Maternal dietary quality, inflammatory potential and offspring adiposity throughout childhood: a pooled analysis of 7 European cohorts (ALPHABET consortium)

AbstractIntroductionThe foetal programming hypothesis posits that optimising early life factors e.g. maternal diets can help avert the burden of adverse childhood outcomes e.g. childhood obesity. To improve applicability to public health messaging, we investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity in a large consortium.MethodsWe harmonized and pooled individual participant data from up to 8,769 mother-child pairs in 7 European mother-offspring cohorts. Maternal early-, late-, and whole-pregnancy dietary quality and inflammatory potential were assessed with Dietary Approaches to Stop Hypertension (DASH) and energy-adjusted Dietary Inflammatory Index (E-DII), respectively. Primary outcome was childhood overweight and obesity (OWOB), defined as age- and sex-specific body-mass-index-z score (BMIz) > 85th percentile based on WHO growth standard. Secondary outcomes were sum-of-skinfold-thickness (SST), fat-mass-index (FMI) and fat-free-mass-index (FFMI) in available cohorts. Outcomes were assessed in early- [mean (SD) age: 2.8 (0.3) y], mid- [6.2 (0.6) y], and late-childhood [10.6 (1.2) y]. We used multivariable regression analyses to assess the associations of maternal E-DII and DASH with offspring adiposity outcomes in cohort-specific analyses, with subsequent random-effects meta-analyses. Analyses were adjusted for maternal age, pre-pregnancy BMI, parity, lifestyle factors, energy intake, educational attainment, offspring age and sex.ResultsA more pro-inflammatory maternal diet, indicated by higher E-DII, was associated with a higher risk of offspring late-childhood OWOB [pooled-OR (95% CI) comparing highest vs. lowest E-DII quartiles: 1.22 (1.01,1.47) for whole-pregnancy and 1.38 (1.05,1.83) for early-pregnancy; both P < 0.05]. Moreover, higher late-pregnancy E-DII was associated with higher mid-childhood FMI [pooled-β (95% CI): 0.11 (0.003,0.22) kg/m2; P < 0.05]; trending association was observed for whole-pregnancy E-DII [0.12 (-0.01,0.25) kg/m2; P = 0.07]. A higher maternal dietary quality, indicated by higher DASH score, showed a trending inverse association with late-childhood OWOB (pooled-OR (95% CI) comparing highest vs. lowest DASH quartiles: 0.58 (0.32,1.02; P = 0.06). Higher early-pregnancy DASH was associated with lower late-childhood SST [pooled-β (95% CI): -1.9 (-3.6,-0.1) cm; P < 0.05] and tended to be associated with lower late-childhood FMI [-0.34 (-0.71,0.04) kg/m2; P = 0.08]. Higher whole-pregnancy DASH tended to associate with lower early-childhood SST [-0.33 (-0.72,0.06) cm; P = 0.10]. Results were similar when modelling DASH and E-DII continuously.DiscussionAnalysis of pooled data suggests that pro-inflammatory, low-quality maternal antenatal diets may influence offspring body composition and obesity risk, especially during mid- or late-childhood. Due to variation of data availability at each timepoint, our results should be interpreted with caution. Because most associations were observed at mid-childhood or later, future studies will benefit from a longer follow-up.

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Maternal dietary quality, inflammatory potential and childhood adiposity: an individual participant data pooled analysis of seven European cohorts in the ALPHABET consortium

BMC Medicine ◽

10.1186/s12916-021-01908-7 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Ling-Wei Chen ◽

Adrien M. Aubert ◽

Nitin Shivappa ◽

Jonathan Y. Bernard ◽

Sara M. Mensink-Bout ◽

...

Keyword(s):

Childhood Obesity ◽

Late Pregnancy ◽

Overweight And Obesity ◽

Dietary Quality ◽

Late Childhood ◽

Dash Score ◽

Inverse Association ◽

Individual Participant Data ◽

Childhood Adiposity ◽

Individual Participant

Abstract Background Mounting evidence suggests that maternal diet influences pregnancy and birth outcomes, but its contribution to the global epidemic of childhood obesity has not as yet been definitively characterized. We investigated whether maternal whole diet quality and inflammatory potential influence childhood adiposity. Methods We harmonized and pooled individual participant data from 16,295 mother-child pairs in seven European birth cohorts. Maternal pre-, early-, late-, and whole-pregnancy (any time during pregnancy) dietary quality and inflammatory potential assessed with the Dietary Approaches to Stop Hypertension (DASH) score and the energy-adjusted Dietary Inflammatory Index (E-DII™) score, respectively. Primary outcome was childhood overweight and obesity (OWOB) (age-and-sex-specific BMI z-score > 85th percentile). Secondary outcomes were sum of skinfold thickness (SST), fat mass index (FMI) and fat-free mass index (FFMI). We used multivariable regression analyses (adjusting for maternal lifestyle and sociodemographic factors) to assess the associations of maternal DASH and E-DII scores with offspring adiposity outcomes in cohort-specific analyses, with subsequent random-effect meta-analyses. Results The study mothers had a mean (SD) age of 30.2 (4.6) years and a mean BMI of 23.4 (4.2) kg/m2. Higher early-pregnancy E-DII scores (more pro-inflammatory diet) tended to be associated with a higher odds of late-childhood [10.6 (1.2) years] OWOB [OR (95% CI) 1.09 (1.00, 1.19) per 1-SD E-DII score increase], whereas an inverse association was observed for late-pregnancy E-DII score and early-childhood [2.8 (0.3) years] OWOB [0.91 (0.83, 1.00)]. Higher maternal whole pregnancy DASH score (higher dietary quality) was associated with a lower odds of late-childhood OWOB [OR (95% CI) 0.92 (0.87, 0.98) per 1-SD DASH score increase]; associations were of similar magnitude for early and late-pregnancy [0.86 (0.72, 1.04) and 0.91 (0.85, 0.98), respectively]. These associations were robust in several sensitivity analyses and further adjustment for birth weight and childhood diet did not meaningfully alter the associations and conclusions. In two cohorts with available data, a higher whole pregnancy E-DII and lower DASH scores were associated with a lower late-childhood FFMI in males and a higher mid-childhood FMI in females (P interactions < 0.10). Conclusions A pro-inflammatory, low-quality maternal antenatal diet may adversely influence offspring body composition and OWOB risk, especially during late-childhood. Promoting an overall healthy and anti-inflammatory maternal dietary pattern may contribute to the prevention of childhood obesity, a complex health issue requiring multifaceted strategy.

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The Impact of Adding Sugars to Milk and Fruit on Adiposity and Diet Quality in Children: A Cross-Sectional and Longitudinal Analysis of the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS) Study

Nutrients ◽

10.3390/nu10101350 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1350 ◽

Cited By ~ 4

Author(s):

Marika Dello Russo ◽

Wolfgang Ahrens ◽

Stefaan De Henauw ◽

Gabriele Eiben ◽

Antje Hebestreit ◽

...

Keyword(s):

Diet Quality ◽

Dietary Guidelines ◽

Dietary Quality ◽

Inverse Association ◽

Cross Sectional ◽

Sweetened Beverages ◽

Idefics Study ◽

The Impact ◽

Age And Sex

Sugar, particularly as free sugars or sugar-sweetened beverages, significantly contributes to total energy intake, and, possibly, to increased body weight. Excessive consumption may be considered as a proxy of poor diet quality. However, no previous studies evaluated the association between the habit of adding sugars to “healthy” foods, such as plain milk and fresh fruit, and indicators of adiposity and/or dietary quality in children. To answer to these research questions, we Panalysed the European cohort of children participating in the IDEFICS study. Anthropometric variables, frequency of consumption of sugars added to milk and fruit (SAMF), and scores of adherence to healthy dietary pattern (HDAS) were assessed at baseline in 9829 children stratified according to age and sex. From this cohort, 6929 children were investigated again after two years follow-up. At baseline, a direct association between SAMF categories and adiposity indexes was observed only in children aged 6–<10 years, while the lower frequency of SAMF consumption was significantly associated with a higher HDAS. At the two year follow-up, children with higher baseline SAMF consumption showed significantly higher increases in all the anthropometric variables measured, with the exception of girls 6–<10 years old. The inverse association between SAMF categories and HDAS was still present at the two years follow-up in all age and sex groups. Our results suggest that the habit to adding sugars to foods that are commonly perceived as healthy may impact the adherence to healthy dietary guidelines and increase in adiposity risk as well.

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Exploring the causal effect of maternal pregnancy adiposity on offspring adiposity: Mendelian randomization using polygenic risk scores

10.1101/2021.04.01.21251414 ◽

2021 ◽

Author(s):

Tom A Bond ◽

Rebecca C Richmond ◽

Ville Karhunen ◽

Gabriel Cuellar-Partida ◽

Maria Carolina Borges ◽

...

Keyword(s):

Confidence Intervals ◽

Early Pregnancy ◽

Mendelian Randomization ◽

Causal Effect ◽

Overweight And Obesity ◽

Sensitivity Analyses ◽

Risk Scores ◽

Polygenic Risk ◽

Offspring Adiposity ◽

Maternal Bmi

AbstractBackgroundIt has been hypothesised that greater maternal adiposity before or during pregnancy causes greater offspring adiposity in childhood and adulthood, via causal intrauterine or periconceptional mechanisms. Previous Mendelian randomization (MR) estimates were imprecise, with wide confidence intervals that included potentially important protective or adverse effects, and may have been biased by collider effects or imperfect adjustment for genetic inheritance. Here we use an improved MR approach to investigate whether associations between maternal pre-/early pregnancy body mass index (BMI) and offspring adiposity from birth to adolescence are causal, or are instead due to confounding.Methods and findingsWe undertook confounder adjusted multivariable (MV) regression and Mendelian randomization (MR) using mother-offspring pairs from two UK cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC) and Born in Bradford (BiB). In ALSPAC and BiB the outcomes were birthweight (BW; N = 9339) and BMI at age 1 (N = 8659) and 4 years (N = 7575), and in ALSPAC only we investigated BMI at 10 (N = 4476) and 15 years (N = 4112) and dual-energy X-ray absorptiometry (DXA) determined fat mass index (FMI) from age 10– 18 years (N = 2659 to 3855). We compared MR results from several polygenic risk scores (PRS), calculated from maternal non-transmitted alleles at between 29 and 80,939 single nucleotide polymorphisms (SNPs). MV and MR showed a consistent positive association of maternal BMI with BW, but for adiposity at most older ages MR estimates were weaker than MV estimates. In MV regression a one standard deviation (SD) higher maternal BMI was associated with a 0.13 (95% confidence interval [CI]: 0.10, 0.16) SD increase in offspring BW. The corresponding MR estimate from the strongest PRS (including up to 80,939 SNPs) was 0.14 (95% CI: 0.05, 0.23), with no difference between the two estimates (Pdifference = 0.84). For 15 year BMI the MV and MR estimates (80,939 SNPs) were 0.32 (95% CI: 0.29, 0.36) and 0.13 (95% CI: 0.01, 0.24) respectively (Pdifference = 1.0e-3). Results for FMI were similar to those for adolescent BMI. As the number of SNPs included in the PRS increased, the MR confidence intervals narrowed and the effect estimates for adolescent adiposity became closer to the MV estimates. Sensitivity analyses suggested the stronger effects with more SNPs were explained by horizontal pleiotropic bias away from zero. Consequently, the unbiased difference between the MV and MR estimates is probably greater than shown in our main analyses. Furthermore, MR estimates from IVs with fewer SNPs provided no strong evidence for a causal effect on adolescent adiposity.ConclusionsOur results suggest that higher maternal pre-/early-pregnancy BMI is not a key driver of higher adiposity in the next generation. Thus, they support interventions that target the whole population for reducing overweight and obesity, rather than a specific focus on women of reproductive age.

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Nutrition Literacy among Adolescents and Its Association with Eating Habits and BMI in Tripoli, Lebanon

Diseases ◽

10.3390/diseases9020025 ◽

2021 ◽

Vol 9 (2) ◽

pp. 25

Author(s):

Sara Taleb ◽

Leila Itani

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Food Habits ◽

Eating Habits ◽

Normal Weight ◽

Overweight And Obesity ◽

Assessment Instrument ◽

Inverse Association ◽

Unhealthy Lifestyle ◽

Cross Sectional

(1) Background: Adolescence is a period of increased autonomy and independent decision making; it determines health behaviors that can persist into the future. Individual factors like food choices and unhealthy lifestyle have an essential role in the development and prevention of obesity among adolescents and are associated with the nutrition literacy of parents and other adults. While the association of parents’ nutrition literacy with adolescent BMI has been addressed, there is still a scarcity of studies that examine the effect of adolescents’ nutrition literacy on their eating habits and body mass index (BMI) status. (2) Methods: A cross-sectional study was conducted that included 189 adolescents (68 with overweight and obesity and 121 with normal weight) aged between 14–19 years from four private schools in Tripoli, Lebanon. A self-administered questionnaire that included the Nutrition Literacy Assessment Instrument (NLAI) and the Adolescent Food Habits Checklist (AFHC) was used. Anthropometrics were measured using standardized procedures. The association between nutrition literacy, food habits and BMI was assessed using a chi squared test for independence and Poisson regression analysis where suitable. (3) Results: Results indicated no association between all five components of nutrition literacy and body mass index categories. Furthermore, there was no association between the Adolescent Food Habits Checklist and overweight or obese BMI status (RR = 0.947, 95%CI: 0.629–1.426) (p = 0.796). No association was observed between nutrition literacy and food habits, except for an inverse association with macronutrients literacy. (4) Conclusions: In conclusion, the study indicated that there was no association between the components of nutrition literacy with body mass index or with food habits, except for macronutrient literacy.

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Prevalence of overweight and obesity and anthropometric reference centiles for Albanian children and adolescents living in four Balkan nation-states

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0253 ◽

2018 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Jakob Tarp ◽

Juel Jarani ◽

Florian Muca ◽

Andi Spahi ◽

Anders Grøntved

Keyword(s):

Public Health ◽

Children And Adolescents ◽

Task Force ◽

Overweight And Obesity ◽

World Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Nation States ◽

Country Differences ◽

Age And Sex

Abstract Background The extent of the obesity epidemic among youth is an important public health statistic which provides an indication of the future burden of non-communicable diseases. Many developing countries, including Albania, do not have systematic and repeated monitoring systems in operation. Methods The Balkan Survey of Inactivity in Children study is a population-based cross-sectional survey including Albanian children living in the four Balkan nation-states of Albania, Kosovo, FYR Macedonia and Montenegro. In total, 19,850 children from 49 schools were approached. The LMS method was used to provide body mass index (BMI), height, weight and waist circumference reference centiles for boys and girls. The World Health Organisation (WHO) and International Obesity Task Force (IOTF) age- and sex-specific BMI cut-points were applied to evaluate adiposity levels. Results A sample of 18,460 participants aged 6–16 years old was available for creation of the BMI for age and sex reference centiles. The prevalence of overweight (including obesity) in the full sample was 21% (95% CI: 20%–21%) according to IOTF cut-off points and 28% (95% CI: 28%–29%) at WHO cut-off points. Overweight/obesity levels where higher in boys than in girls irrespective of the cut-off points applied (p<0.001). Noticeable between-country differences were observed with a prevalence of overweight/obesity of 40% (95% CI: 38%–42%) in Montenegro but only 20% (95% CI: 19%–21%) in Kosovo (WHO cut-off points). Conclusions Overweight/obesity is highly prevalent in Albanian children and adolescents. The apparent sex and country differences may inform public health actions.

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Prediction of Healthy Pregnancy Outcomes in Women with Overweight and Obesity: The Role of Maternal Early-Pregnancy Metabolites

Metabolites ◽

10.3390/metabo12010013 ◽

2021 ◽

Vol 12 (1) ◽

pp. 13

Author(s):

Rama J. Wahab ◽

Vincent W. V. Jaddoe ◽

Romy Gaillard

Keyword(s):

Pregnancy Outcome ◽

Early Pregnancy ◽

Pregnancy Outcomes ◽

Gestational Hypertension ◽

Characteristic Curve ◽

Overweight And Obesity ◽

Large For Gestational Age ◽

Maternal Characteristics ◽

Healthy Pregnancy ◽

Increased Risk

Women with obesity receive intensified antenatal care due to their increased risk of pregnancy complications, even though not all of these women develop complications. We developed a model based on maternal characteristics for prediction of healthy pregnancy outcomes in women with obesity or who are overweight. We assessed whether early-pregnancy metabolites improved prediction. In a population-based cohort study among a subsample of 1180 Dutch pregnant women with obesity or who are overweight, we developed a prediction model using 32 maternal socio-demographic, lifestyle, physical and pregnancy-related characteristics. We determined early-pregnancy amino acids, nonesterifed fatty acids, phospholipids and carnitines in blood serum using liquid chromatography-tandem mass spectrometry. A healthy pregnancy outcome was the absence of fetal death, gestational hypertension, preeclampsia, gestational diabetes, caesarian section, preterm birth, large-for-gestational-age at birth, macrosomia, postpartum weight retention and offspring overweight/obesity at 5 years. Maternal age, relationship status, parity, early-pregnancy body mass index, mid-pregnancy gestational weight gain, systolic blood pressure and estimated fetal weight were selected into the model using backward selection (area under the receiver operating characteristic curve: 0.65 (95% confidence interval 0.61 to 0.68)). Early-pregnancy metabolites did not improve model performance. Thus, in women with obesity or who are overweight, maternal characteristics can moderately predict a healthy pregnancy outcome. Maternal early-pregnancy metabolites have no incremental value in the prediction of a healthy pregnancy outcome.

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Obesity, smoking status and their relationships in selected population groups

Roczniki Państwowego Zakładu Higieny ◽

10.32394/rpzh.2021.0173 ◽

2021 ◽

pp. 291-299

Keyword(s):

Body Composition ◽

Lipid Profile ◽

Fat Mass ◽

Severe Obesity ◽

Overweight And Obesity ◽

Fat Free Mass ◽

Chronic Obstructive ◽

Average Value ◽

Copd Patients ◽

The Mean

Background. Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Obesity is associated with many chronic diseases, including cardiovascular disease and diabetes, and recently the role of overweight and obesity in lung disease has received new interest. Chronic obstructive lung disease is the third-leading cause of death globally, and both obesity and diet appear to play roles in its pathophysiology. Cross-sectional studies have demonstrated an inverse association between obesity and the prevalence of chronic obstructive pulmonary disease (COPD). Objective. This study aims to evaluate the relationship between smoking, lipid profile and obesity (body composition changes) in a selected groups of population (30 non-smokers, 30 smokers and 60 COPD patients). Material and Methods. We evaluated fat mass, fat free mass, body mass index and lipid profile in a group of 120 randomly selected probands (60 COPD patients; 30 smokers without COPD; 30 non-smokers without COPD) to identify possible negative relationships of smoking to body composition. To the measurement of fat mass (FM) and fat free mass (FFM) was used a device Bodystat Quadscan 4000 (Bodystat Ltd, British Isles). The device works by using four-frequency bioelectrical impedance analysis. Laboratory parameters as total cholesterol (T-C), high-density cholesterol (HDL-C), low-density cholesterol (LDL-C) and triacylglycerols (TG) were investigated by automated clinical chemistry analyzer LISA 200th. The measured values were statistically processed and evaluated in a statistical program STATISTICA Cz. Version 7.1. (Kruskall-Wallis test). Results. A comparison of the mean fat mass we found statistically highly significant differences between the group of COPD patients and non-smokers (P <0.001) and insignificant differences (P ≥ 0.05) between the other groups of our experiment. A comparison of the mean fat mass values of all three groups of the experiment shows a steady increase in fat from non-smokers (17.66 ± 10.04 kg) to COPD patients with the highest mean value (25.08 ± 10.14 kg). In the group of COPD patients we recorded the lowest average value of FFM (51.76 ± 13.84 kg), in group of smokers the middle (56.06 ± 10.76 kg) and in non-smokers the highest average value of FFM (59.91 ± 9.90 kg) at relatively the same body weight in the groups. Based on calculated body mass index (BMI), we found in group of COPD patients overweight in 15 cases (25%), obesity in 7 patients (11.67%), severe obesity in 14 patients (23.3%) and morbid obesity in 2 patients (3.33%); in the group of smokers overweight in 16 cases (53.33%), obesity in 5 cases (16.6%) and severe obesity in 1 case (3.33%); in non-smokers we recording overweight in 14 cases (46.67%), obesity in 5 cases (16.67%) and severe obesity in 2 cases (6.67%). In the lipid profile of the monitored groups of probands, we observed statistically significant differences only for LDL cholesterol (LDL-C). There was a statistically significant difference (P <0.001) between the group with COPD and smokers, as well as between the group of smokers and non-smokers (P < 0.05). Conclusions. In the vast majority of patients with COPD, the lung damage that leads to COPD is caused by long-term cigarette smoking. The presence and absence of risk factors such as smoking, inappropriate lipid profile and obesity (amount of fat mass) in selected population groups were observed. Additional studies to explore both the quantitative and qualitative changes in body composition with disease process of COPD are required.

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Association Between Body Composition with Pulmonary Function Tests

10.21203/rs.3.rs-112097/v1 ◽

2020 ◽

Author(s):

Hamidreza Pouragha ◽

Hosein Kazemi ◽

Gholamreza Pouryaghoub ◽

Ramin Mehrdad

Keyword(s):

Body Composition ◽

Pulmonary Function ◽

Visceral Fat ◽

Pulmonary Function Tests ◽

Bioelectrical Impedance ◽

The Body ◽

Fat Free Mass ◽

The Other ◽

Inverse Association ◽

Cross Sectional

Abstract Background: Why is bodyweight not a predictor of lung function, however, height, sex, race, and age are predictors of lung capacity and function. In this study, we want to investigate the association between body composition and pulmonary function. And as much as possible, answer the question of why bodyweight is not predictive of lung function.Method: This cross-sectional study was performed among 2967 employees of Tehran University of Medical Sciences (TUMS) who participated in the TUMS Employees Cohort (TEC) study. The body composition of the participants was measured using the Bioelectrical Impedance Analysis (BIA) method. Anthropometric variables were also measured as a confounder. The pulmonary function of participants was assessed by a forced spirometry test.Results: The correlation of BIA values including fat-free mass and total body water with a pulmonary function such as FEV1, FVC, and FEF25-75 is higher than most anthropometric values such as weight, wrist circumference, and the waist to hip ratio. Also, in regression analysis, age and sex had an association with pulmonary function, but the weight did not show a significant relationship. On the other hand, fat-free mass and visceral fat were significantly associated with pulmonary function. One is direct and the other is inverse.Conclusion: The hypothesis that the results of this study created in the minds of the authors were that; The direct association of fat-free mass with pulmonary function may be ineffective by the inverse association of visceral fat with pulmonary function, leading to a lack of association between weight and pulmonary function.

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Assessment of Active Video Games’ Energy Expenditure in Children with Overweight and Obesity and Differences by Gender

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17186714 ◽

2020 ◽

Vol 17 (18) ◽

pp. 6714

Author(s):

Cristina Comeras-Chueca ◽

Lorena Villalba-Heredia ◽

Marcos Pérez-Llera ◽

Gabriel Lozano-Berges ◽

Jorge Marín-Puyalto ◽

...

Keyword(s):

Video Games ◽

Energy Expenditure ◽

Overweight And Obesity ◽

Fat Free Mass ◽

Nintendo Wii ◽

Active Video Games ◽

Increase Energy Expenditure ◽

Active Video ◽

Xbox Kinect ◽

The Individual

(1) Background: Childhood obesity has become a main global health problem and active video games (AVG) could be used to increase energy expenditure. The aim of this study was to investigate the energy expenditure during an AVG intervention combined with exercise, differentiating by gender. (2) Methods: A total of 45 children with overweight or obesity (19 girls) performed an AVG intervention combined with exercise. The AVG used were the Xbox Kinect, Nintendo Wii, dance mats, BKOOL cycling simulator, and Nintendo Switch. The energy expenditure was estimated from the heart rate recorded during the sessions and the data from the individual maximal tests. (3) Results: The mean energy expenditure was 315.1 kilocalories in a one-hour session. Participants spent the most energy on BKOOL, followed by Ring Fit Adventures, Dance Mats, Xbox Kinect, and the Nintendo Wii, with significant differences between BKOOL and the Nintendo Wii. Significant differences between boys and girls were found, but were partially due to the difference in weight, VO2max, and fat-free mass. (4) Conclusions: The energy expenditure with AVG combined with multi-component exercise was 5.68 kcal/min in boys and 4.66 kcal/min in girls with overweight and obesity. AVG could be an effective strategy to increase energy expenditure in children and adolescents with overweight and obesity.

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