Summary
Background
Ample evidence attests to the relationship between short sleep duration, sleep problems and childhood obesity. However, few studies have examined the association between sleep ...timing and obesity in children.
Objectives
To investigate how sleep duration, problems and timing relate to obesity and obesogenic behaviours in children.
Methods
Eighty‐five children (58.8% girls) with severe obesity and mean (SD) age of 12.1 (2.9) years, were matched by age and sex with peers with normal weight (n = 85,12.0 2.8 years). Sleep and moderate‐to‐vigorous physical activity (MVPA) were measured via accelerometer for seven consecutive days. Children self‐reported emotional eating on the Dutch eating behavior questionnaire. Parents reported children's screen time and sleep problems.
Results
Children with severe obesity had significantly later mean mid‐sleep time, overall (36 minutes later, P < .001), on school nights (36 minutes later, P < .001) and weekend nights (39 minutes later, P = .002) compared to children with normal weight. Children with obesity had more sleep problems (P = .030), but no differences emerged in sleep duration or social jetlag. After adjusting for demographic factors, mid‐sleep time was positively related to screen time (P = .030). Mid‐sleep time and sleep duration were inversely related to time in MVPA (Ps ≤ .041). There were no other significant associations between the sleep variables and the obesogenic behaviours.
Conclusions
Later sleep timing was related to obesogenic behaviours in children and may represent an obesity risk factor.
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BFBNIB, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Aim
The World Health Organization (WHO) published universal growth standards for children below five year of age in 2006. Traditionally, Swedish growth references have been used to monitor growth of ...children in Iceland, but it is not yet known how they compare with these reference charts.
Methods
A total of 2128 longitudinal measurements of length or height, 2132 of weight and 2126 of head circumference between birth and four years of age were collected in 1996‐2000 from 199 healthy children (53% boys) recruited at Landspitali University Hospital. Measurements were converted to z‐scores using the WHO growth standards and Swedish growth references for further analysis with mixed‐effects models.
Results
Length or height, weight and in particular head circumference largely exceeded the WHO standards, with average z‐scores that fluctuated between 0.5 and 1.5. Likewise, the proportion of children with a z‐score larger than 2 SD increased about 10‐fold. Icelandic children were longer and heavier than their Swedish peers during the first six months of life, but differences were less pronounced thereafter.
Conclusion
The growth of Icelandic children deviated significantly from the WHO growth standards. Although more comparable to the Swedish references, significant differences were found, suggesting that a national growth reference would be more appropriate.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Brachyolmia is a skeletal dysplasia characterized by short spine‐short stature, platyspondyly, and minor long bone abnormalities. We describe 18 patients, from different ethnic backgrounds and ages ...ranging from infancy to 19 years, with the autosomal recessive form, associated with PAPSS2. The main clinical features include disproportionate short stature with short spine associated with variable symptoms of pain, stiffness, and spinal deformity. Eight patients presented prenatally with short femora, whereas later in childhood their short‐spine phenotype emerged. We observed the same pattern of changing skeletal proportion in other patients. The radiological findings included platyspondyly, irregular end plates of the elongated vertebral bodies, narrow disc spaces and short over‐faced pedicles. In the limbs, there was mild shortening of femoral necks and tibiae in some patients, whereas others had minor epiphyseal or metaphyseal changes. In all patients, exome and Sanger sequencing identified homozygous or compound heterozygous PAPSS2 variants, including c.809G>A, common to white European patients. Bi‐parental inheritance was established where possible. Low serum DHEAS, but not overt androgen excess was identified. Our study indicates that autosomal recessive brachyolmia occurs across continents and may be under‐recognized in infancy. This condition should be considered in the differential diagnosis of short femora presenting in the second trimester.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
The purpose of the FABO-study is to evaluate the effect of family-based behavioral social facilitation treatment (FBSFT), designed to target children's family and social support networks to enhance ...weight loss outcomes, compared to the standard treatment (treatment as usual, TAU) given to children and adolescents with obesity in a routine clinical practice.
Randomized controlled trial (RCT), in which families (n = 120) are recruited from the children and adolescents (ages 6-18 years) referred to the Obesity Outpatient Clinic (OOC), Haukeland University Hospital, Norway. Criteria for admission to the OOC are BMI above the International Obesity Task Force (IOTF) cut-off ≥ 35, or IOTF ≥ 30 with obesity related co-morbidity. Families are randomized to receive FBSFT immediately or following one year of TAU. All participants receive a multidisciplinary assessment. For TAU this assessment results in a plan and a contract for chancing specific lifestyle behaviors. Thereafter each family participates in monthly counselling sessions with their primary health care nurse to work on implementing these goals, including measuring their weight change, and also meet every third month for sessions at the OOC. In FBSFT, following assessment, families participate in 17 weekly sessions at the OOC, in which each family works on changing lifestyle behaviors using a structured cognitive-behavioral, socio-ecological approach targeting both parents and children with strategies for behavioral maintenance and sustainable weight change. Outcome variables include body mass index (BMI; kg/m
), BMI standard deviation score (SDS) and percentage above the IOTF definition of overweight, waist-circumference, body composition (bioelectric impedance (BIA) and dual-X-ray-absorptiometry (DXA)), blood tests, blood pressure, activity/inactivity and sleep pattern (measured by accelerometer), as well as questionnaires measuring depression, general psychological symptomatology, self-esteem, disturbed eating and eating disorder symptoms. Finally, barriers to treatment and parenting styles are measured via questionnaires.
This is the first systematic application of FBSFT in the treatment of obesity among youth in Norway. The study gives an opportunity to evaluate the effect of FBSFT implemented in routine clinical practice across a range of youth with severe obesity.
ClinicalTrails.gov NCT02687516 . Registered 16th of February, 2016.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The aim of this study was to explore the association between adolescent subjective social status (SSS) and body mass index (BMI) at two different time points and to determine whether this association ...was mediated by health-related behaviors. In 2002 (n = 1596) and 2017 (n = 1534), tenth-grade students (15-16 years old) in schools in the District of Oppland, Norway, completed a survey. Four categories of perceived family economy were measured as SSS, and structural equation modeling was performed, including a latent variable for unhealthy behavior derived from cigarette smoking, snuff-use, and alcohol-drinking as well as dietary and exercise as mediators. No linear association was found between SSS and BMI in 2002 (standardized ß -0.02, (95% confidence interval (CI) -0.07, 0.03)). However, an association was present in 2017 (standardized ß -0.05 (95% CI -0.10, -0.001)), indicating that BMI decreased by 0.05 standard deviations (0.05 × 3.1 = 0.16 BMI unit) for every one-category increase in SSS. This association was mediated by exercise (standardized ß -0.013 (95% CI -0.02, -0.004) and unhealthy behavior (standardized ß -0.009 (95% CI -0.002, -0.04)). In conclusion, a direct association between SSS and BMI was found in 2017 in this repeated cross-sectional survey of 15-16-year-old Norwegian adolescents. This association was mediated through health-related behavior.
Background
Previous studies investigating the association between weight status and onset of puberty in boys have been equivocal. It is currently unclear to what extent weight class influences ...puberty onset and progression.
Objectives
To explore the relationship between degree of sexual maturation and anthropometric measures in Norwegian boys.
Methods
The following endpoints were collected in a Norwegian cross‐sectional study of 324 healthy boys aged 9–16: ultrasound‐determined testicular volume (USTV), total serum testosterone, Tanner pubic hair stage, height, weight, waist circumference (WC), subscapular skinfolds (SSF), and body fat percentage (%BF). Testicular volume‐for‐age z‐scores were used to classify “early,” “average,” or “late” maturing boys. Ordinal logistic regression analyses with a proportional odds model were applied to analyze the association between anthropometric variables and age‐adjusted degree of pubertal development, with results expressed as age‐adjusted odds ratios (AOR). Cumulative incidence curves for reaching pubertal milestones were stratified by BMI.
Results
Boys with a low BMI for age (BMIz < −1) were less likely to have reached a pubertal testicular volume (USTV ≥ 2.7 mL) or a pubertal serum level of testosterone (≥0.5 nmol/L) compared to normal weight boys (AOR 0.3, p = 0.038, AOR 0.3, p = 0.026, respectively), and entered puberty on average with a delay of approximately eight months. Boys with high BMI for age (BMIz > 1) exhibited a comparable timing as normal weight boys. The same was found for WC. Pubertal markers were not associated with SSF or %BF.
Conclusion
By examining the association between puberty and weight status classified as low, average, or high, we found that a low BMI or WC for age were associated with a less advanced pubertal development and delayed timing of puberty in boys. No significant association was observed for a high BMI or WC. Moreover, no significant effects of SSF or %BF were observed. A low weight status should also be considered when assessing pubertal development in boys.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
The prevalence of overweight and obesity (OWOB) has stabilized in some countries, but a portion of children with high body mass index (BMI) may have become heavier. This study aimed to describe the ...distributions of BMI and the point prevalence of OWOB in Norwegian adolescents in 2002 and 2017.
A cross-sectional study involving 15- to 16-year-old adolescents in Oppland, Norway, was undertaken in 2002 and 2017. We calculated their BMI, BMI z-scores (BMIz), and the prevalence of OWOB.
The mean BMI increased from 20.7 to 21.4 (p < 0.001) for girls but remained unchanged at 21.5 vs 21.4 (p = 0.80) for boys. The prevalence of OWOB increased from 9 to 14% among girls (difference 5, 95% CI: 2, 8) and from 17 to 20% among boys (difference 3, 95% CI: - 1, 6%). The BMI density plots revealed similar shapes at both time points for both sexes, but the distribution for girls shifted to the right from 2002 to 2017.
Contrary to previous knowledge, we found that the increase in OWOB presented a uniform shift in the entire BMI distribution for 15-16-year-old Norwegian girls and was not due to a larger shift in a specific subpopulation in the upper percentiles.
Aim
The aim was to examine if breastfeeding practices were associated with body mass index (BMI) and risk of overweight or obesity in third grade (8 years) of elementary school.
Methods
In a regional ...cohort, we related BMI z‐scores and presence of overweight or obesity at 8 years of age with ever being breastfed and with duration of exclusive and partial breastfeeding after adjusting for potential confounders. Parents completed questionnaires on breastfeeding and sociodemographic and lifestyle factors at school entry, and public health nurses measured height and weight. For non‐participants, the nurses anonymously reported these measurements together with sex and age.
Results
90% of participants had been breastfed. In adjusted analyses, BMI z‐scores were not significantly related to whether or not the child had been breastfed (P = .64), or to the duration of exclusive (P = .80) or partial breastfeeding (P = .94). Logistic regression also showed no significant association between breastfeeding measures and overweight or obesity.
Conclusion
This study on 8‐year‐old Norwegian children did not support a commonly held notion that breastfeeding reduces the risk of overweight or obesity.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Abstract
Context
Metformin is used in pregnancy in women with gestational diabetes mellitus, polycystic ovary syndrome (PCOS), and obesity. Metformin passes the placenta.
Objective
To explore the ...effects of metformin use in PCOS pregnancies on offspring growth to 4 years of age.
Design
Follow-up study of two randomized, double-blind, placebo-controlled trials.
Setting
Secondary care centers. Eleven public hospitals in Norway.
Participants
One hundred eighty-two children of mothers with PCOS who participated in two randomized controlled trials.
Intervention
Metformin 1700 or 2000 mg/d or placebo from first trimester to delivery in the original studies. No intervention in the current study.
Main Outcome Measures
Height, weight, body mass index (BMI), and overweight/obesity at 4 years of age and head circumference at 1 year of age, converted to z scores.
Results
The difference in height z score means between the groups at 4 years of age was nonsignificant (0.07 95% confidence interval (CI): –0.22 to 0.36; P = 0.651). At 4 years of age, the metformin group had higher weight z score than the placebo group difference in means: 0.38 (0.07 to 0.69); P = 0.017 and higher BMI z score difference in means: 0.45 (0.11 to 0.78); P = 0.010. There were more overweight/obese children in the metformin group 26 (32%) than in the placebo group 14 (18%) at 4 years of age odds ratio: 2.17 (1.04 to 4.61); P = 0.038. The difference in mean head circumference z score at 1 year of age was 0.27 (–0.04 to 0.58; P = 0.093).
Conclusion
Metformin-exposed children had higher BMI and increased prevalence of overweight/obesity at 4 years of age.
The effects of metformin use in PCOS pregnancies on offspring growth were examined. At 4 years of age, more children were overweight/obese in the metformin group compared with the placebo group.
Background
Treatment seeking children and adolescents with severe obesity often experience barriers to physical activity. Studies objectively measuring physical activity in this group and ...investigating explanatory factors for physical activity levels could inform clinical practice.
Objectives
This study aimed to compare objectively measured physical activity levels among treatment seeking children and adolescents with severe obesity and normal weight peers, and to investigate explanatory factors for time spent in moderate physical activity and vigorous physical activity among children and adolescents with severe obesity.
Methods
Children with severe obesity (n = 85) were matched 1:1 by age, gender, and the season for accelerometer measurements with normal weight peers (n = 85). Children wore accelerometers for seven consecutive days, yielding measures of physical activity, sleep duration and timing. Parents reported on screen time, parental body mass index and participation in organized sports.
Results
Children and adolescents with severe obesity spent significantly less time in moderate physical activity (12 min, p < 0.001) and vigorous physical activity (21 min, p < 0.001) per day compared to normal weight peers. No difference for time spent in sedentary activity was found between groups. For participants with severe obesity, age ≤12 years (p = 0.009) and participation in organized sports (p = 0.023) were related to more moderate physical activity, while age ≤12 years (p = 0.038) and early sleep timing (p = 0.019) were related to more vigorous physical activity.
Conclusion
Children and adolescents with severe obesity were less physically active than their normal weight peers. Factors related to more moderate and vigorous physical activity in children with severe obesity were lower age, participation in organized sports and earlier sleep timing.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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