SummaryBackgroundUnderweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults.MethodsWe pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity).FindingsRegional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys wor...

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m 2 . In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, the...

This study investigated whether parental participation in organized and unorganized physical activity (PA) was associated with children's participation in extracurricular sport. The sample comprised 834 parents and their children (aged 6-10 years), living in central Portugal. Questionnaires assessed parental PA (organized and unorganized) and extracurricular sport participation in children (number of sports and frequency of participation). Multinomial logistic regression was applied to assess associations between parental and child physical behaviors. Having both parents active was significantly associated with frequent participation in more sports both in girls and boys but a strong relation according to gender was found. The odds of boys practicing more than one sport and more times per week were higher if they had an active father. Girls with physically active mothers, particularly with mothers practicing organized PA in a regular way, were engaged in more sports and practiced sport more times per week. The type of PA practiced by the parents was not related to boys' participation in sport. Future interventions should be family-based and focus on the promotion of higher levels of parental PA, including organized, in order to improve their children's active behaviors.

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality worldwide. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) project has been working to improve awareness, prevention and management of this disease. The aim of this study is to evaluate how COPD patients are reclassified by the 2017 GOLD system (versus GOLD 2011), to calculate the level of agreement between these two classifications in allocation to categories and to compare the performance of each classification to predict future exacerbations. Two-hundred COPD patients (>40 years, post bronchodilator forced expiratory volume in one second/forced vital capacity<0.7) followed in pulmonology consultation were recruited into this prospective multicentric study. Approximately half of the patients classified as GOLD D [2011] changed to GOLD B [2017]. The extent of agreement between GOLD 2011 and GOLD 2017 was moderate (Cohen's Kappa = 0.511; p < 0.001) and the ability to predict exacerbations was similar (69.7% and 67.6%, respectively). GOLD B [2017] exacerbated 17% more than GOLD B [2011] and had a lower percent predicted post bronchodilator forced expiratory volume in one second (FEV1). GOLD B [2017] turned to be the predominant category, more heterogeneous and with a higher risk of exacerbation versus GOLD B [2011]. Physicians should be cautious in assessing the GOLD B [2017] patients. The assessment of patients should always be personalized. More studies are needed to evaluate the impact of the 2017 reclassification in predicting outcomes such as future exacerbations and mortality.

Background: Children are often exposed to too much screen time but few studies have explored the use of old and new digital media among young children. This study assesses screen time, including traditional and mobile devices, in preschool and elementary school-aged children, according to their gender, age, and socioeconomic position (SEP). Methods: A total of 8430 children (3 to 10 years; 50.8% boys) from the north, center and south-central Portugal were included in the present study. Data was collected by a parental questionnaire during 2016/2017. Children's screen time (by media device, weekdays and at the weekend; calculated by mean minutes per day) were reported by parents. Analysis were carried to compare screen time by children's age, gender and family SEP (classified using father's educational degree). Results: Daily screen time was high both in children aged 3 to 5 and 6 to 10 years-154 min/day (95% CI: 149.51-158.91) and 200.79 min/day (95% CI: 197.08-204.50), respectivelyand the majority of children, independently of their gender, exceed the recommended 2 h/day of screen viewing. Children are still primarily engaging in screen time through television but the use of mobile devices, particularly tablets, were already high among 3 year-old children and increased with age. SEP was a negative predictor of screen time in the linear regression analysis, including after adjustment. Conclusions: Considering the negative health impacts of excessive screen time, recognizing subgroups at risk of excessive screen time and identifying how each device is used according to age is fundamental to enable appropriate future interventions. The screen time in children aged 3-10 years is longer than the recommended, particularly among boys and in those children from lower SEP. Parents and policymakers should have in mind that children spend most of their screen time watching television but mobile devices are becoming extremely popular starting at a young age.

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.

RESUMOIntrodução: A obesidade abdominal em crianças tem aumentado a ritmo alarmante, mas esse indicador não é avaliado em consultas médicas de rotina. Este estudo pretende avaliar a prevalência de excesso ponderal e obesidade abdominal e a relação entre os dois indicadores de obesidade, em crianças dos 6 aos 10 anos. Material e Métodos: Numa amostra de 793 crianças (408 raparigas) foram medidos o peso, altura e a circunferência abdominal. Os critérios da International Obesity Task Force foram usados para definir o excesso ponderal e obesidade. Obesidade abdominal foi estimada como a relação cintura/altura ≥ 0,50. Testes estatísticos foram usados para testar os objetivos supramencionados. Resultados: A prevalência de excesso ponderal, incluindo obesidade foi de 21,9% (18,9 -25,0), sendo significativamente mais elevada nas raparigas do que nos rapazes (χ 2 = 4,59, p = 0,03). A prevalência de obesidade abdominal foi de 21,9% (18,6 -25,0), sem diferenças significativas em relação ao género (χ 2 = 3,32, p = 0,07). Verificámos que 8,2% (5,9 -10,6) das crianças com peso normal e 59,5% (50,9 -69,0) ABSTRACT Introduction: Central adiposity in children has increased to a higher degree than general adiposity however it is not a routine measurement in clinical practice. We aimed to estimate the prevalence of overweight, obesity, and abdominal fat distribution and observe the prevalence of abdominal obesity among non-obese 6-10-year-old children. Material and Methods: Weight, height, and waist circumference were measured in a sample of 793 children (408 girls). International Obesity Task Force cut-offs were used to define overweight and obesity. Abdominal obesity was defined as waist-to-height ratio ≥ 0.50. Chi-square tests were used to observe the prevalence of the obesity indicators among boys and girls, and the relation between International Obesity Task Force cut-offs and abdominal obesity. Results:The prevalence of overweight, including obesity among children was 21.9% (18.9 -25.0), 6.1% (4.2 -8.0) were obese and 21.9% (18.6 -25.0) had a waist-to-height ratio ≥ 0.50. Girls had significantly higher prevalence of overweight, including obesity compared to boys (χ 2 = 4.59, p = 0.03), but no differences were found for abdominal obesity according to children's gender (χ 2 = 3.32, p = 0.07). A proportion of normal (8.2%; 5.9 -10.6) and overweight children (59.5%; 50.9 -69.0) were abdominally obese. Discussion: The prevalence of general and abdominal obesity in children living in central Portugal is of concern. Many children with abdominal obesity would not be considered obese with the International Obesity Task Force cut-off points. Conclusion: A high proportion of abdominal obesity was observed in children with normal weight or overweight, suggesting that waistto-height ratio should be included in routine clinical practice and might be particularly useful to assess the health status of the child.

Walking or bicycling to school is an important source of physical activity and may help prevent childhood obesity. However, active commuting has been declining in recent decades. The purposes of this study were to explore travel characteristics in children and examine factors associated with active commuting in children living in urban and non-urban setting. Participants were 834 parents and corresponding children aged 6-10 years, living in the district of Coimbra, Portugal. Data were collected during April-June of 2013 and 2014. Anthropometric measures (height, weight, waist circumference) were taken in children. Mode shift and child/family demographics were assessed by a parental questionnaire. School and home addresses were geocoded and the shortest route (meters) was taken in consideration. Although car is the most common way of travel to school, active transportation is significantly more prevalent in children living in the non-urban setting. Different determinants were found associated with active travel according to the level of urbanization. The adjusted logistic regression revealed that, independently of the urbanization, children whose mothers actively commute to work, whose parents reported their neighbor as safe to walk, and children living less than 2000 m from school were significantly more likely to walk to school. Present findings highlight the need to consider models with different levels, including individual, social, and environmental characteristics, when developing interventions and policies to promote active transport to school.