Child Health Promotion Programme Research Articles

Interdisciplinary health promotion program for parents and children on nutritional status, body composition, and metabolic profile

Due to the complexity of obesity in adolescence, interdisciplinary treatment is necessary. The aim of this study was to analyze the effects of an interdisciplinary intervention program with adolescents and their guardians on the nutritional status, body composition, metabolic syndrome indicators and metabolic profile of overweight adolescents. The project lasted 14 weeks and was divided into three stages: recruitment of participants and data collection; interdisciplinary interventions over 12 weeks; and re-evaluations. Of 21 adolescent participants, 57.14% were classified as obese. Optimistic changes were observed in body composition, such as a reduction in the percentage of total fat, visceral fat and abdominal circumference, as well as an increase in the percentage of lean mass for both adolescents and their guardians. The intervention was also significant for the adolescents' blood glucose and HDL-c. As a result, the results showed benefits for adolescents and their guardians in terms of health-related parameters.

Piloting a Community-Based, Culturally Adapted Health Promotion Program for Children with Autism Spectrum Disorder and Developmental Disabilities in First-Generation Korean Immigrant Families.

Children with autism spectrum disorder and developmental disabilities (ASD/DD) face barriers to participation in health promotion programs due to the lack of available and/or affordable programs and trained staff at recreation centers. Children with ASD/DD in Korean immigrant families are one of the most underserved minority groups due to language, racial/ethnic discrimination, and stigma and shame within their own ethnic community. However, little research is available on development, implementation, and evaluation of a culturally adapted community health promotion program in this population. The purpose of this study is to assess effectiveness of a pilot program for children with ASD/DD from first-generation Korean immigrant families. The pilot study used a quantitative, quasiexperimental design (one-group design with pre- and posttest) following a seven-week health promotion program. We recruited 15 children with ASD/DD, ages nine through 16, from first-generation Korean immigrant families. The findings of the study suggest that the pilot program was effective in gaining nutrition knowledge and increasing physical involvement among participants. Given the fact that Asian immigrants are a fast-growing population and that nearly 75 percent of them were born abroad, development and evaluation of a community-based, culturally adapted health promotion program is urgently needed.

Oral health promotion programmes in the Balkan countries: Part I

Background/Aim: The aim of this study was to conduct a comparative analysis of the national oral health programmes in the Balkan countries, to compare key measures and activities in the implementation of the general and specific objectives of the programme, and to analyse the results achieved after the implementation of the programme. Material and Methods: The data were obtained through an electronic search of publicly available documents published by the relevant institutions in the field of dental health care in the Balkan countries. The search terms were: "national programme", "strategy", "action plan", "project", and "oral health". The search was conducted in English and in the native languages of the Balkan Peninsula countries. A comparative analysis of valid documents and those whose validity period has expired was carried out. Results: Bulgaria and the Republic of North Macedonia have valid national preventive programmes. In Cyprus, a strategic plan for the provision of dental services is described. An oral health promotion programme for elementary school children and universal preventive programme for children ("dentist pass") have been implemented in Greece. Serbia has a national preventive programme that has expired, but the programme activities still apply. Albania, Bosnia and Herzegovina, Montenegro, Romania, and Turkey do not have national oral health preventive programmes. Countries in the region with no oral health promotion programmes have poorer oral health indicators compared to countries with existing programmes. Conclusions: While countries in the Balkan Peninsula have made progress in improving the oral health of their inhabitants, the absence of national oral health promotion programmes is striking in many countries in the region. Greater involvement of the community in activities to maintain and improve oral health is needed, as is more comprehensive dental care for vulnerable populations. This paper (Part I) compares national oral health promotion programmes of the Balkan countries, the key measures and activities, and general and specific objectives of the programme.

Perceptions of a Virtual Health Promotion Program for Children on the Autism Spectrum and their Primary Caregiver: A Qualitative Analysis

Over the past decade the popularity of virtual health promotion programs has grown substantially. The primary objective was to explore perceptions of a virtual health promotion grounded in Social Cognitive Theory (SCT) called PLANE (Physical Literacy and Nutrition Education). Major findings suggest SCT constructs were reflected in caregiver responses and worked in synergy with one another offering intrinsic and extrinsic opportunities to promote positive outcomes. Findings could be used to stimulate the ongoing need to promote a variety of accessible ways to engage in health programming programs for families of autistic children.

Parental practices and children's lifestyle correlates of childhood overweight/obesity in Europe: The Feel4Diabetes study.

Parental influences on children's eating and physical activity (PA) and consequently on their weight are fundamental. The present study aimed to identify the predominant correlates of childhood overweight/obesity among a variety of parental practices and children's lifestyle indices in a large sample of children in Europe. Families from low socio-economic status regions were recruited through schools, located in six European countries (Belgium, Finland, Greece, Spain, Bulgaria and Hungary). Seven thousand three hundred ninety-seven children 4-12 years old and their parents were selected using the FINDRISC-questionnaire. Parental practices assessed included parental role modelling, permissiveness and reward. Children's dietary intake and lifestyle behaviours were assessed through parent-reported questionnaires. Regarding parental practices, it was revealed that being sometimes (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.10-1.43) or rarely (OR = 1.43; 95% CI = 1.21-1.69) physically active with the child was associated with greater overweight/obesity risk, whereas rare permission of computer/mobile/tablet (OR = 0.81; 95% CI = 0.67-0.98) and sometimes (OR = 0.77; 95% CI = 0.68-0.88) or rare (OR = 0.77; 95% CI = 0.66-0.91) reward with PA were associated with lower risk. Regarding children's lifestyle factors, consuming > 3 cups/week fresh fruit juices (OR = 1.28; 95% CI = 1.13-1.45), skipping breakfast (OR = 1.37; 95% CI = 1.17-1.61), absence of 1 h of daily PA (OR = 1.40; 95% CI = 1.24-1.58) and increased daily screen time (ST) (OR = 1.23; 95% CI = 1.09-1.39) were associated with greater overweight/obesity risk. All the variables were adjusted for maternal education, child's sex and age. These findings emphasize the necessity of family-centered approaches in health promotion and obesity prevention programs for children. Such programs should focus on parents as the primary role models in exerting positive influence and encouraging healthy eating habits, PA, and ST behaviors in their children, which in turn, may have a substantial impact on children's overall weight status.

Central concepts in mental health promotion programs for children and adolescents: Evidence and examples from Switzerland

Abstract Universal mental health promotion programs draw on a wide range of concepts to promote children's and adolescents’ mental health. This presentation aims to provide an overview of the central concepts from health, developmental and social psychology, psychiatry, and public health/health promotion and to illustrate their application using examples from Swiss mental health promotion programs for children and adolescents. Concepts on internal, biological, psychological and psychosocial factors such as the ten life skills that are recommended by the WHO, self-efficacy, (mental) health literacy, and the resilience literature are looked at as well as concepts on external risk and protective factors such as social support (quality of attachment and relationships, positive family climate and peer relations) and the quality of educational institutions. Evidence on their effectiveness is reported and conceptual similarities and differences as well as the underlying mechanisms of action are explored from a health behavior change perspective using the behavior change wheel. Finally, implications for the design and implementation of mental health promotion programs are discussed

Attitudes of children and adolescents towards healthy lifestyle issues

Abstract Background Health education for promoting healthy lifestyle from early ages is considered to be important. However, this issue has not been thoroughly examined in Georgia. The research, undertaken on adolescents, aimed to analyse adolescents’ lifestyle, awareness and attitudes towards healthy lifestyle. Methods The study applied a mixed methods design and included both, qualitative and quantitative research methods. 145 students aged 17 to 23 years participated in the research. In order to evaluate the adolescent’s perceptions and attitudes, qualitative individual interviews with university students were conducted. For the quantitative method, a self-administered questionnaire assessing the level of adolescents’ awareness and attitudes towards healthy lifestyle was developed. Results This section presents preliminary findings of the study. We found that more than 67% of adolescents were aware on the importance of healthy lifestyle. However, most of the participants did not transfer their knowledge into practice. The participants found it challenging to maintain healthy eating habits due to increased costs of healthy, organic food. The study also confirmed the need for integrated work of public, governmental, and non-governmental organizations to initiate and implement health promotion programs for children and adolescents. Conclusions Overall, the study found that even though adolescents are aware about the importance of the healthy lifestyle, it is challenging for them to maintain it. In order to change adolescents’ attitudes towards unhealthy behaviour, it is necessary to carry out targeted interventions. Key messages • Health education is a necessary component for healthy lifestyle. • Healthy lifestyle requires careful study of the issue and making evidence-based conclusions.

Future in Pediatrics: prevention in maternal child chronic diseases in the first 1000 days

Abstract Introduction The screening and management of obesity, metabolic chronic conditions conditions and genetic predisposition, before and during pregnancy, improve the effects of therapies and reduce the rate congenital diseases, metabolic fetal disorders and early chronic diseases during first 1000days. The maternal child health promotion program ‘Future in Pediatrics’ is dedicated to women in preconception and in early pregnancy, with three steps: 1) a specific survey, 2) a personalisated plan 3) the management of chronic conditions (diabetes, hypertension, overweight, metabolic disorders) and surveillance during the first maternal child 1000 days. Encouraged results Methods In 2019-2021, FUTURA project involved 460 women (before,during and after pregnancy) into 2 groups: group 1 of 280 women, with overweight/ obesity, metabolic conditions, malnutrition, and hypovitaminosis, group 2 of 180 women without chronic conditions, but physical inactivity, high level of homocysteine (60 to 100 μmol/L) and with predisposition for cardiovascular diseases. We have involved the patients in a survey of 100 questions about health, lifestyle, habits, sleep and in a daily diary. In the second time we have realized a personalised and educational program for diet, supplementations sleep, physical activities, health routine. Results The 2 groups of women improved the quality of their health and the management of weight, chronic and metabolic conditions, with impact on reproductive and perinatal health, reduction of inflammatory status and metabolic parameters.We have observed a great influence on cardiovascular health in both groups and decreased of homocysteine levels in the 2nd group. During first 1000 days 393 women, involved into the program, continued with the healthy and preventive routine with zero cases of weight and metabolic chronic disorder in their children. Conclusions This research that the prevention in perinatal health influences the children's health. Key messages • The origins of chronic and metabolic conditions are in uterine life before the conception. The unhealthy lifestyle influenced fertility, cardiovascular health and child health. • The cardiovascular health and metabolic chronic conditions are influenced by first 1000 days health and habits.

Pediatric body mass index trajectories and the risk of hypertension among adolescents in China: a retrospective cohort study.

The impact of pediatric body mass index (BMI) trajectories on the risk of adolescent hypertension (HTN) determined by three separate visits remains unclear. This longitudinal study aims to identify potential pediatric sex-specific BMI trajectories and to assess their associations with HTN and HTN subtypes. Based on the Health Promotion Program for Children and Adolescents (HPPCA) in Suzhou, China, a total of 24,426 participants who had initial normal blood pressure (BP) and had at least four BMI measurements during 2012-2020 were included. HTN was defined as simultaneously having three separate visits of elevated BP in 2020. Latent class growth models were used to explore sex-specific BMI trajectories, whose associations with HTN and HTN subtypes were further examined by logistic regression. The incidence of HTN determined through three separate visits was 3.34%. Four trajectories were identified for both sexes: low BMI increasing, medium BMI increasing, high BMI increasing, and highest BMI increasing. Compared to the medium BMI increasing group, the odds ratio (95% confidential interval) for developing adolescent HTN of the low, high, and highest BMI increasing groups among boys were 0.54 (0.39, 0.75), 1.90 (1.44, 2.51), and 2.89 (1.90, 4.39), respectively; and the corresponding values for girls were 0.66 (0.48, 0.90), 2.30 (1.72, 3.09), and 4.71 (3.06, 7.26). Similar gradually elevated associations between different trajectories with isolated systolic hypertension, systolic and diastolic hypertension were observed. Current results emphasized the adverse effects of stable high BMI on HTN and the benefits of maintaining normal weight throughout childhood.

Evaluation of the effectiveness of the standard traditional Korean medicine-based health promotion program for disadvantaged children in South Korea

BackgroundTraditional Korean Medicine (TKM) is highly integrated with the modern health care system of South Korea and is actively used in the public health field. Since 2014, the Ministry of Health and Welfare of South Korea has supported the development of standard models for TKM-based health promotion programs. This study aimed to develop and evaluate a standard TKM-based health promotion program for disadvantaged children.MethodsUsing convenience sampling, we recruited 16 Community Children’s Centers (CCCs) located in Busan and Yangsan, South Korea, which are welfare daytime facilities for children from socially disadvantaged families. The CCCs were divided into two groups of eight CCCs—intervention CCCs and control CCCs—through random allocation, and children in each group were selected as subjects for the study. For 12 weeks, the TKM-based health promotion program developed in this study along with the basic services of CCCs were applied to children in the intervention group, and only the basic services of CCCs were provided to children in the control group. Data were obtained through pre- and post-surveys with the legal representatives of the children prior to implementing the program and after the 12-week program, respectively. The outcome variables—the number of outpatient visits, absences, lateness/early leaves, infectious symptoms, and EuroQol-5D and EQ-visual analog scale scores–were measured and statistically compared between the groups by descriptive analysis, chi-square test, t-test, and difference-in-differences model with regression analysis.ResultsAt baseline, there were 156 children in the intervention group and 153 children in the control group, among which 155 and 147 children, respectively, were included in the analysis. Results indicated that the number of outpatient visits was significantly lower (by 65%) in the intervention group than in the control group (p = 0.03), and this was similar in the sensitivity analysis. Regarding other outcome variables, the effects were not consistently significant.ConclusionsA standard TKM-based health promotion program has the potential to improve the health of disadvantaged children. In the future, studies with long-term interventions and a larger sample are needed to enhance the applicability of these programs in communities.

COVID-19‒Related Childhood BMI Increases in China: A Health Surveillance‒Based Ambispective Cohort Analysis

IntroductionThe COVID-19 pandemic‒related BMI gain and obesity prevalence changes in children have not been clearly elucidated, especially in China. This study aims to assess the impact of pandemic-related BMI and obesity prevalence change in Chinese children aged 8–12 years.MethodsOn the basis of the Health Promotion Program for Children and Adolescents in Suzhou of China, a total of 72,175 children aged 8–12 years with complete data during 2017–2020 were included. Yearly BMI z-score changes and age- and sex-adjusted BMI changes before (2017–2019) and during (2019–2020) the pandemic were calculated. Multivariate mixed linear models were used to examine the possible difference in annual BMI change rate before and during the pandemic among subgroups.ResultsThe obesity prevalence slightly increased from 12.29% (2017) to 13.28% (2019) but substantially increased to 15.29% in 2020. The mean yearly change in BMI z-score before and during the pandemic were 0.039 (95% CI=0.037, 0.042) and 0.131 (95% CI=0.125, 0.138), respectively, yielding a difference of 0.092 (95% CI=0.087, 0.096). Similarly, changes and age- and sex-adjusted BMI increased by 0.191 (95% CI=0.179, 0.202) during the pandemic compared with those of previous years. Meanwhile, the increase in BMI changes in 2019–2020 compared with that before the pandemic was more obvious in boys than in girls and in underweight or normal-weight children than in their overweight and obese counterparts.ConclusionsBMI gain increased among Chinese children aged 8–12 years during the pandemic. There is an urgent need to formulate effective public health policies to reduce the risk of pandemic-related childhood obesity.

Compensation or Displacement of Physical Activity in Children and Adolescents: A Systematic Review of Empirical Studies

Regular physical activity during childhood and adolescence is associated with health benefits. Consequently, numerous health promotion programs for children and adolescents emphasize the enhancement of physical activity. However, the ActivityStat hypothesis states that increases in physical activity in one domain are compensated for by decreasing physical activity in another domain. Currently, little is known about how physical activity varies in children and adolescents within intervals of one day or multiple days. This systematic review provides an overview of studies that analyzed changes in (overall) physical activity, which were assessed with objective measurements, or compensatory mechanisms caused by increases or decreases in physical activity in a specific domain in children and adolescents. A systematic search of electronic databases (PubMed, Scopus, Web of Science, SportDiscus) was performed with a priori defined inclusion criteria. Two independent researchers screened the literature and identified and rated the methodological quality of the studies. A total of 77 peer-reviewed articles were included that analyzed changes in overall physical activity with multiple methodological approaches resulting in compensation or displacement. Of 40,829 participants, 16,265 indicated compensation associated with physical activity. Subgroup analyses separated by study design, participants, measurement instrument, physical activity context, and intervention duration also showed mixed results toward an indication of compensation. Quality assessment of the included studies revealed that they were of high quality (mean = 0.866). This review provides inconclusive results about compensation in relation to physical activity. A trend toward increased compensation in interventional studies and in interventions of longer duration have been observed.

Program Evaluation using the RE-AIM Framework: A Systematic Review and Application to a Pilot Health Promotion Program for Children

Program Evaluation using the RE-AIM Framework: A Systematic Review and Application to a Pilot Health Promotion Program for Children

Trajectories of body mass index Z-score and risk of high blood pressure in late adolescence in Suzhou children

Objective: To identify age and gender standardized body mass index among children and adolescents and explore their associations with high blood pressure (HBP) in late adolescence. Methods: The current study was based on the Health Promotion Program for Children and Adolescents, school-based surveillance successively conducted from 2012 to 2019 in Suzhou, China. A total of 11 812 children and adolescents aged 16-18 years, who had ≥4 examination records during 2012-2018 and were also involved in a surveillance program in 2019, were included. Latent class growth mixture modeling was used to identify the BMI-Z trajectories in different genders, and multivariate logistic regression was used to analyze the associations between different BMI-Z trajectories and risk of HBP in late adolescence. Results: Six distinct BMI-Z trajectories were determined for both genders:thin, slightly thin,standard, declining, overweight, and obese. Compared with the regular group, the obesity group had 94.0% (OR=1.94, 95%CI: 1.43-2.63) and 107.0% (OR=2.07, 95%CI: 1.33-3.22) increased risk of developing HBP in late adolescence in boys and girls, respectively. However, a neutral association was found between the descending group and HBP in late adolescence. Conclusions: Persistent obesity in children may increase the risk of HBP in their late adolescence. If an obese child restores normal weight before late adolescence, the risk of HBP may reduce.

Unfavorable progression of obesity in children and adolescents due to COVID-19 pandemic: A school-based survey in China.

ObjectiveThe Chinese government decisively imposed nationwide confinement in response to the COVID‐19 outbreak. This study aimed to evaluate the impact of the COVID‐19 pandemic on the progression of obesity in children and adolescents in Changshu, China.MethodsBased on the Health Promotion Program for Children and Adolescents (HPPCA), which is a prospective cross‐sectional and school‐based study, BMI assessed in seven consecutive years (2014 to 2020) among children and adolescents aged 6 to 17 years in Changshu city was extracted. The standardized BMI z scores (zBMI) and prevalence of obesity between 2020 (after COVID‐19 home confinement) and the previous 6 years were compared among age‐specific subgroups and between sexes.ResultsThe mean number of participants per year was 29,648. The overall mean zBMI drastically increased from 0.29 in 2019 to 0.45 in 2020, resulting in a rise of 0.16 (95% CI: 0.14‐0.18); the prevalence of obesity substantially elevated to 12.77% in 2020 (versus 10.38% in 2017), with an acceleration of 2.39% (95% CI: 1.88%‐2.90%). Of note, these increases were more likely to be observed in boys and those 6 to 11 years old.ConclusionsThe COVID‐19 pandemic seemed to exacerbate the obesity epidemic among pediatric populations in Changshu, China.

“Oh I try, but it’s so hard”: parental experiences of health promotion in children withdisabilities

Purpose The purpose of this study was to explore how parents support the health behaviours of their child with a disability, and their motivations for registering their child in a health promotion program for children with physical and/or intellectual disabilities. Methods Using a descriptive qualitative design, semi-structured face-to-face interviews were conducted with individual parents (n = 8) and one group (n = 3) to explore their experiences of health promotion for their child with a disability. Data were analyzed using thematic analysis to identify themes and patterns to develop an understanding of parental perspectives. Results Three themes were identified in the analysis of parents’ experiences supporting their children in health behaviours and registering them in a disability health promotion program: (1) Parents struggle to meet all of their child’s health promotion needs; (2) Parents recognize the social components of healthy behaviours; and (3) Health promotion opportunities tailored for children with disabilities are limited. These themes were not mutually exclusive and had overlapping factors that influenced parental experiences. Conclusion Parents experience many challenges supporting the health behaviours of their children with disabilities. This study reinforces the need for accessible, developmentally appropriate, social health promotion programs for children with disabilities. IMPLICATIONS FOR REHABILITATION Children with disabilities frequently demonstrate significantly higher sedentary behaviours, lower rates of physical activity and consumption of high-fat foods than their typically developing peers. Promoting healthy behaviours such as healthy eating and physical activity among children with disabilities and their families is therefore crucial to the child’s physical and psychosocial wellbeing. Parents of children with disabilities have sufficient health literacy and knowledge but report a lack of appropriate opportunities and strategies to support their child in developing healthy behaviours. Parents need increased availability and accessibility of socially inclusive programs that promote healthy behaviours for children of all physical and cognitive abilities.

Star Babies: Evaluation of a health visiting initiative for first-time parents in Northern Ireland

Star Babies is an enhancement of the universal Child Health Promotion Programme in Northern Ireland, where first-time parents are offered additional regular health visiting support from the antenatal period until the baby is 12 months of age. This study was carried out to evaluate outcomes of first-time parents who received the core Child Health Programme or the enhanced Star Babies programme to identify the areas where the programmes are successful and to quantitatively assess the magnitude of their impact. First-time parents were invited to participate in the study and were divided into two groups: those in the Star Babies programme (n=189) and those in the core Child Health Promotion Programme (n=125). The study found differences between the two groupings of first-time parents and the evaluation of the health visiting services received in terms of infant feeding, knowledge of preventing home accidents and overall satisfaction varied across the two groups. The findings highlight the positive outcomes from an enhanced health visitor-led programme such as Star Babies, with implications for policy, practice and service development.

Overview of Evidence Concerning School-Based Interventions for Improving the Health of School-Aged Children and Adolescents.

Universal prevention approaches that target the general population can be effective for promoting children's health. This overview aims to summarize evidence presented in existing reviews of school-based interventions. We present an overview of evidence sourced from Campbell and Cochrane systematic reviews. These reviews examined randomized controlled trials concerning school-based health-promotion programs for children (mostly aged 4-18 years) in the general population. We identified 56 high-quality reviews. The reviews focused on emotional and behavioral outcomes, infectious diseases, injury reduction, mental health, nutrition intake, oral health, physical and developmental changes, sense-organ diseases, sexual-health outcomes, and substance use/abuse. Positive evidence-such as vision screening plus provision of free spectacles for spectacle wear increase and a combination of social competence and social-influence approaches for preventing illicit drug use-were considered high certainty. Of the various interventions implemented in school settings that involved people from various occupations, some positive effects were found. In most cases, evidence certainty was negatively affected by a high risk of bias within studies, inconsistencies within the estimates, and insufficient sample sizes. Further primary studies in these areas would be helpful for accumulating evidence to promote stronger cooperation between health and education stakeholders.

School-based surveillance on visit-to-visit blood pressure variability and high blood pressure in children and adolescents

BackgroundThe predictive importance of visit-to-visit blood pressure variability (VVV) for high blood pressure (HBP) in a pediatric population has been largely unsettled. We aimed to evaluate it based on Health Promotion Program for Children and Adolescents (HPPCA), a school-based surveillance conducted from 2012 to 2018 in Suzhou, China.MethodsA total of 330,618 participants had BP measurement in 2018 and ≥ 3 BP records during 2012–2017, were recruited from HPPCA. Absolute BP values (in mmHg) were converted into age-, sex- and height- normalized z-scores. VVV was expressed as standard deviation (SD), coefficient of variation (CV) or average real variability (ARV) of BP z-scores during 2012–2017. Logistic regression models were used to assess the associations between VVV and HBP in 2018.ResultsIn 2018, 42,554 (12.87%) subjects were defined as HBP. VVV, except for SBP-CV and DBP-CV, was significantly higher in the HBP group than normotensives group. After adjusting for covariates including mean BP values from 2012 to 2017, SBP-SD, SBP-ARV, DBP-SD and DBP-ARV, increased the risk of HBP by 5.70 [95% confidence interval (95% CI) 5.54–5.87], 4.10 (95% CI 4.01–4.20), 4.70 (95% CI 4.50–4.90) and 3.39 (95% CI 3.28–3.50) times, respectively. Notably, SBP-SD significantly improved risk discrimination of HBP based on other risk variables (c-statistics, net reclassification index and integrated discrimination improvement significantly increased).ConclusionsHigher SD or ARV of BP, was independently related with higher probability of HBP in Chinese pediatric population. SBP-SD could be potentially helpful for detecting HBP. Future researches investigating the predictive value of VVV are warrant.

COVID-19 Pandemic-Related Childhood BMI Increases in China: A Health  Surveillance-Based Ambispective Cohort Analysis

Background: The coronavirus disease 2019 (COVID-19) pandemic has influenced all aspects of our life since the outbreak in December 2019. The pandemic-related body mass index z-score (zBMI) and obesity prevalence changes in children have not been clearly elucidated, especially in China. Methods: Based on the Health Promotion Program for Children and Adolescents in Suzhou of China, a total of 72,175 children aged 8-12 years with complete data for four consecutive years (2017-2020), were included. zBMI and obesity prevalence were calculated. Multiple mixed linear models were used to compare the yearly changes in zBMI before (2017-2019) and during (2019-2020) the pandemic. Finding: The prevalence of obesity slightly increased from 12·29% to 13·28% from 2017 to 2019, but substantially elevated to 15·29% in 2020. The mean [95% Confidence Interval (CI)] of yearly change in zBMI before and during the pandemic were 0 ·039 (0·037, 0·042) and 0·131 (0·125, 0·138), respectively; it yielded a statistically meaningful elevation of 0·092 (95% CI: 0·087, 0·096). Meanwhile, the acceleration of zBMI change in 2019-2020 compared to pre-pandemic were more obvious in boys than in girls. Interpretation: Compared to 2017-2019, zBMI and prevalence of obesity accelerated among Chinese children during the COVID-19 pandemic. Currently, there is an urgent need to formulate effective public health policies to reduce the risk of childhood obesity resulting from the pandemic. Funding: National Natural Science Foundation of China (grant: 81602911), Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD), and Gusu Health Talents Program Training Project in Suzhou, China (GSWS2020100).Declaration of Interest: The authors declare that they have no competing interests.Ethical Approval: This study was approved by the Ethics Committee of Suzhou Center for Disease Prevention and Control (No. SZJK2020-XW001).