Increase In Body Mass Index Z-score Research Articles

BMI z-score as a prognostic factor for height velocity in children treated with recombinant human growth hormone due to idiopathic growth hormone deficiency.

Growth hormone deficiency (GHD) causes growth disturbances during childhood. The most recommended treatment of GHD is the administration of recombinant human growth hormone (rhGH). Recent studies have proved that well-nourished GHD children respond better to rhGH therapy compared to undernourished individuals. The aim of this study was to analyze nutritional status along with height velocity in GHD children during the first two years of rhGH therapy, and to estimate the optimal BMI z-score range in which these children achieve the best growth results. This retrospective analysis included 80 prepubertal idiopathic GHD children treated with rhGH. Anthropometric data were obtained from medical records made at an initial visit and then follow-up visits after 12 and 24 months of treatment. The body mass index (BMI) was calculated and standardized into z-score, basing on Cole's LMS method. Then, the BMI z-score was analyzed in relation to the parameters of growth response. The higher the BMI z-score at treatment entry, the greater the increase in height during the first twelve months of rhGH therapy. BMI z-score ≥0 noted at the beginning of each year of the treatment are associated with significantly better growth increments throughout the first and the second years of the therapy. Prepubertal idiopathic GHD children with BMI z-score below 0 would probably benefit from the improvement of their nutritional status prior to the rhGH treatment beginning. It seems that increasing BMI z-score to obtain values between 0 and 1 would be optimal for the growth process.

Impact of COVID-19 pandemic on children overweight in Japan in 2020.

This study aimed to explore the association between the coronavirus disease (COVID-19) pandemic and overweight incidence among preadolescent elementary school children in Japan. A population-based longitudinal study was conducted in Adachi City, Tokyo, Japan, using data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study. The control group (2016-2018) comprised 434 children, and the COVID-19 exposure group (2018-2020) included 3500 children. Overweight was defined as a body mass index (BMI) z-score of 1 SD or more according to the World Health Organization standards. The study design involved comparing BMI z-scores before and after exposure to the pandemic, considering the associated lifestyle changes and potential consequences on physical activity, parental employment status and income. By 6th grade, the prevalence of overweight increased from 17.7% to 19.2% in the control group and 22.5% to 29.5% in the COVID-19 exposure group. Difference-in-differences analysis revealed that children's exposure to COVID-19 significantly increased BMI z-scores (coefficient 0.22, 95% confidence interval (CI) 0.14-0.29) and a higher odds ratio of overweight (odds ratio 2.51, 95% CI 1.12-5.62), even after adjusting for time-varying covariates. The COVID-19 pandemic has been associated with an increased prevalence of overweight among elementary school children in Japan.

Environmental Phenols and Growth in Infancy: The Infant Feeding and Early Development Study.

Higher mean and rapid increases in body mass index (BMI) during infancy are associated with subsequent obesity and may be influenced by exposure to endocrine-disrupting chemicals such as phenols. In a prospective US-based cohort conducted 2010-2014, we investigated associations between environmental phenol exposures and BMI in 199 infants. We measured seven urinary phenols at ages 6-8 and 12 weeks and assessed BMI z-score at up to 12 study visits between birth and 36 weeks. We examined individual and joint associations of averaged early infancy phenols with level of BMI z-score using mean differences (β [95% confidence intervals (CI)]) and with BMI z-score trajectories using relative risk ratios (RR [95% CI]). Benzophenone-3, methyl and propyl paraben, and all phenols jointly were positively associated with higher mean BMI z-score (0.07 [-0.05, 0.18], 0.10 [-0.08, 0.27], 0.08 [-0.09, 0.25], 0.17 [-0.08, 0.43], respectively). Relative to a Stable trajectory, benzophenone-3, 2,4-dichlorophenol, 2,5-dichlorophenol, and all phenols jointly were positively associated with risk of a Rapid Increase trajectory (1.46 [0.89, 2.39], 1.33 [0.88, 2.01], 1.66 [1.03, 2.68], 1.41 [0.71, 2.84], respectively). Early phenol exposure was associated with a higher mean and rapid increase in BMI z-score across infancy, signaling potential long-term cardiometabolic consequences of exposure.

Assessment of Physical Condition in Cystic Fibrosis Patients during 12-month Treatment with Cystic Fibrosis Transmembrane Conductance Regulator Modulators

Objective − To investigate the effect of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy on physical condition in children with cystic fibrosis (CF) during a 12month period.Materials and Methods − This is a retrospective cohort study including children aged ≥5 years treated with Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) or Lumacaftor/ Ivacaftor (LUM/IVA). A six-minute walk test (6MWT) was performed at baseline and at the 3-month follow-ups. Changes in spirometry and sweat chlorides, and body mass index (BMI) were also observed. Collected data were analysed for changes in 6MWT results in correlation with other parameters. The 6MWT results were compared to those predicted for healthy peers. Missing values were replaced using imputation.Results − Study includes 34 patients (median age 14 years); 28 received ELX/TEZ/ IVA, and 6 LUM/IVA. The average 6MWT walking distance (6MWD) increased from 519.3±107.7 m at baseline to 620.0±99.5 m after 12 months (P<0.0001). The 12 month 6MWD values matched those expected for healthy peers. The increase in BMI z-score (P=0.019) and ppFEV1 (P<0.0001) visible at the 3-month followup was sustained throughout the rest of the year. Sweat chloride concentration decreased (P< 0.0001); after 12 months 13/34 subjects had values below 60 mmol/L. No correlation between 6MWD and other parameters was observed.Conclusion − Significant improvement in 6MWT results was already visible at three months following the initiation of CFTR modulator treatment. After 12 months patients performed 6MWT at a level indistinguishable from that expected of healthy peers.

Abstract P409: Maternal Macronutrient Intake at Pregnancy and Offspring Growth Trajectory Before Adulthood: A Prospective Analysis in the Growing Up Today Study 2 Cohort

Background: Childhood obesity has become a public health challenge globally, with increasing prevalence worldwide. Existing studies have indicated a potential link between maternal macronutrients intake and subsequent weight changes in their offspring during childhood. However, the long-term relationship between maternal macronutrient consumption at pregnancy and the growth trajectory of offspring into adulthood remains unclear. Objectives: We aim to investigate the relationship between maternal macronutrients intake at pregnancy and the trajectory of the offspring BMI z-score, as well as the risk of becoming overweight or obese before adulthood. Method: We included 5,700 children from the Growing Up Today Study 2 born to 4,697 mothers who participated in the Nurses’ Health Study II . Diet was assessed using a validated food frequency questionnaire in 1991 approximately during or before the pregnancy at issue. Age- and gender-specific BMI thresholds described by the International Obesity Task Force were used to define overweight and obesity in childhood and adolescence. Multivariable linear and log-binomial regression models with generalized estimating equations were used to evaluate the association between maternal macronutrients intake at pregnancy and offspring BMI z-score trajectory and the risk of overweight or obesity. Results: During follow-up, 2145 (37.6%) GUTS2 participants met the criteria of overweight or obesity.After multivariate adjustment for maternal, offspring risk factors, total maternal total energy and carbohydrate percent energy, comparing to the 1 st quartile, the highest quartile of total protein consumption at pregnancy was associated with 0.14-unit [β: 0.14 (95% CI: 0.02, 0.26; P-trend = 0.03)] increase in BMI z-score, while no significant association was observed for the risk of offspring overweight or obesity [RR: 1.17 (95% CI: 0.94, 1.46; P-trend = 0.12)]. The relationship persisted for the top quartile of animal protein energy intake [β: 0.14 (95% CI: 0.01, 0.27; P-trend = 0.03)], but not for vegetable protein consumption. Intakes of dietary fats and carbohydrates were not associated with BMI z-score or risk of overweight or obesity. Furthermore, individual macronutrient subgroups, such as saturated fats, mono- and poly-unsaturated fats, or whole grains and refined grains, were not associated with the outcomes of interest, either. Conclusion: Maternal animal protein intake at pregnancy is positively associated with higher offspring BMI z-score before adulthood, but not the risk of developing overweight or obesity during childhood. Other macronutrients are not significantly associated with these childhood body weight outcomes. Overall, these data suggest that the macronutrient composition of maternal diet at peri-pregnancy period has minimal impact on offspring body weight in this well-nourished population.

BMI increase during early childhood in boys with cystic fibrosis and early adrenarche.

Increase in body mass index (BMI) in early childhood (1-6 years) was found to be a contributing factor for impaired final height in boys with Cystic Fibrosis (CF). Early adrenarche (before age 9 years in boys) may contribute to an impaired final height by triggering an early acceleration of bone age resulting in a compromised growth spurt during puberty. We aimed to analyze the timing of adrenarche in boys with CF and to associate BMI increase in early childhood to timing of adrenarche. Boys with CF, aged 8-9 years, visiting the CF expertize center Utrecht were included. Since 2018, anthropomorphic, pubertal and endocrine data were collected. Early adrenarche in boys was defined as a dehydroepiandrosterone sulfate (DHEAS) ≥ 1 µmol/L before the age of 9 years. Thirteen boys (mean age 8.55 ± 0.27 years) were enrolled. The median (IQR) DHEAS-level was 1.3 µmol/L (0.71-2.40). Eight boys (61.5%) had an early rise in DHEAS-levels ≥ 1 µmol/L. Mean increase in BMI Z-score between 1 and 6 years of age (ΔBMI1-6) was -0.07 ± 0.86. A significant correlation was found between ΔBMI1-6 and DHEAS-levels at the age of 8-9 years (r = 0.624, p = 0.040). In five boys with early rise in DHEAS, accelerated bone age was found (average 1.55 ± 0.96 years). In this small cohort, 61.5% of boys with CF between 8 and 9 years had an early rise of DHEAS, which was correlated to ΔBMI1 -6 between 1 and 6 years. Early adrenarche may be caused by ΔBMI1 -6.

OR15-04 Accelerated Longitudinal Weight Gain Among Infants With In Utero COVID-19 Exposure

Abstract Disclosure: M.W. Ockene: None. S.C. Russo: None. H. Lee: None. C. Monthé-Drèze: None. T.L. Stanley: Consulting Fee; Self; RosVivo Therapeutics. Grant Recipient; Self; Pfizer, Inc. I.L. Ma: None. M. Toribio: None. L.L. Shook: None. S.K. Grinspoon: Consulting Fee; Self; Theratechnologies. A.G. Edlow: Consulting Fee; Self; Mirvie, Inc. Grant Recipient; Self; Merck. L.T. Fourman: Consulting Fee; Self; Amryt Pharmaceuticals. Grant Recipient; Self; Amryt Pharmaceuticals. Background: Since its initial outbreak in 2019, coronavirus disease 2019 (COVID-19) has led to unprecedented morbidity and mortality worldwide. Due to a high burden of infection among pregnant women, a novel population of children with in utero exposure to maternal COVID-19 has emerged for which health outcomes are largely unknown. Given the role of the intrauterine environment in shaping chronic disease risk over the life course through effects on fetal programming, there is a pressing need to delineate longitudinal growth patterns among infants born to mothers with COVID-19 during pregnancy. Methods: We conducted a longitudinal cohort study leveraging a prospectively-enrolled perinatal biorepository among 149 infants with in utero exposure to maternal COVID-19 and 127 unexposed controls. Weight, length, and BMI were abstracted from health records at 0, 2 (±0.5), 6 (±1), and 12 (±1) months and standardized using World Health Organization (WHO) growth charts. Linear mixed effect and linear regression models were used to examine differences in anthropometric z-score trajectories over the first year of life between groups. Analyses were adjusted for maternal age, ethnicity, parity, insurance type, and BMI as well as infant sex, birthdate, and breastfeeding. Our pre-specified primary endpoint was change in BMI z-score from birth to 12 months. Results: Infants with in utero COVID-19 exposure versus controls exhibited differential trajectories of weight and BMI, but not length, z-scores over the first year of life (study group x time interaction, P < 0.0001 for weight and BMI z-scores). Infants born to mothers with prenatal COVID-19 had lower BMI z-score at birth (effect size: -0.35, 95% CI, -0.66 to -0.03) and greater increase in BMI z-score from birth to 12 months (effect size: 0.53, 95% CI, 0.06 to 0.99). Change in BMI z-score was greater than the WHO population average of 0 within the exposed (P < 0.0001) but not the unexposed group. Birth weight z-score was found to mediate a significant proportion of the relationship between COVID-19 exposure and postnatal growth (estimate ± standard error, 32 ± 14%, P = 0.02). Conclusions: Infants with in utero exposure to maternal COVID-19 were found to exhibit lower birth weight and accelerated weight gain over the first year of life compared to their unexposed peers. The exaggerated growth trajectory observed in these children may be a catch-up response to a prenatal growth deficit. Lower birth weight and accelerated postnatal weight gain are established risk factors for obesity, abdominal adiposity, and cardiovascular disease later in life. Thus, children born to mothers with prenatal COVID-19 may be at heightened risk of long-term cardiometabolic complications and require close monitoring over the life course. Further studies are now needed to delineate cardiometabolic sequelae of in utero COVID-19 exposure among this emerging global population. Presentation: Friday, June 16, 2023

Barriers in the Management of Obesity in Mexican Children and Adolescents through the COVID-19 Lockdown-Lessons Learned and Perspectives for the Future.

Our study comprised two phases. The initial descriptive cross-sectional phase included surveys of children who are overweight or obese and their parents/guardians from the Pediatric Obesity Clinic at the Child Welfare Unit (UBI, acronym in Spanish) in the Hospital General de México "Dr. Eduardo Liceaga" (n = 129). The participants were studied to explore changes in lifestyle, physical activity, sleep patterns, eating behaviors, food consumption, anxiety, and depression. In the second phase, the biochemical, body composition, and anthropometric parameters of 29 pre-COVID-19 patients were compared before and after the lockdown. The survey showed more moderate anxiety and depression, alterations in sleep, physical inactivity, and an increase in the consumption of animal products, fruits, cereals, tubers, sugary drinks, and ultra-processed food. In the study's comparative phase, we observed a substantial increase in BMI z-score (p = 0.01), waist circumference (p < 0.001), fat mass (p < 0.001), percentage of adiposity (p = 0.002), and basal glucose (p = 0.047) and a drop in lean mass (p = 0.008). The pandemic led to a loss of routines and socioeconomic changes that made it difficult to address weight and obesity in young people. The results show that managing obesity in our patients involves considering both lifestyle and the social environment. This encourages us to consider a comprehensive and personalized approach.

Body mass index and partial remission in 119 children with type 1 diabetes-a 6-year observational study.

This long-term study aimed to analyze the associations between BMI Z-score, HbA1c, and daily insulin requirement (DIR) and the prevalence and duration of partial remission (PR) in children and adolescents with type 1 diabetes (T1D). After retrieving retrospective data for 195 patients from their health records at 24, 48, and 72 months after T1D diagnosis, the study group was comprised of 119 (57 girls) children with a complete dataset for all 6 years. PR was defined according to the ISPAD guidelines. Analyses were carried out in the whole group and subgroups according to PR duration: no PR at all (NPR), PR lasting less than 2 years (PR < 2), and PR at least 2 years (PR ≥ 2). PR was observed in 63% of the patients (78.9% of overweight and 100% of obese patients). NPR patients showed the lowest mean initial BMI Z-score [-0.65 ± 1.29 vs. 0.02 ± 1.42, (PR < 2), p = 0.01 and vs. 0.64 ± 1.43 (PR ≥ 2), p = 0.17]. The dissimilarity in BMI across patients declined over time. Within the NPR group, the initial mean BMI Z-score significantly increased within the first 2 years (unadjusted p < 0.001) and remained constant afterward. In the PR <2 group, the highest increase in BMI Z-score occurred after 4 years (p < 0.001) and then decreased (p = 0.04). In the PR ≥2, the BMI Z-score slightly decreased within the first 2 years (p = 0.02), then increased (p = 0.03) and remained unchanged for the last 2 years. Six years after T1D started, the mean DIRs do not differ among the patient groups (ANOVA p = 0.272). During 6 years of follow-up, PR occurred in almost two-thirds of the studied children including almost all overweight and obese children. We observed a gradual normalization of the BMI Z-score at the end of the follow-up. BMI Z-score increased slightly in children with no remission initially but remained later constant until the end of observation. In both remitter groups, the increase in BMI Z-score appeared later when the protective honeymoon period ended. Regardless of BMI Z-score, the β-cell destruction process progresses, and after 6 years, the DIR is similar for all patients.

Increased Body Mass Index Augments Endothelial Injury and Clinical Outcomes after Hematopoietic Stem Cell Transplantation

Higher body mass index (BMI) is characterized as a chronic inflammatory state with endothelial dysfunction. Endothelial injury after allogeneic hematopoietic stem cell transplantation (allo-HSCT) puts patients at risk for such complications as transplantation-associated thrombotic microangiopathy (TA-TMA) and acute graft-versus-host-disease (aGVHD). To evaluate the impact of increased BMI on endothelial injury after allo-HSCT in pediatric and young adult patients, we conducted a retrospective cohort study evaluating 476 consecutive allo-HSCT children and young adult recipients age 0 to 20 years. Our analysis was subdivided based on distinct age categories (<2 years and 2 to 20 years). BMI was considered as a variable but was also expressed in standard deviations from the mean adjusted for age and sex (z-score), based on established criteria from the World Health Organization (age <2 years) and the Centers for Disease Control and Prevention (age 2 to 20 years) to account for differences associated with age. Primary endpoints included the incidences of TA-TMA and aGVHD. Increased BMI z-score was associated with TA-TMA after allo-HSCT in patients age <2 years (median, 18.1; IQR, 17 to 20; P=.006) and in patients age 2 to 20 years (median, 18.7; IQR, 16 to 21.9; P=.02). Higher BMI z-score correlated with TA-TMA risk in both age groups, with a BMI z-score of .9 in the younger cohort and .7 (IQR, -.4 to 1.6; P=.04) in the older cohort. Increased BMI z-score was associated with an increased risk of TA-TMA in a multivariate analysis of the entire cohort (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.05 to 1.37; P=.008). Multivariate analysis also demonstrated that patients with BMI in the 85th percentile or greater had an increased risk of developing TA-TMA compared to those with a lower BMI percentile (OR, 2.66; 95% CI, 1.62 to 4.32; P < .001). Baseline and day +7 ST2 levels were elevated in subjects with TA-TMA compared to those without TA-TMA in both age groups. Baseline sC5b-9 concentration was not correlated with BMI z-score, but sC5b-9 concentration was increased markedly by 7 days post-allo-HSCT in patients age <2 years who later developed TA-TMA compared to those who never developed TA-TMA (P=.001). The median BMI z-score was higher for patients with aGVHD compared to patients without aGVHD (.7 [range, -3.9 to 3.9] versus .2 [range, -7.8 to 5.4]; P=.03). We show that high BMI is associated with augmented risk of endothelial injury after HSCT, specifically TA-TMA. These data identify a high-risk population likely to benefit from early interventions to prevent endothelial injury and prompt treatment of established endothelial injury.

Prenatal exposure to PM2.5 and its constituents with children's BMI Z-score in the first three years: A birth cohort study

BackgroundLimited studies evaluated the effect of prenatal exposure to fine particulate matter (PM2.5) on childhood growth and no consensus reached yet. No study explored the effect of prenatal exposure to PM2.5 and its constituents on childhood growth in a region with high PM2.5 levels (>50 μg/m3). The present study aimed to examine the association of prenatal exposure to PM2.5 and its constituents with children's BMI Z-score in the first three years. MethodsThe present study was based on a birth cohort in Beijing, China, involving 15,745 mothers with their children who were followed to three years old. We estimated prenatal PM2.5 and its constituents [organic carbon (OC), elemental carbon (EC), sulfate (SO42−), nitrate (NO3−), and ammonium (NH4+)] concentrations based on residential addresses at birth. Height (or length) and weight of children were repeatedly measured, and body mass index (BMI) Z-score was calculated at one, two, and three years old. Generalized linear regression and generalized estimating equation were used to examine the associations between prenatal exposure to PM2.5 and its constituents with BMI Z-score in the first three years. ResultsPrenatal exposure to PM2.5 and its constituents was generally associated with higher BMI Z-score of children aged one, two, and three years. One IQR increase of PM2.5, OC, EC, NO3−, NH4+, and SO42− (21.30 μg/m3, 11.52 μg/m3, 2.40 μg/m3, 8.28 μg/m3, 2.42 μg/m3, and 8.80 μg/m3, respectively) was associated with 0.13 (95%CI: 0.10, 0.16), 0.24 (95%CI: 0.19, 0.29), 0.12 (95%CI: 0.09, 0.16), 0.13 (95%CI: 0.09, 0.17), 0.11 (95%CI: 0.08, 0.13), and 0.24 (95%CI: 0.19, 0.30) increase in BMI Z-score from one to three years old, respectively. ConclusionThe study suggested that prenatal exposure to PM2.5 and its constituents was associated with higher BMI Z-score of children in the first three years. Public health policy for controlling harmful PM2.5 constituents should be developed to promote child health.

The role of dieting, happiness with appearance, self-esteem, and bullying in the relationship between mental health and body-mass index among UK adolescents: a longitudinal analysis of the Millennium Cohort Study.

Mental illness and obesity are among the biggest challenges to population health, they are linked, and may be modifiable during adolescence. We aimed to determine intervening pathways between mental health and BMI z-score symptoms across adolescence. In this longitudinal cohort study, we used path models to examine self-reported dieting, happiness with appearance, self-esteem and bullying at 14 years as potential mediators of the cross-lagged relationship between mental health (via the Strengths and Difficulties Questionnaire) and Body Mass Index (BMI) z-score at 11 and 17 years by sex in the UK Millennium Cohort Study, a prospective cohort study of 18,818 children born in the UK between September 1st, 2000, and January 31st, 2002. Full, incomplete data on all singleton children still participating in the study by age 11 years were analysed in GSEM via maximum likelihood estimation (N=12,450). We found happiness with appearance and self-esteem, but not dieting or bullying, mediated the relationship between BMI age 11 and mental health age 17. Each increase in BMI z-score at 11 years was associated with 0.12 increase for boys and a 0.19 increase for girls in scores of unhappiness with appearance (boys: b 0.12, 95% C.I.; girls b 0.19, C.I. 0.14 to 0.23) and a 16% increase for boys and a 22% increase for girls in odds of low self-esteem (boys OR 1.16, 95% C.I. 1.07 to 1.26; girls: OR 1.22, 95% C.I. 1.15 to 1.30) at 14 years. In turn, for both boys and girls, being unhappy with appearance and low self-esteem at 14 years were associated with a greater likelihood of emotional and externalizing symptoms at 17 years. Early prevention strategies to encourage healthy physical and mental development of children need to focus on the promotion of positive body-mage and self-esteem. The National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR).

Combined intake of sugar‐sweetened beverages and sugar‐containing ultra‐processed foods is associated with an increase in body mass index during early childhood

Sugar-containing ultra-processed (SUP) foods and beverages consumption has increased globally in recent years and contributes to the rising global trends of obesity and diet-related chronic non-communicable diseases. However, there are limited longitudinal studies of SUP foods and beverages intake and weight gain in children. To examine associations between intake of sugar-sweetened beverages (SSB) and SUP foods and changes in body mass index during early childhood. Multistage sampling was used to select a nationally representative sample of Uruguayan children living in urban areas from the 2012-2013 Continuous Household Survey. The sample for this analysis included all children aged 0-3 years 11 months with dietary data in 2013-2014 (wave 1; n=2611) and in 2015-2016 (wave 2; n=2383). Multilevel regression modelling tested the association between children's consumption of SSB and SUP foods and change in BMI z-score (BMIz). In multivariable-adjusted models, intake of SSB and SUP foods (in combination but not individually) in both waves was positively associated with change in BMIz over 2 years β coefficient: 0.13 (95% confidence interval [CI]: 0.02, 0.23). BMIz decreased among non-consumers (β: -0.12, 95% CI: -0.24, -0.00, p=0.048). Associations were significant for SUP foods but not SSB foods individually. Children consuming ≥2 SSB and SUP foods (vs. <2) at baseline had increased BMIz (p for trend=0.02). Early and current intake of SSB and SUP foods and beverages was associated with increases in BMIz in children over 2 years.

Evaluation of a cluster-randomized controlled trial: Communities for Healthy Living, family-centered obesity prevention program for Head Start parents and children

BackgroundThis study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families.MethodsUsing a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one of three intervention start times. CHL involved a media campaign and enhanced nutrition support. Parents were invited to join Parents Connect for Healthy Living (PConnect), a 10-week wellness program. At the beginning and end of each school year (2017-2019), data were collected on the primary outcome of child Body Mass Index z-score (BMIz) and modified BMIz, and secondary outcomes of child weight-related behaviors (diet, physical activity, sleep, media use) and parents’ weight-related parenting practices and empowerment. Data from 2 years, rather than three, were utilized to evaluate CHL due to the COVID-19 pandemic. We used mixed effects linear regression to compare relative differences during intervention vs. control periods (n = 1274 vs. 2476 children) in (1) mean change in child BMIz and modified BMIz, (2) the odds of meeting child health behavior recommendations, (3) mean change in parenting practices, and (4) mean change in parent empowerment. We also compared outcomes among parents who chose post-randomization to participate in PConnect vs. not (n = 55 vs. 443).ResultsDuring intervention periods (vs. control), children experienced greater increases in BMIz and modified BMIz (b = 0.06, 95% CI = 0.02,0.10; b = 0.07, 95% CI = 0.03, 0.12), yet were more likely to meet recommendations related to three of eight measured behaviors: sugar-sweetened beverage consumption (i.e., rarely consume; Odds Ratio (OR) = 1.5, 95% CI = 1.2,2.3), water consumption (i.e., multiple times per day; OR = 1.6, 95% CI = 1.2,2.3), and screen time (i.e., ≤1 hour/day; OR = 1.4, 95% CI = 1.0,1.8). No statistically significant differences for intervention (vs. control) periods were observed in parent empowerment or parenting practices. However, parents who enrolled in PConnect (vs. not) demonstrated greater increases in empowerment (b = 0.17, 95% CI = 0.04,0.31).ConclusionsInterventions that emphasize parent engagement may increase parental empowerment. Intervention exposure was associated with statistically, but not clinically, significant increases in BMIz and increased odds of meeting recommendations for three child behaviors; premature trial suspension may explain mixed results.Trial registrationClinicalTrials.gov, NCT03334669, Registered October 2017.

Effects of COVID-19 pandemic on pediatric weight: A retrospective chart review

The COVID-19 pandemic forced United States school closures in March 2020. Students moved to online learning, fostering a sedentary lifestyle. As the pandemic heightened population disparities, the impact on weight gain may also be unequally distributed. This study aimed to evaluate changes in body mass index (BMI) z-scores and weight percentiles of pediatric patients during the pandemic and associated demographics to identify those at risk for weight gain. Methods included a retrospective chart review of patients 5–18 years-oldwitha well-visit in the three years 2018, 2019 and 2020; first identified with a well-visit in August-September of 2020.BMI z-scores and weight percentiles were analyzed using a correlated errors regression model appropriate for longitudinal data. This longitudinal approach was used to model outcomes by patient demographics.Interaction terms with time were evaluated for each variable. Of 728 patients, mean age was 9.7 years (2018); 47 % female, 70 % white, and 23 % publicly insured. BMI z-score did not increase significantly from 2018-2019 versus 2019–2020. Weight percentile demonstrated a slight trajectory increase over these same time points. Publicly insured patients demonstrated significantly greater increase in BMI z-score versus privately insured patients (p = 0.009). Mean differences between groups increased from 0.26 in 2018 (95 % CI [0.07, 0.45]) to 0.42 in 2020 (95 % CI [0.23, 0.61]). Results were similar for weight percentile. Publicly insured pediatric patients experienced significant increase in BMI-z score and weight percentile, but over time this trajectory remained constant. The results support targeting at risk subgroups in addressing long-term impacts of the pandemic.

Sleep quality, sleep apnea, and metabolic health in children treated with adenotonsillectomy.

The aim of this study was to determine if cardiopulmonary coupling (CPC) calculated sleep quality (SQI) may predict changes in metabolic health in children treated with early adenotonsillectomy (eAT) for obstructive sleep apnea (OSA). Secondary analysis of the Childhood Adenotonsillectomy Trial (CHAT)was performed including children 5.0-9.9years with OSA assigned to eAT. The cohort was stratified based on SQI and AHI to evaluate (1) response to eAT in children with high sleep quality (SQI ≥ 75) and mild-OSA, AHI < 5.0 (group1) and children with moderate-OSA AHI ≥ 5.0 or SQI < 75 (group2) at baseline and (2) effect of eAT therapy on metabolic health, GroupRemission (AHI < 1.0, SQI ≥ 75) compared to GroupResidual. At baseline group2 (n=124)had higher average heart rate during sleep (AHRSleep), 87 vs. 81 beats/minute (p < 0.001)compared to group1 (n=72). After surgery, group2 on average had less increase in BMI z-score 0.13 vs. 0.27, (p = 0.025), improved their SQI + 2.06 compared to decline - 3.75 in group1, (p = 0.015), decreased AHRSleep-- 2.90 vs. - 0.34 (p = 0.025) and AHI - 5.00 vs. - 0.36 (p = 0.002). GroupRemission was younger 6.59 vs. 7.41; p < 0.001; with lower BMI z-score 0.90 vs. 1.34; p = 0.021; AHRSleep 80.60 vs. 83.50; p = 0.032; fasting insulin (µIU/ml) 7.54 vs. 12.58; p = 0.017 and glucose (mmol/L) 4.45 vs. 4.60; p = 0.049, with better lipid metabolism though not statisticallysignificantly, low-density-lipoprotein 90.26mg/dL vs. 97.94; p = 0.081 and cholesterol 154.66mg/dL vs. 164.36; p = 0.076. The results may indicate that children with mild-OSA and high-SQI may be less likely to benefit from eAT than children with moderate-OSA. To improve metabolic health, successfully treating both AHI and SQI is likely needed. CPC-calculated SQI may have a role to identify children less likely to benefit from eAT and to evaluate success of therapy. ClinicalTrials.gov Identifier: NCT00560859.

Changes in body size and body composition in survivors of childhood cancer: seven years follow-up of a prospective cohort study

Cancer treatment is known to have impact on nutritional status, and both underweight and overweight have been reported in several studies in survivors. A limitation of most studies is that they relied on retrospective data or were limited to a subgroup of patients. The current study aims to describe changes in body size and body composition prospectively seven years after diagnosis in a heterogeneous sample of childhood cancer survivors and to evaluate associated factors. The study population consisted of children diagnosed with hematological, solid and brain malignancies aged 0-18 years at diagnosis. Data of body size, body composition, and associated factors were collected at diagnosis, one year and seven years after diagnosis. In the total cohort mean BMI z-score increased during treatment. In children with hematological and brain malignancies BMI z-score continued to increase after end of treatment leading to quadrupling of the prevalence of obesity seven years after diagnosis. BMI at diagnosis (β=-0.34, P=0.007) and maternal BMI (β=0.25, P=0.046) were associated with the increase in BMI z-score. Mean fat mass (FM) z-score, already high at diagnosis, increased during treatment in children with hematological and brain malignancies and evened out during follow-up. Changes in FM z-score were predicted by type of malignancy (hematologic malignancy versus solid tumor β=0.48, P=0.008; brain tumor versus solid tumor β=0.45, P=0.012). Mean fat free mass (FFM) z-scores started low at diagnosis, particularly in patients with brain tumors, increased during treatment in patients with solid and brain malignancies, though decreased in children with hematological malignancies. At 7 years follow-up a clear increase to normal was seen. Age at diagnosis (β=0.43, P=0.004) and initial FFM (β=-0.49, P=0.001) were found to be significant predictors for changes in FFM z-scores. The finding that the once obtained extra weight and FM during treatment persisted after termination of treatment in children with hematological and brain malignancies, stresses the importance to create awareness about the risk of developing overweight in children during cancer treatment.

The Longitudinal Effect of Area Socioeconomic Changes on Obesity: a Longitudinal Cohort Study in the USA from 2003 to 2017.

Despite several dimensions of area socioeconomic status (SES), past literature has been dominated by the use of area socioeconomic position. We examined the longitudinal effect of three area SES measures (i.e., socioeconomic position, inequality, and segregation) on obesity. Using longitudinal data from the Fragile Families & Child Wellbeing Study (N = 1493), we estimated a linear mixed model to examine the effect of three time-varying area SES measures on time-varying measures of objectively measured body mass index z-score (BMIz) from ages 5years to 15years. Findings showed that BMIz increased steadily over time (B = 0.02, 95% CI = 0.02, 0.03). A significant interaction between time and area socioeconomic position indicates that children in areas with higher socioeconomic position had a smaller increase in BMIz than those in low socioeconomic areas (B = - 0.02, 95% CI = - 0.02, - 0.01). A non-linear relationship of area income inequality with BMIz such that BMIz was higher as area income inequality was greater, but the effect diminishes in magnitude with a higher level of area income inequality (linear term: B = 0.07; quadratic term: B = - 0.03). Area income segregation was associated with greater BMIz (B = 0.08, 95% CI = 0.03, 0.12). No time interaction effect was found for area income inequality and segregation. Results highlight a need for community health policy efforts and evidence-based interventions to address childhood obesity issues in low-SES areas.

Fetal exposure to cannabis, neonatal adiposity, and postnatal growth trajectories: The Healthy Start study

Objective: Cannabis use during pregnancy is associated with lower birth weight and may influence postnatal growth. We estimated associations of fetal exposure to cannabis with neonatal adiposity and body mass index (BMI) z-score trajectories through age 3 years, as well as effect modification by breastfeeding. Methods: We leveraged a subsample of 130 mother-child pairs from a Colorado-based cohort. Twelve cannabinoids/metabolites (including delta 9-tetrahydrocannabinol [THC] and cannabidiol [CBD]) were measured in maternal urine collected at ~27 weeks gestation. Fetal exposure to cannabis was dichotomized as exposed (any cannabinoid&amp;#x2265;limit of quantification) and not exposed (cannabinoids&amp;#x3c;limit of quantification). Generalized linear models estimated the associations between fetal exposure to cannabis with birth weight and neonatal adiposity (measured by air displacement plethysmography). A mixed-effects model estimated the association between fetal cannabis exposure and BMI z-score trajectories. Interaction by breastfeeding duration was assessed by including a product term (with fetal exposure to cannabis) in a mixed-effects model. Results: Fetal exposure to cannabis was associated with lower birth weight (-206g; 95% CI: -393, -18; p=0.03) and neonatal adiposity (-2.0%; 95% CI: -3.7, -0.02; p=0.03) followed by rapid postnatal growth through 3 years (0.37 increase in BMI z-score per square root year; 95% CI: 0.01, 0.60; p=0.02). Breastfeeding modified this association (p for interaction&amp;#x3c;0.01). Among cannabis-exposed offspring who were not breastfed, BMI z-scores were 0.42 lower at 6 months (95% CI: -1.15, 0.31) but 0.54 higher at 36 months (95% CI: -0.36, 1.44). Conversely, BMI z-scores were no different by fetal cannabis exposure among offspring who were breastfed for ~5 months. Conclusions: Our data suggests that fetal exposure to cannabis alters fetal and postnatal growth, and that breastfeeding may stabilize over-compensatory growth among cannabis-exposed offspring. Although the impact of lactational exposure to cannabis requires further investigation, it remains important to caution against cannabis use during pregnancy and lactation.

The Longitudinal Relation between Infant Feeding Styles and Growth Trajectories among Families from Low-Income Households

BackgroundParental feeding styles, including the emotional environment parents create to modify a child’s eating behaviors, have been associated with measures of adiposity in cross-sectional studies. The longitudinal relation between parental feeding styles in early infancy and adiposity in later infancy/toddlerhood are scant and have shown mixed results, particularly in families from low-income households. ObjectivesThis study examined the relation between parental feeding styles and infant BMI z-score trajectories between 6 and 18 mo in families from low-income households. MethodsParent–infant dyads were recruited during the infant’s 6-, 9-, or 12-mo well-child visit. Feeding styles were assessed using the Infant Feeding Style Questionnaire (IFSQ). Infant anthropometrics from birth through 18 mo were extracted from the electronic medical record. BMI z-score slopes were estimated for each infant between 0-6 mo and 6–18 mo. Associations between feeding styles and BMI z-score slopes were examined using mixed models controlling for demographic, clinical, and feeding covariates. ResultsThe final analytic sample included 198 dyads (69% Black; median infant age: 9.0 mo; IQR: 6.8–10.3 mo). The predominant parent feeding styles included the following: laissez-faire (30%), restrictive (28%), responsive (23%), and pressuring (19%). In adjusted models, the predominant feeding style at enrollment was associated with the BMI z-score slope between 6 and 18 mo, with the responsive feeding style exhibiting a steeper increase in BMI z-score than other feeding styles. Infant feeding style was not associated with BMI z-score slope between birth and 6 mo of age. Infants of parents who exhibited restrictive feeding styles were more likely to have a BMI ≥85th percentile at their last measurement. ConclusionsThe predominant parent feeding style during infancy in a low-income population was associated with infant BMI z-score between 6 and 18 mo of age, but not earlier. Further studies are needed to better understand how predictive factors collectively contribute to BMI increase in the first 2 y.