Delay discounting (DD), which reflects a tendency to devalue rewards as the time to their receipt increases, is associated with health behaviors such as sleep disturbances, obesity, and externalizing behavior among adolescents. Response patterns characterized by inconsistent or unexpected reward valuation, called non-systematic responding (NSR), may also predict health outcomes. Many researchers flag and exclude NSR trials prior to analysis, which could lead to systematic bias if NSR (a) varies by demographic characteristics or (b) predicts health outcomes. Thus, in this study we characterized NSR and examined its potential beyond error by comparing it against DD with a secondary data analysis of the Adolescent Brain Cognitive Development (ABCD) Study-a population-based study that tracked youths (N = 11,948) annually from 8 to 11 years of age over 4 years. We assessed DD and NSR using the Adjusting Delay Discounting Task when youths were approximately 9.48 years old (SD = 0.51). We also examined three maladaptive health outcomes annually: sleep disturbances, obesity, and externalizing psychopathology. Our analysis revealed variations in NSR across races, ethnicities, and body mass index categories, with no significant differences observed by sex or gender. Notably, NSR was a stronger predictor of obesity and externalizing psychopathology than DD and inversely predicted the growth trajectory of obesity. These findings suggest that removing NSR patterns could systematically bias analyses given that NSR may capture unexplored response variability. This study demonstrates the significance of NSR and underscores the necessity for further research on how to manage NSR in future DD studies.

The decreasing prevalence of physical activity (PA) among urban children in Sub-Saharan Africa is a growing public health concern. More emphasis should focus on examining the influence of parental PA behaviour on the children's PA patterns. We explored associations of 24 ​hour (h) accelerometer-measured movement behaviours of guardian-child pairs in Nairobi City County, Kenya.

This cross-sectional study assessed 80 pairs consisting of children aged 9-14 years and their guardians in one area of low and one area of middle socioeconomic status (SES) (Embakasi Sub-County and Lang'ata Sub-County), in Nairobi City County, Kenya. The study used waist worn Tri-axial Actigraph (GT3X+ and ActiSleep+) accelerometers to quantify PA and sedentary time (SED). Association between guardians' and children's PA was examined using linear regression, adjusting for guardians' educational attainment and household wealth.

Of the children, 42 (52.5%) and 76 (96.2%) of the guardians were women. Children in low SES areas spent more time (p ​< ​0.001) in moderate-to-vigorous physical activity compared to children from middle SES area. The guardians in low SES area were younger and spent more time in light PA (p ​= ​0.036) while their counterparts had higher daily SED (p ​= ​0.049). Guardian's SED associated with higher children's SED (p ​= ​0.033) even after adjusting for guardians' educational attainment (p ​= ​0.032) and wealth (p ​= ​0.05). There was no association between guardians' and children's MVPA.

Considered alongside the extant literature, these results suggest that health promotion strategies should aim to reduce parental SED time while also planning to increase children's PA.

Prenatal exposure to bisphenol analogues (BPs) is increasingly common and may affect children's reproductive development. However, human evidence is limited and inconsistent. Based on the Shanghai-Minhang Birth Cohort Study that enrolled participants in 2012 at Minhang Maternal and Child Health Hospital in Shanghai, China, we measured BPs in maternal urine samples collected during late pregnancy and children's anogenital distance (AGD: boys, AGDAP (anus-penis), AGDAS (anus-scrotum); girls, AGDAC (anus-clitoris), AGDAF (anus-fourchette)) from birth to 48 months as an indicator of reproductive development. A total of 545 mother-child pairs were included. Boys with detected maternal bisphenol A (BPA), bisphenol F (BPF), bisphenol S (BPS) and bisphenol AF (BPAF) tended to have increased AGDAP at 6 months, while at 12 months, BPA, BPS, and BPAF were associated with a marginal decrease in AGDAP. In girls, higher levels of BPA, BPF and BPS were associated with longer AGD at 48 months and higher risks of rapid AGD growth. Bayesian kernel machine regression models showed significant associations between BPs mixtures and AGD in both sexes, with BPF and BPS identified as major contributors. Our study revealed the lasting, sex-specific impacts of prenatal exposure to BPA and its alternatives on children's reproductive development.

Cardiometabolic traits are heritable, and some display parent-of-origin effects, which indicates preferential inheritance from one parent or parental bias. Most studies of these phenomena have focused on adult populations. We aimed to investigate the heritability and parent-of-origin effects on cardiometabolic traits in a birth cohort with serial measurements to determine whether these patterns emerged early in life.

The Pune Maternal Nutrition Study comprises a birth cohort in which offspring and parents were studied from birth and followed up for 24 years. We investigated parent-of-origin effects on cardiometabolic traits cross-sectionally at available timepoints using linear regression, and longitudinally across the life course using mixed-effect regression. Maternal and paternal effects on offspring phenotype were modelled after adjusting for age, sex and BMI. Parent-of-origin effects were calculated based on the difference between maternal and paternal effects. We also investigated these effects in another birth cohort, that of the Pune Children's Study. Genetic parent-of-origin effects were assessed using generalised estimating equations after taking the parental origin of the alleles into account.

Birthweight showed a maternal parent-of-origin effect. At 24 years, maternal bias was seen for some obesity-related traits for daughters, while paternal bias was seen for WHR in sons. A shift from paternal bias at 6 years to maternal bias at 24 years for the skinfold thickness was observed in daughters. Fasting glucose and lipids showed maternal bias at 6, 12 and 24 years. For fasting insulin and HOMA2-S, a negative maternal effect at 6 years transitioned to a positive one at 12 years. For HOMA2-B, a paternal effect at 6 years transitioned to a maternal one at 12 years, and this remained so at 24 years. Some of these findings were also observed in the cohort from the Pune Children's Study. Longitudinal modelling revealed stronger paternal effects over time for fasting insulin and HOMA indices but maternal effects for glucose and lipids, reflecting their cumulative effect over time. Genetic variants at the KCNQ1 locus showed a maternal parent-of-origin effect on birthweight, on HOMA2-B at 12 years, and on lipids at 6 and 12 years.

Our study provides proof of concept of the existence of parent-of-origin effects on cardiometabolic traits from birth, through childhood and puberty, until adult age. Our results indicate a predominantly maternal influence on intrauterine, pubertal and reproductive-age metabolism in the offspring. While the longitudinal analysis indicated a maternal bias for the macronutrients (glucose and lipids), and a paternal bias for glucose-insulin metabolism, the cross-sectional analysis revealed a transition between parental influence across physiological stages. This dynamic relationship may have its origins in the life-history theory of evolution, and could inform strategies for primordial prevention aimed at curbing the rising burden of cardiometabolic disease. Further studies are needed to determine the mechanisms underlying such effects.

Obesity is a potential risk factor for anemia in children. This systematic review (SR) was undertaken to estimate the association of obesity with iron deficiency (ID) and ID anemia (IDA), in children.

A systematic literature search for observational studies was done in PubMed, EMBASE, Scopus, and the Cochrane library, with additional hand-searching. Two reviewers independently screened the search output, included eligible studies, extracted data, and assessed study quality using the National Institutes of Health tool. The main outcomes were association of obesity with anemia (IDA), and ID. Secondary outcomes were hemoglobin level, serum iron, ferritin, transferrin receptor saturation, and hepcidin. Meta-analysis was done using a random-effects model. Comparisons were expressed through pooled OR with 95% CI.

Forty-two studies comprising one cohort, 29 cross-sectional, and 12 case-control studies comparing 16,633 children living with obesity and 32,573 children without obesity were included. The pooled OR (95% CI) for ID was 1.64 (1.22, 2.21), 16 studies, 20,949 children; and 0.78 (0.43, 1.43), 17 studies, 40,022 children, for IDA. The pooled prevalence of ID was 20.07% (14.98, 25.16) among children living with obesity (16 studies, 3147 children), compared to 16.1% (11.82, 20.38) in children without obesity. Children living with obesity had significantly lower levels of hemoglobin, iron, % transferrin saturation, and higher levels of ferritin and hepcidin than children without obesity.

There is a significant association between iron deficiency and obesity in children.

Prenatal exposure to phthalates might influence the development of childhood obesity. Most previous studies used body mass index (BMI) at a specific age instead of BMI development, which might be a better indicator of later health. We aimed to assess the association of prenatal phthalate exposure with longitudinal BMI development from infancy to adolescence. Among 1,379 mother-child pairs from a population-based cohort study, phthalate concentrations were measured in maternal spot urine samples, collected during first, second and third trimester. We estimated age- and sex-adjusted BMI standard deviation scores (SDS) at 6 months and 1, 2, 3, 4, 6, 10 and 13 years. We examined the associations of maternal phthalate urine concentrations during pregnancy with repeated measures of BMI using linear mixed effects models. An interquartile range higher natural log-transformed maternal first trimester high-molecular weight phthalate and di-2-ethylhexylphthalate (DEHP) urine concentrations were associated with a -0.10 (95% confidence interval (CI) -0.15 to -0.04), and -0.09 (95% CI -0.15 to -0.04) lower age- and sex-adjusted BMI at 6 months. An interquartile range higher natural log-transformed maternal first trimester phthalic acid and low-molecular weight phthalate urine concentrations were associated with a 0.11 (95% CI 0.03 to 0.18) and 0.13 (95% CI 0.04 to 0.21) higher age- and sex-adjusted BMI at 13 years old. No significant associations were observed for maternal second and third trimester phthalate urine concentrations with BMI. Thus, higher maternal phthalate metabolites urine concentrations appear to be related to lower BMI at early ages but with higher BMI at later ages.

To examine gut microbiota diversity, composition and metabolites in relation to overall mass (OM), fat mass (FM) and lean soft tissue mass (LSTM) measured by dual x-ray absorptiometry (DXA) in 5-year-old children.

Mothers of the Gen3G cohort were enrolled prenatally in 2010-2013 in Quebec, Canada; 153 children from the cohort had data on gut microbiota and DXA scans at 5-6.4 years of age, and 140 also had plasma metabolite data. We characterized gut microbiota by 16S rRNA Illumina sequencing and metabolites by untargeted multiplatform mass spectrometry. We examined associations of microbial alpha diversity, beta diversity, composition (amplicon sequence variants; ASVs) and metabolites (microbial metabolites) with DXA measures, adjusting for age, sex, diet and drinking water.

Of the 153 children, 43.1% were female, and 96.1% self-identified as white. The median BMI was the 52nd percentile. Microbial richness (alpha diversity) was positively associated with OM, FM and LSTM. Of the 542 ASVs tested, 7 were associated with OM, 5 with FM and 4 with LSTM. One Veillonella ASV and two Blautia ASVs were significantly associated with all outcomes. Among 278 microbial metabolites, no metabolites were associated with FM, while glycoursodeoxycholate was associated with OM, and glycoursodeoxycholate, 3-hydroxybutyrate and gamma-glutamylalanine were associated with LSTM.

In 5-year-old children, gut microbiota alpha diversity, richness and specific gut microbes were associated with OM, FM and LSTM. Many of the associations followed a similar pattern for FM and LSTM, suggesting they may not be specific to adiposity but rather reflect overall growth.

Individuals with autism spectrum disorder (ASD) may be at increased risk of both obesity and underweight.

To examine the association between ASD and weight status in children and adolescents, adjusting for individual- and neighbourhood-level sociodemographic factors.

We conducted a cross-sectional study of children and adolescents ≥2 and ≤18 years old using health administrative and demographic data from Ontario, Canada. Using growth measurements from a large primary care database between 2011 and 2016, we categorized weight status using World Health Organization definitions. We defined ASD based on a previously validated algorithm.

We included 568 children and adolescents with ASD and 32 967 without ASD. Comparing those with ASD to those without ASD, prevalence of underweight was 3.5% versus 1.9%, overweight 19.0% versus 18.2%, obesity 12.9% versus 7.3%, and severe obesity 5.8% versus 2.2%. In the fully adjusted multinomial logistic regression model, ASD remained associated with underweight (adjusted odds ratio [aOR] 2.02; 95% confidence interval [CI] 1.27-3.20), obesity (aOR 1.87; 95% CI 1.44-2.43) and severe obesity (aOR 2.62; 95% CI 1.81-3.80).

Children and adolescents with ASD are at increased risk of underweight, obesity, and severe obesity, independent of sociodemographic characteristics. Strategies addressing growth and weight status are warranted in this population.

Background: Evidence supports that motor competence is inversely associated with weight status, yet less is known about this relationship among young people who are underweight. We hypothesized that there is a non-linear trajectory of motor competence across weight status categories (from underweight to obesity). Purpose: To check whether a non-liner relationship exists between motor competence and weight status in adolescents. Research Design: Cross-sectional study. Study sample: we assessed the motor competence of 310 participants (44.8% boys), aged 12-15 years. Data Collection: Motor competence was assessed the Korperkoordinationstest für Kinder (KTK). Weight status (underweight, normal weight, overweight and obesity) was determined using body mass index (BMI). Results: Motor competence was inversely associated with BMI in normal weight (rho = -.222, p = .001), overweight (rho = -.309, p = .028) and obesity (rho = -.663, p < .001), but not in underweight (rho = .193, p = .508). Adolescents with normal weight presented higher motor competence than those with overweight (mean difference = 17.198, p = .001) and obesity (mean difference = 31.686, p < .001). There was no significant difference in motor competence between normal weight and underweight categories. In addition, boys showed a curvilinear trajectory of motor competence, being ascendant from underweight to normal weight and then downward with increasing BMI. Polynomial regressions, fitting a non-linear model, confirmed a non-linear relationship between motor competence and BMI in boys (B = -3.534, p < .001). Conclusions: Our findings suggest that the inverse relationship between motor competence and BMI does not occur in adolescents who are underweight. Furthermore, our results supported the non-linear hypothesis about the relationship between motor competence and weight status in boys.

This study aimed to identify sleep profiles in a representative sample of Slovak adolescents and investigate their associations with adiposity indicators and cardiorespiratory fitness.

Data from the 2022 Health Behaviour in School-aged Children (HBSC) study conducted in Slovakia were analysed. Survey questions on sleep duration and problems from the entire HBSC sample (n = 8906) were used to identify sleep profiles. Associations with adiposity indicators and cardiorespiratory fitness were investigated in a subsample of 924 adolescents (average age 13.3 ± 1.48; 56.2% boys) who completed the HBSC survey, bioimpedance analysis, and 20-metre shuttle run test.

Three sleep profiles were identified-optimal sleepers, optimal sleepers with sporadic sleep problems and poor sleepers. Crude models showed that poor sleepers had significantly higher body fat percentage and fat mass index, along with lower cardiorespiratory fitness, compared to optimal sleepers. After adjustment, only the association between sleep profiles and cardiorespiratory fitness remained significant.

The observed associations between sleep profiles and cardiorespiratory fitness may help better target future intervention resources towards adolescents with low cardiorespiratory fitness levels.

Most studies of prepubertal weight and puberty have not used continuous or long follow-up periods. We explored the effect that birth weight and growth trajectories from 0-9 years of age had on starting puberty.

Data were obtained from 1510 children in Tianjin, China, who were born in 2013 and selected by cluster random sampling. Information on pubertal status was collected by parent-reported questionnaires and up to 14 anthropometric measurements were obtained from physical examinations. A group-based trajectory model was applied to fit the growth trajectories. Cox regression and log-binomial regression were used for association analyses.

After exclusions, we studied 1164 children (50.9% girls) up to a mean age of 9.6 years. Girls with a low birth weight or low-stable growth trajectories were less likely to have started puberty, while those with macrosomia or high-stable growth trajectories had a higher risk of having started puberty. Combined analyses showed that the risk of pubertal initiation for girls with a normal birth weight and low-stable trajectories was 0.76. It was 1.42 for those with macrosomia and high-stable trajectories. Similar results were not found in the boys.

It is important that pubertal initiation studies investigate growth over the life course.

In this planned ancillary analysis of our completed clinical trial, we hypothesized that among older children with sickle cell anemia (SCA) and severe acute malnutrition, those with higher levels of food insecurity would have lower end-of-trial body mass index (BMI) z-scores compared to their peers with SCA and lower levels of food insecurity.

Data from 108 children who completed the feasibility trial for managing severe acute malnutrition in older children with SCA in Nigeria were analyzed. Children aged 5-12 years old with severe acute malnutrition (BMI z-score of <-3.0) were randomly allocated to receive either supplemental ready-to-use therapeutic food (RUTF) alone or RUTF with moderate-dose hydroxyurea (20 mg/kg/day). Caregivers completed the United States Household Food Security Survey Module to measure food security. We focused on the childhood section for its accuracy in assessing food security in older children. Higher scores (0-8) indicate greater food insecurity. We constructed multivariable linear regression models to estimate the association between childhood food insecurity and BMI z-scores at baseline and endpoint.

Most participants were food insecure, with 55% (n = 59) and 34% (n = 37) having low and very low food security, respectively. Higher scores on the continuous food security measure, indicating lower food security, were associated with lower BMI z-scores at both study entry (β = -0.05, p = 0.047) and after malnutrition treatment (β = -0.07, p = 0.016).

Among severely malnourished children with SCA, lower childhood food security scores are associated with an adverse treatment response, reflected by a lower BMI z-score at the trial's end.

NCT03634488, https://clinicaltrials.gov/study/NCT03634488.

This study aimed to understand the prevalence of screen time in hospitalized children and identify factors predicting excessive screen use during hospitalization.

This cross-sectional quantitative study was conducted with patients from the Pediatric Inpatient Unit of a Brazilian hospital, from March 2022 to April 2023. A total of 260 children were included. Family members completed questionnaires about screen time during hospitalization and at home, as well as providing information on physical activity and functionality. Socioeconomic and demographic details were obtained from electronic records.

During hospitalization, children spent a median of 270 min per day on screens, significantly more than at home. Excessive screen time at home, better patient functionality, and lower caregiver education levels were significant predictors of excessive screen use during hospitalization.

Excessive use of screen devices among hospitalized children, with only a minority adhering to the World Health Organization's screen time recommendations. Key predictors of excessive screen use included high screen time at home, lower caregiver education levels, and preserved child functionality.

We characterized the spatial-temporal trends of obesity among Chinese children and adolescents from 1985 to 2019 and examined the impact of social determinants of health (SDOH) patterns.

Using data from the Chinese National Survey on Students' Constitution and Health (CNSSCH) conducted between 1985 and 2019, featuring seven cross-sectional surveys, we employed spatial-temporal analysis methods and collected 23 obesity-related variables to identify SDOH patterns. A general linear regression model investigated associations between SDOH patterns and obesity prevalence.

Obesity prevalence rose from 0.1% to 8.1%. Northern regions formed a high-obesity cluster, whereas Southern regions were low-obesity clusters. The following four SDOH patterns emerged: Western Resource-Limited Frontier, Coastal-Central Development Belt, Inland Agricultural Heartland, and Metropolitan Resource-Rich Hubs. Prevalence was 5.7%, 5.8%, 10.2%, and 11.3% for Patterns 1 through 4, respectively. Compared with Pattern 2, Patterns 3 and 4 showed higher obesity risks.

Childhood obesity prevalence in China increased with regional disparities from 1985 to 2019, with higher prevalence in the North and lower prevalence in the South. SDOH patterns were linked to spatial clusters, suggesting that regions characterized by advanced urbanization, abundant resources (Pattern 4), and a dietary profile heavy in carbohydrates and low in protein (Pattern 3) potentially contributed to increased obesity risk.

Childhood obesity is a major public health concern, associated with early-onset comorbidities and a high likelihood of persisting into adulthood. Anti-obesity medications (AOMs) may serve as an adjunct to lifestyle modifications for managing pediatric obesity.

To evaluate prescribing patterns, weight outcomes, and cardiometabolic impacts of AOMs among children and adolescents aged 10-18 years within Clalit Health Services (CHS), the largest health maintenance organization in Israel.

This retrospective observational study analyzed data from CHS's electronic database (2017-2024). The study cohort included 307 208 children with BMI measurements exceeding World Health Organization (WHO)-defined thresholds for overweight or obesity. Among these, 2236 (0.7%) were prescribed AOMs (metformin, GLP-1 receptor agonist, or orlistat). A secondary analysis assessed longitudinal changes in BMI z-scores and cardiometabolic parameters among individuals who purchased at list two prescriptions of AOMs.

AOMs prescriptions were more common among females, younger patients, those with higher BMI z-scores, and medium-to-high socioeconomic position (SEP) levels. Children prescribed AOMs exhibited a higher prevalence of obesity-related comorbidities and greater engagement with dietitians and endocrine specialists. Metformin was the most commonly prescribed medication (73.8%), followed by GLP-1 receptor agonist (24.5%) and orlistat (1.7%). Females demonstrated higher rates of medication adherence and longer treatment durations than males. Among the 1717 participants with ≥2 AOMs purchases, BMI z-scores significantly declined during treatment, accompanied by reductions in blood glucose, HbA1c, triglycerides, and total cholesterol, and increases in HDL cholesterol. BMI z-scores and cardiometabolic parameters partially regressed after treatment cessation but remained improved compared to baseline.

AOMs demonstrate potential for weight management and cardiometabolic improvement in children with obesity, particularly among those with severe obesity and comorbidities, within real-world settings. However, the modest utilization rate highlights the need for improved accessibility and further real-world evidence to optimize treatment strategies for pediatric obesity.

Obstructive sleep apnea (OSA) affects up to 40% of children and adolescents with obesity and is linked to hyperinsulinism. However, the mechanisms underpinning this association remain unclear. The study aims to assess the three key determinants of hyperinsulinemia: insulin clearance, secretion, and sensitivity in paediatric patients with OSA.

We enrolled 70 Children with obesity and suspected OSA who performed a nocturnal polygraphy to confirm OSA diagnosis and a 3-hour OGTT to assess glucose homeostasis. Mild OSA was defined for 1 < AHI ≤ 5, moderate-severe OSA as AHI >5. Insulin secretion rate (ISR) was estimated using C-peptide deconvolution. Basal and total insulin clearance during OGTT were calculated. Whole-body insulin sensitivity was evaluated with the Matsuda Index (WBISI), while hepatic insulin resistance index (HIRI) was calculated based on the AUCs of plasma glucose and insulin during the initial 30 minutes of OGTT.

A total of 36 children had mild OSA and 34 had moderate-severe OSA. The latter group showed reduced insulin clearance during OGTT (p = 0.008) and higher HIRI (p = 0.03). Basal insulin clearance (p = 0.07), ISR (p = 0.34), beta-cell glucose sensitivity (p = 0.53), and WBISI (p = 0.56) were similar between the two groups. OSA severity negatively correlated with fasting insulin clearance (r = -0.29, p = 0.01) and OGTT insulin clearance (r = -0.32, p = 0.007) and positively correlated with HIRI (r = 0.29, p = 0.02).

Moderate-severe OSA in children with obesity is associated with impaired insulin clearance and hepatic insulin sensitivity. These factors may contribute to hyperinsulinism in paediatric OSA.

Obesity is a major public health concern affecting millions of people globally. Early identification of individuals susceptible to obesity is crucial for reducing the burden of obesity. Obesity is often defined based on body-mass-index (BMI), and tracking BMI trajectories from early childhood offers a valuable tool for risk stratification. Although the role of mothers in shaping these trajectories is well-recognized, the paternal influence on childhood obesity development remains a knowledge gap. We hypothesize that children of fathers with obesity have higher odds of being in the rapid BMI growth trajectory with stronger estimates when the mother is also with overweight or obesity.

We analyzed data from the Canadian CHILD Cohort Study, a pregnancy cohort in which both parents were enrolled in early pregnancy when BMI was assessed. The child's BMI was repeatedly collected from birth to age five. We used group-based trajectory modeling to identify offspring BMI z-score (BMIz) trajectory groups (age-and-sex standardized) and weighted multinomial logistic regression analysis to determine the associations between prenatal paternal BMI and offspring growth trajectories, stratified by maternal weight categories.

Among 2 238 participants, the mean prenatal paternal BMI was 27.44 (SD = 4.77), and 22.83% of fathers were with obesity. The four identified offspring BMIz trajectories were: low stable (n = 220, 9.83%), normative (n = 1 356, 60.59%), high stable (n = 572, 25.56%), and rapid BMIz growth trajectory (n = 90, 4.02%). Children of normal-weight mothers and fathers with obesity had 1.86 higher odds (OR: 1.86; 95%CI: 1.22-2.84) of being classified in the rapid growth BMIz trajectory, compared to children of normal-weight fathers. The odds of being in the rapid growth BMIz trajectory were higher when both mothers and fathers were with obesity (OR: 4.35; 95%CI: 2.65-7.14).

Children of fathers with obesity had higher odds of being in the rapid BMI growth trajectory, particularly when also the mother was with overweight or obesity. These results support the need for preconception advice and interventions for couples to optimize their offspring's health.

Ambient air pollution may contribute to childhood obesity through various mechanisms. However, few longitudinal studies examined the relationship between pre- and postnatal exposure to air pollution and obesity outcomes in childhood. We aimed to investigate the association between pre- and postnatal exposure to air pollution and body mass index (BMI) and the risk of overweight/obesity throughout childhood in European cohorts. This study included mother-child pairs from 10 European birth cohorts (n = 37111 (prenatal), 33860 (postnatal)). Exposure to nitrogen dioxide (NO2) and fine particulate matter with aerodynamic diameter < 2.5 µm (PM2.5) was estimated at the home addresses during pre- and postnatal periods (year prior outcome assessment). BMI z-scores (continuous) and overweight/obesity status (categorical: zBMI≥+2 (<5 years) or ≥+1 (≥5 years) standard deviations) were derived at 0-2, 2-5, 5-9, 9-12 years. Associations between air pollution exposure and zBMI were estimated separately for each pollutant and cohort using linear and logistic longitudinal mixed effects models, followed by a random-effects meta-analysis. The overweight/obesity prevalence ranged from 12.3-40.5 % between cohorts at 0-2 years, 16.7-35.3 % at 2-5 years, 12.5-40.7 % at 5-9 years, and 10.7-43.8 % at 9-12 years. Results showed no robust associations between NO2 exposure and zBMI or overweight/obesity risk. Exposure to PM2.5 during pregnancy was associated with 23 % (95%CI 1.05;1.37) higher overweight/obesity risk across childhood, and higher zBMI and overweight/obesity risk at 9-12 years. Heterogeneity between cohorts was considerable (I2:25-89 %), with some cohort-specific associations; e.g., pre- and postnatal exposure to PM2.5 was associated with lower zBMI across age periods in UK cohorts (ALSPAC and BiB), while postnatal exposure to PM2.5 and NO2 was associated with higher zBMI in one Dutch cohort (Generation R). Overall, this large-scale meta-analysis suggests that prenatal PM2.5 exposure may be associated with adverse childhood obesity outcomes, but provides no evidence to support an effect of postnatal air pollution exposure, although cohort-specific associations were observed.

Cardio-metabolic risks emerge in early life and progress further in adult life. In recent times, COVID-19 pandemic aggravated risks owing to poor food security and diet quality. We aimed to assess the prevalence of cardiometabolic traits including the metabolically obese normal weight phenotype and its socioeconomic differentials in children and adolescents aged 6-19 years in India.

A baseline assessment was conducted between August and December, 2022, as part of a school-based cohort study that aimed at longitudinally evaluating the anthropometric and metabolic parameters among urban children and adolescents aged 6-19 years from three public (non-fee paying) and two private (fee paying) schools in India. Private and public schools were considered as a proxy for higher and lower socioeconomic status respectively. Blood pressure and blood samples in a fasting state were obtained only from adolescents aged 10-19 years. The prevalence and its 95% confidence interval using the Clopper exact method and adjusted prevalence ratios were calculated using random-effects logistic regression models.

Among 3888 recruited students, 1985 (51.05%) were from public schools, and 1903 (48.95%) were from private schools aged 6-19 years. The overall prevalence of underweight was 4.95% (95% CI 4.29-5.69), with a significantly higher prevalence in public schools (8.09%) than private schools (1.69%). The overall prevalences of general obesity and central obesity were 13.41% (95% CI 12.35-14.52) and 9.15% (95% CI 8.26-10.11), respectively, with significantly higher prevalence in private schools (p < 0.001). The prevalences of general and central obesity were four times (adjusted PR = 4.42, 95% CI 2.90-6.72) and eight times (adjusted PR = 8.31, 95% CI 4.82-14.35) higher, respectively, in private schools than public schools. The overall prevalence of hypertension was 7.37% (95% CI 6.33-8.51), and similar prevalences were found in public and private schools. Private school students had 2.37 times higher prevalence of impaired fasting plasma glucose (adjusted PR = 2.37, 95% CI 1.19-4.72) and 3.51 times higher prevalence of metabolic syndrome (adjusted PR = 3.51, 95% CI 1.54-8.01) than public school students. Among 2160 adolescents, 67.73% (1463) had normal body mass index. The prevalence of metabolically obese normal weight phenotype (MONW) was 42.86% (95% CI 40.30-45.44), which is higher in public [46.39% (95% CI 43.25-49.54)] than private [35.33% (95% CI 30.99-39.86)] schools (p < 0.001) with adjusted PR of 0.91 (95% CI 0.70-1.17). The most prevalent cardio-metabolic abnormality among metabolically obese normal weight phenotype was low high-density lipoprotein-c, significantly higher among adolescents from public schools (62.12% vs 52.73%, p = 0.039) than private schools. The prevalence of metabolically obese underweight (MOUW) (48/115) was 41.74% (95% CI 32.61-51.30), being higher among adolescents in public schools than private schools but not significant (p = 0.264).

Effective implementation of food security measures and targeted initiatives will be crucial to mitigate the socioeconomic disparities associated with the growing burden of cardiometabolic traits. Metabolic obesity among phenotypically normal or underweight adolescents should not be overlooked but should be intervened early through novel screening criteria to prevent future cardiovascular burdens. These findings also have implications for low- and -middle income countries like India, which are undergoing a nutritional transition where socioeconomic status strongly influences cardio-metabolic traits.

High gestational weight gain (GWG) is positively associated with acute postpartum adiposity, long-term postpartum weight retention (LPPWR), and later cardiometabolic health, but whether associations persist into midlife remains unknown.

Among Black and Dominican women from a prospective cohort (N = 210), GWG adherence to 2009 Institute of Medicine (IOM) guidelines and restricted cubic spline GWG z scores were calculated. At 17 years post delivery, weight, height, waist circumference (WC), systolic and diastolic blood pressure, fat mass (FM), and fat-free mass were measured. Linear and logistic regression estimated associations between GWG and long-term postpartum outcomes, adjusting for covariates.

Over one-half (60%) of participants had GWG above IOM guidelines. At 17 years, mean (SD) BMI was 31.2 (6.7) kg/m2. GWG above IOM guidelines was positively associated with 17-year FM (β = 5.11 kg; 95% CI: 2.35-7.88), WC (β = 4.95 cm; 95% CI: 2.07-7.83), and LPPWR from prepregnancy to 17 years (β = 6.10 kg; 95% CI: 2.46-9.75), but not with blood pressure. Positive associations were also observed between GWG z scores and body fat percentage, FM, fat-free mass, WC, and LPPWR.

As women age into midlife, high GWG continues to be associated with higher adiposity, as well as weight gain more than 6 kg above prepregnancy weight, compared with those who gain within or below IOM guidelines.

Magnetically controlled growing rods (MCGRs) have become the current standard in the growth-friendly treatment of patients with early-onset scoliosis (EOS). MCGRs allow noninvasive lengthenings with external lengthening device and reduce the need for surgical procedures. The association of preoperative body mass index (BMI) and the outcomes of the MCGR treatment is not well known.

Prospectively collected international database was reviewed for EOS patients treated with MCGR. Patients without preoperative BMI data or follow-up <2 years were excluded. Patients were classified as healthy weight, overweight, and underweight using Centers for Disease Control and Prevention (CDC) growth charts. Quality of life was assessed using EOSQ-24. Results were analyzed from the 2-year follow-up.

A total of 663 patients were categorized into underweight (n=91), healthy weight (n=417), and overweight (n=155) groups. There were no significant differences in major curve correction or thoracic height increase among the BMI groups, irrespective of etiology. Distribution of BMI categories differed significantly by etiology (P=0.009), with lower healthy weight proportions in the syndromic group (92/167, 55%) compared with idiopathic (131/177, 74%) (adjusted P=0.004), and a higher underweight proportion in neuromuscular (36/244, 15%) compared with idiopathic (15/177, 8.5%) (adjusted P=0.044). Higher BMI z-scores were associated with an increased incidence of complications, including implant-related complications (RR 1.1, 95% CI 1.0-1.3) and implant breakage (RR 1.3, 95% CI 1.1-1.7). Healthy weight and underweight patients experienced lower overall complication rates compared with overweight patients. Implant-related complications were less common in underweight patients compared with overweight patients (RR 0.45, 95% CI 0.20-0.90). Higher BMI z-score was a significant predictor of implant breakage, whereas preoperative major curve, kyphosis, and etiology were not. EOSQ-24 scores did not differ significantly among BMI groups, and changes in scores were comparable across groups during follow-up.

BMI status did not influence curve correction, thoracic height increase, or EOSQ-24 outcomes in early-onset scoliosis patients. However, the higher incidence of implant breakage in overweight patients suggests that elevated BMI should be carefully considered when planning treatment.

Level III.

To develop and validate the psychometric properties, reliability, and criterion validity of the Physical Activity Barriers Scale for pediatric type 1 diabetes (PABS-1) in Spanish-speaking children and adolescents with type 1 diabetes.

A cross-sectional study was conducted with a sample of 93 Spanish-speaking children and adolescents with type 1 diabetes. The PABS-1 questionnaire was developed by experts and refined with patient feedback. Its validity was assessed by comparing results with accelerometer data, linking scores to objective physical activity measures.

The PABS-1 showed good internal consistency, with a Cronbach's alpha (α) coefficient of 0.89, indicating strong reliability. Confirmatory factor analysis supported a four-factor structure, with physical, diabetes-related, psychological, and environmental barriers showing good fit indices (comparative fit index [CFA] = 0.94, root mean square error of [RMSEA] = 0.06, standardized root mean square residual [SRMR] = 0.05). Although the associations were small, the total PABS-1 score was significantly negatively correlated with cardiorespiratory fitness (Spearman's rho [ρ]= -0.15, p = 0.035) and moderate-to-vigorous physical activity (ρ = -0.12, p = 0.039). Among the four factors, motivational barriers exhibited the strongest associations with physical activity and fitness, showing significant negative correlations.

The PABS-1 is a valid and reliable tool for assessing perceived barriers to physical activity in Spanish-speaking children and adolescents with type 1 diabetes.

To evaluate the effect of vitamin D supplementation on vitamin D deficiency (VDD) and glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM).

This controlled clinical trial involved children and adolescents with T1DM for at least one year. Participants with VDD (25(OH)D < 30 ng/mL) were allocated to the intervention group and oral supplementation with cholecalciferol was prescribed at a dose of 2000 IU/day for 12 weeks. Sociodemographic, clinical, laboratory, lifestyle,anthropometric data and the Fok-I polymorphism (rs2228570) vitamin D receptor were collected. The effect of the intervention was assessed using Glass's Delta.

Of the 133 participants, 77.4 % were assigned to the intervention group (n = 103). Serum 25(OH)D concentration increased from 19.2 ± 6.2 to 30.9 ± 10.1 ng/mL (Glass's Delta = 1.2; CI 0.8/-1.4).A minimal effect was showed on glycemic control (Glass's Delta = 0.1; CI -0.2/0.4). A higher dose of insulin (β = -4.6; CI -8.1/-1.1; p = 0.010) and a high BMI (β = -0.3; CI - 0.6/-0.01; p = 0.059) were associated with lower serum 25(OH)D concentration, and sedentary (β = 0.20; CI - 0.1/0.7; p = 0.004) associated with higher HbA1C after 12 weeks of supplementation.

Oral cholecalciferol supplementation was effective in correcting VDD. This study identified the minimal effect of this intervention on glycemic control.

To determine how gestational age at birth and postnatal growth relate to body composition in childhood.

We calculated conditional growth (birth-2 years, 2 years-6 years) and measured body composition at 2 and 6 years using bioelectrical impedance in cohorts of New Zealand children born very preterm (VPT; 23-31 weeks), late preterm (LPT; 35- <37 weeks) and term (≥37 weeks). We explored the relationships between growth and fat mass (FM) index and fat-free mass (FFM) index at 6 years using multivariable linear regression.

Of 1125 children (51% male), 202 were VPT, 114 LPT and 809 Term. Compared to Term, VPT but not LPT were lighter and shorter at 2 and 6 years and had lower FM index and FFM index. The association between weight growth from 2 to 6 years and both FM index and FFM index at 6 years was stronger than for weight growth from birth to 2 years or height growth at any period in all gestational age groups.

Size and body composition at 2 and 6 years are different between infants born VPT, but not LPT, and at term. Later weight growth is more strongly associated with childhood body composition than earlier growth.

Measuring food security accurately has implications for policies and programming designed to address both hunger and obesity risk among children.

We aimed to examine the validity of the Latin American and Caribbean Food Security Scale (ELCSA) for use in Samoa.

The ELCSA was administered verbally to 454 Samoan mothers who were participants in an ongoing longitudinal cohort study (the Ola Tuputupua'e Study). Internal consistency and construct validity were examined with Rasch modeling, which generated item severity and item infit statistics. Associations between food security and several cohort characteristics including maternal education, household income, and child dietary intake were examined to determine whether common associations present in the extant literature could be replicated. Face and content validity were explored through focus group discussions with n = 34 of the participants.

The ELCSA showed strong reliability and internal consistency and, with minor exceptions, participants clearly understood the survey questions. On the basis of Rasch modeling, the score thresholds for food insecurity used in the original tool are appropriate for use in Samoa. Many families in Samoa experience some degree of food insecurity, primarily driven by a lack of access to "healthy" foods, although extreme food insecurity was infrequent. The managed process of food insecurity is largely consistent with that found elsewhere, although uniquely protective factors such as continued subsistence farming and community food sharing mitigate the absolute lack of food for most families.

The Samoan translation of the 15-question ELCSA has validity for use among nonpregnant Samoan women with children. Although there are unique protective factors, food insecurity should be continuously monitored in Samoa with efforts made to provide resources to families experiencing extreme food insecurity.

Monogenic defects in the leptin-melanocortin pathway are associated with hyperphagia and severe, early-onset obesity. Early childhood growth patterns in height, weight, and BMI, might serve as phenotypic markers for specific genetic disorders; however, reliable data are scarce. This study aimed to evaluate the natural history of height, weight, and BMI in early childhood in a large European group of individuals with monogenic obesity.

This multicentre observational study analysed height, weight, and BMI from birth to age 5 years in individuals diagnosed with biallelic (likely) pathogenic LEP, LEPR, POMC, PCSK1, or MC4R variants or monoallelic (likely) pathogenic MC4R variants from six European centres (Berlin and Ulm, Germany; Cambridge, UK; Madrid, Spain; Paris, France; Rotterdam, Netherlands). All patient data up to May 31, 2022 were included in this analysis. All individuals had at least two height or weight measurements between birth and age 5 years. Early childhood growth trajectories were compared with those of control children with obesity without a known genetic cause, following a negative next-generation sequencing panel. Diagnostic performance of BMI as a predictor test for monogenic obesity was also evaluated.

We included 147 individuals with monogenic obesity. From the age of 6 months onwards, children with biallelic variants (n=88, 55% female vs 45% male) had substantially higher BMIs than those with monoallelic MC4R variants (n=59, 53% female vs 47% male) and control children (n=113, 59% female vs 41% male). Children with biallelic LEP, LEPR, and MC4R variants showed a steep BMI increase during the first year of life, followed by a plateau until age 5 years, whereas those with biallelic POMC variants did not plateau. Accelerated linear growth was only observed in children with biallelic MC4R variants starting from age 1 year. The optimal BMI cut-off for distinguishing individuals with biallelic variants from control individuals was identified at age 2 years, with a test positivity cutoff of 24·0 kg/m2 (sensitivity: 0·96 [95% CI 0·89-1·00], specificity: 0·83 [0·74-0·90], AUC: 0·96 [0·91-0·99], p<0·0001). However, BMI had poor diagnostic performance for monoallelic MC4R variants.

This study identified characteristic early childhood BMI trajectories for different forms of monogenic obesity. From age 6 months onwards, individuals with biallelic variants can be distinguished from those with monoallelic variants and common obesity. A BMI ≥24 kg/m2 at age 2 years had good diagnostic performance for biallelic variants, informing future recommendations for genetic screening for monogenic obesity.

Federal Ministry of Education and Research as part of the German Center for Child and Adolescent Health, German Research Foundation, Spanish Ministry of Health, The Wellcome Trust, Botnar Fondation, Leducq Foundation, National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre, and NIHR Senior Investigator Award.

Cystic fibrosis (CF) is an autosomal recessive, chronic, potentially lethal genetic disease. CF manifestations are due to mutations in the CF transmembrane receptor transporter (CFTR) gene which codes for a protein (CFTR) that acts as an anion transporter, mainly chlorine, at epithelial cells where it is expressed. Cystic fibrosis related liver disease (CFRLD) includes a spectrum of hepatobiliary manifestations whose diagnosis and follow-up remains a challenge.

Cross-sectional, descriptive study from 10 Spanish cystic fibrosis units. Clinical and biochemical data obtained. Patients categorized into 3 groups according to liver involvement based on ESPGHAN 2017 criteria. Liver stiffness assessed by transient elastography (TE) and findings from abdominal ultrasound recorded. Statistics performed using SPSS v25.0.

We obtained hepatic TE data from 155 pediatric CF patients. Forty-four classified as CFRLD, 38 (86%) had CFRLD without cirrhosis and 6 (14%) had cirrhosis. Fourteen patients without CFRLD (12%) had ultrasound abnormalities. Mean liver elastography value (kPa) was 4.7 (3.5-5.3) in non-CFRLD and 6.09 (4.4-6.7) in CFRLD (p=0.01; T Student [T]).

CFRLD is common in children with CF. Transient elastography is a useful method for diagnosis and follow-up, as higher values of TE are found in patients with CFRLD.

Trimethylamine N-oxide (TMAO) is a metabolite derived from gut microbiota that has been associated with cardiovascular and metabolic disease risk in adults. However, its role in assessing cardiometabolic risk in adolescents is unclear.

This study investigates the association between serum TMAO levels and cardiometabolic health indicators in Brazilian adolescents.

This is a multicenter, cross-sectional analysis involving 4446 participants aged 12 to 17 years from four Brazilian cities. Serum TMAO levels were quantified using liquid chromatography-tandem mass spectrometry, and associations with clinical, metabolic, and inflammatory variables were evaluated through multivariate linear regression analyses.

After adjusting for potential confounders, being in the highest tertile of serum TMAO was positively associated with waist circumference [β 1.45; 95% confidence interval (CI) 0.77, 2.14; P < .001], body mass index Z-score (β .19; 95% CI 0.10, 0.27; P < .001), and C-reactive protein (β .24; 95% CI 0.13, 0.34; P < .001). A negative association between the highest tertile of TMAO and fasting plasma glucose was also observed (β -1.22; 95% CI -1.77, -0.66; P < .001).

TMAO may serve as an emerging biomarker for cardiometabolic risk assessment in adolescents.

Neurogenic bladder due to myelomeningocele (MMC) is a significant risk factor for chronic kidney disease in children. Cystatin C (CysC) is a more accurate GFR marker than creatinine as it is unaffected by muscle mass but may be influenced by fat mass and BMI. This study evaluates: (1) GFR measurement accuracy using CysC and creatinine in MMC-related neurogenic bladder, (2) the relationship between body composition via bioelectrical impedance analysis (BIA) and renal parameters, and (3) the use of BIA for non-invasive GFR and body composition assessment.

Forty children (median age 9.96 years) underwent serum creatinine, CysC testing, and BIA measurements. We assessed age, sex, spinal lesion level, anthropometric measurements, BMI, and activity using Hoffer's scale. GFR was calculated using five creatinine-based formulas, three CysC-based, and three combining CysC and creatinine, including BIA GFR as an alternative approach.

Creatinine-based GFR estimates were significantly higher than CysC-based GFR. Although only 30% of MMC patients met the traditional BMI criteria for overweight/obesity, 62.5% were obese based on BIA-measured body fat percentage. Significant differences were found in CysC and CysC-based GFR equations within BMI and fat mass groups. Positive correlations were observed between CysC and body weight, BMI percentiles, body fat mass and fat-to-muscle ratio. Muscle mass positively correlated with creatinine.

BIA-determined fat mass percentage is a more sensitive obesity indicator than BMI in MMC patients. CysC levels and CysC-based GFR equations are influenced by body fat mass, requiring consideration of adiposity to avoid misestimating renal impairment.

Rapid shifts in dietary patterns, marked by increased consumption of ultra-processed foods (UPFs), are increasingly impacting the health and wellbeing of infants and toddlers in low- and middle-income countries.

Utilizing data from the Demographic and Health Surveys, other national surveys, NCD-RisC data and Euromonitor sales data, we examine changes in stunting and overweight/obesity prevalence alongside the latest data on UPF consumption trends.

The prevalence of overweight/obesity among children and mothers is increasing rapidly while stunting rates decline slowly. Simultaneously, there is a significant increase in consumption of UPFs, especially among preschool-aged children. Increasingly, poorer households are experiencing faster rates of increase in overweight and obesity prevalence compared to wealthier households. Results highlight the early socialization of infants and toddlers to unhealthy discretionary foods including UPFs, potentially setting the stage for long-term dietary preferences that favour food with high sugar or excess sodium.

There is an urgent need to address the rapid increases in UPF consumption among infants and toddlers. Options include expanding the WHO Code on marketing to protect 0-3-year-olds; creating front-of-package warning labels focusing on products for children ages 0-3 years to remove all added sugar and limit sodium in foods and beverages they consume.

Nonalcoholic Fatty Pancreas Disease (NAFPD) is characterized by excessive lipid accumulation within the pancreas in the absence of alcohol intake, potentially leading to pancreatic dysfunction and metabolic complications, including type 2 diabetes mellitus, acute and chronic pancreatitis, and pancreatic carcinoma. The authors aim to estimate the prevalence of NAFPD and its association with anthropometric parameters in a cohort of Chilean adolescents.

The authors conducted a cross-sectional analysis of the "Growth and Obesity Chilean Cohort Study" (GOCS), a longitudinal study involving nearly 1000 children, followed yearly since 2006. All participants underwent anthropometric measurements and abdominal ultrasonography.

A total of 741 adolescents were included; 30 exhibited ultrasonography findings compatible with fatty pancreas (4 %). Adolescents with NAFPD had higher BMI z-score (2.33 (1.52-2.69) vs 0.67 (-0.2-1.4), p < 0.001), waist circumference (WC) (90.9 (81.53-98.58) vs 72.2 (67.55-79.83), p < 0.001), waist-to-height ratio (0.55 (0.48-0.6) vs 0.44 (0.41-0.49), p < 0.001), triponderal index (17.35 (15.14-19.25) vs 13.62 (12.07-15.54), p < 0.001), subcutaneous fat (32.4 (21.77-44.95) vs 16.2 (9.3 - 25.3), p < 0.001), visceral fat (45.15 (36.92-62.08) vs 35.5 (28.55-44.25), p < 0.001), systolic blood pressure (p = 0.009), and diastolic blood pressure but only in boys (p = 0.004) compared with controls. The prevalence of liver steatosis was significantly higher in the NAFPD group (63.3% vs 5.2 %, p < 0.001). After adjusting for sex and BMI, only the association with waist circumference and liver steatosis remains statistically significant.

In adolescents, NAFPD has a prevalence of 4 % and is associated with a higher BMI z-score, WC, superficial fat, and blood pressure levels. Liver steatosis exhibited a strong association with NAFPD.

Autism spectrum disorder (ASD) is often accompanied by a variety of comorbidities. A high prevalence of patients has difficulties with food intake, which can lead to malnutrition, obesity and dyslipidaemia. Although several factors influencing dietary intake in this population have been investigated in the literature, the lack of standardised assessment protocols has led to heterogeneous results across studies. This study protocol describes the methodology used to assess nutritional aspects such as feeding problems, food intake and biochemical variables in children and adolescents with ASD.

The clinical protocol for nutritional screening in autism is a clinically based cross-sectional study design that focuses on the assessment of nutrition in children and adolescents with ASD aged 2 to under 19 years. Participants and caregivers are assessed in three clinical steps by a team of dietitians. Nutritional aspects are assessed, such as feeding behaviour (Brief Autism Mealtime Behavior Inventory, Children's Eating Behavior Questionnaire), food intake (3 non-consecutive days of 24-hour food record), anthropometric measurements to calculate nutritional indicators according to WHO standards and blood samples (analysis of fasting glucose, triglycerides, total cholesterol and its subfractions). The data collected have the potential for descriptive and multivariate analyses to investigate associations among clinical, dietary difficulties, nutritional and biochemical variables.

The study protocol was approved by the institutional review board of the Federal University of Pelotas (CAEE: 94253518.0.0000.5317). The results will be disseminated through peer-reviewed publications and conferences.

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) affects approximately 1 in 15 000 individuals. We leveraged the power of multicentre registry data to assess the trend and predictors of blood pressure (BP) within children and young persons with 21OHD to inform monitoring strategies.

Data from the International CAH Registry in patients younger than 20 years was compared to normative values. Values of BP were modeled to create reference curves, multiple change point analysis applied to quantify the difference with normative data. Covariate adjustment was informed by a directed acyclic graph, prior to joint outcome regression modeling to accurately assess predictors of BP.

A total of 6436 visits within 554 patients (52.5% females) showed BP-Standard deviation scores (SDS) were higher at younger ages. Patients under five years had systolic BP-SDS of 1.6 (Q1:0.6-Q3:2.7) decreasing to 1.0 (Q1:0.2-Q3:1.8) over 5 years, equating to 31.0% over the 95th centile decreasing to 15.0%. Higher doses of fludrocortisone were associated with a small increase in systolic BP equivalent to 1.2 mmHg with every 100 µg extra fludrocortisone. Renin of 100µU/mL was associated with 4.6 mmHg lower systolic BP than a renin of 1µU/mL, higher 17OH-progesterone and androstenedione also predicted lower systolic and diastolic BP (P < .05).

Higher BP in children with 21OHD is common and particularly pronounced at a younger age, but may not be attributable to excessive mineralocorticoid replacement. There is a need to improve our understanding of the determinants of this raised BP as well as its long-term effects.