Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is understudied among US adolescents despite rising obesity rates.
This study analysed the prevalence and trends of obesity and MASLD among US adolescents aged 12–17 using data from the National Health and Nutrition Examination Survey (NHANES). We developed a new screening model utilizing FibroScan-measured controlled attenuation parameter (CAP) scores, body measurements and blood chemistry data from 2017 to 2020 to assist in analysing MASLD trends from 1999 to 2020.
Between 2017 and 2020, the prevalence of obesity and MASLD was approximately 20%, with about 70% of obese adolescents affected by MASLD. The condition was more common in boys, particularly among Mexican American adolescents. Additionally, 97.2% of those with NAFLD also had MASLD. Adolescents with MASLD had significantly higher body weight, waist circumference, triglyceride levels and alanine transaminase (ALT) levels, along with lower high-density lipoprotein (HDL) cholesterol and an increased risk of liver fibrosis. Insufficient physical activity and poor diet quality were key risk factors for developing MASLD. From 1999 to 2020, the prevalence of MASLD rose significantly, paralleling the increasing rates of obesity.
The study underscores the pressing need to screen at-risk adolescents for metabolic issues associated with steatotic liver diseases, given the rising obesity rates among adolescents. The high overlap between MASLD and NAFLD diagnoses indicates that the transition from NAFLD to MASLD can be effectively integrated into paediatric practice.
Limited insight exists into the weight development in children with obesity not receiving obesity treatment.
This cohort study included 467 Danish children aged 5–10 years with obesity (iso-BMI >30 kg/m2) not receiving treatment. Data from mandatory health check-ups on school-children's height and weight (converted to BMI z-scores) were merged with the Danish National Registries. A multivariable logistic regression weighted for the duration of follow-up was used to estimate odds ratios (OR) for normalization of BMI (iso-BMI 18.5–25 kg/m2) and obesity remission (iso-BMI 18.5–30 kg/m2).
During a median follow-up of more than 6 years, 7.9% of the children normalized their BMI, while 45.4% obtained obesity remission. BMI z-score at inclusion acted as a strong inverse predictor for normalizing BMI (OR 0.14 per one-unit SD, CI: 0.03–0.53) and for obesity remission (OR 0.17 per one-unit SD, CI: 0.08–0.37). No other significant predictors were observed in the weighted multivariable models.
Higher BMI z-scores inversely predict normalizing BMI and achieving obesity remission in untreated children. Given that many children naturally achieve obesity remission or weight normalization, resources should focus on understanding barriers of obesity maintenance and to develop effective strategies for those who do not experience improvement.
There is limited evidence on how changes in obesity from childhood to adolescence are associated with adolescent mental health. We examined the associations between childhood obesity trajectories, obesity episodes, and mental health at age 17.
Data were from the UK Millennium Cohort Study. Obesity trajectory groups at ages 7 and 17 (n = 8306) and previous obesity episodes (number of sweeps with obesity) at ages 7, 11 and 14 (n = 7246) were examined. Caregiver and self-reported internalising and externalising symptoms at age 17 were used to measure mental health. Linear regression models were used.
Relative to never developing obesity, obesity development (β = 1.01; 95% CI = 0.71, 1.32) and persistence (β = 1.18; 95% CI = 0.74, 1.61) were associated with higher internalising symptoms at age 17 and worsening (increase in scores) of these symptoms between ages 7 and 17 (β = 0.87; 95% CI = 0.57, 1.17 and β = 0.86; 95% CI = 0.56, 1.26 for development and persistence, respectively). Obesity development was associated with higher externalising symptoms at age 17 (β = 0.52; 95% CI = 0.25, 0.80) and worsening of these symptoms over time (β = 0.30; 95% CI = 0.07, 0.53). Having multiple past obesity episodes was not associated with worsening mental health independent of follow-up weight status. There were no differences in mental health outcomes between children who reversed versus never developed obesity.
Obesity development or persistence from ages 7 to 17 are associated with worsening mental health. If childhood obesity is reversed, there appears to be no evidence of a negative association between previous obesity and mental health at age 17.
To investigate the association of sleep-disordered breathing (SDB) severity with cardiometabolic and inflammatory markers independently of the adiposity levels; and to explore the role of cardiorespiratory fitness in these associations in children with overweight/obesity.
A total of 109 children aged 8–11 years with overweight/obesity were included in this cross-sectional study. SDB was assessed using a scale of the reduce version of the Paediatric Sleep Questionnaire. Cardiometabolic markers included fasting blood lipids biomarkers (i.e., low- and high-density lipoprotein cholesterol, and triglycerides), blood pressure, insulin, glucose, and the homeostatic model assessment index. Inflammatory markers (i.e., interleukin-6, interleukin-1β, C-reactive protein [CRP], and tumour necrosis factor alpha) were analysed. Cardiorespiratory fitness was assessed by the 20 m shuttle-run test.
No significant associations were found between SDB severity and most of the cardiometabolic markers after correcting for adiposity and multiple comparisons (all p's >0.05). SDB severity was positively related to CRP (β = 0.352, p = 0.002), yet not with the remaining inflammatory markers analysed. The interaction effect of cardiorespiratory fitness presented a positive trend in the association of SDB with CRP (p = 0.1). When stratified analyses by cardiorespiratory fitness levels were conducted, a positive relation was found between SDB and CRP in the low cardiorespiratory fitness group (β = 0.465, p = 0.014), but not in the high cardiorespiratory fitness group (β = 0.236, p = 0.108).
SDB severity was positively associated with CRP independently of the adiposity levels, but not with other inflammatory or cardiometabolic risk factors in children with overweight/obesity. Moreover, our results suggest that higher levels of cardiorespiratory fitness may attenuate the adverse effect of SDB severity on systematic inflammation in children with overweight/obesity.
Although the genetic interplay with the environment has a major impact on obesity development, little is known on whether breastfeeding could modulate the genetic predisposition to obesity.
To investigate whether breastfeeding attenuates the effect of an obesity genetic risk score (GRS) on adiposity in European adolescents.
Totally 751 adolescents from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study were included, divided according to breastfeeding status into never breastfed, 1–3 months and ≥4 months. Adjusting by socioeconomic status and lifestyle factors multiple linear regression models were used to assess (1) the main effect of breastfeeding duration and (2) its interaction effect with an obesity GRS, to predict different adiposity measures.
A significant negative association between ≥4 months of breastfeeding and waist circumference (WC) z-score was observed [β (95% confidence interval), p-value] = [β = −0.189 (−0.37, −0.00), p = 0.044]. Also, significant interaction effects were observed for 1–3 and ≥4 months of breastfeeding and obesity GRS regarding body mass index (BMI) z-score [β = 0.155 (0.06, 0.24), p = 0.001] and [β = 0.108 (0.01, 0.18), p = 0.020, respectively] and fat mass index (FMI) z-score [β = 0.134 (0.04, 0.22), p = 0.003] and [β = 0.100 (0.01, 0.18), p = 0.026, respectively].
Breastfeeding modulates the association between the obesity GRS and body composition in adolescents.
Obesity during pregnancy is related to fetal overgrowth. Effective interventions that can mitigate this risk are needed.
This study aimed to investigate the effect of a lifestyle intervention for pregnant women with obesity on fetal growth trajectories.
In the DALI trial, pregnant women with a body mass index ≥29.0 kg/m2 and without gestational diabetes at baseline were randomized to counselling on physical activity (PA), healthy eating (HE) or a combination (PA + HE), or to usual care (UC). Fetal growth trajectories were modelled based on a combination of estimated fetal weight (EFW) from repeated ultrasound scans and weight measured at birth. Differences in fetal growth trajectories between groups were assessed.
Three hundred eighty-four women were included. Those in the PA + HE intervention had slower EFW gain from 32 weeks onwards, with differences (PA + HE vs. UC) at 32, 36 and 40 weeks of −54.1 g (−146.7 to 38.9 g), −84.9 g (−194.0 to 24.7 g), and −99.8 g (−227.1 to 28.1 g), respectively. Effects appeared stronger in males, with a difference at 40 weeks of −185.8 g (−362.5 g to −9.2 g) versus −23.4 g (−190.4 g to 143.5 g) in females.
A lifestyle intervention for pregnant women with obesity resulted in attenuated fetal growth, which only reached significance in male offspring. Future larger trials are needed to confirm these findings and elucidate underlying pathways.
To determine whether BMI differences observed at 5 years of age, from early intervention in infancy, remained apparent at 11 years.
Participants (n = 734) from the original randomized controlled trial (n = 802) underwent measures of body mass index (BMI), body composition (DXA), sleep and physical activity (24-h accelerometry, questionnaire), diet (repeated 24-h recalls), screen time (daily diaries), wellbeing (CHU-9D, WHO-5), and family functioning (McMaster FAD) around their 11th birthday. Following multiple imputation, regression models explored the effects of two interventions (‘Sleep’ vs. ‘Food, Activity and Breastfeeding’ [FAB]) using a 2 × 2 factorial design.
Five hundred twelve children (48% female, mean [SD] age 11.1 [0.1] years) returned for the 11-year assessment (63% of original sample). Significant differences in BMI z-score (mean difference; 95% CI: −0.16; −0.41, 0.08) or the risk of overweight (including obesity) (odds ratio; 95% CI: 0.85; 0.56, 1.29) were no longer observed between children who had received the sleep intervention compared with those who had not. By contrast, children who had received the FAB intervention had greater BMI z-scores (0.24; 0.01, 0.47) and a higher risk of obesity (1.56; 1.03, 2.36) than children not enrolled in FAB. No significant differences were observed in any lifestyle variables nor wellbeing measures across all groups.
Sustained reductions in BMI and obesity risk from an early sleep intervention were not apparent 9 years later, whereas a more traditional lifestyle intervention resulted in increased rates of obesity, not explained by any differences in lifestyle behaviours measured.
ClinicalTrials.gov number NCT00892983, https://clinicaltrials.gov/study/NCT00892983.
Conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) of behavioural and psychological interventions for managing paediatric obesity.
Eligible studies, published between 1985 and 2022, included 0 to 18 year olds with outcomes reported ≥3 months post-baseline, including patient-reported outcome measures (PROMs), cardiometabolic and anthropometric outcomes, and adverse events (AEs). We pooled data using a random effects model and assessed certainty of evidence (CoE) related to minimally important difference estimates for outcomes using GRADE.
We included 73 unique RCTs (n = 6305 participants, 53% female). Intervention types included physical activity (n = 1437), nutrition (n = 447), psychological (n = 1336), technology-based (n = 901) or multicomponent (≥2 intervention types, n = 2184). Physical activity had a small effect on health-related quality of life (HRQoL), varying effects ranging from moderate to very large on blood pressure, lipids and insulin resistance, and a small effect on BMIz. Nutrition had a small effect on lipids, insulin resistance and BMIz. Psychological interventions showed a small effect on HRQoL and triglycerides and moderate benefits on depressive symptoms, while technology interventions showed small benefits on blood pressure and BMIz. Multicomponent interventions had a large benefit on anxiety, small benefit on depressive symptoms, with large to very large benefits on lipids, and small benefits for diastolic blood pressure, insulin resistance and BMIz. AEs were reported infrequently, and when reported, were described as mild.
Physical activity and multicomponent interventions showed improvements in PROMs, cardiometabolic and anthropometric outcomes. Future trials should consistently measure PROMs, evaluate outcomes beyond the intervention period, and study children <6 years of age.
Studies on how birth body mass index (BMI) affects health outcomes in preterm infants are relatively limited.
To analyze the association between BMI at birth and neonatal health outcomes in extremely low and very low birth weight preterm infants in China.
Used data from the Chinese Premature Infant Informatization Platform (2022–2023). Preterm infants were categorized based on their birth BMI z-scores into three groups: low BMI group (< −2), normal BMI group (−2 to 2) and high BMI group (>2). The relationship between BMI and neonatal health outcomes was then analyzed.
The final analysis included 1662 extremely low and very low birth weight preterm infants. The results indicated that low BMI was significantly associated with an increased risk of respiratory distress syndrome (RDS) (AOR 1.61, 95% CI 1.31–2.30), bronchopulmonary dysplasia (BPD) (AOR 1.34, 95% CI 1.00–1.80) and necrotizing enterocolitis (NEC) (AOR 1.57, 95% CI 1.01–2.42). High BMI was significantly associated with an increased risk of RDS (AOR 1.60, 95% CI 1.05–2.45).
BMI at birth is significantly associated with the risks of RDS, BPD and NEC in ELBW and VLBW, highlighting the importance of monitoring BMI as an additional risk predictor in a population of neonates already at high risk for adverse outcomes.
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