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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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Ultra-Processed Foods and Health Outcomes: A Narrative Review.
Elizabeth, L, Machado, P, Zinöcker, M, Baker, P, Lawrence, M
Nutrients. 2020;12(7)
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Ultra-processed food (UPF) is prevalent in diets world-wide. This review aims to look at the results of studies that have investigated associations between levels of UPF consumption and health outcomes on healthy participants. 43 studies were reviewed; studies covered all age groups (including children and adolescents) in a number of different countries. Studies looked at overweight, obesity and cardio-metabolic risks as outcomes as well as cancer, cardiovascular disease, type 2 diabetes, mortality, gastrointestinal disorders, depression, frailty and asthma. In 37 studies, there was at least one statistically significant association between UPF exposure and at least one adverse health outcome. No study reported an association between UPF exposure and beneficial health outcomes. This review has shown that a high intake of UPFs is associated with a range of adverse health outcomes, disorders and conditions. This has the potential to significantly influence the global burden of disease. As well as this; evidence suggests a higher risk of all-cause mortality with high consumption of UPFs. No study reported an association between UPF and beneficial health outcomes. The review has also shown beneficial outcomes were associated with diets higher in unprocessed and minimally processed foods.
Abstract
The nutrition literature and authoritative reports increasingly recognise the concept of ultra-processed foods (UPF), as a descriptor of unhealthy diets. UPFs are now prevalent in diets worldwide. This review aims to identify and appraise the studies on healthy participants that investigated associations between levels of UPF consumption and health outcomes. This involved a systematic search for extant literature; integration and interpretation of findings from diverse study types, populations, health outcomes and dietary assessments; and quality appraisal. Of 43 studies reviewed, 37 found dietary UPF exposure associated with at least one adverse health outcome. Among adults, these included overweight, obesity and cardio-metabolic risks; cancer, type-2 diabetes and cardiovascular diseases; irritable bowel syndrome, depression and frailty conditions; and all-cause mortality. Among children and adolescents, these included cardio-metabolic risks and asthma. No study reported an association between UPF and beneficial health outcomes. Most findings were derived from observational studies and evidence of plausible biological mechanisms to increase confidence in the veracity of these observed associations is steadily evolving. There is now a considerable body of evidence supporting the use of UPFs as a scientific concept to assess the 'healthiness' of foods within the context of dietary patterns and to help inform the development of dietary guidelines and nutrition policy actions.
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A Biopsychosocial Model of Sex Differences in Children's Eating Behaviors.
Keller, KL, Kling, SMR, Fuchs, B, Pearce, AL, Reigh, NA, Masterson, T, Hickok, K
Nutrients. 2019;11(3)
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This paper discusses the role of sex on children’s appetite and responses to food cues. The review flips the question of whether the variations in obesity and eating disorders seen by biological sex are actually influenced by, and to what extent, by sex eg. is sex the determining factor for differing responses? It specifically reviews behaviours in children aged 11 years and younger, avoiding adolescence (the typical age when differences in eating patterns occur), to understand if these differences are correlated with sex, given the high incidence of female eating disorders. The researchers reviewed specific traits including food acceptance, food intake, picky eating, appetitive traits, eating compensation, eating in the absence of hunger, and meal-specific microstructural patterns (e.g., bite rate and eating speed). They found that girls typically like a wider variety of foods than boys and had a greater preference for plant foods whilst boys typically preferred meats and foods higher in fats and sugar. No sex differences were found for picky eating. Boys were found to have greater enjoyment for eating, with girls showing more food avoidance traits, however this may be from parental strategies reinforcing this behaviour in girls. Boys are more readily satiated and better able to regulate their food and drink intake than girls. Yet boys are also more likely to eat in the absence of hunger and have a faster eating rate and larger bite size. The paper concludes that the studies reviewed are suggestive of male–female differences in food liking and intake, appetitive traits, self-regulatory eating, and meal-related microstructure.
Abstract
The prevalence of obesity and eating disorders varies by sex, but the extent to which sex influences eating behaviors, especially in childhood, has received less attention. The purpose of this paper is to critically discuss the literature on sex differences in eating behavior in children and present new findings supporting the role of sex in child appetitive traits and neural responses to food cues. In children, the literature shows sex differences in food acceptance, food intake, appetitive traits, eating-related compensation, and eating speed. New analyses demonstrate that sex interacts with child weight status to differentially influence appetitive traits. Further, results from neuroimaging suggest that obesity in female children is positively related to neural reactivity to higher-energy-dense food cues in regions involved with contextual processing and object recognition, while the opposite was found in males. In addition to differences in how the brain processes information about food, other factors that may contribute to sex differences include parental feeding practices, societal emphasis on dieting, and peer influences. Future studies are needed to confirm these findings, as they may have implications for the development of effective intervention programs to improve dietary behaviors and prevent obesity.
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Egg Consumption in U.S. Children is Associated with Greater Daily Nutrient Intakes, including Protein, Lutein + Zeaxanthin, Choline, α-Linolenic Acid, and Docosahexanoic Acid.
Papanikolaou, Y, Fulgoni, VL
Nutrients. 2019;11(5)
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Dietary guidelines recommend children and adolescents consume nutrient-dense foods to promote growth and development, and recently eggs have been included in these recommendations. At present, there are no studies in children and adolescents that have examined nutrient-related associations of egg consumption. Therefore, the aim of this study was to investigate egg consumption and nutrient intakes, diet quality and growth outcomes relative to non-egg consumers. Using cross-sectional data from the US National Health and Nutrition Examination Survey (NHANES), data from 3,299 egg consumers and 17,030 non-egg consumers aged 2-18 was examined. Compared with non-egg consumption, egg consumption was associated with elevated intake of protein, healthy fats, antioxidants and various vitamins and minerals, and lower intake of sugar. There were several shortfall nutrients associated with egg consumption including fibre, iron, and folate. No associations were found when examining diet quality and growth-relate measures. This analysis demonstrated several nutrient-related benefits to support the continued inclusion of eggs in the dietary patterns of children and adolescents. Based on these results, the authors conclude this study illustrates an opportunity to communicate the benefits linked with egg consumption to individuals that influence children and adolescents.
Abstract
Dietary pattern recommendations include consuming a variety of nutrient-dense foods in children and adolescents to promote optimal growth and development. The current study investigated associations with egg consumption and nutrient intakes, diet quality, and growth outcomes relative to non-egg consumers. The analysis used data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2001-2012 in children and adolescents aged 2-18 years (N = 3,299, egg consumers; N = 17,030, egg non-consumers). Daily energy and nutrient intakes were adjusted for the complex sample design of NHANES using appropriate weights. Consuming eggs was associated with increased daily energy intake relative to non-egg consumption. Children and adolescents consuming eggs had elevated daily intake of protein, polyunsaturated, monounsaturated and total fat, α-linolenic acid, docosahexaenoic acid (DHA), choline, lutein + zeaxanthin, vitamin D, potassium, phosphorus, and selenium. Egg consumers had greater consumption, sodium, saturated fat, with reduced total and added sugar versus egg non-consumers. The analysis also showed that egg consumption was linked with lower intake of dietary folate, iron, and niacin. No associations were determined when examining diet quality and growth-related measures. A sub-analysis considering socioeconomic status showed that egg consumption was positively related with daily lutein + zeaxanthin and DHA intake. The current analysis demonstrated several nutrient-related benefits to support the continued inclusion of eggs in the dietary patterns of children and adolescents.
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New Insights about How to Make an Intervention in Children and Adolescents with Metabolic Syndrome: Diet, Exercise vs. Changes in Body Composition. A Systematic Review of RCT.
Albert Pérez, E, Mateu Olivares, V, Martínez-Espinosa, RM, Molina Vila, MD, Reig García-Galbis, M
Nutrients. 2018;10(7)
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Metabolic Syndrome is the term used to group a cluster of health concerns including overweight, obesity, hypertension, elevated cholesterol, blood glucose intolerance and insulin resistance which together can contribute to the development of Type II Diabetes and Cardiovascular Disease. Diagnosis is usually given if a patient has three or more of these conditions however the diagnosis in children and adolescents is often inconsistent, and so guidelines for therapeutic strategies for metabolic syndrome also vary greatly. This review looked at 9 studies of children aged up to 19 years old, all diagnosed with metabolic syndrome, and given dietary, physical, psychological, and pharmacological interventions, to try and understand what the best clinical approach might be. It was found that a balanced diet combined with aerobic and resistance exercise helped to significantly reduce body mass, more so than the trials which included treatment with Metformin. A balance diet included calorie restriction and carbohydrate reduction, carefully planned around the daily exercise program of 2-3 resistance sessions each week and frequent cardio sessions of differing intensity and duration. They concluded that a minimum of 6 months was needed to reach optimal weight loss and body fat loss. Overall, the findings of this study support diet and physical exercise as beneficial clinical interventions, whilst the use of medication is still unclear.
Abstract
OBJECTIVE To record which interventions produce the greatest variations in body composition in patients ≤19 years old with metabolic syndrome (MS). METHOD search dates between 2005 and 2017 in peer reviewed journals, following the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses). The selection criteria were: diagnostic for MS or at least a criterion for diagnosis; randomized clinical trials, ≤19 years of age; intervention programs that use diet and/or exercise as a tool (interventions showing an interest in body composition). RESULTS 1781 clinical trials were identified under these criteria but only 0.51% were included. The most frequent characteristics of the selected clinical trials were that they used multidisciplinary interventions and were carried out in America. The most utilized parameters were BMI (body mass index) in kg/m² and BW (body weight) in kg. CONCLUSIONS Most of the clinical trials included had been diagnosed through at least 2 diagnostic criteria for MS. Multidisciplinary interventions obtained greater changes in body composition in patients with MS. This change was especially prevalent in the combinations of dietary interventions and physical exercise. It is proposed to follow the guidelines proposed for patients who are overweight, obese, or have diabetes type 2, and extrapolate these strategies as recommendations for future clinical trials designed for patients with MS.
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Beverage consumption patterns among 4-19 y old children in 2009-14 NHANES show that the milk and 100% juice pattern is associated with better diets.
Maillot, M, Rehm, CD, Vieux, F, Rose, CM, Drewnowski, A
Nutrition journal. 2018;17(1):54
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Recommendations for milk and/or fruit juice consumption in children’s diets has remained inconclusive. The aim of this study was to assess whether patterns in beverage consumption among children and adolescents can influence food choices and overall diet quality. Beverage consumption patterns of 8119 children and adolescents were analysed based on data from the National Health and Nutrition Examination Survey (NHANES). Beverage patterns were defined as milk pattern, juice pattern, milk and juice or other caloric beverages. This analysis found that while children rarely limit their drinking choices to a single beverage, those who primarily consumed milk, juice or a combination of the two were associated with better dietary choices. Based on this study, the authors conclude that promotion of milk and juice consumption, compared to other caloric beverages, may be an effective way to improve overall diet quality in children and adolescents.
Abstract
BACKGROUND Patterns of beverage consumption among children and adolescents can be indicative of food choices and total diet quality. METHODS Analyses of beverage consumption patterns among 8119 children aged 4-19 y were based on the first 24-h recall of the National Health and Nutrition Examination Survey (2009-14 NHANES). Four pre-defined beverage patterns were: 1) milk pattern; 2) 100% juice pattern; 3) milk and 100% juice pattern; and 4) other caloric beverages. Food- and nutrient-based diet quality measures included the Healthy Eating Index 2010. RESULTS Most children drank other caloric beverages, as opposed to milk (17.8%), 100% juice (5.6%), or milk and 100% juice (13.5%). Drinkers of milk and 100% juice had diets that did not differ from each other in total calories, total and added sugars, fiber, or vitamin E. Milk drinkers consumed more dairy and had higher intakes of calcium, potassium, vitamin A and vitamin D as compared to all other patterns. Juice drinkers consumed more total fruit, same amounts of whole fruit, and had higher intakes of vitamin C as compared to the other consumption patterns. Drinkers of both milk and 100% juice had the highest HEI 2010 scores of all the consumption patterns. CONCLUSIONS Beverage consumption patterns built around milk and/or 100% juice were relatively uncommon. Promoting the drinking of milk and 100% juice, in preference to other caloric beverages, may be an effective strategy to improve children's diet quality. Restricting milk and 100% juice consumption may encourage the selection of other caloric beverages.
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Does additional support provided through e-mail or SMS in a Web-based Social Marketing program improve children's food consumption? A Randomized Controlled Trial.
Rangelov, N, Della Bella, S, Marques-Vidal, P, Suggs, LS
Nutrition journal. 2018;17(1):24
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Nutrition programmes designed for children are often difficult to implement and monitor as parents exert a powerful influence on eating habits. The World Health Organization has started to recommend Social Marketing as a way to promote a healthy diet and other lifestyle behaviours, however it is not currently clear to what extent text or email directed to parents can improve children’s eating behaviour. The aim of this randomised trial was to examine the effect of a Social Marketing healthy nutrition program on children’s food intake, while also considering whether additional support through text or email resulted in additional positive change in 608 children. Families were randomised to one of three groups, where the parent received intervention by Web, Web and email or Web and text, and children’s food consumption was assessed using a food diary. This study showed a Social Marketing tailored program for parents delivered through the Web and complemented with letters directed to children can improve children’s eating behaviours. The additional use of text and email did not significantly improve positive behaviour change.
Abstract
BACKGROUND The FAN Social Marketing program was developed to improve dietary and physical activity habits of families with children in Ticino, Switzerland. The aim of this study was to examine if the effects of the program on children's food intake differed by intervention group. METHODS Effects of the FAN program were tested through a Randomized Controlled Trial. The program lasted 8 weeks, during which participants received tailored communication about nutrition and physical activity. Families were randomly allocated to one of three groups, where the parent received the intervention by the Web (G1), Web + e-mail (G2) or Web + SMS (G3). Children in all groups received tailored print letters by post. Children's food consumption was assessed at baseline and immediate post intervention using a 7-day food diary. Generalized linear mixed models with child as a random effect and with time, treatment group, and the time by treatment interaction as fixed effects were used to test the impact of the intervention. RESULTS Analyses were conducted with a sample of 608 children. After participating in FAN the marginal means of daily consumption of fruit changed from 0.95 to 1.12 in G1, from 0.82 to 0.94 in G2, and from 0.93 to 1.18 in G3. The margins of the daily consumption of sweets decreased in each group (1.67 to 1.56 in G1, 1.71 to 1.49 in G2, and 1.72 to 1.62 in G3). The change in vegetable consumption observed from pre to post intervention in G3 (from 1.13 to 1.21) was significantly different from that observed in G1 (from 1.21 to 1.17). CONCLUSIONS A well-designed Web-based Social Marketing intervention complemented with print letters can help improve children's consumption of water, fruit, soft drinks, and sweets. The use of SMS to support greater behavior change, in addition to Web-based communication, resulted only in a small significant positive change for vegetables, while the use of e-mail in addition to Web did not result in any significant difference. TRIAL REGISTRATION The trial was retrospectively registered in the ISRCTN registry (ID ISRCTN48730279 ).
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Eating at food outlets and leisure places and "on the go" is associated with less-healthy food choices than eating at home and in school in children: cross-sectional data from the UK National Diet and Nutrition Survey Rolling Program (2008-2014).
Ziauddeen, N, Page, P, Penney, TL, Nicholson, S, Kirk, SF, Almiron-Roig, E
The American journal of clinical nutrition. 2018;107(6):992-1003
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Poor diet in childhood and adolescence has been recognised as a risk factor for obesity during adulthood. Public health research has found the food environment to be an important determinant of diet, specifically for this age group, and the major environments are home, school, and food outlets/leisure places. The aim of this cross-sectional study is to provide a comprehensive analysis of the types of food consumed in each environment based on data from 4636 children and adolescents in the United Kingdom. This study showed the most common eating location across all age groups was at home, and this was associated with less sugar and takeaway food consumption. Based on these results, the authors conclude that home and school are both important areas to target for public health policy, however also highlight the importance of providing healthier food options for adolescents outside of these environments.
Abstract
Background: Where children eat has been linked to variations in diet quality, including the consumption of low-nutrient, energy-dense food, a recognized risk factor for obesity. Objective: The aim of this study was to provide a comprehensive analysis of consumption patterns and nutritional intake by eating location in British children with the use of a nationally representative survey. Design: Cross-sectional data from 4636 children (80,075 eating occasions) aged 1.5-18 y from the UK National Diet and Nutrition Survey Rolling Program (2008-2014) were analyzed. Eating locations were categorized as home, school, work, leisure places, food outlets, and "on the go." Foods were classified into core (considered important or acceptable within a healthy diet) and noncore (all other foods). Other variables included the percentage of meals eaten at home, sex, ethnicity, body mass index, income, frequency of eating out, takeaway meal consumption, alcohol consumption, and smoking. Results: The main eating location across all age groups was at home (69-79% of eating occasions), with the highest energy intakes. One-third of children from the least-affluent families consumed ≤25% of meals at home. Eating more at home was associated with less sugar and takeaway food consumption. Eating occasions in leisure places, food outlets, and "on the go" combined increased with age, from 5% (1.5-3 y) to 7% (11-18 y), with higher energy intakes from noncore foods in these locations. The school environment was associated with higher intakes of core foods and reduced intakes of noncore foods in children aged 4-10 y who ate school-sourced foods. Conclusions: Home and school eating are associated with better food choices, whereas other locations are associated with poor food choices. Effective, sustained initiatives targeted at behaviors and improving access to healthy foods in leisure centers and food outlets, including food sold to eat "on the go," may improve food choices. Home remains an important target for intervention through family and nutrition education, outreach, and social marketing campaigns. This trial was registered with the ISRTCN registry (https://www.isrctn.com) as ISRCTN17261407.
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Randomized trial of peanut consumption in infants at risk for peanut allergy.
Du Toit, G, Roberts, G, Sayre, PH, Bahnson, HT, Radulovic, S, Santos, AF, Brough, HA, Phippard, D, Basting, M, Feeney, M, et al
The New England journal of medicine. 2015;372(9):803-13
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Children with peanut allergies are at a higher risk of death and anaphylaxis. This randomised, open-label, controlled study investigated whether reducing peanut exposure or eliminating peanuts is a better strategy to prevent peanut allergy development. Six hundred and forty infants between the ages of four months and eleven months old were randomly assigned to different cohorts depending on whether they had a pre-existing sensitivity to peanut extract. The study also assessed the proportion of infants with peanut allergies at 60 months. The introduction of peanuts at an early age significantly reduced peanut allergies in infants at high risk. Those who consumed peanuts had elevated peanut-specific IgG4 antibody levels whereas those who avoided peanuts had elevated peanut-specific IgE antibody levels. At the age of sixty months, the proportion of infants in the intention-to-treat group that developed peanut allergy was higher in the infants who avoided peanuts than in those who consumed them. As this study only included low-risk infants, future robust studies will be required to prove the benefits of peanuts’ early introduction. These results can be used by healthcare professionals to develop potential strategies to reduce the prevalence of peanut allergy in children.
Abstract
BACKGROUND The prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia. We evaluated strategies of peanut consumption and avoidance to determine which strategy is most effective in preventing the development of peanut allergy in infants at high risk for the allergy. METHODS We randomly assigned 640 infants with severe eczema, egg allergy, or both to consume or avoid peanuts until 60 months of age. Participants, who were at least 4 months but younger than 11 months of age at randomization, were assigned to separate study cohorts on the basis of preexisting sensitivity to peanut extract, which was determined with the use of a skin-prick test--one consisting of participants with no measurable wheal after testing and the other consisting of those with a wheal measuring 1 to 4 mm in diameter. The primary outcome, which was assessed independently in each cohort, was the proportion of participants with peanut allergy at 60 months of age. RESULTS Among the 530 infants in the intention-to-treat population who initially had negative results on the skin-prick test, the prevalence of peanut allergy at 60 months of age was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). Among the 98 participants in the intention-to-treat population who initially had positive test results, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group (P=0.004). There was no significant between-group difference in the incidence of serious adverse events. Increases in levels of peanut-specific IgG4 antibody occurred predominantly in the consumption group; a greater percentage of participants in the avoidance group had elevated titers of peanut-specific IgE antibody. A larger wheal on the skin-prick test and a lower ratio of peanut-specific IgG4:IgE were associated with peanut allergy. CONCLUSIONS The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00329784.).
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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.