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...

Introduction and objective. Due to the COVID-19 pandemic all schools in Poland were closed and obliged to conduct lessons remotely. The aim of the study is to present the demographic analysis of difficulties with remote learning, as perceived by students during coronavirus pandemic in Poland. Materials and method. In April 2020, a nationwide online survey was conducted among adolescents aged 11-18 (N=2408). Quantitative and qualitative data were used. Teenagers were asked about the problems connected with remote learning. In order to examine the overall level of remote learning difficulties, a scale of remote learning difficulties (RLD) was devised (range 0-23 points). Differences connected with gender, age and place of residence were analysed. Results. More than a half of the teenagers surveyed rated the increased demands from teachers as a major problem. This answer appeared statistically more often among girls than boys (59.6% v. 53.2%). Almost every third adolescent saw the lack of consultation (31.6%) as a significant problem. Difficulties related to learning in the remote system were most often described as considerable by the oldest students (17-18-years-old) and those living in rural areas. The big problem for them was usually much higher requirements of teachers and poor organization of distance learning. The mean level on the scale of remote learning burden was M=11.9 (SD=7.1). Technical difficulties and insufficient skills in using software constituted additional problems most frequently mentioned by students. Conclusions. There is a need to pay particular attention to organizing appropriate technical conditions for remote learning, especially in rural areas, where students have complained more often than in cities about equipment and problems with access to the Internet during the pandemic.

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.

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

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Introduction. Schools are important settings for the promotion of healthy diet and sufficient physical activity to prevent civilisation diseases related to lifestyle. Objective. To describe school physical activity and nutrition environment in elementary schools in Poland, and to asses differences in school physical activity and nutrition environments, depending on school location and size. Materials and method. Data was used from the World Health Organisation European Childhood Obesity Surveillance Initiative (COSI) conducted in 2016 in 135 Polish schools. Logistic regression was used to asses association between the location and individual school environment indicator. On the basis of answers to 20 questions about school physical activity and nutrition environment, a positive school environmental assessment index was compiled. Results. Large, urban schools were characterised by a significantly greater availability of sweet snacks, whereas flavoured milk with added sugar was more often available in small and rural schools. The univariate logistics analysis parameters showed that an urban-rural location had a significant association for the availability of an indoor gym and existence of a canteen and a shop. Analysing the positive schools environmental assessment index, there were no statistically significant differences in mean values due to location, but statistically significant differences were found depending on the school size, with the highest level in large schools and the lowest in small schools. Conclusions. The factor which adversely differentiates the school environment in terms of healthy nutrition and physical activity is primarily the school size, and then the school location. Systemic and social solutions should aim at reducing the small school "exclusion syndrome", both in rural and in urban areas, also with regard to infrastructure and availability of conditions conducive to healthy nutrition and physical activity.

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