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Obesity: tackling the causes of the causes
The BMJ Opinion provides comment and opinion written by The British Medical Journal's international community of readers, authors, and editors.
2021
Abstract
This article analyses the responsibility of society systems’ structures towards the obesity epidemic - and how strongly a shift in the government responses is required to tackle this issue. Our “obesogenic” environments hinder the population from accessing healthy lifestyle and dietary patterns, while portraying obesity as an individual’s lack of personal willpower. By challenging the current views on obesity, this article proposes that new policies must be created to eliminate inequalities and to provide long-term solutions to the root causes of obesity, deeply entrenched across all aspects of society.
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The Science Of Mood And Your Microbiome
Dr. Mark Hyman is a practicing family physician and an internationally recognised leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, the Head of Strategy and Innovation of the Cleveland Clinic Center for Functional Medicine, a thirteen-time New York Times bestselling author, and Board President for Clinical Affairs for The Institute for Functional Medicine.
2021
Abstract
In this episode of the Doctor’s Farmacy podcast, Dr. Hyman chats with Dr. Uma Naidoo about all-things related to food and mood, connecting the dots between what we eat and its impact on everything - from anxiety and depression to ADHD and so much more. Dr. Naidoo is a Harvard trained psychiatrist, professional chef, and Nutrition Specialist. She specialises in nutritional psychiatry and she is regarded as a medical pioneer in this more newly recognised field. In her role as a Clinical Scientist, Dr. Naidoo founded and directs the first hospital-based clinical service in Nutritional Psychiatry in the US. With Dr. Hyman, they discuss the impact of America’s mental health crisis and reliance on medications to treat depression, anxiety, and how creating a personalized nutritional plan could benefit mental illness therapy. They also dive into the correlation between anxiety, depression, gluten, and folates, while explaining how the food we eat can drive neuroinflammation. They also talk about the research behind omega-3’s for neuroinflammatory conditions, and how poor food choices affect us from childhood.
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The Role of Iron in Brain Development: A Systematic Review.
McCann, S, Perapoch Amadó, M, Moore, SE
Nutrients. 2020;12(7)
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Iron deficiency is the most common vitamin or mineral deficiency worldwide and is particularly common among pregnant women, infants and young children due to high iron demands during periods of rapid growth. Iron plays an important role in the development of the brain, and animal studies suggest that getting enough iron in pregnancy and early childhood is particularly important. The aims of this systematic review were to (i) investigate the relationship between iron status and brain development and (ii) assess whether this relationship differs according to age or type of development (‘domain’). The researchers looked for studies on iron deficiency or iron supplementation in pregnancy and up to 4 years of age. 26 observational studies and 28 intervention studies were included in the review. There was no clear relationship between iron status and developmental outcomes across any of the ages or domains included. Many of the studies were of low quality and there was a wide variation in study design, along with a lack of research on pregnancy and early infancy. The researchers concluded that evidence for the impact of iron deficiency or iron supplementation on early development is inconsistent. Further high-quality research is needed, particularly within pregnancy and early infancy, which has previously been neglected.
Abstract
One-third of children falter in cognitive development by pre-school age. Iron plays an important role in many neurodevelopmental processes, and animal studies suggest that iron sufficiency in pregnancy and infancy is particularly important for neurodevelopment. However, it is not clear whether iron deficiency directly impacts developmental outcomes, and, if so, whether impact differs by timing of exposure or developmental domain. We searched four databases for studies on iron deficiency or iron supplementation in pregnancy, or at 0-6 months, 6-24 months, or 2-4 years of age. All studies included neurodevelopmental assessments in infants or children up to 4 years old. We then qualitatively synthesized the literature. There was no clear relationship between iron status and developmental outcomes across any of the time windows or domains included. We identified a large quantity of low-quality studies, significant heterogeneity in study design and a lack of research focused on pregnancy and early infancy. In summary, despite good mechanistic evidence for the role of iron in brain development, evidence for the impact of iron deficiency or iron supplementation on early development is inconsistent. Further high-quality research is needed, particularly within pregnancy and early infancy, which has previously been neglected.
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Respiratory and Allergic Effects in Children Exposed to Pesticides-A Systematic Review.
Buralli, RJ, Dultra, AF, Ribeiro, H
International journal of environmental research and public health. 2020;17(8)
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Agricultural pesticides are harmful chemicals used to protect plants from pests and diseases. There has been previous research showing a link between pesticide usage and respiratory symptoms, asthma, allergies, and lung function irregularities in children. To evaluate the relationship between pesticide usage and allergic and respiratory effects in children, 21 studies were included in this systematic review. This systematic review reports an association between multiple sources of pesticide exposure during fetal and early development and respiratory symptoms and allergies among children. Compared to high-income countries, children in the middle- and low-income countries were exposed to multiple pesticide sources. As current scientific evidence is sparse, more research is needed to determine the causal relationship between pesticides and respiratory and allergic symptoms in children. Robust research in low- and middle-income countries is necessary. Healthcare professionals can use the results of this study to understand the harmful effects of pesticide exposure in children and to take clinical decisions to reduce the exposure and its effects.
Abstract
Pesticide exposure may affect children's respiratory and allergic health, although results from epidemiological studies have not reached consensus. This review aims to analyze the scientific evidence on respiratory and allergic effects of exposure to agricultural pesticides in children aged up to 12 years old. The databases PubMed, Web of Science, Scielo, and Lilacs were screened to select articles published in English, Spanish, or Portuguese, and 21 articles were included in this review. Most investigations were conducted in North America (mostly in the United States), while no studies conducted in Latin America or Africa were found, despite their intensive use of pesticides. Children are exposed to pesticides through multiple pathways from the prenatal period throughout later developmental stages and may experience several respiratory effects. Most studies (79%) found positive associations with pesticide exposure and children's respiratory and allergic effects such as asthma, wheezing, coughs, acute respiratory infections, hay fever, rhinitis, eczema, chronic phlegm, and lung function impairments. Contrastingly, 21% of the studies found no associations between pesticide exposure and children's respiratory health. The vast differences among the characteristics of the studies hamper any comparison of the results. Exposure to pesticides may have several impacts on childhood respiratory health. More studies must be conducted, especially in low- and middle-income countries, preferably with comparable research protocols adapted to local realities. Efforts should be made to develop comprehensive risk mitigation strategies and behavioral interventions to reduce children's exposure to pesticides used in agriculture and respiratory health effects, and to ensure healthy childhood growth.
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Associations of dietary intake with cardiometabolic risk in a multi-ethnic cohort: a longitudinal analysis of the Determinants of Adolescence, now young Adults, Social well-being and Health (DASH) study.
Goff, LM, Huang, P, Silva, MJ, Bordoli, C, Enayat, EZ, Molaodi, OR, Cassidy, A, Maynard, M, Harding, S
The British journal of nutrition. 2019;121(9):1069-1079
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Ethnic inequalities in a wide range of chronic diseases are well documented. Poor dietary habits in childhood may contribute to higher rates of chronic diseases such as type 2 diabetes (T2D), hypertension and Coronary Heart Disease (CHD). This study was a longitudinal follow-up of a subsample of the Determinants of Adolescent Social well-being and Health (DASH) study. The researchers aimed to identify dietary patterns and investigate their impact on chronic diseases in young adulthood. The study participants were 107 White British, 102 Black Caribbean, 132 Black African, 98 Indian, 111 Bangladeshi/Pakistani and 115 other/mixed ethnicity. Participants completed a 24-hour dietary intake recall and behaviour questionnaire at age 11-13yrs, and then again at age 21-23yrs. Body mass index (BMI), blood pressure, blood cholesterol and blood sugar were measured. The researchers found that dietary behaviours such as skipping breakfast and a low intake of fruit and vegetables were common. Rates of skipping breakfast and low fruit and vegetable consumption were highest among Black African and Black Caribbean participants. BMI and cholesterol levels in young adults were higher among those who regularly skipped breakfast. The researchers concluded that skipping breakfast is more common in certain ethnic groups and is associated with risk factors for chronic disease in young adults. They suggest that interventions to improve dietary habits could be targeted at specific population groups.
Abstract
Unfavourable dietary habits, such as skipping breakfast, are common among ethnic minority children and may contribute to inequalities in cardiometabolic disease. We conducted a longitudinal follow-up of a subsample of the UK multi-ethnic Determinants of Adolescent Social well-being and Health cohort, which represents the main UK ethnic groups and is now aged 21-23 years. We aimed to describe longitudinal patterns of dietary intake and investigate their impact on cardiometabolic risk in young adulthood. Participants completed a dietary behaviour questionnaire and a 24 h dietary intake recall; anthropometry, blood pressure, total cholesterol and HDL-cholesterol and HbA1c were measured. The cohort consisted of 107 White British, 102 Black Caribbean, 132 Black African, 98 Indian, 111 Bangladeshi/Pakistani and 115 other/mixed ethnicity. Unhealthful dietary behaviours such as skipping breakfast and low intake of fruits and vegetables were common (56, 57 and 63 %, respectively). Rates of skipping breakfast and low fruit and vegetable consumption were highest among Black African and Black Caribbean participants. BMI and cholesterol levels at 21-23 years were higher among those who regularly skipped breakfast at 11-13 years (BMI 1·41 (95 % CI 0·57, 2·26), P=0·001; cholesterol 0·15 (95 % CI -0·01, 0·31), P=0·063) and at 21-23 years (BMI 1·05 (95 % CI 0·22, 1·89), P=0·014; cholesterol 0·22 (95 % CI 0·06, 0·37), P=0·007). Childhood breakfast skipping is more common in certain ethnic groups and is associated with cardiometabolic risk factors in young adulthood. Our findings highlight the importance of targeting interventions to improve dietary behaviours such as breakfast consumption at specific population groups.
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The Obemat2.0 Study: A Clinical Trial of a Motivational Intervention for Childhood Obesity Treatment.
Luque, V, Feliu, A, Escribano, J, Ferré, N, Flores, G, Monné, R, Gutiérrez-Marín, D, Guillen, N, Muñoz-Hernando, J, Zaragoza-Jordana, M, et al
Nutrients. 2019;11(2)
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Multicomponent interventions consisting of dietary modification, physical activity, behavioural therapy, and education have shown to improve body mass index, blood pressure, and lipids profile. The Obemat2.0 trail was designed and conducted to implement and to test the efficacy of a structured multicomponent motivational therapy to treat childhood obesity. The study is a randomised clustered clinical trial with a treatment on children with obesity lasting 12 months. The study had two arms: a control group and an intervention group. The recruitment started in June 2016 and the fieldwork is expected to end in June 2019. The study results will show whether a multicomponent program, including a bundle of motivational strategies conducted in primary centres by therapists with 12h of specific training could be more effective than usual care. Authors expect this clinical trial to open a window of opportunity to support professionals at the primary care level to treat childhood obesity.
Abstract
The primary aim of the Obemat2.0 trial was to evaluate the efficacy of a multicomponent motivational program for the treatment of childhood obesity, coordinated between primary care and hospital specialized services, compared to the usual intervention performed in primary care. This was a cluster randomized clinical trial conducted in Spain, with two intervention arms: motivational intervention group vs. usual care group (as control), including 167 participants in each. The motivational intervention consisted of motivational interviewing, educational materials, use of an eHealth physical activity monitor and three group-based sessions. The primary outcome was body mass index (BMI) z score increments before and after the 12 (+3) months of intervention. Secondary outcomes (pre-post intervention) were: adherence to treatment, waist circumference (cm), fat mass index (z score), fat free mass index (z score), total body water (kg), bone mineral density (z score), blood lipids profile, glucose metabolism, and psychosocial problems. Other assessments (pre and post-intervention) were: sociodemographic information, physical activity, sedentary activity, neuropsychological testing, perception of body image, quality of the diet, food frequency consumption and foods available at home. The results of this clinical trial could open a window of opportunity to support professionals at the primary care to treat childhood obesity. The clinicaltrials.gov identifier was NCT02889406.
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A Systematic Review of the Association of Skipping Breakfast with Weight and Cardiometabolic Risk Factors in Children and Adolescents. What Should We Better Investigate in the Future?
Monzani, A, Ricotti, R, Caputo, M, Solito, A, Archero, F, Bellone, S, Prodam, F
Nutrients. 2019;11(2)
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Childhood obesity is a major public health issue across the world. The incidence of skipping breakfast among children and adolescent is rising. Numerous studies have shown a positive relationship between skipping breakfast and overweight or obesity. The aim of the study was to analyse the association of skipping breakfast with body weight and metabolic outcomes in the paediatric population. The study is a systemic review focusing on studies published in the last ten years. 39 articles were included for analysis and data from a total of 286,804 children and adolescents were reported. The systemic review demonstrates that children and adolescents who skip breakfast are at higher risk to be or become overweight or obese. Authors conclude that skipping breakfast may be a potential marker of lifestyle behaviours in children and adolescents that promote overweight or obesity and metabolic diseases.
Abstract
The incidence of skipping breakfast in pediatric subjects is rising, and a relationship with overweight (OW) and obesity (OB) has been shown. Associations with cardiovascular outcomes and skipping breakfast in adults have been reported. The purpose of this systematic review was to summarize the association of skipping breakfast with body weight and metabolic outcomes in the pediatric population. We searched relevant databases (2008⁻2018) and identified 56 articles, of which 39 were suitable to be included, basing on inclusion criteria (observational; defined breakfast skipping; weight and/or metabolic outcomes). Overall, 286,804 children and adolescents living in 33 countries were included. The definitions of OW/OB, skipping breakfast, and the nutrient assessment were highly heterogeneous. Confounding factors were reported infrequently. The prevalence of skipping breakfast ranged 10⁻30%, with an increasing trend in adolescents, mainly in girls. Skipping breakfast was associated with OW/OB in the 94.7% of the subjects. The lack of association was shown mainly in infants. Moreover, 16,130 subjects were investigated for cardiometabolic outcomes. Skipping breakfast was associated with a worse lipid profile, blood pressure levels, insulin-resistance, and metabolic syndrome. Five studies reported a lower quality dietary intake in breakfast skippers. This review supports skipping breakfast as an easy marker of the risk of OW/OB and metabolic diseases, whether or not it is directly involved in causality. We encourage intervention studies using standardized and generalizable indicators. Data on confounders, time of fasting, chronotypes, and nutrition quality are needed to establish the best practice for using it as a tool for assessing obesity risk.
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The views of young children in the UK about obesity, body size, shape and weight: a systematic review.
Rees, R, Oliver, K, Woodman, J, Thomas, J
BMC public health. 2011;11:188
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Obesity in children is an increasing problem in Westernised societies; obese children are more at risk of poorer health in the short and long term. The aim of the study was to explore the views of children about the meanings of obesity and body size, shape or weight and their own experience of these issues. This systemic review looked at 28 studies done in UK, conducted after 1997 in children aged 4-11. The review’s findings suggest that for children, the health consequences of obesity seemed to be mostly irrelevant. Impact on their social lives was far more important. Also, despite often having healthy body sizes, children continue to dislike their own bodies. This review highlights the need to consider the social aspect of childhood obesity and that children’s perspectives should be used in the policy making process. The authors conclude that the studies did not fully represent children’s diversity and therefore higher quality research is needed to enable relevant interventions to be put into place.
Abstract
BACKGROUND There are high levels of concern about childhood obesity, with obese children being at higher risk of poorer health both in the short and longer terms. Children's attitudes to, and beliefs about, their bodies have also raised concern. Children themselves have a stake in this debate; their perspectives on this issue can inform the ways in which interventions aim to work.This systematic review of qualitative and quantitative research aimed to explore the views of UK children about the meanings of obesity and body size, shape or weight and their own experiences of these issues. METHODS We conducted sensitive searches of electronic databases and specialist websites, and contacted experts. We included studies published from the start of 1997 which reported the perspectives of UK children aged 4-11 about obesity or body size, shape or weight, and which described key aspects of their methods. Included studies were coded and quality-assessed by two reviewers independently.Findings were synthesised in two analyses: i) an interpretive synthesis of findings from open-ended questions; and ii) an aggregative synthesis of findings from closed questions. We juxtaposed the findings from the two syntheses. The effect of excluding the lowest quality studies was explored. We also consulted young people to explore the credibility of a subset of findings. RESULTS We included 28 studies. Instead of a focus on health, children emphasised the social impact of body size, describing experiences and awareness of abuse and isolation for children with a greater weight. Body size was seen as under the individual's control and children attributed negative characteristics to overweight people. Children actively assessed their own size; many wished their bodies were different and some were anxious about their shape.Reviewers judged that children's engagement and participation in discussion had only rarely been supported in the included studies, and few study findings had depth or breadth. CONCLUSIONS Initiatives need to consider the social aspects of obesity, in particular unhelpful beliefs, attitudes and discriminatory behaviours around body size. Researchers and policy-makers should involve children actively and seek their views on appropriate forms of support around this issue.
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Adolescent diet and subsequent serum hormones, breast density, and bone mineral density in young women: results of the Dietary Intervention Study in Children follow-up study.
Dorgan, JF, Liu, L, Klifa, C, Hylton, N, Shepherd, JA, Stanczyk, FZ, Snetselaar, LG, Van Horn, L, Stevens, VJ, Robson, A, et al
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2010;19(6):1545-56
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Population and animal studies suggest that fat in the diet may have an influence on the development of breast cancer, but the results of studies in humans are inconsistent. This randomised controlled trial aimed to determine the effects of a lower-fat diet during childhood and adolescence on markers associated with breast cancer risk in adults. Female participants were initially recruited at age 8-10 years old, as part of a study to test the effects of lower-fat diets on cholesterol levels in children. The study diet limited total fat intake to 28% of calories (<8% saturated fat, <9% polyunsaturated fat, remainder monounsaturated), cholesterol was limited to 150mg/day and consumption of fibre was encouraged. The children followed the diet for 7 years, when the trial was terminated. This follow-up study was conducted 9 years later, when the participants were aged 25 to 29 years old. After adjusting for current diet, the lower-fat diet group had significantly higher oestradiol levels and bone mineral density. Progesterone concentrations and breast density did not differ between the two groups. The authors concluded that consumption of a lower-fat diet during adolescence does not appear to affect factors associated with breast cancer risk. Current diet may be more important than adolescent diet in determining hormone levels in premenopausal women.
Abstract
BACKGROUND Adolescent diet is hypothesized to influence breast cancer risk. We evaluated the long-term effects of an intervention to lower fat intake among adolescent girls on biomarkers that are related to breast cancer risk in adults. METHODS A follow-up study was conducted on 230 girls who participated in the Dietary Intervention Study in Children (DISC), in which healthy, prepubertal, 8 to 10 year olds were randomly assigned to usual care or to a behavioral intervention that promoted a reduced fat diet. Participants were 25 to 29 years old at follow-up visits. All tests of statistical significance are two-sided. RESULTS In analyses that did not take account of diet at the time of the follow-up visit, the only statistically significant treatment group difference was higher bone mineral content in intervention group participants compared with usual care group participants; their mean bone mineral contents were 2,444 and 2,377 g, respectively. After adjustment for current diet, the intervention group also had statistically significantly higher bone mineral density and luteal phase serum estradiol concentrations. Serum progesterone concentrations and breast density did not differ by treatment group in unadjusted or adjusted analyses. CONCLUSIONS Results do not support the hypothesis that consumption of a lower fat diet during adolescence reduces breast cancer risk via effects on subsequent serum estradiol and progesterone levels, breast density, or bone mineral density. It remains unclear, however, if the results are specific to the DISC intervention or are more broadly applicable. IMPACT Modest reductions in fat intake during adolescence are unlikely to lower later breast cancer risk via long-term effects on the biomarkers measured.