1
January 2020, Volume 8, Issue 1, Number 17
Maryam Bahreynian1 , Marjan Mansourian2 , Nafiseh Mozaffarian3 , Parinaz Poursafa4 , Mehri Khoshhali3* , Roya Kelishadi3
Review Article:
The Association Between Exposure to Ambient Particulate
Matter and Childhood Obesity: A Systematic Review and
Meta-analysis
Context: Physical environment contamination and in particular, air pollution might cause long-term
adverse effects in child growth and a higher risk of catching non-communicable diseases later in life.
Objective: This study aimed to overview the human studies on the association of exposure to
ambient Particulate Matter (PM) with childhood obesity.
Data Sources: We systematically searched human studies published until March 2018 in PubMed,
Scopus, Ovid, ISI Web of Science, Cochrane library, and Google Scholar databases.
Study Selection: All studies that explored the association between PM exposure and childhood
obesity were assessed in the present study, and finally, 5 studies were used in the meta-analysis.
Data Extraction: Two independent researchers performed the data extraction procedure and
quality assessment of the studies. The papers were qualitatively assessed by STROBE (Strengthening
the Reporting of Observational studies in Epidemiology) statement checklist.
Results: The pooled analysis of PM exposure was significantly associated with increased Body Mass
Index (BMI) (Fisher’s z-distribution=0. 028; 95% CI=0. 017, 0. 038) using the fixed effects model. We
also used a random-effect model because we found a significant high heterogeneity of the included
studies concerning the PM (I2=94. 4%; P<0. 001). PM exposure was associated with increased BMI
(Fisher’s z-distribution=0. 022; 95% CI=-0. 057, 0. 102). However, the overall effect size was not
significant, and heterogeneity of the included studies was similar to the fixed effect model.
Discussion: Our findings on the significant association between PM10 exposure and the increased
BMI (r=0. 034; 95%CI=0. 007, 0. 061) without heterogeneity (I2=16. 6%, P=0. 274) (in the studies with
PM10) suggest that the PM type might account for the heterogeneity among the studies.
Conclusion: The findings indicate that exposure to ambient PM10 might have significant effects on
childhood obesity.
A B S T R A C T
Key Words:
Air pollution, Particulate
matter, Childhood
obesity, Meta-analysis
Article info:
Received: 10 Oct 2018
First Revision: 23 Feb 2019
Accepted: 09 Mar 2019
Published: 01 Jan 2020
1. Department of Nutrition Child Growth, and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Dis-
eases, Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.
2. Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
3. Department of Pediatrics, Child Growth, and Development Research Center, Research Institute for Primordial Preve ...
Identifying and Prioritizing Chemicals with Uncertain Burden oMalikPinckney86
Identifying and Prioritizing Chemicals with Uncertain Burden of Exposure:
Opportunities for Biomonitoring and Health-Related Research
Edo D. Pellizzari,1 Tracey J. Woodruff,2 Rebecca R. Boyles,3 Kurunthachalam Kannan,4 Paloma I. Beamer,5 Jessie P. Buckley,6
Aolin Wang,2 Yeyi Zhu,7,8 and Deborah H. Bennett9 (Environmental influences on Child Health Outcomes)
1Fellow Program, RTI International, Research Triangle Park, North Carolina, USA
2Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San
Francisco, San Francisco, California, USA
3Bioinformatics and Data Science, RTI International, Research Triangle Park, North Carolina, USA
4Wadsworth Center, New York State Department of Health, Albany, New York, USA
5Department of Community, Environment and Policy, Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
6Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Heath, Johns Hopkins University,
Baltimore, Maryland, USA
7Northern California Division of Research, Kaiser Permanente, Oakland, California, USA
8Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
9Department of Public Health Sciences, University of California, Davis, Davis, California, USA
BACKGROUND: The National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) initiative aims to understand the
impact of environmental factors on childhood disease. Over 40,000 chemicals are approved for commercial use. The challenge is to prioritize chemi-
cals for biomonitoring that may present health risk concerns.
OBJECTIVES: Our aim was to prioritize chemicals that may elicit child health effects of interest to ECHO but that have not been biomonitored nation-
wide and to identify gaps needing additional research.
METHODS: We searched databases and the literature for chemicals in environmental media and in consumer products that were potentially toxic. We
selected chemicals that were not measured in the National Health and Nutrition Examination Survey. From over 700 chemicals, we chose 155 chemi-
cals and created eight chemical panels. For each chemical, we compiled biomonitoring and toxicity data, U.S. Environmental Protection Agency ex-
posure predictions, and annual production usage. We also applied predictive modeling to estimate toxicity. Using these data, we recommended
chemicals either for biomonitoring, to be deferred pending additional data, or as low priority for biomonitoring.
RESULTS: For the 155 chemicals, 97 were measured in food or water, 67 in air or house dust, and 52 in biospecimens. We found in vivo endocrine, de-
velopmental, reproductive, and neurotoxic effects for 61, 74, 47, and 32 chemicals, respectively. Eighty-six had data from high-throughput in vitro
assays. Positive results for endocrine, developmental, neurotoxicity, ...
Identifying and prioritizing chemicals with uncertain burden ossuser47f0be
This document summarizes a study that aimed to prioritize chemicals for biomonitoring that may present health risks to children, as part of the National Institutes of Health's ECHO initiative. The researchers identified over 700 chemicals from environmental media and consumer products databases that had not been measured in the NHANES. They compiled toxicity and exposure data on 155 chemicals and organized them into 8 panels. Based on the data, 36 chemicals were recommended for biomonitoring, 108 were deferred pending more research, and 11 were deemed a low priority. The study identified many chemicals that lack data on biomonitoring methods and health effects, representing opportunities for future research.
Prevalence of obesity & factors leading to obesity among high school stud...Anjum Hashmi MPH
This document summarizes a research study on childhood obesity among high school students in Hyderabad, Pakistan. The study aimed to determine the prevalence of obesity and factors leading to obesity. Some key findings:
1) The prevalence of overweight was 23% in boys and 16% in girls, while obesity prevalence was 15% in boys and 8% in girls.
2) Multivariate analysis showed that girls were 67% less likely to be obese than boys. Older age groups were also less likely to be obese.
3) Students from middle socioeconomic status families were over 3 times more likely to be obese than lower socioeconomic status students.
4) Eating fruit more than 4 times a
1. The study examined the association between prenatal air pollution exposure and childhood IQ in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood cohort.
2. Prenatal exposure to particulate matter (PM10) was associated with slightly lower full-scale IQ scores in children, while nitrogen dioxide and road proximity were not associated.
3. The association between PM10 and IQ appeared to be modified by maternal plasma folate levels during pregnancy, with a stronger negative association observed among children of mothers in the lowest folate quartile.
Diet and Exercise Research Paper 2 PC correctedAustin Clark
This meta-analysis reviewed 7 randomized controlled trials examining the effects of diet, exercise, and mixed interventions on obesity measures in children. The studies included a total of 1,530 children who were approximately 55% overweight or obese at baseline. The analysis found no statistically significant effects of any intervention type on BMI, BMI z-score, or weight compared to controls. There was significant heterogeneity between the studies. While the results did not support the efficacy of these interventions, dietary interventions favored weight gain while exercise and mixed interventions favored weight loss, though insignificantly. Additional high-quality research is still needed to determine effective obesity interventions for children.
A Review Of Electronic Interventions For Prevention And Treatment Of Overweig...Carrie Cox
Three sentences:
The review examined 24 studies of electronic interventions for preventing or treating obesity in children and adolescents. Most studies showed some positive changes in dietary, physical activity or weight outcomes, however the overall quality of the studies was poor. Further high quality research is needed to accurately determine the effectiveness of electronic interventions for obesity in youth.
Chemical Risk Assessment Traditional vs PublicHealth PerspeJinElias52
Chemical Risk Assessment: Traditional vs Public
Health Perspectives
Preventing adverse health ef-
fects of environmental chemical
exposure is fundamental to pro-
tecting individual and public he-
alth. When done efficiently and
properly, chemical risk assess-
ment enables risk management
actions that minimize the in-
cidence and effects of environ-
mentally induced diseases related
to chemical exposure. However,
traditional chemical risk assess-
ment is faced with multiple chal-
lenges with respect to predicting
and preventing disease in human
populations, and epidemiological
studies increasingly report obser-
vations of adverse health effects
at exposure levels predicted
from animal studies to be safe
for humans. This discordance
reinforces concerns about the
adequacy of contemporary risk
assessment practices for pro-
tecting public health.
It is becoming clear that to
protect public health more effec-
tively, future risk assessments will
need to use the full range of
available data, draw on innovative
methods to integrate diverse data
streams, and consider health
endpoints that also reflect the
range of subtle effects and mor-
bidities observed in human pop-
ulations.
Considering these factors,
there is a need to reframe
chemical risk assessment to be
more clearly aligned with the
public health goal of minimizing
environmental exposures asso-
ciated with disease. (Am J Public
Health. 2017;107:1032–1039.
doi:10.2105/AJPH.2017.303771)
Maureen R. Gwinn, PhD, Daniel A. Axelrad, MPP, Tina Bahadori, ScD, David Bussard, BA, Wayne E.
Cascio, MD, Kacee Deener, MPH, David Dix, PhD, Russell S. Thomas, PhD, Robert J. Kavlock, PhD, and
Thomas A. Burke, PhD, MPH
See also Greenberg, p. 1020.
For the past several decades,human health risk assessment
has been a pillar of environmental
health protection. In general,
the products of risk assessment
have been numerical risk values
derived from animal toxicology
studies of observable effects at
high doses of individual chem-
icals. Although this approach has
contributed to our understanding
of overt health outcomes from
chemical exposures, it does not
always match our understanding
from epidemiology studies of the
consequences of real-world ex-
posures in human populations,
which are characterized by expo-
sure to multiple pollutants, often
chronically, at concentrations that
can fluctuate over wide ranges;
susceptible populations and life
stages; potential interactions be-
tween chemicals and nonchemical
stressors and background disease
states; and lifestyle factors that
modify exposures (e.g., airtight
houses).1 Theseandotherissuesare
particularly important when de-
termining risk of complex diseases,
such as cardiovascular disease.
Ten years ago, the National
Research Council offered a new
paradigm for evaluating the safety
of chemicals on the basis of
chemical characterization, testing
using a toxicity pathway ap-
proach, and modeling and ex-
trapolating the ...
Identifying and Prioritizing Chemicals with Uncertain Burden oMalikPinckney86
Identifying and Prioritizing Chemicals with Uncertain Burden of Exposure:
Opportunities for Biomonitoring and Health-Related Research
Edo D. Pellizzari,1 Tracey J. Woodruff,2 Rebecca R. Boyles,3 Kurunthachalam Kannan,4 Paloma I. Beamer,5 Jessie P. Buckley,6
Aolin Wang,2 Yeyi Zhu,7,8 and Deborah H. Bennett9 (Environmental influences on Child Health Outcomes)
1Fellow Program, RTI International, Research Triangle Park, North Carolina, USA
2Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San
Francisco, San Francisco, California, USA
3Bioinformatics and Data Science, RTI International, Research Triangle Park, North Carolina, USA
4Wadsworth Center, New York State Department of Health, Albany, New York, USA
5Department of Community, Environment and Policy, Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
6Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Heath, Johns Hopkins University,
Baltimore, Maryland, USA
7Northern California Division of Research, Kaiser Permanente, Oakland, California, USA
8Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
9Department of Public Health Sciences, University of California, Davis, Davis, California, USA
BACKGROUND: The National Institutes of Health’s Environmental influences on Child Health Outcomes (ECHO) initiative aims to understand the
impact of environmental factors on childhood disease. Over 40,000 chemicals are approved for commercial use. The challenge is to prioritize chemi-
cals for biomonitoring that may present health risk concerns.
OBJECTIVES: Our aim was to prioritize chemicals that may elicit child health effects of interest to ECHO but that have not been biomonitored nation-
wide and to identify gaps needing additional research.
METHODS: We searched databases and the literature for chemicals in environmental media and in consumer products that were potentially toxic. We
selected chemicals that were not measured in the National Health and Nutrition Examination Survey. From over 700 chemicals, we chose 155 chemi-
cals and created eight chemical panels. For each chemical, we compiled biomonitoring and toxicity data, U.S. Environmental Protection Agency ex-
posure predictions, and annual production usage. We also applied predictive modeling to estimate toxicity. Using these data, we recommended
chemicals either for biomonitoring, to be deferred pending additional data, or as low priority for biomonitoring.
RESULTS: For the 155 chemicals, 97 were measured in food or water, 67 in air or house dust, and 52 in biospecimens. We found in vivo endocrine, de-
velopmental, reproductive, and neurotoxic effects for 61, 74, 47, and 32 chemicals, respectively. Eighty-six had data from high-throughput in vitro
assays. Positive results for endocrine, developmental, neurotoxicity, ...
Identifying and prioritizing chemicals with uncertain burden ossuser47f0be
This document summarizes a study that aimed to prioritize chemicals for biomonitoring that may present health risks to children, as part of the National Institutes of Health's ECHO initiative. The researchers identified over 700 chemicals from environmental media and consumer products databases that had not been measured in the NHANES. They compiled toxicity and exposure data on 155 chemicals and organized them into 8 panels. Based on the data, 36 chemicals were recommended for biomonitoring, 108 were deferred pending more research, and 11 were deemed a low priority. The study identified many chemicals that lack data on biomonitoring methods and health effects, representing opportunities for future research.
Prevalence of obesity & factors leading to obesity among high school stud...Anjum Hashmi MPH
This document summarizes a research study on childhood obesity among high school students in Hyderabad, Pakistan. The study aimed to determine the prevalence of obesity and factors leading to obesity. Some key findings:
1) The prevalence of overweight was 23% in boys and 16% in girls, while obesity prevalence was 15% in boys and 8% in girls.
2) Multivariate analysis showed that girls were 67% less likely to be obese than boys. Older age groups were also less likely to be obese.
3) Students from middle socioeconomic status families were over 3 times more likely to be obese than lower socioeconomic status students.
4) Eating fruit more than 4 times a
1. The study examined the association between prenatal air pollution exposure and childhood IQ in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood cohort.
2. Prenatal exposure to particulate matter (PM10) was associated with slightly lower full-scale IQ scores in children, while nitrogen dioxide and road proximity were not associated.
3. The association between PM10 and IQ appeared to be modified by maternal plasma folate levels during pregnancy, with a stronger negative association observed among children of mothers in the lowest folate quartile.
Diet and Exercise Research Paper 2 PC correctedAustin Clark
This meta-analysis reviewed 7 randomized controlled trials examining the effects of diet, exercise, and mixed interventions on obesity measures in children. The studies included a total of 1,530 children who were approximately 55% overweight or obese at baseline. The analysis found no statistically significant effects of any intervention type on BMI, BMI z-score, or weight compared to controls. There was significant heterogeneity between the studies. While the results did not support the efficacy of these interventions, dietary interventions favored weight gain while exercise and mixed interventions favored weight loss, though insignificantly. Additional high-quality research is still needed to determine effective obesity interventions for children.
A Review Of Electronic Interventions For Prevention And Treatment Of Overweig...Carrie Cox
Three sentences:
The review examined 24 studies of electronic interventions for preventing or treating obesity in children and adolescents. Most studies showed some positive changes in dietary, physical activity or weight outcomes, however the overall quality of the studies was poor. Further high quality research is needed to accurately determine the effectiveness of electronic interventions for obesity in youth.
Chemical Risk Assessment Traditional vs PublicHealth PerspeJinElias52
Chemical Risk Assessment: Traditional vs Public
Health Perspectives
Preventing adverse health ef-
fects of environmental chemical
exposure is fundamental to pro-
tecting individual and public he-
alth. When done efficiently and
properly, chemical risk assess-
ment enables risk management
actions that minimize the in-
cidence and effects of environ-
mentally induced diseases related
to chemical exposure. However,
traditional chemical risk assess-
ment is faced with multiple chal-
lenges with respect to predicting
and preventing disease in human
populations, and epidemiological
studies increasingly report obser-
vations of adverse health effects
at exposure levels predicted
from animal studies to be safe
for humans. This discordance
reinforces concerns about the
adequacy of contemporary risk
assessment practices for pro-
tecting public health.
It is becoming clear that to
protect public health more effec-
tively, future risk assessments will
need to use the full range of
available data, draw on innovative
methods to integrate diverse data
streams, and consider health
endpoints that also reflect the
range of subtle effects and mor-
bidities observed in human pop-
ulations.
Considering these factors,
there is a need to reframe
chemical risk assessment to be
more clearly aligned with the
public health goal of minimizing
environmental exposures asso-
ciated with disease. (Am J Public
Health. 2017;107:1032–1039.
doi:10.2105/AJPH.2017.303771)
Maureen R. Gwinn, PhD, Daniel A. Axelrad, MPP, Tina Bahadori, ScD, David Bussard, BA, Wayne E.
Cascio, MD, Kacee Deener, MPH, David Dix, PhD, Russell S. Thomas, PhD, Robert J. Kavlock, PhD, and
Thomas A. Burke, PhD, MPH
See also Greenberg, p. 1020.
For the past several decades,human health risk assessment
has been a pillar of environmental
health protection. In general,
the products of risk assessment
have been numerical risk values
derived from animal toxicology
studies of observable effects at
high doses of individual chem-
icals. Although this approach has
contributed to our understanding
of overt health outcomes from
chemical exposures, it does not
always match our understanding
from epidemiology studies of the
consequences of real-world ex-
posures in human populations,
which are characterized by expo-
sure to multiple pollutants, often
chronically, at concentrations that
can fluctuate over wide ranges;
susceptible populations and life
stages; potential interactions be-
tween chemicals and nonchemical
stressors and background disease
states; and lifestyle factors that
modify exposures (e.g., airtight
houses).1 Theseandotherissuesare
particularly important when de-
termining risk of complex diseases,
such as cardiovascular disease.
Ten years ago, the National
Research Council offered a new
paradigm for evaluating the safety
of chemicals on the basis of
chemical characterization, testing
using a toxicity pathway ap-
proach, and modeling and ex-
trapolating the ...
ASSOCIATION BETWEEN SCREEN TIME AND OBESITY IN CHILDREN AND ADOLESCENTS Narr...Karen Gomez
This document summarizes a narrative review of 34 studies that examined the association between screen time and obesity in children and adolescents. The studies involved over 164,000 individuals between ages 5-19. Most studies found that increased screen time was significantly associated with higher rates of overweight and obesity. Screen time was also often associated with unhealthy eating habits and reduced physical activity. The studies suggest that screen time above 1-4 hours per day can negatively impact body composition in children and adolescents. Maintaining screen time within recommended limits may help prevent obesity.
Epidemiological studies are applicable to communicable and non-com.docxSALU18
Epidemiological studies are applicable to communicable and non-communicable diseases. Childhood obesity is an area that is receiving more attention in public health due to the multiple morbidities that emerge as a result of this condition. Below are links to a cross-sectional study and a case-control study. Imagine that you are interested in conducting a case-control or cross-sectional study proposal of childhood obesity vs. birth weight (prenatal and early life influences). Both articles below address prenatal influences on childhood obesity and birth weight using different approaches.
Article 1 -attached
Article 2-attached
Using the information in the articles, answer the following questions using AMA format.
1. How would you select cases and controls for this study and how would you define exposure and outcome variables for a case-control study design? What other factors would you control for?
2. How would you design a proposal measuring the effect of birthweight on childhood obesity for a cross-sectional study design? What other factors would you control for?
BioMed CentralBMC Public Health
ss
Open AcceStudy protocol
Cross sectional study of childhood obesity and prevalence of risk
factors for cardiovascular disease and diabetes in children aged 11–
13
Anwen Rees*1, Non Thomas1, Sinead Brophy2, Gareth Knox1 and
Rhys Williams2
Address: 1Cardiff School of Sport, University of Wales Institute Cardiff, Wales, UK and 2School of Medicine, Swansea University, Wales, UK
Email: Anwen Rees* - [email protected]; Non Thomas - [email protected]; Sinead Brophy - [email protected];
Gareth Knox - [email protected]; Rhys Williams - [email protected]
* Corresponding author
Abstract
Background: Childhood obesity levels are rising with estimates suggesting that around one in
three children in Western countries are overweight. People from lower socioeconomic status and
ethnic minority backgrounds are at higher risk of obesity and subsequent CVD and diabetes.
Within this study we examine the prevalence of risk factors for CVD and diabetes (obesity,
hypercholesterolemia, hypertension) and examine factors associated with the presence of these
risk factors in school children aged 11–13.
Methods and design: Participants will be recruited from schools across South Wales. Schools
will be selected based on catchment area, recruiting those with high ethnic minority or deprived
catchment areas. Data collection will take place during the PE lessons and on school premises. Data
will include: anthropometrical variables (height, weight, waist, hip and neck circumferences, skinfold
thickness at 4 sites), physiological variables (blood pressure and aerobic fitness (20 metre multi
stage fitness test (20 MSFT)), diet (self-reported seven-day food diary), physical activity (Physical
Activity Questionnire for Adolescents (PAQ-A), accelerometery) and blood tests (fasting glucose,
insulin, lipids, fibrinogen (Fg), adiponectin (high molecular weight), C-react ...
Previous studies on occupational exposures in parents and cancer risks in their children support a
link between solvents and paints with childhood leukaemia. Few studies have focused specifically on benzene.
Objectives: To examine whether parental occupational exposure to benzene is associated with an increased
cancer risk in a census-based cohort of children.
This paper investigates the causal effect of education on various health outcomes and behaviors in Italy, exploiting a 1963 reform that raised compulsory schooling by three years. The reform provides exogenous variation in education levels needed for causal identification. Using survey data on Italians, the paper analyzes effects on chronic diseases, BMI, smoking, physical activity, preventive health behaviors, and more. Considering multiple outcomes simultaneously allows for a more comprehensive assessment than prior studies examining only one or a few measures. The results provide new causal evidence on how education impacts health in Italy.
This document summarizes a systematic review of factors associated with childhood overweight and obesity in South Asian countries. The review included 11 studies from India, Pakistan, Bangladesh, and Sri Lanka that used BMI to measure overweight and obesity in children and adolescents. The studies found wide variation in overweight prevalence from 3.1-19.7% and obesity prevalence from 1.2-14.5%. Lack of physical activity was associated with overweight/obesity in most studies, while higher socioeconomic status, urban residence, and consumption of junk food/fast food were also identified as risk factors.
The National Children's Study aims to understand environmental factors contributing to childhood obesity through a large prospective birth cohort study of 100,000 American children. It will address limitations of past studies by following children from before conception through age 21 and collecting extensive data on genetics, behaviors, social environment, chemical exposures, and health outcomes. This life-course approach will provide insights into early-life and community-level influences on obesity risk and their interactions. The study aims to guide evidence-based strategies for obesity prevention.
The National Children's Study aims to understand environmental factors contributing to childhood obesity through a large prospective birth cohort study of 100,000 American children. It will address limitations of past studies by following children from before conception through age 21 and collecting extensive data on genetic, behavioral, social, built environment, and chemical exposure factors. This life-course approach will provide insights into obesity origins and allow examination of interactions among multiple influences over time. The study aims to guide evidence-based strategies for obesity prevention.
2
WEEK 2-ASSIGNMENT
Research Article Summaries
Magdalyn38
RES 5240 Applied Research Methods
Feb.28, 2020
What is the Intricate Relationship between Television Watching and Childhood Obesity?
1. Caroli, M., Argentieri, L., Cardone, M., & Masi, A. (2004). Role of television in childhood obesity prevention. International Journal of Obesity, 28(3), S104-S108.
The study seeks to come up with an explanation of the relationship between childhood obesity and TV watching. Food and obesity have many documented consequences and when coupled up with a sedentary lifestyle, the combined effects are quite negative. Specific aspects of TV watching, in this case, are documented and they are linked to the prevalence of childhood obesity in different countries in Europe. The intricate relationship between childhood obesity could also be attributed to the role of the different European government regulations which in all its differences has led to a significant difference in the prevalence of childhood obesity as per the authors of the article.
The research sought to review the role of television in specific activities. Amongst them, one of the effects of TV is the fact that it replaces vigorous activities. As such, there is a positive correlation between the time in which one spends on TV watching and being overweight. This is regardless of the ages of the people. The TV watching activity, as presented in the article, is also linked to obesity prevalence among the different ages of children. Generally, the more the number of hours that one spends watching TV, the higher the chance they are going to be obese.
Through the analysis of literature in the area, it is almost blatant that people that spent more than 4 hours on the TV seemed to have increased in the last 30 years. The analysis of literature was thematic in nature and this was geared towards finding information that was almost prevalent across the different secondary sources. The analysts targeted specific television food commercials targeting children, the use of food in movies and even other kid shows. Besides that, the obese subjects presented in kids’ content were reviewed with the aim of finding out ridiculous traits, and the results that worsen situations. The situation gets worse through the perceived isolation of these subjects. The method of enquiry in the article was evidently a literature study. The data obtained were mainly secondary data and this was through a thematic search of the secondary literature done in the area.
2. Zhang, G., Wu, L., Zhou, L., Lu, W., & Mao, C. (2016). Television watching and risk of childhood obesity: a meta-analysis. The European Journal of Public Health, 26(1), 13-18.
This article is important and a viable contribution to the topic since it attempts to bring to light the relationship between the times spent watching TV and the risk of obesity among children. The article puts forward the argument that over the past few years, childhood obesity r.
2
WEEK 2-ASSIGNMENT
Research Article Summaries
Magdalyn38
RES 5240 Applied Research Methods
Feb.28, 2020
What is the Intricate Relationship between Television Watching and Childhood Obesity?
1. Caroli, M., Argentieri, L., Cardone, M., & Masi, A. (2004). Role of television in childhood obesity prevention. International Journal of Obesity, 28(3), S104-S108.
The study seeks to come up with an explanation of the relationship between childhood obesity and TV watching. Food and obesity have many documented consequences and when coupled up with a sedentary lifestyle, the combined effects are quite negative. Specific aspects of TV watching, in this case, are documented and they are linked to the prevalence of childhood obesity in different countries in Europe. The intricate relationship between childhood obesity could also be attributed to the role of the different European government regulations which in all its differences has led to a significant difference in the prevalence of childhood obesity as per the authors of the article.
The research sought to review the role of television in specific activities. Amongst them, one of the effects of TV is the fact that it replaces vigorous activities. As such, there is a positive correlation between the time in which one spends on TV watching and being overweight. This is regardless of the ages of the people. The TV watching activity, as presented in the article, is also linked to obesity prevalence among the different ages of children. Generally, the more the number of hours that one spends watching TV, the higher the chance they are going to be obese.
Through the analysis of literature in the area, it is almost blatant that people that spent more than 4 hours on the TV seemed to have increased in the last 30 years. The analysis of literature was thematic in nature and this was geared towards finding information that was almost prevalent across the different secondary sources. The analysts targeted specific television food commercials targeting children, the use of food in movies and even other kid shows. Besides that, the obese subjects presented in kids’ content were reviewed with the aim of finding out ridiculous traits, and the results that worsen situations. The situation gets worse through the perceived isolation of these subjects. The method of enquiry in the article was evidently a literature study. The data obtained were mainly secondary data and this was through a thematic search of the secondary literature done in the area.
2. Zhang, G., Wu, L., Zhou, L., Lu, W., & Mao, C. (2016). Television watching and risk of childhood obesity: a meta-analysis. The European Journal of Public Health, 26(1), 13-18.
This article is important and a viable contribution to the topic since it attempts to bring to light the relationship between the times spent watching TV and the risk of obesity among children. The article puts forward the argument that over the past few years, childhood obesity r ...
This document summarizes the findings of the Global Burden of Disease 2013 study on comparative risk assessment of 79 behavioral, environmental, and metabolic risks. Some key findings include:
- These 79 risks accounted for 57.2% of all deaths and 41.6% of all disability-adjusted life years globally in 2013.
- The six individual risks or risk clusters that caused the most disability-adjusted life years were dietary risks, high blood pressure, childhood malnutrition, tobacco smoke, air pollution, and high BMI.
- Risk patterns varied significantly between regions and countries, with factors like childhood malnutrition, unsafe sex, and unsafe water being top risks in sub-Saharan Africa compared to high blood pressure, BMI, and tobacco
This study used a multilevel analysis to examine how neighbourhood factors modify the effect of smoking on birth weight in British Columbia, Canada. The study found:
1) Maternal smoking had a significant negative and non-linear association with birth weight that varied substantially between neighbourhoods.
2) Neighbourhood socioeconomic status, education levels, air pollution, and immigrant density interacted with smoking levels and were associated with birth weight. Higher neighbourhood education and immigrant density helped offset the negative impact of smoking on birth weight.
3) Including neighbourhood variables and their interactions with individual factors explained a large portion of the variability in birth weight between neighbourhoods. This suggests neighbourhood context influences how risk factors like smoking affect birth outcomes
Analysis the Effect of Educational Package on Promotion of Protective Behavio...Editor IJCATR
This study analyzed the effect of an educational package on promoting protective behaviors for dust exposure among teachers in Ahvaz, Iran. 200 teachers were divided into case and control groups. The case group received a 4-week educational program based on the health belief model covering knowledge, perceptions, and behaviors regarding dust exposure. Results showed a significant increase in the case group's knowledge, health beliefs, and protective behaviors immediately and 2 months after the intervention compared to the control group. The educational package was effective in promoting protective behaviors for dust exposure among teachers.
Environmental Pollutants and Disease in American: Children: Estimates of Morbidity, Mortality, and Costs for Lead Poisoning, Asthma, Cancer, and Developmental Disabilities
This document provides an introduction to critical appraisal and its importance in evaluating research. It then reviews a clinical paper on risk factors for overweight and obesity among school children in Bangladesh. The review summarizes the paper's objectives, study design, population, sampling, variables, analysis, findings and conclusions. It concludes that having overweight parents and engaging in sedentary activities over 4 hours per day increased obesity risk, while home exercise reduced risk. The review also lists some limitations of the paper.
A Study of Propensity Score on Influencing Factors of Length of Stay in Hospi...Scientific Review SR
Background: Burns are a global public health problem, which are universal and can happen to anyone. Because the physical functions in children and adults are different, the confounding factors are easy to affect the results of study. Objective: In this study, we aimed to explore influencing factors of the length of hospital stay (LOS) when the confounding factors were excluded by Propensity Score (PS) in children and adults. Methods: Patients hospitalized for burn from 2014 to 2016 were retrieved from the medical record system of a general biggest hospital in Zunyi. A database was established to analyze the influencing factors of LOS between children and adults by the PS. Results A total of 465 children (61.7% males) and 327 (69.7% males) adults were recruited. The average age was 3.61±3.57 years and 42.48±14.76 years in children and adults with burns respectively. Before PS matching, low age and skin grafting were the protective factors for LOS (Hazard Ratio [HR]=0.993 and 0.339). The risk factors of LOS were male (HR=1.234), the burn depth and total body surface area (TBSA), and burn etiology (HR=1.497). After PS matching, only skin grafting (HR=0.080) and treatment within 24 hours (HR=1.865) were the common influencing factors of LOS. Conclusion the confounding factors were excluded by the PS method, and skin grafting was still a protective factor of LOS for both children and adults. The results provide a reference for the promotion of skin grafting to reduce LOS in burn patients.
Running head LITERATURE REVIEW 1LITERATURE REVIEW 5.docxcowinhelen
Running head: LITERATURE REVIEW 1
LITERATURE REVIEW 5
Literature Review
Name:
Institution:
Literature Review (Childhood Obesity)
Childhood Obesity describes attainments of weight beyond the normal body mass index ration leading to the vulnerability in lines. In the study, the use of article will facilitate the process. As noted, the researcher of the material sought to evaluate the factors that contribute to obesity in children. Their study focused on dieting and physical exercise as the primary factors that contribute to obesity. The researchers commenced the process by identifying the research question, proceeded with instruments then selected the design before engaging the target population to validate the research hypothesis. The target group for the study comprised of children aged below 12 years. They included children from a different racial background. Both boys and girls featured in the study. The researcher hypothesized the cause of obesity with the motive of encouraging the adaptation of intervention programs. The study prioritized preventive measures with the intent of decreasing cases of obesity in children in less than six months.
The literature for study includes article 1, 2, 3 and 4. Article 5, 6, 7 and 8 also featured in the study. The research sought to evaluate the prevailing trends concerning the wellness of the children using a collection of questions. The first article by Bleich, Segal, Wu, and Wilson& Wang sought to evaluate the role of community-based prevention. The second article by Tester et al examined the characteristics of the condition in children aged between 2 and 5. The third article by Cunningham, Kramer, & Narayan quantified the prevalence of the condition. Arthur, Scharf, and DeBoer’s fourth sought to evaluate the role of food insecurity in the contraction of obesity. The fifth and sixth Fetter et al and Lydecke, Riley, & Grilo examined the role of physical activity and parenting subsequently. The exploration of the implication of the limitation of the dietary behavior of the micro levels of the condition and parents understanding on the condition featured in the seventh and eight articles composed by Marcum, et al, and Vollmer respectively.
The sample population for the study in the first article comprised of the young population in homes school and care setting. The second article engaged children aged between 2 and 5 years. The third article engaged 7738 participants comprising of learners in kindergarten. The group in the early childhood stage featured in the fourth article as the sample population for the study seeking to investigate cases of obesity. The sample differed from the group engaged in the fifth and sixth article. The category interviewed comprised of the parents of the youth and pre-adolescents, the seventh and eight articles engaged the mothers of the children and the fathers averaging 35 years of white origin.
The limitation of the first article is that the resear ...
The SUPERB study aimed to collect longitudinal data on behaviors that influence exposure to environmental toxins through three data collection platforms: telephone interviews, internet surveys, and home monitoring. Two cohorts were enrolled - families with young children from Northern California and older individuals aged 55+ from Central California. Telephone interviews were conducted to collect data on food consumption, activities, and household product use over the past year for both cohorts. The study aimed to improve recruitment of underrepresented groups and used various methods to minimize participant burden and maximize retention over time. Future reports will analyze patterns of exposure-related behaviors within and between the cohorts.
Childhood obesity prevention literature reviewAmber Breidel
This document provides a literature review on childhood obesity prevention and treatment. It summarizes 18 research studies related to prevention and treatment approaches. Key findings from the prevention studies include the role of television in childhood obesity, the relationship between fussy eating and body composition, and the impact of parental support programs. Key findings from the treatment studies include the effectiveness of appetite awareness training and factors influencing healthy lifestyle changes in low-income families engaged in obesity treatment programs. The review covers a range of interventions, outcomes, populations and methodologies.
at SciVerse ScienceDirectSocial Science & Medicine 75 (201.docxikirkton
at SciVerse ScienceDirect
Social Science & Medicine 75 (2012) 323e330
Contents lists available
Social Science & Medicine
journal homepage: www.elsevier.com/locate/socscimed
Breastfeeding and risk of overweight and obesity at nine-years of age
Cathal McCrory*, Richard Layte 1
The Economic and Social Research Institute, Whitaker Square, Sir John Rogerson’s Quay, Dublin 2, Ireland
a r t i c l e i n f o
Article history:
Available online 17 April 2012
Keywords:
Ireland
Breastfeeding
Children
Overweight
Obesity
Body mass index (BMI)
Cohort study
* Corresponding author. Tel.: þ353 1 8632027; fax:
E-mail address: [email protected] (C. McCror
1 Tel.: þ353 1 8632027; fax: þ353 1 8632100.
0277-9536/$ e see front matter � 2012 Elsevier Ltd.
doi:10.1016/j.socscimed.2012.02.048
a b s t r a c t
Whether breastfeeding is protective against the development of childhood overweight and obesity
remains the subject of considerable debate. Although a number of meta-analyses and syntheses of the
literature have concluded that the greater preponderance of evidence indicates that breastfeeding
reduces the risk of obesity, these findings are by no means conclusive. The present study used data from
the Growing Up in Ireland study to examine the relationship between retrospectively recalled breast-
feeding data and contemporaneously measured weight status for 7798 children at nine-years of age
controlling for a wide range of variables including; socio-demographic factors, the child’s own lifestyle-
related behaviours, and parental BMI. The results of the multivariable analysis indicated that being
breastfed for between 13 and 25 weeks was associated with a 38 percent (p < 0.05) reduction in the risk
of obesity at nine-years of age, while being breastfed for 26 weeks or more was associated with a 51
percent (p < 0.01) reduction in the risk of obesity at nine-years of age. Moreover, results pointed towards
a doseeresponse patterning in the data for those breastfed in excess of 4 weeks. Possible mechanisms
conveying this health benefit include slower patterns of growth among breastfed children, which it is
believed, are largely attributable to differences in the composition of human breast milk compared with
synthesised formula. The suggestion that the choice of infant feeding method has important implications
for health and development is tantalising as it identifies a modifiable health behaviour that is amenable
to intervention in primary health care settings and has the potential to improve the health of the
population.
� 2012 Elsevier Ltd. All rights reserved.
Introduction
The belief that breastfeeding during infancy affords protection
against a number of diseases features prominently in the epide-
miological literature; there is considerable evidence to support this
assertion. Breastfeeding is associated with reduced risk for
a number of neonatal infections including gastro-intestinal infec-
tions, diarrhoeal infections, and types of extra-intestinal infecti ...
1. Analyze the case and determine the factors that have made KFC a s.docxaulasnilda
1. Analyze the case and determine the factors that have made KFC a successful global business.
2. Why are cultural factors so important to KFC’s sales success in India and China?
3. Spot the cultural factors in India that go against KFC’s original recipe.
4. Why did Kentucky Fried Chicken change its name to KFC?
5. What PESTEL factors contributed to KFC’s positioning?
6. How does the SWOT analysis of KFC affect the future of KFC?
Points to be considered:
1. Please follow 6th edition of the APA Format.
2. On separate page, the word "Abstract,' centered on paper followed by 75-100 word overview.
3. References needs to be Peer Reviewed Articles.
4. This assignment should be 15-20 pages excluding the title and reference pages. The paper should contain at least one graph, figure, chart, or table.
5. Please use the questions as Headings for the topics in the Paper.
I have attached the case study document below.
.
1. A.Discuss how the concept of health has changed over time. B.Di.docxaulasnilda
1. A.Discuss how the concept of "health" has changed over time. B.Discuss how the concept has evolved to include wellness, illness, and overall well-being. C.How has health promotion changed over time? D.Why is it important that nurses implement health promotion interventions based on evidence-based practice?
2. A.Compare and contrast the three different levels of health promotion (primary, secondary, tertiary). B.Discuss how the levels of prevention help determine educational needs for a patient.
.
More Related Content
Similar to 1January 2020, Volume 8, Issue 1, Number 17Maryam Bahr.docx
ASSOCIATION BETWEEN SCREEN TIME AND OBESITY IN CHILDREN AND ADOLESCENTS Narr...Karen Gomez
This document summarizes a narrative review of 34 studies that examined the association between screen time and obesity in children and adolescents. The studies involved over 164,000 individuals between ages 5-19. Most studies found that increased screen time was significantly associated with higher rates of overweight and obesity. Screen time was also often associated with unhealthy eating habits and reduced physical activity. The studies suggest that screen time above 1-4 hours per day can negatively impact body composition in children and adolescents. Maintaining screen time within recommended limits may help prevent obesity.
Epidemiological studies are applicable to communicable and non-com.docxSALU18
Epidemiological studies are applicable to communicable and non-communicable diseases. Childhood obesity is an area that is receiving more attention in public health due to the multiple morbidities that emerge as a result of this condition. Below are links to a cross-sectional study and a case-control study. Imagine that you are interested in conducting a case-control or cross-sectional study proposal of childhood obesity vs. birth weight (prenatal and early life influences). Both articles below address prenatal influences on childhood obesity and birth weight using different approaches.
Article 1 -attached
Article 2-attached
Using the information in the articles, answer the following questions using AMA format.
1. How would you select cases and controls for this study and how would you define exposure and outcome variables for a case-control study design? What other factors would you control for?
2. How would you design a proposal measuring the effect of birthweight on childhood obesity for a cross-sectional study design? What other factors would you control for?
BioMed CentralBMC Public Health
ss
Open AcceStudy protocol
Cross sectional study of childhood obesity and prevalence of risk
factors for cardiovascular disease and diabetes in children aged 11–
13
Anwen Rees*1, Non Thomas1, Sinead Brophy2, Gareth Knox1 and
Rhys Williams2
Address: 1Cardiff School of Sport, University of Wales Institute Cardiff, Wales, UK and 2School of Medicine, Swansea University, Wales, UK
Email: Anwen Rees* - [email protected]; Non Thomas - [email protected]; Sinead Brophy - [email protected];
Gareth Knox - [email protected]; Rhys Williams - [email protected]
* Corresponding author
Abstract
Background: Childhood obesity levels are rising with estimates suggesting that around one in
three children in Western countries are overweight. People from lower socioeconomic status and
ethnic minority backgrounds are at higher risk of obesity and subsequent CVD and diabetes.
Within this study we examine the prevalence of risk factors for CVD and diabetes (obesity,
hypercholesterolemia, hypertension) and examine factors associated with the presence of these
risk factors in school children aged 11–13.
Methods and design: Participants will be recruited from schools across South Wales. Schools
will be selected based on catchment area, recruiting those with high ethnic minority or deprived
catchment areas. Data collection will take place during the PE lessons and on school premises. Data
will include: anthropometrical variables (height, weight, waist, hip and neck circumferences, skinfold
thickness at 4 sites), physiological variables (blood pressure and aerobic fitness (20 metre multi
stage fitness test (20 MSFT)), diet (self-reported seven-day food diary), physical activity (Physical
Activity Questionnire for Adolescents (PAQ-A), accelerometery) and blood tests (fasting glucose,
insulin, lipids, fibrinogen (Fg), adiponectin (high molecular weight), C-react ...
Previous studies on occupational exposures in parents and cancer risks in their children support a
link between solvents and paints with childhood leukaemia. Few studies have focused specifically on benzene.
Objectives: To examine whether parental occupational exposure to benzene is associated with an increased
cancer risk in a census-based cohort of children.
This paper investigates the causal effect of education on various health outcomes and behaviors in Italy, exploiting a 1963 reform that raised compulsory schooling by three years. The reform provides exogenous variation in education levels needed for causal identification. Using survey data on Italians, the paper analyzes effects on chronic diseases, BMI, smoking, physical activity, preventive health behaviors, and more. Considering multiple outcomes simultaneously allows for a more comprehensive assessment than prior studies examining only one or a few measures. The results provide new causal evidence on how education impacts health in Italy.
This document summarizes a systematic review of factors associated with childhood overweight and obesity in South Asian countries. The review included 11 studies from India, Pakistan, Bangladesh, and Sri Lanka that used BMI to measure overweight and obesity in children and adolescents. The studies found wide variation in overweight prevalence from 3.1-19.7% and obesity prevalence from 1.2-14.5%. Lack of physical activity was associated with overweight/obesity in most studies, while higher socioeconomic status, urban residence, and consumption of junk food/fast food were also identified as risk factors.
The National Children's Study aims to understand environmental factors contributing to childhood obesity through a large prospective birth cohort study of 100,000 American children. It will address limitations of past studies by following children from before conception through age 21 and collecting extensive data on genetics, behaviors, social environment, chemical exposures, and health outcomes. This life-course approach will provide insights into early-life and community-level influences on obesity risk and their interactions. The study aims to guide evidence-based strategies for obesity prevention.
The National Children's Study aims to understand environmental factors contributing to childhood obesity through a large prospective birth cohort study of 100,000 American children. It will address limitations of past studies by following children from before conception through age 21 and collecting extensive data on genetic, behavioral, social, built environment, and chemical exposure factors. This life-course approach will provide insights into obesity origins and allow examination of interactions among multiple influences over time. The study aims to guide evidence-based strategies for obesity prevention.
2
WEEK 2-ASSIGNMENT
Research Article Summaries
Magdalyn38
RES 5240 Applied Research Methods
Feb.28, 2020
What is the Intricate Relationship between Television Watching and Childhood Obesity?
1. Caroli, M., Argentieri, L., Cardone, M., & Masi, A. (2004). Role of television in childhood obesity prevention. International Journal of Obesity, 28(3), S104-S108.
The study seeks to come up with an explanation of the relationship between childhood obesity and TV watching. Food and obesity have many documented consequences and when coupled up with a sedentary lifestyle, the combined effects are quite negative. Specific aspects of TV watching, in this case, are documented and they are linked to the prevalence of childhood obesity in different countries in Europe. The intricate relationship between childhood obesity could also be attributed to the role of the different European government regulations which in all its differences has led to a significant difference in the prevalence of childhood obesity as per the authors of the article.
The research sought to review the role of television in specific activities. Amongst them, one of the effects of TV is the fact that it replaces vigorous activities. As such, there is a positive correlation between the time in which one spends on TV watching and being overweight. This is regardless of the ages of the people. The TV watching activity, as presented in the article, is also linked to obesity prevalence among the different ages of children. Generally, the more the number of hours that one spends watching TV, the higher the chance they are going to be obese.
Through the analysis of literature in the area, it is almost blatant that people that spent more than 4 hours on the TV seemed to have increased in the last 30 years. The analysis of literature was thematic in nature and this was geared towards finding information that was almost prevalent across the different secondary sources. The analysts targeted specific television food commercials targeting children, the use of food in movies and even other kid shows. Besides that, the obese subjects presented in kids’ content were reviewed with the aim of finding out ridiculous traits, and the results that worsen situations. The situation gets worse through the perceived isolation of these subjects. The method of enquiry in the article was evidently a literature study. The data obtained were mainly secondary data and this was through a thematic search of the secondary literature done in the area.
2. Zhang, G., Wu, L., Zhou, L., Lu, W., & Mao, C. (2016). Television watching and risk of childhood obesity: a meta-analysis. The European Journal of Public Health, 26(1), 13-18.
This article is important and a viable contribution to the topic since it attempts to bring to light the relationship between the times spent watching TV and the risk of obesity among children. The article puts forward the argument that over the past few years, childhood obesity r.
2
WEEK 2-ASSIGNMENT
Research Article Summaries
Magdalyn38
RES 5240 Applied Research Methods
Feb.28, 2020
What is the Intricate Relationship between Television Watching and Childhood Obesity?
1. Caroli, M., Argentieri, L., Cardone, M., & Masi, A. (2004). Role of television in childhood obesity prevention. International Journal of Obesity, 28(3), S104-S108.
The study seeks to come up with an explanation of the relationship between childhood obesity and TV watching. Food and obesity have many documented consequences and when coupled up with a sedentary lifestyle, the combined effects are quite negative. Specific aspects of TV watching, in this case, are documented and they are linked to the prevalence of childhood obesity in different countries in Europe. The intricate relationship between childhood obesity could also be attributed to the role of the different European government regulations which in all its differences has led to a significant difference in the prevalence of childhood obesity as per the authors of the article.
The research sought to review the role of television in specific activities. Amongst them, one of the effects of TV is the fact that it replaces vigorous activities. As such, there is a positive correlation between the time in which one spends on TV watching and being overweight. This is regardless of the ages of the people. The TV watching activity, as presented in the article, is also linked to obesity prevalence among the different ages of children. Generally, the more the number of hours that one spends watching TV, the higher the chance they are going to be obese.
Through the analysis of literature in the area, it is almost blatant that people that spent more than 4 hours on the TV seemed to have increased in the last 30 years. The analysis of literature was thematic in nature and this was geared towards finding information that was almost prevalent across the different secondary sources. The analysts targeted specific television food commercials targeting children, the use of food in movies and even other kid shows. Besides that, the obese subjects presented in kids’ content were reviewed with the aim of finding out ridiculous traits, and the results that worsen situations. The situation gets worse through the perceived isolation of these subjects. The method of enquiry in the article was evidently a literature study. The data obtained were mainly secondary data and this was through a thematic search of the secondary literature done in the area.
2. Zhang, G., Wu, L., Zhou, L., Lu, W., & Mao, C. (2016). Television watching and risk of childhood obesity: a meta-analysis. The European Journal of Public Health, 26(1), 13-18.
This article is important and a viable contribution to the topic since it attempts to bring to light the relationship between the times spent watching TV and the risk of obesity among children. The article puts forward the argument that over the past few years, childhood obesity r ...
This document summarizes the findings of the Global Burden of Disease 2013 study on comparative risk assessment of 79 behavioral, environmental, and metabolic risks. Some key findings include:
- These 79 risks accounted for 57.2% of all deaths and 41.6% of all disability-adjusted life years globally in 2013.
- The six individual risks or risk clusters that caused the most disability-adjusted life years were dietary risks, high blood pressure, childhood malnutrition, tobacco smoke, air pollution, and high BMI.
- Risk patterns varied significantly between regions and countries, with factors like childhood malnutrition, unsafe sex, and unsafe water being top risks in sub-Saharan Africa compared to high blood pressure, BMI, and tobacco
This study used a multilevel analysis to examine how neighbourhood factors modify the effect of smoking on birth weight in British Columbia, Canada. The study found:
1) Maternal smoking had a significant negative and non-linear association with birth weight that varied substantially between neighbourhoods.
2) Neighbourhood socioeconomic status, education levels, air pollution, and immigrant density interacted with smoking levels and were associated with birth weight. Higher neighbourhood education and immigrant density helped offset the negative impact of smoking on birth weight.
3) Including neighbourhood variables and their interactions with individual factors explained a large portion of the variability in birth weight between neighbourhoods. This suggests neighbourhood context influences how risk factors like smoking affect birth outcomes
Analysis the Effect of Educational Package on Promotion of Protective Behavio...Editor IJCATR
This study analyzed the effect of an educational package on promoting protective behaviors for dust exposure among teachers in Ahvaz, Iran. 200 teachers were divided into case and control groups. The case group received a 4-week educational program based on the health belief model covering knowledge, perceptions, and behaviors regarding dust exposure. Results showed a significant increase in the case group's knowledge, health beliefs, and protective behaviors immediately and 2 months after the intervention compared to the control group. The educational package was effective in promoting protective behaviors for dust exposure among teachers.
Environmental Pollutants and Disease in American: Children: Estimates of Morbidity, Mortality, and Costs for Lead Poisoning, Asthma, Cancer, and Developmental Disabilities
This document provides an introduction to critical appraisal and its importance in evaluating research. It then reviews a clinical paper on risk factors for overweight and obesity among school children in Bangladesh. The review summarizes the paper's objectives, study design, population, sampling, variables, analysis, findings and conclusions. It concludes that having overweight parents and engaging in sedentary activities over 4 hours per day increased obesity risk, while home exercise reduced risk. The review also lists some limitations of the paper.
A Study of Propensity Score on Influencing Factors of Length of Stay in Hospi...Scientific Review SR
Background: Burns are a global public health problem, which are universal and can happen to anyone. Because the physical functions in children and adults are different, the confounding factors are easy to affect the results of study. Objective: In this study, we aimed to explore influencing factors of the length of hospital stay (LOS) when the confounding factors were excluded by Propensity Score (PS) in children and adults. Methods: Patients hospitalized for burn from 2014 to 2016 were retrieved from the medical record system of a general biggest hospital in Zunyi. A database was established to analyze the influencing factors of LOS between children and adults by the PS. Results A total of 465 children (61.7% males) and 327 (69.7% males) adults were recruited. The average age was 3.61±3.57 years and 42.48±14.76 years in children and adults with burns respectively. Before PS matching, low age and skin grafting were the protective factors for LOS (Hazard Ratio [HR]=0.993 and 0.339). The risk factors of LOS were male (HR=1.234), the burn depth and total body surface area (TBSA), and burn etiology (HR=1.497). After PS matching, only skin grafting (HR=0.080) and treatment within 24 hours (HR=1.865) were the common influencing factors of LOS. Conclusion the confounding factors were excluded by the PS method, and skin grafting was still a protective factor of LOS for both children and adults. The results provide a reference for the promotion of skin grafting to reduce LOS in burn patients.
Running head LITERATURE REVIEW 1LITERATURE REVIEW 5.docxcowinhelen
Running head: LITERATURE REVIEW 1
LITERATURE REVIEW 5
Literature Review
Name:
Institution:
Literature Review (Childhood Obesity)
Childhood Obesity describes attainments of weight beyond the normal body mass index ration leading to the vulnerability in lines. In the study, the use of article will facilitate the process. As noted, the researcher of the material sought to evaluate the factors that contribute to obesity in children. Their study focused on dieting and physical exercise as the primary factors that contribute to obesity. The researchers commenced the process by identifying the research question, proceeded with instruments then selected the design before engaging the target population to validate the research hypothesis. The target group for the study comprised of children aged below 12 years. They included children from a different racial background. Both boys and girls featured in the study. The researcher hypothesized the cause of obesity with the motive of encouraging the adaptation of intervention programs. The study prioritized preventive measures with the intent of decreasing cases of obesity in children in less than six months.
The literature for study includes article 1, 2, 3 and 4. Article 5, 6, 7 and 8 also featured in the study. The research sought to evaluate the prevailing trends concerning the wellness of the children using a collection of questions. The first article by Bleich, Segal, Wu, and Wilson& Wang sought to evaluate the role of community-based prevention. The second article by Tester et al examined the characteristics of the condition in children aged between 2 and 5. The third article by Cunningham, Kramer, & Narayan quantified the prevalence of the condition. Arthur, Scharf, and DeBoer’s fourth sought to evaluate the role of food insecurity in the contraction of obesity. The fifth and sixth Fetter et al and Lydecke, Riley, & Grilo examined the role of physical activity and parenting subsequently. The exploration of the implication of the limitation of the dietary behavior of the micro levels of the condition and parents understanding on the condition featured in the seventh and eight articles composed by Marcum, et al, and Vollmer respectively.
The sample population for the study in the first article comprised of the young population in homes school and care setting. The second article engaged children aged between 2 and 5 years. The third article engaged 7738 participants comprising of learners in kindergarten. The group in the early childhood stage featured in the fourth article as the sample population for the study seeking to investigate cases of obesity. The sample differed from the group engaged in the fifth and sixth article. The category interviewed comprised of the parents of the youth and pre-adolescents, the seventh and eight articles engaged the mothers of the children and the fathers averaging 35 years of white origin.
The limitation of the first article is that the resear ...
The SUPERB study aimed to collect longitudinal data on behaviors that influence exposure to environmental toxins through three data collection platforms: telephone interviews, internet surveys, and home monitoring. Two cohorts were enrolled - families with young children from Northern California and older individuals aged 55+ from Central California. Telephone interviews were conducted to collect data on food consumption, activities, and household product use over the past year for both cohorts. The study aimed to improve recruitment of underrepresented groups and used various methods to minimize participant burden and maximize retention over time. Future reports will analyze patterns of exposure-related behaviors within and between the cohorts.
Childhood obesity prevention literature reviewAmber Breidel
This document provides a literature review on childhood obesity prevention and treatment. It summarizes 18 research studies related to prevention and treatment approaches. Key findings from the prevention studies include the role of television in childhood obesity, the relationship between fussy eating and body composition, and the impact of parental support programs. Key findings from the treatment studies include the effectiveness of appetite awareness training and factors influencing healthy lifestyle changes in low-income families engaged in obesity treatment programs. The review covers a range of interventions, outcomes, populations and methodologies.
at SciVerse ScienceDirectSocial Science & Medicine 75 (201.docxikirkton
at SciVerse ScienceDirect
Social Science & Medicine 75 (2012) 323e330
Contents lists available
Social Science & Medicine
journal homepage: www.elsevier.com/locate/socscimed
Breastfeeding and risk of overweight and obesity at nine-years of age
Cathal McCrory*, Richard Layte 1
The Economic and Social Research Institute, Whitaker Square, Sir John Rogerson’s Quay, Dublin 2, Ireland
a r t i c l e i n f o
Article history:
Available online 17 April 2012
Keywords:
Ireland
Breastfeeding
Children
Overweight
Obesity
Body mass index (BMI)
Cohort study
* Corresponding author. Tel.: þ353 1 8632027; fax:
E-mail address: [email protected] (C. McCror
1 Tel.: þ353 1 8632027; fax: þ353 1 8632100.
0277-9536/$ e see front matter � 2012 Elsevier Ltd.
doi:10.1016/j.socscimed.2012.02.048
a b s t r a c t
Whether breastfeeding is protective against the development of childhood overweight and obesity
remains the subject of considerable debate. Although a number of meta-analyses and syntheses of the
literature have concluded that the greater preponderance of evidence indicates that breastfeeding
reduces the risk of obesity, these findings are by no means conclusive. The present study used data from
the Growing Up in Ireland study to examine the relationship between retrospectively recalled breast-
feeding data and contemporaneously measured weight status for 7798 children at nine-years of age
controlling for a wide range of variables including; socio-demographic factors, the child’s own lifestyle-
related behaviours, and parental BMI. The results of the multivariable analysis indicated that being
breastfed for between 13 and 25 weeks was associated with a 38 percent (p < 0.05) reduction in the risk
of obesity at nine-years of age, while being breastfed for 26 weeks or more was associated with a 51
percent (p < 0.01) reduction in the risk of obesity at nine-years of age. Moreover, results pointed towards
a doseeresponse patterning in the data for those breastfed in excess of 4 weeks. Possible mechanisms
conveying this health benefit include slower patterns of growth among breastfed children, which it is
believed, are largely attributable to differences in the composition of human breast milk compared with
synthesised formula. The suggestion that the choice of infant feeding method has important implications
for health and development is tantalising as it identifies a modifiable health behaviour that is amenable
to intervention in primary health care settings and has the potential to improve the health of the
population.
� 2012 Elsevier Ltd. All rights reserved.
Introduction
The belief that breastfeeding during infancy affords protection
against a number of diseases features prominently in the epide-
miological literature; there is considerable evidence to support this
assertion. Breastfeeding is associated with reduced risk for
a number of neonatal infections including gastro-intestinal infec-
tions, diarrhoeal infections, and types of extra-intestinal infecti ...
Similar to 1January 2020, Volume 8, Issue 1, Number 17Maryam Bahr.docx (20)
1. Analyze the case and determine the factors that have made KFC a s.docxaulasnilda
1. Analyze the case and determine the factors that have made KFC a successful global business.
2. Why are cultural factors so important to KFC’s sales success in India and China?
3. Spot the cultural factors in India that go against KFC’s original recipe.
4. Why did Kentucky Fried Chicken change its name to KFC?
5. What PESTEL factors contributed to KFC’s positioning?
6. How does the SWOT analysis of KFC affect the future of KFC?
Points to be considered:
1. Please follow 6th edition of the APA Format.
2. On separate page, the word "Abstract,' centered on paper followed by 75-100 word overview.
3. References needs to be Peer Reviewed Articles.
4. This assignment should be 15-20 pages excluding the title and reference pages. The paper should contain at least one graph, figure, chart, or table.
5. Please use the questions as Headings for the topics in the Paper.
I have attached the case study document below.
.
1. A.Discuss how the concept of health has changed over time. B.Di.docxaulasnilda
1. A.Discuss how the concept of "health" has changed over time. B.Discuss how the concept has evolved to include wellness, illness, and overall well-being. C.How has health promotion changed over time? D.Why is it important that nurses implement health promotion interventions based on evidence-based practice?
2. A.Compare and contrast the three different levels of health promotion (primary, secondary, tertiary). B.Discuss how the levels of prevention help determine educational needs for a patient.
.
1. Abstract2. Introduction to Bitcoin and Ethereum3..docxaulasnilda
1.
Abstract
2.
Introduction to Bitcoin and Ethereum
3.
Background
a. How do we understand Ethereum and Smart Contracts?
b. Blockchain Cryptocurrency and Smart Contracts
c. What are Pros and Cons of using Ethereum?
d. Ethereum Virtual Machine
4.
Platforms or Programming for Smart Contracts
5.
Smart Contract Applications
6.
Research Methodology
a. Current Smart Contract Applications
b. Security Issues
c. Privacy Issues
d. Performance Issues
7.
Ethereum System and Solidity Smart Contracts
a. What do we understand about Ethereum and the Likes?
b. How does Ethereum and the likes work?
8.
Ethereum and Hyperledger in Smart Contracts
9.
What can we get by the term Scalability?
10.
Smart Contracting Programming and High-Level Issues
a. Usability
b. Ethical and Legal Issues
11.
Specifications and Implementations
12.
Pros and Cons of using Ethereum Smart Contracts
13.
Current Trends on Ethereum
14.
Future State of Ethereum Smart Contracts or Virtual Machines
15.
Conclusion
Note: Paper about Ethereum
20 pages
ppt 12-14 slides.
No plagiarism,
APA , Citations, and references.
.
1. A. Compare vulnerable populations. B. Describe an example of one .docxaulasnilda
1. A. Compare vulnerable populations. B. Describe an example of one of these groups in the United States or from another country. C.Explain why the population is designated as "vulnerable." Include the number of individuals belonging to this group and the specific challenges or issues involved. D. Discuss why these populations are unable to advocate for themselves, the ethical issues that must be considered when working with these groups, and how nursing advocacy would be beneficial.
2. A. How does the community health nurse recognize bias, stereotypes, and implicit bias within the community? B. How should the nurse address these concepts to ensure health promotion activities are culturally competent? C. Propose strategies that you can employ to reduce cultural dissonance and bias to deliver culturally competent care. D. Include an evidence-based article that addresses the cultural issue. E. Cite and reference the article in APA format.
.
1. A highly capable brick and mortar electronics retailer with a l.docxaulasnilda
1. A highly capable brick and mortar electronics retailer with a loyal regional customer base (such as Fry's) should adopt which of the following medium term strategies?
"50% off" sale every month
Divest
Niche or harvest
Invest in R&D
2. Amazon's strategy involves offering expanded variety but at very competitive prices. This is primarily achieved through
Economies of scope
Focus on international markets
Economies of scale
Innovative products
3. Uber is an example of industry chaining in which of the following ways?
Economies of scale for service providers
Economies of scope for customers
Improving access and reduced search costs for customers and service providers
Lower wages for service providers and lower prices for customers
4. Shareholder returns are primarily derived from
Growth in share value and dividend payments
dividend payments only
Growth in company profits
Growth in the share value only
5. Strategy is defined best as:
A unique value proposition supported by sound financial decisions
A unique value proposition supported by synergies in operations
A unique value proposition supported by aggressive marketing
A unique value proposition supported by a complex supply chain
6. The cost of attracting new customers is the highest with which of the following groups?
Early adopters
Late majority
Laggards
Innovators
7. In the context of the Differentiation (Quality) vs Efficiency trade-off curve, the efficient frontier refers to:
The company that provides maximum quality for a given cost
The company that provides minimum cost
The company that provides maximum quality
The company that maximizes efficiency
8. Nike hiring sports stars to be brand ambassadors is an example of which of the following mechanisms?
Market development
Customer segmentation
Product development
Market penetration
9. Which of the following is an indication of strategic committment of a company in an industry
Lowering wages of the workforce
Increased technology investment
Acquiring real-estate in an urban location of demand
Increased divident payments for two years in a row
10. A pharma company with a deep roster of capable engineers and scientists and that is the market leader is best advised to begin development of a new drug as:
A partnership with smaller competitors
License its innovation from other laboratories
An independent venture
Smaller scale effort
11. The most valuable competency in the declining phase of an industry is:
Resposiveness
Innovation
Efficiency
Quality
12. There is often limited capacity relative to demand in the early growth period of an industry because:
Capacity is very expensive in the later stages of an industry
Only few companies have products or technologies in a budding industry
Prices tend to be low in the embryonic stage
Many companies compete for early advantage in an emerging industry
13. If the willingness to pay of .
1. A. Research the delivery, finance, management, and sustainabili.docxaulasnilda
1. A. Research the delivery, finance, management, and sustainability methods of the U.S. health care system.
B. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes.
C.Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect.
D. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders.
E.Support your post with a peer-reviewed journal article.
2. The Affordable Care Act was signed into law by President Barack Obama in March 2010. Many of the provisions of the law directly affect health care providers. Review the following topic materials:
"About the Affordable Care Act"
"Health Care Transformation: The Affordable Care Act and More"
What are the most important elements of the Affordable Care Act in relation to community and public health? What is the role of the nurse in implementing this law?
.
1. All of the following artists except for ONE used nudity as part.docxaulasnilda
1. All of the following artists except for ONE used nudity as part of her/ his work:
a) Ana Mendieta
b) Carolee Schneeman
c) Yoko Ono
d) Judy Chicago
e) Robert Mapplethorpe
2. All of the following except ONE are features of Conceptualism (though not all apply to every Conceptualist work)
a) Audience participation
b) Use of text/language within visual works
c) Direct criticism of the art museum
d) Very expensive artworks
e) Sets of instructions to follow
f) Temporary or fleeting projects
3. Please match the following description with correct art movement or tendency:
1) Minimalism
2) Fluxus
3) Abstract Expressionism
4) Feminist practices
5) Conceptualism
A. Created action paintings that blurred the line between art and life
B. Included works drawing attention to the unethical actions of art museums
C. An idealistic to recalibrate the human senses
D. A loose knit international group of artists that made performances and other unconventional works
E. Argued that the criteria for determining historical value in visual art has been too narrow
4. The following art movement or tendencies except for ONE can be considered to have been responses to Abstract Expressionism (through sometimes for very different reasons)
a) Conceptualism
b) Pop Art
c) Earthwork
d) Surrealism
e) Minimalism
.
1. According to the article, what is myth and how does it functi.docxaulasnilda
1. According to the article, what is myth and how does it function as a naturalizing agent?
2. What is a sign?What is its relation to myth?
3. If advertising “is not an attempted sale of products – evidence shows that consumers are able to resist ‘advertising in the imperative’(12.) – but a ‘clear expression of a culture’ and cultural beliefs” then what does the iPod advert express about current culture?
4. What does the iPod advert presented in the article “sell”?
Attachments have resources
.
1. 6 Paragraph OverviewReflection on Reading Assigbnment Due Before.docxaulasnilda
1. 6 Paragraph Overview/Reflection on Reading Assigbnment Due Before Class Commences
The Critical Theorists: Critical Legal Theory, Critical Race Theory, Critical Feminist Theory, & Critical Latinx Theory
Wacks Chapters 13 & 14
Bix Chapter 19
2.6 Paragraph Overview/Reflection on Reading Assigbnment Due Before Class Commences
Why Obey the Law & Why Punish?
Wacks Chapters 11 & 12
Bix Chapters 9 & 16
3.6 Paragraph Overview/Reflection on Reading Assigbnment Due Before Class Commences
Wacks Chapter 10
Bix Chapter 10
.
1. A.Compare independent variables, B.dependent variables, and C.ext.docxaulasnilda
Independent variables are those that are manipulated by the researcher, dependent variables are those that are measured, and extraneous variables are those that are not controlled that could influence the dependent variable. Researchers attempt to control extraneous variables through random assignment and holding all variables constant except the independent variable. Levels of evidence range from expert opinion to randomized controlled trials, with stronger evidence able to lead to broader practice changes.
1. According to the Court, why is death a proportionate penalty for .docxaulasnilda
1. According to the Court, why is death a proportionate penalty for child rape? Do you agree? Explain your reasons.
2. Who should make the decision as to what is the appropriate penalty for crimes? Courts? Legislatures? Juries? Defend your answer.
3. In deciding whether the death penalty for child rape is cruel and unusual, is it relevant that Louisiana is the only state that punishes child rape with death?
4. According to the Court, some crimes are worse than death. Do you agree? Is child rape one of them? Why? Why not?
THE RESPONSE TO THE FOUR QUESTIONS ALL TOGETHER SHOULD LEAD ADD UP TO 400 WORDS IN TOTAL.
.
1- Prisonization What if . . . you were sentenced to prison .docxaulasnilda
1- Prisonization?
What if . . . you were sentenced to prison? Do you believe you would become a more seasoned criminal or would learning criminal ways from those who were caught make you a worse criminal? Explain
2- Gangs of Prison?
What if . . . you were appointed as warden at a medium security prison which had a terrible problem with gang affiliations? What methods would you employ to combat the problem? Explain.
3-The solidarity of inmate culture (Big House era) developed through several characteristics. Name them?
.
1. 250+ word count What is cultural and linguistic competence H.docxaulasnilda
1. 250+ word count
What is cultural and linguistic competence? How does this competency apply to public health? Why is this important to the practice of public health?
2. 250+ word count
Reflect on your own cultural and linguistic competence. How confident are you in your ability to address the needs of diverse communities? How do you think you could improve your level of cultural and linguistic competence?
.
1. 200 words How valuable is a having a LinkedIn profile Provid.docxaulasnilda
1. 200 words How valuable is a having a LinkedIn profile? Provide example to support your statement.
2. 200 words What benefits does it add your academic and professional development? Provide example to support your statement.
3. 200 words How does having this profile contribute to networking as healthcare and public health professionals? Provide example to support your statement.
4. 200 words What other social media and networking platforms are available to network with other healthcare and public health professionals? Provide example to support your statement.
.
1. According to recent surveys, China, India, and the Philippines ar.docxaulasnilda
1. According to recent surveys, China, India, and the Philippines are the three most popular countries for IT outsourcing. Write a short paper (2-4 paragraphs) explaining what the appeal would be for US companies to outsource IT functions to these countries. You may discuss cost, labor pool, language, or possibly government support as your reasons. There are many other reasons you may choose to highlight in your paper. Be sure to use your own words.
2.) Many believe that cloud computing can reduce the total cost of computing and enhance “green computing” (environmental friendly). Why do you believe this to be correct? If you disagree, please explain why?
.
1. Addressing inflation using Fiscal and Monetary Policy tools.S.docxaulasnilda
1. Addressing inflation using Fiscal and Monetary Policy tools.
Scenario - The US economy is currently experiencing high rates of inflation. You
have Fiscal and Monetary policy tools available to address this problem:
a. To attack the problem of inflation you must select one Monetary Policy
tool and one Fiscal Policy tool. Write down the name of your Fiscal Policy
tool and your Monetary Policy tool.
i. Think the options through and write down your choices.
b. Please explain why you selected the tools that you selected and why you did
not select the other choices? Do this for both monetary and fiscal policy
tools!
i. Specifically, explain what is so good about the tool you selected and what is not so
good about the tools you did not select? Do this for both the Monetary Policy tool
and the Fiscal Policy tool. The key here is to use some decision criteria in making
your choice.
c. Thoroughly and completely explain how your solution (both the monetary
and the fiscal policy tool) would work to solve the problem of inflation, and
indicate the impact your solution would have on at least 5 key economic
variables. Be specific.
i. Present this using the chain of events format with up or down arrows to indicate the
direction of impact on each variable. I need to see the detail.
2. Addressing recession using Fiscal and Monetary Policy tools.
Scenario - The US economy is currently experiencing recession. You have Fiscal
and Monetary policy tools available to address this problem:
a. To attack the problem of recession, you must select at least one Monetary
Policy tool and one Fiscal Policy tool. Write down the name of your Fiscal
Policy tool and your Monetary Policy tool.
i. Think the options through and write down your choices.
b. Please explain why you selected the tools that you selected and why you did
not select the other choices? Do this for both monetary and fiscal policy
tools!
i. Specifically, explain what is so good about the tool you selected and what is not so
good about the tools you did not select? Do this for both the Monetary Policy tool
and the Fiscal Policy tool. The key here is to use some decision criteria in making
your choice.
c. Thoroughly and completely explain how your solution (both monetary and
fiscal policy tools) would work to solve the problem of recession, and
indicate the impact your solution would have on the key economic
variables. Be specific.
i. Present this using the chain of events format with up or down arrows to indicate the
direction of impact on each variable. I need to see the detail.
3. Please list and explain the 4 key supply side growth factors we discussed, and
discuss the viability (do-ability) of each in terms of getting our economy growing
again, given that today our economy is not growing.
a. The slides should provide you with what you need here.
b. The issue of viability – if the economy is growing slowly or not at all, do we have any chance
of achieving suc.
1. A vulnerability refers to a known weakness of an asset (resou.docxaulasnilda
1. A vulnerability refers to a
known
weakness of an asset (resource) that can be exploited by one or more attackers. In other words, it is a known issue that allows an attack to succeed.
For example, when a team member resigns and you forget to disable their access to external accounts, change logins, or remove their names from company credit cards, this leaves your business open to both intentional and unintentional threats. However, most vulnerabilities are exploited by automated attackers and not a human typing on the other side of the network.
Testing for vulnerabilities is critical to ensuring the continued security of your systems. Identify the weak points. Discuss at least four questions to ask when determining your security vulnerabilities.
2.
Topic:
Assume that you have been hired by a small veterinary practice to help them prepare a contingency planning document. The practice has a small LAN with four computers and Internet access. Prepare a list of threat categories and the associated business impact for each. Identify preventive measures for each type of threat category. Include at least one major disaster in the plan. 200-300 words.
.
1. According to the readings, philosophy began in ancient Egypt an.docxaulasnilda
1. According to the readings, philosophy began in ancient Egypt and then spread to Greece.
True/False
2. This question is based on the presentation of logical concepts in the first reading.
Consider the following argument: "All chemists are Lutheran. Rita is Lutheran. So, Rita must be a chemist."
Is the argument …
Deductive & Invalid
Inductive & Valid
Deductive & Strong
Inductive & Weak
3. Would Socrates agree or disagree with the following statement:
Each of us invents his or her own truth and if you feel it in your heart and really want it to be true then don't listen to those who criticize your belief.
He would agree
He would disagree
4. According to the first reading, Thales asked some important "gateway" questions. Which of the following is not one of the gateway questions discussed in the reading:
Does the diverse range of things we experience have a single common explanation or cause?
Does God exist?
Is the universe intelligible?
5. Scientism is the belief that science is one of many paths to truth about the world.
True/False
6. Deductive arguments always aim to show
The conclusion is probably true
The conclusion must be true
7. In the type of argument known as _____, we begin with premises about a phenomenon or state of affairs to be explained; then we reason from those premises to an explanation for that state of affairs.
deduction
inference to the best explanation
syllogism
anaological induction
8. In the online lecture, the multiverse hypothesis is put forward by Stenger in support of theism.
True/False
9. According to the reading, the cosmic coincidences were known in ancient times.
True/False
10. According to the reading, the problem with Darwin's claim that his theory of natural selection explains all the order in nature is that no evolutionary process of natural selection is possible unless a background system of amazing complexity already exists; but since it must exist prior to any evolutionary process, it cannot be explained as the result of an evolutionary process.
True/False
11. Suppose we have two highly improbable hypotheses: H1 and H2. Suppose H2 is slightly less improbable than H1, all else equal.
According to the presentation of best explanation arguments in the reading, H2 presents a more reasonable explanation than H1.
True/False
12. According to the reading, the fine tuning argument shows that we can know with certainty that an intelligent designer exists.
True/False
13. According to the readings, science cannot possibly explain the source of the order in the universe.
True/False
14. The design argument is presented in the readings as an analogical argument and it is also presented as an inference to the best explanation.
True/False
15. According to the online readings, Ockham's Razor favors the multiverse theory over theism,
True/False
16. The proposition that Mount Rainier has snow on its peak would be an example of a proposition known to be true a priori.
True/False
17. Which of the foll.
1-Explain what you understood from the paper with (one paragraph).docxaulasnilda
1-Explain what you understood from the paper with (one paragraph)
2-What is a Lorenze curve and how is it disputed by Paglin
3-What is the method used in the paper and what can you say about the data used and the empirical aspect of the paper.
4-What other common measurements out there for measuring income inequality, poverty, and development gap.
.
1-Explanation of how healthcare policy can impact the advanced p.docxaulasnilda
The document discusses how healthcare policy impacts advanced practice nurses and why advocacy is an essential part of their role. It explains the four pillars of transformational leadership and how that approach can influence policy change. Finally, it addresses the need for advanced practice nurses to advocate for policies that support patient-centered care through research, leadership, and professional growth.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Pollock and Snow "DEIA in the Scholarly Landscape, Session One: Setting Expec...
1January 2020, Volume 8, Issue 1, Number 17Maryam Bahr.docx
1. 1
January 2020, Volume 8, Issue 1, Number 17
Maryam Bahreynian1 , Marjan Mansourian2 , Nafiseh
Mozaffarian3 , Parinaz Poursafa4 , Mehri Khoshhali3* , Roya
Kelishadi3
Review Article:
The Association Between Exposure to Ambient Particulate
Matter and Childhood Obesity: A Systematic Review and
Meta-analysis
Context: Physical environment contamination and in particular,
air pollution might cause long-term
adverse effects in child growth and a higher risk of catching
non-communicable diseases later in life.
Objective: This study aimed to overview the human studies on
the association of exposure to
ambient Particulate Matter (PM) with childhood obesity.
Data Sources: We systematically searched human studies
published until March 2018 in PubMed,
Scopus, Ovid, ISI Web of Science, Cochrane library, and
Google Scholar databases.
Study Selection: All studies that explored the association
between PM exposure and childhood
obesity were assessed in the present study, and finally, 5 studies
were used in the meta-analysis.
2. Data Extraction: Two independent researchers performed the
data extraction procedure and
quality assessment of the studies. The papers were qualitatively
assessed by STROBE (Strengthening
the Reporting of Observational studies in Epidemiology)
statement checklist.
Results: The pooled analysis of PM exposure was significantly
associated with increased Body Mass
Index (BMI) (Fisher’s z-distribution=0. 028; 95% CI=0. 017, 0.
038) using the fixed effects model. We
also used a random-effect model because we found a significant
high heterogeneity of the included
studies concerning the PM (I2=94. 4%; P<0. 001). PM exposure
was associated with increased BMI
(Fisher’s z-distribution=0. 022; 95% CI=-0. 057, 0. 102).
However, the overall effect size was not
significant, and heterogeneity of the included studies was
similar to the fixed effect model.
Discussion: Our findings on the significant association between
PM10 exposure and the increased
BMI (r=0. 034; 95%CI=0. 007, 0. 061) without heterogeneity
(I2=16. 6%, P=0. 274) (in the studies with
PM10) suggest that the PM type might account for the
heterogeneity among the studies.
Conclusion: The findings indicate that exposure to ambient
PM10 might have significant effects on
childhood obesity.
A B S T R A C T
Key Words:
Air pollution, Particulate
matter, Childhood
3. obesity, Meta-analysis
Article info:
Received: 10 Oct 2018
First Revision: 23 Feb 2019
Accepted: 09 Mar 2019
Published: 01 Jan 2020
1. Department of Nutrition Child Growth, and Development
Research Center, Research Institute for Primordial Prevention
of Non-communicable Dis-
eases, Student Research Committee, Isfahan University of
Medical Sciences, Isfahan, Iran.
2. Department of Biostatistics and Epidemiology, School of
Health, Isfahan University of Medical Sciences, Isfahan, Iran.
3. Department of Pediatrics, Child Growth, and Development
Research Center, Research Institute for Primordial Prevention
of Non-communicable Dis-
eases, Isfahan University of Medical Sciences, Isfahan, Iran.
4. Environment Research Center, Research Institute for
Primordial Prevention of Non-communicable Diseases, Isfahan
University of Medical Sciences, Isfahan, Iran.
* Corresponding Author:
Mehri Khoshhali, MD.
Address: Department of Pediatrics, Child Growth and
Development Research Center, Research Institute for Primordial
Prevention of Non-communicable Dis-
eases, Isfahan University of Medical Sciences, Isfahan, Iran.
Tel: +98 (311) 7925215
E-mail: m. [email protected] com
Citation Bahreynian M, Mansourian M, Mozaffarian N, Poursafa
P, Khoshhali M, Kelishadi R. The Association Between
Exposure
to Ambient Particulate Matter and Childhood Obesity: A
4. Systematic Review and Meta-analysis. Journal of Pediatrics
Review. 2020;
8(1):1-14. http://dx. doi. org/10. 32598/jpr. 8. 1. 1
: http://dx. doi. org/10. 32598/jpr. 8. 1. 1
Use your device to scan
and read the article online
https://orcid.org/0000-0001-9832-0106
https://orcid.org/0000-0002-7217-0282
https://www.ncbi.nlm.nih.gov/pubmed/?term=Mozaffarian%20N
%5BAuthor%5D&cauthor=true&cauthor_uid=29442253
https://orcid.org/0000-0002-8113-6721
https://orcid.org/0000-0002-8067-4122
https://orcid.org/0000-0002-2883-8652
https://orcid.org/0000-0001-7455-1495
http://jpr.mazums.ac.ir/page/69/Open-Access-Policy
https://www.ncbi.nlm.nih.gov/pubmed/?term=Mozaffarian%20N
%5BAuthor%5D&cauthor=true&cauthor_uid=29442253
http://dx.doi.org/10.32598/jpr.8.1.1
https://crossmark.crossref.org/dialog/?doi=10.32598/jpr.8.1.1
http://jpr.mazums.ac.ir/page/69/Open-Access-Policy
2
January 2020, Volume 8, Issue 1, Number 17
1. Context
hildhood obesity is a growing public health
problem, even in developing countries (1, 2). It
is associated with several health complications
during childhood, which will usually extend to
adulthood (3). It has several underlying causes,
5. both genetic and environmental factors (4, 5).
Recently, researchers have paid attention to the as-
sociation between air pollution and obesity, and some
studies suggest that ambient air pollution may increase
the risk of catching Non-communicable Diseases (NCDs)
in adults, diseases such as cardiovascular diseases, dia-
betes and cancer (6-8). However, little epidemiological
evidence is available on the association of exposure to
ambient air pollution with the development of child-
hood obesity (9-11). Physical environment contamina-
tion and in particular, air pollution might cause long-
term adverse effects in child growth and a higher risk of
developing NCDs later in life. The “Obesogenic Environ-
ment” hypothesis discusses the impact of environmen-
tal chemicals with endocrine disruption properties that
can change child growth patterns and result in weight
gain, obesity, and obesity-related NCDs (12).
Some previous studies reveal a positive association
between exposure to Polycyclic Aromatic Hydrocar-
bons (PAHs) and childhood obesity (11, 13). A recent
study conducted in China reports that long-term ex-
posure to air pollutants, including Particulate Matter
(PM)
10
, NO
2
, SO
2
, and O
3
6. is associated with higher risk
of childhood obesity and hypertension (14). More-
over, the association of residential traffic density and
roadway proximity with rapid infant weight gain and
childhood obesity has been documented in some pre-
vious studies (15-18). A study on Latino children living
in the US shows that higher exposure to NO
2
and PM
2.
5
is related to higher Body Mass Index (BMI) at the age
of 18 (19). However, some other studies report no as-
sociation between exposure to vehicular traffic and
pollutants and the risk of obesity and dyslipidemia in
children (20, 21). Therefore, the overall evidence on
obesogenic properties of air pollutants is controversial.
2. Objectives
Due to the high prevalence of childhood obesity, its
multifactorial nature, and the importance of conducting
preventive strategies, we aimed to provide a systematic
review and meta-analysis on the association of expo-
sure to ambient PM and childhood obesity.
3. Data Sources
We performed a systematic review and meta-analysis
of human studies that explored the association be-
tween PM exposure and childhood obesity. We con-
7. sidered PECO as the following: Population (P): Children
and adolescents; Exposure (E): PM exposure; Compari-
son (C) (There is no comparison between exposed and
non-exposed groups because we have reported the cor-
relations of PM exposure and BMI); and Outcome (O):
Childhood obesity (BMI).
We systematically searched human studies available
on the study subject until March 2018 in PubMed, Sco-
pus, Ovid, ISI Web of Science, Cochrane library, and
Google Scholar databases. All cross-sectional and co-
hort studies were selected. We used the search terms of
“Air Pollution” OR “Pollutants” OR “Particulate Matter”
in combination with “Obesity” OR “Weight” OR “Body
Mass Index” OR “BMI” OR “Overweight” OR “Cardio-
metabolic” OR “Metabolic Syndrome” OR “Metabolic
Syndrome X” OR “Mets” OR “Adiposity” AND “Child” OR
“Adolescent” OR “School-aged” OR “Youth” OR “Teen-
ager” OR “Boy” OR “Girl” OR “Student” OR “Pediatrics”
in the form of Medical Subject Headings (MeSH) and
truncations. The relevant articles were examined with-
out any language restriction.
4. Study Selection
After removing the duplicates, the relevant papers
were selected in three phases. In the first and the second
phases, titles and abstracts of papers were screened,
and the irrelevant papers were excluded. In the third
phase, the full texts of the remaining papers were ex-
plored carefully to select only the relevant papers. To
find any additional pertinent study, the reference list of
all reviews and related papers were screened as well.
The included studies had the following criteria: 1.
Observational cross-sectional design; 2. Longitudinal
8. cohort studies which report the study association; 3.
Measurement of PM concentration as an index for air
pollution exposure; and 4. Reporting the Odds Ratio
(OR), Relative Risk (RR), and β-coefficient of PM with
child obesity. In the final step, all statistics were changed
to the correlation coefficient values.
5. Data Extraction
Two reviewers extracted the data independently using
a data collection form, including the first author’s name,
publication year, sample size, study design, as well as
C
Bahreynian M, et al. Exposure to Ambient Particulate Matter
and Childhood Obesity. Association Between Exposure to
Ambient Particulate. J Pediatr Rev. 2020; 8(1):1-14.
3
January 2020, Volume 8, Issue 1, Number 17
age, exposure measurement, statistical analysis, and
the variables adjusted in the analyses.
5. 1. Quality assessment
Two independent reviewers (MB and MKH) evalu-
ated the methodological quality of each study. The
Strengthening the Reporting of Observational studies in
Epidemiology (STROBE) checklist was used for the qual-
ity assessment of the papers. According to STROBE (22
questions), the included studies were divided into three
9. groups of high, medium, and low-quality. The studies
scored one to eight were ranked as low-quality studies,
9-16 as medium-quality ones, and 17-22 as high-quality
papers. The two reviewers agreed on (80%) of cases.
The remaining discrepancies were resolved by consulta-
tion and consensus.
5. 2. Statistical analysis
The effect sizes of RR, OR, and β-coefficient from all ar-
ticles were extracted directly from the original reports.
All effect sizes were transformed into (r: correlation),
and Fisher z-transformation of the r value was applied
for the pooled analysis (22, 23). The potential heteroge-
neity across studies was evaluated using the Cochran’s
Q test and was expressed using the I2 index. The pooled
results for Fisher z-transformation were calculated by
the fixed-effects model (for low heterogeneity) or the
random-effects model (for high heterogeneity). Publica-
tion bias was evaluated by the Egger’s and the Begg’s
tests. Subgroup analyses and meta-regression were per-
formed to seek the sources of heterogeneity. The sensi-
tivity analyses were performed by omitting one study at
a time to gauge the robustness of our results. All statisti-
cal analyses were conducted in STATA V. 14. 0.
6. Results
We initially retrieved 4391 articles from the databases.
Figure 1 represents the search results. After the initial
study of the titles and abstracts, the duplicate papers
were omitted, and out of 4276 papers, five articles
remained. No additional references were identified
through checking the reference lists of selected papers.
The main characteristics of the studies included in the
10. systematic review are presented in Appendix 1. Overall,
the studies reported data on 33825 subjects, and they
were published between 2010 and 2018.
6. 1. Meta-analysis of the correlations
Figure 2 showed the pooled results using random ef-
fect model. It showed that PM exposure was associat-
ed with the increased BMI (Fisher-z= 0. 022; 95% CI (-0.
057, 0. 102)) that overall effect size was not significant
and heterogeneity of the included studies was as same
fixed effect model.
Table 1 presents the results of the meta-regression
analysis. The univariate meta-regression analyses in-
dicated that none of the factors, including mean age,
sample size, study location (Europe, Asia, and the USA),
study type (cross-sectional and cohort), and PM type
(2. 5 and 10) contributed to the heterogeneity of meta-
analysis (P>0. 05 for all).
Table 2 presents the results of subgroup analysis ac-
cording to the study location, study type, and PM type.
We observed significant association between PM
10
ex-
posure and the increased BMI (Fisher’s z=0. 034; 95%
CI=0. 007, 0. 061) with no apparent heterogeneity
(I2=16. 6%, P=0. 274) in the studies with PM
10
. It sug-
gests that the PM type may partially account for the het-
11. erogeneity among the studies on BMI (Figure 3).
Begg’s test and Egger’s test revealed no obvious publi-
cation bias among these studies. The P-values for these
tests were higher than 0. 05 (P=0. 661 and 1. 0, respec-
tively). The results of sensitivity analyses showed that
with excluding the study of Fleisch AF et al. (7. 7 years),
the pooled Fisher’s z for the subgroup PM
2. 5
increased.
Although this change was not significant, it decreased
the overall heterogeneity (I2=83. 1%, P<0. 001) (Figure
4).
Figure 4 Forest plot of Fisher’s z values for the cor-
relation between PM and BMI by PM type after exclud-
ing the study of Fleisch AF et al. (7. 7 years) Table 3
presents the results of converting Fisher’s z values into
correlation values. We found a significant relationship
between PM
10
and BMI (r=0. 034, P=0. 015), but the
association of PM
2. 5
and BMI was not statistically sig-
nificant (r=0. 035, P=0. 606).
7. Discussion
This systematic review and meta-analysis revealed a weak
positive association between ambient PM
12. 10
and child obe-
sity. However, the results for PM
2. 5
was not significant. A few
meta-analysis or large sample size studies have explored
the association of ambient PM with adult obesity or birth
weight, but with childhood obesity (24-26).
Bahreynian M, et al. Exposure to Ambient Particulate Matter
and Childhood Obesity. Association Between Exposure to
Ambient Particulate. J Pediatr Rev. 2020; 8(1):1-14.
4
January 2020, Volume 8, Issue 1, Number 17
NOTE: Weights are from random effects analysis
Overall (I-squared = 94.4%, p = 0.000)
Fioravanti S et al (PM2.5) (2018)
Poursafa P et al (2017)
Fleisch AF et al (3.3 years) (2016)
Study
Mao G et al (2017)
13. Fioravanti S et al (PM 10) (2018)
Fleisch AF et al (7.7 years) (2016)
Dong GH et al (2014)
ID
0.02 (-0.06, 0.10)
0.01 (-0.08, 0.09)
0.41 (0.27, 0.56)
-0.00 (-0.05, 0.05)
0.03 (-0.03, 0.08)
-0.01 (-0.09, 0.07)
-0.20 (-0.25, -0.15)
0.04 (0.03, 0.05)
ES (95% CI)
100.00
13.80
10.56
15.20
%
15. %
15.22
13.80
15.20
16.21
Weight
0-.557 0 .557
Figure 2. Forest plot of Fisher’s z values indicating the
correlation between PM and BMI
Bahreynian M, et al. Exposure to Ambient Particulate Matter
and Childhood Obesity. Association Between Exposure to
Ambient Particulate. J Pediatr Rev. 2020; 8(1):1-14.
16. Articles screened by
title and abstract
(n=4276)
Excluded non-
relevant articles
(n=4271)
Full text articles assessed for eligibility and studies
included in the meta-analysis (n=5)
(Two studies reported PM10 and five studies reported
PM2.5 as the indicators of air pollution.
Three studies reported PM2.5, one study reported
PM10 and one study reported both PM2.5 and PM10.
Removed duplicates
articles (n=115)
Articles identified through
electronic database search
(n=4391)
(PubMed: 662; Scopus: 2600; ISI
Web of Science: 1129)
Figure 1. The flowchart of the search results
17. 5
January 2020, Volume 8, Issue 1, Number 17
Table 1. Results of meta-regression analyses for the potential
source of heterogeneity
Covariate B SE P 95% CI
Year of publication 0. 016 0. 056 0. 790 (-0. 128, 0. 159)
Mean age 0. 040 0. 030 0. 243 (-0. 038, 0. 118)
PM2. 5 (Ref, PM10) 0. 024 0. 162 0. 889 (-0. 392, 0. 440)
Sample size of study -0. 0000002 0. 000007 0. 974 (-0. 00002,
0. 00002)
Study location: (Ref. : Asia)
USA -0. 264 0. 144 0. 107 (-0. 664, 0. 136)
Europe -0. 207 0. 159 0. 109 (-0. 649, 0. 235)
Study type: Cohort (Ref: Case control) -0. 238 0. 121 0. 107 (-
0. 550, 0. 074)
SE: Standard Error; CI: Confidence Interval
Table 2. Results of subgroup analysis on the association
between PM and BMI
Variables Groups NO. of Study Effect Size (Fisher’ z) 95% CI P
Heterogeneity
18. I2 (%) P
PM type
10 2 0. 034 (0. 007, 0. 061) 0. 015 16. 60 0. 274
2. 5 3 0. 035 (-0. 099, 0. 169) 0. 606 95. 30 < 0. 001
Study type
Cross-sectional 2 0. 218 (-0. 148, 0. 583) 0. 243 96. 10 < 0. 001
cohort 3 -0. 037 (-0. 132, 0. 057) 0. 442 91. 60 < 0. 001
Study location
Asia 2 0. 218 (-0. 148, 0. 583) 0. 243 96. 10 < 0. 001
Europe 1 -0. 001 (-0. 06, 0. 057) 0. 961 0. 00 0. 818
USA 2 -0. 059 (-0. 2, 0. 083) 0. 416 95. 50 < 0. 001
Figure 3. Forest plot of Fisher’s z values indicating the
correlation between PM and BMI by PM type
NOTE: Weights are from random effects analysis
.
.
Overall (I-squared = 94.4%, p = 0.000)
Fleisch AF et al (7.7 years) (2016)
Poursafa P et al (2017)
19. Fioravanti S et al (PM 10) (2018)
ID
Mao G et al (2017)
PM10
Fleisch AF et al (3.3 years) (2016)
Study
Fioravanti S et al (PM2.5) (2018)
PM2.5
Subtotal (I-squared = 95.3%, p = 0.000)
Dong GH et al (2014)
Subtotal (I-squared = 16.6%, p = 0.274)
0.02 (-0.06, 0.10)
-0.20 (-0.25, -0.15)
0.41 (0.27, 0.56)
-0.01 (-0.09, 0.07)
ES (95% CI)
0.03 (-0.03, 0.08)
-0.00 (-0.05, 0.05)
22. 69.99
16.21
30.01
0-.557 0 .557
Bahreynian M, et al. Exposure to Ambient Particulate Matter
and Childhood Obesity. Association Between Exposure to
Ambient Particulate. J Pediatr Rev. 2020; 8(1):1-14.
6
January 2020, Volume 8, Issue 1, Number 17
These five studies investigated more than 33000 par-
ticipants. The current literature provides conflicting re-
sults on the association between air pollution and child-
hood obesity (19-21, 27). We found a relatively weak
positive relationship between exposure to PM
10
and
childhood BMI, consistent with most previous studies
findings. Five of the seven studies included in the cur-
rent meta-analysis reported the direct association of air
pollution and child weight, whereas two cohort studies
did not report such association (20, 21).
Such discrepancies among these studies results might
be due to confounding factors like age, gender, ethnicity,
23. physical activity, level of exposures, and some other fac-
tors. These findings might be confounded by heterogene-
ity due to multiple dispersions between studies such as
study design, different techniques to measure PM con-
centration, the way PM levels is reported, and other vari-
ous confounders which were adjusted in the analysis.
Only a few cross-sectional studies have investigated the
relation of air pollution and obesity in children (16, 17, 20,
27-29). In a longitudinal study, higher exposure to NO
2
and
NOTE: Weights are from random effects analysis
.
.
Overall (I-squared = 83.1%, p = 0.000)
Study
Dong GH et al (2014)
ID
Mao G et al (2017)
Poursafa P et al (2017)
Subtotal (I-squared = 16.6%, p = 0.274)
Subtotal (I-squared = 89.4%, p = 0.000)
24. Fioravanti S et al (PM 10) (2018)
Fioravanti S et al (PM2.5) (2018)
PM2.5
PM10
Fleisch AF et al (3.3 years) (2016)
0.05 (-0.00, 0.10)
0.04 (0.03, 0.05)
ES (95% CI)
0.03 (-0.03, 0.08)
0.41 (0.27, 0.56)
0.03 (0.01, 0.06)
0.09 (-0.02, 0.20)
-0.01 (-0.09, 0.07)
0.01 (-0.08, 0.09)
-0.00 (-0.05, 0.05)
100.00
%
23.11
26. 100.00
%
23.11
Weight
19.21
8.64
38.06
61.94
14.95
14.95
19.14
0-.557 0 .557
Figure 4. Forest plot of Fisher’s z values, indicating the
correlation between PM and BMI by PM type after excluding
the study of Fleisch
AF et al (7. 7 years)
Table 3. The correlation between PM exposure and BMI
Variables
Effect Size Heterogeneity
Pooled r 95% CI P I2 P τ2
27. PM10 0. 034 (0. 007, 0. 061) 0. 015 16. 60% 0. 0002 0. 0002
PM2. 5 0. 035 (-0. 099, 0. 167) 0. 606 95. 30% 0. 0216 0. 022
overall 0. 022 (-0. 057, 0. 102) 0. 579 94. 40% 0. 0101 0. 010
τ2: Between-studies variance
Bahreynian M, et al. Exposure to Ambient Particulate Matter
and Childhood Obesity. Association Between Exposure to
Ambient Particulate. J Pediatr Rev. 2020; 8(1):1-14.
7
January 2020, Volume 8, Issue 1, Number 17
PM
2. 5
was associated with higher BMI, body fat percent-
age, and abdominal obesity during follow up and at the
age of 18 in children who were overweight or obese at
the study baseline (19). Another study conducted on over-
weight and obese minority youths found that higher expo-
sures to NO
2
and PM
2. 5
during one year before the study
was not associated with obesity, but it was related to low-
28. er insulin sensitivity and higher acute insulin response to
glucose, which might contribute to obesity (19, 30).
The mechanisms linking air pollution to obesity risk and
type-2 diabetes are not entirely determined. The effects
of air pollutants on immune response, oxidative stress,
and insulin resistance might explain the results (31).
Air pollutants such as PM might increase the infiltra-
tion and activation of immune-competent cells, includ-
ing monocyte and macrophages, in body tissues (32).
Previous findings also indicated that early life exposure
to PM
2. 5
might result in insulin resistance and obesity
later in life, through NAD(P)H oxidase-derived super-
oxide anions, which might cause changes in adipocyte
numbers and size (33).
Animal studies suggest that higher exposure to air pol-
lutants might result in increased adipose tissue inflam-
mation, accumulation of glucose in skeletal muscles,
and therefore it might contribute to metabolic dysfunc-
tion and obesity (34, 35). Furthermore, previous studies
indicate that long-term exposure to combustion-related
air pollutants can increase systemic inflammation and
oxidative stress (34).
Little information is available about the biological basis
of the relationship between exposure to air pollutants and
childhood obesity. There may be a potential for residual
confounders, including socioeconomic status and physi-
cal activity, which can be associated with both air pollu-
tion exposure and children’s weight. Therefore, residual
29. confounding may affect the study results due to the as-
sociations of poor diet and low physical activity with child
overweight and metabolic disruption. Also, these factors
may be related to residential proximity to sources of air
pollution (36, 37). For example, children living in areas with
higher levels of air pollution usually belong to lower socio-
economic families who often consume higher amounts of
total or saturated fats (27, 38).
Lack of physical activity among the children living in pollut-
ed regions (because of their parental control to restrict the
children’s exposure to air pollution) may be another reason
for the excess weight in children. It is documented that over-
weight children usually have less frequent and shorter peri-
ods of activities compared to their normal weight peers (39,
40). However, the findings on the associations of exposure
to air pollutants and childhood obesity are unlikely to be
confounded by these factors, because many of these studies
had adjusted these associations for socioeconomic status, as
a strong predictor of dietary intake and physical activity (36).
Furthermore, misclassification of exposure to air pollut-
ants might have occurred with residential-based estimates
of pollutant exposure, which might decrease the observed
effects (41). Some studies also lack information about oth-
er potential confounders such as active and passive smok-
ing as well as exposure to noise pollution (19). Previous
studies suggest that tobacco exposure and near roadway
air pollution contribute to synergistic effects on the devel-
opment of child obesity (18).
The findings of the current study concerning the asso-
ciation of exposure to ambient PM with childhood obesity
should be considered with caution. The cross-sectional
design of some studies used for this meta-analysis might
30. preclude any causality. Another limitation is the high het-
erogeneity between studies. Other potential risk factors
like child physical activity, familial socioeconomic status,
and climate conditions were not available in some studies.
8. Conclusions
This systematic review and meta-analysis indicate
that exposure to ambient PM
10
has a weak positive as-
sociation with childhood obesity. This finding should be
considered in future studies and preventive programs.
Our results are also useful for health policymakers and
health care providers to design health promotion inter-
ventions and preventive strategies. More research is
needed to clarify the effect of other ambient air pollut-
ants on child health status.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles were considered in this article.
Funding
This research did not receive any specific grant from
funding agencies in the public, commercial, or not-for-
profit sectors.
Authors contribution's
Bahreynian M, et al. Exposure to Ambient Particulate Matter
31. and Childhood Obesity. Association Between Exposure to
Ambient Particulate. J Pediatr Rev. 2020; 8(1):1-14.
8
January 2020, Volume 8, Issue 1, Number 17
Conceptualization, methodology, and investigation: All au-
thors; Writing-original draft: Maryam Bahreynian; Writing-
review & editing: Maryam Bahreynian, Roya Kelishadi, Meh-
ri Khoshhali, and Marjan Mansourian; Supervision: Roya
Kelishadi and Mehri Khoshhali.
Conflicts of interest
The authors declared no conflict of interests.
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44. Effect Size
CI (95%
)
Adjustm
ent Factors
M
ichael
Jerrett
,
2010
Southern
California,
U
SA
Cohort
8-year
follow
-
up
2889
10–18 years
Body M
ass
Index (BM
45. I)
Traffi
c-related air
pollution
Annual
average daily
traffi
c (AADT)
150 m
B (SE):
0. 0039 (0. 0008)
G
ender, cohorts variables
parental education,
personal w
eekly sm
oking,
second hand sm
oke (cur-
rent + past), ever asthm
a,
buffer population, gam
m
a
46. index, proportion of below
poverty people w
ithin
census block, norm
alized
difference vegetation
index (N
DVI), foreign-born,
com
m
unity-level violent
crim
e rate, and having no
food stores w
ithin 500-m
road netw
ork buffer w
ith
random
com
m
unity effects
47. AADT 300 m
0. 0013 (0. 0008)
Pei, 2013
G
erm
any
Cohort
10-year
follow
-
up
3121
Fem
ales
(N
=1114),
M
ales
(N
=1158)
10 (W
e predicted
standardized body
m
48. ass index (BM
I) at 10
years of age using stan -
dardized BM
Is from
birth to 5 years. )
M
aternal sm
oking dur-
ing pregnancy
β (CI):
0. 13
(0. 03, 0. 22)
Parental education, fam
-
ily incom
e, and m
aternal
sm
oking during pregnancy
M
ichael Jer-
50. cover, street connectivity,
recreational program
m
ing
w
ithin 5 km
of the hom
e,
and fast food access w
ithin
500 m
of the hom
e
Traffi
c density
0. 0002 (0. 0001)
N
on-Freew
ay
N
O
x
0. 0861 (0. 0255)
51. Bahreynian M, et al. Exposure to Ambient Particulate Matter
and Childhood Obesity. Association Between Exposure to
Ambient Particulate. J Pediatr Rev. 2020; 8(1):1-14.
11
January 2020, Volume 8, Issue 1, Number 17
Author(s)/
D
ate
Study
Location
Study
D
esign
Follow
U
p
D
ura-
tion
Sam
ple
54. obtained at m
unicipal
air pollution m
onitoring
stations.
PM
10 (μg/m
3)
O
R(CI):
1. 19
(1. 11–1. 26)
Age, gender, parental
education, breast
feeding, low
birth w
eight,
area of residence per
person, house decorations,
hom
e coal use, ventilation
device in the kitchen, air
exchange in w
inter, passive
55. sm
oking exposure,
and districts
SO
2 (ppb)
1. 11
(1. 03–1. 20)
N
O
2 (ppb)
1. 13
(1. 04–1. 22)
O
3 (ppb)
1. 14
(1. 04–1. 24)
Rob M
cCon -
nel,
2015
Southern
California,
U
SA
58. okers at
hom
e: 1. 08 (0. 19,
1. 97)
M
aternal sm
oking
during pregnancy:
0. 72 (0. 14, 1. 31)
N
RP: 1. 13 (0. 61,
1. 65).
The difference in
the attained BM
I
(95%
CI):
O
ne sm
oker at
hom
e: 0. 95 (0. 42,
1. 47)
≥ 2 sm
okers at
59. hom
e: 1. 77 (1. 04,
2. 51
M
aternal sm
oking
during pregnancy;
1. 14 (0. 66, 1. 62
N
RP: 1. 27 (0. 75,
1. 80)
Bahreynian M, et al. Exposure to Ambient Particulate Matter
and Childhood Obesity. Association Between Exposure to
Ambient Particulate. J Pediatr Rev. 2020; 8(1):1-14.
12
January 2020, Volume 8, Issue 1, Number 17
Author(s)/
D
ate
Study
Location
Study
D
62. 7 years
of age)
1418
M
ean (standard
deviation) of age at
early childhood visit 3.
3 (0. 4),
and at m
id-childhood
visit 8. 0 (0. 9)
BM
I z-score
Spatiotem
poral m
odels
to estim
ate prenatal
and early life residential
PM
2. 5 and black carbon
exposure as w
ell as traf-
fic density and
63. roadw
ay proxim
ity.
PM
2. 5 (μg/m
3)
3. 3 years
Child (age, sex and race/
ethnicity), m
other (age,
education, and sm
ok-
ing during pregnancy),
neighborhood (census
tract m
edian incom
e),
season and date of health
outcom
e
Third trim
es -
ter
64. 0. 0
(-0. 1, 0. 1)
Year prior to
early child-
hood visit
-0. 0
(-0. 1, 0. 1)
N
ear-residence
traffi
c density
Birth address
0. 0
(-0. 0, 0. 1)
Early child -
hood address
0. 0
(-0. 0, 0. 1)
Proxim
ity to
m
ajor roadw
ay,
birth address
65. Reference:≥200m
<50m
0. 3
(0. 0, 0. 7)
[50, 100m
]
-0. 0
(-0. 4,0. 3
[100, 200m
]
0. 4
(0. 1, 0. 6)
Proxim
ity to
m
ajor roadw
ay,
early child -
hood address
Reference:≥200m
<50 m
0. 1
(-0. 2, 0. 5)
66. [50, 100 m
]
-0. 0
(-0. 4, 0. 3)
[100, 200 m
]
0. 1
(-0. 2, 0. 3)
Yueh-
HsiuM
athil -
daChiua
2017
Boston,
U
SA
Cohort
4. 0±0.
7 years
239
BM
I, z-
score
67. Prenatal daily PM
2.
5 exposure w
as esti-
m
ated using a validated
satellite-based spatio-
tem
poral
m
odel.
Prenatal PM
2. 5 level
(μg/m
3
M
edian IQ
R
10. 7(9. 9─11. 4)
PM
2. 5 (μg/m
3)
G
irls
68. -0. 12
(-0. 37,-0. 03)
M
aternal age, race/
ethnicity, education, pre-
pregnancy BM
I, and child’s
age at anthropom
etric
m
easurem
ent
Boys
0. 21
(0. 003,-0. 37)
Bahreynian M, et al. Exposure to Ambient Particulate Matter
and Childhood Obesity. Association Between Exposure to
Ambient Particulate. J Pediatr Rev. 2020; 8(1):1-14.
13
January 2020, Volume 8, Issue 1, Number 17
Author(s)/
D
71. I
N
O
2 and PM
2. 5 w
ere
m
odeled as long-term
exposure using cum
ula-
tive
12-m
onth averaged
exposure during the
follow
-up.
Estim
ated effect esti-
m
ates w
ere reported
for a
72. A 5-ppb difference in
N
O
2 and a 4-μg/m
3
difference in PM
2. 5
N
O
2
(ppb)
2. 1
(0. 1, 4. 1)
Sex, Tanner stage, the
season of testing
(w
arm
/cold), prior year
exposure at each follow
-up
visit, social position, body
fat percentage (w
here
appropriate), study w
73. ave,
and study entry year
PM
2. 5 (μg/m
3)
3. 8
(1, 6. 6)
Poursafa,
2017
Iran
Cross-
sectional
---
186
6-18
BM
I
The air quality index
(AQ
I) is used to describe
the level of air pollution
w
ith adverse health
74. effects. W
e used PM
2.
5 data.
Β=0. 34
Age and gender
Sara Fiora-
vant, 2018
Italy
Cohort
8-year
follow
-
up
581
Birth-8 years
Prevalence
of over-
w
eight/
obesity w
as
9. 3%
and
75. 36. 9%
Air pollution w
as as-
sessed at the residential
address
N
O
2 (per 10 μg/
m
3)
0. 99
(0. 86, 1. 12)
M
aternal and paternal
education, m
aternal pre-
pregnancy BM
I, m
aternal
sm
oking during pregnancy,
gestational
diabetes, m
aternal age at
76. delivery, gestational age,
childbirth w
eight, breast-
feeding duration, age (in
m
onths) at w
eaning
N
O
X (per 20 μg/
m
3)
0. 98
(0. 86, 1. 12)
PM
10 (per 10 μg/
m
3)
0. 971
(0. 77, 1. 23)
PM
2. 5 (per 5 μg/
m
3)
78. -
up
1,446
first 2 years of life
Com
paring the
highest and low
-
est quartiles of
PM
(2:5 μg/m
3)
The adjusted Rela-
tive Risks (RRs)
1. 3
(1. 1, 1. 5)
M
aternal age at delivery,
race/ ethnicity, education
level, sm
oking status,
diabetes, m
arriage status,
household incom
79. e per
year, the season of child-
birth, preterm
birth, birth
w
eight, and breastfeeding
Bahreynian M, et al. Exposure to Ambient Particulate Matter
and Childhood Obesity. Association Between Exposure to
Ambient Particulate. J Pediatr Rev. 2020; 8(1):1-14.
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RESEARCH ARTICLE Open Access
Salivary epigenetic biomarkers as
82. predictors of emerging childhood obesity
Amanda Rushing1, Evan C. Sommer2, Shilin Zhao3, Eli K.
Po’e4 and Shari L. Barkin5*
Abstract
Background: Epigenetics could facilitate greater understanding
of disparities in the emergence of childhood
obesity. While blood is a common tissue used in human
epigenetic studies, saliva is a promising tissue. Our prior
findings in non-obese preschool-aged Hispanic children
identified 17 CpG dinucleotides for which differential
methylation in saliva at baseline was associated with maternal
obesity status. The current study investigated to
what extent baseline DNA methylation in salivary samples in
these 3–5-year-old Hispanic children predicted the
incidence of childhood obesity in a 3-year prospective cohort.
Methods: We examined a subsample (n = 92) of Growing Right
Onto Wellness (GROW) trial participants who were
randomly selected at baseline, prior to randomization, based on
maternal phenotype (obese or non-obese).
Baseline saliva samples were collected using the Oragene DNA
saliva kit. Objective data were collected on child
height and weight at baseline and 36 months later. Methylation
arrays were processed using standard protocol.
Associations between child obesity at 36 months and baseline
salivary methylation at the previously identified 17
CpG dinucleotides were evaluated using multivariable logistic
regression models.
Results: Among the n = 75 children eligible for analysis,
baseline methylation of Cg1307483 (NRF1) was significantly
associated with emerging childhood obesity at 36-month follow-
up (OR = 2.98, p = 0.04), after adjusting for child
age, gender, child baseline BMI-Z, and adult baseline BMI. This
83. translates to a model-estimated 48% chance of child
obesity at 36-month follow-up for a child at the 75th percentile
of NRF1 baseline methylation versus only a 30%
chance of obesity for a similar child at the 25th percentile.
Consistent with other studies, a higher baseline child
BMI-Z during the preschool period was associated with the
emergence of obesity 3 years later, but baseline
methylation of NRF1 was associated with later obesity even
after adjusting for child baseline BMI-Z.
Conclusions: Saliva offers a non-invasive means of DNA
collection and epigenetic analysis. Our proof of principle
study provides sound empirical evidence supporting DNA
methylation in salivary tissue as a potential predictor of
subsequent childhood obesity for Hispanic children. NFR1
could be a target for further exploration of obesity in this
population.
Keywords: Obesity, Hispanic children, Epigenetics,
Methylation, Saliva
Background
The prevalence of pediatric obesity has been increasing
at an alarming rate in the last forty years [1, 2]. Although
pediatric obesity prevalence is a global issue, the United
States is facing epidemic levels of pediatric obesity [3, 4].
The Center for Disease Control and Prevention indicates
that the prevalence of obesity among children aged 2–
19 years old has risen from 13.9% in 2000 to 18.5% in
2016 [5]. However, some ethnic groups have an even
higher obesity prevalence [1, 6]. For example, the 2015–
2016 National Health and Nutrition Examination Survey
(NHANES) reported 25.8% of Hispanic 2–19 year-olds
were obese compared to 14.1% of their non-Hispanic
white counterparts [7]. Identifying what influences dif-
85. increased risk of diabetes, hypertension, and cardiovas-
cular disease in adulthood [8–10]. Recent literature indi-
cates that susceptibility to obesity within an
“obesogenic” environment differs among individuals [11,
12]. It is not clear what mechanisms are responsible for
obesity variation, but many studies identify a dynamic
interaction of genetic and environmental exposures at
sensitive periods of development [13, 14]. While mono-
genic DNA mutations exist and are associated with
obesity, common forms of childhood obesity have frus-
trated the scientific community with the so-called prob-
lem of missing heritability. It appears that obesity is a
multi-trait, multi-state phenotype. The field of epigenet-
ics, modifications that affect transcriptional plasticity,
might offer insights into the emerging phenotype of
childhood obesity. Epigenetic patterns, often measured
by DNA methylation, change rapidly in response to en-
vironmental factors such as nutrition and physical activ-
ity and are specifically vulnerable to changes during
early childhood development. Moreover, epigenetic pat-
terns vary between ethnic groups and could explain dif-
fering susceptibility to early emerging obesity and its
commonly associated later chronic diseases [15–18].
Epigenetic patterns are tissue-dependent. While blood
is a common tissue used in studies of human epigenetic
changes, saliva is also a promising tissue. Saliva could be
particularly valuable in studying pediatric populations
given the ease of tissue access, cost-efficiency, and the
ability to collect it in multiple settings [19, 20]. Abraham
and colleagues illustrated that when comparing DNA
fragmentation, quality, and genotype concordance, saliva
is comparable to blood samples [21]. When examining
methylation patterns, both saliva and blood reliably as-
86. sess epigenetic modifications [22]. In comparing the col-
lection of blood and saliva samples, saliva collection is
associated with lower infection rates, decreased cost, in-
creased patient acceptance, and higher participant com-
pliance [23]. Saliva also has the advantage of offering
insight into the gastrointestinal tract, which could be
useful when examining obesity. The ease of saliva collec-
tion coupled with DNA fidelity could allow for a more
practical source of DNA collection for children. Given
that salivary tissue is used less often for epigenetic stud-
ies, this approach is novel.
Recently, Oelsner et al. examined 92 saliva samples
from 3 to 5-year-old Hispanic children who were at risk
for obesity but not yet obese and analyzed 936 genes
previously associated with obesity [24]. The cross-
sectional study identified 17 CpG dinucleotides that
demonstrated an association between baseline differen-
tial child DNA methylation and maternal BMI (obese
versus non-obese). While this analysis was conducted on
baseline saliva samples, these children subsequently par-
ticipated in a three-year longitudinal study where more
than a third of children became obese. The current study
investigates to what extent baseline child salivary DNA
methylation patterns were associated with the emerging
incidence of childhood obesity in this 3-year prospective
cohort of young Hispanic children [25].
Methods
Informed consent
Trained, bilingual study staff administered written
consents to the parent or legal guardian of the child
of interest in the language of their choice (English or
Spanish). The parent or legal guardian provided con-
sent for both themselves and their child. Because this
87. was a low health literacy population, the consenting
process utilized specific measures to ensure partici-
pant understanding including a “teach-back” method
and protocol visual aids [26]. The study was approved
by Vanderbilt University Review Board (IRB No.
120643).
Sample population study subjects
We examined a subsample (n = 92) of Growing Right
Onto Wellness (GROW) trial participants [24]. They
were randomly selected at baseline, before
randomization, based on maternal phenotype. One
group of children had obese mothers (BMI ≥30 and
waist circumference ≥ 100 cm), and the other had non-
obese mothers (BMI < 30 and waist circumference < 100
cm). The two groups were matched on child age and
gender. The current study examines this subsample as a
prospective cohort, after a 3-year follow-up.
Child participant eligibility criteria in the original
GROW study included: 3–5 years old, no known medical
conditions, and being at risk for obesity (high normal
weight or overweight) but not yet obese (BMI ≥50th
and < 95th percentile). Three children were excluded
due to being obese at baseline. Parent eligibility criteria
included: ≥18 years old, signed written consent to par-
ticipate in a 3-year trial, consistent phone access, spoke
English or Spanish, and no known medical conditions
that would preclude routine physical activity. Families
were recruited from East Nashville and South Nashville.
All parents self-reported that at least one person in their
household was eligible to participate in a program that
qualified them as underserved. The underserved pro-
grams included but were not limited to TennCare (Me-
dicaid), Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC), CoverKids, Food
88. Stamps, and/or reduced-price school meals [25]. To be
eligible for analysis in the epigenetic study reported here,
child BMI must have been collected at the 36-month
follow-up (n = 75).
Rushing et al. BMC Medical Genetics (2020) 21:34 Page
2 of 9
Saliva collection and assay method
Baseline saliva samples from children were collected vol-
untarily from interested participants using a separate
consenting form in the participant’s language of choice.
Saliva was collected from children at baseline using the
Oragene DNA saliva kit. Children were asked to fast for
30 min and rinse their mouths with water immediately
before collection. Two mL of saliva was collected from
children using saliva sponges, inserted between the
cheek and gums in the upper cheek pouch without
swabbing the buccal mucosa. Samples were collected at
home or in community centers. To ensure safety and de-
crease contamination, trained sample collectors wore
gloves and capped the samples as soon as the saliva was
collected. After samples were properly collected and la-
beled, the samples were sent to the Vanderbilt Technol-
ogy for Advanced Genomics (VANTAGE) core at
Vanderbilt University. DNA was then extracted from the
saliva using the PrepIT L2P reagent with guidance from
DNA Genotek’s recommendations and stored at − 80
degrees Centigrade.
Anthropometric data
Objective height and weight for parent-child pairs were
collected and used to calculate BMI (kg/m2) at baseline
and 36 months. Trained research staff collected weight
89. and height of participants using standard anthropomet-
ric procedures, and participants wore only light clothing
and no shoes. Height was measured to the nearest 0.1
cm using a stadiometer (Perspective Enterprise, Portage,
MI), and weight was measured to the nearest 0.1 kg
using a calibrated scale. BMI measurements were col-
lected using the trial protocol [27]. BMI-Z was calcu-
lated based on each child’s BMI, gender, and age, and
BMI categories were defined using CDC guidelines: nor-
mal weight (<85th percentile); overweight (≥85th and <
95th percentile); and obese (≥95th percentile).
Statistical analysis
Categorical variables were summarized using frequencies
and percentages, and Pearson’s chi-squared test was
used to evaluate baseline differences. Continuous vari-
ables were summarized using means and standard devia-
tions, and the Wilcoxon rank-sum test was used to
evaluate baseline differences.
Genome-wide DNA methylation was conducted on
the 92 saliva samples using the Infinium Illumina
HumanMethylation 450 K BeadChip (Illumina, San
Diego, CA, USA). Methylation arrays were processed
using a standard protocol [24, 28] and quality control
was done using the Methylation module (V1.9.0). Sam-
ples with a call rate lower than 98% were excluded,
resulting in the removal of one sample (total baseline eli-
gible sample n = 91). The Background Subtraction
method [29] was used for methylation array
normalization. In this method, the average signals of
built-in negative controls represent background noise
and are subtracted from all probe signals to make unex-
pressed targets equal to zero. Outliers were removed
using the median absolute deviation method. Lastly, the
90. normalized values were log-transformed and multiplied
by 10 to put degree of methylation on a continuous scale
from 0 to 10 for statistical analysis.
Associations between child obesity at 36 months and
baseline methylation levels were evaluated using multi-
variable logistic regression models. Other variables were
included in the models as covariates, including child age,
child baseline BMI-Z, child gender, and parent baseline
BMI. Statistical significance was defined as p < 0.05. All
analyses were performed using R software (www.r-pro-
ject.org) version 3.5.0.
Results
Of the original 92 participants in the baseline subsample,
75 met quality control and eligibility requirements and
were included for analysis. The mean age was 4.3 years
(SD = 0.8), and the mean baseline BMI was 16.7 (SD =
0.8). Within the analytic sample, at baseline, 64.0% (n =
48) were normal weight, and 36.0% (n = 27) were over-
weight, and 73.3% (n = 55) were Hispanic-Mexican.
Among parents, 48.0% (n = 36) were obese (stratified by
design for this subsample). Refer to Table 1 for further
baseline demographic descriptions of the sample. At the
study’s conclusion, 37% (n = 28) of children were obese.
Comparing children who were non-obese at 36 months
(n = 47) to those who were obese at 36 months (n = 28),
there were no statistically significant differences in base-
line child characteristics, although, descriptively, baseline
weight-related characteristics appeared to be lower in
children who were not obese at follow-up. Parents did
not have any significantly different baseline characteris-
tics between the two groups, although mean age was de-
scriptively slightly younger in parents of children who
became obese at 36 months (33.0 vs. 30.4) (Table 2).
91. Table 3 describes the associations between children’s
continuous degree of baseline methylation at each CpG
dinucleotide and childhood obesity at 36 months for the
75 children with follow-up data. The multivariable logis-
tic regression model was adjusted for child gender, base-
line age, baseline BMI-Z, and adult baseline BMI. After
accounting for these covariates, higher baseline methyla-
tion of cg01307483 (NRF1) was significantly associated
with a higher probability of childhood obesity at 36
months (odds ratio = 2.98, 95% CI = [1.06, 8.38], p =
0.04). PPARGC1B methylation was potentially associated
with decreased obesity at 36 months but was not statisti-
cally significant. SORCS2 methylation was not statisti-
cally significant for cg03218460 or cg18431297 [30, 31].
Rushing et al. BMC Medical Genetics (2020) 21:34 Page
3 of 9
http://www.r-project.org
http://www.r-project.org
In the logistic regression model analyzing the NRF1 di-
nucleotide, child gender, child baseline age, and baseline
parent BMI, were not significant predictors of childhood
obesity at 36 months (Table 4). However, in this model,
child baseline BMI-Z and baseline differential methyla-
tion of NRF1 were significant predictors of childhood
obesity at 36 months. Figure 1 displays the model-
predicted probability of child obesity at 36-month
follow-up as a function of increasing NRF1 methylation.
Child baseline BMI-Z was a significant predictor in all
but two CpG dinucleotide models (odds ratio = 3.09–
4.08, p < 0.05). Median degree of baseline methylation at
each CpG dinucleotide examined in this study is shown
92. in Additional file 1: Table S1.
Discussion
To our knowledge, this is the first prospective cohort
study that investigates DNA methylation collected via
salivary samples as a predictor of childhood emerging
obesity among 3–5-year-old Hispanic children. Although
other studies have investigated DNA methylation pat-
terns in children who are already obese, our prospective
study investigated how these patterns might be used to
predict the future emergence of obesity in non-obese
preschool-aged children above and beyond what is pro-
vided by their age, gender, baseline BMI-Z, and their
mother’s BMI. After adjusting for these covariates, base-
line methylation of Cg1307483 (NRF1) was significantly
associated with emerging childhood obesity at 36-month
follow-up with a significant positive odds ratio (OR =
2.98, p = 0.04). To place this odds ratio finding into con-
text and enhance interpretation, the model estimated a
Table 1 Demographics of Sample Populationa
Child Characteristics Total (n = 75)
Gender
Male 35 (46.7%)
Female 40 (53.3%)
Age at anthropometry collection (years) 4.3 (0.8)
Age category (years)
3 34 (45.3%)
96. Overweight 8 (17.0%) 3 (10.7%)
Obese 21 (44.7%) 15 (53.6%)
Waist
circumference
(cm)
97.0 (16.2) 99.3 (16.1) 0.47
Abbreviations: BMI body mass index, BMI-Z BMI z-score
a Values are mean (SD) or frequency (percent)
b Wilcoxon rank-sum test used for continuous variables, and
Pearson’s chi-
squared used for categorical variables
Rushing et al. BMC Medical Genetics (2020) 21:34 Page
4 of 9
48% chance of child obesity at 36-month follow-up for a
child at the 75th percentile of NRF1 methylation versus
only a 30% chance of obesity for a similar child at the
25th percentile.
Consistent with other studies, a higher baseline child
BMI-Z during the preschool period was associated with
the emergence of obesity 3 years later, but baseline
methylation of NRF1 was associated with later obesity
even after adjusting for baseline BMI-Z. NRF1 is associ-
ated with the innate immune response governing adipo-
cyte inflammation and cytokine expression, as well as
brown adipose tissue thermogenic adaption. It also plays
a role in insulin resistance [34–36]. The current results
build on the existing literature by demonstrating that
97. DNA methylation of a critical CpG dinucleotide within
the NRF1 gene in 3–5-year-old non-obese children is
associated with the emergence of obesity 3 years later.
This provides a potential target of further investigation
and suggests that adipocyte inflammation might already
be affected before the phenotypic emergence of child-
hood obesity in Hispanic children. Other studies demon-
strate that early life exposures can affect later health and
disease outcomes. This life-course understanding of
emerging phenotypes might contribute to health
disparities.
It is important to note that prior studies implicated
NRF1 associated with existing obesity and young His-
panic children using blood and skeletal muscle samples
as well [36]. Comuzzie and colleagues investigated
chromosome 7q in Hispanic children and found unique
loci contributing to pediatric obesity [33]. As in our
study, the genes significantly associated with obesity
Table 3 Association of Baseline Methylationa at Each CpG
Dinucleotide With Child Obesity Status at 36-Month Follow-Up
Unique CpG
Dinucleotide
Associated
Gene
Odds
Ratio
95% CI p-
value
98. Biological Relevance
cg21790991 FSTL1 1.35 [0.88,
2.06]
0.16 Regulate endothelial cell function and vascular remodeling
in response to hypoxic ischemia
[30, 40]
cg03218460 SORCS2 2.08 [0.83,
5.21]
0.12 Functions to regulate fasting insulin levels and secretion of
insulin, diabetes susceptibility
[41, 42]
cg23241637 ZNF804A 1.47 [0.61,
3.49]
0.39 Schizophrenia [43, 44]
cg04798490 SHANK2 1.51 [0.6,
3.8]
0.38 Autism [45, 46]
cg01307483 NRF1 2.98 [1.06,
8.38]
0.04* Innate immune response governing adipocyte
inflammation, cytokine expression,
and insulin resistance [34–36]
cg19312314 CBS 0.75 [0.27,
2.13]
99. 0.59 Catalyzes the conversion of homocysteine to cystathionine,
associated with homocystinuria
and hydrogen sulfide production [47]
cg14321859 DLC1 1.82 [0.69,
4.81]
0.23 Regulates Rho GTP-binding proteins, cytoskeletal
signaling, tumor suppressor, adipocyte dif-
ferentiation [48, 49]
cg03067613 ATP8B3 1.24 [0.4,
3.8]
0.71 Reproduction [37]
cg11296553 CEP72 0.99 [0.03,
32.38]
0.99 Ulcerative colitis [38]
cg16509445 CRYL1 1.04 [0.23,
4.63]
0.96 Heptocellular carcinoma [50]
cg16344026 PPARGC1B 0.27 [0.04,
2.04]
0.21 Fat oxidation, non-oxidative glucose metabolism, and
energy regulation, ubiquitous in duo-
denum and small intestines [51, 52]
cg15354625 ODZ4 0.78 [0.12,
4.94]
100. 0.79 Bipolar disorder [53]
cg23836542 CHN2 1.13 [0.14,
9.07]
0.91 Encodes GTP-metabolizing protein that regulates cell
proliferation and migration, insulin re-
sistance [54, 55]
cg07511564 NXPH1 1.02 [0.34,
3.03]
0.97 Forms a tight complex with alpha neurexins, promoting
adhesion between dendrites and
axons, diabetic neuropathy [56, 57]
cg18799510 GRIN3A 1.02 [0.32,
3.28]
0.98 Schizophrenia [31, 58]
cg14996807 UNC13A 3.17 [0.64,
15.76]
0.16 ALS [59, 60]
cg18431297 SORCS2 1.01 [0.51,
1.99]
0.98 Neuropeptide receptor activity, strongly expressed in the
central nervous system, acts with
IGF1 in the setting of cardiovascular disease [42, 61]
a Degree of methylation was a continuous variable calculated by
log-transforming the normalized values and multiplying by 10
to put it on a scale from 0 to 10
101. (see Methods section)
Rushing et al. BMC Medical Genetics (2020) 21:34 Page
5 of 9
suggest a strong inflammatory influence. While our
study does not confirm this hypothesis, it does provide
supplemental data supporting this theory. Because NRF1
is a major transcription factor in metabolic regulation
and stimulates the expression of PPARGC1B, these look
like promising targets for further research and interven-
tion approaches. Although direct comparisons between
saliva and blood cannot be made in the current study,
the fact that we noted the same association in saliva as
found in blood and skeletal muscle further bolsters sup-
port for the use of saliva as a useful tissue for epigenetic
inquiry.
Other genes could also play an important role in both
predicting later obesity and understanding the pathways
that lead to obesity. For example, PPARGC1B methyla-
tion had a potentially strong association with decreased
obesity at 36 months but was not statistically significant.
PPARGC1B is associated with fat oxidation, non-
oxidative glucose metabolism, and energy regulation [37,
38]. Similarly, SORCS2 methylation, which functions to
regulate fasting insulin levels and secretion of insulin,
was potentially associated with increased obesity at 36
months but was not statistically significant in this rela-
tively small sample [31, 39]. Repeating this work in a lar-
ger sample is necessary for further understanding these
and other epigenetic contributions to the early emer-
gence of obesity in populations who experience higher
health disparities associated with obesity. Moreover,
102. while the small analytic sample size precluded moder-
ation analysis in the current study, it would be interest-
ing for future research to explore whether the potential
relationships between methylation and subsequent obes-
ity status depend on initial BMI status or other potential
moderators of interest (e.g., gender, ethnicity, income,
etc.).
To-date, many epigenetic studies have focused on the
exploration of molecular pathways. While it is not yet
known if these DNA methylation patterns can be used
as biomarkers, our study provides a proof-of-principle
demonstrating that even in non-obese Hispanic children,
Fig. 1 Model Predicted Probability of Child Obesity at 36-
month Follow-up as a Function of NRF1 Methylation. Figure 1
displays the logistic
regression model-predicted probability of child obesity at 36
months as a function of the degree of methylation of
cg01307483 (NRF1). The solid
line indicates the predicted probability, and the gray shaded
region represents the 95% confidence interval. As the degree of
methylation of
NRF1 increases, the probability of child obesity at 36 months
increases significantly
Table 4 Association of baseline differential DNA methylationa
with obesity at 36 months, adjusted for co-variates
Odds Ratio 95% CI P Value
Child
Baseline BMI-Z 3.25 [1.00, 10.50] 0.049
103. Baseline age 1.50 [0.76, 2.94] 0.24
Gender (male) 0.59 [0.21, 1.63] 0.31
Parent
Baseline BMI 0.99 [0.92, 1.07] 0.86
CpG Baseline Methylation
Cg10307483 (NRF1) 2.98 [1.06, 8.38] 0.04
a Degree of methylation was a continuous variable calculated by
log-
transforming the normalized values and multiplying by 10 to put
it on a scale
from 0 to 10 (see Methods section)
Rushing et al. BMC Medical Genetics (2020) 21:34 Page
6 of 9
some differential methylation patterns are associated
with the later emergence of obesity. While it is clear that
susceptibility to obesity within an “obesogenic” environ-
ment varies among individuals, it is not clear why. This
line of epigenetic inquiry using saliva as an accessible tis-
sue for pediatric study holds promise for guiding further
exploration in both understanding and intervening be-
fore the emergence of childhood obesity.
Although NFR1 was significantly related to child obes-
ity at 36-month follow-up, the relatively small sample
size analyzed in this study might have contributed to a
failure to detect important relationships for the other
CpG dinucleotides. Expanding the current analysis to in-
104. clude larger sample sizes would help to confirm and val-
idate the findings. While there was a strict collection
protocol for saliva collection, contamination and human
collection error are possible when collecting salivary
DNA. Although previous literature indicates DNA
methylation in saliva and blood samples are similar, the
current study only investigated methylation patterns in
saliva and cannot be used to make direct comparisons to
blood. Furthermore, although this sample yields insight
into Hispanic 3–5-year-olds, DNA methylation patterns
should be studied in children of various ages and race/
ethnicities.
Conclusions
Saliva offers a non-invasive means of DNA collection
and epigenetic analysis. This proof of principle study
provides empirical evidence supporting the idea that
DNA methylation assessed using salivary tissue collected
in non-obese children could be used as an important
predictor of childhood obesity 3 years later. NFR1 could
be a target for further exploration of obesity in Hispanic
children.
Supplementary information
Supplementary information accompanies this paper at
https://doi.org/10.
1186/s12881-020-0968-7.
Additional file 1: Table S1. CpG Dinucleotide Methylation.
Abbreviations
BMI: Body Mass Index; BMI-Z: Body Mass Index Z-score;
DNA: Deoxyribonucleic Acid; GROW: The Growing Right Onto
Wellness Trial;
NHANES: National Health and Nutrition Examination Survey;
VANTAGE: The
105. Vanderbilt Technologies for Advanced Genomics; WIC: The
Special
Supplemental Nutrition Program for Women, Infants, and
Children
Acknowledgements
We are grateful for the participation of the Hispanic families
involved in this
study.
Authors’ contributions
Conceived and designed experiment: SB, AR; Analyzed the
data: SZ, ES;
Wrote the paper: SB, AR, SZ, ES, EP. All authors edited and
proofed the
paper. All authors read and approved the final manuscript.
Funding
This research was supported by grants (U01 HL103620) with
additional
support for the remaining members of the COPTR Consortium
(U01HL103622, U01HL103561, U01HD068890, U01HL103629)
from the
National Heart, Lung, and Blood Institute and the Eunice
Kennedy Shriver
National Institute of Child Health and Development and the
Office of
Behavioral and Social Sciences Research. The content is solely
the
responsibility of the authors and does not necessarily represent
the official
views of the National Heart, Lung, And Blood Institute, the
National Institutes
of Health, or the National Institute of Child Health and
Development. This
research was also supported by grants 5P30DK092986–03 from
106. the National
Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK) and
5UL1TR0045 from the Vanderbilt Institute for Clinical and
Translational
Research (VICTR). The NHLBI and NICHD played an advisory
role in all phases
of the study, including the design and conduct of the study;
collection,
analysis, and interpretation of the data; and in writing the
manuscript.
Availability of data and materials
The genetic dataset supporting the conclusions of this article are
available in
NCBI’s Gene Expression Omnibus and are accessible through
GEO Series
access number GSE72556
(https://www.ncbi.nlm.nih.gov/geo/query/acc.
cgi?acc=GSE72556).
Ethics approval and consent to participate
Data were collected after written informed consent was obtained
by parent/
legal guardian. This study was approved by the Vanderbilt
University
Institutional Review Board (IRB No. 120643).
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1Louisiana State University Health Sciences Center, School of
107. Medicine, 1901
Perdido Street, New Orleans, LA 70112, USA. 2Department of
Pediatrics,
Vanderbilt University Medical Center, 2146 Belcourt Ave,
Nashville, TN
37232-9225, USA. 3Department of Biostatistics, Vanderbilt
University Medical
Center, 571 Preston Research Building, 2220 Pierce Ave,
Nashville, TN
37232-6838, USA. 4Department of Pediatrics, Vanderbilt
University Medical
Center, 2146 Belcourt Ave, Nashville, TN 37232-9225, USA.
5Department of
Pediatrics, Vanderbilt University School of Medicine, 2200
Children’s Way,
Doctor’s Office Tower 8232, Nashville, TN 37232-9225, USA.
Received: 5 March 2019 Accepted: 6 February 2020
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