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Association between Childhood Obesity and Dietary Intake and Lifestyle

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Pediatric Nutrition".

Deadline for manuscript submissions: closed (15 July 2024) | Viewed by 20689

Special Issue Editors


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Guest Editor
Department of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy
Interests: children; adolescents; cardiovascular risk; overweight and obesity; visceral adiposity; hypertension; dyslipidemia; insulin resistance; uric acid; cytokines
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Guest Editor
ICANS-DIS, Department of Food Environmental and Nutritional Sciences, University of Milan, 20133 Milan, Italy
Interests: body composition; obesity; ketogenic diet; metabolic syndrome; eating behavior; Mediterranean diet
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Obesity is a complex multifactorial disorder resulting from genetic and environmental factors, and in pediatric age, the interaction between these factors is pivotal, and primary prevention becomes of paramount value.

In children and adolescents, family, school, and peers have fundamental influences on the development of lifestyles and nutrition, which are also determined by mass media and commercials. Equally important are economic, social, and cultural factors, and extensive evidence shows that the poorest and most marginalized individuals are at greater risk of obesity. The inability to participate in sports and living outdoors can also promote the onset of excess weight, and data are emerging on the negative role of environmental pollution. Psychological issues, such as emotional deprivation, depression or bullying, may also contribute to inducing or maintaining obesity.

Obesity is a disease in itself, but it is also a risk factor for several diseases, particularly cardiovascular diseases. In excess-weight children and adolescents, high blood pressure, dyslipidemia, and glucose metabolism disorders including type 2 diabetes, hyperuricemia, and nonalcoholic hepatic steatosis are common, and their early occurrence is growing dramatically with the increasing prevalence of overweight and obesity. Moreover, because obese children will often become obese adults, the current epidemic of excess weight among the younger generation could create problems for the maintenance of welfare systems.

This Special Issue of Nutrients aims to collect scientific contributions, in the form of original articles or reviews, to improve understanding of the factors (genetic and environmental, lifestyle, and dietary) associated with the development of obesity in children and adolescents and to understand whether traditional and digital interventions aimed at changing these factors can help to reduce the pediatric obesity epidemic.

Dr. Simonetta Genovesi
Prof. Dr. Simona Bertoli
Guest Editors

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Keywords

  • children
  • obesity
  • lifestyle
  • diet
  • cardiovascular risk

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Published Papers (10 papers)

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Research

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14 pages, 982 KiB  
Article
Development and Validation of a Questionnaire to Measure Adherence to a Mediterranean-Type Diet in Youth
by Yu-Jin Kwon, Young-Hwan Park, Yae-Ji Lee, Li-Rang Lim and Ji-Won Lee
Nutrients 2024, 16(16), 2754; https://doi.org/10.3390/nu16162754 - 18 Aug 2024
Viewed by 850
Abstract
Proper nutrition during childhood is crucial for preventing chronic diseases and ensuring optimal growth. This study aimed to develop and validate the Korean version of the KIDMED (K-KIDMED) questionnaire to accurately measure Mediterranean diet (MD) adherence among Korean children and adolescents. A total [...] Read more.
Proper nutrition during childhood is crucial for preventing chronic diseases and ensuring optimal growth. This study aimed to develop and validate the Korean version of the KIDMED (K-KIDMED) questionnaire to accurately measure Mediterranean diet (MD) adherence among Korean children and adolescents. A total of 226 parents, representing their children and adolescents, completed the K-KIDMED, a 112-item food frequency questionnaire (FFQ), and a 24-h dietary recall method through an anonymous online survey. The K-KIDMED comprised 11 questions, with five excluded from the original scoring as they did not apply to the FFQ. Scores were categorized into three levels of adherence to the MD: low (1 or less), average (2–4), and good (5 or more). The agreement between total MD scores from the Korean version of the Mediterranean diet adherence screener and the FFQ was moderate (intraclass correlation coefficient = 0.455, 95% confidence interval: 0.346, 0.553). Among the 226 children and adolescents, 36.7% had low adherence to the KIDMED, 43.3% had intermediate adherence, and 19.9% had good adherence. Higher K-KIDMED scores were correlated with greater intakes of fiber, vitamin K, vitamin B6, and potassium (all p < 0.05). We developed the K-KIDMED as a valid tool to assess MD adherence in Korean children and adolescents. Full article
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11 pages, 551 KiB  
Article
Effects of New Complementary Feeding Guidelines on Eating Behaviour, Food Consumption and Growth in Colombian Children: 6-Year Follow-Up of a Randomised Controlled Trial
by Gilma Olaya Vega and Mary Fewtrell
Nutrients 2024, 16(14), 2311; https://doi.org/10.3390/nu16142311 - 18 Jul 2024
Viewed by 1058
Abstract
Complementary feeding (CF) may influence later eating behaviour and growth. Our previous Randomised Control Trial (RCT) reported that new CF guidelines (NCFGs) implemented in 6–12-month-old infants in Bogota, Colombia, had positive short-term effects on red meat, vegetable and fruit consumption. Here, we assessed [...] Read more.
Complementary feeding (CF) may influence later eating behaviour and growth. Our previous Randomised Control Trial (RCT) reported that new CF guidelines (NCFGs) implemented in 6–12-month-old infants in Bogota, Colombia, had positive short-term effects on red meat, vegetable and fruit consumption. Here, we assessed the effects of the NCFGs on food consumption, eating behaviour and growth at 6 years of age. Weight and height were measured using 50 children (58.8%) from the cohort. Feeding behaviour was measured using the Child Eating Behaviour Questionnaire (CEBQ) and maternal and child food consumption was measured using a semi-quantitative food frequency questionnaire. The control group (CG) had a significantly higher weekly consumption of chocolate milk drinks (p = 0.05). The mean food responsiveness (FR) score was significantly higher in the CG (p < 0.001). Although HAZ (height for age Z-score) at 6 years of age was significantly higher in the CG (p < 0.02), there was no significant difference between groups in the change in HAZ from 6 months and 12 months to 6 years of age. BMIZ (body mass index Z-score) and % overweight (CG 18.5% versus NCFG 13%) or obese (3.7% versus 0%) were not significantly different between groups. BMIZ was positively predicted by FR (β 0.293; p = 0.014) and negatively predicted by weekly red meat consumption episodes per week at 12 months (β −0.169; p = 0.020). Although there was no direct effect of an intervention on BMIZ at 6 years of age, the results were consistent with an indirect effect via intervention effects on meat consumption at an age of 12 months and FR at 6 years of age. However, further longitudinal studies with a larger sample size are needed. Full article
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16 pages, 562 KiB  
Article
Dietary Quality Evidenced by the Healthy Eating Index and Cardiovascular Disease Risk Factors in Kuwaiti Schoolchildren
by Abdulaziz Kh. Al-Farhan, Lorraine J. Weatherspoon, Karin A. Pfeiffer, Wei Li and Joseph J. Carlson
Nutrients 2024, 16(8), 1243; https://doi.org/10.3390/nu16081243 - 22 Apr 2024
Viewed by 1323
Abstract
Background: Poor dietary quality is associated with adiposity and other risks of cardiovascular disease (CVD) in children. In Kuwait, although children’s food choices are a concern, no studies have evaluated dietary quality relative to the risk of CVD in Kuwaiti schoolchildren. This study [...] Read more.
Background: Poor dietary quality is associated with adiposity and other risks of cardiovascular disease (CVD) in children. In Kuwait, although children’s food choices are a concern, no studies have evaluated dietary quality relative to the risk of CVD in Kuwaiti schoolchildren. This study hypothesized that dietary quality using the Healthy Eating Index (HEI) is associated with CVD risk factors in children and that there are associated sex differences. Objective: Our main objective was to evaluate the dietary quality of schoolchildren and investigate whether poor HEI scores are associated with CVD risk and if there are sex differences. Methods: This was a cross-sectional study of Kuwaiti fifth graders (n = 313; 53% girls; mean age = 10.4 ± 0.4 years) who completed an adapted Block Kids 2004 food frequency questionnaire. Anthropometric, blood pressure, and biochemical data were also measured. HEI-2010 and HEI-2015 scores were calculated. Statistics: A general linear model and logistic regression were applied, controlling for moderate–vigorous physical activity (MVPA) and screen time (ST). Results: The total HEI-2010 and HEI-2015 scores were 58 and 52 points, respectively; a trend analysis indicated that more girls than boys had poor (≤50 points) HEI-2015 scores (p < 0.063). The maximum scores for total vegetables (p < 0.001), dairy (p < 0.034), and fatty acids (p < 0.01) were significantly higher in girls, while the maximum scores for whole grains (p < 0.046) and protein (p < 0.006), but not sodium (p < 0.009), were higher in boys. Obesity was inversely associated with poor total HEI 2010 and HEI 2015 scores (OR: 0.347, 95% CI: 0.234 - 0.516, p < 0.001 and OR: 0.561, 95% CI: 0.391–0.805, p < 0.002, respectively). However, the correlation was lost after adjustment for possible confounding factors. Conclusions: Dietary quality for children overall in this study was low, and there was only a weak association between poor scores and elevated blood pressure and none between scores and obesity. These findings have public health implications and warrant further investigation and attention. Full article
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13 pages, 480 KiB  
Article
Comparison of Performance in the Six-Minute Walk Test (6MWT) between Overweight/Obese and Normal-Weight Children and Association with Haemodynamic Parameters: A Cross-Sectional Study in Four Primary Schools
by Alice Giontella, Angela Tagetti, Sara Bonafini, Denise Marcon, Filippo Cattazzo, Irene Bresadola, Franco Antoniazzi, Rossella Gaudino, Paolo Cavarzere, Martina Montagnana, Angelo Pietrobelli, Claudio Maffeis, Pietro Minuz and Cristiano Fava
Nutrients 2024, 16(3), 356; https://doi.org/10.3390/nu16030356 - 25 Jan 2024
Viewed by 1889
Abstract
Physical activity plays a pivotal role in preventing obesity and cardiovascular risks. The six-minute walk test (6MWT) is a tool to assess functional capacity and predict cardiovascular events. The aim of this cross-sectional study was to compare the performance and haemodynamic parameters before [...] Read more.
Physical activity plays a pivotal role in preventing obesity and cardiovascular risks. The six-minute walk test (6MWT) is a tool to assess functional capacity and predict cardiovascular events. The aim of this cross-sectional study was to compare the performance and haemodynamic parameters before and after a 6MWT between obese/overweight vs. normal-weight children (average age 8.7 ± 0.7 years) participating in a project involving four primary schools in South Verona (Italy). Validated questionnaires for physical activity and diet, as well as blood drops, were collected. Overweight or obese children (OW&OB; n = 100) covered a shorter 6MWT distance compared to normal-weight children (NW, n = 194). At the test’s conclusion, the OW&OB group exhibited a higher Rate Pulse Product (RPP = Systolic Blood Pressure × Heart Rate) as compared to the NW. Body Mass Index, waist-to-height ratio, fat mass by electrical impedance, and trans fatty acids showed direct correlations with pre and post-test haemodynamic parameters, such as RPP, and inverse correlations with oxygen saturation. OW&OB children demonstrated lower performance in this low-intensity exercise test, along with an elevated haemodynamic response. Excess fat in childhood can be considered a risk factor for haemodynamic stress, with potential deleterious consequences later in life. Efforts should be initiated early to break this cycle. Full article
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22 pages, 3537 KiB  
Article
The Connection between Knowledge and the Nutritional Behaviour of Parents and the Occurrence of Overweight and Obesity among Preschool Children—A Pilot Study
by Aleksandra Mazurkiewicz and Ewa Raczkowska
Nutrients 2024, 16(1), 174; https://doi.org/10.3390/nu16010174 - 4 Jan 2024
Cited by 3 | Viewed by 2639
Abstract
The phenomenon of overweight and obesity constitutes a threat for health and children’s lives at preschool age. Eating habits formed during this period seriously affect not only future dietary preferences but also the development of diet-related diseases. The purpose of the present study [...] Read more.
The phenomenon of overweight and obesity constitutes a threat for health and children’s lives at preschool age. Eating habits formed during this period seriously affect not only future dietary preferences but also the development of diet-related diseases. The purpose of the present study was the assessment of the relationship between the state of knowledge of children’s nutrition and parents’ eating behaviour and the prevalence of overweight and obesity in children aged 4–6 years. The study was conducted using 200 parent–child pairs. The behaviour and nutritional knowledge of parents was assessed using a questionnaire method. In contrast, anthropometric measurements were taken among the children. Nutritional disorders were noted in 46.5% of children of whom 39.0% struggled with overweight and 7.5% with obesity. The study showed that the children of parents with higher levels of nutritional knowledge were more likely to develop overweight and obesity. It also proved that irregularity of parental food intake predisposed the development of excessive body weight in children (p = 0.0049). Therefore, it is reasonable to undertake further investigation into factors implying the development of nutritional disorders among those youngest. Early recognition of dietary mistakes can contribute to their elimination at an early age. Full article
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11 pages, 298 KiB  
Article
Bullying Victimization, Real and Perceived Physical Fitness, and Self-Perception Profiles in Middle-School Students with Overweight or Obesity
by Giada Ballarin, Francesca Gallè, Lucia Dinacci, Federica Liberti, Fabrizio Liguori, Maria Cristina Nisco, Antonia Cunti and Giuliana Valerio
Nutrients 2023, 15(24), 5019; https://doi.org/10.3390/nu15245019 - 6 Dec 2023
Cited by 1 | Viewed by 1556
Abstract
Bullying victimization has been associated with body weight and physical fitness. In order to compare the prevalence of victimization among adolescents with normal weight or overweight/obesity and to evaluate the association between real or perceived physical fitness and self-perception profiles, a sample of [...] Read more.
Bullying victimization has been associated with body weight and physical fitness. In order to compare the prevalence of victimization among adolescents with normal weight or overweight/obesity and to evaluate the association between real or perceived physical fitness and self-perception profiles, a sample of 128 middle-school youths (mean age: 12.2 ± 0.8 years, 61% males) was recruited. The body mass index (BMI) Z score was calculated. Physical fitness was assessed by hand grip strength (HGS), long jump (LJ), and a 3 min step test (3MST). Perceived physical fitness, self-perception profiles (social competence, athletic competence, and physical appearance), and experiences of victimization (teasing about physical appearance, verbal offenses, and exclusion from group activities) were explored using validated questionnaires. Eighty youths (62.5%) showed overweight/obesity. Compared to their counterparts, normal-weight subjects showed lower HGS and perceived muscular strength; higher LJ and 3MST performance; higher perceived overall fitness, speed and flexibility, and physical appearance. Teasing and verbal offences were more frequent among students with overweight/obesity. Being teased about physical aspects was positively related with the BMI Z score. Exclusion from groups was positively associated with LJ performance. All the types of victimization investigated were inversely related to perceived social competence. These findings suggest that self-perception may protect one from victimization, regardless of nutritional status. Full article
16 pages, 345 KiB  
Article
Diet and Acanthosis Nigricans over a Two-Year Period in Children of the Pacific Region
by Douglas Taren, Halimatou Alaofè, Ashley B. Yamanaka, Patricia Coleman, Travis Fleming, Tanisha Aflague, Leslie Shallcross, Lynne Wilkens and Rachel Novotny
Nutrients 2023, 15(12), 2718; https://doi.org/10.3390/nu15122718 - 12 Jun 2023
Cited by 1 | Viewed by 1957
Abstract
Background: The impact that dietary carbohydrates have on children developing type 2 diabetes remains controversial. Furthermore, there are limited pediatric longitudinal studies on changes in body mass index (BMI) and diet related to the development of acanthosis nigricans (AN), a risk factor associated [...] Read more.
Background: The impact that dietary carbohydrates have on children developing type 2 diabetes remains controversial. Furthermore, there are limited pediatric longitudinal studies on changes in body mass index (BMI) and diet related to the development of acanthosis nigricans (AN), a risk factor associated with type 2 diabetes. Methods: Two 24 h dietary records were collected for 558 children, 2–8 years of age, at baseline and at a 2-year follow-up. Data on age, sex, BMI, and the presence of AN were also collected at each time point from the Children’s Healthy Living Program. Logistic regression was used to determine factors associated with the presence of AN at follow-up. Multinominal regression was used to determine factors associated with changes in AN status. Linear regression was used to measure the associations between changes in dietary intake and in the Burke Score for AN. Results: AN was present in 28 children at baseline and 34 children at follow-up. Adjusting for the presence of AN at baseline, age, sex, study group, baseline BMI, change in BMI z-score, time between assessments, and baseline intake, an increase from baseline for each teaspoon of sugar and serving of carbohydrate-rich food increased the risk for having AN at follow-up by 9% and 8%, respectively (p ≤ 0.05). An increased intake of added sugar (teaspoons) increased the risk of developing AN by 13% (p ≤ 0.01) and an increase in servings of foods rich in starch increased the risk of developing AN by 12% (p ≤ 0.01) compared to children who never had AN. Increasing the intake of fruit was also associated with decreased Burke Scores using multiple regression. However, the intake of energy and macronutrients were not associated with AN. Conclusions: Added sugar and foods rich in starch were independently associated with the occurrence of AN, suggesting the type of carbohydrates consumed is a factor in AN occurrence. Full article
14 pages, 4234 KiB  
Article
Serum, Urine, and Fecal Metabolome Alterations in the Gut Microbiota in Response to Lifestyle Interventions in Pediatric Obesity: A Non-Randomized Clinical Trial
by Yujin Lee, Joo-Youn Cho and Ky Young Cho
Nutrients 2023, 15(9), 2184; https://doi.org/10.3390/nu15092184 - 4 May 2023
Cited by 3 | Viewed by 2456
Abstract
Pediatric obesity is associated with alterations in the gut microbiota and its metabolites. However, how they influence obesity and the effect of lifestyle interventions remains unknown.. In this non-randomized clinical trial, we analyzed metabolomes and microbial features to understand the associated metabolic pathways [...] Read more.
Pediatric obesity is associated with alterations in the gut microbiota and its metabolites. However, how they influence obesity and the effect of lifestyle interventions remains unknown.. In this non-randomized clinical trial, we analyzed metabolomes and microbial features to understand the associated metabolic pathways and the effect of lifestyle interventions on pediatric obesity. Anthropometric/biochemical data and fasting serum, urine, and fecal samples were collected at baseline and after an eight-week, weight-reduction lifestyle modification program. Post-intervention, children with obesity were classified into responder and non-responder groups based on changes in total body fat. At baseline, serum L-isoleucine and uric acid levels were significantly higher in children with obesity compared with those in normal-weight children and were positively correlated with obesogenic genera. Taurodeoxycholic and tauromuricholic α + β acid levels decreased significantly with obesity and were negatively correlated with obesogenic genera. Branched-chain amino acid and purine metabolisms were distinguished metabolic pathways in the obese group. Post-intervention, urinary myristic acid levels decreased significantly in the responder group, showing a significant positive correlation with Bacteroides. Fatty acid biosynthesis decreased significantly in the responder group. Thus, lifestyle intervention with weight loss is associated with changes in fatty acid biosynthesis, and myristic acid is a possible therapeutic target for pediatric obesity. Full article
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Review

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19 pages, 366 KiB  
Review
Non-Pharmacological Treatment for Cardiovascular Risk Prevention in Children and Adolescents with Obesity
by Simonetta Genovesi, Andrea Vania, Margherita Caroli, Antonina Orlando, Giulia Lieti, Gianfranco Parati and Marco Giussani
Nutrients 2024, 16(15), 2497; https://doi.org/10.3390/nu16152497 - 31 Jul 2024
Viewed by 1384
Abstract
In younger generations, excess weight has reached very alarming levels. Excess weight in adults is associated with increased mortality and morbidity from cardiovascular disease. However, it is not easy to distinguish to what extent these effects are the result of obesity itself or [...] Read more.
In younger generations, excess weight has reached very alarming levels. Excess weight in adults is associated with increased mortality and morbidity from cardiovascular disease. However, it is not easy to distinguish to what extent these effects are the result of obesity itself or how much is due to the various cardiovascular risk factors that often accompany excess weight. Several risk factors, such as hypertension, dyslipidemia, hyperuricemia, glucose intolerance, and type 2 diabetes mellitus, are already present in pediatric age. Therefore, early intervention with the goal of correcting and/or eliminating them is particularly important. In the child and adolescent with obesity, the first approach to achieve weight reduction and correct the risk factors associated with severe excess weight should always be non-pharmacologic and based on changing poor eating habits and unhealthy lifestyles. The purpose of this review is to give an update on non-pharmacological interventions to be implemented for cardiovascular prevention in children and adolescents with obesity, and their effectiveness. In particular, interventions targeting each individual cardiovascular risk factor will be discussed. Full article
14 pages, 1014 KiB  
Review
Food Intake and Sleep Disorders in Children and Adolescents with Obesity
by Valeria Calcaterra, Virginia Rossi, Veronica Maria Tagi, Paola Baldassarre, Roberta Grazi, Silvia Taranto and Gianvincenzo Zuccotti
Nutrients 2023, 15(22), 4736; https://doi.org/10.3390/nu15224736 - 9 Nov 2023
Cited by 6 | Viewed by 4671
Abstract
Over the last few decades, numerous scientific studies have investigated the possible association between sleep duration and adiposity during childhood, since it has been reported that sleep deprivation causes a related increase in caloric intake. Even though the underlying pathogenetic mechanisms are still [...] Read more.
Over the last few decades, numerous scientific studies have investigated the possible association between sleep duration and adiposity during childhood, since it has been reported that sleep deprivation causes a related increase in caloric intake. Even though the underlying pathogenetic mechanisms are still under study and not completely known, the effect of dietetic habits and nutrient intake on sleep quality and patterns has been reported. The aim of this study is to explore the intricate interplay between food intake/diet patterns and pediatric sleep disturbances in children and adolescents with obesity, emphasizing the importance of not underestimating this aspect in the prevention and treatment of this complex disease. Recent evidence supports a high correlation between specific diet patterns and foods with sleep disturbances in children at all ages. Diets rich in fiber, fruit, vegetables, and anti-inflammatory nutrients and low in saturated fats seem to promote better sleep quality. Sleep disturbances are, in turn, risk factors for the development of obesity. Therefore, food strategies should be applied to counteract this harmful process. Unraveling the complex links between dietary habits, sleep patterns, and obesity is essential for developing effective strategies to combat this critical public health issue. Full article
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