Current Recommendations for Nutritional Management of Overweight and Obesity in Children and Adolescents: A Structured Framework

Nutritional management is an important component of the treatment of pediatric overweight and obesity, but clinicians struggle to keep abreast with the abundant literature. Therefore, our aim is to provide a tool that integrates the current recommendations and clinical expertise to assist dietitians and other practitioners in their decision making about the nutritional management of pediatric overweight and obesity. To construct this practice-based evidence-informed framework, we conducted a systematic review of the guidelines on nutritional management of pediatric overweight or obesity in 2 databases and in the grey literature. We analyzed and synthesized recommendations of 17 guidelines. We selected the recommendations that were common to at least 30% of the guidelines and added by consensus the recommendations relevant to clinical expertise. Finally, we structured the framework according to the Nutritional Care Process in collaboration with a specialized team of dietitians who assessed its validity in clinical practice. The framework contributes to facilitate the integration of evidence-based practice for dietitians by synthesizing the current evidence, supporting clinical expertise, and promoting structured care following Nutrition Care Process model for children and adolescents with obesity.

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Effect of Warm-Needling Acupuncture in Overweight and Obese Adults: Protocol for a Systematic Review and Meta-Analysis

10.21203/rs.3.rs-49620/v1 ◽

2020 ◽

Author(s):

Junpeng YAO ◽

Liping Chen ◽

Hui Zheng ◽

Lin Zhang ◽

Ying Li

Keyword(s):

Systematic Review ◽

Evaluation System ◽

Grey Literature ◽

Overweight And Obesity ◽

Biomedical Literature ◽

Current Evidence ◽

Controlled Trials ◽

Cochrane Central Register ◽

Academic Degree ◽

Warm Needling

Abstract Background: Overweight and obesity are chronic metabolic diseases characterized by abnormal or excessive fat accumulation that presents a risk to health. Warm-needling acupuncture (WNA), which combines the characteristics of acupuncture and moxibustion, has been commonly used to manage obesity with reasonable weight control in recent years. Therefore, our objective is to systematically appraise the efficacy and safety of WNA for overweight and obesity.Methods: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Excerpt Medica Database (EMBASE), ALT HealthWatch, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), the Chinese Biomedical Literature Database (CBM), Wanfang Data, and grey literature (trial registries, conference proceedings and academic degree dissertations) will be searched for the identification of articles. All randomized controlled trials (RCTs) involving WNA independently or as an adjunct to other active therapies, compared with the same therapies alone, will be included. The principal outcome will be the difference in BMI from baseline to the end of studies. Secondary outcomes include the change of weight, waist circumference, percentage of body fat, serum lipid before and after treatment. The severity and incidence of adverse events will be measured as the safety assessment. Study selection, data extraction, and assessment of risk of bias will be performed independently by two reviewers. A third reviewer will resolve and determine disagreements. The Review Manager software (V.5.3.5) and Stata software (V.14.0) will be used for data synthesis. Furthermore, the quality of the evidence for the results will be described according to the Grading of Recommendations Assessment, Development and Evaluation system (GRADE) with GRADEprofiler software (V.3.6.1).Discussion: This is the first systematic review to evaluate the effect of WNA in the management of obesity. This program will provide a high-quality synthesis of the current evidence to identify whether WNA is an effective therapeutic approach for overweight and obesity.Systematic review registration: PROSPERO CRD42019146380.

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Interventions to Prevent Obesity in Mexican Children and Adolescents: Systematic Review

Prevention Science ◽

10.1007/s11121-021-01316-6 ◽

2021 ◽

Author(s):

Magaly Aceves-Martins ◽

Lizet López-Cruz ◽

Marcela García-Botello ◽

Yareni Yunuen Gutierrez-Gómez ◽

Carlos Francisco Moreno-García

Keyword(s):

Children And Adolescents ◽

Assessment Tool ◽

Public Health Practice ◽

Relevant Information ◽

Overweight And Obesity ◽

Current Evidence ◽

Media Campaigns ◽

Mexican Children ◽

Qualitative Approaches ◽

Weight Outcomes

AbstractThe prevalence of overweight and obesity has been rising among Mexican children and adolescents in the last decades. To systematically review obesity prevention interventions delivered to Mexican children and adolescents. Thirteen databases and one search engine were searched for evidence from 1995 to 2021. Searches were done in English and Spanish to capture relevant information. Studies with experimental designs, delivered in any setting (e.g., schools or clinics) or digital domains (e.g., social media campaigns) targeting Mexican children or adolescents (≤ 18 years) and reporting weight outcomes, were included in this review. In addition, the risk of bias was appraised with the Effective Public Health Practice Project Quality Assessment Tool. Twenty-nine studies with 19,136 participants (3–17 years old) were included. The prevalence of overweight and obesity at baseline ranged from 21 to 69%. Most of the studies (89.6%) were delivered in school settings. The duration ranged from 2 days to 3 school years, and the number of sessions also varied from 2 to 200 sessions at different intensities. Overall, anthropometric changes varied across studies. Thus, the efficacy of the included studies is heterogeneous and inconclusive among studies. Current evidence is heterogeneous and inconclusive about the efficacy of interventions to prevent obesity in Mexican children and adolescents. Interventions should not be limited to educational activities and should include different components, such as multi-settings delivery, family inclusion, and longer-term implementations. Mixed-method evaluations (including robust quantitative and qualitative approaches) could provide a deeper understanding of the effectiveness and best practices.

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Diagnostic performance of mid-upper arm circumference to identify overweight and obesity in children and adolescents: a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-044624 ◽

2021 ◽

Vol 11 (3) ◽

pp. e044624

Author(s):

Binyam Girma Sisay ◽

Hamid Yimam Hassen ◽

Seifu Hagos Gebreyesus

Keyword(s):

Systematic Review ◽

Children And Adolescents ◽

Diagnostic Performance ◽

Meta Analysis ◽

Grey Literature ◽

Overweight And Obesity ◽

Upper Arm ◽

Arm Circumference ◽

Mid Upper Arm Circumference ◽

Obesity In Children

IntroductionMid-upper arm circumference (MUAC) has been suggested as an alternative screening tool to identify overweight and obesity in children and adolescents. Several studies have examined the diagnostic performance of MUAC to identify overweight and obesity in children and adolescents. However, the existing literature shows a considerable variability in measures of diagnostic performance and hence makes it difficult to direct clinical and public health practice. Therefore, this systematic review and meta-analysis aimed to synthesise evidence on the performance of MUAC to identify overweight and obesity in children and adolescents.Methods and analysisA systematic search of databases including PubMed, EMBASE, SCOPUS, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Web of Science, CINAHL and PsycINFO will be conducted. The search will cover all studies until 1 April 2021. Grey literature will also be retrieved from Google Scholar. Titles and abstracts will be screened by two independent reviewers. The Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used to assess the risk of bias and clinical applicability of each study. To assess possible publication bias, we will use Deeks’ funnel plot. We will investigate the sources of heterogeneity by visual inspection of the paired forest plots and summary receiver operating characteristic plots. The pooled summary statistics for the area under the curve, sensitivities, specificities, likelihood ratios and diagnostic ORs with 95% CI will be reported.Ethics and disseminationThe underlying study is based on published articles thus does not require ethical approval. The findings of the systematic review and meta-analysis will be published in a peer-reviewed journal and disseminated in different scientific conferences and seminars.PROSPERO registration numberCRD42020183148.

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A Comprehensive, Multidisciplinary, Personalized, Lifestyle Intervention Program is Associated with Increased Leukocyte Telomere Length in Children and Adolescents with Overweight and Obesity

Nutrients ◽

10.3390/nu13082682 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2682

Author(s):

George Paltoglou ◽

Christina Raftopoulou ◽

Nicolas C. Nicolaides ◽

Sofia M. Genitsaridi ◽

Sofia I. Karampatsou ◽

...

Keyword(s):

Children And Adolescents ◽

Telomere Length ◽

Lifestyle Intervention ◽

Intervention Program ◽

Overweight And Obesity ◽

Initial Assessment ◽

Biological Aging ◽

Childhood And Adolescence ◽

Lifestyle Interventions ◽

Lifestyle Intervention Program

Leucocyte telomere length (LTL) is a robust marker of biological aging and is associated with obesity and cardiometabolic risk factors in childhood and adolescence. We investigated the effect of a structured, comprehensive, multidisciplinary, personalized, lifestyle intervention program of healthy diet and physical exercise on LTL in 508 children and adolescents (239 males, 269 females; 282 prepubertal, 226 pubertal), aged 10.14 ± 0.13 years. Participants were classified as obese (n = 267, 52.6%), overweight (n = 174, 34.2%), or of normal BMI (n = 67, 13.2%) according to the International Obesity Task Force (IOTF) cutoff points and were studied prospectively for one year. We demonstrated that LTL increased significantly after 1 year of the lifestyle interventions, irrespective of gender, pubertal status, or body mass index (BMI). Waist circumference was the best negative predictor of LTL at initial assessment. The implementation of the lifestyle interventions also resulted in a significant improvement in clinical (BMI, BMI z-score and waist to height ratio) and body composition indices of obesity, inflammatory markers, hepatic enzymes, glycated hemoglobin (HbA1C), quantitative insulin sensitivity check index (QUICKI), and lipid profile in all participants. These findings indicate that the increased LTL may be associated with a more favorable metabolic profile and decreased morbidity later in life.

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POS1309 PREVALENCE AND CORRELATES OF UNDERWEIGHT, OVERWEIGHT AND OBESITY AMONG PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS (JIA): EVIDENCE FROM THE NATIONAL PAEDIATRIC RHEUMATOLOGIC DATABASE (NPRD)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2058 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 936.2-937

Author(s):

F. Milatz ◽

J. Klotsche ◽

M. Niewerth ◽

J. Hörstermann ◽

D. Windschall ◽

...

Keyword(s):

Physical Activity ◽

Juvenile Idiopathic Arthritis ◽

General Population ◽

Children And Adolescents ◽

Treatment Response ◽

Weight Status ◽

Overweight And Obesity ◽

Age Group ◽

Group 3 ◽

Obesity In Children

Background:In patients with JIA, growth impairment and variance in body composition are well-known long-term complications that may be associated with prolonged drug therapy (e.g. glucocorticoids) as well as impaired physical and psychosocial well-being. An increased accumulation of body fat represents a significant risk factor for metabolic abnormalities and a modifiable variable for a number of comorbidities. Recently, evidence has emerged in favour of the potential negative influence of overweight on the course of the disease and treatment response [1].Objectives:The study aimed a) to estimate the prevalence of underweight, overweight and obesity in children and adolescents with JIA compared to the general population, and b) to investigate correlates of patients’ weight status.Methods:A cross-sectional analysis of physicians’ recorded body weights and heights of patients with JIA enrolled in the NPRD in the year 2019 was performed. Underweight (BMI <10th), overweight (BMI >90th) and obesity (BMI >97th) were defined according to age- and sex-specific percentiles used in the German reference system. For comparison with data from the general population [2], sex- and age-matched pairs of 3-17-year-old patients and controls were generated. A multinomial logistic regression analysis was performed to examine the association between weight status and patients’ clinical and self-reported outcomes.Results:In total, data from 6.515 children and adolescents with JIA (age 11.2 ± 4.1 years, disease duration 4.9 ± 3.8 years, 67% girls, 40% persistent oligoarthritis) were included. Of these, 3.334 (age 5.9 ± 2.1 years, 52.5% girls) could be considered for matched-pair analysis. Compared with the general population, patients underweight, overweight and obesity rates were 10.6% (vs. 8.1%), 8.8% (vs. 8.5%) and 6.1% (vs. 5.7%), respectively. No significant sex differences were found in either group. Largest difference in prevalence was registered for underweight, specifically in the age group 3-6 years (12.9% patients vs. 5.9% controls). Similar to the general population, higher rates of overweight were observed in adolescent patients than in affected children (19.1% age group 11-13 vs. 8.4% age group 3-6). While the highest underweight prevalence was registered in patients with RF+ polyarthritis (16%), patients with Enthesitis-related arthritis (22%), psoriatic arthritis (21%) and systemic JIA (20%) showed the highest overweight rates (including obesity). Younger age (OR = 0.51, 95% CI = 0.31-0.83), more frequent physical activity (OR = 0.92, 95% CI = 0.85-0.99) and high parental vocational education (OR = 0.39, 95% CI = 0.18-0.80) were independently associated with a lower likelihood of being overweight/obese.Conclusion:The overall prevalence of underweight, overweight and obesity in children and adolescents with JIA is comparable to that found in the general population. Behavioural health promotion, including regular physical activity, as part of the treatment strategy in JIA should preventively already begin at preschool age and necessarily be made accessible to patients of all educational levels.References:[1]Giani T et al. The influence of overweight and obesity on treatment response in juvenile idiopathic arthritis. Front Pharmacol 2019;10:637.[2]Schienkiewitz A et al. BMI among children and adolescents: prevalences and distribution considering underweight and extreme obesity. Bundesgesundheitsbl 2019;62:1225–1234.Acknowledgements:The National Paediatric Rheumatological Database has been funded by AbbVie, Chugai, Novartis and GSK.Disclosure of Interests:Florian Milatz: None declared, Jens Klotsche: None declared, Martina Niewerth: None declared, Jana Hörstermann: None declared, Daniel Windschall: None declared, Frank Weller-Heinemann Speakers bureau: Pfizer, AbbVie, SOBI, Roche and Novartis., Frank Dressler: None declared, Rainer Berendes: None declared, Johannes-Peter Haas: None declared, Gerd Horneff: None declared, Kirsten Minden Speakers bureau: Pfizer, AbbVie, Consultant of: Novartis

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Prevalence of Metabolic Syndrome in Children and Adolescents with Type 1 Diabetes Mellitus and Possibilities of Prevention and Treatment: A Systematic Review

Nutrients ◽

10.3390/nu13061782 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1782

Author(s):

Monika Grabia ◽

Renata Markiewicz-Żukowska ◽

Katarzyna Socha

Keyword(s):

Systematic Review ◽

Metabolic Syndrome ◽

Type 1 Diabetes ◽

Children And Adolescents ◽

Treatment Options ◽

Overweight And Obesity ◽

Excess Body Weight ◽

Healthy Population ◽

Prevention And Treatment

Overweight and obesity are an increasingly common problem, not only among the healthy population, but also in adolescents with type 1 diabetes (T1DM). Excess body weight is related to many cardiometabolic complications as well as a high risk of metabolic syndrome (MetS). The purpose of this systematic review is to provide a concise and critical overview of the prevalence of MetS in children and adolescents with T1DM and, ultimately, to discuss prevention and treatment options. The study was conducted in accordance with PRISMA guidelines. This review shows that, apart from the growing percentage of overweight and obese children and adolescents with T1DM (on average 20.1% and 9.5%, respectively), the problem of the increasing incidence of MetS (range from 3.2 to 29.9%, depending on the criteria used) is one of the most important phenomena of our time. One of the methods of prevention and treatment is a combined approach: changing eating habits and lifestyle, but there are also reports about the beneficial effects of the gut microflora.

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Influences of exercise interventions on overweight and obesity in children and adolescents

Public Health Nursing ◽

10.1111/phn.12862 ◽

2021 ◽

Author(s):

Junga Lee

Keyword(s):

Children And Adolescents ◽

Overweight And Obesity ◽

Exercise Interventions ◽

Obesity In Children

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Free Sugars Consumption in Canada

Nutrients ◽

10.3390/nu13051471 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1471

Author(s):

Huma Rana ◽

Marie-Claude Mallet ◽

Alejandro Gonzalez ◽

Marie-France Verreault ◽

Sylvie St-Pierre

Keyword(s):

Type 2 Diabetes ◽

Weight Gain ◽

Total Energy ◽

Children And Adolescents ◽

Overweight And Obesity ◽

Free Sugars ◽

Added Sugars ◽

Increased Risk ◽

Baked Products

Free sugars (FS) are associated with a higher risk of dental decay in children and an increased risk of weight gain, overweight and obesity and type 2 diabetes. For this reason, Canada’s Food Guide recommends limiting foods and beverages that contribute to excess free sugars consumption. Estimating FS intakes is needed to inform policies and interventions aimed at reducing Canadians’ consumption of FS. The objective of this study was to estimate FS intake of Canadians using a new method that estimated the free sugars content of foods in the Canadian Nutrient File, the database used in national nutrition surveys. We define FS as sugars present in food products in which the structure has been broken down. We found that 12% of total energy (about 56 g) comes from FS in the diet of Canadians 1 year of age and older (≥1 year). The top four sources were: (1) sugars, syrups, preserves, confectionary, desserts; (2) soft drinks; (3) baked products and (4) juice (without added sugars), and accounted for 60% of total free sugars intake. The results show that efforts need to be sustained to help Canadians, particularly children and adolescents, to reduce their FS intake.

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Secular Trends of Underweight, Overweight, and Obesity in Children and Adolescents from Ukraine

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063302 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3302

Author(s):

Katarzyna Dereń ◽

Justyna Wyszyńska ◽

Serhiy Nyankovskyy ◽

Olena Nyankovska ◽

Marta Yatsula ◽

...

Keyword(s):

Children And Adolescents ◽

Age Groups ◽

Overweight And Obesity ◽

The Body ◽

World Health ◽

Public Health Issue ◽

Significant Difference ◽

Significant Public Health ◽

Health Organization ◽

Obesity In Children

Overweight and obesity, as well as underweight in children and adolescents, pose a significant public health issue. This study aimed to investigate the secular trend of the incidence of underweight, overweight, and obesity in children from Ukraine in 2013/2014 and 2018/2019. The studies were conducted in randomly selected primary and secondary schools in Ukraine. In total, 13,447 children (6468 boys and 6979 girls) participated in the study in 2013/2014 and 18,144 children (8717 boys and 9427 girls) participated in 2018/2019. Measurements of body weight and height were performed in triplicate. Underweight, overweight, and obesity were diagnosed according to the standards of the World Health Organization (WHO). In the group of girls, a significant difference between 2013/2014 and 2018/2019 measurements was found only among 7-year-olds. The percentage of girls at this age exceeding the body mass index (BMI) norm was lower in the 2018/2019 study. In boys, a significant difference was also found in 7-year-olds, and, as in girls, a lower share of overweight and obesity was found in 2018/2019. But for the ages of 12, 13, and 15, the significant differences had a different character—more overweight or obese boys were found in the 2018/2019 study. The proportion of underweight children was similar for the majority of age groups in both genders and did not differ in a statistically significant way.

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School-based interventions for the treatment of childhood obesity: a systematic review, meta-analysis and meta-regression of cluster randomised controlled trials

Public Health Nutrition ◽

10.1017/s1368980021001117 ◽

2021 ◽

pp. 1-28

Author(s):

Tarcisus Ho ◽

Ling Jie Cheng ◽

Ying Lau

Keyword(s):

Childhood Obesity ◽

Children And Adolescents ◽

Meta Analysis ◽

Overweight And Obesity ◽

Risk Of Bias ◽

Medium Effect ◽

School Based ◽

Cluster Randomised ◽

School Based Interventions ◽

Meta Regression

Abstract Objective Schools offer an ideal setting for childhood obesity interventions due to their access to children and adolescents. This review aimed to systematically review the impact of school-based intervention for the treatment of childhood obesity. Design Eight databases were searched from inception till May 30, 2020. A revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to evaluate the risk of bias and overall evidence. Meta-analysis and meta-regression were performed on Stata software using the random-effects model. Overall effect was evaluated using Hedges’ g, and heterogeneity was assessed using Cochran’s Q and I2. Setting Cluster randomised trials (cluster-RCTs) delivered in school. Participants Children and adolescents (6-18 years of age) with overweight and obesity. Results Twelve cluster-RCTs from seven countries with 1,755 participants were included in the meta-analysis. School-based interventions for the treatment of childhood obesity reduced body mass index (BMI) and BMI z-scores with a medium effect (g=0·52). Subgroup analyses showed the greater effectiveness of brief school-based interventions and the interventions conducted in lower-middle to upper-middle economies. Meta-regression assessed the heterogeneity and the final model, with covariates of the type of economies and trial duration, accounted for 41.2% of the variability. The overall quality of evidence was rated low because of the high risk of bias and inconsistency. Conclusions School-based interventions is a possible approach to provide universal healthcare for the treatment of childhood obesity, and further well-designed cluster-RCTs with longer follow-up are needed. This study is registered with PROSPERO (CRD42020160735).

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