Estimating Global Prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease in Overweight or Obese Children and Adolescents: Systematic Review and Meta-Analysis

Objectives: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new terminology updated from non-alcoholic fatty liver disease (NAFLD). We aim to estimate the global prevalence of MAFLD in overweight or obese children and adolescents, by repurposing existing data on fatty liver disease.Methods: We screened relevant articles published up to December 2020. Pooled prevalence was calculated using Logit transformations.Results: Our search returned 35,441 records, of which 156 studies fulfilled the inclusion criteria. The overall prevalence of MAFLD was 33.78% in the general population and 44.94% in a special population based on child obesity clinics, regardless of the diagnostic techniques. For subgroup analysis, MAFLD prevalence was significantly higher in boys compared to girls (36.05 vs. 26.84% in the general population; 50.20 vs. 35.34% in the child obesity clinics-based population). Interestingly, based on study source, the pooled prevalence of MAFLD was 1.5-fold higher in other “fatty liver disease” studies compared to the classical “NAFLD” studies in the general population.Conclusion: MAFLD is highly prevalent in overweight or obese children and adolescents. Raising awareness and urgent actions are warranted to control the MAFLD pandemic across the globe.

Income and neighbourhood deprivation in relation to obesity in urban dwelling children 0–12 years of age: a cross-sectional study from 2013 to 2019

BackgroundChildhood obesity is a major public health concern. This study evaluated the independent and joint associations of family-level income, neighbourhood-level income and neighbourhood deprivation, in relation to child obesity.MethodsA cross-sectional study was conducted in children ≤12 years of age from TARGet Kids! primary care network (Greater Toronto Area, 2013–2019). Parent-reported family income was compared with median neighbourhood income and neighbourhood deprivation measured using the Ontario Marginalization Index. Children’s height and weight were measured and body mass index (BMI) z-scores (zBMI) were calculated. ORs and 95% CIs were estimated for the three exposure variables separately using multilevel multinomial logistic regression models with zBMI categories as the outcome, adjusting in model 1 for age, sex, ethnicity and number of family members and in model 2 adding family income. A joint measure was derived combining income and deprivation measures.ResultsA total of 5962 children were included. Low family income (Q1 vs Q5: OR=4.69, 95% CI 2.65 to 8.29), low neighbourhood income (Q1 vs Q5: OR=2.18, 95% CI 1.33 to 3.58) and high neighbourhood deprivation (Q1 vs Q5: OR=2.45, 95% CI 1.52 to 3.95) were each associated with increased OR of child obesity. However, after adjustment for family income, the association for both neighbourhood income (OR=1.39, 95% CI 0.82 to 2.34) and deprivation (OR=1.56, 95% CI 0.94 to 2.58) and obesity was attenuated. Children from low-income families living in low-income or high deprivation neighbourhoods had higher OR of obesity.ConclusionChild obesity was independently associated with low family-level income and a joint measure suggests that neighbourhood also matters. Socioeconomic inequalities at both individual and neighbourhood levels should be addressed in childhood obesity interventions.

Simple Energy Balance or Microbiome for Childhood Obesity Prevention?

Obesity prevention interventions generally have either not worked or had effects inadequate to mitigate the problem. They have been predicated on the simple energy balance model, which has been severely questioned by biological scientists. Numerous other etiological mechanisms have been proposed, including the intestinal microbiome, which has been related to childhood obesity in numerous ways. Public health research is needed in regard to diet and the microbiome, which hopefully will lead to effective child obesity prevention.

Validation of a social-cognitive theory-based tool for measuring factors influencing obesity prevention behaviors in 4-6 years old children using confirmatory factor analysis (CFA)

Background: Child obesity is one of the main health problems all across the world, which leads to mental and physical health problems. Various models are used in designing intervention to prevent child obesity, one of which is social-cognitive theory (SCT). The constructs of social-cognitive theory are commonly used for designing preventive interventions. However, there is no specific tool based on the constructs of social-cognitive theory to assess the factors associated with child obesity. Aim: The aim of this study was to investigate the validity and confirmatory factor analysis of a SCT-based questionnaire for assessing obesity preventing behaviors among 4-6 years old children. Method: A cross-sectional study was first conducted in 2016 on 240 preschool children aged 4-6 years in Behbahan city (a city in southwest Iran) to assess the obesity prevention behaviors among them using a SCT-based questionnaire. To investigate the validity and confirmatory factor analysis of the SCT-based questionnaire, content and face validity as well as forward-backward translation method were used. Reliability of the questionnaire was also measured by Cronbach’s alpha coefficient and Intra-class Correlation Coefficient (ICC). Construct validity was assured by confirmatory factor analysis. To measure the obesity prevention behaviors in 4-6 years old children, the construct of SCT, including environment, emotional coping, outcome expectations, goal setting and self-efficacy were used. Also, the obesity prevention behaviors used in the model included physical activity, consumption of fruit and vegetable, consumption of sugar-free drinks, and screen. Results: Results of this study confirmed the acceptable content and face validity of the SCT-based questionnaire. The results of confirmatory factor analysis also confirmed the factor loading of more than 0.3 for all variables; therefore, the SCT-based questionnaire had an acceptable validity and reliability. Conclusions: Since the SCT-based questionnaire had an acceptable validity and reliability, it can be used to assess the obesity prevention behaviors in 4-6 year old children, and also to design relevant educational interventions. Keywords: Validation, Social-Cognitive Theory, Behavior, Childhood obesity, Preschool, Prevention

Do genetic risk scores for childhood adiposity operate independent of BMI of their mothers?

Objectives Genetic predisposition and maternal body mass index (BMI) are risk factors for childhood adiposity, defined by either BMI or overweight. We aimed to investigate whether childhood-specific genetic risk scores (GRSs) for adiposity-related traits are associated with childhood adiposity independent of maternal BMI, or whether the associations are modified by maternal BMI. Methods We constructed a weighted 26-SNP child BMI-GRS and a weighted 17-SNP child obesity-GRS in overall 1674 genotyped children within the Danish National Birth Cohort. We applied a case-cohort (N = 1261) and exposure-based cohort (N = 912) sampling design. Using logistic regression models we estimated associations of the GRSs and child overweight at age 7 years and examined if the GRSs influence child adiposity independent of maternal BMI (per standard deviation units). Results In the case-cohort design analysis, maternal BMI and the child GRSs were associated with increased odds for childhood overweight [OR for maternal BMI: 2.01 (95% CI: 1.86; 2.17), OR for child BMI-GRS: 1.56 (95% CI: 1.47; 1.66), and OR for child obesity-GRS 1.46 (95% CI: 1.37; 1.54)]. Adjustment for maternal BMI did not change the results, and there were no significant interactions between the GRSs and maternal BMI. However, in the exposure-based cohort design analysis, significant interactions between the child GRSs and maternal BMI on child overweight were observed, suggesting 0.85–0.87-fold attenuation on ORs of child overweight at higher values of maternal BMI and child GRS. Conclusion GRSs for childhood adiposity are strongly associated with childhood adiposity even when adjusted for maternal BMI, suggesting that the child-specific GRSs and maternal BMI contribute to childhood overweight independent of each other. However, high maternal BMI may attenuate the effects of child GRSs in children.