Pediatric Obesity最新文献

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a major public health concern. A thorough analysis of the link between ultra-processed food (UPF) intake and MASLD in the adolescent population is lacking.

Methods: Adolescent participants of the National Health and Nutrition Examination Survey (NHANES) pre-pandemic cohort were included. Different controlled attenuation parameter (CAP) cut-offs were used to assess MASLD. The percentage energy intake of UPF, categorized according to the NOVA classification, to total energy intake was taken as the main outcome marker. Structural equation modelling (SEM) was used to better quantify the causal connection between UPF and liver steatosis.

Results: UPF consumption constituted a median 75% (62-86) of total energy intake. There was no significant correlation between UPF intake and CAP (ρ = 0.061, p = 0.091). The median proportion UPF intake was not associated with steatosis severity. SEM similarly yielded a weak and non-significant correlation of 0.078. In participants with MASLD, total energy intake was significantly higher (p < 0.001) and sugar-containing beverage (SCB) consumption showed a non-significant trend towards higher consumption.

Conclusions: No clinically relevant association between UPF intake and MASLD in adolescents could be demonstrated. Our results nonetheless suggest that total energy intake and consumption of SCBs are important contributors to paediatric obesity and MASLD.

Background: Uric acid (UA) and homeostatic model assessment of insulin resistance (HOMA-IR) are endogenous biomarkers implicated in metabolic disorders and dysfunction.

Objectives: To investigate the structural associations between sugar-sweetened beverage intake (SSB), UA, HOMA-IR and adolescent latent MetS construct (MetsC) representing paediatric metabolic syndrome (MetS).

Methods: A population-based representative adolescent cohort (n = 1454) was evaluated for risk profiles of MetS. Structural equation modelling was performed to identify multifactor structural associations between study parameters and evaluate mediating effects.

Results: Adolescents had a single-factor latent construct representing MetS. Increased SSB intake was associated with higher UA and HOMA-IR levels, and the two biomarkers were positively associated with the MetsC score. UA and HOMA-IR exerted three mediating effects on the association between fructose-rich tea beverage (FTB) intake of >500 mL/day and MetsC: adjusted standardized coefficient and mediating effect (%), FTB → UA → MetsC: 0.071, 23.1%; FTB → HOMA-IR → MetsC: 0.034, 11.0%; FTB → UA → HOMA-IR → MetsC: 0.010, 3.1%. The UA-associated pathways accounted for 31.1% of the overall mediation on the association between bottled sugar-containing beverage intake and MetsC. After accounting for the UA- and HOMA-IR-derived detrimental effects, the fructose-rich tea beverage intake of >500 mL/day had a tea-related beneficial effect on MetsC, with an adjusted standardized coefficient of -0.103.

Conclusions: UA and HOMA-IR individually and jointly mediate the adverse effects of high fructose-rich SSB intake on the mechanisms underlying paediatric MetS. Fructose-free tea-based beverages may have a beneficial effect on latent MetS structure in adolescents.

Introduction: Limited evidence exists on the relationship between ultra-processed food (UPF) consumption and overweight/obesity amongst young children. This study aimed to assess UPF consumption, its socioeconomic correlates and its association with overweight/obesity amongst under-five children in Lebanon.

Materials and methods: Data pertinent to children aged 6 months to 4.9 years (n = 893) from a cross-sectional national survey were used. Anthropometric measurements were obtained, and multi-component questionnaires were administered to mothers. Dietary intake was assessed using the 24-h recall approach. NOVA classification was used to assign food items into four groups according to the extent of industrial processing. Contributions of each group to total energy intake (EI) and macronutrient and micronutrient intakes were estimated. Regression models were conducted to explore the correlates of UPF consumption as well as the association between UPF consumption and overweight/obesity status.

Results: UPFs were found to contribute 47% of daily EI. Girls and children with higher household income had significantly higher UPF intakes. Children whose mothers had an intermediate, high school, or technical diploma and were employed and whose fathers had higher education levels consumed significantly less EI from UPFs. Children whose %EI fell within the second and third tertiles of UPF intake had significantly higher odds of overweight/obesity as compared to those in the first tertile (adjusted odds ratio [AOR]: 1.21, 95% confidence interval [CI]: 1.09, 1.32 and AOR: 1.61, 95% CI: 1.47, 1.76, respectively), after adjusting for confounders.

Conclusion: The high intake of UPFs coupled with its association with overweight/obesity call for public health nutrition interventions aimed at improving feeding and dietary practices in this age group.

Anti-obesity medications (AOMs) have emerged as one element of comprehensive obesity clinical care intended to improve long-term health outcomes for children and adolescents. The number of pediatric AOM clinical trials has burgeoned in recent years as new pharmacotherapeutics have been developed. Factors related to growth and development in children and adolescents can present unique challenges in terms of designing and conducting clinical trials investigating the safety and efficacy of AOMs. These barriers can delay the AOM development and evaluation process, increase the cost of performing trials, create challenges in the interpretation of results, influence the generalizability of the findings and present ethical dilemmas. In an effort to address these issues and provide guidance to streamline the process of designing and conducting pediatric AOM clinical trials, relevant key stakeholders convened a series of roundtable meetings to discuss, debate and achieve harmonization on design features. Stakeholder participants included a multidisciplinary group of international pediatric obesity experts, patient (parent) representatives and representatives from academic medicine, key regulatory agencies and industry. Topics of discussion included primary efficacy end-points, secondary end-points, eligibility criteria, trial run-in and follow-up phases, use of active comparators and guidelines for down-titration and/or stopping rules for excessive weight reduction. Consensus recommendations were agreed upon. Regarding end-points, emphasis was placed on moving away from BMI z-score as a primary outcome, incorporating multiple alternative BMI-related outcomes and measuring adiposity/body fat as a prominent secondary end-point. Trial eligibility criteria were carefully considered to maximize generalizability while maintaining safety. The limited value of trial run-in phases was discussed. It was also underscored that designing trials with extended follow-up periods after AOM withdrawal should be avoided owing to ethical issues (including possible psychological harm) related to weight regain without providing the opportunity to access other treatments. The panel emphasized the value of the randomized, placebo-controlled trial but recommended the thoughtful consideration of the use of active comparators in addition to, or instead of, placebo to achieve clinical equipoise when appropriate. Finally, the panel recommended that clinical trial protocols should include clear guidance regarding AOM down-titration to avoid excessive weight reduction when applicable.

Objective: Assess longer-term changes in food habits and anthropometry among Grades 1-2 primary school students from four public schools in Colombo, Sri Lanka, following a 3-week programme including a classroom-based motivational storybook discussion and self-monitoring food diary (FD).

Methods: This follow-up study assessed changes from baseline (pre-intervention) BMI z-scores and food habits (increased healthy food-item consumption/decreased unhealthy food-item consumption reflected by an increase in FD score) and parental perceptions (anonymous questionnaires) among 863 students (aged 6-8 years), between 9 and 12 months after completing the programme (November 2019-February 2020).

Results: Food habits showed sustained improvement from baseline mean FD score (baseline vs. follow-up: 51 ± 23% vs. 67 ± 22%, p < 0.001), with children from all BMI subgroups (underweight [UW], normal weight [NW], overweight [OW] and obesity [OB]) showing a significant increase in FD scores (ranging from 14.1% to 17.2%, p < 0.001). BMI z-scores increased in children living with UW (-2.85 to -2.21, p < 0.00) and NW (-0.70 to -0.57, p < 0.001), but did not change in children with OW (+1.5 to +1.49, p = 0.83) and OB (+2.85 to +2.21, p = 0.19). Most parents (n = 497, 97.8%) reported satisfaction with programme outcomes.

Conclusion: This programme led to sustained improvement in food habits among young primary school children from all BMI categories, increase in BMI towards the median among children living with UW and NW, and stabilization of BMI in children with OW and OB, suggesting it as a useful tool for improving nutritional status of young children in low- and middle-income countries (LMIC) facing the double burden of under- and overnutrition.

Background: Breastfeeding is a protective measure against childhood overweight and obesity. However, many children are not breastfed the recommended duration, with those from disadvantaged backgrounds more likely to cease breastfeeding early.

Objectives: Investigate the association between duration of any breastfeeding and body mass index (BMI) and estimate the health, economic and equity impacts of increasing breastfeeding duration to at least 6 months.

Methods: We modelled the association between any breastfeeding duration and BMI at age 6/7 years, using a nationally representative cohort of 3935 Australian children (survey weighted to 221 103 children). We then used a simulation model to predict the impact of increasing breastfeeding duration to at least 6 months in all children on prevalence of overweight (including obesity) and associated healthcare costs to age 16/17 years.

Results: Achieving breastfeeding duration of at least 6 months could prevent 2933 cases of overweight at age 16/17 years, translating to healthcare cost-savings of AUD $4.29 million. Although most cases (68%) would come from low socio-economic backgrounds this would make only a minor difference in reducing inequalities.

Conclusion: Efforts to support increased breastfeeding duration could result in reduced prevalence of overweight and obesity and save healthcare costs, however, additional action would be required to improve equity.