Body Mass Index Z-score Research Articles

IMPROVEMENT IN GROWTH AND NUTRITION STATUS AFTER ANTI-TNF THERAPY INITIATION AMONG PATIENTS WITH PEDIATRIC CROHN’S DISEASE: RESULTS FROM THE COMBINE TRIAL

Abstract BACKGROUND Growth failure impacts 15-40% of children with Crohn’s disease (CD). Potential causes of growth failure include chronic inflammation, malabsorption, and poor nutritional intake. Control of inflammation is key to improving growth outcomes. Anti-TNF therapy has been associated with improved growth and nutritional status in affected children. Large studies of serial outcomes of growth after anti-TNF therapy initiation are limited. OBJECTIVE We sought to 1) describe baseline weight, height, and BMI status at anti-TNF initiation in children with CD in a large, multicenter clinical trial, 2) compare the demographic and clinical characteristics of children with and without weight, height, and BMI disturbance, and 3) describe follow-up anthropometric parameters at approximately 12 and 24 months after anti-TNF initiation. METHODS We analyzed data from the COMBINE trial, a multicenter study comparing infliximab or adalimumab in combination with oral methotrexate to anti-TNF monotherapy for children with CD. We obtained demographic, clinical, and anthropometric data at time of enrollment and after 12 and 24 months. Weight, height, and BMI Z-scores were dichotomized as normal (≥ -1) versus disturbance (< -1) at each time point. We used standard descriptive statistics to summarize the distribution of Z-scores and bivariate statistics to compare demographic, clinical, and treatment characteristics among participants with versus without growth disturbance at baseline. RESULTS Our study population included 199 children (25% female, 83% white, mean age 12 years). Of these, 53 (26.6%) had a weight disturbance at baseline (Table 1). Of 188 children with height data available at baseline, 52 (27.7%) had a height disturbance and 37 (19.7%) had a BMI disturbance. The mean short pediatric CD activity index (sPCDAI) was higher in those defined with weight, height, and BMI disturbance at baseline compared to those with normal parameters (Table 2). Gender, race, ethnicity, and age at time of anti-TNF initiation were not different between groups with and without weight, height, or BMI disturbances. Approximately 12 months after enrollment, the proportion of patients with height disturbance was 6.1% with a continued decrease to 0.9% at 24 months. BMI disturbance was observed in 7.5% of participants at 12 months and 2.8% at 24 months. Weight disturbance was observed among 5.7% and 0.8% of participants at 12 and 24 months respectively. DISCUSSION A substantial proportion of children with CD had weight, height, and BMI disturbance at time of anti-TNF initiation. These proportions decreased at approximately 12 months and 24 months, demonstrating significant improvement in growth disturbances after anti-TNF therapy. Table 1 % of children with weight, height, and BMI disturbance (Z-score <-1) at time of enrollment in addition to 12 and 24 months after anti-TNF therapy initiation. Table 2 Mean short pediatric Crohn’s disease activity index (sPCDAI) for BMI, weight, and height at time of anti-TNF initiation.

Impact of maternal depression on malnutrition treatment outcomes in older children with sickle cell anemia

BackgroundMalnutrition and sickle cell anemia (SCA) result in high childhood mortality rates. Although maternal depression is an established risk factor for malnutrition in younger children, little is known about its impact on treatment response in children with malnutrition. We aimed to determine the relationship, if any, between maternal depression scores and malnutrition treatment outcomes in older children with SCA.MethodsWe conducted a planned ancillary study to our randomized controlled feasibility trial for managing severe acute malnutrition in children aged 5–12 with SCA in northern Nigeria (NCT03634488). Mothers of participants completed a depression screen using the Patient Health Questionnaire (PHQ-9).We used a multivariable linear regression model to describe the relationship between the baseline maternal PHQ-9 score and the trial participant’s final body mass index (BMI) z-score.ResultsOut of 108 mother-child dyads, 101 with maternal baseline PHQ-9 scores were eligible for inclusion in this analysis. At baseline, 25.7% of mothers (26 of 101) screened positive for at least mild depression (PHQ-9 score of 5 or above). The baseline maternal PHQ-9 score was negatively associated with the child’s BMI z-score after 12 weeks of malnutrition treatment (β=-0.045, p = 0.041).ConclusionsMaternal depressive symptoms has an impact on malnutrition treatment outcomes. Treatment of malnutrition in older children with sickle cell anemia should include screening for maternal depression and, if indicated, appropriate maternal referral for depression evaluation and treatment.Trial RegistrationThe trial was registered at clinicaltrials.gov (#NCT03634488) on January 30, 2018, https://clinicaltrials.gov/study/NCT03634488.

P080 High faecal pH and low total microbial load associate with normalisation of faecal calprotectin in children with Crohn’s disease treated with exclusive enteral nutrition; results from iPENS, a multicentre, prospective study

Abstract Background Exclusive enteral nutrition (EEN) is a main therapy for active Crohn’s disease (CD) in children, but normalisation of faecal calprotectin (FCAL) varies among patients, even in those who enter clinical remission. To better understand disease characteristics related to EEN efficacy and its mechanism of action, we compared clinical and microbial parameters between patients whose FCAL normalised against those who did not at EEN completion. Methods Children with CD, clinically responding to EEN, were recruited from 11 UK hospitals (January 2020- May 2023, NCT04225689) and provided a single faecal sample before EEN completion. Patients were divided in two groups according to levels of FCAL at EEN completion (FCAL<250 and FCAL>250 mg/kg). Levels of faecal short chain fatty acids (SCFA), faecal sample characteristics (pH, water content (%), bristol stool score) and total microbial load (qPCR) were compared between the two groups. Anthropometric and clinical parameters (blood inflammatory markers, use of immunosuppressants, disease duration, disease location) were also compared. Machine learning using feature elimination with data imputation for missing data was performed to identify associations between clinical, anthropometry, microbial parameters and FCAL normalisation. Results At EEN completion, 84 children (female, 35%) were recruited [age, median (IQR): 13.2 (11.8, 14.9 years)] with a median (Q1, Q3) FCAL of 643 (146, 2033) mg/kg. Out of 84 patients, 35 (42%) had an FCAL<250 mg/kg. Total microbial load and SCFA were measured in a subset of patients (n=44). Patients with FCAL<250mg/kg had a higher faecal pH and lower microbial load compared to those with FCAL>250mg/kg [faecal pH; FCAL<250 mg/kg: 8.3 (8.1, 8.6) vs FCAL>250 mg/kg; 7.95 (7.6, 8.3), p=0.001; microbial load (log10 16S rRNA gene copies/g): FCAL<250mg/kg: 10.7 (10.4, 10.9) vs FCAL>250mg/kg: 11.0 (10.5, 11.2), p=0.02]. Median BMI z-score was also non-significantly (p=0.052) higher in patients with FCAL<250mg/kg. The use of immunosuppressants at EEN completion, disease duration, disease location and other faecal parameters were not different between the two groups. A multicomponent random forest model (clinical, blood inflammatory markers, anthropometry, faecal parameters) predicted normalisation of FCAL with 71% accuracy (sensitivity: 69%, specificity: 71%, p=<0.001, Figure 1). Higher faecal pH, BMI z-scores and lower total microbial load were the most influential parameters relating to FCAL<250mg/kg. Conclusion We showed that the efficacy of EEN in reducing gut inflammation might be, at least in part, mediated via reducing gut bacterial biomass and modulating luminal pH and the downstream effects this may have on inflammatory members of the microbial community.

Change in Weight Status Among Children Who Do and Do Not Participate in Intensive Health Behavior and Lifestyle Treatment for Obesity.

Background: Primary care providers (PCPs) are expected to provide weight management counseling despite having low confidence in their ability to be effective. This analysis examined change in weight status between children who received usual care from their PCP and those who received one of two structured weight management programs in a randomized control trial. Methods: Data from parent-child dyads who were referred to the Guided Self-Help Obesity Treatment in the Doctor's Office study, but did not participate, were examined to determine change in weight status compared with those who participated in the trial. Families were divided into four groups: Group 1, structured treatment with high attendance; Group 2, structured treatment with low attendance; Group 3, PCP/usual care with some weight management counseling; and Group 4, PCP/usual care with no counseling. Anthropometric data and PCP delivery of weight management counseling were abstracted from the electronic health record. Main outcomes were changes in child BMI z-scores, BMI as a percentage relative to the 95th percentile, and BMI as a difference relative to the 95th percentile at the end of treatment and 6-month follow-up for each group. Results: Groups 1 and 2 showed significant decreases in weight status over time, with Group 1 showing the greatest decrease. Groups 3 and 4 remained relatively stable. Changes in weight status in Groups 2, 3, and 4 were significantly different from Group 1 at post-treatment. Conclusions: While structured weight management programs have a significant impact on weight status, those who received some counseling by their PCP did not show significant increases in weight status and were relatively weight stable. Efforts should be broadened to support PCPs as they provide weight management counseling in the office.

Moderating role of 1-minute abdominal test in the relationship between cardiometabolic risk factors and adiponectin concentration in adolescents

BackgroundAdiponectin is an anti-inflammatory cytokine secreted by adipose tissue, has been associated with adiposity and cardiometabolic risk, and has controversial results with muscular fitness. The aim of this study was to analyze the interaction of 1-minute abdominal test in the relationship between adiposity, body composition, cardiometabolic risk and adiponectin concentration in adolescents.MethodsThis is a cross-sectional study conducted with 62 adolescents of both sexes, aged 11 to 16 years, approved by the Ethics Committee of Research in Humans (CAEE: 62963916.0.0000.5223). Body mass, height, abdominal circumference (AC), waist circumference (WC), fat mass (FM), fat-free mass (FFM), high density lipoprotein (HDL-c), low density lipoprotein (LDL-c), triglycerides (TG), adiponectin, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP), 1-minute abdominal test (ABD) were measured. Body mass index (BMI), z-score BMI (BMI-z), triponderal mass index (TMI), and waist-to-height ratio (WHtR) were calculated. The macro PROCESS for SPSS v.24.0 was used for moderation analyses, with linear regression models.ResultsInverse interactions were found for adiposity (BMI, BMI-z, TMI, AC, WC, WHtR), body composition (FM, FFM) and CMRF (SBP, DBP, MBP, TG) versus 1-minute abdominal test with adiponectin concentration, demonstrating that abdominal test is a moderator in these relationships.ConclusionWe conclude that 1-minute abdominal test may play an important role in the relationship between obesity and cardiometabolic risk. We found that muscular fitness can confer a protective effect on adolescents with high levels of abdominal test.

Comparison of international height and BMI-for-age growth references and their correlation with adiposity in Brazilian schoolchildren.

This study verified the diagnostic accuracy of the nutritional status classified by the international height and BMI references of the World Health Organization (WHO) (WHO/2007), International Obesity Task Force (IOTF/2012) and MULT (2023). The data pool was composed by 22737 subjects aged five to 16 years from the Santos and Porto Alegre surveys. A correlation matrix between the z-scores of the BMI references and the skinfold measurements was calculated through the Pearson correlation coefficient (r), and the subject's nutritional status was classified according to the international growth references. The accuracy for diagnosing obesity was performed separately by sex and using the 95th percentile of the triceps and subscapular skinfold sum, while Lin's concordance coefficient, Bland-Altman method and the Cohen's Kappa coefficient (Kappa) were used to verify the concordance and reliability among the BMI references. The correlation matrix showed a high positive correlation among the BMI z-scores (r ≥ 0·99) and among the skinfold measurements (r ≥ 0·86). The prevalence of stunting was higher when applying the MULT reference (3·4 %) compared with the WHO reference (2·3 %). The Bland-Altman plots showed the lowest critical difference (CD) between the height references of WHO and MULT (CD = 0·22). Among the BMI references, the WHO obesity percentile presented lower performance than MULT for boys, presenting a lower +LR value (WHO = 6·99/MULT 18 years = 10·99; 19 years = 8·99; 20 years = 8·09) for the same -LR values (0·04). Therefore, MULT reference holds promise as a valuable tool for diagnosing childhood obesity, particularly when considering sex differences. This enhances its suitability for assessing the nutritional status of Brazilian schoolchildren.

Group-Based Trajectory Modeling to Identify Patterns of Antipsychotic-Associated Weight Gain Among Children and Adolescents.

Antipsychotic-associated weight gain (AAWG) is a common adverse effect of second-generation antipsychotic (SGA) medications among children and adolescents. This study applied group-based trajectory modeling to identify latent trajectories of AAWG among children and adolescents and associated risk factors. This was a retrospective analysis of the IQVIA Ambulatory EMR-US database from 2016 to 2021. The cohort consisted of patients aged 6 to 19 years who were SGA naive and received at least 90 days of continuous SGA prescriptions. Group-based trajectory modeling was used to identify latent trajectories of AAWG development during a 24-month period since SGA initiation, and multinomial logistic regression analysis was conducted to examine the risk factors associated with the identified AAWG trajectories. A total of 16,262 patients were included. Group-based trajectory modeling identified the following 4 distinctive AAWG trajectories: persistent severe weight gain (4.2%), persistent moderate weight gain (20.1%), minor weight change (69.6%), and gradual weight loss (6.1%). Compared with the minor weight change group, younger age (12-17 vs 5-11: odds ratio [OR], 0.634; 95% confidence interval [CI], 0.521-0.771), lower baseline body mass index z -score (OR, 0.216; 95% CI, 0.198-0.236), and receiving olanzapine as the initial SGA (olanzapine vs aripiprazole: OR, 1.686; 95% CI, 1.673-1.699) were more likely to follow severe weight gain trajectories. The area under the receiver operating characteristic curves for comparing severe weight gain versus minor weight change groups and moderate weight vs minor weight change groups in the multinomial regression model were 0.91 and 0.8, respectively. A quarter of pediatric SGA recipients experienced persistent weight gain during the SGA treatment. The risk of having persistent AAWG can be predicted using patient characteristics collected before SGA initiation and the initial SGA agent.

Offspring sex modifies the association between early-pregnancy adiposity and 2-year-old physical activity-The Glowing Study.

Rodent models suggest that in utero exposure to under and overnutrition programs offspring physical activity (PA) behaviors. Such nexus has not been established in humans. This study evaluated the association of early pregnancy maternal adiposity with offspring PA at age 2 years (2-yo-PA) taking into consideration prenatal and postnatal factors. Women (n = 153) were enrolled early in pregnancy (<10 weeks). At enrollment, maternal adiposity [air displacement plethysmography, fat mass index (FMI, kg/m2)] and PA (accelerometers, activity counts) were measured, and age, race, and education self-reported. Gestational weight gain was measured at the research facility. Offspring birthweight and sex were self-reported. At age 2 years, parental feeding practices (child feeding questionnaire) were assessed, whereas anthropometrics (length and weight) and physical activity (accelerometers) were objectively measured. Offspring body mass index z-scores were calculated. Generalized linear regression analysis modeled the association of maternal FMI and 2-yo-PA [average activity counts (AC)4/day]. In bivariate associations, 2-yo-PA did not associate with maternal FMI (β = -0.22, CI = -0.73 to 0.29, p = 0.398). However, maternal FMI interacted with offspring sex in association with 2-yo-PA. Specifically, 2-yo-PA was lower in girls (β = -1.14, CI = -2.1 to -0.18, p = 0.02) compared to boys when maternal FMI was ≥7 kg/m2. When stratified by sex, 2-yo-PA of girls negatively associated with maternal FMI (β = -0.82, CI = -1.43 to 0.29, p = 0.009) while no association was found between maternal FMI and boy's PA (β = 0.32, CI = -0.38 to 1.01, p = 0.376). The association of 2-yo-PA and early pregnancy maternal adiposity was modified by offspring sex. Offspring's physical activity decreased with increasing early pregnancy adiposity maternal in girls but not boys in second parity dyads.

Associations Between Weight-Loss Attempts, Weight-Related Stress, and Body Image During Childhood and Adolescence in Children With Parental Obesity.

Background: Few longitudinal studies have investigated the role of weight-loss attempts or weight-related stress on body image during childhood. We examined whether weight-loss attempts and weight-related stress are associated with weight misperception and body dissatisfaction across childhood and adolescence. Methods: Data were drawn from the Quebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort of Canadian children with parental obesity (8-10 years: n = 630; 10-12 years: n = 564; 15-17 years: n = 377). We assessed weight-loss attempts and weight-related stress at baseline and first follow-up, and perceived and desired silhouettes at first and second follow-up with questionnaires. Weight misperception consisted of the difference in BMI z-score (zBMI) from the perceived silhouette and the measured zBMI. Body dissatisfaction consisted of the discordance between perceived and desired silhouettes. We estimated multivariable mixed-effects regression models adjusting for age, sex, pubertal stage, parental BMI and education, and sport-based teasing. Results: Weight loss attempts were associated with a higher weight misperception score (ever tried, beta [95% confidence intervals; CI]: 0.13 [0.01-0.24]) and with 2.13 times higher desire to be thinner (95% CI: 1.39-3.26) at the subsequent follow-up. Similarly, children stressed by their weight had a higher misperception score (beta [95% CI]: 0.15 [0.02-0.27]) and greater desire to be thinner at the next follow-up (odds ratio [95% CI]: 1.73 [0.999-3.00]). Conclusions: Weight-loss attempts and weight-related stress in children and adolescents are associated with weight misperception and body dissatisfaction, supporting empowerment and counseling focusing on healthy eating behaviors and a positive body image. Clinical Trial Registration Number: NCT03356262.

Obstructive sleep related breathing disorders and cardiometabolic risk factors – A Portuguese birth cohort

BackgroundPediatric obstructive sleep related breathing disorders (SRBD) are an important under-diagnosed health problem with associated cardiometabolic comorbidities, demonstrated with polysomnographic studies in selected samples. Our main goal was to assess the prevalence of SRBD in a population-based cohort and to analyze its association with cardiometabolic risk factors, in general and by sex. MethodsPediatric Sleep Questionnaire (PSQ) was applied to parents of 7-years-old children evaluated in the birth cohort, Generation XXI. Sex, anthropometrics, blood pressure (BP), lipid profile, glucose, insulin, HOMA-IR, and high-sensitivity C-reactive protein were compared among children with/without SRBD, using Chi-square, Mann-Whitney tests and logistic regression models. ResultsA total of 1931 children (51.2 % boys) were included; 17.5 % were overweight and 15.7 % obese. The prevalence of SRBD was 13.4 %, more frequent among boys (15.7 % vs.10.9 %, p = 0.002) and in overweight/obese children (22.0 % vs.13.6 % vs.11.3 % in obese, overweight and normal weight group, respectively, p < 0.001). Children with SRBD had higher systolic BP (107 ± 8 vs.105±9 mmHg; p = 0.001) and lower HDL-cholesterol levels (54 ± 11 vs.56 ± 11 mg/dL; p = 0.04) than children without SRBD. After adjustment for sex, age, birthweight-for-gestational age and maternal age, children with SRBD had higher BMI-z-score, systolic BP, insulin and HOMA-IR levels, and lower HDL-cholesterol, when compared to those without SRBD, but these associations were lost when adjusting to BMI z-score. Analyzing obese children with the same regression model, those with SRBD presented lower HDL-cholesterol than those without SRBD. ConclusionsOur results identified a male predominance of SRBD in pre-pubertal children and highlighted the potential contribution of SRBD to cardiovascular risk in obese children.

COVID-19 impact on overweight and obesity rates in Aotearoa | New Zealand 4-year-old children

BackgroundCOVID-19 has had profound societal impacts. This study estimated overweight, obesity, and extreme obesity rates in 4-year-old children over pre- and post-COVID-19 periods, and investigated differential changes between sex, ethnic and deprivation groups.MethodsA national screening programme of 4-year-old children undertaking B4 School Checks (B4SCs) between 1 January 2010 and 7 March 2023 was analysed. B4SCs include anthropometric measurements enabling sex-specific body mass index-for-age Z-scores (BMI z-scores) to be derived. Children with ≥85th, ≥95th, and ≥99.7th percentile BMI z-scores were classified as overweight, obese, and extremely obese.ResultsThe eligible sample included 656,038 children (48.8% girls). Overall, 210,492 (32.1%) children were overweight, 95,196 (14.5%) obese, and 19,926 (3.0%) extremely obese. While decreasing in the pre-COVID-19 period, annual prevalence estimates for overweight, obese, and extremely obese significantly (all p < 0.001) increased in the year after COVID-restrictions were implemented. However, after three years, overweight and obese prevalence estimates were no different to pre-COVID levels overall or stratified by sex for ethnicity and deprivation groups. Extreme obesity prevalence estimates also decreased but remained higher than pre-COVID levels.ConclusionThe sharp and steep increases in prevalence estimates all dampened relatively quickly. The question remains whether these rates will continue to decrease in time.ImpactCompared to pre-COVID-19 estimates, the prevalence of overweight, obesity and extreme obesity significantly and substantially increased for 4-year-old children in the immediate post-COVID-19 period.These post-COVID-19 prevalence estimates dampened relatively quickly, returning to pre-COVID-19 rates for overweight and obesity after 3 years.Inequities between ethnic and social deprivation groups in overweight and obesity prevalence estimates remained similar between pre- and post-COVID-19 periods.

Parenting Styles and Psychosocial Factors of Mother-Child Dyads Participating in the ENDORSE Digital Weight Management Program for Children and Adolescents during the COVID-19 Pandemic.

Semi-structured clinical interviews were conducted with all participating mothers pre-and post-intervention. The Parenting Styles and Dimensions Questionnaire (PSDQ) evaluated the mothers' parenting styles. The psychosocial functioning of the participating children was assessed with the parental version of the Strengths and Difficulties Questionnaire (SDQ). The relationship between parenting styles, psychosocial parameters, and weight outcomes was investigated using a linear regression analysis. Weight-related stigma at school (56%), body image concerns (66%), and difficulties in family relationships (48%) were the main concerns documented during the initial psychological interviews. According to the SDQ, there was a significant decrease in children's conduct problems during the study's initial phase (pre-pilot group). A decrease in maternal demandingness (i.e., strict parenting style) was associated with a decrease in BMI z-score (beta coefficient = 0.314, p-value = 0.003). Decreasing parental demandingness was associated with better weight outcomes, highlighting the importance of assessing parenting factors in pediatric weight management programs.

Bisphenol A and cardiometabolic risk in adolescents: Data from the Generation XXI cohort

Background and aimsBisphenol A (BPA), an endocrine disruptor widely used in food contact materials, has been linked to a worse health profile. This study intends to estimate the association between BPA exposure and cardiometabolic patterns at adolescence. Methods and resultsData from the Portuguese population-based birth cohort Generation XXI at the age of 13 were used (n = 2386 providing 3-day food diaries and fasting blood samples). BPA exposure was measured in 24-h urine from a subsample (n = 206) and then predicted in all participants using a random forest method and considering dietary intake from diaries. Three cardiometabolic patterns were identified (normal, modified lipid profile and higher cardiometabolic risk) using a probabilistic Gaussian mixture model. Multinomial regression models were applied to associate BPA exposure (lower, medium, higher) and cardiometabolic patterns, adjusting for confounders. The median BPA exposure was 1532 ng/d, corresponding to 29.4 ng/kg/d. Adolescents higher exposed to BPA (compared to medium and lower levels) had higher BMI z-score (kg/m2) (0.68 vs. 0.39 and 0.52, respectively; p = 0.008), higher levels of body fat (kg) (16.3 vs. 13.8 and 14.6, respectively; p = 0.002), waist circumference (76.2 vs. 73.7 and 74.9, respectively; p = 0.026), insulinemia (ug/mL) (14.1 vs. 12.7 and 13.1, respectively; p = 0.039) and triglyceridemia (mg/dL) (72.7 vs. 66.1 and 66.5, respectively; p = 0.030). After adjustment, a significant association between higher BPA and a higher cardiometabolic risk pattern was observed (OR: 2.55; 95%CI: 1.41, 4.63). ConclusionHigher BPA exposure was associated with a higher cardiometabolic risk pattern in adolescents, evidencing the role of food contaminants in health.

The effect of the Mid-Day Meal programme on the longitudinal physical growth from childhood to adolescence in India.

The study aims to examine the effect of the world's largest school-feeding programme, the Mid-Day Meal (MDM) programme, on the changes in the underweight prevalence among school-children in India. Data from the Indian Human Development Survey (IHDS) Rounds 1 (2004-05) and 2 (2011-12) were utilized. The sample included individual-level information of children aged 6 to 9 years in IHDS-1 who then turned 13 to 16 years in IHDS-2. The sample was categorised into four groups based on their MDM consumption history (Group 1: no MDM support in IHDS-1 and IHDS-2, Group 2: MDM support in IHDS-1, Group 3: MDM support in IHDS-2, Group 4: persistent MDM support in IHDS-1 and IHDS-2). The dependent variable was underweight status as defined by the World Health Organisation Child Growth Standards Body Mass Index for age (BMI Z-score) < -2 SD of the median. Bivariate analysis was used to examine the prevalence of underweight and establish associations between underweight status and socio-demographic characteristics. Logistic regression was performed to assess the strength of the association of socio-demographic characteristics and MDM consumption patterns with underweight across poor and non-poor asset groups. The findings suggest that early and persistent MDM support among respondents reduced the likelihood of low BMI Z-scores compared to those without MDM support. Respondents from the poor asset group who received MDM support in at least one of the two survey rounds had higher odds of being underweight in comparison with those who did not receive MDM support at all. Girls and adolescents residing in the Eastern region of India were less likely to be underweight. The study shows that the MDM programme was effective in reducing the rate of underweight among school children. However, continuous programme upscaling with a special focus on children from poor households will significantly benefit India's school-aged children.

Review of impacts of using body mass index as a screening tool in school children: A scoping review.

Body mass index (BMI) is used to screen for under- or overweight. However, it is unknown whether BMI-screening in school children reduces the incidence of overweight and obesity. We aimed to summarise the knowledge on positive and negative consequences on BMI and weight-related perceptions and behaviours of BMI-screening followed by an intervention to prevent and/or address obesity. We performed a systematic literature search, April 2023, using the PubMed, ScienceDirect and Google Scholar databases. We included randomised controlled trials and observational studies, including children aged 6 to 18 years and examining BMI-screening in a school setting. The primary outcome measures were BMI and weight status. Secondary outcome measures were weight-related perceptions and behaviours. Three studies met the inclusion criteria; two randomised controlled trials and one observational study. All studies used BMI-screening followed by sending report cards to the parents. None of the studies found a change in BMI z-scores in school children. Screening could cause transitory body-dissatisfaction and increase peer weight talk, yet potentially reduce problematic weight behaviours like skipping meals or excessive dieting. Reporting BMI to parents may influence their perception of their children's weight status, but does not change behaviour. The sparse evidence available suggested that BMI screening followed by sending report cards to parents does not change BMI z-scores among children in primary, middle and high school. Studies using appropriate evidence-based weight management interventions as a follow-up are lacking. Such studies may improve future prevention, detection and treatment of weight-related issues.

Efficacy of atypical antipsychotics in the treatment of fecal incontinence in children and adolescents: a randomized clinical trial

ObjectivesFunctional retentive overflow incontinence (retentive FI) is the most common cause of fecal soiling in children. Based on the clinical experiences, the treatment of retentive FI in patients with comorbid psychiatric disorders was accelerated when Risperidone was used as treatment for their psychiatric comorbidities; therefore, this study was conducted to evaluate the effect of risperidone in the treatment of retentive FI in children and adolescents.MethodsIn this double-blind, randomized, placebo-controlled trial, 140 patients aged 4–16 years eligible for the study were randomized into two groups, receiving either 0.25–0.5 mg of Risperidone syrup (n = 70) or maltodextrin syrup (placebo group, n = 70) every 12 h daily for 12 weeks. Sociodemographic data, including age, sex, weight, height, BMI, BMI z-score, and socioeconomic status, was recorded, and the number of nocturnal FI, diurnal FI, and painful defecations was measured.Results136 participants (69 on Risperidone and 67 on placebo) were included in the study. Mean age of participants in the intervention and placebo groups were 7.2 ± 2.4 years and 8.0 ± 3.1 years, respectively. The mean number of nocturnal FI (Ptrend=0.39) and diurnal FI (Ptrend=0.48) in patients without psychiatric comorbidities, and the number of painful defecations for participants with and without psychiatric comorbidities (P = 0.49, P = 0.47, respectively) were not significantly different between the groups, but a significant effect was observed in diurnal FI after Risperidone treatment in patients with psychiatric comorbidities (P < 0.001).ConclusionRisperidone, when used along with other non-pharmacological interventions, may be helpful in treating FI in pediatric patients with psychiatric comorbidities.

Predictive values of Mallampati score, tonsillar size, and BMI z-score in the presence and severity of obstructive sleep apnea in pediatric population.

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder in children. Determination of risk factors for the development of OSA is essential for early diagnosis and treatment of the disease and decreases the risk of negative consequences. This study aimed to investigate the predictive values of Mallampati score, tonsillar size, and BMI z-score in the presence and severity of OSA in children. This prospective cross-sectional study included 114 children with OSA symptoms. All children were assessed by BMI z-score, Mallampati score, and tonsillar size and underwent overnight polysomnography. They were consecutively selected and assigned to 4 groups as follows: Group 1 included normal-weight with a low Mallampati score; Group 2 involved normal-weight with a high Mallampati score; Group 3 included obese with a low Mallampati score; and Group 4 involved obese with a high Mallampati score. Of the 114 included children, 58 were female and 56 were male, with a mean age of 13.1 ± 2.9 years. OSA frequency and apnea-hypopnea index were significantly higher in group 4 compared with other groups (p = 0.003 and p < 0.0001, respectively), whereas average and minimum spO2 were significantly lower (for both, p = 0.001). Mallampati score and BMI z-score were found to be significant for predicting OSA (odds ratio = 4.147, 95% CI: 1.440-11.944; p = 0.008 and odds ratio = 1.760, 95% CI: 1.039-2.980; p = 0.035, respectively). Among OSA patients, the Mallampati score, tonsillar size, and BMI z-score were found to be significant for predicting OSA severity (odds ratio = 4.520, 95% CI: 1.332-15.335, p = 0.015, odds ratio = 9.177, 95% CI: 2.513-33.514, p = 0.001, and odds ratio = 2.820, 95% CI: 1.444-5.508; p = 0.002, respectively). The coexistence of the Mallampati score and BMI z-score significantly increases the presence of OSA in children. Mallampati score, tonsillar size, and BMI z-score are promising parameters for predicting OSA severity.

Do maternal socioeconomic status influence child overweight?

The prevalence of overweight among Chinese children under 5 years of age has been increasing steadily. Using data from China Health and Nutrition Survey (CHNS) spanning from 1991 to 2015, this study investigates the relationship between maternal employment status, maternal education level, and the prevalence of child overweight among Chinese children under 5 years old. The findings indicate that having mothers with low middle school education significantly reduces their children's body mass index z-scores (BMIZ) (p < 0.05). However, no significant association is observed between maternal education level and childhood overweight in urban areas. In rural areas, only when the maternal education level is college or above, there is a significant increase in BMIZ (p < 0.01). The impact of maternal education level on childhood obesity is influenced by household per capita income, and when household per capita income reaches a certain level, higher maternal education is negatively associated with child BMIZ. The study also reveals a significant negative association between maternal employment (p < 0.01)，average weekly working days (p < 0.01), and the BMIZ of children under 5 years of age, while the interaction effect between them is positive and significant. This study has recommended some policy interventions, by promoting parental education on child feeding and parenting, providing professional child care, and offering financial subsidies to families with children under 5.

Effectiveness of utilizing step-monitoring devices to prevent and treat obesity in children and adolescents: A systematic review and meta-analysis.

Children and adolescents who are overweight and obese represent a growing public health issue. The use of step-monitoring devices as an intervention tool may be a simple, cost-effective, and easily replicable solution for addressing obesity in children and adolescents. No prior systematic reviews have evaluated the effectiveness of utilizing step-monitoring devices as an intervention method for obesity in children and adolescents. Previous studies on using step-monitoring devices to prevent and treat obesity in children and adolescents were identified in the following databases: Web of Science, EMBASE, PubMed, Cochrane Library, SPORTDiscus, and SCOPUS. The search period for each database ranged from the year of their inception to 8 March 2023 (updated in June 2024). Meta-analyses were performed for mean differences (MDs) in body mass index (BMI), BMI z-score (BMI-Z), body fat, waist circumference, and body weight. From 12,907 relevant records, 23 studies were included in this meta-analysis. The included studies were mainly at low risk of bias, except for blinding. Step-monitoring device-based interventions had significant effects in reducing BMI-Z (MD -0.06; 95% CI -0.10 to -0.02), body fat (MD -0.95%; 95% CI -1.35 to -0.54), and body weight (MD -1.23 kg; 95% CI -2.36 to -0.10). However, there was no significant effect on BMI (MD -0.16 kg/m2; 95% CI -0.55 to 0.22) and waist circumference (MD -0.33 cm; 95% CI -1.23 to 0.58). Subgroup analyses indicated that participants who were overweight or obese showed greater intervention effects on BMI and BMI-Z compared to participants with normal weight. The programs with an intervention duration of ≤6 months presented a greater intervention effect on BMI-Z than those with an intervention duration of more than 6 months. The programs that established goals had a greater intervention effect on body fat than those that did not. Step-monitoring devices may be an effective and generalizable intervention tool for the prevention and treatment of obesity in children and adolescents. Future studies should further explore how to set step goals and the duration of interventions to achieve better intervention effects.

The association of cadmium heavy metal with growth failure in children: A systematic review and meta-analysis.

Introduction: early exposure to cadmium toxic metal has been suggested to be associated with reduced infants/children growth; nevertheless, the available evidence is contradictory. Objective: this meta-analysis aimed to examine the association of cadmium exposure through biological samples to growth measurements of infants/children, including body weight, height, body mass index (BMI), BMI-for-age (BMI Z-score), weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) z-scores. Methods: a systematic search in PubMed and Scopus was implemented to obtain the related studies. The standardized beta coefficients (β) and 95 % confidence intervals (95 % CI) were used as effect sizes to test the associations using the random effects analysis. Results: a total of 15 studies with 6,181 participants were included in the meta-analysis. In the overall analysis, pooled analysis of available data revealed that cadmium exposure was inversely linked to height (β = -0.06, 95 % CI = -0.12 to -0.01) and WAZ (β = -0.01, 95 % CI = -0.02 to -0.003). These relationships were also supported by prospective cohort studies and urinary cadmium exposure. In the stratified analysis, cadmium exposure was negatively linked to the weight of children in prospective cohort studies, in studies that assessed urinary cadmium exposure. No significant association was detected between cadmium exposure and BMI, BMI Z-score, WHZ, and HAZ in the overall and subgroup analyses. Conclusions: this meta-analysis emphasized the importance of cadmium exposure as a risk factor for growth failure in infants/children.