Childhood Obesity最新文献

Background: Enhancing the quality of Family Child Care Home (FCCH) meals is an opportunity to impact children's diet and health. The purpose of this study is to assess Happy Healthy Homes (HHH) randomized controlled trial impact on health-related foods and nutrients served to and consumed by young children and achievement of Child and Adult Care Food Program (CACFP) requirements and best practices. Methods: Forty-five CACFP participating FCCHs in a moderately sized midwestern city were recruited in 2017-2018 and randomized to nutrition intervention (NUT n = 24) or control (CON n = 21). Participants received two in-home, individual 90-minute education sessions, one 3-hour small group class, and a 15-minute check-in phone call over 3 months. Outcomes include 3- and 12-month served and consumed fiber, sugar, grains, vegetables, and fruit and achievement of CACFP Best Practices. Primary analyses at 12 months used a mixed model under an intent-to-treat paradigm to account for repeated measures on participants with 3-month outcomes. Sensitivity analyses were completed on those with complete 12-month measures. Results: There were no statistically significant group-by-time effects for foods served, consumed, or CACFP Best Practices score in the primary analysis. However, in sensitivity analysis, the CACFP Best Practice score (out of 18) increased in NUT +0.5 from 8.9 ± 1.5 at baseline at 12 months and decreased -0.9 in CON from 9.9 ± 1.7 at baseline, group by time p = 0.05. Conclusions: The HHH intervention did improve the CACFP Best Practices score for lunches served. The study's effect may have been limited due to sample size and attrition. Trial Registration: Clinicaltrials.gov, NCT03560050. Retrospectively registered on 23 May 2018. First participant enrolled October 2017.

Background: Examining sedentary time (ST) by disaggregating the day into periods such as before, during, and after preschool allows interventionists to understand when sedentary behaviors are most severe. This study aimed to determine if there are sex differences in ST before, during, and after preschool hours in US preschoolers. Methods: A secondary analysis of a two-cohort study with a sample size of 292 preschoolers (67% African Americans/Blacks; 100% from low-income families) was used. Measures were collected in Fall 2017 and Fall 2018. Preschoolers wore an accelerometer on the non-dominant wrist for 8 consecutive days to obtain ST minutes before, during, and after preschool periods. Three separate linear regressions were conducted to test sex differences in ST before, during, and after preschool hours. ST for each period of the day was considered the outcome variable predicted by sex and covarying for BMI percentile. Results: Girls were more sedentary than boys during preschool (F (1, 226) = 5.15, p = 0.006; b = -0.09 [-0.15, -0.03]), but not before preschool (F(1, 225) = 0.98, p = 0.32; b = 2.50 [-2.46, 7.45]) nor after preschool (F(1, 227) = 3.62, p = 0.06; b = 6.60 [-0.21, 13.42]). Conclusions: This difference in ST could have an unfavorable health impact among preschool girls. Given that childhood obesity prevalence dramatically increases from preschool age to childhood, there is a need to design family-based interventions that provide parents/caregivers strategies to develop habits around healthy eating and physical activity that they can carry into later life stages.

Background: The COVID-19 pandemic has exacerbated the obesity epidemic, with both adults and children demonstrating rapid weight gain during the pandemic. However, the impact of having a COVID-19 diagnosis on this trend is not known. Methods: Using longitudinal data from January 2019 to June 2023 collected by the US National Institute for Health's National COVID Cohort Collaborative (N3C), children (age 2-18 years) with positive COVID-19 test results {n = 11,474, 53% male, mean [standard deviation (SD)] age 5.57 [±3.29] years, 54% White, mean [SD] 5.2 [±2.9] BMI observations per participant} were matched with COVID-19-negative children with identical demographic characteristics and similar observation window. We compared BMI percentile trajectories between the COVID-19-positive and COVID-19-negative cohorts, with further evaluation performed on COVID-19-positive patients stratified by hospitalization status. Results: COVID-19-positive patients had a greater increase in $\%BM{I}_{p95}$ than COVID-19-negative patients (average increase of 2.34 (±7.73) compared to 1.46 (±6.09), p < 0.0005). COVID-19-positive patients gained more weight after their diagnosis of COVID-19 than before. Nonhospitalized children gained more weight than hospitalized children [average increase in $\%BM{I}_{p95}$ of 2.38 (±7.65) compared to 1.87 (±8.54)]. Mixed-effect regression analyses demonstrated that these associations remained even after adjusting for time, demographics, and baseline $\%BM{I}_{p95}$. Conclusions: Having a COVID-19 diagnosis was associated with more rapid weight gain, especially after diagnosis and early in the pandemic. Future research should explore the reasons for this association and the implications for future health emergencies.

Background: We aimed to quantify associations of cardiovascular (CV) large and small artery measures with body composition and body mass (1) separately and (2) in combination in 11- to 12-year-old children and their parents. Methods: In the population-based cross-sectional Child Health CheckPoint study (1495 children, mean 12 ± 0.4 years, 49.3% girls; 1496 parents, mean 44.3 ± 5.0 years, 86.7% mothers), we measured weight, height, body composition [truncal fat, non-truncal fat, fat-free mass (FFM)], and CV functional (blood pressure, pulse wave velocity, arterial elasticity) and structural (carotid intima-media thickness, retinal arteriolar/venular caliber) outcomes. Using compositional data analyses, we examined associations of body composition (expressed as log ratios) and body mass (multiplicative total) with CV measures in separate and combined models. Results: Mean BMI z-score was 0.3 in children [standard deviation (SD) 1.0, 4.5% obese], and mean BMI was 27.9 in parents (SD 6.1, 28.8% obese). In both children and adults, more adverse CV measurements were associated with higher %truncal fat, %non-truncal fat, and body mass and lower %FFM. Compared with normal-weight children, children with obesity had poorer CV measures (e.g., 1 SD faster pulse wave velocity, 0.5 SD lower arterial elasticity), with higher body mass and lower %FFM mainly accounting for these relationships. All relationships were similar, albeit larger, for parents. Conclusion: Poorer CV health in both generations was associated with higher body mass, lower %FFM, and, to a lesser extent, higher %truncal and non-truncal fat. Trials could test whether weight reduction interventions with vs. without FFM preservation differentially improve CV functional and structural precursors.

Existing studies that have demonstrated a positive association between obesity and depression have been among adults, did not utilize the Patient Health Questionnaire (PHQ), or were conducted in a homogenous patient population. In this retrospective longitudinal cohort study of patients >11 and <18 years old with obesity in one health system we analyzed associations between change in BMI between two BMI measurements and PHQ-9 scores using chi-square and Kruskal-Wallis tests. We used PHQ-9 scores dichotomized at

Background: There are now four FDA-approved anti-obesity medications (AOMs) for youth ≥12 years, which can be effective therapies to treat obesity and obesity-related comorbidities. Objectives: This study describes parent/guardian (caregiver) openness to using AOMs for adolescents with obesity and evaluates factors that may contribute to openness. Methods: Caregivers of adolescents aged 12-17 years were surveyed. Self-reported height, weight, demographic information, family, and personal history of obesity or obesity-related comorbidities were collected. Participants rated their openness to starting an AOM for their child for obesity alone or obesity-related comorbidities on a 7-point Likert scale. A Likert rating of less than 4 was considered "less open" versus 4-7 was considered "more open." Results: A total of 344 participants completed the survey. Average openness toward AOM use for obesity as the only indication (as opposed to comorbid conditions) was 3.2 ± 1.74. Caregivers who were knowledgeable that the FDA-approved AOM use in adolescents had greater odds of being open to using these medications compared with caregivers who were not knowledgeable (odds ratio: 2.18; 95% confidence interval: 1.25-2.86). Conclusions: Caregivers reported openness to starting an AOM if they had prior knowledge of these medications, highlighting the need for family education on AOM use and indications.

It is unknown if children and youth who live in rural or "less rural" locations who enroll in the provincially funded Generation Health Clinic (British Columbia, Canada), a family-based lifestyle program for weight management, present with different health behaviors at baseline. Thus, we assessed sociodemographic and health behavior (diet, physical activity, and sleep) collected between 2015 and 2019. Data were stratified by age (children: ≤12 years; adolescents: ≥13 years) and geographical location ("less urban" and urban) based on Statistics Canada definitions and then analyzed using independent t-tests and chi-square tests. We found that more "urban" children consumed more daily family meals (p < 0.001), ate out weekly (p = 0.02), ate "other" vegetables (p = 0.002), and had less frequent sports drink consumption (p < 0.001) compared with less urban children. No significant differences in health behaviors were seen in adolescents. These findings suggest that a participant's geographical location should be considered when developing family-based interventions for weight management.

Objective: Relationships between gonadotropins, sex hormones, and vascular structure and function in adolescents of varying weight statuses have not been fully investigated. In the present study, we examined associations among these in female and male adolescents with normal weight or obesity. Methods: We performed a cross-sectional analysis of adolescents (n = 58; 12-<18 years) grouped according to BMI percentile (BMI%) into normal weight (5th-<85th BMI%; n = 25) and obesity (≥95th BMI%; n = 33) categories. Fasting blood samples were collected to measure follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estradiol. Vascular function was measured via ultrasonography for measures of carotid artery diameter compliance (cDC), incremental elastic modulus (cIEM), and brachial artery flow mediated dilation (FMD). Results: Females with obesity had a significantly (p = 0.009) greater mean FMD compared with those with normal weight. FSH, LH, testosterone, and estradiol did not differ between normal weight and obesity groups in either sex. After adjusting for age and multiple comparisons, higher testosterone was associated with decreased cDC (R² = 0.189; p = 0.018) and increased cIEM (R² = 0.346; p = 0.002) across all females. In all males, higher estradiol was associated with decreased cDC (R² = 0.404; p = 0.006) and increased cIEM (R² = 0.411; p = 0.003). Conclusion: We found that testosterone and estradiol were associated with vascular measures in female and male adolescents, respectively. Future studies are needed to confirm these relationships in larger cohorts and among those with BMIs in the overweight (85th-<95th BMI%) and severe obesity (BMI ≥120% of the 95th percentile and/or ≥35 kg/m²) categories.

Background: Steatotic liver disease (SLD) represents a multisystem disease and is a common complication of childhood obesity. We studied fat content at the abdominal level (liver, subcutaneous, and visceral) and the response to childhood obesity management. Methods: In this retrospective longitudinal study, 8-18-year-olds with a body mass index (BMI) z-score above 1.28 (corresponding to a BMI above the 90th percentile), as a proxy for obesity, were offered person-centered, family-oriented obesity management in a hospital setting and in a magnetic resonance (MR) scan. Liver fat content (LFC) was assessed by MR spectroscopy, whereas subcutaneous adipose tissue and visceral adipose tissue (VAT) were assessed by MR imaging. We conducted nonparametric tests to evaluate baseline-to-follow-up changes and comparisons between participants with and without an MR assessment. Additionally, a logistic regression model examined the association between changes in LFC and BMI z-score. Results: The study group comprised 1002 children and adolescents (52% females) with an MR assessment at baseline. The median age was 13.0 years, the median BMI was 28.4, and the BMI z-score was 2.90. At baseline, 378 (38%) exhibited SLD defined by an LFC above 1.5%. Among the 322 with a follow-up MR scan, 76% of the patients with SLD reduced their LFC. BMI z-score and VAT (both p < 0.001) were reduced during intervention. Conclusions: SLD is highly prevalent (38%) in children and adolescents with obesity. A chronic care obesity management model reduced the fat content in the liver, the visceral fat, and the degree of obesity.

Background: To examine longitudinal associations of early neighborhood Child Opportunity Index 2.0 (COI) with children's BMI trajectories and identify whether household economic resources moderate relations of COI in infancy/toddlerhood and the preschool years to longitudinal BMI growth between 2 and 12 years. Methods: Family data (n = 1091) were drawn from the Family Life Project, a longitudinal study of families residing in rural high-poverty areas. Neighborhood COI was obtained for each developmental period: infancy/toddlerhood (2-15 months) and the preschool years (2-5 years). BMIs were created from anthropometrics collected at six time points. Results: Higher neighborhood COIs during the infancy/toddlerhood (β = -0.0130, p < 0.01) and preschool years (β = -0.0093, p < 0.05) were associated with lower BMI at 5 years of age; although the latter became nonsignificant after adjusting for infancy/toddlerhood COI. Both household income and time spent in poverty moderated associations of infancy/toddlerhood exposure to neighborhood COI with BMI change. Among children residing in not poor households, higher neighborhood level child opportunity was associated with a slower increase in BMI from 2 to 12 years (β = -0.0369, p < 0.05), and a lower BMI at 12 years (β = -0.0395, p < 0.05). Conclusions: Neighborhood COI during the infant and toddler years is longitudinally associated with child growth, and long-term associations are evident among children residing in not poor households. Future work is needed to better understand how family and neighborhood-level resources interact to influence obesity risk, particularly for those at high risk.