Risk Factors For Childhood Obesity Research Articles

The predictive utility of the in utero exposome for childhood adiposity in independent and integrated frameworks.

To assess the predictive potential of the in utero exposome in relation to childhood adiposity as indicated by body mass index z-scores (BMIz) and the fourth versus first quartile of % fat mass (FM) at median age of 4.6 years. We leveraged data on clinical risk factors for childhood obesity during the perinatal period, along with cord blood per/polyfluoroalkyl substances (PFAS) and cord blood DNA methylation, in 268 mother-offspring pairs. We used the sparsity ranked LASSO penalized regression framework for each outcome and assessed model performance based on % variability explained for BMIz and area under the receiver operating characteristic curve (AUC) for the fourth versus first quartile of %FM. We employed cross-validation for model tuning and split-sample validation for model evaluation. Mean ± SD BMIz was 0.01 ± 1.1, %FM was 19.8 ± 6.34%. The optimal model for predicting BMIz explained 19.1% of the variability in the validation set and included only clinical characteristics: maternal pre-pregnancy BMI, paternal BMI, gestational weight gain, physical activity during pregnancy and child race/ethnicity. The optimal model for fourth versus first quartiles of %FM achieved an AUC of 0.82 ± 0.01 in the validation set, with the clinical features again emerging as the strongest predictors. In this study sample, perinatal chemical exposures and the epigenome have low utility in predicting childhood adiposity, beyond known clinical risk factors.

Association of Dietary Patterns, C-Reactive Protein, and Risk of Obesity Among Children Aged 9–17 Years in Guangzhou, China: A Cross-Sectional Mediation Study

Background: Childhood obesity is a major public health challenge in the 21st century, and diet is one of the key modifiable factors in its prevention. This study examined the link between dietary patterns of children and general and central obesity, including the role of C-reactive protein (CRP). Methods: This study enrolled 2413 children aged 9–17. Anthropometric measurements, CRP levels, and dietary data were collected. Factor analysis identified dietary patterns, and logistic regression examined the association between CRP levels and childhood obesity. Multiple linear regression determined the correlation between dietary patterns and CRP. Mediation analysis assessed the role of CRP in the link between dietary patterns and childhood obesity. Results: Three dietary patterns were identified. The rice and meat pattern was significantly correlated to the risk of childhood obesity (OR = 1.166, 95%CI: 1.000, 1.359 for general obesity; OR = 1.215, 95%CI: 1.071, 1.377 for central obesity). CRP was positively correlated with childhood obesity risk (OR = 2.301, 95%CI: 1.776, 2.982 for general obesity; OR = 2.165, 95%CI: 1.738, 2.697 for central obesity). The fruit and vegetable pattern was inversely related to CRP (β= −0.059, 95%CI: −0.081, −0.036), while the snack pattern was positively correlated (β= 0.043, 95%CI: 0.020, 0.065). CRP had a suppressive effect on the association between the fruit and vegetable pattern and snack pattern with childhood obesity. Conclusions: This study revealed the rice and meat pattern as a risk factor for childhood obesity, and cross-sectional evidence linked the fruit and vegetable pattern and snack pattern to childhood obesity risk, mediated by CRP.

RISK FACTORS OF CHILDHOOD OBESITY IN URBAN VS. RURAL INDIA: A SYSTEMATIC REVIEW

Background: - Childhood obesity has become a pressing global public health issue, particularly in low- and middle-income countries like India. This systematic review aims to investigate the prevalence of childhood obesity and its associated risk factors in urban and rural regions of India. Methods: - A comprehensive systematic search was conducted in PubMed, Embase, and Scopus databases to identify relevant English-language studies published within the past decade. Inclusion criteria included studies conducted in India, focusing on children and adolescents aged 0-18, and reporting either the prevalence of childhood obesity or related risk factors. Ten studies, comprising both cross-sectional and quantitative research designs, met these criteria. Results: - The findings reveal a significant disparity in childhood obesity prevalence between urban and rural areas of India. Urban regions exhibit notably higher rates, with a pooled prevalence estimated at 9.0% (95% CI: 2.0 to 17), compared to 4.0% (95% CI: 4.0 to 5.0) in rural areas. Risk factors associated with childhood obesity in urban settings include unhealthy dietary habits, limited physical activity, higher income levels, parental education, and attendance at private schools. In rural areas, gender, age, and household size emerged as potential risk factors. Discussion: - These findings underscore the urgent need for geographically tailored interventions to address the urban-rural disparities in childhood obesity. Lifestyle-oriented strategies promoting healthier dietary patterns and increased physical activity are essential. Gender-inclusive programs targeting both boys and girls are crucial. Future research should consider regional and cultural diversity to design more effective public health responses. Conclusion: - This systematic review provides valuable insights into the prevalence and risk factors of childhood obesity in India. It highlights the necessity for customized interventions and lifestyle adjustments to combat this escalating public health challenge and reduce disparities in health outcomes.

The role of metformin in modulating cardiometabolic risk in obese pediatric populations with metabolic syndrome: A systematic review

Introduction: Obesity significantly increases the risk of developing cardiometabolic complications, which are precursors to cardiovascular diseases (CVD). In children and adolescents, metabolic dysfunctions such as insulin resistance, dyslipidemia, and hypertension are key contributors to early-onset cardiovascular risk. Metformin, a well-established antidiabetic agent, has shown potential benefits in addressing these metabolic imbalances. However, the long-term impact of metformin on cardiovascular outcomes in obese pediatric patients remains unclear. Aim: This systematic review aims to evaluate the effect of metformin on cardiometabolic parameters in obese children and adolescents with metabolic syndrome, focusing on insulin sensitivity, body mass index (BMI), blood pressure, and lipid profiles. Methods: A systematic review was conducted by searching databases including PubMed, Cochrane Library, Embase, and Web of Science. The inclusion criteria targeted randomized controlled trials (RCTs), cohort studies, systematic reviews, and meta-analyses published between 2004 and 2024. Pediatric patients aged 6-18 years with obesity and metabolic syndrome were included. The primary outcomes assessed were BMI, insulin sensitivity, lipid profiles, blood pressure, and cardiovascular outcomes. Results: A total of 23 studies, including 10 RCTs and 1 meta-analysis, were reviewed, involving 777 patients. Metformin demonstrated consistent improvements in insulin sensitivity and BMI in obese children and adolescents. Several studies reported modest reductions in BMI, improved insulin resistance, and better lipid profiles. However, variability in results was observed regarding long-term cardiovascular outcomes. While metformin reduced systolic blood pressure and carotid intimal-medial thickness (CIMT), the long-term impact on preventing major cardiovascular events remained inconclusive. Discussion: Metformin’s benefits on cardiometabolic risk factors in obese children are primarily attributed to its effects on insulin sensitivity, lipid metabolism, and inflammatory pathways. Its ability to activate AMP-activated protein kinase (AMPK) leads to improved metabolic profiles and reduced inflammation and is crucial for mitigating obesity-related cardiovascular risks. Despite these positive effects, the evidence for long-term prevention of cardiovascular events is limited and requires further exploration. Conclusions: Metformin offers significant short-term benefits in improving BMI, insulin sensitivity, and cardiometabolic parameters in obese children and adolescents. However, its long-term efficacy in preventing cardiovascular events remains uncertain. Further studies are necessary to establish its role in long-term cardiovascular protection in pediatric populations

Newborn adiposity is associated with cord blood DNA methylation at IGF1R and KLF7.

This study aimed to identify whether cord blood DNA methylation at specific loci is associated with neonatal adiposity, a key risk factor for childhood obesity. An epigenome-wide association study was conducted using the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study as a discovery sample. Linear regression models adjusted for maternal and offspring covariates and cell counts were used to analyze associations between neonatal adiposity as measured by sum of three skinfold thicknesses and cord blood DNA methylation. Assays were performed with Illumina EPIC arrays (791,359 CpG sites after quality control). Replication was performed in an independent cohort, Genetics of Glucose regulation in Gestation and Growth (Gen3G). In 2740 HAPO samples, significant associations were identified at 89 CpG sites after accounting for multiple testing (Bonferroni-adjusted p < 0.05). Replication analyses conducted in 139 Gen3G participants confirmed associations for seven CpG sites. These included IGF1R, which encodes a transmembrane receptor involved in cell growth and survival that binds insulin-like growth factor I and insulin, and KLF7, which encodes a regulator of cell proliferation and inhibitor of adipogenesis; both are key regulators of growth during fetal life. These findings support epigenetic mechanisms in the developmental origins of neonatal adiposity and as potential biomarkers of metabolic disease risk.

Feasibility of a culturally adapted technology-delivered, family-based childhood obesity intervention for Latino/Hispanic families in rural Nebraska: the Hispanic Family Connections study protocol

IntroductionAddressing childhood obesity risk factors like home environment, parental roles, excess weight, physical activity and healthy eating among Latino/Hispanic (L/H) families living in rural communities is an important priority. However,...

A randomized controlled trial to test the efficacy of a brief Triple P discussion group to increase healthy feeding practices and reduce risk factors for infant obesity.

Test the efficacy of a brief 2-hr parenting intervention in increasing protective factors against and reducing risk factors for infant obesity. A 2 (Baby Healthy Living Triple P vs. care-as-usual) × 3 (baseline, postintervention, 6-month follow-up) design was used. Eighty-two parents of 4- to 18-month-old infants meeting at least two risk factors for early childhood obesity (e.g., parent/child overweight, low education level) were randomized to intervention (n = 42) or control group (n = 40). Parents questionnaires and child weight status was measured. Results showed an intervention effect on a primary outcome, early feeding practices (restrictive: d = 0.44, 95% CI [-0.01,0.88], pressuring: d = 0.11, 95% CI [-0.32,0.54], nonresponsive behaviors: (d = 0.32, 95% CI [-0.11,0.75]), and on a secondary outcome, feeding beliefs (d = 0.29, 95% CI [-0.14,0.73]). No beneficial impact was found on other primary outcomes (responsiveness in feeding: quantity d = 0.50, 95% CI [-0.03,1.03]) and nutritive d = 0.52, 95% CI [-0.03,1.07], mealtime environment: d = 0.35, 95% CI [-0.78,0.08], self-efficacy in responsive feeding: d = 0.21, 95% CI [-0.22,0.64]), or secondary outcomes (parental self-efficacy: d = 0.08, 95% CI [-0.50,0.35]), parent emotional eating (d = 0.01, 95% CI [-0.43,0.43]), food restraint (d = 0.42, 95% CI [-0.85,0.02]), and body satisfaction (d = 0.01, 95% CI [-0.43,0.43]) and child weight status (d = 0.11, 95% CI [-0.54,0.32]). Promising though limited support was demonstrated for a brief, low-intensity program to help parents in the prevention of obesity for infants at risk.

Associations of Longitudinal BMI-Percentile Classification Patterns in Early Childhood with Neighborhood-Level Social Determinants of Health.

Background: Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. Methods: We extracted electronic health record data from 2012 to 2019 for a children's health system that includes two hospitals and wide network of outpatient clinics spanning five East Coast states in the United States. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. Results: From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n = 429; 1.16%), overweight most of the time (n = 15,006; 40.65%), increasing BMI percentile (n = 9,060; 24.54%), decreasing BMI percentile (n = 5,058; 13.70%), and always normal weight (n = 7,357; 19.89%). Compared to children in the decreasing BMI percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Conclusions: Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

Associations of longitudinal BMI percentile classification patterns in early childhood with neighborhood-level social determinants of health.

Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. We extracted EHR data from 2012-2019 for a children's health system that includes 2 hospitals and wide network of outpatient clinics spanning 5 East Coast states in the US. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n=429; 1.16%), overweight most of the time (n=15,006; 40.65%), increasing BMI-percentile (n=9,060; 24.54%), decreasing BMI-percentile (n=5,058; 13.70%), and always normal weight (n=7,357; 19.89%). Compared to children in the decreasing BMI-percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them. This study demonstrates the association between longitudinal BMI-percentile patterns and SDOH in early childhood. Five distinct clusters with different BMI-percentile trajectories are found and a strong association between these clusters and SDOH is observed. Our findings highlight the importance of targeted prevention and treatment interventions based on children's SDOH.

Rising socioeconomic disparities in childhood overweight and obesity in Belgium

BackgroundChildhood overweight, especially obesity, significantly impacts children’s health and poses an increased risk of adult-onset diseases. This study aims to analyse the evolution of childhood overweight and obesity in Belgium from 1997 to 2018 and assess its variation across parental socioeconomic status (SES).MethodsThe Health Interview Survey, a cross-sectional survey representative of the Belgian population, has been conducted since 1997, with the latest survey conducted in 2018. This study focuses on children aged 2–17 years. Body Mass Index (BMI, kg/m²) was derived from self-reported data, supplemented with proxy reports for children under 15 years old. Overweight and obesity were classified using age/sex-specific cut-off points. Highest parental educational level served as the indicator of SES. In addition to reporting the overall prevalence and the 95% confidence interval (95%CI) of childhood overweight and obesity by year, this study examines the absolute difference in prevalence between SES groups (low minus high) and calculates the Odds Ratio (OR, adjusted for age and sex) to evaluate the relative difference.ResultsThe overall prevalence of childhood overweight rose from 13.6% (95%CI = 11.2-16.1%) in 1997 to 18.9% (95%CI = 16.3-21.5%) in 2018; while it remained stable for obesity, fluctuating between 5.4% and 6.3% over the same period. This increase was more pronounced among children with low SES compared to those with high SES. Consequently, the absolute difference between children with low and high SES increased over time from 8.0% points (pp) in 1997 to 14.9 pp in 2018 for overweight, and from 3.1 pp to 6.8 pp for obesity. In terms of relative inequalities, overall, children with low SES exhibited significantly higher odds of overweight and of obesity than those with high SES (OR varying between 2 à 3 for overweight and between 2 and 4 for obesity).ConclusionsThe escalating disparities over time highlight SES as a significant risk factor for childhood overweight and obesity. Addressing these inequalities requires interventions such as providing healthy meals and increasing sports opportunities at school. Additionally, it is recommended to regulate fast food outlets near schools and limit unhealthy food marketing, particularly because children with low SES are more exposed to such influences.

Early feeding practices and eating behaviour in preschool children: The CORALS cohort

AbstractThis study aimed to investigate if the duration of breastfeeding and the method at initiation of complementary feeding affect eating behaviour in children aged 3−6 years. This is a cross‐sectional analysis from the Childhood Obesity Risk Assessment Longitudinal Study project, an ongoing longitudinal cohort study that aims to identify childhood obesity risk factors in Spanish children. A total of 1215 children aged 3−6 years were included. Breastfeeding duration and the method of initiation of complementary feeding [baby‐led weaning (BLW), traditional/spoon or mixed method] were evaluated. Eating behaviour at 3−6 years was assessed with the Child Eating Behaviour Questionnaire. Generalized linear models were fitted to assess the association between the aforementioned exposures and eating behaviour.Children breastfed for ≥4 months were less likely to be fussy eaters at 3−6 years compared to those breastfed for &lt;1 month (OR: 0.86 95% CI: 0.76−0.98; p = 0.031). Compared to those children using the traditional/spoon‐feeding method, those initiating complementary feeding through BLW or through a mixed approach were more likely to have higher scores on the enjoyment of food (EF) (OR, 95% CI: 1.33, 1.13−1.57; p = 0.001 and 1.17, 1.05−1.30; p = 0.002, respectively) and lower scores on food fussiness (FF) at 3−6 years (0.76, 0.62−0.91; p = 0.004 and 0.87, 0.78−0.98; p = 0.033, respectively). Breastfeeding for ≥4 months and initiation of complementary feeding with the BLW and a mixed approach were associated with greater EF and lower FF, which should endure practice.

Independent and Joint Effects of Prenatal Incense-Burning Smoke Exposure and Children's Early Outdoor Activity on Preschoolers' Obesity.

Incense burning is a significant source of indoor air pollution in many Asian regions. There is emerging evidence that maternal prenatal exposure to incense-burning smoke may be a risk factor for childhood obesity. We aimed to extend this new line of research by investigating the independent and joint effect of incense-burning smoke exposure, and children's outdoor activity in early life, on preschoolers' obesity. A total of 69,637 mother-child dyads were recruited from all kindergartens in the Longhua District of Shenzhen, China. Information on sociodemographic characteristics, maternal exposure to incense-burning smoke (IBS) during pregnancy, and frequency and duration of outdoor activity at the age of 1-3 years was collected by a self-administered questionnaire. In addition, the heights and weights of the children were measured by the research team. Logistic regression models and cross-over analyses were conducted to investigate the independent and combined effects of maternal exposure to incense-burning smoke during pregnancy and children's early outdoor activity on obesity in preschoolers. We found that prenatal exposure to incense-burning smoke increased the risk of the presence of obesity in preschoolers' (AOR = 1.13, 95% CI = 1.03-1.23). Additionally, lower frequencies (<3 times/week) or shorter durations (<60 min/time) of outdoor activity from the age of 1-3 years were significantly associated with the presence of obesity, with AORs of 1.24 (95% CI =1.18-1.32) and 1.11 (95% CI = 1.05-1.17), respectively. Furthermore, the cross-over analysis showed that prenatal exposure to IBS combined with a lower frequency of early outdoor activity (AOR = 1.47, 95% CI = 1.31-1.66) or a shorter duration of outdoor activity during ages of 1-3 years (AOR = 1.22, 95% CI = 1.07-1.39) increased the risk of obesity in preschoolers. Finally, additive interactions between prenatal exposure to IBS and postnatal outdoor activity on obesity were identified. Our study indicates that maternal exposure to incense-burning smoke during pregnancy and early lower postanal outdoor activity may independently and jointly increase the risk of obesity among preschoolers.

IJCM_187A: Prevalence and risk factors of childhood obesity among school-going children in a metropolitan city of india.

Background: Childhood obesity is a grave public health concern in the 21st century. It is becoming a widespread problem in low and middle-income countries, particularly in urban areas. Childhood obesity is a precursor to metabolic syndrome, poor physical health, mental disorders, respiratory problems, and glucose intolerance, which can all continue into adulthood. Developing countries like India face a unique problem of a ‘double burden’, where undernutrition and obesity co-exist. Objectives: The study aimed to determine the prevalence of overweight/ obesity among school-going children and to identify the modifiable risk factors associated with it. Methodology: An epidemiological cross-sectional study was conducted in a private school located in the Western suburbs of Mumbai. The study included all students from the 1st to 10th standard of the secondary section, who were willing to participate. Before the study, necessary permissions were obtained from the school authorities and parental consent was taken. The study was conducted over 4 days in October 2023. Data was collected through interviews using a pre-structured questionnaire. The collected data will be analyzed using SPSS for descriptive and inferential statistics. Results: Among 521 participants, the Prevalence of Overweight is 14.77% and Obesity is 6.71% in our study. Statistical significance was found between BMI and Smartphone usage, BMI and Occupation of Mother. Conclusion: Dietary factors have always been associated with overweight &amp; obesity however our study reveals that other factors also play a pivotal role in development of obesity which is an important risk factor for Non- Communicable Diseases further in adulthood.

Prevalence and Associated Risk Factors of Childhood Obesity and Overweight in Erbil City, Kurdistan, Iraq: A Household Survey

The prevalence of overweight and obesity has increased dramatically during the last three decades. It is estimated that 170 million youngsters (under the age of 18) worldwide are overweight. Obesity is commonly regarded as one of the most significant public health problems of the early 21st century due to its rapid rise and severe public health consequences. According to previous research, the prevalence rate of obesity and overweight increased in Erbil. This study aims to determine the prevalence of childhood overweight and obesity rates in Erbil. This study was a household survey based on a cross-sectional study that was conducted, and a multi-stage sampling strategy was used to choose the study sample. A questionnaire was conducted to collect the data, SPSS was used for analysing the data, and Chi-square (X²), was used to identify any kind of association between different variables in the study, whereas the p-value was considered (0.05). Regarding ethical approval, the study was conducted under the guidelines of the ethical approval research committee in the College of Medicine. In this research, the prevalence rate of obesity and overweight was 30.4%, 7.7% of them were obese, and 22.7% were overweight. The obesity rates between males and females were not different. Lifestyle and habit had an impact on increasing weight gain, though the number of meals, outside eating, fast foods, and snacks between meals were statistically not significant. However, eating without hunger was significant the p-value was (0.008). On the other hand, the children's habit of using electronic devices, smartphones, and other devices was significant, either using their mobile phone or their parent's phone. In conclusion, in Erbil city, the prevalence rate of obesity and overweight was dramatically increased, as well as the lifestyle factor that contributed to the development of these conditions, especially among those children exposed to multi-screen devices. According to these results, families have to improve their lifestyles and decrease the use of electrical devices by children.

Effect of COVID-19 Pandemic Lockdowns on Body Mass Index of Primary School Children from Different Socioeconomic Backgrounds

BackgroundChildhood obesity is associated with various health outcomes. Restrictive measures to contain the spread of the Coronavirus Disease 2019 (COVID-19) pandemic, like lockdowns and school closures, affected children’s daily structure, physical activity, dietary habits, and sleep quality, possibly exacerbating risk factors for childhood obesity and higher body mass index (BMI) in children. Poor socioeconomic conditions may have led to relatively higher risk for elevated BMI levels following pandemic measures. In this study, the impact of measures related to the COVID-19 pandemic on the BMI of third graders was investigated regarding children’s socioeconomic background (SEB).MethodsData from 41,728 children (8.84 ± 0.56 years, 20,431 female) were collected in the context of a cohort study. Children were tested either before the pandemic (preCOVID: Sept2017–March2020, n = 26,314), or following the first (postLDI: Aug2020–Dec2020, n = 6657) or second lockdown in Germany (postLDII: Aug2021–Jan2022, n = 8757). SEB was based on the official school type classification of the state of Berlin. Outcome was BMI standard deviation scores (SDS).ResultsSignificant effects of Time and SEB revealed elevated BMIs in postLDI (M = 0.23, p = 0.011) and postLDII (M = 0.22, p = 0.011) compared to preCOVID (M = 0.17) cohorts and higher BMIs for children with lower SEB (b = − 0.13, p < 0.001). A significant Time × SEB interaction indicated that the effect of SEB on children’s BMI increased in response to lockdowns, especially in postLDII (b = − 0.05, p = 0.006). Results suggest that the COVID-19-related measures lead to increased BMI in children, and that children of lower SEB were at particular risk for higher BMIs following lockdowns.ConclusionsThese findings highlight the dependency of children’s BMI on societal circumstances. Over the course of two lockdowns in Germany, children have experienced BMI increments, particularly in low socioeconomic areas. Authorities are called into action to counteract increasing rates of childhood weight by promoting physical activity of children and establishing related post-pandemic offers.

Childhood obesity - risk factors and prevention strategies

Introduction and purpose: Obesity is one of the most serious health challenges in modern society. Over the last 40 years, the number of obese school-age children has increased tenfold. This not only has significant consequences for physical health, but also affects psychosocial aspects and the quality of life of the young generation. The aim of this study is to conduct a comprehensive review of the literature on obesity among children and adolescents, focused on identifying the main risk factors and analyzing effective forms of prevention. Materials and methods: A review of the literature available in the "PubMed" database and books was conducted. The search was performed by using the following keywords: "childhood obesity", "childhood obesity risk factors", “childhood obesity prevention” State of knowledge: The risk factors for obesity in children and adolescents include genetic factors, endocrine diseases, improper diet, low physical activity, low socioeconomic status, stress, psychological factors, short sleep time, medications, hypothalamic obesity and H. pylori. As part of the prevention of obesity in children and adolescents, it is recommended to develop appropriate habits in children and adolescents. The influence of parents on health behaviors in children is important. Top-down activities such as health campaigns and legal regulations also have a significant impact. Summary: Due to research conducted over the years, awareness of obesity risk factors has increased. To effectively prevent this disease, an integrated approach is necessary, taking into account both education and changes in the social environment. Implementing these strategies requires cooperation at local, regional, national and international levels.

Fibroblast growth factor-21 and Visfatin as potential predictors for metabolic risk factors in obese children

Fibroblast growth factor-21 (FGF-21) and Visfatin are associated with obesity. However; reviewing the literature; no studies were found to assess their role as potential markers for the metabolic disorders related to obesity in children. Assess the relations between serum FGF-21 and Visfatin with obesity and its metabolic disorders, and their use as potential predictors for metabolic risk factors in a sample of Egyptian obese children. This cross-sectional study included 111 Egyptian children (45 males and 66 females); aged 6–10 years to avoid the effect of puberty (prepubertal). The exclusion criteria (by full History taking and clinical examination) were the presence of any sign of puberty according to Tanner stage, the presence of identified causes of obesity (genetic syndromes, chromosomal or endocrinal disorders), chronic diseases (cardiovascular, gastrointestinal, and respiratory), or drug use like steroids; that would interfere with the type of obesity and affect the normal growth of the children. Also, any child with a BMI between 85 and 95th percentiles (overweight) was excluded from the study. All participating obese children were suffering from exogenous simple obesity. They were classified according to their body mass index (BMI) percentiles into 72 obese (BMI ≥ 95th), and 39 control non-obese ones (BMI > 15th to < 85th), based on the Egyptian Growth Charts for children and adolescents. Ethical approvals were granted from both the Ethics Committee of the “National Research Centre” and the “Faculty of Postgraduate Childhood Studies” (Approval No. 17/125). Also, informed written consent was taken from either of the parents and assent from the participating children. They were subjected to blood pressure assessment, anthropometric measurements (weight [Wt], height [Ht], BMI, waist [WC], and hip [HC] circumferences), and laboratory evaluation (Visfatin, FGF-21, LDL, HDL, TG, cholesterol, fasting glucose, insulin, and calculation of HOMA-IR). Mann–Whitney test and Spearman’s correlation test were applied. Obese children had significantly higher values than control ones regarding all the studied clinical (SBP, DBP), anthropometric parameters (Wt, Ht, BMI, WC, and HC), FBG, Insulin, HOMA-IR, Visfatin, and FGF-21, and had significantly lower values regarding HDL and Cholesterol. Among obese children, both FGF-21 and Visfatin had significant negative correlations with BMI and HC. At the same time, serum FGF-21 had a highly significant positive correlation with HDL. Visfatin and FGF-21 had highly significant positive correlations with each other. In the control group, both serum Visfatin or FGF-21 had insignificant correlations with each other and with all the studied clinical and anthropometric parameters. FGF-21 and Visfatin are related to the obesity markers, but they cannot be used as potential predictors for metabolic disturbance in obese prepubertal children; both had insignificant correlations with the metabolic risk factors.

BMI Z-Score (SDS) versus Calculated Body Fat Percentage: Association with Cardiometabolic Risk Factors in Obese Children and Adolescents

Introduction: BMI or BMI-standardized deviation score (SDS) in children and adolescents is still the standard for weight classification. [BMJ. 2019;366:4293] developed a formula to calculate body fat percentage (%BF) based on age, sex, height, weight, and ethnicity. Using data from the German/Austrian APV registry, we investigated whether the calculated %BF is superior to BMI-SDS in predicting arterial hypertension, dyslipidaemia, and impaired glucose metabolism. Methods: 94,586 children and adolescents were included (12.5 years, 48.3% male). Parental birth country (BC) was used to depict ethnicity (15.8% migration background); 95.67% were assigned to the ethnicity “white.” %BF was calculated based on the Hudda formula. The relationship between BMI-SDS or %BF quartiles and outcome variables was investigated by logistic regression models, adjusted for age, sex, and migration background. Vuong test was applied to analyse predictive power. Results: 58.4% had arterial hypertension, 33.5% had dyslipidaemia, and 11.6% had impaired glucose metabolism. Boys were significantly more often affected, although girls had higher calculated %BF (each p < 0.05). After adjustment, both models revealed significant differences between the quartiles (all p < 0.001). The predictive power of BMI-SDS was superior to %BF for all three comorbidities (all p < 0.05). Discussion: The prediction of cardiometabolic comorbidities by calculated %BF was not superior to BMI-SDS. This formula developed in a British population may not be suitable for a central European population, which is applicable to this possibly less heterogeneous collective. Additional parameters, especially puberty status, should be taken into account. However, objective determinations such as bioimpedance analysis may possibly be superior to assess fat mass and cardiometabolic risk than calculated %BF.

Use of the WHO Nutrient Profile Model for Food Marketing Regulation in Germany: Feasibility and Public Health Implications

Introduction: Exposure to marketing for foods high in sugar, salt, and fat is considered a key risk factor for childhood obesity. To support efforts to limit such marketing, the World Health Organization Regional Office for Europe has developed a nutrient profile model (WHO NPM). Germany’s Federal Ministry of Food and Agriculture plans to use this model in proposed new food marketing legislation, but it has not yet been tested in Germany. The present study therefore assesses the feasibility and implications of implementing the WHO NPM in Germany. Methods: We applied the WHO NPM to a random sample of 660 food and beverage products across 22 product categories on the German market drawn from Open Food Facts, a publicly available product database. We calculated the share of products permitted for marketing to children based on the WHO NPM, both under current market conditions and for several hypothetical reformulation scenarios. We also assessed effects of adaptations to and practical challenges in applying the WHO NPM. Results: The median share of products permitted for marketing to children across the model’s 22 product categories was 20% (interquartile range (IQR) 3–59%) and increased to 38% (IQR 11–73%) with model adaptations for fruit juice and milk proposed by the German government. With targeted reformulation (assuming a 30% reduction in fat, sugar, sodium, and/or energy), the share of products permitted for marketing to children increased substantially (defined as a relative increase by at least 50%) in several product categories (including bread, processed meat, yogurt and cream, ready-made and convenience foods, and savoury plant-based foods) but changed less in the remaining categories. Practical challenges included the ascertainment of the trans-fatty acid content of products, among others. Conclusion: The application of the WHO NPM in Germany was found to be feasible. Its use in the proposed legislation on food marketing in Germany seems likely to serve its intended public health objective of limiting marketing in a targeted manner specifically for less healthy products. It seems plausible that it may incentivise reformulation in some product categories. Practical challenges could be addressed with appropriate adaptations and procedural provisions.

Use of the WHO Nutrient Profile Model in Germany: feasibility and public health implications

Abstract Background Exposure to marketing for foods high in sugar, salt, and fat is considered a key risk factor for childhood obesity. To support efforts to limit such marketing, the World Health Organization Regional Office for Europe has developed a nutrient profile model (WHO NPM), published as second edition in March 2023. The German government plans to use this model in new food marketing legislation, but it has not yet been tested in Germany. Methods We applied the WHO NPM to a random sample of 660 food and beverage products across 22 product categories on the German market from Open Food Facts, a product database. We calculated the share of products permitted for marketing to children under current market conditions and for hypothetical reformulation scenarios. We assessed practical challenges in applying the WHO NPM and the effects of model adaptations. Results The median share of products permitted for marketing to children across the 22 categories was 20% (interquartile range (IQR) 3-59%) and increased to 38% (IQR 11-73%) with model adaptations proposed by the German government. With targeted reformulation (i.e. a 30% reduction in fat, sugar, sodium, and/or energy) the share increased substantially (defined as a relative increase by at least 50%) in several product categories (including bread, processed meat, yogurt, convenience foods, and savoury plant-based foods), but changed less in others. Practical challenges included the ascertainment of the trans-fatty acid content of products, among others. Conclusions The application of the WHO NPM in Germany was found to be feasible. Its use in the proposed legislation on food marketing in Germany seems likely to serve its intended public health objective of limiting marketing in a targeted manner specifically for less healthy products. It seems plausible that it may incentivise reformulation in some product categories. Practical challenges could be addressed with adaptations and procedural provisions. Key messages • The practical application of the WHO Europe Nutrient Profile Model 2023 edition to a random sample of food and beverage products on the German market was found to be feasible. • With targeted reformulation, the share of products permitted for marketing to children under the WHO Europe Nutrient Profile Model increases substantially.