG sites and specifically several CpGs in the PTPRS and PER3 genes differentially methylated between obese and non-obese children, suggesting a role for DNA methylation concerning development of childhood obesity.

Cross‐sectional and prospective associations of meeting 24‐h movement guidelines with overweight and obesity in preschool children

Abstract: BACKGROUND Cross-sectional studies report that meeting the newly developed 24-h movement guidelines (≥60 min moderate to vigorous physical activity (MVPA), ≤120 min screen time and 9-11 h sleep duration) are associated with lower adiposity indicators in children. However, prospective data are absent. METHODS The study sample consisted of 830 children from the PRIMROSE study with GT3X+ accelerometer measured physical activity and parent reported screen time and sleep duration at age 4 years and objectively measured anthropometrics at age 4 and 5 years. The main outcome variables were weight status, body mass index (BMI) and BMI z-score at ages 4 and 5 years. Exposure variables were defined as meeting vs. not meeting the 24-h movement guidelines and combinations of these recommendations. RESULTS On average, 18.4% of the total study sample met the combination of MVPA, sleep duration and screen time recommendations. In isolation, the MVPA, screen time and sleep guidelines were met by 31%, 63% and 98% of the total study sample, respectively. Adherence to any single recommendation, or any combination of recommendations at age 4 years, was not associated with being overweight or obese nor with BMI and BMI z-score at age 4 or 5 years. CONCLUSIONS In contrast to previous cross-sectional studies, neither individual movement behaviours nor combinations of behaviours at age 4 years was associated with overweight or obesity, BMI or BMI z-score at age 4 or 5 years. More prospective data are needed before effects on weight status from meeting the 24-h movement guidelines are elucidated.

Sugar intake by type (added vs. naturally occurring) and physical form (liquid vs. solid) and its varying association with children's body weight, NHANES 2009–2014

Abstract: Background Sugars and their primary dietary sources (milk, fruits, sweetened foods and beverages) are associated, in different ways, with a range of health outcomes, including obesity. The contribution made to total sugar intake and how the different types and forms of sugar associate with body weight is unclear. Objective To describe sugar consumption and examine its association with weight status among U.S. children by sugar type [added {AS} vs. naturally occurring {NOS}] and form (solid vs. liquid). Design Cross-sectional dietary data (2 24-h recalls) from children 2-19 years in the National Health and Nutrition Examination Survey, 2009-2014 (n = 8136) were used to estimate the amount of each type and form of sugar by age and weight status. Linear regression models tested trends and the multivariate adjusted association between the different sugars and weight status. Results Mean total sugar, AS, and NOS was 118.1 g [25.3% total energy {TE}], 71.5 g (14.8% TE), 46.7 g (10.5% TE), respectively. AS in sugar-sweetened (non-dairy) beverages and NOS in juices contributed 6.9% and 2.4% of TE, respectively. Only %TE from AS (controlled for potential demographic, lifestyle confounders) was associated with change in body mass index z-score (BMIz) [AS in beverages: BMIz β + 0.01 {95% CI: 0.002, 0.03}; AS in foods: BMIz β - 0.03 {95% CI: -0.04, -0.02}]. Conclusion Dietary sugars, most of which are AS, are a major contributor of calories in the diets of U.S. children. Only AS in non-dairy sources were associated with weight although the direction differed by the form consumed. AS in beverages were associated positively and those in foods were associated inversely with children's weight status.

Low maternal vitamin D status in pregnancy increases the risk of childhood obesity

Abstract: BACKGROUND Vitamin D may modulate adipogenesis. However, limited studies have investigated the effect of maternal vitamin D during pregnancy on offspring adiposity or cardiometabolic parameters with inconclusive results. OBJECTIVES The objective of this study is to examine the association of maternal 25(OH)-vitamin D [25(OH)D] status with offspring obesity and cardiometabolic characteristics in 532 mother-child pairs from the prospective pregnancy cohort Rhea in Crete, Greece. METHODS Maternal 25(OH)D concentrations were measured at the first prenatal visit (mean: 14 weeks, SD: 4). Child outcomes included body mass index standard deviation score, waist circumference, skin-fold thickness, blood pressure and serum lipids at ages 4 and 6 years. Body fat percentage was also measured at 6 years. Body mass index growth trajectories from birth to 6 years were estimated by mixed effects models with fractional polynomials of age. Adjusted associations were obtained via multivariable linear regression analyses. RESULTS About two-thirds of participating mothers had 25(OH)D concentrations <50 nmol L-1 . Offspring of women in the low 25(OH)D tertile (<37.7 nmol L-1 ) had higher body mass index standard deviation score (β 0.20, 95% CI: 0.03, 0.37), and waist circumference (β 0.87 95% CI: 0.12, 1.63) at preschool age, compared with the offspring of women with higher 25(OH)D measurements (≥37.7 nmol L-1 ), on covariate-adjusted analyses. The observed relationships persisted at age 6 years. We found no association between maternal 25(OH)D concentrations and offspring blood pressure or serum lipids at both time points. CONCLUSIONS Exposure to very low 25(OH)D concentrations in utero may increase childhood adiposity indices. Given that vitamin D is a modifiable risk factor, our findings may have important public health implications.