Childhood Obesity最新文献

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.

Background: Early childhood education (ECE) educators play an instrumental role in children's health and development but unfortunately have poor health themselves. This project examined the physical and psychological health of New York licensed ECE educators. Methods: A sequential, explanatory mixed methods design (quan→QUAL) consisted of a 110-item survey and semi-structured interviews to examine physical (diet, physical activity [PA], sleep, and body mass index [BMI]) and psychological health (stress and burnout). Quantitatively, multiple linear regressions tested associations between physical and psychological health, controlling for age and income, using R (v4.3.2, 2023); α < 0.05. Qualitatively, content analysis with pattern recognition for pragmatic synthesis was performed. Results: Survey respondents (n = 1423) and interview participants (n = 36) worked in a variety of ECE settings; 74% had overweight/obesity and 24% deemed themselves "unhealthy." Many had poor health behaviors-low diet quality (74%), limited regular PA (28%), poor sleep quality (34%), and moderate/high stress levels (74%). Most desired changes to health behaviors but were challenged due to work environments and job demands. Work-based factors impacted both their physical and mental health and influenced their personal life. Burnout and stress were high, and feelings of underappreciation were prevalent. Higher burnout (emotional exhaustion) was significantly associated with higher BMI (β = 0.18, p < 0.01) and stress (β = 1.09, p < 0.01) and lower PA (β = 2.62, p < 0.01) and sleep (β = 0.94, p < 0.01). Conclusion: ECE educators are experiencing high stress/burnout, have poor health behaviors, and have high prevalence of obesity. Workplace health promotion efforts are needed to improve educators' health and potentially that of the children in their care.

The importance of establishing national surveillance systems to monitor physical activity promotion is well recognized. This article outlines the methodological process undertaken to develop an evaluation rubric for assessing state licensing regulations alignment with the National Physical Activity Plan Education Sector Early Childhood Education (ECE) strategy. This tool offers a cost-effective mechanism for ongoing surveillance of ECE physical activity policies, with the potential to inform modifications that promote uniform standards and establish consistent, high-quality opportunities for the nation's youngest children.

Background: Although racial, ethnic minorities, and immigrants are more likely to have poor diet-related health outcomes, few studies have compared children's dietary quality across diverse households, which is the formative step to designing targeted interventions. The current study evaluates and compares the dietary quality of young children from diverse racial, ethnic, and immigrant households in Nebraska. Methods: Cross-sectional survey data were collected from adults living in Nebraska with at least one 2-6-year-old child residing in their household via an online survey regarding their federal assistance program participation and dietary quality of child(ren) residing in their household, measured using the short Healthy Eating Index (sHEI). Results: With nearly two-third participating in a federal assistance program, the sample includes respondents from diverse households (n = 1,277) including first-generation immigrant (n = 61), non-immigrant Hispanic (n = 538), non-immigrant non-Hispanic White (n = 509), non-immigrant non-Hispanic Black or African American (n = 120), and non-Hispanic American Indian or Native Hawaiian (n = 49). Based on analysis of covariance controlling for demographic variables, children from immigrant households had lower mean sHEI score 43.9 as compared to non-immigrant Hispanic 46.4, non-immigrant non-Hispanic White 47.1, non-immigrant non-Hispanic Black or African American 50.2, and non-Hispanic American Indian or Native Hawaiian 48.9. Racial/ethnic/immigrant household group differences were also observed for some sHEI component scores. Conclusions: Children from immigrant and non-immigrant Hispanic households had significantly lower sHEI scores on some subcomponents compared with other groups. Findings emphasize the need for additional research and culturally responsive multilevel nutrition interventions.