Pub Date : 2024-11-04DOI: 10.1001/jamapediatrics.2024.4707
Micheal Sandbank, James E Pustejovsky
{"title":"Evidence That Intervention Dosage Is Associated With Better Outcomes in Autism-Reply.","authors":"Micheal Sandbank, James E Pustejovsky","doi":"10.1001/jamapediatrics.2024.4707","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.4707","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamapediatrics.2024.4438
Gabriel Tse, Aydin Zahedivash, Arash Anoshiravani, Jennifer Carlson, William Haberkorn, Keith E Morse
{"title":"Large Language Model Responses to Adolescent Patient and Proxy Messages.","authors":"Gabriel Tse, Aydin Zahedivash, Arash Anoshiravani, Jennifer Carlson, William Haberkorn, Keith E Morse","doi":"10.1001/jamapediatrics.2024.4438","DOIUrl":"10.1001/jamapediatrics.2024.4438","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamapediatrics.2024.4361
Susanna Tall, Suvi M Virtanen, Mikael Knip
Importance: A meta-analysis published in 2001 suggested that exposure to infections measured by day care attendance may be important in the pathogenesis of type 1 diabetes. Several new studies on the topic have since been published.
Objective: To investigate the association between day care attendance and risk of type 1 diabetes and to include all available literature up to March 10, 2024.
Data sources: Data from PubMed and Web of Science were used and supplemented by bibliographies of the retrieved articles and searched for studies assessing the association between day care attendance and risk of type 1 diabetes.
Study selection: Studies that reported a measure of association between day care attendance and risk of type 1 diabetes were included.
Data extraction and synthesis: Details, including exposure and outcome assessment and adjustment for confounders, were extracted from the included studies. The multivariable association with the highest number of covariates, lowest number of covariates, and unadjusted estimates and corresponding 95% CIs were extracted. DerSimonian and Laird random-effects meta-analyses were performed and yielded conservative confidence intervals around relative risks.
Main outcomes and measures: The principal association measure was day care attendance vs no day care attendance and risk of type 1 diabetes.
Results: Seventeen articles including 22 observational studies of 100 575 participants were included in the meta-analysis. Among the participants, 3693 had type 1 diabetes and 96 882 were controls. An inverse association between day care attendance and risk of type 1 diabetes was found (combined odds ratio, 0.68; 95% CI, 0.58-0.79; P < .001; adjusted for all available confounders). When the 3 cohort studies included were analyzed separately, the risk of type 1 diabetes was 15% lower in the group attending day care; however, the difference was not statistically significant (odds ratio, 0.85; 95% CI, 0.59-1.12; P = .37).
Conclusions and relevance: These results demonstrated that day care attendance appears to be associated with a reduced risk of type 1 diabetes. Increased contacts with microbes in children attending day care compared with children who do not attend day care may explain these findings. However, further prospective cohort studies are needed to confirm the proposed association.
{"title":"Day Care Attendance and Risk of Type 1 Diabetes: A Meta-Analysis and Systematic Review.","authors":"Susanna Tall, Suvi M Virtanen, Mikael Knip","doi":"10.1001/jamapediatrics.2024.4361","DOIUrl":"10.1001/jamapediatrics.2024.4361","url":null,"abstract":"<p><strong>Importance: </strong>A meta-analysis published in 2001 suggested that exposure to infections measured by day care attendance may be important in the pathogenesis of type 1 diabetes. Several new studies on the topic have since been published.</p><p><strong>Objective: </strong>To investigate the association between day care attendance and risk of type 1 diabetes and to include all available literature up to March 10, 2024.</p><p><strong>Data sources: </strong>Data from PubMed and Web of Science were used and supplemented by bibliographies of the retrieved articles and searched for studies assessing the association between day care attendance and risk of type 1 diabetes.</p><p><strong>Study selection: </strong>Studies that reported a measure of association between day care attendance and risk of type 1 diabetes were included.</p><p><strong>Data extraction and synthesis: </strong>Details, including exposure and outcome assessment and adjustment for confounders, were extracted from the included studies. The multivariable association with the highest number of covariates, lowest number of covariates, and unadjusted estimates and corresponding 95% CIs were extracted. DerSimonian and Laird random-effects meta-analyses were performed and yielded conservative confidence intervals around relative risks.</p><p><strong>Main outcomes and measures: </strong>The principal association measure was day care attendance vs no day care attendance and risk of type 1 diabetes.</p><p><strong>Results: </strong>Seventeen articles including 22 observational studies of 100 575 participants were included in the meta-analysis. Among the participants, 3693 had type 1 diabetes and 96 882 were controls. An inverse association between day care attendance and risk of type 1 diabetes was found (combined odds ratio, 0.68; 95% CI, 0.58-0.79; P < .001; adjusted for all available confounders). When the 3 cohort studies included were analyzed separately, the risk of type 1 diabetes was 15% lower in the group attending day care; however, the difference was not statistically significant (odds ratio, 0.85; 95% CI, 0.59-1.12; P = .37).</p><p><strong>Conclusions and relevance: </strong>These results demonstrated that day care attendance appears to be associated with a reduced risk of type 1 diabetes. Increased contacts with microbes in children attending day care compared with children who do not attend day care may explain these findings. However, further prospective cohort studies are needed to confirm the proposed association.</p>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamapediatrics.2024.4368
Yaxing Meng, James E Sharman, Fiia Iiskala, Feitong Wu, Markus Juonala, Katja Pahkala, Suvi P Rovio, Brooklyn J Fraser, Rebecca K Kelly, Nina Hutri, Mika Kähönen, Tomi Laitinen, Antti Jula, Jorma S A Viikari, Olli T Raitakari, Costan G Magnussen
<p><strong>Importance: </strong>Despite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remain understudied.</p><p><strong>Objective: </strong>To evaluate BP tracking from childhood to midadulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multiple time points.</p><p><strong>Design, setting, and participants: </strong>The analyses were performed in 2023 using data gathered from September 1980 to August 2018 within the longitudinal Cardiovascular Risk in Young Finns Study. Participants had BP examined 9 times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and midadulthood (39-56 years).</p><p><strong>Exposures: </strong>BP classifications (normal, elevated, hypertension) were based on AAP guidelines for children and adolescents and the 2017 American College of Cardiology/American Heart Association guidelines for adults.</p><p><strong>Main outcomes and measures: </strong>Outcomes were BP classifications at follow-up visits. Tracking coefficients were calculated using generalized estimated equations. Transition probabilities among BP classifications were estimated using multistate Markov models.</p><p><strong>Results: </strong>This study included 2918 participants (mean [SD] baseline age, 10.7 [5.0] years; 1553 female [53.2%]). Over 38 years, the tracking coefficient (odds ratio [OR]) for maintaining elevated BP/hypertension was 2.16 (95% CI, 1.95-2.39). Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP from childhood to midadulthood (transition probability: from normal BP to stage 2 hypertension, 0.20; 95% CI, 0.17-0.22 vs 0.08; 95% CI, 0.07-0.10; maintaining stage 2 BP, 0.32; 95% CI, 0.27-0.39 vs 0.14; 95% CI, 0.09-0.21; from stage 2 hypertension to normal BP, 0.23; 95% CI, 0.19-0.26 vs 0.58; 95% CI, 0.52-0.62. For both sexes, the probability of transitioning from adolescent hypertension to normal BP in midadulthood was lower (transition probability, ranging from 0.16; 95% CI, 0.14-0.19 to 0.44; 95% CI, 0.39-0.48) compared with childhood hypertension (transition probability, ranging from 0.23; 95% CI, 0.19-0.26 to 0.63; 95% CI, 0.61-0.66). The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter. Children with normal BP generally maintained this status into adolescence (male: transition probability, 0.64; 95% CI, 0.60-0.67; female: transition probability, 0.81; 95% CI, 0.79-0.84) but decreased by young adulthood (male: transition probability, 0.41; 95% CI, 0.39-0.44; female: transition probability, 0.69; 95% CI, 0.67-0.71).</p><p><strong>Conclusion and relevance: </strong>Results of this cohort study reveal an e
{"title":"Tracking and Transition Probability of Blood Pressure From Childhood to Midadulthood.","authors":"Yaxing Meng, James E Sharman, Fiia Iiskala, Feitong Wu, Markus Juonala, Katja Pahkala, Suvi P Rovio, Brooklyn J Fraser, Rebecca K Kelly, Nina Hutri, Mika Kähönen, Tomi Laitinen, Antti Jula, Jorma S A Viikari, Olli T Raitakari, Costan G Magnussen","doi":"10.1001/jamapediatrics.2024.4368","DOIUrl":"10.1001/jamapediatrics.2024.4368","url":null,"abstract":"<p><strong>Importance: </strong>Despite its relevance for pediatric blood pressure (BP) screening, the long-term predictive utility and natural progression of pediatric BP classification remain understudied.</p><p><strong>Objective: </strong>To evaluate BP tracking from childhood to midadulthood using the American Academy of Pediatrics (AAP) thresholds and estimate transition probabilities among BP classifications over time considering multiple time points.</p><p><strong>Design, setting, and participants: </strong>The analyses were performed in 2023 using data gathered from September 1980 to August 2018 within the longitudinal Cardiovascular Risk in Young Finns Study. Participants had BP examined 9 times over 38 years, from childhood (aged 6-12 years) or adolescence (15-18 years) to young adulthood (21-27 years), late young adulthood (30-37 years), and midadulthood (39-56 years).</p><p><strong>Exposures: </strong>BP classifications (normal, elevated, hypertension) were based on AAP guidelines for children and adolescents and the 2017 American College of Cardiology/American Heart Association guidelines for adults.</p><p><strong>Main outcomes and measures: </strong>Outcomes were BP classifications at follow-up visits. Tracking coefficients were calculated using generalized estimated equations. Transition probabilities among BP classifications were estimated using multistate Markov models.</p><p><strong>Results: </strong>This study included 2918 participants (mean [SD] baseline age, 10.7 [5.0] years; 1553 female [53.2%]). Over 38 years, the tracking coefficient (odds ratio [OR]) for maintaining elevated BP/hypertension was 2.16 (95% CI, 1.95-2.39). Males had a higher probability than females of progressing to and maintaining hypertension and a lower probability of reverting to normal BP from childhood to midadulthood (transition probability: from normal BP to stage 2 hypertension, 0.20; 95% CI, 0.17-0.22 vs 0.08; 95% CI, 0.07-0.10; maintaining stage 2 BP, 0.32; 95% CI, 0.27-0.39 vs 0.14; 95% CI, 0.09-0.21; from stage 2 hypertension to normal BP, 0.23; 95% CI, 0.19-0.26 vs 0.58; 95% CI, 0.52-0.62. For both sexes, the probability of transitioning from adolescent hypertension to normal BP in midadulthood was lower (transition probability, ranging from 0.16; 95% CI, 0.14-0.19 to 0.44; 95% CI, 0.39-0.48) compared with childhood hypertension (transition probability, ranging from 0.23; 95% CI, 0.19-0.26 to 0.63; 95% CI, 0.61-0.66). The probability of maintaining normal BP sharply decreased in the first 5 to 10 years, stabilizing thereafter. Children with normal BP generally maintained this status into adolescence (male: transition probability, 0.64; 95% CI, 0.60-0.67; female: transition probability, 0.81; 95% CI, 0.79-0.84) but decreased by young adulthood (male: transition probability, 0.41; 95% CI, 0.39-0.44; female: transition probability, 0.69; 95% CI, 0.67-0.71).</p><p><strong>Conclusion and relevance: </strong>Results of this cohort study reveal an e","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1001/jamapediatrics.2024.3297
Pin-Yen Chen, Chung-Ming Chen
{"title":"Low-Dose Iron and Early Development in Breastfed Infants.","authors":"Pin-Yen Chen, Chung-Ming Chen","doi":"10.1001/jamapediatrics.2024.3297","DOIUrl":"10.1001/jamapediatrics.2024.3297","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1227"},"PeriodicalIF":24.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1001/jamapediatrics.2024.3300
Hong-Kun Jiang, Wan-Lin Cui
{"title":"Low-Dose Iron and Early Development in Breastfed Infants.","authors":"Hong-Kun Jiang, Wan-Lin Cui","doi":"10.1001/jamapediatrics.2024.3300","DOIUrl":"10.1001/jamapediatrics.2024.3300","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1227-1228"},"PeriodicalIF":24.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1001/jamapediatrics.2024.3618
John J Reilly
{"title":"Prevalence of Obesity Is Higher Than Published Estimates Suggest.","authors":"John J Reilly","doi":"10.1001/jamapediatrics.2024.3618","DOIUrl":"10.1001/jamapediatrics.2024.3618","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1232"},"PeriodicalIF":24.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1001/jamapediatrics.2024.3452
Ea Hoppe Blaabæk, Daniel Juhász Vigild, Felix Elwert, Peter Fallesen, Lars H Andersen
Importance: Childhood exposure to mild traumatic brain injury (mTBI) is common. Individuals with a childhood history of mTBI experience more frequent criminal justice involvement in mid to late adolescence and adulthood. No study had been conducted to examine whether the link is causal or spurious.
Objective: To determine whether mTBI in childhood causes criminal justice involvement in mid to late adolescence.
Design, setting, and participants: This cohort study used population-based data for all children born between 1995 and 2000 in Denmark, with data linked to emergency department (ED) visits and hospitalizations before age 10 years and all criminal charges and convictions from ages 15 to 20 years. The exposure group contained all individuals diagnosed with mTBI before age 10 years without other intracranial or extracranial injuries; the comparison group was individuals not diagnosed with mTBI or intracranial or extracranial injuries. Sibling and twin fixed-effects models were used to evaluate the association after controlling for family-level confounding. Data were analyzed from May 2021 to July 2024.
Exposures: Mild TBI before age 10 years without other intracranial or extracranial injuries before or at the time of diagnosis.
Main outcomes and measures: Associations between mTBI before age 10 years and criminal charges and convictions from ages 15 to 20 for the entire study population and separately by sex at birth, controlling for additional covariates.
Results: The final analytic sample consisted of 343 027 individuals, 13 514 in the exposure group and 329 513 in the comparison group. Of the total sample, 166 455 (49%) were female and 176 572 were male (51%). A total of 326 191 participants (95%) had at least 1 parent with Danish citizenship, and 79 386 mothers (23%) held a college degree. There was a positive association between mTBI and criminal charges (odds ratio [OR], 1.26; 95% CI, 1.19-1.34) and convictions (OR, 1.24; 95% CI, 1.16-1.33). When controlling for family-level confounding, the associations became statistically insignificant and, in most models, greatly reduced. Results were robust across multiple model specifications.
Conclusions and relevance: This study found that although mTBI in childhood was predictive of adolescent criminal justice involvement, there was no evidence that mTBI caused criminal charges or convictions.
{"title":"Mild Traumatic Brain Injury and Criminal Charges and Convictions in Mid and Late Adolescence.","authors":"Ea Hoppe Blaabæk, Daniel Juhász Vigild, Felix Elwert, Peter Fallesen, Lars H Andersen","doi":"10.1001/jamapediatrics.2024.3452","DOIUrl":"10.1001/jamapediatrics.2024.3452","url":null,"abstract":"<p><strong>Importance: </strong>Childhood exposure to mild traumatic brain injury (mTBI) is common. Individuals with a childhood history of mTBI experience more frequent criminal justice involvement in mid to late adolescence and adulthood. No study had been conducted to examine whether the link is causal or spurious.</p><p><strong>Objective: </strong>To determine whether mTBI in childhood causes criminal justice involvement in mid to late adolescence.</p><p><strong>Design, setting, and participants: </strong>This cohort study used population-based data for all children born between 1995 and 2000 in Denmark, with data linked to emergency department (ED) visits and hospitalizations before age 10 years and all criminal charges and convictions from ages 15 to 20 years. The exposure group contained all individuals diagnosed with mTBI before age 10 years without other intracranial or extracranial injuries; the comparison group was individuals not diagnosed with mTBI or intracranial or extracranial injuries. Sibling and twin fixed-effects models were used to evaluate the association after controlling for family-level confounding. Data were analyzed from May 2021 to July 2024.</p><p><strong>Exposures: </strong>Mild TBI before age 10 years without other intracranial or extracranial injuries before or at the time of diagnosis.</p><p><strong>Main outcomes and measures: </strong>Associations between mTBI before age 10 years and criminal charges and convictions from ages 15 to 20 for the entire study population and separately by sex at birth, controlling for additional covariates.</p><p><strong>Results: </strong>The final analytic sample consisted of 343 027 individuals, 13 514 in the exposure group and 329 513 in the comparison group. Of the total sample, 166 455 (49%) were female and 176 572 were male (51%). A total of 326 191 participants (95%) had at least 1 parent with Danish citizenship, and 79 386 mothers (23%) held a college degree. There was a positive association between mTBI and criminal charges (odds ratio [OR], 1.26; 95% CI, 1.19-1.34) and convictions (OR, 1.24; 95% CI, 1.16-1.33). When controlling for family-level confounding, the associations became statistically insignificant and, in most models, greatly reduced. Results were robust across multiple model specifications.</p><p><strong>Conclusions and relevance: </strong>This study found that although mTBI in childhood was predictive of adolescent criminal justice involvement, there was no evidence that mTBI caused criminal charges or convictions.</p>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1164-1171"},"PeriodicalIF":24.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1001/jamapediatrics.2024.3330
Kar Hau Chong, Thomas Suesse, Penny L Cross, Sarah T Ryan, Eivind Aadland, Oluwayomi Aoko, Ankhmaa Byambaa, Valerie Carson, Jean-Philippe Chaput, Hayley Christian, Dylan P Cliff, Marieke De Craemer, Clarice Maria de Lucena Martins, Christine Delisle Nyström, Catherine E Draper, Asmaa El Hamdouchi, Alex Antonio Florindo, Hongyan Guan, Amy S Ha, Najmeh Hamzavi Zarghani, Kylie D Hesketh, Mohammad Sorowar Hossain, Jajat Jajat, Thanh Kim, Denise Koh, Anna V Kontsevaya, Nicholas Kuzik, Marja H Leppänen, Marie Löf, Himangi Lubree, Kim Meredith-Jones, Tawonga W Mwase-Vuma, Johan Y Y Ng, Rachel Novotny, Jackline Jema Nusurupia, Bang N Pham, Bee Koon Poh, John J Reilly, Amanda E Staiano, Kuston Sultoni, Chiaki Tanaka, Hong K Tang, Rachael W Taylor, Simone A Tomaz, Mark S Tremblay, Stewart G Trost, Ali Turab, Susana Vale, V Pujitha Wickramasinghe, Anthony D Okely
Importance: The prevalence estimates of physical activity, sedentary behavior, and sleep (collectively known as movement behaviors) in 3- and 4-year-old children worldwide remains uncertain.
Objective: To report the proportion of 3- and 4-year-old children who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep across 33 countries.
Design, setting, and participants: Pooled analysis of data from 14 cross-sectional studies (July 2008 to September 2022) identified through systematic reviews and personal networks. Thirty-three countries of varying income levels across 6 geographical regions. Each study site needed to have at least 40 children aged 3.0 to 4.9 years with valid accelerometry and parent-/caregiver-reported screen time and sleep duration data. Data were analyzed from October 2022 to February 2023.
Exposures: Time spent in physical activity was assessed by reanalyzing accelerometry data using a harmonized data-processing protocol. Screen time and sleep duration were proxy reported by parents or caregivers.
Main outcomes and measures: The proportion of children who met the World Health Organization guidelines for physical activity (≥180 min/d of total physical activity and ≥60 min/d of moderate- to vigorous-intensity physical activity), screen time (≤1 h/d), and sleep duration (10-13 h/d) was estimated across countries and by World Bank income group and geographical region using meta-analysis.
Results: Of the 7017 children (mean [SD] age, 4.1 [0.5] years; 3585 [51.1%] boys and 3432 [48.9%] girls) in this pooled analysis, 14.3% (95% CI, 9.7-20.7) met the overall guidelines for physical activity, screen time, and sleep duration. There was no clear pattern according to income group: the proportion meeting the guidelines was 16.6% (95% CI, 10.4-25.3) in low- and lower-middle-income countries, 11.9% (95% CI, 5.9-22.5) in upper-middle-income countries, and 14.4% (95% CI, 9.6-21.1) in high-income countries. The region with the highest proportion meeting the guidelines was Africa (23.9%; 95% CI, 11.6-43.0), while the lowest proportion was in North and South America (7.7%; 95% CI, 3.6-15.8).
Conclusions and relevance: Most 3- and 4-year-old children in this pooled analysis did not meet the current World Health Organization guidelines for physical activity, sedentary behavior, and sleep. Priority must be given to understanding factors that influence these behaviors in this age group and to implementing contextually appropriate programs and policies proven to be effective in promoting healthy levels of movement behaviors.
{"title":"Pooled Analysis of Physical Activity, Sedentary Behavior, and Sleep Among Children From 33 Countries.","authors":"Kar Hau Chong, Thomas Suesse, Penny L Cross, Sarah T Ryan, Eivind Aadland, Oluwayomi Aoko, Ankhmaa Byambaa, Valerie Carson, Jean-Philippe Chaput, Hayley Christian, Dylan P Cliff, Marieke De Craemer, Clarice Maria de Lucena Martins, Christine Delisle Nyström, Catherine E Draper, Asmaa El Hamdouchi, Alex Antonio Florindo, Hongyan Guan, Amy S Ha, Najmeh Hamzavi Zarghani, Kylie D Hesketh, Mohammad Sorowar Hossain, Jajat Jajat, Thanh Kim, Denise Koh, Anna V Kontsevaya, Nicholas Kuzik, Marja H Leppänen, Marie Löf, Himangi Lubree, Kim Meredith-Jones, Tawonga W Mwase-Vuma, Johan Y Y Ng, Rachel Novotny, Jackline Jema Nusurupia, Bang N Pham, Bee Koon Poh, John J Reilly, Amanda E Staiano, Kuston Sultoni, Chiaki Tanaka, Hong K Tang, Rachael W Taylor, Simone A Tomaz, Mark S Tremblay, Stewart G Trost, Ali Turab, Susana Vale, V Pujitha Wickramasinghe, Anthony D Okely","doi":"10.1001/jamapediatrics.2024.3330","DOIUrl":"10.1001/jamapediatrics.2024.3330","url":null,"abstract":"<p><strong>Importance: </strong>The prevalence estimates of physical activity, sedentary behavior, and sleep (collectively known as movement behaviors) in 3- and 4-year-old children worldwide remains uncertain.</p><p><strong>Objective: </strong>To report the proportion of 3- and 4-year-old children who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep across 33 countries.</p><p><strong>Design, setting, and participants: </strong>Pooled analysis of data from 14 cross-sectional studies (July 2008 to September 2022) identified through systematic reviews and personal networks. Thirty-three countries of varying income levels across 6 geographical regions. Each study site needed to have at least 40 children aged 3.0 to 4.9 years with valid accelerometry and parent-/caregiver-reported screen time and sleep duration data. Data were analyzed from October 2022 to February 2023.</p><p><strong>Exposures: </strong>Time spent in physical activity was assessed by reanalyzing accelerometry data using a harmonized data-processing protocol. Screen time and sleep duration were proxy reported by parents or caregivers.</p><p><strong>Main outcomes and measures: </strong>The proportion of children who met the World Health Organization guidelines for physical activity (≥180 min/d of total physical activity and ≥60 min/d of moderate- to vigorous-intensity physical activity), screen time (≤1 h/d), and sleep duration (10-13 h/d) was estimated across countries and by World Bank income group and geographical region using meta-analysis.</p><p><strong>Results: </strong>Of the 7017 children (mean [SD] age, 4.1 [0.5] years; 3585 [51.1%] boys and 3432 [48.9%] girls) in this pooled analysis, 14.3% (95% CI, 9.7-20.7) met the overall guidelines for physical activity, screen time, and sleep duration. There was no clear pattern according to income group: the proportion meeting the guidelines was 16.6% (95% CI, 10.4-25.3) in low- and lower-middle-income countries, 11.9% (95% CI, 5.9-22.5) in upper-middle-income countries, and 14.4% (95% CI, 9.6-21.1) in high-income countries. The region with the highest proportion meeting the guidelines was Africa (23.9%; 95% CI, 11.6-43.0), while the lowest proportion was in North and South America (7.7%; 95% CI, 3.6-15.8).</p><p><strong>Conclusions and relevance: </strong>Most 3- and 4-year-old children in this pooled analysis did not meet the current World Health Organization guidelines for physical activity, sedentary behavior, and sleep. Priority must be given to understanding factors that influence these behaviors in this age group and to implementing contextually appropriate programs and policies proven to be effective in promoting healthy levels of movement behaviors.</p>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1199-1207"},"PeriodicalIF":24.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11443432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}