Childhood Obesity Research Articles

THE EFFECTS OF 12 WEEKS BASIC GYMNASTICS EXERCISES ON BODY COMPOSITION AND LIPID PROFILES IN OBESE CHILDREN

Obesity is a major health concern in the world because it is associated with many diseases. It has been shown that basic gymnastics exercises effectively prevent and treat this problem. Therefore, the present study investigated the effect of 12 weeks of basic gymnastics exercises on body composition and lipid profile in obese girls. In this quasi-experimental study, with a design pre-test-post-test and a control group, 30 obese girls with Body Mass Index (BMI) at or above the 95th percentile and the average age of 9.4 years, were selected purposefully and were divided into 2 groups (Basic gymnastics training, and control) randomly. The training protocol was implemented for 12 weeks, three times a week, and 45 minutes for each session incrementally. Body composition and lipid profile indices were measured in two stages: pre-test and post-test. In order to analyze the data, multivariate covariance tests were used. The results of the study showed that the exercise intervention significantly reduced the fat percentage and BMI index in obese children (p≤0.001). In addition, a significant decrease in total cholesterol, triglyceride, and Low Density Lipoprotein Cholesterol (LDL-C) and a significant increase in High Density Lipoprotein Cholesterol (HDL-C) were observed (p≤0.002). These findings indicate the beneficial effects of basic gymnastics training on body composition and lipid profile in obese children. Therefore, the use of basic gymnastics training is recommended to improve these factors.

Complications of excess weight seen in two tier 3 paediatric weight management services: an observational study.

Children and young people living with severe obesity experience a range of complications of excess weight (CEW); however the prevalence of complications is not well defined. We have evaluated baseline characteristics and CEW of patients from two UK tier 3 paediatric weight management services. All new patients aged 2-17 years seen from March 2022 to February 2023 were included. Baseline demographic data was collected, and patients screened for CEW. PedsQL-4.0 questionnaires were used to assess health-related quality of life (HRQL). 185 patients were included, median age 14.3 years (range 3.3-18.0), 50.8% were girls. Of the patients, 73.8% were white British, with a significant excess of patients living in the most deprived decile (41.4%). Median body mass index SD score was +3.55 (IQR 3.11-3.90) and median body fat was 49.3% (IQR 42.3%-55.1%). Autistic spectrum disorder, attention deficit hyperactivity disorder and learning difficulties were vastly over-represented.Dyslipidaemia was the most common (51.6%) complication, followed by hypertension (28.9%), metabolic dysfunction-associated steatotic liver disease (17.8%), obstructive sleep apnoea (9.0%) and idiopathic intracranial hypertension (4.3%). Mean glycated haemoglobin was 35.0 mmol/mol (IQR 33-38). 8.1% had type 2 diabetes mellitus. Many of these complications were detected through screening in CEW clinics.Both child-reported (mean 51.9/100) and parented-reported (47.8/100) HRQL scores were low. Mental health problems were common: 26.2% with anxiety and 7.7% with depression. This study demonstrates the significant and profound mental and organ-specific pathology resulting from severe obesity in childhood, highlighting the clinical necessity for CEW clinics. A rigorous approach to identify complications at an early stage is essential to improve long-term health outcomes.

Usability and engagement of web application on parental behaviors for child obesity intervention

Background: Childhood obesity is a growing global health issue, with increasing prevalence in Asian countries, including Malaysia. Web applications such as JEJAK BMI offer an alternative intervention to address this concern by targeting parental behaviors that could influence their children’s weight. The usability and engagement of the app used are important elements that could influence the intervention outcome. Objective: To assess the engagement and usability of JEJAK BMI apps that could affect parental use of apps in child obesity interventions. Methods: To evaluate the app’s usability, three criteria were evaluated which were ease of use, visual appeal and functionality, post-intervention questionnaires were completed by the parents. Results: The study found that most parents considered the app practical, easy to use, visually engaging and functional. However, the impact on children's BMI over the short term was inconclusive. Conclusion: The JEJAK BMI web application demonstrated strong usability and positive effects on parental behaviors. Nonetheless, significant changes in children's BMI may require longer-term interventions and additional strategies.

Improvement in Symptoms of Depression and Anxiety and Cardiometabolic Risk Factors in Children and Adolescents with Overweight and Obesity Following the Implementation of a Multidisciplinary Personalized Lifestyle Intervention Program.

Background/Objectives: Childhood obesity is one of the most challenging contemporary public health problems. Children and adolescents with obesity experience multiple psychosocial difficulties, such as low self-esteem, depression, anxiety, and behavioral problems, which persist for a long time. The aim of the study was to assess the effect of a multidisciplinary personalized lifestyle intervention for depressive and anxiety symptoms, as evaluated by psychometric questionnaires, and their effect and association with cardiometabolic parameters in children and adolescents with overweight and obesity before and after the intervention. Methods: Six hundred and eleven (n = 611) children and adolescents (mean age ± SE: 10.39 ± 0.10 years; 51.5% females, 46.6% pubertal) were studied prospectively. Subjects were classified as being obese (50.2%), overweight (33.5%), or having a normal BMI (16.2%) according to IOTF criteria. All participants entered a 1-year lifestyle intervention program; laboratory investigations were obtained at the beginning and end of the study and two psychometric questionnaires were completed, the CDI and SCARED, which evaluate symptoms of depression and anxiety, respectively. Results: Following the lifestyle intervention, a significant decrease was noted in anxiety scores in all subjects and in depression scores in youth with obesity, as well as in adolescents with obesity, while females displayed a reduced response to the intervention. Insulin resistance and metabolic syndrome parameters, cortisol, PRL, and LH concentrations were positive predictors for depressive and anxiety symptoms. Conclusions: The implementation of a multidisciplinary personalized lifestyle intervention program in the management of childhood obesity is associated with a significant decrease in cardiometabolic and psychosocial comorbidities in children with and without excess adiposity. The improvement in mental health is likely mediated by an improvement in energy metabolism with subsequent improvement in neuroinflammation owing to lifestyle changes.

Liver magnetic resonance imaging, non-alcoholic fatty liver disease and metabolic syndrome risk in pre-pubertal Mexican boys.

Rising global pediatric obesity rates, increase non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) prevalence, with MetS being a NAFLD risk factor. NAFLD can be asymptomatic, with liver function tests insensitive to mild disease, and liver biopsy, risking complications. Thus, we investigated multiparametric MRI (mpMRI) metrics of liver fat (proton density fat fraction, PDFF) and disease activity (fibro-inflammation; iron-corrected T1, cT1), in a Hispanic pre-pubertal pediatric cohort, with increased risk of NAFLD. Pre-pubertal boys (n = 81) of varying Body-Mass Index (BMI) were recruited in Mexico City. Most children (81%) had normal liver transaminase levels, 38% had high BMI, and 14% had ≥ 3 MetS risk factors. Applying mpMRI thresholds, 12%, 7% and 4% of the cohort had NAFLD, NASH and high-risk NASH respectively. Participants with ≥ 3 MetS risk factors had higher cT1 (834ms vs. 737ms, p = 0.004) and PDFF (8.7% vs. 2.2%, p < 0.001) compared to those without risk factors. Those with elevated cT1 tended to have high BMI and high insulin (p = 0.005), HOMA-IR (p = 0.005) and leptin (p < 0.001). The significant association of increased risk of MetS with abnormal mpMRI, particularly cT1, proposes the potential of using mpMRI for routine pediatric NAFLD screening of high-risk (high BMI, high MetS risk score) populations.

THE ROLE OF NURSING IN THE PREVENTION AND CONTROL OF CHILDHOOD OBESITY

Research on nursing interventions in the prevention and control of childhood obesity has addressed three main determinants: sedentary lifestyles, poor diet, and psychosocial and environmental factors. Through an integrative literature review, negative points associated with each determinant were identified, such as increased risk of obesity, nutritional deficiencies, social stigma, and lack of emotional support. However, several nursing interventions have been highlighted as effective in addressing these problems, including nutritional education, promotion of physical activity, psychosocial support, and advocacy for healthy environments. Authors such as Jardim (2017), Borfe et al. (2017), Serra et al. (2018), among others, have contributed significantly to the development of these strategies. The research highlights the role of nurses in promoting child health, highlighting the importance of a multidimensional and collaborative approach to prevent and control childhood obesity. In summary, the results obtained provide valuable insights to improve nursing practices, promoting healthy lifestyle habits, and combating the childhood obesity epidemic.

Shaping childhood obesity: behavioral and environmental risk factors associated with body mass index trajectories between 2 and 9 years in Samoan children.

Pacific children are at high obesity risk, yet the behavioral and environmental factors that contribute to obesity development in this setting remain poorly understood. We assessed associations between childhood risk factors for obesity with body mass index (BMI) trajectories between ages 2-9 years in Samoa. In a prospective cohort of 485 children from 'Upolu, we measured weight and height at ages 2-4 (2015), 3.5-8 (2017-18), and 5.5-11 years (2019-20). Modern dietary pattern adherence was assessed using factor analysis of primary caregiver-reported food frequency questionnaire data. Physical activity was estimated with the Netherlands Physical Activity Questionnaire. Socioeconomic resources were assessed using an 18-item household asset score. Urbanicity was based on village residence. Associations of these risk factors with predicted weight, height, and BMI (at 1-year intervals and velocity) were assessed using multilevel cubic spline regressions. Females had greater adjusted weight velocity with high modern dietary pattern adherence compared to low (p-value for interaction with age spline term 1 = 0.028 and age spline term 2 = 0.007). Starting at age 3 years, children with higher physical activity had higher BMI, but this association was not meaningful up to age 9 (all p-value > 0.05). Males with very high compared to low household assets had higher BMI from age 2 to 4 years (95% CI: 0.26-1.53 kg/m2, p = 0.006) and greater BMI velocity (p-value for interaction with age spline term 2 = 0.001). Males in the urban region had the greatest BMI gain after age 5 compared to the rural region (p-value for interaction with age spline term 2 = 0.014). High, centile-crossing BMI trajectories suggest that obesity prevention and intervention are needed among Samoan children before age 9 years. Positive associations between high modern dietary pattern adherence, greater asset ownership, and urbanization offer initial insights into who, and which behavioral risk factors, should be prioritized in implementing public health solutions.

Intensity and enjoyment of play-based HIIT in children and adolescents with obesity

High-intensity interval training (HIIT) has been suggested as an effective treatment approach of childhood obesity. The objective of the present study was to examine intensity, enjoyment, and perceived exertion of a 4x4-minute play-based HIIT program for children and adolescents with obesity. 83 participants (42.2% girls, 12.3±1.5 years, 57.8% boys, 12.0±1.6 years) completed a 12-week intervention comprising three weekly sessions. After nine sessions (weeks 2, 6, and 11), participants rated perceived exertion (RPE) with a Borg scale and enjoyment of activities using the Physical Activity Enjoyment Scale (PACES). Heart rate (HR) was recorded to assess time spent in high- and moderate-intensity. Participants spent more time in high-intensity during strength-based(P=0.004) and running-based(P=0.007) activities compared to ball games, and more time was spent in moderate-intensity during ball games compared to strength-based(P=0.033) and running-based(P=0.028) activities. Overall, boys spent more time in moderate-intensity than girls(P=0.007). Participants rated RPE lower for ball games than for strength-based(P&lt;0.001) and running-based(P&lt;0.001) activities. Boys rated running-based activities more enjoyable than girls(P=0.021). Exercise intensity and RPE vary by activity in HIIT for children and adolescents with obesity. Ball games led to less high-intensity time and were seen as less exhausting. No differences in RPE or enjoyment were found over time.

Exploring the Link between the Obesity and ADHD

Obesity is a chronic, multifactorial and recurrent disease. ADHD is a chronic neurodevelopmental disorder in early childhood. The core symptoms include attention deficit, hyperactivity/impulsivity and oppositional defiance. Research shows that there is a significant correlation between obesity and ADHD, and the probability of overweight and obese children suffering from ADHD is significantly higher than that of normal weight children. This paper discusses the association mechanism between ADHD and obesity from the perspectives of genetics, eating disorders, intestinal flora and poor physical exercise. At the same time, in view of the prevention and intervention of the comorbidity of ADHD and obesity, this paper also puts forward various means such as diet intervention, exercise prevention intervention and drug treatment. However, the relationship between obesity and ADHD is complex, and the comorbidity problem needs to be solved urgently. Establishing an effective early screening system, implementing targeted prevention and intervention measures, and strengthening public awareness and understanding of comorbidities are important ways to improve the quality of life of this group. Further research is needed in the future.

Declining trends of overweight and obesity in 4-year-olds during 2007-2022 in Northern Sweden

Abstract Background Overweight among preschool children is a huge public health issue. The prevalence of both childhood overweight and obesity increased during the COVID-19-pandemic. Our aim was to study the development of overweight and obesity among 4-year-olds in Västerbotten, Sweden, from 2007 until 2022 with special focus on the COVID-19-pandemic and the year after. Methods This is a repeated cross-sectional study that utilized individual data from most 4-year-old children living in Västerbotten County, Sweden in 2007-2022, implying that the children were born 2003-2108. We included encrypted and anonymized individual anthropometrical data from the routine 4-year-old Child Health Care visit. There were 47 004 4-year-old children living in the county and we included data from 42 584 children, 21 966 boys and 20 618 girls at the age of 46-51 months. Results Overweight and obesity decreased over the study period. In 2007 the prevalence of overweight was 13.4% for boys and 14.9% for girls and obesity 3.7% for boys and 2.7% for girls. In 2022 the prevalence of overweight had declined to 9.5% for boys and 12.1% for girls and the prevalence of obesity to 1.8% and 2.1%, respectively. During the COVID-19-pandemic the prevalence of overweight and obesity for both boys and girls increased and then rapidly returned to the pre-pandemic level in 2022. Conclusions In a setting with free standardized Child Health Care, we present a clear decline in the prevalence of overweight and obesity among Swedish preschool children over time. As in other settings the prevalence of overweight and obesity increased during the COVID-19-pandemic, but we also report a rapid decline in overweight and obesity after the pandemic. It is essential to understand the underlying mechanisms responsible for this favorable trend. Key messages • We present clear decline in the prevalence of overweight and obesity in preschool children over time in a setting with free standardized Child Health Care. • It is important to understand the possible mechanisms of the favorable trend of decrease of the prevalence of overweight and obesity in children pre- and post-pandemic.

Effects of aerobic exercise on executive function among overweight and obese children: a systematic review and meta-analysis.

Overweight and obesity are serious public health issues worldwide and significantly impair children's executive function (EF). However, there is no consensus regarding the benefits of aerobic exercise, on the EF of overweight and obese children. This study systematically evaluated the intervention effects of aerobic exercise on EF and its subcomponents (inhibitory control, working memory, and cognitive flexibility) in overweight and obese children. We searched six databases-PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, and China National Knowledge Infrastructure-until March 17, 2024 for randomized controlled trials examining the effects of aerobic exercise on the EF of overweight and obese children the Cochrane Risk of Bias Assessment Tool. Following heterogeneity testing, RevMan 5.4 and Stata 17.0 were used for meta-analysis and subgroup analysis of the three indicators. The standardized mean difference (SMD) and 95% confidence intervals (CI) were used as statistical measures for effect analysis with the SMD value as the effect size and a p-value of ≤0.05 indicating statistical significance. Eighteen studies involving 1,260 participants were included. Aerobic exercise significantly improved overall EF (SMD = -0.50, 95% CI [-0.68, -0.32], p < 0.01) with a moderate to high positive effect on inhibitory control (SMD = -0.52, 95% CI [-0.72, -0.31], p < 0.01) and working memory (SMD = -0.63, 95% CI [-1.06, -0.20], p < 0.01) but not on cognitive flexibility (SMD = -0.32, 95% CI [-0.71, 0.07], p = 0.11). These results suggest that EF in overweight and obese children is influenced by factors such as exercise characteristics and body mass index (BMI). Subgroup analysis revealed a significant moderating effect of exercise type, exercise intensity, session time, and individual BMI on EF. Aerobic exercise selectively improved EF in overweight and obese children. Subgroup analysis indicated that cognitive engagement in ball game interventions of at least moderate intensity and a single session of 25-40 min are more beneficial for improving EF in overweight and obese children. Extremely obese children (BMI > 25 kg/m2) do not benefit from the intervention, highlighting the need for a specific focus on intervention outcomes in future studies.

Health promotion at local level in Portugal: is childhood obesity a concern in municipal programs?

Abstract Health promotion programs targeted at distinct health outcomes such as childhood obesity, at local level are increasingly used worldwide. There is a need to better understand the role of local governments (municipalities) as key public health promoters namely in the prevention of obesity in children. This study aims to provide some input regarding this issue in Portugal. In order to achieve this goal, health enhancing programs promoted by Portuguese municipalities in which children could participate were identified. The search of such programs was limited to the municipalities that were part of the Portuguese Network of Healthy Municipalities in 2021 (N = 57). A subsequent document analysis was conducted to describe how municipalities conceptualized children’s health by retrieving information on which topics the programs were focused on, or acted upon, and identify which socio-ecological model levels of health determinants were addressed (or not) by each program. The 77 identified programs were promoted by 30 municipalities and only 11 programs addressed childhood obesity. Most programs focused on the individual health determinants (N = 27) and provided limited information overall, which hindered a more in-depth analysis. The findings suggest that Portuguese municipalities seem to disregard their potential as public health promoters. Childhood obesity is a major public health concern at national level, as reflected in the National Health Plans, but not perceived as such locally. Municipalities are the closest government entities to the population, and it is their responsibility to ensure the population’s quality of life, by addressing the social and environmental determinants of health. Hence, municipalities should instill health concerns in all their actions/interventions, taking in consideration the most recent evidence, specifically in the case of childhood obesity. Key messages • This study findings suggest that, despite childhood obesity being a major public health concern at national level, as reflected in the National Health Plans, it is not perceived as such locally. • There is a need to better understand the role of municipalities as key public health promoters considering they are responsible to intervene on the social and environmental determinants of health.

Effects of a multidisciplinary program with physical exercise in pediatric obesity

Abstract Background Childhood obesity is a growing public health concern worldwide, with prevalence rates increasing in recent decades. This epidemic not only predisposes children to immediate health risks such as cardiovascular disease and musculoskeletal problems but also significantly increases their risk of obesity-related comorbidities in adulthood. Recognizing the multifactorial nature of pediatric obesity, interventions targeting lifestyle modifications are crucial to its control. Among these interventions, physical exercise emerges as a cornerstone in combating pediatric obesity. Purpose Our study examines the effectiveness of a twelve-week online physical exercise program on body composition and functional capacity in children and adolescents with obesity. Methods The sample consists of 30 participants (9 girls and 21 boys, aged 11-17 y) from the Pediatrics Department of Senhora da Oliveira Hospital in Guimarães (HSOG). Using standardized protocols, anthropometric measures (body weight and waist circumference) were measured. Functional capacity was assessed through squats, push-ups, and elbow plank tests (maximum repetitions in 60 seconds). All analyses were done using SPSS software, and the alpha level was 5%. Results Significant impacts of the exercise program were observed in body weight and waist circumference variables. Multivariate tests indicated a statistically significant interaction between the Moment*Groups factors (weight p = 0.040; waist circumference p = 0.007). Moreover, functional capacity was also influenced by the exercise program (squat p = 0.034; push-ups p = 0.013; and elbow plank p = 0.025). Conclusions Our results underscore the significant public health impact of integrating physical exercise into a multidisciplinary program for pediatric obesity. Innovative use of online interventions facilitated broader reach and accessibility, resulting in measurable improvements in body weight, waist circumference, and functional capacity among participants. Key messages • Integrating exercise into multidisciplinary programs improves pediatric obesity outcomes. • Online interventions broaden accessibility and effectiveness in preventing childhood obesity.

Longitudinal associations between accelerometry-assessed sleep clusters and obesity in adolescence and young adulthood: the German GINIplus and LISA birth cohorts study

Abstract Background Some studies have identified diverse sleep patterns in adolescents and adults by considering multidimensional objective sleep parameters. However, whether sleep patterns are consistent from adolescence to young adulthood and their long-term associations with obesity remain unknown. Purpose This study aimed to investigate the longitudinal associations of objectively measured and clustering-identified sleep patterns with body mass index (BMI) and overweight/obesity in adolescence and young adulthood, and to test whether these associations change over time or are modified by genetic risk. Methods A total of 1973 participants wearing 7-day accelerometers in either 15-year (n=1347, aged 14.3-16.4 years) and/or 20-year (n=1262, aged 19.5-22.4 years) follow-ups of German GINIplus and LISA birth cohorts were included. Sleep clusters were identified by K-means cluster analysis on 12 accelerometry-assessed sleep characteristics at each follow-up. BMI and overweight/obesity were measured by physical exams or self-/parent-reported questionnaires. Multivariable linear and logistic regression models with generalized estimating equations were tested. The interaction effects with time of follow-ups and polygenic risk scores (PRS, n=1087) for BMI were further examined. Results Although sleep characteristics changed from adolescence to young adulthood, such as shorter total sleep time (mean 7.2 to 6.6 hours), the consistent five sleep clusters were classified in both periods: good sleep, delayed sleep phase, sleep irregularity and variability, fragmented sleep, and prolonged sleep latency. Compared to the "good sleep" cluster, the "prolonged sleep latency" cluster showed significant associations with higher BMI (β=0.56, 95% confidence interval (CI) = [0.06, 1.05]) and increased odds of overweight/obesity (odds ratio (OR)=1.55, 95%CI= [1.02, 2.34]). PRS was associated with higher BMI (β=0.65, 95%CI= [0.39, 0.91]) and overweight/obesity (OR=1.52, 95%CI= [1.15, 2.00]), with no significant gene-sleep cluster interaction effect. Only among males, the interaction effects with time of follow-ups on overweight/obesity were observed in the "delayed sleep phase", "sleep irregularity and variability", and "fragmented sleep" clusters (p-interaction &amp;lt;0.05), showing more harmful effects with increasing age. Conclusions Five sleep patterns were identified consistently across adolescence and young adulthood, and the "prolonged sleep latency" pattern was associated with higher BMI and overweight/obesity, independent of genetic risk. For young adult males, "delayed sleep phase", "sleep irregularity and variability" and "fragmented sleep" patterns seemed to have more unfavorable impacts on overweight/obesity.

Hubungan Aktivitas Fisik dan Durasi Tidur Dengan Status Gizi pada Remaja di SMA Negeri 7 Bandar Lampung Tahun 2024

According to the Indonesian Health Survey (2023), the prevalence data on nutritional status (BMI/U) in children aged 16-18 years consists of very thin 1.8%, thin 5.5%, Normal 84.5%, Overweight 6.4%, Obese 1.8% (SKI, 2023). Bandar Lampung City has a high prevalence of obesity in adolescents. Of the 10 districts in Lampung Province, 3 of them have high obesity problems with a prevalence above 10%, namely: West Lampung Regency 10.3% Bandar Lampung City 11.1% and Metro City 9.9%. The purpose of this study was to determine the relationship between physical activity and sleep duration with nutritional status in adolescents at State Senior High School 7 Bandar Lampung. This type of research uses the Descriptive Analytical method with a Cross-Sectional approach. The population of this study was all 90 students of class XI IPS at State Senior High School 7 Bandar Lampung. The sampling technique used the random sampling method with a total sample of 82 respondents. The results of the study showed the effect of physical activity on nutritional status with a p-value of 0.024 and no effect of sleep duration on nutritional status with a p-value of 0.908. It is hoped that students will be able to know the knowledge related to the relationship between physical activity and sleep duration on one nutrient so that it can be a positive encouragement in implementing healthy lifestyle habits.

Disparities in Breastfeeding Patterns Persist Despite Improved Rates: Findings from Irish COSI R6

Abstract Background Breastfeeding is crucial for reducing childhood obesity, recommended exclusively for 6 months by World Health Organisation (WHO). Previous reports have highlighted disparities in breastfeeding patterns between Irish and non-Irish mothers. The Irish Childhood Obesity Surveillance Initiative (COSI) family survey offers insights into breastfeeding rates and patterns in Ireland and their differences between Irish and non-Irish mothers. Aims This study aims to compare the breastfeeding rates in Ireland between COSI Round 6 (R6) and COSI R5, elucidating the differences between Irish and non-Irish mothers. Additionally, it aims to establish the association between breastfeeding pattern and socio-economic factors involved in the Irish households. Methods Parents of 1st and 2nd class children (mean age 7) from 121 sentinel schools invited to participate in the family survey, returned it by post or online using Lime Survey. Ethical approval was secured for COSI R6, with consent from families. Data on breastfeeding rates and pattern were collected, anonymised, and analysed using SPSS version 29. Results Around 88% of respondents were mothers. The number of children breastfed for at least a month increased in R6 (55.7%) compared to R5 (45.6%). The mean duration of exclusive breastfeeding increased to 5.86 months in R6 from 4.91 months in R5, in line with WHO recommendations. Significant disparities were found in breastfeeding patterns, with higher rates among non-Irish mothers (67.8%) compared to Irish mothers (52.6%) (p &amp;lt; 0.001). Linear regression showed a significant association between breastfeeding duration and maternal birth country. Irish mothers exhibited a negative coefficient (b1=-2.442; 95% CI -4.1 to -0.8; p = 0.004), suggesting shorter breastfeeding durations compared to non-Irish mothers. Conclusions Breastfeeding rates improved in COSI R6 compared to R5. There are significant disparities in breastfeeding pattern between Irish and non-Irish mothers. Key messages • Improved breastfeeding rates indicate good feeding practices in Ireland. • Targeted interventions and policies are necessary to address the disparities between Irish and non-Irish mothers in breastfeeding patterns.

Early life social predictors of longitudinal relations between childhood BMI and overeating

Abstract Introduction The progression of obesity is a continuous process involving a complex system of genetic, environmental, and behavioural factors. Socioeconomic disadvantage as well as psychological distress may lead to overeating, subsequently associated with increased energy intake and weight gain. Recent evidence indicated that the association between childhood obesity and overeating might be bidirectional. Therefore, this study aimed to longitudinally investigate the directionality of the association between childhood BMI and overeating and to identify antecedent early childhood predictors. Methods The study sample included 5,777 children from the European Longitudinal Study of Parents and Children (ELSPAC), collected between 18 months and 11 years of child age. The outcomes were child BMI and overeating. Predictors included maternal BMI, maternal education, single-parent households, financial difficulties, and adverse childhood experiences (ACEs). The random intercept cross-lagged panel model (RI-CLPM) was applied. Results The results showed temporal stability in the development of overeating and BMI, with a bidirectional relationship that strengthened over time. The child’s BMI was predicted by maternal BMI (β = 0.37, p &amp;lt; 0.001). The child’s overeating was predicted by maternal BMI (β = 0.13, p &amp;lt; 0.001), but a stronger effect was found for ACEs (β = 0.24, p &amp;lt; 0.001). ACEs mediated the impact of maternal education, financial difficulties, and single parenthood on overeating with indirect effects of β = -0.01 (p = 0.005), β = 0.04, (p &amp;lt; 0.001), and β = 0.07 (p &amp;lt; 0.001), respectively. Conclusions We observed stable bidirectional longitudinal effects, with a stronger association from BMI to overeating. The results suggested two main pathways: one linked to maternal BMI and early childhood BMI increase followed by overeating, and the other associated with ACEs mediating the effect of early childhood socioeconomic factors on overeating, leading to gradual BMI gain. #NGEU Key messages • The study revealed a stable bidirectional association between childhood BMI and overeating, with a stronger association from BMI to overeating. • There are two potential pathways in childhood obesity development, one involving maternal BMI, and the second associated with social disadvantage and ACEs.

Impact of the COVID-19 pandemic on lifestyle’s behaviours of school-aged children in Portugal

Abstract Background COVID-19 pandemic impacted children’s daily routines. Based on this, WHO Collaborating Centre for Nutrition and Childhood Obesity in collaboration with WHO Regional Office for Europe coordinated the study about the impact of COVID-19 on lifestyle’s behaviours of school-age children in Europe, where 17 Member States participated, including Portugal. Methods Cross-sectional study was conducted within the sixth round of COSI Portugal, following a WHO common methodological protocol, during 2021-2022 school year. A national representative sample of families with children 6-8 years old were included and asked to report on variables comparing two periods: pre and during the COVID-19 pandemic. Results 5139 families participated. 11.4% reported a worsening of their perceived wealth and the percentage of fathers and mothers working full- or part-time decreased (74.6% to 68.7% and 70.6% to 59.6%, respectively) during pandemic. Children’s consumption of sweets (19.4%), savoury snacks (13.8%), fruit (11.9%) and vegetables (7.1%) increased, and sugary soft drinks (13.8%) decreased during pandemic. Family behaviours with the highest increases during pandemic were “eating together as a family” (35.4%), “cooking meals together with your child” (33.6%), “buying food in large quantities” (33.6%) and “eating home-cooked meals” (29.1%). Approximately, one in four parents reported children’s physical activity decreased and almost one in two reported an increase in recreational screen time. Parents who perceived their child as overweight during pandemic doubled (f7.9% to 14.6%). Children’s well-being behaviours that worsened more during pandemic were “having fun with friends” (44.3%), “got on well at school” (27.9%), “feel full of energy” (23.8%) and “feel fit and well” (22.2%). Conclusions These observations underscore the need to “build back better” post-pandemic with a focus on preventing and controlling childhood obesity and its determinants. Key messages • Portuguese children experienced negative impacts of the pandemic in their lifestyle behaviours, particularly on their physical health and well-being, with a report of a poorer socioeconomic situation. • This study and its findings give us a first-of-its-kind view into the physical and mental outcomes of the pandemic on school-aged children with a focus on the long-term, high-risk disease of obesity

Determinants of appetite in the first year of life: Results from a prospective study of infants

Abstract Childhood obesity, a growing public health problem, was shown to be associated with appetite traits (ATs) in infancy but little research exists on the determinants of early appetite. We aimed to examine the association between parental, pregnancy and infant variables on ATs during the first year of life. We followed up 450 healthy term infants assessing Enjoyment of Food (EF), Food Responsiveness (FR), Satiety Responsiveness (SR) and Slowness in Eating (SE), using the Baby (at 2-4 weeks (wk) &amp; 6m) and the Child (at 12m) Eating Behaviour Questionnaires. Associations between parental sociodemographic and lifestyle, pregnancy, infant feeding and anthropometric factors, and these ATs were investigated. Multivariable linear regression models were built for each AT, incorporating statistically significant variables from minimally adjusted models (sex, gestational age, and ethnicity). Results primarily focus on ATs at 2-4wks, as later ATs were largely influenced by these values. Higher father’s BMI (β = 0.013, p = 0.022) was associated with increased EF at 2-4wks. Later gestational age (β = 0.106, p = 0.032), and gestational diabetes (β = 0.538, p = 0.002) were associated with higher FR 2-4wk while mixed feeding compared to exclusively breast feeding (β =-0.281, p = 0.013) with lower FR 2-4wk. Female sex (β = 0.174, p = 0.009) was positively, while gestational age (β=-0.076, 0.022), father’s educational attainment (β=-0.199, p = 0.003), father habitual smoking (β=-0.167, p = 0.020) and 4wk WFA z-score (β = 0.087, p = 0.037) were negatively associated with SR 2-4wk. Lastly, higher 4wk WFA z-score (β=-0.151, p = 0.012) and bottle feeding (β=-0.378, p = 0.003) were associated with decreased SE 2-4wk. Acknowledging that a causal association cannot be established in an observational study, this data suggests that parental lifestyle and pregnancy factors could influence infant ATs and hence risk of later obesity, highlighting the importance of preconception health in mitigating the problem of childhood obesity. Key messages • Appetite traits in early infancy are influenced by infant feeding and anthropometric variables, but also by parental and pregnancy characteristics. • The importance of preconception health is paramount in mitigating the problem of childhood obesity.

The impact of the COVID-19 pandemic on physical activity among primary school children in Ireland

Abstract Background The containment measures implemented during COVID-19 to curb the virus’s spread disrupted family life globally and profoundly impacted children’s daily behaviours. A decrease in children’s physical activity during COVID-19 is one such health behaviour change that was observed in many European countries. This study aimed to understand the pandemic’s impact on primary school children’s physical activity in Ireland which is important given the epidemic of childhood obesity and chronic diseases in the long term. Methods All Childhood Obesity Surveillance Initiative (COSI) participating countries (n = 45) could voluntarily implement the COVID study as part of their COSI Round 6 (R6) data collection or separately. The parents of First and Second-class primary school children (n = 2,784) who consented to participate in COSI-Ireland R6 were invited to complete the family survey which included the standardised COVID study. The COVID module assessed children’s lifestyles and health behaviours before and during the pandemic through 12 questions. Consenting parents supplied their email or postal address and completed the survey in hardcopy or electronically using LimeSurvey. Descriptive statistics were then calculated on the cleaned pseudonymised dataset (n = 1,060) using IBM SPSS Statistics 27. Results The time spent playing actively outside school hours remained the same for some children on both weekdays and weekends (24.2% and 37.1%, respectively). An increase rather than a decrease in the time spent in active play was also observed among almost twice as many children across Ireland on both weekdays (47.3% and 24.2% respectively), and weekends (40.10% and 21.80% respectively). Conclusions The positive findings show that the public health messaging from the Irish Government which emphasized the importance of staying active during COVID-19 may have been effective. Further research to assess children’s physical activity during COVID-19 is warranted to inform future pandemics. Key messages • In Ireland, unlike in many European countries, a substantial number of primary school children increased their time spent playing actively during the COVID-19 pandemic. • A unique trend in Irish children’s physical activity levels compared to their European counterparts.