April 2024

Celebrating a Milestone: NCCOR's 2023 Annual Report Showcases Strategic Impact on Childhood Obesity Research

April 2024, NCCOR

NCCOR announces the publication of our 2023 Annual Report, “Making a Strategic Difference.” The report highlights the past year’s achievements and features a special section celebrating NCCOR’s 15-year anniversary.

A Legacy of Impact and Innovation
When NCCOR began, childhood obesity rates were rising, and prevention research faced several challenges. The field needed new measures, and organizations had few opportunities to collaborate, share resources, or create a cohesive approach. In response, leading funders proposed a pioneering solution—a research collaborative that would harness the power of multi-agency and multi-disciplinary teams to advance strategic priorities that no single organization could accomplish alone.

Today, NCCOR stands as a testament to the power of collaboration. Over the past 15 years, NCCOR has created seven innovative research tools, published over 200 resources and research articles, hosted more than 70 webinars and workshops, and fostered a dynamic research community. The 2023 Annual Report highlights this history and features a visually engaging timeline showcasing a selection of NCCOR’s major activities and achievements.

Highlighting Key Achievements of 2023
In addition to reflecting on NCCOR’s history, the 2023 Annual Report highlights accomplishments of the past year, including:

• Introducing sleep variables into the Catalogue of Surveillance Systems, a major achievement that will make it easier for researchers to study the interconnected relationships between diet, physical activity, and sleep.
• Publishing new recommendations to improve dietary assessment methods for children aged six to 24 months.
• Supporting outreach and communication efforts to support the new Healthy Eating Index and USDA’s healthy equity framework.
• Advancing strategies to improve measures for addressing social determinants of health.Launching a new NCCOR website, with one of the most comprehensive repositories of childhood obesity research online.

Please visit the NCCOR website for more information and to download the full 2023 Annual Report.

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NCCOR Toolbox: Sleep Webinar Now Available Online

April 2024, NCCOR

Did you miss last month’s Connect & Explore webinar on the link between sleep health and childhood obesity? Now you can watch the recording and download the slides for “Sleep’s Role in Child Health: Expanding NCCOR’s Catalogue of Surveillance Systems” on the NCCOR website. This 1-hour webinar featured experts from the National Institutes of Health who led the effort to add sleep variables to the Catalogue of Surveillance Systems (CSS). Our speakers discussed the intersection between sleep and childhood obesity and explained how the new sleep variables can advance childhood obesity research.

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Celebrating 50 Years of WIC

April 2024, NCCOR

Since the first clinic opened in 1974, WIC has improved the health and well-being of millions of pregnant women, infants, children, and families. The National WIC Association is celebrating this remarkable legacy and continuing to advocate for a bright and promising future of WIC. Visit their website to download partner resources and view their video series featuring the stories of those whose lives have been positively affected by WIC.

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SHAPE America’s new National Physical Activity Plan

April 2024, NCCOR

SHAPE America’s new National Physical Education Standards and National Health Education Standards — released in 2024 after a multi-year revision process — provide a comprehensive framework for educators to deliver high-quality instruction and make a positive difference in the health and well-being of every student. The SHAPE America website contains detailed standards for different audiences and a free educator toolkit with resources to share with administrators, colleagues, parents, and the community.

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New Research Findings on the Impact of School Meals for All

April 2024, NCCOR

A new recording from the Food Research & Action Center (FRAC) shares findings and key recommendations from two new FRAC reports: The Reach of School Breakfast and Lunch During the 2022–2023 School Year and The State of Healthy School Meals for All: California, Maine, Massachusetts, Nevada, and Vermont Lead the Way. These complementary reports shine a light on what happened in states with the end of the nationwide waivers which allowed schools to offer meals at no charge during the pandemic, and how statewide policies in five states helped to counteract the impact of the waivers expiring.

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Study Suggests High Blood Pressure Could Begin in Childhood

March 31, 2024, EurekAlert!

Children and teenagers living with overweight or obesity are more likely to have high blood pressure as adults (aged 50-64 years), suggesting the processes behind the condition could begin as early as childhood, suggests new research being presented at this year’s European Congress on Obesity (ECO) in Venice, Italy (12-15 May). Children and teenagers living with overweight or obesity are more likely to have high blood pressure as adults (aged 50-64 years), suggesting the processes behind the condition could begin as early as childhood, suggests new research being presented at this year’s European Congress on Obesity (ECO) in Venice, Italy (12-15 May).

Results of the Swedish population-based study showed that blood pressure in adult men increased in a linear relationship with both higher childhood BMI (at age 8 years) and greater BMI change during puberty (BMI at 20 years minus childhood BMI), independent of each other. In women, blood pressure in middle age increased in linear association with greater pubertal BMI change, but not childhood BMI.

“Our results suggest that preventing overweight and obesity beginning in childhood matters when it comes to achieving a healthy blood pressure in later life”, says lead author Dr Lina Lilja from the University of Gothenburg in Sweden. “Children and teenagers living with overweight or obesity might benefit from targeted initiatives and lifestyle modifications to reduce the substantial disease burden associated with high blood pressure in later life from diseases such as heart attacks, strokes, and kidney damage.”

Hypertension (persistent high blood pressure) is an important public health challenge worldwide because of its high prevalence and the associated risk of cardiovascular disease. WHO estimates that 1.28 billion adults aged 30-79 years are living with hypertension around the world [1]. High blood pressure is the main cause of heart attacks, strokes, and chronic kidney disease, and is one of the most preventable and treatable causes of premature deaths worldwide. Modifiable risk factors include unhealthy diets, physical inactivity, and being overweight or obese.

A high BMI in adults is strongly associated with increased blood pressure and hypertension. However, the relative contribution of an elevated BMI during childhood and puberty to blood pressure in midlife is unknown.

To find out more, researchers analysed data on 1,683 individuals (858 men and 825 women) born between 1948 and 1968 who were involved in two population-based cohorts—both the BMI Epidemiology Study Gothenburg (BEST) cohort and the Swedish CArdioPulmonary bioImage Study (SCAPIS)—to examine the association between BMI during development and systolic and diastolic blood pressure in midlife (50-64 years of age).

The researchers measured the developmental BMI of participants from the BEST Gothenburg cohort using school health care records (at the age of 7 to 8 years) and for young adult age (at age 18 to 20) from school health care or medical examinations on enrolment in the military which was mandatory for young men until 2010. Information on blood pressure in midlife (at age 50-64 years) was taken from participants in the SCAPIS study who were not on medication for high blood pressure at the time of blood pressure measurement. All analyses were adjusted for birth year.

The researchers used standard deviation, a commonly used statistical tool that shows what is within a normal range compared to the average.

In analyses including both childhood BMI and the pubertal BMI change in the same model, results showed that for men, an increase of one BMI unit from the average BMI in childhood (BMI 15.6kg/m2) was associated with a 1.30 mmHg increase in systolic blood pressure and a 0.75 mmHg increase in diastolic blood pressure, independent of each other.

Similarly, a one BMI unit increase from the average pubertal BMI (equivalent to an average pubertal BMI change of 5.4kg/m2) in men was associated with a 1.03 mmHg increase in systolic blood pressure and a 0.53 mmHg increase in diastolic blood pressure in middle age, independent of each other.

In women, a one BMI unit increase in pubertal BMI was associated with a 0.96 mmHg increase in systolic blood pressure and a 0.77 mmHg increase in diastolic blood pressure in middle age, irrespective of childhood BMI. In contrast, childhood BMI was not linked with systolic or diastolic blood pressure in midlife, irrespective of the pubertal BMI change.

“Although the differences in blood pressure are not very large, if blood pressure is slightly elevated over many years, it can damage blood vessels and lead to cardiovascular and kidney disease”, explains co-author Dr Jenny Kindblom from Sahlgrenska University Hospital i Sweden. “Our findings indicate that high blood pressure may originate in early life. Excessive fat mass induces chronic low grade inflammation and endothelial dysfunction [impaired functioning of the lining of the blood vessels] already in childhood. Higher amounts of visceral abdominal fat increases the risk of developing hypertension in adults. And we have previously shown that a large pubertal BMI change in men is associated with visceral obesity [fat around the internal organs] at a young adult age. So enlarged visceral fat mass might, in individuals with a high BMI increase during puberty, be a possible mechanism contributing to higher blood pressure.”

She adds, “This study is important given the rising tide of obesity among children and teens. It is vital that we turn the focus from high blood pressure in adults to include people in younger age groups.”

The authors note that the results are from observational findings, so more studies are needed to understand whether there are specific ages in childhood and/or adolescence when BMI is particularly important to blood pressure in adulthood. They also point to some limitations, including that a definite cause-and-effect link between BMI and high blood pressure cannot be determined in this type of population-based study; blood pressure was measured at a single point in time; the analyses were unable to account for the influence of other known risk factors such as diet and physical activity which could have influenced the results; and because most of the study participants were white, the results may not be generalizable to people from other racial or ethnic groups.

High blood pressure is defined as a systolic blood pressure (SBP) at or above 140mmHg or diastolic blood pressure (DBP) at or above 90mmHg.

[Source]

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Study Shows Obesity in Childhood Associated with a More than Doubling of Risk of Developing Multiple Sclerosis in Early Adulthood

March 28, 2024 EurekAlert!

New research to be presented at this year’s European Congress on Obesity in Venice, Italy (12-15 May) shows that having obesity in childhood is associated with a more than doubling of the risk of later developing multiple sclerosis. The study is by Professor Claude Marcus and Associate Professor Emilia Hagman, Karolinska Institutet, Stockholm, Sweden, and colleagues.

Emerging evidence implies a link between high BMI in adolescence and an increased risk of Multiple Sclerosis (MS). Yet, most studies evaluating this association are cross-sectional, have retrospective design with self-reported data, have used solely genetic correlations, or use paediatric weight data before the obesity epidemic. Therefore, to authors aimed to prospectively evaluate the risk of developing MS in a large cohort of patients with paediatric obesity compared with the general population.

They included patients aged 2 – 19 years with obesity enrolled in the Swedish Childhood Obesity Treatment Register (BORIS) between 1995 – 2020, and a matched comparison group from the general population. Matching criteria included sex, year of birth, and residential area. Exclusion criteria were secondary obesity (eg brain tumours such as craniopharyngioma), and genetic syndromes (eg Prader Willi, morbus Down), and MS diagnosis before 15 years of age (that is, already developing in childhood). MS was identified through Sweden’s National Patient Register. Individuals were followed from obesity treatment initiation, or from 15 years of age if treatment was initiated earlier, until MS diagnosis, death, emigration, or August 2023, whichever came first. The authors computer and statistical modelling to calculate any potential association. Due to previous reported genetic associations of MS, the authors also assessed levels of parental MS which was present in 0.99% in the obesity cohort and 0.68% in the general population comparators.

The data included 21 661 patients (54% boys) from the paediatric obesity cohort with a median age of obesity treatment initiation (behaviour and lifestyle modification) of 11.4 years (years and 102 230 general population comparators. The median follow-up time was 5.6 years, corresponding to median age of 20.8 years in the follow-up population (and 50% of the population were aged between 18 and 25 at the point analysis, with the highest age in the cohort 45 years).

During follow-up, 0.13% [n=28, 18 (64%) female, 10 (36%) male] developed MS in the obesity cohort, whereas the corresponding number in the general population was 0.06% [n=58, 38 (66%) female, 20 (34%) male]. The mean (SD) age of MS diagnosis was comparable between the groups; 23.4 years in the obesity cohort versus 22.8 years in the general population comparators. (see graph in full abstract). The small numbers who developed MS so far means that the study was not sufficiently statistically powered to state the increased risk to females developing MS – however the results follow the general increased risk to females (the estimate ratio of female: male affected by MS in the general population is 4:1).

The crude incidence rate of MS per 100 000 person years was 19.3 in the obesity cohort and 8.3 in the general population cohort. Analyses adjusted for presence of parental MS (heredity) (which was more prevalent in the obesity cohort, as above) revealed that the risk of developing MS was more 2.3 times higher than in the paediatric obesity cohort, with both these findings statistically significant.

The authors say: “Despite the limited follow-up time, our findings highlight that obesity in childhood is associated with an increased susceptibility of early-onset MS more than two-fold. Given that paediatric obesity is prevalent, it is likely to serve as a critical etiological contributor to the escalating prevalence of MS. Paediatric obesity is associated with several autoimmune diseases and the leading hypothesis is that the persistent low-grade inflammatory state, typically observed in obesity, is mediating the association. Understanding these pathways is crucial for developing targeted prevention and intervention strategies to normalise the risk for MS in children and adolescents with obesity.”

They add: “There are several studies showing that MS has increased over several decades and obesity is believed to be one major driver for this increase. Thanks to our prospective study design, we can confirm this theory.”*

“Even though the risk for MS is more than double among children and adolescence with obesity, the absolute risk for MS remains lower than for many other comorbidities associated with obesity. Nevertheless, our study adds to the evidence that obesity in early life increases the risk for a plethora of diseases including MS, and not only the well-known cardiometabolic conditions such as heart disease and diabetes.”

[Source]

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Health and Economic Value of Eliminating Socioeconomic Disparities in US Youth Physical Activity

March 15, 2024, JAMA Network

Importance  There are considerable socioeconomic status (SES) disparities in youth physical activity (PA) levels. For example, studies show that lower-SES youth are less active, have lower participation in organized sports and physical education classes, and have more limited access to PA equipment.

Objective  To determine the potential public health and economic effects of eliminating disparities in PA levels among US youth SES groups.

Design and Setting  An agent-based model representing all 6- to 17-year-old children in the US was used to simulate the epidemiological, clinical, and economic effects of disparities in PA levels among different SES groups and the effect of reducing these disparities.

Main Outcomes and Measures  Anthropometric measures (eg, body mass index) and the presence and severity of risk factors associated with weight (stroke, coronary heart disease, type 2 diabetes, or cancer), as well as direct and indirect cost savings.

Results  This model, representing all 50 million US children and adolescents 6 to 17 years old, found that if the US eliminates the disparity in youth PA levels across SES groups, absolute overweight and obesity prevalence would decrease by 0.826% (95% CI, 0.821%-0.832%), resulting in approximately 383 000 (95% CI, 368 000-399 000) fewer cases of overweight and obesity and 101 000 (95% CI, 98 000-105 000) fewer cases of weight-related diseases (stroke and coronary heart disease events, type 2 diabetes, or cancer). This would result in more than $15.60 (95% CI, $15.01-$16.10) billion in cost savings over the youth cohort’s lifetime. There are meaningful benefits even when reducing the disparity by just 25%, which would result in $1.85 (95% CI, $1.70-$2.00) billion in direct medical costs averted and $2.48 (95% CI, $2.04-$2.92) billion in productivity losses averted. For every 1% in disparity reduction, total productivity losses would decrease by about $83.8 million, and total direct medical costs would decrease by about $68.7 million.

Conclusions and Relevance  This study quantified the potential savings from eliminating or reducing PA disparities, which can help policymakers, health care systems, schools, funders, sports organizations, and other businesses better prioritize investments toward addressing these disparities.

[Source]

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School-age Girls with Obesity Are More Likely to Experience Joint and Muscle Pain

March 12, 2024 EurekAlert!

Girls with obesity are more likely to experience pain in their bones, joints, muscles, ligaments or tendons compared with children with a healthy weight, according to research by Queen Mary University of London. The same did not apply to boys.

Queen Mary researchers hope their findings will raise awareness that obesity may contribute to musculoskeletal problems in children.

In the study, published today in Archives of Disease in Childhood, researchers analysed anonymised information on 120,000 children, linking data from the National Child Measurement Programme with GP records. They found that girls with obesity were 1.7 times more likely than those with a healthy weight to have at least one GP consultation for a musculoskeletal symptom or diagnosis. Previous research has indicated a link between musculoskeletal problems and obesity in children, but this study is the first to observe the association within a large, ethnically diverse population in the UK, with high levels of childhood obesity and deprivation.

Knee pain was the most common symptom reported in the study, followed by back pain. The authors note that musculoskeletal problems in this context may be caused by excess weight placing additional stress on the body’s joints, but more research is needed to understand why this results in an increase in problems for girls and not boys.

The National Child Measurement Programme is a Government initiative whereby children of primary school age in England are weighed and measured at school by health professionals. The programme gathers data to understand long-term trends in childhood obesity and inform national and local authority policies.

The research was funded by a grant from Barts Charity.

Nicola Firman, Health Data Scientist at Queen Mary University of London, said:

“Our findings demonstrate the value of linking and studying anonymised health data – without knowing the identity of any child, we were able to produce important insights into the consequences of obesity for health during childhood.”

“We hope our findings will increase awareness of the significance of poor musculoskeletal health, and drive more research into understanding the link with childhood obesity. More needs to be done at policy-level to support families to prevent obesity and potentially reduce the risk of musculoskeletal pain.”

Victoria King, Director of Funding and Impact at Barts Charity said:

“With our funding, the REAL-HEALTH team at Queen Mary is using anonymised health data to gain insights and build tools that are directly impacting health outcomes locally. We are excited to see the results of this first-of-its-kind study from the team, showing an association between childhood obesity and musculoskeletal disorders in a diverse UK population. Building a stronger evidence base on the possible causes of joint and muscle pain could lead to policy changes that will improve the health of children in East London, as well as nationally.”

[Source]

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