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Association Between Picky Eating, Weight Status, Vegetable, and Fruit Intake in Children and Adolescents: Systematic Review and Meta-Analysis. 儿童和青少年挑食、体重状况、蔬菜和水果摄入量之间的关系:系统回顾与元分析》。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-01 Epub Date: 2024-07-11 DOI: 10.1089/chi.2023.0196
Rati Jani, Chris Irwin, Roshan Rigby, Rebecca Byrne, Penelope Love, Farheen Khan, Catalina Larach, Wai Yew Yang, Subhadra Mandalika, Catherine R Knight-Agarwal, Nenad Naumovski, Kimberley Mallan

Aim: Picky eating is a common appetitive trait reported among children and adolescents and may have detrimental effects on their weight, vegetable, and fruit intake, impacting health status. However, an updated systematic review of the literature and summary of effect estimates is required. This study aims to explore the association between picky eating with weight, vegetable and fruit intake, vegetable-only intake, and fruit-only intake. Methods: A systematic literature search of six electronic scientific databases and data extraction was performed between November 2022 and June 2023. Original articles that examined picky eating in association with weight, vegetable and/or fruit intake were included. PRISMA guidelines were followed and meta-analytical and meta-regression analyses were conducted to compute summary effect estimates and explore potential moderators. PROSPERO registration: CRD42022333043. Results: The systematic review included 59 studies of which 45 studies were included in the meta-analysis. Overall, the summarized effect estimates indicated that picky eating was inversely associated with weight [Cohen's dz: -0.27, 95% confidence interval (CI): -0.41 to -0.14, p < 0.0001]; vegetable and fruit intakes (Cohen's dz: -0.35, 95% CI: -0.45, -0.25, p < 0.0001); vegetable-only intake (Cohen's dz: -0.41, 95% CI: -0.56, -0.26, p < 0.0001), and fruit-only intake (Cohen's dz: -0.32, 95% CI: -0.45, -0.20, p < 0.0001). Picky eating was positively associated with underweight (Cohen's dz: 0.46, 95% CI: 0.20, 0.71 p = 0.0008). Conclusion: Although effect sizes were small, picky eating was inversely associated with weight, vegetable, and fruit intakes, and positively associated with underweight in children and adolescents aged birth to 17 years.

目的:据报道,挑食是儿童和青少年中常见的食欲特征,可能会对他们的体重、蔬菜和水果摄入量产生不利影响,从而影响健康状况。然而,我们需要对文献进行最新的系统回顾,并总结效果估计值。本研究旨在探讨挑食与体重、蔬菜和水果摄入量、纯蔬菜摄入量和纯水果摄入量之间的关系。研究方法在 2022 年 11 月至 2023 年 6 月期间,对六个电子科学数据库进行了系统的文献检索和数据提取。纳入了研究挑食与体重、蔬菜和/或水果摄入量相关性的原创文章。研究遵循了PRISMA指南,并进行了元分析和元回归分析,以计算简要效应估计值并探索潜在的调节因素。PROSPERO 注册:CRD42022333043。结果系统综述包括 59 项研究,其中 45 项研究被纳入荟萃分析。总体而言,汇总的效应估计值表明,挑食与体重[Cohen's dz:-0.27,95% 置信区间(CI):-0.41 至 -0.14,p < 0.0001]、蔬菜和水果摄入量(Cohen's dz:-0.35,95% CI:-0.45,-0.25,p <0.0001);纯蔬菜摄入量(Cohen's dz:-0.41,95% CI:-0.56,-0.26,p <0.0001)和纯水果摄入量(Cohen's dz:-0.32,95% CI:-0.45,-0.20,p <0.0001)。挑食与体重不足呈正相关(Cohen's dz:0.46,95% CI:0.20,0.71 p = 0.0008)。结论挑食与体重、蔬菜和水果摄入量呈负相关,与体重不足呈正相关。
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引用次数: 0
High Blood Pressure in Children Aged 3 to 12 Years Old With Overweight or Obesity. 3 至 12 岁超重或肥胖儿童的高血压。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-01 Epub Date: 2024-05-03 DOI: 10.1089/chi.2023.0143
James T Nugent, Kaitlin R Maciejewski, Emily B Finn, Randall W Grout, Charles T Wood, Denise Esserman, Jeremy J Michel, Yuan Lu, Mona Sharifi

Objective: (1) To describe the prevalence of high blood pressure (BP) and the association with BMI in young children with overweight/obesity; (2) to evaluate the accuracy of a single high BP to diagnose sustained hypertension over three visits. Methods: We used pre-intervention data from the Improving Pediatric Obesity Practice Using Prompts (iPOP-UP) trial. We included children aged 3-12 years with BMI ≥85th percentile at well-visits in 2019-2021 at 84 primary care practices in 3 US health systems in the Northeast, Midwest, and South. BP percentiles were calculated from the first visit with BP recorded during the study period. Hypertensive-range BP was defined by the 2017 American Academy of Pediatrics guideline. We tested the association between BMI classification and hypertensive BP using multivariable logistic regression. Results: Of 78,280 children with BMI ≥85th percentile, 76,214 (97%) had BP recorded during the study period (mean 7.4 years, 48% female, 53% with overweight, and 13% with severe obesity). The prevalence of elevated or hypertensive BP was 31%, including 27% in children with overweight and 33%, 39%, and 49% with class I, II, and III obesity, respectively. Higher obesity severity was associated with higher odds of hypertensive BP in the multivariable model. Stage 2 hypertensive BP at the initial visit had specificity of 99.1% (95% confidence interval 98.9-99.3) for detecting sustained hypertension over ≥3 visits. Conclusions: High BP is common in 3- to 12-year-olds with overweight/obesity, with higher obesity severity associated with greater hypertension. Children with overweight/obesity and stage 2 BP are likely to have sustained hypertension and should be prioritized for evaluation. Trial Registration: ClinicalTrials.gov Identifier: NCT05627011.

目的:(1) 描述超重/肥胖幼儿的高血压(BP)患病率及其与体重指数(BMI)的关系;(2) 评估单次高血压诊断三次持续高血压的准确性。方法:我们使用了 "使用提示改进儿科肥胖症实践"(iPOP-UP)试验的干预前数据。我们纳入了2019-2021年在美国东北部、中西部和南部3个医疗系统的84个初级保健诊所进行健康检查时BMI≥85百分位数的3-12岁儿童。血压百分位数从研究期间有血压记录的首次就诊开始计算。高血压范围由 2017 年美国儿科学会指南定义。我们使用多变量逻辑回归法检验了 BMI 分级与高血压之间的关联。结果显示在体重指数≥85百分位数的78280名儿童中,76214名(97%)在研究期间记录了血压(平均7.4岁,48%为女性,53%超重,13%重度肥胖)。血压升高或高血压的发生率为 31%,其中超重儿童为 27%,I 级、II 级和 III 级肥胖儿童分别为 33%、39% 和 49%。在多变量模型中,肥胖严重程度越高,患高血压的几率越高。首次就诊时的第二阶段高血压对检测≥3 次就诊的持续高血压的特异性为 99.1%(95% 置信区间为 98.9-99.3)。结论:高血压常见于3-12岁的超重/肥胖儿童,肥胖严重程度越高,高血压越严重。超重/肥胖且血压处于第二阶段的儿童很可能患有持续性高血压,应优先进行评估。试验注册:ClinicalTrials.gov Identifier:NCT05627011。
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引用次数: 0
Considerations for Interpreting Childhood Obesity Treatment Trials from the COVID-19 Pandemic Era. 解读 COVID-19 大流行时代儿童肥胖症治疗试验的考虑因素。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-01 Epub Date: 2024-04-29 DOI: 10.1089/chi.2024.0232
Bethany Forseth, Bradley M Appelhans, Ann M Davis
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引用次数: 0
Emotional Eating Prevalence and Correlates in Adolescents in the United States. 美国青少年情绪性进食的普遍性及其相关因素。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-01 Epub Date: 2024-07-03 DOI: 10.1089/chi.2023.0184
Katherine M Kidwell, Megan A Milligan, Alexa Deyo, Jillian Lasker, Alison Vrabec

Background: Adolescent obesity rates continue to rise. A better understanding of who engages in emotional eating, a maladaptive eating style, is needed. Despite emotional eating being a frequent research target, the prevalence of emotional eating in US adolescents is currently unknown. Methods: Nationally representative adolescents (n = 1622, m = 14.48 years, 63.8% non-Hispanic White, 50.6% female) reported eating behaviors in the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating (FLASHE) study. Frequencies and one-way ANOVAs were conducted to examine the rates of emotional eating across demographic and weight status groups. Correlations between emotional eating and dietary intake were examined. Results: In total, 30% of adolescents engaged in emotional eating. Older adolescents (35% of 17-year-olds), females (39%), non-Hispanic White individuals (32%), and adolescents with obesity (44%) had significantly higher rates of emotional eating. Controlling for weight status, greater adolescent emotional eating was correlated with more frequent intake of energy-dense/nutrient-poor foods (β = 0.10, p < 0.001), junk food (β = 0.12, p < 0.001), and convenience foods (β = 0.13, p < 0.001). Conclusions: This study fills a critical gap by providing insight into how common adolescent emotional eating is and highlighting demographic factors that are associated with higher rates. Nearly a third of adolescents in the United States reported eating due to anxiety or sadness, with rates higher in older adolescents, girls, non-Hispanic White adolescents, and adolescents with obesity. Emotional eating was associated with consuming less healthy foods, which conveys immediate and long-term health risks. Practitioners can intervene with emotional eating to reduce obesity and comorbid health risks.

背景:青少年肥胖率持续上升:青少年肥胖率持续上升。我们需要更好地了解哪些人会出现情绪化进食这种不适应的进食方式。尽管情绪化进食经常成为研究目标,但目前美国青少年情绪化进食的发生率尚不清楚。研究方法具有全国代表性的青少年(n = 1622,m = 14.48 岁,63.8% 为非西班牙裔白人,50.6% 为女性)在美国国家癌症研究所的家庭生活、活动、阳光、健康和饮食(FLASHE)研究中报告了饮食行为。研究人员通过频率和单因素方差分析来检测不同人口和体重状况组的情绪化进食率。研究还探讨了情绪化饮食与饮食摄入量之间的相关性。结果显示共有 30% 的青少年有情绪化进食行为。年龄较大的青少年(占 17 岁青少年的 35%)、女性(39%)、非西班牙裔白人(32%)和肥胖青少年(44%)的情绪化进食率明显更高。在控制体重状况的前提下,青少年情绪化饮食与更频繁地摄入高能量/低营养食物(β = 0.10,p < 0.001)、垃圾食品(β = 0.12,p < 0.001)和方便食品(β = 0.13,p < 0.001)相关。结论这项研究填补了一项重要空白,让我们了解了青少年情绪化饮食的普遍程度,并强调了与高发率相关的人口因素。据报告,美国近三分之一的青少年因焦虑或悲伤而进食,其中年龄较大的青少年、女孩、非西班牙裔白人青少年和肥胖青少年的进食率更高。情绪化进食与摄入较少的健康食品有关,会带来直接和长期的健康风险。医生可以对情绪化进食进行干预,以减少肥胖和并发症的健康风险。
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引用次数: 0
Disparities in Obesogenic Environments by Income, Race/Ethnicity, and Rurality Across All US Counties. 美国各县按收入、种族/族裔和乡村划分的肥胖环境差异。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-01 Epub Date: 2024-07-03 DOI: 10.1089/chi.2024.0217
Andrew T Kaczynski, Marilyn E Wende, Caylin A Eichelberger, Farnaz Hesam Shariati

Background: Research is needed to explore inequities in physical activity (PA) and access to healthy eating resources for children on a national scale. This study examined disparities in childhood obesogenic environments across all United States (US) counties by income and race/ethnicity and their interaction with county rurality. Methods: Data for four PA variables (exercise opportunities, school proximity, walkability, crime) and six nutrition variables (grocery stores, farmers markets, fast-food restaurants, full-service restaurants, convenience stores, and births at baby-friendly hospitals) were collected for all US counties (n = 3142) to comprise the Childhood Obesogenic Environment Index (COEI). Variables were ranked and allocated a percentile for each county, and a total obesogenic environment score was created by averaging variable percentiles. Analysis of variance was used to assess differences by tertiles of county-level median household income (low/intermediate/high) and percentage of non-Hispanic (NH) White residents (low/intermediate/high). Interaction tests were used to assess effect modification by rurality, and stratified results were presented for all significant interactions. Results: There were significant differences in COEI values according to tertiles of median household income (F = 260.9, p < 0.0001). Low-income counties (M = 54.3, SD = 8.3) had worse obesogenic environments than intermediate (M = 49.9, SD = 7.9) or high (M = 45.9, SD = 8.8) income counties. There was also a significant interaction between rurality and median household income (F = 13.9, p < 0.0001). Similarly, there were significant differences in COEI values according to tertiles of race/ethnicity (F = 34.5, p < 0.0001), with low percentage NH White counties (M = 51.8, SD = 9.8) having worse obesogenic environment scores than intermediate (M = 48.7, SD = 8.4) or high (M = 49.5, SD = 8.5) NH White counties. There was also a significant interaction between rurality and race/ethnicity (F = 13.9, p < 0.0001). Conclusion: Low-income counties and those with more racial/ethnic minority residents, especially in rural areas, had less supportive PA and healthy eating environments for youth. Targeted policy and environmental approaches that aimed to address concerns specific to underserved communities are needed.

背景:需要在全国范围内开展研究,探讨儿童在体育活动(PA)和获得健康饮食资源方面的不平等现象。本研究按收入、种族/族裔及其与乡村地区的交互作用,考察了美国所有县的儿童肥胖环境差异。研究方法:收集了美国所有县(n = 3142)的四个运动变量(锻炼机会、学校邻近程度、步行能力、犯罪率)和六个营养变量(杂货店、农贸市场、快餐店、全套服务餐馆、便利店和在爱婴医院分娩)的数据,以组成儿童致肥胖环境指数(COEI)。对每个县的变量进行排序并分配百分位数,通过平均变量百分位数得出致肥胖环境总分。方差分析用于评估县级家庭收入中位数(低/中/高)和非西班牙裔(NH)白人居民百分比(低/中/高)的差异。交互检验用于评估乡村地区的效应修正,所有显著交互检验的分层结果均已列出。结果根据家庭收入中位数的分层,COEI 值存在明显差异(F = 260.9,p < 0.0001)。低收入县(M = 54.3,SD = 8.3)的致肥环境比中等收入县(M = 49.9,SD = 7.9)或高收入县(M = 45.9,SD = 8.8)更差。农村地区与家庭收入中位数之间也存在明显的交互作用(F = 13.9,P < 0.0001)。同样,不同种族/族裔的 COEI 值也存在显著差异(F = 34.5,P < 0.0001),低百分比的 NH 白人县(M = 51.8,SD = 9.8)的致肥环境得分低于中等百分比(M = 48.7,SD = 8.4)或高百分比(M = 49.5,SD = 8.5)的 NH 白人县。农村地区与种族/族裔之间也存在明显的交互作用(F = 13.9,P < 0.0001)。结论:低收入县和少数民族居民较多的县,尤其是农村地区的县,对青少年的 PA 和健康饮食环境支持较少。需要采取有针对性的政策和环境方法来解决服务不足社区的具体问题。
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引用次数: 0
A Latent Class Analysis of Family Eating Behaviors and Home Environment Habits on Preschool-Aged Children's Body Mass Index. 家庭饮食行为和家庭环境习惯对学龄前儿童体重指数的潜类分析。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-01 Epub Date: 2024-07-11 DOI: 10.1089/chi.2024.0243
Jennifer E Carroll, Jennifer A Emond, Nicole VanKim, Elizabeth Bertone-Johnson, Susan R Sturgeon

Background: The etiology of obesity is multifaceted, with multiple risk factors occurring during early childhood (e.g., fast food frequency, eating dinner as a family, TV in the bedroom). Many past studies have largely considered obesity risk factors in isolation, when in reality, the risk factors likely cluster together. A latent class analysis can be used to identify patterns in child eating behaviors, parent feeding behaviors, and household habits among preschool-aged children and their families to identify distinct, heterogenous classes and to determine if classes are associated with overweight and obesity. Methods: We used data from a community-based study of 624 three- to five-year-old children and a parent in New Hampshire, from March 2014 to October 2015. Parent-reported data were used to determine frequency of eating behaviors and household habits. Height and weight were objectively measured. Results: Four classes were identified; Class 1: "Healthy/Mildly accommodating," Class 2: "Healthy/Accommodating," Class 3: "Moderately healthy/Moderately accommodating," and Class 4: "Least healthy/Least accommodating." Compared with Class 1, children in Class 4 had increased odds of being overweight or obese [adjusted odds ratio (aOR): 1.64, 95% confidence interval (CI): 1.13-2.15], whereas Classes 2 and 3 were not associated with BMI (Class 2: aOR: 1.24, 95% CI: 0.62-1.86; Class 3: aOR: 1.31, 95% CI: 0.81-1.81). Conclusion: Study findings highlight that child-parent interactions around meals differentially relate to children's weight status given the context of children's eating habits. Most important, our study findings confirm the importance of adapting multiple healthy habits within the home social and physical environment to offset obesity risk in young children.

背景:肥胖症的病因是多方面的,在儿童早期就存在多种风险因素(如快餐频率、全家共进晚餐、卧室看电视)。过去的许多研究大多孤立地考虑肥胖风险因素,而实际上,这些风险因素很可能聚集在一起。潜类分析可用于识别学龄前儿童及其家庭中儿童饮食行为、父母喂养行为和家庭习惯的模式,以确定不同的异质性类别,并确定这些类别是否与超重和肥胖有关。研究方法我们使用了 2014 年 3 月至 2015 年 10 月对新罕布什尔州 624 名三至五岁儿童和一名家长进行的社区研究数据。家长报告数据用于确定饮食行为频率和家庭习惯。身高和体重进行了客观测量。结果显示确定了四个等级:第1级:"健康/轻度迁就";第2级:"健康/迁就";第3级:"中度健康/中度迁就";第4级:"最不健康/最不迁就"。与 1 级相比,4 级儿童超重或肥胖的几率增加[调整后的几率比(aOR):1.64,95% 置信区间(CI):1.13-2.15],而 2 级和 3 级与 BMI 无关(2 级:aOR:1.24,95% CI:0.62-1.86;3 级:aOR:1.31,95% CI:0.81-1.81)。结论研究结果表明,在儿童饮食习惯的背景下,儿童与父母在进餐时的互动与儿童的体重状况有着不同的关系。最重要的是,我们的研究结果证实了在家庭社会和物理环境中培养多种健康习惯对抵消幼儿肥胖风险的重要性。
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引用次数: 0
The Association Between a Neighborhood Adverse Childhood Experiences Index and Body Mass Index Among New York City Youth. 纽约市青少年中邻里不良童年经历指数与身体质量指数之间的关系》(The Association Between a Neighborhood Adverse Childhood Experiences Index and Body Mass Index Among New York City Youth)。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-01 Epub Date: 2024-07-03 DOI: 10.1089/chi.2024.0215
Krista Schroeder, Levent Dumenci, Sophia E Day, Kevin Konty, Jennie G Noll, Kevin A Henry, Shakira F Suglia, David C Wheeler, Kira Argenio, David B Sarwer

Background: The role of neighborhood factors in the association between adverse childhood experiences (ACEs) and body mass index (BMI) has not been widely studied. A neighborhood ACEs index (NAI) captures neighborhood environment factors associated with ACE exposure. This study examined associations between BMI and an NAI among New York City (NYC) youth. An exploratory objective examined the NAI geographic distribution across NYC neighborhoods. Methods: Data for students attending NYC public general education schools in kindergarten-12th grade from 2006-2017 (n = 1,753,867) were linked to 25 geospatial datasets capturing neighborhood characteristics for every census tract in NYC. Multivariable hierarchical linear regression tested associations between BMI and the NAI; analyses also were conducted by young (<8 years), school age (8-12 years), and adolescent (>12 years) subgroups. In addition, NAI was mapped by census tract, and local Moran's I identified clusters of high and low NAI neighborhoods. Results: Higher BMI was associated with higher NAI across all sex and age groups, with largest magnitude of associations for girls (medium NAI vs. low NAI: unstandardized β = 0.112 (SE 0.008), standardized β [effect size] = 0.097, p < 0.001; high NAI vs. low NAI: unstandardized β = 0.195 (SE 0.008), standardized β = 0.178, p < 0.001) and adolescents (medium NAI vs. low NAI: unstandardized β = 0.189 (SE 0.014), standardized β = 0.161, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.364 (SE 0.015), standardized β = 0.334, p < 0.001 for adolescent girls; medium NAI vs. low NAI: unstandardized β = 0.122 (SE 0.014), standardized β = 0.095, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.217 (SE 0.015), standardized β = 0.187, p < 0.001 for adolescent boys). Each borough of NYC included clusters of neighborhoods with higher and lower NAI exposure, although clusters varied in size and patterns of geographic dispersion across boroughs. Conclusions: A spatial index capturing neighborhood environment factors associated with ACE exposure is associated with higher BMI among NYC youth. Findings complement prior literature about relationships between neighborhood environment and obesity risk, existing research documenting ACE-obesity associations, and the potential for neighborhood factors to be a source of adversity. Collectively, evidence suggests that trauma-informed place-based obesity reduction efforts merit further exploration as potential means to interrupt ACE-obesity associations.

背景:邻里因素在童年不良经历(ACE)与体重指数(BMI)之间的关联中的作用尚未得到广泛研究。邻里ACE指数(NAI)捕捉了与ACE暴露相关的邻里环境因素。本研究探讨了纽约市青少年的体重指数与邻里ACE指数之间的关系。一项探索性目标是研究 NAI 在纽约市各社区的地理分布情况。研究方法:将 2006 年至 2017 年纽约市公立普通教育学校幼儿园至 12 年级学生的数据(n = 1,753,867 人)与 25 个地理空间数据集链接,捕捉纽约市每个人口普查区的邻里特征。多变量分层线性回归测试了体重指数与 NAI 之间的关联;还按年龄(12 岁)分组进行了分析。此外,还按人口普查区绘制了 NAI 图,并通过当地的 Moran's I 确定了 NAI 高和 NAI 低的社区集群。研究结果在所有性别和年龄组中,较高的体重指数与较高的 NAI 相关,其中女孩的相关程度最高(中 NAI 与低 NAI 之比:非标准化 β = 0.112(SE 0.008), standardized β [effect size]=0.097, p < 0.001; high NAI vs. low NAI: unstandardized β = 0.195 (SE 0.008), standardized β = 0.178, p < 0.001) and adolescents (medium NAI vs. low NAI: unstandardized β = 0.189 (SE 0.014), standardized β = 0.161, p < 0.001, 高 NAI vs. 低 NAI: unstandardized β = 0.364 (SE 0.015), standardized β = 0.334, p < 0.001 for adolescent girls; medium NAI vs. low NAI: unstandardized β = 0.178, p < 0.001.高 NAI 对低 NAI:未标准化 β = 0.122(SE 0.014),标准化 β = 0.095,p<0.001;高 NAI 对低 NAI:未标准化 β = 0.217(SE 0.015),标准化 β = 0.187,p<0.001(青少年男孩)。纽约市的每个区都包括非净入学率较高和较低的社区集群,但各区集群的规模和地理分布模式各不相同。结论捕捉与ACE暴露相关的邻里环境因素的空间指数与纽约市青少年较高的体重指数有关。研究结果补充了之前关于邻里环境与肥胖风险之间关系的文献、记录 ACE 与肥胖关系的现有研究,以及邻里因素成为逆境来源的可能性。总之,有证据表明,以创伤为基础的地方性减少肥胖工作值得进一步探索,以作为中断 ACE 与肥胖关联的潜在手段。
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引用次数: 0
Socio-Ecologic Influences on Weight Trajectories Among Children with Obesity Living in Rural and Urban Settings. 生活在农村和城市环境中的肥胖儿童体重轨迹的社会生态影响因素。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-01 Epub Date: 2024-07-08 DOI: 10.1089/chi.2023.0193
Zoe Barbour, Cynthia Mojica, Hector Olvera Alvarez, Byron Alexander Foster

Background: Childhood obesity is a risk factor for poor cardiovascular, metabolic, and respiratory health. The studies examining influences of socio-ecologic factors on weight trajectories using longitudinal data are limited, often examine single measures (e.g., proximity to parks), and have not examined the specific trajectories of children with obesity. Methods: We examined influences on weight among 1518 children, 6-12 years of age, who had obesity using body mass index (BMI) criteria. BMI slope trajectories were categorized as decreasing, flat, or increasing, with a median of 2.1 years of follow-up. We examined socio-ecologic exposures, stratified by rural and urban settings, using census tracts to map indices, including food access, proximity to parks, normalized difference vegetation index, and area deprivation index (ADI). We used ordinal logistic regression to examine the associations between the socio-ecologic factors and BMI trajectories. Results: Among the 1518 children, 360 (24%) had a decreasing BMI trajectory with the remainder having flat (23%) or increasing (53%) trajectories. Children in rural areas were more likely to live in high disadvantage areas, 85%, compared with urban children, 46%. In the multivariable ordinal model, living in a lower ADI census tract had a 0.78 (95% CI 0.61-0.99) lower odds of being in an increasing BMI slope group, and no other socio-ecologic factor was associated. Conclusions: The area deprivation index captures a range of resources and social context compared with the built environment indicators, which had no association with BMI trajectory. Further work examining how to develop effective interventions in high deprivation areas is warranted.

背景:儿童肥胖症是心血管、代谢和呼吸系统健康不良的风险因素。利用纵向数据研究社会生态因素对体重轨迹影响的研究非常有限,而且通常只研究单一指标(如是否靠近公园),没有研究肥胖儿童的具体轨迹。方法:我们以体重指数(BMI)为标准,研究了 1518 名 6-12 岁肥胖儿童的体重影响因素。BMI 斜率轨迹分为下降、持平或上升,中位随访时间为 2.1 年。我们利用人口普查区绘制指数图,包括食物获取途径、靠近公园的程度、归一化差异植被指数和地区剥夺指数(ADI),按农村和城市环境对社会生态暴露进行了研究。我们使用序数逻辑回归法研究了社会生态因素与体重指数轨迹之间的关联。研究结果在 1518 名儿童中,360 人(24%)的体重指数呈下降趋势,其余儿童的体重指数呈持平(23%)或上升(53%)趋势。与城市儿童(46%)相比,农村儿童更有可能生活在高度贫困地区(85%)。在多变量序数模型中,生活在 ADI 较低人口普查区的儿童处于 BMI 上升斜率组的几率为 0.78(95% CI 0.61-0.99),而其他社会生态因素均与之无关。结论与建筑环境指标相比,地区贫困指数捕捉到了一系列资源和社会背景,而建筑环境指标与 BMI 轨迹没有关联。有必要进一步研究如何在高度贫困地区制定有效的干预措施。
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引用次数: 0
Perceived Responsibility for Bariatric Surgery, Eating, and Exercise Behaviors Among Adolescent Bariatric Surgery Candidates. 青少年减肥手术候选者对减肥手术、饮食和运动行为的责任感。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-01 Epub Date: 2024-07-25 DOI: 10.1089/chi.2024.0228
Mary Beth McCullough, Allison Cunning, Rebecca Klam, Amy L Weiss, Diana Rancourt

Background: Adolescents' perceived responsibility for weight management behaviors has yet to be studied in relation to bariatric surgery. The current study examined perceived responsibility to pursue bariatric surgery and engage in specific weight management behaviors among adolescents seeking bariatric surgery and its associations with demographic, family support, and eating disorder symptoms. Methods: Data were collected using retrospective chart review of adolescent bariatric surgery candidates presenting to a tertiary interdisciplinary clinic. Data included demographics and adolescents' self-report of (1) perceived responsibility (i.e., primarily adolescent; primarily parent; shared) for the decision to pursue bariatric surgery and weight management behaviors, (2) family support for eating and exercise behaviors, and (3) eating disorder symptoms. Analyses included one-way analysis of covariance, chi-squared tests, and Kruskal-Wallis tests. Results: Participants reporting primarily teen or shared responsibility for seeking bariatric surgery were older than those reporting primarily parent responsibility (p = 0.023). Teens perceiving primary responsibility for their own healthy eating reported less family encouragement for healthy eating (p = 0.011) and more eating disorder symptoms (p = 0.002) than those reporting primarily parent or shared responsibility. Teens reporting primary responsibility for exercise reported less family encouragement for healthy eating (p = 0.012) compared with those reporting shared responsibility. Conclusions: This study is the first to provide a description of health behavior responsibilities in a sample of adolescents with severe obesity seeking bariatric surgery. Not only will these insights improve our understanding of this population, but it can also inform presurgical discussions with adolescents and their parents.

背景:青少年对体重管理行为的责任感与减重手术的关系尚待研究。本研究调查了寻求减肥手术的青少年对进行减肥手术和参与特定体重管理行为的责任感及其与人口统计学、家庭支持和饮食失调症状的关系。研究方法通过对一家三级跨学科诊所的青少年减肥手术申请者进行回顾性病历审查来收集数据。数据包括人口统计学特征和青少年对以下方面的自我报告:(1)决定进行减肥手术和体重管理行为的责任感(即主要由青少年承担;主要由父母承担;共同承担);(2)家庭对饮食和运动行为的支持;以及(3)饮食失调症状。分析包括单因子协方差分析、卡方检验和 Kruskal-Wallis 检验。结果显示在寻求减肥手术方面,报告主要由青少年或共同承担责任的参与者比报告主要由父母承担责任的参与者年龄更大(P = 0.023)。与父母或共同承担主要责任的青少年相比,认为自己对健康饮食负有主要责任的青少年在健康饮食方面得到的家庭鼓励较少(p = 0.011),出现的饮食失调症状较多(p = 0.002)。与报告共同承担责任的青少年相比,报告主要负责锻炼的青少年在健康饮食方面得到的家庭鼓励较少(p = 0.012)。结论:本研究首次对寻求减肥手术的重度肥胖青少年的健康行为责任进行了描述。这些见解不仅能增进我们对这一人群的了解,还能为与青少年及其父母进行术前讨论提供参考。
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引用次数: 0
The Effect of an Obesity Prevention Intervention Among Specific Subpopulations: A Heterogeneity of Treatment Effect Analysis of the Greenlight Trial. 预防肥胖干预措施在特定亚人群中的效果:绿光试验的治疗效果异质性分析》。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-01 Epub Date: 2024-05-08 DOI: 10.1089/chi.2023.0171
William J Heerman, H Shonna Yin, Jonathan S Schildcrout, Aihua Bian, Russell L Rothman, Kori B Flower, Alan M Delamater, Lee Sanders, Charles Wood, Eliana M Perrin

Background: Understanding how different populations respond to a childhood obesity intervention could help optimize personalized treatment strategies, especially with the goal to reduce disparities in obesity. Methods: We conducted a secondary analysis of the Greenlight Cluster Randomized Controlled Trial, a health communication focused pediatric obesity prevention trial, to evaluate for heterogeneity of treatment effect (HTE) by child biological sex, caregiver BMI, caregiver reported race and ethnicity, primary language, and health literacy. To examine HTE on BMI z-score from 2 to 24 months of age, we fit linear mixed effects models. Results: We analyzed 802 caregiver-child pairs, of which 52% of children were female, 58% of households reported annual family income of <$20,000, and 83% did not have a college degree. We observed evidence to suggest HTE by primary language (p = 0.047 for Spanish vs. English) and the combination of primary language and health literacy (p = 0.01). There was insufficient evidence to suggest that the Greenlight intervention effect differed by biological sex, caregiver BMI, or by race/ethnicity. Conclusions: This HTE analysis found that the Greenlight obesity prevention intervention had a more beneficial effect on child BMI z-score over 2 years for children of caregivers with limited health literacy and for caregivers for whom Spanish was the primary language.

背景:了解不同人群对儿童肥胖症干预措施的反应有助于优化个性化治疗策略,尤其是为了减少肥胖症的差异。研究方法我们对 "绿光集群随机对照试验"(一项以健康传播为重点的儿科肥胖预防试验)进行了二次分析,以评估治疗效果(HTE)在儿童生理性别、照顾者体重指数、照顾者报告的种族和民族、主要语言和健康素养方面的异质性。为了研究 2 到 24 个月大时 BMI z 分数的 HTE,我们建立了线性混合效应模型。结果:我们分析了 802 对照顾者-儿童组合,其中 52% 的儿童为女性,58% 的家庭报告了家庭年收入(西班牙语与英语的比较 p = 0.047)以及主要语言和健康素养的组合(p = 0.01)。没有足够的证据表明 "绿光 "干预效果因生理性别、照顾者体重指数或种族/民族而异。结论:这项HTE分析发现,对于健康素养有限的看护者和以西班牙语为主要语言的看护者,绿光预防肥胖干预措施在2年内对儿童的BMI z-score有更有益的影响。
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引用次数: 0
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Childhood Obesity
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