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BMJ Open Jan 2019To systematically examine the evidence of harms and benefits relating to time spent on screens for children and young people's (CYP) health and well-being, to inform...
OBJECTIVES
To systematically examine the evidence of harms and benefits relating to time spent on screens for children and young people's (CYP) health and well-being, to inform policy.
METHODS
Systematic review of reviews undertaken to answer the question 'What is the evidence for health and well-being effects of screentime in children and adolescents (CYP)?' Electronic databases were searched for systematic reviews in February 2018. Eligible reviews reported associations between time on screens (screentime; any type) and any health/well-being outcome in CYP. Quality of reviews was assessed and strength of evidence across reviews evaluated.
RESULTS
13 reviews were identified (1 high quality, 9 medium and 3 low quality). 6 addressed body composition; 3 diet/energy intake; 7 mental health; 4 cardiovascular risk; 4 for fitness; 3 for sleep; 1 pain; 1 asthma. We found moderately strong evidence for associations between screentime and greater obesity/adiposity and higher depressive symptoms; moderate evidence for an association between screentime and higher energy intake, less healthy diet quality and poorer quality of life. There was weak evidence for associations of screentime with behaviour problems, anxiety, hyperactivity and inattention, poorer self-esteem, poorer well-being and poorer psychosocial health, metabolic syndrome, poorer cardiorespiratory fitness, poorer cognitive development and lower educational attainments and poor sleep outcomes. There was no or insufficient evidence for an association of screentime with eating disorders or suicidal ideation, individual cardiovascular risk factors, asthma prevalence or pain. Evidence for threshold effects was weak. We found weak evidence that small amounts of daily screen use is not harmful and may have some benefits.
CONCLUSIONS
There is evidence that higher levels of screentime is associated with a variety of health harms for CYP, with evidence strongest for adiposity, unhealthy diet, depressive symptoms and quality of life. Evidence to guide policy on safe CYP screentime exposure is limited.
PROSPERO REGISTRATION NUMBER
CRD42018089483.
Topics: Adolescent; Adolescent Behavior; Child; Child Behavior; Child, Preschool; Depression; Exercise; Feeding Behavior; Humans; Pediatric Obesity; Quality of Life; Review Literature as Topic; Screen Time
PubMed: 30606703
DOI: 10.1136/bmjopen-2018-023191 -
Pharmacological Research Sep 2021Obesity is frequently a comorbidity of type 2 diabetes. Even modest weight loss can significantly improve glucose homeostasis and lessen cardiometabolic risk factors in...
INTRODUCTION
Obesity is frequently a comorbidity of type 2 diabetes. Even modest weight loss can significantly improve glucose homeostasis and lessen cardiometabolic risk factors in patients with type 2 diabetes, but lifestyle-based weight loss strategies are not long-term effective. There is an increasing need to consider pharmacological approaches to assist weight loss in the so called diabesity syndrome. Aim of this review is to analyze the weight-loss effect of non-insulin glucose lowering drugs in patients with type 2 diabetes.
MATERIAL AND METHODS
A systematic analysis of the literature on the effect of non-insulin glucose lowering drugs on weight loss in patients with type 2 diabetes was performed. For each class of drugs, the following parameters were analyzed: kilograms lost on average, effect on body mass index and body composition.
RESULTS
Our results suggested that anti-diabetic drugs can be stratified into 3 groups based on their efficacy in weight loss: metformin, acarbose, empagliflozin and exenatide resulted in a in a mild weight loss (less than 3.2% of initial weight); canagliflozin, ertugliflozin, dapagliflozin and dulaglutide induces a moderate weight loss (between 3.2% and 5%); liraglutide, semaglutide and tirzepatide resulted in a strong weight loss (greater than 5%).
CONCLUSIONS
This study shows that new anti-diabetic drugs, particularly GLP1-RA and Tirzepatide, are the most effective in inducing weight loss in patients with type 2 diabetes. Interestingly, exenatide appears to be the only GLP1-RA that induces a mild weight loss.
Topics: Diabetes Mellitus, Type 2; Gastric Inhibitory Polypeptide; Glucagon-Like Peptide 1; Glucagon-Like Peptide-1 Receptor; Humans; Hypoglycemic Agents; Obesity; Weight Loss
PubMed: 34302978
DOI: 10.1016/j.phrs.2021.105782 -
The International Journal of Behavioral... Aug 2017A wide range of interventions has been implemented and tested to prevent obesity in children. Given parents' influence and control over children's energy-balance... (Review)
Review
BACKGROUND
A wide range of interventions has been implemented and tested to prevent obesity in children. Given parents' influence and control over children's energy-balance behaviors, including diet, physical activity, media use, and sleep, family interventions are a key strategy in this effort. The objective of this study was to profile the field of recent family-based childhood obesity prevention interventions by employing systematic review and quantitative content analysis methods to identify gaps in the knowledge base.
METHODS
Using a comprehensive search strategy, we searched the PubMed, PsycIFO, and CINAHL databases to identify eligible interventions aimed at preventing childhood obesity with an active family component published between 2008 and 2015. Characteristics of study design, behavioral domains targeted, and sample demographics were extracted from eligible articles using a comprehensive codebook.
RESULTS
More than 90% of the 119 eligible interventions were based in the United States, Europe, or Australia. Most interventions targeted children 2-5 years of age (43%) or 6-10 years of age (35%), with few studies targeting the prenatal period (8%) or children 14-17 years of age (7%). The home (28%), primary health care (27%), and community (33%) were the most common intervention settings. Diet (90%) and physical activity (82%) were more frequently targeted in interventions than media use (55%) and sleep (20%). Only 16% of interventions targeted all four behavioral domains. In addition to studies in developing countries, racial minorities and non-traditional families were also underrepresented. Hispanic/Latino and families of low socioeconomic status were highly represented.
CONCLUSIONS
The limited number of interventions targeting diverse populations and obesity risk behaviors beyond diet and physical activity inhibit the development of comprehensive, tailored interventions. To ensure a broad evidence base, more interventions implemented in developing countries and targeting racial minorities, children at both ends of the age spectrum, and media and sleep behaviors would be beneficial. This study can help inform future decision-making around the design and funding of family-based interventions to prevent childhood obesity.
Topics: Adolescent; Australia; Child; Child, Preschool; Developing Countries; Diet; Energy Intake; Europe; Exercise; Family; Health Behavior; Humans; Minority Groups; Obesity; Pediatric Obesity; Research Design; Risk-Taking; United States
PubMed: 28836983
DOI: 10.1186/s12966-017-0571-2 -
Nutrients Mar 2023Overweight and obesity in childhood and adolescence represents one of the most challenging public health problems of our century owing to its epidemic proportions and... (Review)
Review
Overweight and obesity in childhood and adolescence represents one of the most challenging public health problems of our century owing to its epidemic proportions and the associated significant morbidity, mortality, and increase in public health costs. The pathogenesis of polygenic obesity is multifactorial and is due to the interaction among genetic, epigenetic, and environmental factors. More than 1100 independent genetic loci associated with obesity traits have been currently identified, and there is great interest in the decoding of their biological functions and the gene-environment interaction. The present study aimed to systematically review the scientific evidence and to explore the relation of single-nucleotide polymorphisms (SNPs) and copy number variants (CNVs) with changes in body mass index (BMI) and other measures of body composition in children and adolescents with obesity, as well as their response to lifestyle interventions. Twenty-seven studies were included in the qualitative synthesis, which consisted of 7928 overweight/obese children and adolescents at different stages of pubertal development who underwent multidisciplinary management. The effect of polymorphisms in 92 different genes was assessed and revealed SNPs in 24 genetic loci significantly associated with BMI and/or body composition change, which contribute to the complex metabolic imbalance of obesity, including the regulation of appetite and energy balance, the homeostasis of glucose, lipid, and adipose tissue, as well as their interactions. The decoding of the genetic and molecular/cellular pathophysiology of obesity and the gene-environment interactions, alongside with the individual genotype, will enable us to design targeted and personalized preventive and management interventions for obesity early in life.
Topics: Adolescent; Child; Humans; Pediatric Obesity; Overweight; Body Mass Index; Genotype; Polymorphism, Single Nucleotide
PubMed: 36986146
DOI: 10.3390/nu15061416 -
International Journal of Environmental... Mar 2021High prevalence of physical inactivity and obesity in children and adolescents has become a global problem. This systematic review aimed to examine the existing... (Review)
Review
High prevalence of physical inactivity and obesity in children and adolescents has become a global problem. This systematic review aimed to examine the existing literature regarding the factors that influence participation in physical activity (PA) in children and adolescents with reference to the social ecological model (SEM) proposed by McLeroy et al. (1988). The SEM provides a framework under which the influencing factors are categorized into five levels: intrapersonal, interpersonal, organizational, community, and public policy. A systematic search of relevant literature published before July 2020 was conducted through Ebsco, ProQuest, PubMed Central, Scopus, and Web of Science. A total of fourteen studies met the inclusion criteria. The selected articles were all of high quality as assessed using the Mixed Methods Appraisal Tool (2018). The results indicated that gender, age, ethnicity, and self-concept were the most common influencing factors at the intrapersonal level. At the interpersonal and organization levels, supports from friends, parents, and teachers were positive predictors of students' PA participation. Accessibility of facilities and safe neighborhoods was a crucial factor that influenced children and adolescents' participation in PA at the community level. Future studies on the effective types of policies or practices that could successfully promote facilities' accessibility and improve neighborhood safety are required. The outcomes of this systematic review are expected to inform practice and support the development and implementation of sound policies for the promotion of PA participation in children or adolescents from a comprehensive social ecological viewpoint.
Topics: Adolescent; Child; Exercise; Humans; Pediatric Obesity; Schools; Sedentary Behavior; Social Environment
PubMed: 33803733
DOI: 10.3390/ijerph18063147 -
Maternal & Child Nutrition Jul 2022The prevalence of childhood obesity is increasing worldwide with long-term health consequences. Effective strategies to stem the rising childhood obesity rates are... (Review)
Review
The prevalence of childhood obesity is increasing worldwide with long-term health consequences. Effective strategies to stem the rising childhood obesity rates are needed but systematic reviews of interventions have reported inconsistent effects. Evaluation of interventions could provide more practically relevant information when considered in the context of the setting in which the intervention was delivered. This systematic review has evaluated diet and physical activity interventions aimed at reducing obesity in children, from birth to 5 years old, by intervention setting. A systematic review of the literature, consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Three electronic databases were searched from 2010 up to December 2020 for randomised controlled trials aiming to prevent or treat childhood obesity in children up to 5 years old. The studies were stratified according to the setting in which the intervention was conducted. Twenty-eight studies were identified and included interventions in childcare/school (n = 11), home (n = 5), community (n = 5), hospital (n = 4), e-health (n = 2) and mixed (n = 1) settings. Thirteen (46%) interventions led to improvements in childhood obesity measures, including body mass index z-score and body fat percentage, 12 of which included both parental/family-based interventions in conjunction with modifying the child's diet and physical activity behaviours. Home-based interventions were identified as the most effective setting as four out of five studies reported significant changes in the child's weight outcomes. Interventions conducted in the home setting and those which included parents/families were effective in preventing childhood obesity. These findings should be considered when developing optimal strategies for the prevention of childhood obesity.
Topics: Body Mass Index; Child; Diet; Exercise; Humans; Overweight; Parents; Pediatric Obesity
PubMed: 35333450
DOI: 10.1111/mcn.13354 -
Archives of Disease in Childhood Jan 2019To compare the odds of depression in obese and overweight children with that in normal-weight children in the community. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To compare the odds of depression in obese and overweight children with that in normal-weight children in the community.
DESIGN
Systematic review and random-effect meta-analysis of observational studies.
DATA SOURCES
EMBASE, PubMed and PsychINFO electronic databases, published between January 2000 and January 2017.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Cross-sectional or longitudinal observational studies that recruited children (aged <18 years) drawn from the community who had their weight status classified by body mass index, using age-adjusted and sex-adjusted reference charts or the International Obesity Task Force age-sex specific cut-offs, and concurrent or prospective odds of depression were measured.
RESULTS
Twenty-two studies representing 143 603 children were included in the meta-analysis. Prevalence of depression among obese children was 10.4%. Compared with normal-weight children, odds of depression were 1.32 higher (95% CI 1.17 to 1.50) in obese children. Among obese female children, odds of depression were 1.44 (95% CI 1.20 to 1.72) higher compared with that of normal-weight female children. No association was found between overweight children and depression (OR 1.04, 95% CI 0.95 to 1.14) or among obese or overweight male subgroups and depression (OR 1.14, 95% CI 0.93 to 1.41% and 1.08, 95% CI 0.85 to 1.37, respectively). Subgroup analysis of cross-sectional and longitudinal studies separately revealed childhood obesity was associated with both concurrent (OR 1.26, 95% CI 1.09 to 1.45) and prospective odds (OR 1.51, 95% CI 1.21 to 1.88) of depression.
CONCLUSION
We found strong evidence that obese female children have a significantly higher odds of depression compared with normal-weight female children, and this risk persists into adulthood. Clinicians should consider screening obese female children for symptoms of depression.
BACKGROUND
Childhood mental illness is poorly recognised by healthcare providers and parents, despite half of all lifetime cases of diagnosable mental illness beginning by the age of 14 years. Globally, depression is the leading cause of disease burden, as measured by disability-adjusted life years, in children aged 10-19 years. Untreated, it is associated with poor school performance and social functioning, substance misuse, recurring depression in adulthood and increased suicide risk, which is the second leading cause of preventable death among young people. The resulting cost to the National Health Service of treating depression is estimated at over £2 billion, and the wider social and economic impact of depression is likely to be considerable. .
Topics: Child; Child Health; Depression; Humans; Mental Health; Observational Studies as Topic; Pediatric Obesity; Suicide; Suicide Prevention
PubMed: 29959128
DOI: 10.1136/archdischild-2017-314608 -
PloS One 2016Adolescent obesity and depression are increasingly prevalent and are currently recognised as major public health concerns worldwide. The aim of this study is to evaluate... (Meta-Analysis)
Meta-Analysis Review
Adolescent obesity and depression are increasingly prevalent and are currently recognised as major public health concerns worldwide. The aim of this study is to evaluate the bi-directional associations between obesity and depression in adolescents using longitudinal studies. A systematic literature search was conducted using Pubmed (including Medline), PsycINFO, Embase, CINAHL, BIOSIS Preview and the Cochrane Library databases. According to the inclusion criteria, 13 studies were found where seven studies evaluated depression leading to obesity and six other studies examined obesity leading to depression. Using a bias-adjusted quality effects model for the meta-analysis, we found that adolescents who were depressed had a 70% (RR 1.70, 95% CI: 1.40, 2.07) increased risk of being obese, conversely obese adolescents had an increased risk of 40% (RR 1.40, 95% CI: 1.16, 1.70) of being depressed. The risk difference (RD) of early adolescent depression leading to obesity is 3% higher risk than it is for obesity leading to depression. In sensitivity analysis, the association between depression leading to obesity was greater than that of obesity leading to depression for females in early adulthood compared with females in late adolescence. Overall, the findings of this study suggest a bi-directional association between depression and obesity that was stronger for female adolescents. However, this finding also underscores the importance of early detection and treatment strategies to inhibit the development of reciprocal disorders.
Topics: Adolescent; Depression; Depressive Disorder; Female; Humans; Longitudinal Studies; Male; Pediatric Obesity; Prospective Studies; Risk
PubMed: 27285386
DOI: 10.1371/journal.pone.0157240 -
Pharmacological Research Jun 2023Due to the lipophilic nature of vitamin D, overweight and obese patients have an increased risk of inadequate circulating 25-hydroxy-vitamin D (25(OH)D) concentrations.... (Meta-Analysis)
Meta-Analysis Review
Due to the lipophilic nature of vitamin D, overweight and obese patients have an increased risk of inadequate circulating 25-hydroxy-vitamin D (25(OH)D) concentrations. Vitamin D deficiency has in turn several consequences especially among children and adolescents. Therefore, a few supplementation strategies of vitamin D for pediatric subjects with an excessive body weight have been proposed, but their efficacy remains controversial. The aim of this systematic review and meta-analysis was to evaluate the effect of vitamin D supplementation in overweight and obese children and adolescents. Three databases (PubMed, Embase and Web of Science) were searched to collect trials on the effect of vitamin D supplementation in the pediatric overweight or obese population. Twenty-three studies were included in the systematic review. Results on modification of metabolic or cardiovascular outcomes were controversial. On the other hand, the meta-analysis showed a mean difference by 1.6 ng/ml in subjects supplemented with vitamin D as compared to placebo. In conclusion, vitamin D supplementation slightly increases 25(OH)D levels in pediatric subjects with overweight and obesity. However, the effects on metabolic and cardiovascular outcomes remain controversial. New efforts should be devoted to promoting effective interventions to improve the health of children and adolescents with overweight and obesity.
Topics: Humans; Child; Adolescent; Overweight; Pediatric Obesity; Vitamin D; Vitamin D Deficiency; Dietary Supplements; Vitamins; Weight Gain
PubMed: 37178775
DOI: 10.1016/j.phrs.2023.106793 -
Advances in Nutrition (Bethesda, Md.) Jul 2023To our knowledge, no systematic review with meta-analysis has separately synthesized the effects of Mediterranean diet-based interventions in children and adolescents in... (Meta-Analysis)
Meta-Analysis Review
Mediterranean Diet-Based Interventions to Improve Anthropometric and Obesity Indicators in Children and Adolescents: A Systematic Review with Meta-Analysis of Randomized Controlled Trials.
To our knowledge, no systematic review with meta-analysis has separately synthesized the effects of Mediterranean diet-based interventions in children and adolescents in relation to the effects on anthropometric measures. A better understanding of the effects of Mediterranean diet-based interventions on anthropometric variables could facilitate their implementation in efforts to prevent obesity in the young population. The aim of the present meta-analysis was to evaluate the effects of Mediterranean diet-based interventions on anthropometric and obesity indicators among children and adolescents. Four databases were systematically searched (PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews), including all studies up until 15 March, 2023. Eligible articles were randomized controlled trials measuring the effect of an intervention based on the promotion of the Mediterranean diet and obesity-associated parameters. The effect size of each study was estimated by Cohen's d for continuous variables or risk difference for categorical variables. Compared to the control group, the Mediterranean diet-based interventions showed small and significant reductions in body mass index (d = -0.14; 95% CI: -0.26, -0.01; I = 77.52%). Participants in the Mediterranean diet-based interventions had a significant reduction in the percentage of obesity (risk difference = 0.12; 95% CI: 0.01, 0.23; I = 84.56%) in comparison with the control group. Interventions had greater effects when aiming at participants with excess weight (that is, overweight or obesity), both for body mass index, waist circumference, waist-to-height ratio, percentage of obesity, and percentage of abdominal obesity. Mediterranean diet-based interventions have a significant effect on reducing the body mass index as well as reducing obesity in children and adolescents (aged 3-18 y). This trial was registered at PROSPERO as CRD42023386789.
Topics: Child; Humans; Adolescent; Pediatric Obesity; Diet, Mediterranean; Exercise; Randomized Controlled Trials as Topic; Overweight; Body Mass Index
PubMed: 37127186
DOI: 10.1016/j.advnut.2023.04.011