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1.
The effect of diet, exercise, and lifestyle intervention on childhood obesity: A network meta-analysis.
Bae, JH, Lee, H
Clinical nutrition (Edinburgh, Scotland). 2021;(5):3062-3072
Abstract
BACKGROUND & AIMS Trials investigating the efficacy of different interventions for overweight children are limited and controversial. Therefore, the aim of this study is to perform a network meta-analysis on the efficacy of various interventions for children with obesity (an average age of 6-12 years old). METHODS We obtained the data of trials reporting pre-post obesity relevant outcomes (e.g. BMI, BMI z-score, percent body fat, or percent overweight) from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), PubMed, and Web of Science databases (completed before February 25, 2019) and included at least one pair of direct comparison groups. The mean difference of outcomes and their associated 95% CI were used to determine the efficacy. The P-score was calculated to illustrate the rank probability of various treatments for different outcomes using a network meta-analysis. Our meta-analysis included 24 studies that evaluated the interventions for childhood obesity. RESULTS All 24 trials had no high risk of bias. Interventions such as exercise without parents (E w/o P); diet with parents (D w/P); and diet, exercise, and lifestyle with parents (D+E+L w/P) were significantly effective for children with obesity when compared with no intervention. CONCLUSIONS E w/o P exhibited the highest P-score, with the D w/P and D+E+L w/P ranks having P-scores of 0.7486 and 0.5464, respectively. Moreover, the results indicate that E w/o P, D w/P, and D+E+L w/P were significantly effective treatments for children with obesity when compared with no intervention.
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2.
Impact of weight management nutrition interventions on dietary outcomes in children and adolescents with overweight or obesity: a systematic review with meta-analysis.
Duncanson, K, Shrewsbury, V, Burrows, T, Chai, LK, Ashton, L, Taylor, R, Gow, M, Ho, M, Ells, L, Stewart, L, et al
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2021;(1):147-177
Abstract
BACKGROUND The impact of obesity interventions on dietary intake in children and adolescents with overweight or obesity is unclear. This systematic review aimed to investigate the impact of the dietary component of weight management interventions on the change in diet in children and adolescents with overweight or obesity. METHODS Eligible randomised controlled trials (RCTs) published between 1975 and 2020 were identified by a systematic search following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Meta-analyses of eligible study outcomes were performed using statistical software. A multilevel random effects model was used with three significant random effects fitted using restricted maximum likelihood estimation. RESULTS This review identified 109 RCTs, including 95 that reported at least one statistically significant dietary outcome change and 14 reporting no significant dietary change. Results from the meta-analyses (n = 29 studies) indicated that, compared to control groups, intervention groups achieved significantly greater reductions in mean total energy intake at ≤6 months (-194 kcal day-1 , 95% confidence interval = -275.80 to -112.90 kcal day-1 , P < 0.001) and up to 12 months (-112 kcal day-1 95% confidence interval = -218.92 to -5.83 kcal day-1 ) P = 0.038), increases in fruit and/or vegetable intakes over 2-12 months (n = 34, range +0.6 to +1.5 servings day-1 ) and reductions in consumption of sugar-sweetened beverages (n = 28, range -0.25 to -1.5 servings day-1 ) at 4-24 months follow-up. CONCLUSIONS Obesity interventions with a dietary component have a modest but sustained impact on reducing total energy intake and improving intakes of specific food groups in children and adolescents with overweight or obesity. High quality RCTs that are powered to detect change in diet as a primary outcome are warranted.
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3.
Effects of aerobic exercise on obese children with metabolic syndrome: a systematic review and meta-analysis.
Cao, Y, Zhu, L, Liu, J
Journal of pediatric endocrinology & metabolism : JPEM. 2021;(9):1069-1079
Abstract
OBJECTIVES Metabolic syndrome (MetS) is systemic metabolic disease that results from insulin resistance or obesity. Numerous meta-analyses have investigated the effect of exercise on different populations, but none were aimed at the effect of aerobic exercise alone on obese children. This review systematically assessed and performed a meta-analysis on the effect of aerobic exercise on obese children with MetS. CONTENT MEDLINE via PubMed, Embase, SPORTDiscus, and the Cochrane library were searched and screened from inception to 20 October 2020 for randomized controlled trials. The inclusion criteria were obese children who met the criteria for MetS and aged 5-19 years old in an aerobic exercise group. The meta-analysis included eight trials with a total of 197 participants. Aerobic exercise significantly improved the waist circumference (mean difference [MD]=-3.97; 95% confidence interval [CI]=-6.12 to -1.83; p<0.01), body mass index (standardized MD [SMD]=-0.5; 95% CI=-0.70 to -0.29; p<0.01), triglyceride (SMD=-24.6; 95% CI=-33.85 to -15.35; p<0.01), high-density lipoprotein cholesterol (SMD=2.36; 95% CI=0.44 to 4.27; p<0.01), and systolic blood pressure (SMD=-6.90; 95% CI=-10.46 to -3.35; p<0.01). SUMMARY Based on the results of this meta-analysis, during the intervention period of the included studies, aerobic exercise alone mainly affected the lipoprotein, blood pressure, and body dimensions but cannot completely cure the MetS of obese children. OUTLOOK The effects of different types of aerobic exercise on obese children with MetS and exercise dose to cure the MetS of obese children needs to be further studied.
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4.
The Effect of Growth Rate during Infancy on the Risk of Developing Obesity in Childhood: A Systematic Literature Review.
Halilagic, A, Moschonis, G
Nutrients. 2021;(10)
Abstract
The prevalence of childhood obesity has been trending upwards over the last few decades. Recent evidence suggests that infant growth rate has the potential to increase the risk of obesity development during childhood. This systematic literature review aimed to summarise the existing evidence on the relationship between infant growth rate and subsequent childhood obesity. Studies were sought for that assessed the effect of infant growth rate on outcomes of overweight, obesity, BMI, waist circumference or body composition measures among a population group of children aged 2 to 12 years old. Data sources included PubMed, CINAHL, Web of Science and MedLine. Twenty-four studies were identified as eligible and included in this review, out of 2302 publications. The ADA Quality Checklist was used to assess the quality of individual studies. Ten studies received a positive result and 14 studies a neutral result. A narrative synthesis was completed to present study characteristics and results. Several independent positive associations were determined between rapid growth at different stages during infancy and overweight, obesity, BMI, waist circumference and body composition in childhood. Further investigation is required to determine if a specific period of infancy carries greater associations of risk with childhood outcomes. Determining an ideal rate of infants' growth as a means to minimise the future risk of childhood obesity should be the focus of future research that will also inform early life obesity prevention strategies. Registration no.: CRD42021244029.
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5.
Association of maternal caffeine intake during pregnancy with low birth weight, childhood overweight, and obesity: a meta-analysis of cohort studies.
Jin, F, Qiao, C
International journal of obesity (2005). 2021;(2):279-287
Abstract
BACKGROUND Epidemiological studies reported inconsistent results on the associations between maternal caffeine intake during pregnancy and risk of low birth weight (LBW) and childhood overweight and obesity in their offspring. METHODS We conducted a meta-analysis of cohort studies to quantitatively assess these associations. Pertinent studies were identified by searching PubMed and Embase through June 2019. Study-specifics risk estimates were combined using fixed effects models, or random-effects models when significant heterogeneity was detected. Dose-response analysis was modeled by using restricted cubic splines. RESULTS A total of 15 cohort studies, with 102,347 pregnancy women, was included in the meta-analysis. The pooled relative risk (RR) for LBW was 1.33 (95% CI: 1.12, 1.57) for mothers with the highest compared with the lowest level of caffeine intake during pregnancy, with significant heterogeneity across studies (I2 = 49.3%, P = 0.032). The pooled RR was 1.07 (95% CI: 1.02, 1.11) for each 100 mg/day increase of caffeine intake. The pooled RR for childhood overweight and obesity was 1.39 (95% CI: 1.15, 1.69) for mothers with the highest compared with the lowest level of caffeine intake during pregnancy. No significant heterogeneity across studies was detected (I2 = 38.9%, P = 0.179). The pooled RR was 1.31 (95% CI: 1.11, 1.55) for each 100 mg/day increase of caffeine intake. No evidence of publication bias was indicated. CONCLUSIONS Maternal caffeine intake during pregnancy is associated with higher risk of LBW and childhood overweight and obesity. Further studies may focus on investigating the potential mechanisms before the recommendation of complete avoidance of caffeine intake during pregnancy.
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6.
Is School Gardening Combined with Physical Activity Intervention Effective for Improving Childhood Obesity? A Systematic Review and Meta-Analysis.
Qi, Y, Hamzah, SH, Gu, E, Wang, H, Xi, Y, Sun, M, Rong, S, Lin, Q
Nutrients. 2021;(8)
Abstract
School gardening activities (SGA) combined with physical activities (PA) may improve childhood dietary intake and prevent overweight and obesity. This study aims to evaluate the effect of SGA combined with PA on children's dietary intake and anthropometric outcomes. We searched studies containing randomized controlled trials up to January 2021 in Web of Science, PubMed, Cochrane Library, and the EBSCO database on this topic for children aged 7 to 12 years. Fourteen studies met the requirements for meta-analysis (n = 9187). We found that SGA has no obvious effect on improving children's BMI (WMD = -0.49; p = 0.085; I2 = 86.3%), BMI z-score (WMD = -0.12; p = 0.235; I2 = 63.0%), and WC (WMD = -0.98; p = 0.05; I2 = 72.9%). SGA can effectively improve children's FVs (WMD = 0.59, p = 0.003, I2 = 95.3%). SGA combined with PA can significantly increase children's FVs but cannot greatly improve weight status. Although more studies on this topic are needed to prove the effectiveness of this method, the results of our review show that both SGA and SGA combined with PA has a modest but positive impact of reducing BMI and WC outcomes but can significantly increase children's FVs.
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7.
Psychopathological Symptoms and Well-Being in Overweight and Underweight Adolescents: A Network Analysis.
Zeiler, M, Philipp, J, Truttmann, S, Waldherr, K, Wagner, G, Karwautz, A
Nutrients. 2021;(11)
Abstract
Overweight and underweight adolescents have an increased risk of psychological problems and reduced quality of life. We used a network analysis approach on a variety of psychopathology and well-being variables to identify central factors in these populations. The network analysis was conducted on data of 344 overweight adolescents (>90th BMI-percentile) and 423 underweight adolescents (<10th BMI-percentile) drawn from a large community sample (10-19 years) including behavioral and emotional problems (Youth Self-Report), eating disorder risk (SCOFF) and well-being variables (KIDSCREEN). Additionally, psychopathology and well-being scores of overweight and underweight individuals were compared with 1.560 normal weight adolescents. Compared to their normal weight peers, overweight adolescents showed elevated psychopathology and eating disorder risk as well as reduced well-being. Underweight adolescents reported increased levels of internalizing problems but no increased eating disorder risk or reduced well-being. The network analysis revealed that anxious/depressed mood and attention problems were the most central and interconnected nodes for both overweight and underweight subsamples. Among underweight individuals, social problems and socially withdrawn behavior additionally functioned as a bridge between other nodes in the network. The results support psychological interventions focusing on improving mood, coping with negative emotions and tackling inner tension.
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8.
Weight Gain Associated with COVID-19 Lockdown in Children and Adolescents: A Systematic Review and Meta-Analysis.
Chang, TH, Chen, YC, Chen, WY, Chen, CY, Hsu, WY, Chou, Y, Chang, YH
Nutrients. 2021;(10)
Abstract
BACKGROUND Lockdown is an effective nonpharmaceutical intervention to reduce coronavirus disease 2019 (COVID-19) transmission, but it restricts daily activity. We aimed to investigate the impact of lockdown on pediatric body weight and body mass index (BMI). METHODS The systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Four online databases (EMBASE, Medline, the Cochrane Library and CINAHL) were searched. RESULTS The pooled results showed that lockdown was associated with significant body weight gain (MD 2.67, 95% CI 2.12-3.23; p < 0.00001). The BMI of children with comorbidities or obesity did not change significantly. The BMI of general population was significantly higher during lockdown than before the pandemic (MD 0.94, 95% CI 0.32-1.56; p = 0.003). However, heterogeneity was high (I2 = 84%). Among changes in weight classification, increases in the rates of obesity (OR 1.23, 95% CI 1.10-1.37; p = 0.0002) and overweight (OR 1.17, 95% CI 1.06-1.29; p = 0.001) were reported. CONCLUSIONS Our meta-analysis showed significant increases in body weight and BMI during lockdown among school-age children and adolescents. The prevalence of obesity and overweight also increased. The COVID-19 pandemic worsened the burden of childhood obesity.
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9.
The Impact of Childhood Obesity on Joint Alignment: A Systematic Review and Meta-Analysis.
Molina-Garcia, P, Miranda-Aparicio, D, Ubago-Guisado, E, Alvarez-Bueno, C, Vanrenterghem, J, Ortega, FB
Physical therapy. 2021;(7)
Abstract
OBJECTIVE It has been suggested that overweight/obesity (OW/OB) impairs the normal alignment of children and adolescents' musculoskeletal system. However, to date, no study has systematically reviewed or quantified the effect of OW/OB on the development of joint malalignments in children and adolescents. The purpose of this study was to systematically review the association between OW/OB and joint alignment in children and adolescents and to quantify the evidence on whether children and adolescents with OW/OB have a higher risk of developing joint malalignments than their peers of normal weight. METHODS PubMed and Web of Science databases were systematically searched from inception to March 9, 2020. Studies investigating the association between OW/OB and joint alignment in children and adolescents were selected. Nonoriginal articles, participants with movement pattern diseases, and adolescents studied while pregnant were excluded. Two independent reviewers conducted the study selection and data extraction. Qualitative synthesis of evidence and random effect meta-analyses (risk ratio [RR]) were performed. RESULTS Seventy-three studies (5 longitudinal and 68 cross-sectional) met the inclusion criteria involving 1,757,107 children and adolescents. There was consistent evidence supporting associations of OW/OB with rounded shoulder, lumbar hyperlordosis, genu valgum, and flatfoot. Our meta-analysis showed that children and adolescents with OW/OB had a significantly higher risk of lumbar hyperlordosis (RR = 1.41), genu valgum (RR = 5.92), flatfoot (RR = 1.49), and any joint malalignment (RR = 1.68) when compared with their peers of normal weight. The presence of genu valgum and flatfoot were the most robust results. CONCLUSION Based on these findings, OW/OB is associated with the presence of joint malalignments in children and adolescents. IMPACT This is the first study that has systematically reviewed the effect of OW/OB on the development of joint malalignments in children and adolescents.
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10.
Identification and evaluation of risk of generalizability biases in pilot versus efficacy/effectiveness trials: a systematic review and meta-analysis.
Beets, MW, Weaver, RG, Ioannidis, JPA, Geraci, M, Brazendale, K, Decker, L, Okely, AD, Lubans, D, van Sluijs, E, Jago, R, et al
The international journal of behavioral nutrition and physical activity. 2020;(1):19
Abstract
BACKGROUND Preliminary evaluations of behavioral interventions, referred to as pilot studies, predate the conduct of many large-scale efficacy/effectiveness trial. The ability of a pilot study to inform an efficacy/effectiveness trial relies on careful considerations in the design, delivery, and interpretation of the pilot results to avoid exaggerated early discoveries that may lead to subsequent failed efficacy/effectiveness trials. "Risk of generalizability biases (RGB)" in pilot studies may reduce the probability of replicating results in a larger efficacy/effectiveness trial. We aimed to generate an operational list of potential RGBs and to evaluate their impact in pairs of published pilot studies and larger, more well-powered trial on the topic of childhood obesity. METHODS We conducted a systematic literature review to identify published pilot studies that had a published larger-scale trial of the same or similar intervention. Searches were updated and completed through December 31st, 2018. Eligible studies were behavioral interventions involving youth (≤18 yrs) on a topic related to childhood obesity (e.g., prevention/treatment, weight reduction, physical activity, diet, sleep, screen time/sedentary behavior). Extracted information included study characteristics and all outcomes. A list of 9 RGBs were defined and coded: intervention intensity bias, implementation support bias, delivery agent bias, target audience bias, duration bias, setting bias, measurement bias, directional conclusion bias, and outcome bias. Three reviewers independently coded for the presence of RGBs. Multi-level random effects meta-analyses were performed to investigate the association of the biases to study outcomes. RESULTS A total of 39 pilot and larger trial pairs were identified. The frequency of the biases varied: delivery agent bias (19/39 pairs), duration bias (15/39), implementation support bias (13/39), outcome bias (6/39), measurement bias (4/39), directional conclusion bias (3/39), target audience bias (3/39), intervention intensity bias (1/39), and setting bias (0/39). In meta-analyses, delivery agent, implementation support, duration, and measurement bias were associated with an attenuation of the effect size of - 0.325 (95CI - 0.556 to - 0.094), - 0.346 (- 0.640 to - 0.052), - 0.342 (- 0.498 to - 0.187), and - 0.360 (- 0.631 to - 0.089), respectively. CONCLUSIONS Pre-emptive avoidance of RGBs during the initial testing of an intervention may diminish the voltage drop between pilot and larger efficacy/effectiveness trials and enhance the odds of successful translation.