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Summary: Background: The prevalence of childhood obesity in the U.S. has increased, likely due to decreased physical activity, increased sedentary behaviour and unhealthy diets. Little is known about the relationships between these factors and weight gain in those under the age of three. Objectives: This study aimed to understand the longitudinal associations of weight gain over 6‐month intervals with child and parent characteristics as children develop from 6 to 36 months. Methods: Mother and infant data were collected at 6‐month intervals from 6 to 36 months. Weight (kg) was the primary outcome variable, and potential explanatory variables included child and parent characteristics, physical activity, motor development, diet and sleep. Structural equation modelling was used to assess associations between explanatory variables and 6‐month weight gain. Results: Weight increased ~1 kg per 6‐month interval (p < 0.001) from 6 to 36 months. Childcare outside of the home at 12 months was associated with 0.272 kg (p = 0.002) greater weight gain at 18 months, while children's physical activity was associated with 0.228 kg (per 2 SD, p = 0.051) less weight gain during the same time period. Mother's TV and screen media use (0.102 kg per hour/day, p = 0.046) and child's intake of high‐energy beverages at 18 months (0.387 kg, p = 0.037) were both associated with greater weight gain at 24 months. Conclusion: Childcare, physical activity, screen media use and high‐energy beverage consumption might affect weight gain at different time points in early childhood. These insights can inform efforts to prevent excessive weight gain and childhood obesity effectively. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Metabolic dysfunction‐associated steatotic liver disease (MASLD) is the most common chronic liver disease among US children. Studies have associated food insecurity with MASLD in adults, but there are few studies of pediatric MASLD, particularly in high‐risk populations. We assessed the impact of household food insecurity at 4 years of age on MASLD in Latinx children. Methods: Using a prospective cohort design, Latina mothers were recruited during pregnancy and followed with their children until early to mid‐childhood. Our primary exposure was household food insecurity at 4 years of age measured using the validated US Household Food Security Food Module. Our primary outcome, MASLD, was defined as alanine transaminase (ALT) ≥95th% for age/gender plus body mass index (BMI) ≥85% at time of ALT measurement (assessed between ages 5–12). We used multivariable logistic regression models to test for independent associations between household food insecurity and pediatric MASLD. Results: Among 136 children, 28.7% reported household food insecurity at 4 years of age and 27.2% had MASLD in early to middle childhood. Approximately 49% of children with MASLD and 21% of children without MASLD were food insecure (p < 0.01). Exposure to household food insecurity at age 4 was independently associated with a 3.7‐fold higher odds of MASLD later in childhood (95% CI: 1.5–9.0, p < 0.01). Conclusions: Exposure to household food insecurity at 4 years of age was associated with increased risk for MASLD later in childhood. Further studies are needed to explore mechanism(s) and impact of reducing food insecurity on risk for MASLD. [ABSTRACT FROM AUTHOR]

Summary: Objective: Rising prevalence of obesity has led to increased rates of prediabetes and diabetes mellitus (DM) in children. This study compares rates of prediabetes and diabetes using two recommended screening tests (fasting plasma glucose [FPG] and haemoglobin A1c [HbA1c]). Study Design: Data were collected prospectively from 37 multi‐component paediatric weight management programs in POWER (Paediatric Obesity Weight Evaluation Registry). Results: For this study, 3962 children with obesity without a known diagnosis of DM at presentation and for whom concurrent measurement of FPG and HbA1c were available were evaluated (median age 12.0 years [interquartile range, IQR 9.8, 14.6]; 48% males; median body mass index 95th percentile [%BMIp95] 134% [IQR 120, 151]). Notably, 10.7% had prediabetes based on FPG criteria (100–125 mg/dL), 18.6% had prediabetes based on HbA1c criteria (5.7%–6.4%), 0.9% had DM by FPG abnormality (≥126 mg/dL) and 1.1% had DM by HbA1c abnormality (≥6.5%). Discordance between the tests was observed for youth in both age groups (10–18 years [n = 2915] and age 2–9 years [n = 1047]). Conclusion: There is discordance between FPG and HbA1c for the diagnosis of prediabetes and DM in youth with obesity. Further studies are needed to understand the predictive capability of these tests for development of DM (in those diagnosed with prediabetes) and cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Summary: Background: Leptin resistance occurs with obesity, but it is unknown if individuals at risk for obesity develop leptin resistance prior to obesity. Objective: Investigate whether leptin resistance is independent of weight status in children at risk for obesity due to intrauterine exposure to maternal obesity or gestational diabetes mellitus (GDM). Methods: Mother–child dyads (N = 179) were grouped by maternal pregnancy weight and GDM status: (1) normal weight, no GDM; (2) overweight/obesity, no GDM; (3) overweight/obesity with GDM. Children (4–10 years) were further stratified by current body mass index (BMI) <85th or ≥85th percentile. Leptin resistance of children and mothers was calculated as fasting leptin/fat mass index. Two‐way ANOVA was used to assess whether leptin concentrations and leptin resistance differed by current weight status or in utero exposure group, after adjusting for race, sex and Tanner stage. Results: Children with a BMI ≥85th percentile had more leptin resistance than those with a BMI <85th percentile (p < 0.001), but leptin resistance did not differ by in utero exposure. Similarly, leptin resistance in women was associated with weight status and not prior GDM. Conclusions: Results suggest that leptin concentrations are associated with obesity but not risk for obesity based on in utero exposure to maternal obesity or GDM. [ABSTRACT FROM AUTHOR]

Summary: Background: Time spent on screens and adiposity change rapidly from childhood to adolescence, with differences by gender and race/ethnicity. Objective: Apply time‐varying effect models (TVEMs) to a nationally representative sample of youth to identify the age ranges when the cross‐sectional associations between television viewing, computer use, and adiposity are significant. Methods: Data from 8 to 15‐year‐olds (n = 3593) from the National Health and Nutrition Examination Survey (2011–2018) were extracted. TVEMs estimated the associations between television viewing, computer use, and fat mass index as dynamic functions of the participants' age, stratified by gender and race/ethnicity. Results: TVEMs revealed age‐specific statistically significant associations that differed by gender and race/ethnicity. Notably, computer use was related to higher adiposity in non‐Hispanic White females aged 9.3–11.4 years (slope β‐range: 0.1–0.2) and in non‐Hispanic Black females older than 14.8 years (β‐range: 0.1–0.5). In males, these age windows were 13.5–15.0 years (non‐Hispanic White, β‐range: 0.1–0.2), 11.4–13.0 years (non‐Hispanic Black, β‐range: 0.1–0.14), and older than 13.0 years (Hispanic, β‐range: 0.1–0.4). Conclusions: More research during the specific age ranges in the demographic subgroups identified here could increase our understanding of tailored interventions in youth. [ABSTRACT FROM AUTHOR]

Summary: Background: Child health experts raise numerous concerns about the negative effects of children's exposure to unhealthy digital food marketing, including advertising and branded product placements on child‐oriented videos. Objectives: YouTube banned food advertising on "made‐for‐kids" channels in 2020, but research is needed to assess food‐related appearances on increasingly popular child‐influencer videos. Methods: Content analysis examined a sample of videos (n = 400) uploaded in 2019–2020 by popular child‐influencers on YouTube "made‐for‐kids" channels. We identified and coded all branded and non‐branded food‐related appearances (i.e., food, beverages, restaurants), ads, promotions, and sponsorship disclosures, and compared 2019 to 2020. Results: Two‐thirds of videos (n = 260) had at least one food‐related appearance, including branded product appearances (n = 153), other brand appearances (n = 60), and non‐branded food‐related appearances (n = 203). Branded products appeared 592 times (M = 3.9/video), including candy brands (42% of appearances) and sweet/salty snacks, sugary drinks, and ice cream (32% combined). Total food‐related appearances did not change (2019–2020), but candy brand appearances increased significantly. Videos with non‐branded healthy food category appearances also increased, but 70% also showed unhealthy branded and/or unbranded foods. Just one video disclosed a food‐brand sponsorship. Conclusions: Additional policies are needed to protect young children from potential exposure to unhealthy branded foods on popular YouTube child‐influencer channels. [ABSTRACT FROM AUTHOR]

Summary: Background: Gestational weight gain (GWG) and anthropometric trajectories may affect foetal programming and are potentially modifiable. Objectives: To assess concomitant patterns of change in weight, circumferences and adiposity across gestation as an integrated prenatal exposure, and determine how they relate to neonatal body composition. Methods: Data are from a prospective cohort of singleton pregnancies (n = 2182) enrolled in United States perinatal centres, 2009–2013. Overall and by prepregnancy BMI group (overweight/obesity and healthy weight), joint latent trajectory models were fit with prenatal weight, mid‐upper arm circumference (MUAC), triceps (TSF) and subscapular (SSF) skinfolds. Differences in neonatal body composition by trajectory class were assessed via weighted least squares. Results: Six trajectory patterns reflecting co‐occurring changes in weight and MUAC, SSF and TSF across pregnancy were identified overall and by body mass index (BMI) group. Among people with a healthy weight BMI, some differences were observed for neonatal subcutaneous adipose tissue, and among individuals with overweight/obesity some differences in neonatal lean mass were found. Neonatal adiposity measures were higher among infants born to individuals with prepregnancy overweight/obesity. Conclusions: Six integrated trajectory patterns of prenatal weight, subcutaneous adipose tissue and circumferences were observed that were minimally associated with neonatal body composition, suggesting a stronger influence of prepregnancy BMI. [ABSTRACT FROM AUTHOR]

Summary: Background: Impulsivity and reward sensitivity are personality traits associated with obesity and binge‐eating disorder (BED), but little research has examined prospective associations between these traits and body mass index z‐score (BMI‐z) differentially for children with and without BED. Objective: Using data from the Adolescent Brain and Cognitive Development study, the present analysis examined predictive associations between impulsivity and reward sensitivity facets with BMI‐z 1 year later in children with versus without BED. Methods: Nine‐to‐ten‐year‐old children were recruited across the United States and completed self‐report questionnaires and clinical interviews at baseline, and height and weight were taken at baseline and 1‐year follow‐up. Multivariable models were run with baseline impulsivity and reward sensitivity facets predicting 1‐year BMI‐z in children with versus without BED. Results: Reward sensitivity and impulsivity were unrelated to BMI‐z at follow‐up in children without BED. Greater negative urgency (i.e., proclivity to act rashly without forethought in response to negative emotions) and lower positive urgency (i.e., proclivity to act rashly without forethought due to positive emotions) predicted increased BMI‐z at 1‐year follow‐up in children with BED subsample. Conclusions: Findings indicate the importance of developing theoretical models and interventions for obesity prevention in children with BED that address emotional impulsivity. [ABSTRACT FROM AUTHOR]

Summary: Background: Paediatric overweight and obesity (OW/OB) constitute a serious public health concern. Given that psychological problems may be key contributors to the onset and maintenance of paediatric obesity, the present study examined past and current psychiatric comorbidities across the weight spectrum during middle childhood among a nationally representative sample. Methods: Participants were 11 708 9‐ to 10‐year‐old children (31.6% with OW/OB) and their caregivers who participated in the first wave of data collection in the Adolescent Brain Cognitive Development (ABCD) study. Logistic regressions were used to examine the association between weight status (i.e., underweight, healthy weight, OW, OB) and likelihood of current/past psychiatric diagnoses. Results: Compared to healthy weight children, those with OW/OB were more likely to have current/past major depressive disorder and binge eating disorder. Relative to healthy weight children, those with OB were more likely to have prior separation anxiety disorder, current specific phobia and oppositional defiant disorder; those with OW were more likely to have PTSD; and those with underweight were more likely to have ADHD. Conclusions: Results suggest cross‐sectional associations among negative emotionality, binge eating, and OW/OB, and highlight the need for ongoing prospective research to investigate directionality of associations and mechanisms of effects. [ABSTRACT FROM AUTHOR]

Summary: Objective: To describe characteristics of paediatric weight management (PWM) programs across the United States and evaluate associations with program‐specific retention rates and body mass index (BMI) outcomes at 6 months. Methods: A program profile survey was administered to 33 programs within the Paediatric Obesity Weight Evaluation Registry (POWER) to assess program staffing, services, and treatment format. Patient retention and percent of the 95th BMI percentile (%BMIp95) changes were assessed for each program. Results: At 6 months program retention rates ranged from 15% to 74% (median: 41%), and program %BMIp95 changes ranged from −9.0 to +0.5 percentage points (median: −1.7). Percent of patients with ≥5 percentage‐point decrease in %BMIp95 ranged from 17% to 71% across programs (median: 29%). No associations were detected between program characteristics and retention or %BMIp95 changes. Conclusions: Six‐month patient retention and BMI outcomes vary substantially in PWM programs across the United States. Yet, no associations were found between PWM treatment factors and these program‐level patient outcomes. [ABSTRACT FROM AUTHOR]

Summary: Background: In the United States, the underlying reasons for racial/ethnic disparities in type 2 diabetes risk remain unclear. However, differences in genetic risk for insulin resistance and peripheral adipose tissue distribution may be contributing factors. Objective: To investigate racial/ethnic differences in associations of genetic risk for insulin resistance with leg fat and insulin sensitivity in a cohort of American children. Methods: Participants were healthy European–American (n = 83), African–American (n = 79) and Hispanic–American (n = 74) children aged 7–12 years. Genetic risk scores were derived from published variants associated with insulin resistance phenotypes in European adults. Body composition was assessed using dual‐energy X‐ray absorptiometry. Insulin sensitivity was determined from the frequently sampled intravenous glucose tolerance test and minimal modelling. Statistical models were adjusted for age, sex, pubertal stage and body composition. Results: In the combined cohort, risk score was inversely associated with insulin sensitivity (p = 0.033) but not leg fat (p = 0.170). Within Hispanic Americans, risk score was inversely associated with insulin sensitivity (p = 0.027) and leg fat (p = 0.005), while associations were non‐significant in European and African Americans (p > 0.200). Conclusions: The higher type 2 diabetes risk observed among Hispanic Americans may have a genetic basis related to an inability to store lipid in peripheral adipose tissue. [ABSTRACT FROM AUTHOR]

Summary: Background: Children's fast‐food consumption increases risks for obesity and other diet‐related diseases. To address concerns, from 2010 to 2016 U.S. fast‐food restaurants implemented voluntary policies to offer healthier drinks and/or sides with kids' meals. Objectives: Examine the effectiveness of voluntary kids' meal policies. Methods: Online repeated cross‐sectional survey (2010, 2013, 2016) of U.S. caregivers (N = 2093) who purchased fast‐food for their child (2‐11 years) in the past week. Logistic regression examined associations between healthier kids' meal policy implementation and caregivers' purchases of kids' meals and selection of healthier sides and drinks. Separate models investigated caregivers' attitudes about McDonald's kids' meal items. Results: Overall, 55% of caregivers reported choosing a kids' meal for their child, and approximately one‐half of those caregivers selected a healthier drink and/or side. Healthier kids' meal policy implementation was associated with increased selection of healthier sides, but not healthier drinks or choice of kids' meals over higher‐calorie menu items. Child's age, caregiver gender and visit frequency were significant in most models. Caregivers' perceptions that their child(ren) like healthier drinks and sides were positively associated with selection of those items. Conclusions: Existing healthier kids' meal policies may not improve children's fast‐food consumption. Public health initiatives should examine more effective alternatives. [ABSTRACT FROM AUTHOR]

Summary: Background: There is concern regarding how the COVID‐19 pandemic may impact the psychological and physical health of children, but to date, studies on mental health during the pandemic in children are limited. Furthermore, unprecedented lifestyle stressors associated with the pandemic may aggravate the childhood obesity epidemic, but the role of BMI on child activity levels and psychological outcomes during COVID‐19 is unknown. Objectives: We investigated how emotional responses (positive/negative affect), physical activity (PA) and sedentary behaviours related to anxiety among U.S. children with healthy weight and overweight/obesity during the pandemic. Methods: Sixty‐four typically developing children (63% girls, 53% healthy weight) aged 9 to 15 years completed two virtual visits during the height of 'stay‐at‐home' measures from April 22 to July 29, 2020. Children completed 24‐hours PA recalls, state portion of State‐Trait Anxiety Inventory for Children and the 10‐item Positive and Negative Affect Schedule for Children. Results: Independent of child BMI status, child anxiety scores were over five standard deviations greater than normative values from paediatric populations prior to the pandemic. Higher positive affect and PA were each associated with reduced anxiety levels in children with overweight/obesity, whereas higher positive affect was associated with reduced anxiety in children with healthy weight. Greater leisure screen time was associated with higher negative affect irrespective of child BMI status. Conclusions: These associations highlight the potential mental health benefits of maintaining positive affect, engaging in PA and limiting leisure screen time for children during the pandemic and suggest that these associations may be particularly relevant for children with overweight/obesity. [ABSTRACT FROM AUTHOR]

Summary: Background: There are concerns that fruit juice and milk contribute to childhood obesity. Objective: Determine the relationship between fruit juice and milk intakes and body mass index (BMI) change among preadolescents/adolescents. Methods: Participants aged 9 to 16 years old from the Growing Up Today Study II completed surveys including validated food frequency questionnaires in 2004, 2006 and 2008. The contributions of one serving of juice or milk to total energy intake and 2‐year change in BMI were evaluated using multiple linear regression. Additional analyses were conducted with subgroups of juice (orange juice and other fruit juice) and milk (low fat and high fat). Missing values for BMI were imputed using a multiple imputation approach, after which data from 8173 participants and 13 717 2‐year interval observations were analysed. Results: Baseline fruit juice consumption was inversely associated with BMI change in girls (β = −.102 kg/m2, SE = 0.038, P value =.008) but not boys after controlling for race, age, baseline BMI, and baseline and 2‐year changes in total energy intake and physical activity. Orange juice was inversely associated with BMI change among girls (β = −.137 kg/m2, SE = 0.053, P value =.010) while other fruit juice, low fat and high fat milk were not associated with BMI change. Conclusion: Orange juice was inversely associated with 2‐year BMI change among preadolescent/adolescent girls but not boys and there were no significant associations with other juices or milk among either gender. [ABSTRACT FROM AUTHOR]

Summary: Background: DXA is a widely used technique to assess body composition. Reference values based on a large general population cohort of European children and adolescents were missing. The aim of this study was to provide age‐ and sex‐specific reference percentiles of body composition parameters for European children and adolescents and to compare them to the American NHANES cohort. Additionally, exponents accounting best for height biases were analysed. Methods: DXA scans of 1573 participants, aged 6 to 18 years, recruited from 2011 to 2019 by the Austrian LEAD study, a representative population‐based cohort, have been used to create reference charts using the LMS model. Results: Reference charts displaying percentile curves and the corresponding reference values are provided. Fat mass parameters were higher in females, while lean mass parameters were higher in males. Compared to the NHANES cohort medians of FMI and LMI were always lower. For FMI, BMI, LMI and ALMI the best fitting exponent were 2.5, 3, 3 and 3.5 respectively Conclusions: The present study provides reference charts for children and adolescents aged 6 to 18 years, for body composition parameters assessed by DXA. The charts enable comparison to a European general‐population cohort and indicate that reference populations should be chosen with caution. [ABSTRACT FROM AUTHOR]

Summary: Background: Within the context of high childhood obesity prevalence, there is a concern that community efforts intended to reduce childhood obesity may lead to unintended adverse outcomes. Objective: This analysis examined relationships between community programs, policies, and environmental changes (CPPs) for obesity prevention with unhealthy dieting behaviours and body weight satisfaction in children. Methods: Using the Healthy Communities Study 2013 to 2015 survey sample of 5138 US children aged 4 to 15 years old, multilevel models examined associations between standardized CPP intensity scores and child dieting behaviours and weight satisfaction, adjusting for community and child‐level covariates and clustered study design. Results: In fully adjusted models, higher total, physical activity, and nutrition CPP intensity scores were associated with lower odds of dissatisfaction with weight (1 year total CPP odds ratio [OR]: 0.41, 95% confidence interval [CI], 0.22‐0.73; 6 year total CPP OR: 0.48, 0.29‐0.80). Higher physical activity CPP intensity over the past year was associated with greater odds of weight satisfaction (OR: 1.77, 95% CI, 1.10‐2.84). No associations were observed with dieting behaviours. Conclusions: Results suggest that community efforts focusing on nutrition and physical activity to prevent childhood obesity may be associated with weight satisfaction and not with unhealthy dieting behaviours. [ABSTRACT FROM AUTHOR]

Summary: Background: Community initiatives to promote physical activity in children are common, but evidence supporting their effectiveness is limited. Objectives: The objective of this study is to examine the relationships between community programmes and policies and children's physical activity in a large and diverse sample of US communities. Methods: Programmes and policies to promote children's physical activity were assessed in 130 communities by key informant interviews, and physical activity behaviours were measured by self‐report and parental report in samples of children in each community (total n = 5138). Associations between composite indices of community programmes and policies and indicators of total and moderate‐to‐vigorous physical activity were examined without and with adjustment for demographic factors. Results: An index reflecting the 6‐year history of the number of behaviour change strategies used in community programmes and policies was positively associated with children's moderate‐to‐vigorous physical activity. This association was attenuated with adjustment for demographic factors. Effect modification analyses found that the association was positive among non‐Hispanic children but was negative for Hispanic children. Conclusions: Community initiatives to promote physical activity in children were positively associated with children's physical activity in non‐Hispanic children. Such initiatives were negatively associated with physical activity in Hispanic children, suggesting that future research should consider unique cultural factors when designing community initiatives to promote activity in this population sub‐group. What is already known about this subject? Most children and youth in the USA do not meet current physical activity guidelines.Children's physical activity levels vary across gender and race/ethnicity groups, and they also vary across school and community groups.Previous community interventions to increase children's physical activity have yielded modest and inconsistent outcomes. What this study adds? An index that is reflective of community programmes and policies aimed at increasing physical activity was found to be positively related to children's physical activity but only in non‐Hispanic children.This study shows that community initiatives to promote children's physical activity operate inconsistently across ethnicity groups.Research is needed to identify community programmes and policies that positively influence physical activity in Hispanic children. This article is part of the supplement: The Healthy Communities Study: Examining Community Programs, Policies and Other Characteristics in Relation to Child Weight, Diet, and Physical Activity [ABSTRACT FROM AUTHOR]

Summary: Background: Physical activity helps prevent excessive weight gain in youth. Few studies have examined regional variations in common activities, walking and bicycling. Objective: The primary aim was to examine participation in previous 7‐day walking/bicycling for active transport and for fun/exercise by region, gender and age groups. Methods: Children (n = 2693) from 130 diverse, geographically distributed US communities reported participation in previous 7‐day walking/bicycling. Mixed model ANOVAs were used to compare walking/bicycling by region, gender and age groups using Healthy Communities Study data. Results: Walking/bicycling for fun/exercise was higher in the Midwest, South and West compared with the Northeast, with the same regional patterns for boys, girls and 9–11‐year olds. Walking/bicycling to non‐school destinations was higher in the Midwest compared with the South and Northeast, with the same pattern for girls and 9–11‐year olds. Walking/bicycling to school was higher Midwest, Northeast and West compared with the South, with similar patterns for girls and 12–15‐year olds. Conclusions: Walking/bicycling for fun/exercise and to non‐school destinations had higher prevalence than active transport to school. The Northeast reported lower walking/bicycling for fun/exercise; the South and Northeast reported lower walking/bicycling to non‐school destinations. Program/policy initiatives should consider contextual demographic influences, as well as purpose/destination of walking/bicycling. What is known: Children and adolescents are less active than recommended.In the USA, regional disparities exist in obesity and physical activity.Walking and bicycling for recreation and for active transport have potential for positive public health impact. What this study adds: There is regional variation in the prevalence of walking and bicycling to school and other destinations and for fun or exercise.Walking and bicycling to school settings was less prevalent than walking and bicycling to other settings and for fun or exercise.Based on regional gender and age patterns, there appears to be more complexity in factors influencing active transport than recreational walking or bicycling. This article is part of the supplement: The Healthy Communities Study: Examining Community Programs, Policies and Other Characteristics in Relation to Child Weight, Diet, and Physical Activity [ABSTRACT FROM AUTHOR]

Summary: Background: Sugars and their primary dietary sources (milk, fruits, sweetened foods and beverages) are associated, in different ways, with a range of health outcomes, including obesity. The contribution made to total sugar intake and how the different types and forms of sugar associate with body weight is unclear. Objective: To describe sugar consumption and examine its association with weight status among U.S. children by sugar type [added {AS} vs. naturally occurring {NOS}] and form (solid vs. liquid). Design: Cross‐sectional dietary data (2 24‐h recalls) from children 2–19 years in the National Health and Nutrition Examination Survey, 2009–2014 (n = 8136) were used to estimate the amount of each type and form of sugar by age and weight status. Linear regression models tested trends and the multivariate adjusted association between the different sugars and weight status. Results: Mean total sugar, AS, and NOS was 118.1 g [25.3% total energy {TE}], 71.5 g (14.8% TE), 46.7 g (10.5% TE), respectively. AS in sugar‐sweetened (non‐dairy) beverages and NOS in juices contributed 6.9% and 2.4% of TE, respectively. Only %TE from AS (controlled for potential demographic, lifestyle confounders) was associated with change in body mass index z‐score (BMIz) [AS in beverages: BMIz β + 0.01 {95% CI: 0.002, 0.03}; AS in foods: BMIz β − 0.03 {95% CI: −0.04, −0.02}]. Conclusion: Dietary sugars, most of which are AS, are a major contributor of calories in the diets of U.S. children. Only AS in non‐dairy sources were associated with weight although the direction differed by the form consumed. AS in beverages were associated positively and those in foods were associated inversely with children's weight status. [ABSTRACT FROM AUTHOR]

Summary: Background: Intakes of dietary sugars is a global concern, and many national and international organizations have set targets to limit consumption. However, it is unclear to what extent intakes of total and added sugars vary between geographies. Objectives: The aim of this study was to assess the differences in intakes of total and added sugars in 4 to 13‐year‐old children in China, Mexico and the United States. The secondary aim was to identify main sources of total and added sugars in the diets of these children. Methods: Secondary data analysis was conducted using the 2011 China Health and Nutrition Survey, 2012 Mexican National Health and Nutrition Survey, and 2009–2012 US National Health and Nutrition Examination Surveys. Total and added sugar intakes were calculated using the US Food Patterns Equivalents Database. Results: Mean intakes of total and added sugars were 26 and 9 g d−1 among Chinese children, 92 and 55 g d−1 among Mexican children, and 124 and 76 g d−1 among US children, respectively. The top food sources of total sugars were fruits among Chinese children, and sugar‐sweetened beverages and milk‐based beverages among Mexican and US children. Conclusions: These data highlight the heterogeneity of food patterns worldwide and the need for adapted country‐specific public health recommendations on sugars. [ABSTRACT FROM AUTHOR]

Summary: Background: Previous studies have indicated that snacking is contributing to increased calorie intake of American children and that the energy density of snacks in US diets has increased in recent decades. Objective: Examine short‐term and long‐term trends in the energy density and food sources of snacks for US children from 1977 to 2014, and examine whether trends differ between socio‐demographic groups. Methods: We used data collected from eight nationally representative surveys of food intake in 49,952 US children age 2–18 years, between 1977 and 2014. Overall patterns of snacking, trends in energy intake from snacking, trends in food and beverage sources and energy density of snacks across race‐ethnic, age, gender, education and income groups were examined. Results: In all socio‐demographic groups, there was a significant increase in per capita energy intake deriving from snacks from 1977 to 2014 (P < 0.01). Salty snack intake doubled over the study period, and sugar‐sweetened beverage intake decreased overall from 1977 to 2014 but increased in Non‐Hispanic Blacks. Non‐Hispanic Blacks had the largest increase in per capita intake from foods as a snack from 1977 to 2014. Children in the lowest poverty level and household education groups had more than 100% increase in calorie intake from snacks from 1977 to 2014. Conclusions: We found that snacking behaviour in the USA differs between race‐ethnic, household education, gender and income groups, yet snacking remains a significant component of children's diets and the foods consumed at these snacks are not the types of foods recommended by the US dietary guidelines. [ABSTRACT FROM AUTHOR]

Objectives Childhood obesity is a risk factor for non-alcoholic fatty liver disease and poses important public health issues for children. Racial differences in alanine aminotransferase (ALT) levels among children have not been described. This study aimed to identify racial differences in upper limit normal (ULN) ALT levels and evaluate the effect of obesity on elevated levels in children without other metabolic risk factors. Methods National Health and Nutrition Examination Surveys and clinical data from the Loyola University Health System were used to determine ULN ALT by race and gender. Quantile regression was used to evaluate the impact of obesity on elevated ALT and to identify potential risk factors for ALT above the ULN. Results Upper limit normal (ULN) ALT was approximately 28.0 and 21.0-24.0 U/L for boys and girls, respectively. No significant difference in ULN ALT across race was observed. Obesity was significantly associated with elevated ALT; obese children with elevated ALT had values 10 U/L higher than normal-weight children. Conclusions Racial differences in ALT levels among adults are not evident in children. Obesity, in the absence of metabolic risk factors and other causes of liver disease, is associated with elevated ALT, providing evidence against the concept of healthy obesity in children. [ABSTRACT FROM AUTHOR]

Summary: Background: Maternal symptoms of depression are related to suboptimal parenting practices and child well‐being; women with elevated symptoms tend to be less responsive to their children. Objective: The objective is to explore how maternal depressive symptomatology is related to childhood obesity‐promoting parenting behaviours, and whether depressive symptomatology moderates the association between perceived child negativity and the use of food to soothe among low‐income mothers. Methods: There is a cross‐sectional sample of 60 mothers and their formula fed infants/toddlers participating in the Special Supplemental Woman, Infants and Children Program. Measures included the Infant Behaviors Questionnaire, Baby's Basic Needs Questionnaire, the feeding problem assessment form and Center for Epidemiological Studies Depression Scale. Results: Depressive symptoms exceeded the clinical screening cut‐off for 38% of women. Mothers with depressive symptoms perceived their child to be more negative and were more likely to use food to soothe, add cereal to the bottle and put baby to bed with bottle than mothers without depressive symptoms. Generalized linear models revealed that child negativity was associated with greater use of food to soothe but that this effect was moderated by maternal depression: negativity was positively associated with food to soothe among non‐depressed but not depressed mothers. Conclusions: A high proportion of low‐income mothers reported elevated depressive symptoms; depressive symptomatology was positively associated with perceived child negativity and greater reported use of controlling feeding practices. Screening for maternal depressive symptoms may help in providing more individually tailored counselling on responsive feeding. [ABSTRACT FROM AUTHOR]

Summary: Background: Insufficient information is available on the relationship between obesity and outcome of paediatric patients with acute pancreatitis. Objectives: This study aimed to investigate the effect of obesity on outcomes of paediatric patients with acute pancreatitis based on a national administrative database. Methods: A total of 500 cases in 416 paediatric patients with acute pancreatitis (aged 5–17 years) were referred from 260 hospitals between 2010 and 2012 in Japan. Patients were divided into two groups according to the presence of obesity: with obesity (n = 65) and without obesity (n = 435). Patient data were collected from the administrative database to compare the prevalence of severe acute pancreatitis, in‐hospital mortality, length of stay (LOS) and medical costs between the groups. Results: Both prevalence of severe acute pancreatitis and in‐hospital mortality were significantly higher in paediatric patients with obesity than those without (36.9% vs. 16.3% and 3.1% vs. 0.0%; P < 0.001, respectively). Longer LOS and higher medical costs were also observed in paediatric patients with obesity (25.7 vs. 15.2 days, P < 0.001 and 14 169.5 vs. 7457.7 US dollars, P < 0.001, respectively). Conclusion: This study demonstrated that obesity significantly influenced the outcomes of paediatric acute pancreatitis. [ABSTRACT FROM AUTHOR]

Summary: Background: There is limited research describing associations between food insecurity and dietary intake. Objective: To examine differences in dietary intake by food security status among a nationally representative sample of children and adolescents in the USA. Methods: The sample included 5136 children, ages 2–15 years, from the National Nutrition and Health Examination Survey, 2007–2010. Propensity score weighting was used to improve covariate balance between food‐secure and food‐insecure (marginal, low or very low food security) participants. Multivariate measurement error models were used to model usual intake of various dietary components and assess differences by food security status. Results: Initial analyses using multivariate measurement error models determined there were no differences between food‐insecure and food‐secure children across several dietary components. In sensitivity analyses, children experiencing very low food security consumed fewer whole grains and more solid fats and added sugars compared with their food‐secure counterparts. Some of these differences were attenuated after propensity score weighting, although intake of whole grains and added sugars remained significantly different. Conclusions: Food insecurity was largely not associated with dietary intake among 2–15‐year‐old US children, although some differences were observed comparing food‐secure children to those experiencing very low food security. [ABSTRACT FROM AUTHOR]

Summary: Background: Obesity in childhood is related to multiple lifestyle factors. Our objective was to evaluate the relationship between consumption of 100% fruit juice and weight status over time among pre‐school children. Methods: We used linear and logistic multivariable regression to evaluate body mass index (BMI) z‐score and overweight/obese status as a function of 100% fruit juice intake for 8950 children examined at ages 2, 4 and 5 years as part of the Early Childhood Longitudinal Study–Birth Cohort, a representative sample of the United States. Results: Cross‐sectional analysis at ages 4 and 5 years showed no difference in the prevalence of overweight and obesity between consistent juice drinkers and inconsistent/non‐drinkers. Longitudinal analysis found that children who drank 100% juice consistently at age 2 years had greater increases in BMI z‐score by age 4 years than infrequent/non‐drinkers (P < 0.0001), a difference driven by lesser increases in height z‐score (P = 0.0003) and slightly greater increases in weight z‐score (P = 0.0550) among consistent juice drinkers over the 2 to 4 year time period. Additionally, consistent juice drinkers at age 2 had higher odds of becoming overweight by age 4 (adjusted odds ratio 1.30; CI 1.06–1.60). These differences in growth parameters were not noted between ages 4 and 5 years. Conclusions: Drinking 100% fruit juice regularly at age 2 is associated with higher odds of becoming overweight between 2 and 4 years. Paediatricians and parents can discourage excessive fruit juice consumption as part of a larger effort to avoid unhealthy gain in BMI in young children. [ABSTRACT FROM AUTHOR]

What is already known about this subject It is often not feasible to measure percent body fat using precise methods such as dual-emission X-ray absorptiometry ( DXA)., Equations developed to estimate percent body fat in youth using measures that are feasible to collect in a variety of settings usually have been developed in focused samples and therefore have low generalizability., What this study adds First equations developed in a representative sample of American youth that estimate percent body fat using self-reported demographic variables as well as measured skin-folds and other anthropometric variables that are feasible to collect in a variety of settings., Equations were demonstrated to have low levels of bias by BMI category and by race/ethnicity in non- Hispanic Whites, Mexican- Americans and African- Americans., Background Percent body fat equations are usually developed in specific populations and have low generalizability. Objectives To use a nationally representative sample of the American youth population (8-17 years old) from the 1999-2004 National Health and Nutrition Examination Survey data to develop gender-specific percent body fat equations. Methods Percent body fat equations were developed for girls and boys using information on weight, height, waist circumference, triceps skin-folds, age, race/ethnicity and menses status compared to dual-emission X-ray absorptiometry. Terms were selected using forward and backward selection in regression models in a 2/3 development sample and were cross-validated in the remaining sample. Final coefficients were estimated in the full sample. Results Final equations included ten terms in girls and eight terms in boys including interactions with age and race/ethnicity. In the cross-validation sample, the adjusted R2 was 0.818 and the root mean squared error was 2.758 in girls. Comparable estimates in boys were 0.893 and 2.525. Systematic bias was not detected in the estimates by race/ethnicity or by body mass index categories. Conclusion Gender-specific percent body fat equations were developed in youth with a strong potential for generalizability and utilization by other investigators studying adiposity-related issues in youth. [ABSTRACT FROM AUTHOR]

What is already known about this subject The prevalence of obesity in the United States has increased dramatically over the past three decades., There is a growing spectrum of severe obesity among children and adolescents., Obesity trends and race/ethnic differences may be evident at a young age., What this study adds Among children aged 3-5 years, the prevalence of obesity and severe obesity was higher in boys than in girls, and highest among children of Hispanic ethnicity., Within this young age group, higher body mass index (BMI) was associated with greater height percentile., Among obese children aged 5 years, provider recognition of obesity or elevated BMI was high, approaching 80% of children., Background Early childhood adiposity may have significant later health effects. This study examines the prevalence and recognition of obesity and severe obesity among preschool-aged children. Methods The electronic medical record was used to examine body mass index ( BMI), height, sex and race/ethnicity in 42 559 children aged 3-5 years between 2007 and 2010. Normal or underweight ( BMI < 85th percentile); overweight ( BMI 85th-94th percentile); obesity ( BMI ≥ 95th percentile); and severe obesity ( BMI ≥ 1.2 × 95th percentile) were classified using the 2000 Centers for Disease Control and Prevention growth charts. Provider recognition of elevated BMI was examined for obese children aged 5 years. Results Among 42 559 children, 12.4% of boys and 10.0% of girls had BMI ≥ 95th percentile. The prevalence was highest among Hispanics (18.2% boys, 15.2% girls), followed by blacks (12.4% boys, 12.7% girls). A positive trend existed between increasing BMI category and median height percentile, with obesity rates highest in the highest height quintile. The prevalence of severe obesity was 1.6% overall and somewhat higher for boys compared with girls (1.9 vs. 1.4%, P < 0.01). By race/ethnicity, the highest prevalence of severe obesity was seen in Hispanic boys (3.3%). Among those aged 5 years, 77.9% of obese children had provider diagnosis of obesity or elevated BMI, increasing to 89.0% for the subset with severe obesity. Conclusions Obesity and severe obesity are evident as early as age 3-5 years, with race/ethnic trends similar to older children. This study underscores the need for continued recognition and contextualization of early childhood obesity in order to develop effective strategies for early weight management. [ABSTRACT FROM AUTHOR]

What is already known about this subject Many companies have signed voluntary agreements to restrict the marketing of foods high in fat, sugar and salt directly to children., Several nutrient profiling schemes have been proposed for defining products which can be advertised to children., What this study adds Provides evidence that industry-led nutrient profiling schemes are less effective in restricting the advertising of energy-dense foods compared to government-led models., Provides evidence that industry-led nutrient profiling schemes particularly favour the continued advertising of foods high in sugar., Background The food and beverage industry have made voluntary pledges to reduce children's exposure to the marketing of energy-dense foods and beverages, and in 2012 announced the replacement of company-specific nutrient profiling schemes with uniform sets of criteria from 2013 (in the USA) and 2014 (in the European Union [ EU]). Objective To compare the proposed USA and EU nutrient profiling schemes and three government-led schemes, paying particular attention to the differences in sugar criteria. Method Food and beverage products permitted to be advertised in the USA under pre-2013 criteria were examined using five nutrient profiling schemes: the forthcoming USA and EU schemes and three government-approved schemes: the US Interagency Working Group ( IWG) proposals, the United Kingdom Office of Communications ( Of Com) regulations and the Danish Forum co-regulatory Code. Results Under the new USA and EU nutrient profiling schemes, 88 (49%) and 73 (41%) of a total of 178 products would be permitted to be advertised, respectively. The US IWG permitted 25 (14%) products; the Ofcom regulations permitted 65 (37%) and the Danish Code permitted 13 (7%). Conclusion Government-led schemes are significantly more restrictive than industry-led schemes, primarily due to their tougher sugar criteria. The Danish Forum (93%) and USA IWG scheme (86%) are the most restrictive of the five examined. Further harmonization of nutrient profiling schemes is needed to reduce children's exposure to the promotion of energy-dense foods. [ABSTRACT FROM AUTHOR]

Summary: Background: There is cumulative recognition that increases in the dietary share of ultra‐processed foods result in deterioration of the nutritional quality of the overall diet and adverse health outcomes. Objective: The purpose of this study was to assess the consumption of ultra‐processed foods and to examine its association with added sugar content in the diet of US children aged 2 to 19 years. Methods: We classified all food items according to the NOVA food classification system and looked at the consumption of ultra‐processed foods, measured as percentage of total energy intake. We assessed dietary added sugar content by estimating its contribution to total energy intake and the proportion of individuals with diets exceeding the recommended limit of 10% of total energy intake from added sugars. We also examined the proportion of those who surpassed twice that limit. Gaussian and Poisson regressions estimated the association between consumption of ultra‐processed foods and estimates of added sugar content. Results: Ultra‐processed foods contributed to 65% of total energy intake and to 92% of energy from added sugars in the diet of US children. The mean percent energy provided by added sugars in the observed period was 14.3%. Most individuals (70.9%) had diets exceeding the recommended limit of added sugar (<10% of total energy intake), and 18.4% of the population had diets surpassing twice the recommended level (20% of total energy intake). A 5.5% point increase in the dietary share of ultra‐processed foods determined a 1 percentage point increase in the dietary content of added sugars, with stronger adjusted associations among younger children. Conclusions: Public health efforts to reduce added sugars in the diet of US children must put greater emphasis on decreasing the consumption of ultra‐processed foods. [ABSTRACT FROM AUTHOR]

Summary: Background: Effects of food environments (FEs) on childhood obesity are mixed. Objectives: To examine the association of residential FEs with childhood obesity and variation of the association across gender and urbanicity. Methods: We used the US Early Childhood Longitudinal Study—Kindergarten Cohort data, with 9440 kindergarteners followed up from 1998 to 2007. The Dun and Bradstreet commercial datasets in 1998 and 2007 were used to construct 12 FE measures of children, ie, changes in the food outlet mix and density of supermarkets, convenience stores, full‐service restaurants, fast‐food restaurants, retail bakery, dairy‐product stores, health/dietetic food stores, confectionery stores, fruit/vegetable markets, meat/fish markets, and beverage stores. Two‐level mixed‐effect and cluster robust logistic regression models were fitted to examine associations. Results: Decreased exposures to full‐service restaurants, retail bakeries, fruit/vegetable markets, and beverage stores were generally obesogenic, while decreased exposure to dairy‐product stores was generally obesoprotective; the magnitude and statistical significance of these associations varied by gender and urbanicity of residence. Higher obesity risk was associated with increased exposure to full‐service restaurants among girls, and with decreased exposures to fruit/vegetable markets in urban children, to beverage stores in suburban children, and to health/dietetic food stores in rural children. Mixed findings existed between genders on the associations of fruit/vegetable markets with child weight status. Conclusion: In the United States, exposure to different FEs seemed to lead to different childhood obesity risks during 1998 to 2007; the association varied across gender and urbanicity. This study has important implications for future urban design and community‐based interventions in fighting the obesity epidemic. [ABSTRACT FROM AUTHOR]

Summary: Objective: To examine associations between consumption of low‐calorie sweetened beverages (LCSBs), sugar, and total energy intake in children in the United States. Methods: We used 24‐hour dietary recalls from 7026 children enrolled in the National Health and Nutrition Examination Survey (NHANES) 2011 to 2016 to assess energy and macronutrient intake among LCSB (≥4 oz LCSB, <4 oz SB), SB (≥4 oz SB, <4 oz LCSB), and LCSB + SB consumers (≥4 oz each) compared with water consumers (≥4 oz water, <4 oz LCSB and SBs). Sample weights and complex survey procedures were used for all analyses. Results: Adjusting for body mass index (BMI) percentile, LCSB, SB, and LCSB + SB consumption was associated with 196, 312, and 450 more total calories and 15, 39, and 46 more grams of added sugar, which amounts to 60, 156, 184 more calories from added sugar, compared with water consumers (P <.05 for all pairwise comparisons). No differences in energy intake were observed between LCSB and SB consumers. [Correction added on 28 May 2019, after first online publication: In the preceding sentence, quantities of added sugar reported are in grams. The corresponding calories have also been specified in this version.] Conclusions: These findings challenge the utility of LCSB for weight management in children and adolescents. [ABSTRACT FROM AUTHOR]

Summary: Background: Little is known about the incidence and natural history of obesity remission among children outside of weight loss programmes. Objectives: The objectives are to characterize and identify sociodemographic and early life predictors of obesity remission between kindergarten and eighth grade among a nationally representative sample of US children. Methods: The sample included children with obesity [age‐specific and gender‐specific body mass index percentile (BMI) ≥95] at the spring kindergarten assessment of the Early Childhood Longitudinal Study, Kindergarten Class of 1998–99. Weight categories across 8 years of follow‐up were used to identify three transition patterns: persistent obesity remission, non‐persistent obesity remission and non‐remission. Weight, height and BMI changes between remission categories were examined and predictors of persistent remission were identified. Results: One‐third of children with obesity in kindergarten experienced remission during follow‐up and 21.6% of children experienced persistent remission through eighth grade. Female gender and high socio‐economic status predicted persistent remission; these associations were attenuated after accounting for baseline BMI. Children experiencing persistent remission gained less weight across waves than those experiencing non‐remission. Conclusions: A meaningful proportion of young children with obesity experience remission by eighth grade. Further study is needed to identify factors that support obesity remission among children outside of treatment contexts. [ABSTRACT FROM AUTHOR]

Background: Public health experts raise concerns about adolescents' and black youth's greater exposure to TV advertising for unhealthy foods and beverages compared with children and white youth., Objectives: Examine how television-viewing patterns and rates of advertising during targeted programming contribute to this greater exposure., Methods: Nielsen panel data provided viewing times and amount of food advertising viewed on U.S. television in 2008 and 2012. Researchers compared results by network type (black-, child- and youth-targeted), age group (preschoolers, children and adolescents) and race (black and white youth)., Results: Food advertising exposure increased with age for both black and white youth, but black youth viewed approximately 50% or more ads than did white youth of the same age. Higher rates of food advertising on youth-targeted networks explained greater adolescent exposure. However, greater television viewing and higher rates of advertising on youth- and black-targeted networks both contributed to black youth's greater exposure. From 2008 to 2012, increases in food-ads-per-hour increased exposure for all youth., Conclusions: Food advertisers and networks, especially those targeting adolescents and black youth, must do more to reduce advertising that negatively impacts young people's health. Furthermore, reducing commercial-television viewing by black youth may help reduce health disparities affecting their communities., (© 2016 World Obesity Federation.)

Background: Breakfast consumption has been associated with reduced risk of overweight and obesity among children, but previous evidence reviews fail to confirm a causal relationship., Objectives: To review recent literature on breakfast consumption and adiposity among children and discuss potential underlying mechanisms., Methods: A comprehensive literature search of studies published since the 2010 US National Evidence Library review (January 2010-January 2015) was conducted., Results: Twelve studies met inclusion criteria. All were conducted in industrialized countries: six in Europe, four in the USA, one in China and one in Australia. Ten of the studies used observational longitudinal designs, with follow-up periods ranging from 1 to 27 years (median: 3, mean: 7.4); of these, eight reported inverse associations between breakfast consumption and excess adiposity, while two found no association. The other studies (1 case-control, 1 experimental) each reported a protective effect of breakfast consumption on overweight and obesity among children., Conclusions: Findings corroborate results from previous reviews, adding support for a possible, protective role for breakfast consumption in preventing excess adiposity during childhood and adolescence. However, drawing a causal conclusion from the collective evidence is curtailed by methodological limitations and inconsistencies, including study design, follow-up duration and frequency, exposure and outcome assessment, as well as limited consideration of confounding, mediating and effect-modifying variables. More rigorous study designs employing valid and standardized measurement of relevant variables are needed., (© 2016 World Obesity.)