Abstract Objective To evaluate the association between inflammatory markers and abdominal fat assessed by ultrasound in prepubertal children with and without excess weight. Methods A cross-sectional study involving 241 prepubertal children, 156 with obesity, 37 with overweight, and 48 with normal weight, aged five to ten years, who were followed at a research unit on Childhood Obesity from a teaching hospital belonging to a public health system. The concentration of interleukin-6, tumor necrosis factor-α and C-reactive protein were assessed and regression analyses, considering outcome variables such as abdominal wall and intra-abdominal fat thickness measured by ultrasound, were performed. Results The findings highlighted an association between abdominal fat and inflammatory markers, even in children at this young age group. Subcutaneous fat showed a stronger association with inflammatory biomarkers compared to intra-abdominal fat when performing logistic regression, with a positive association between tumor necrosis factor-α and abdominal wall thickness equal to or greater than the 75th percentile in adjusted logistic regression (OR: 18.12; CI 95 %: 1.57: 209.55). Conclusions Abdominal wall fat, in contrast to what is often observed in adults, appears to have a greater impact on chronic inflammation related to excessive weight in very young children. crosssectional cross sectional 24 15 obesity 3 overweight 4 years system interleukin6, interleukin6 interleukin 6, 6 interleukin-6 factorα factor α Creactive C reactive analyses intraabdominal intra performed group th OR (OR 18.12 1812 18 12 9 % 1.57 157 1 57 209.55. 20955 209.55 . 209 55 209.55) adults 2 interleukin- 18.1 181 1.5 5 2095 209.5 20 18. 1. 209.

ABSTRACT Introduction: Although the cause of childhood obesity is multifactorial, it is known that breastfeeding (BF) could be a protective element. Objective: To determine the association of obesity in children with the duration of BF, parental educational levels and types of employment and family formation in a group of children from Encarnación, Paraguay. Methodology: This was a longitudinal, retrospective and descriptive study with an analytical component carried out in 200 children of both sexes. Nutritional status was evaluated at 2, 4 and 6 years, duration of BF. Families were grouped according to parental education levels and types of employment (Group A: up to 6th grade of Elementary Education [EE] and informal economy work; Group B: up to 12th grade of EE and public/commercial employment; Group C: tertiary education and managerial employment positions or business ownership. A value of p <0.05 was considered significant. Results: 50% (n=100) were men, 96.5% (n=193) from urban areas, 70% (n=140) came from nuclear families, 73% (n=146) were families from group B. BF duration was ≤4 months 5.5% (n=11), up to 6 months 9% (n=18), 7 to 11 months 20.5% (n=41), continued BF (≥1 year) 63 .5%(n=127). 14.5%, 18% and 18.5% were obese at 2, 4 and 6 years respectively. There was greater obesity at 4 years with BF <6 months (42.9% vs 16.1% Chi2 p=0.02), but not at 2 or 6 years. No significant association of obesity with parental employment or educational level or with the presence of a partner (Chi2 p≥0.05). Conclusion: Breastfeeding duration of less than 6 months is associated with a higher frequency of obesity at 4 years of age.

RESUMEN Introducción: Aunque la causa de la obesidad infantil es multifactorial, se sabe que la lactancia materna (LM) podría ser un elemento protector. Objetivo: Determinar la asociación de obesidad en los niños con la duración de la LM, escolaridad y tipo de empleo de padres y conformación familiar en un grupo de niños de Encarnación-Paraguay. Metodología: estudio longitudinal, retrospectivo y descriptivo con componente analítico realizado con 200 niños de ambos sexos. Se evaluó estado nutricional a los 2, 4 y 6 años, duración de LM, agrupación familiar según nivel de escolaridad y tipo de empleo (Grupo A: hasta 6° grado de la Educación Escolar Básica (EEB) y trabajo informa; 2)Grupo B: hasta 3° de EEB y empleados públicos/comerciales; 3)Grupo C: educación terciaria y cargos jerárquicos o dueños de corporaciones.Se consideró valor de p<0,05 como significativo. Resultados: 50%(n=100) fueron varones, 96,5%(n=193) del área urbana, 70%(n=140) con familia nuclear, 73%(n=146) fueron familias del grupo B. Tuvo LM ≤4 meses el 5,5%(n=11), hasta 6 meses 9%(n=18), 7 a 11 meses el 20,5%(n=41), LM continuada (≥1 año) el 63,5%(n=127). Presentaron obesidad el 14,5%, 18% y 18,5% a los 2, 4 y 6 años respectivamente. Hubo mayor obesidad a los 4 años con LM <6 meses (42,9% vs 16,1% Chi2 p=0,02), no así a los 2 o 6 años. Sin asociación significativa de obesidad con tipo de empleo y escolaridad de los padres o con presencia de pareja (Chi2 p≥0,05). Conclusión: La duración de lactancia materna menor a 6 meses se asocia con mayor frecuencia de obesidad a los 4 años.

Abstract Introduction: Obesity is an ongoing pandemic that coincided with the COVID-19 pandemic, and it has been recognized as a significant risk factor for severe COVID-19 cases. This study aims to analyze the relationship between excess malnutrition and the severity of COVID-19 in minors through a systematic review. Methods: A systematic review was conducted following PRISMA guidelines. The search was carried out in PubMed/MEDLINE and SciELO databases using keywords, covering the period from 2020 to 2023. Studies of children and adolescents reporting age and nutritional status in English and Spanish were included. Studies with other pathologies, animal studies, pregnant women, and other reviews were excluded. The study was registered on the PROSPERO platform. Results: A total of 28 articles met the search criteria, of which 18 found a relationship between childhood obesity and increased severity, associated with longer hospital stays, mechanical ventilation requirements, and death. Additionally, out of 7 studies addressing Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C), 3 found a relationship between obesity and the risk of developing MIS-C. Conclusion: Obesity is a risk factor for severe COVID-19 and an increased risk of developing and worsening MIS-C in children and adolescents. Identifying high-risk groups for severe COVID-19 could help guide hospital admissions and SARS-CoV-2 vaccination strategies.

Resumen Introducción: La obesidad es una pandemia en curso que coincidió con la pandemia de la COVID-19, y ha sido reconocida como un factor de riesgo significativo en los casos graves de COVID-19. Este estudio tiene como objetivo analizar la relación entre la malnutrición por exceso y la severidad de la COVID-19 en menores de edad mediante una revisión sistemática. Métodos: Se realizó una revisión siguiendo las guías PRISMA. La búsqueda se llevó a cabo en las bases de datos PubMed/MEDLINE y SciELO, usando palabras clave, abarcando el periodo entre 2020 y 2023. Se incluyeron estudios de niños y adolescentes que reportaran edad y estado nutricional, y que estuvieran en inglés o español. Se excluyeron estudios con otras patologías, estudios en animales, embarazadas y otras revisiones. El estudio fue registrado en la plataforma PROSPERO. Resultados: Se incluyeron 28 artículos que cumplían con los criterios de búsqueda, de los cuales 18 encontraron una relación entre la obesidad infantil y una mayor gravedad de la COVID-19, asociada a hospitalizaciones más prolongadas, requerimiento de ventilación mecánica y fallecimientos. Además, de los 7 estudios que abordaron el Síndrome Inflamatorio Multisistémico en niños asociado a la COVID-19 (SIM-C), 3 mostraron una relación entre la obesidad y el riesgo de desarrollar SIM-C. Conclusión: La obesidad es un factor de riesgo para una COVID-19 severa y un mayor riesgo de desarrollo y gravedad del SIM-C en niños y adolescentes. Identificar los grupos de alto riesgo de COVID-19 grave podría ayudar a orientar la estrategia de hospitalización y vacunación contra el SARS-CoV-2.

Abstract This article aims to analyse the relationship between physical activity (PA) environment at schools, sex, age, and obesity in children, using a network approach. This is a cross-sectional study, with 1,200 children (8.1±1.0 years old) from eight public schools in the same municipality. Weight and height measurements were assessed to calculate the Body Mass Index (BMI) and classified as healthier weight or overweight. To assess the PA environment at school, a interview with the school´s manager was conducted. The association between the PA environment at school and obesity was tested using a Network Analysis performed on the Jasp software. Positive associations between BMI and Physical Education classes (0.847), physical education teacher (0.349), break duration (0.564), and indoor sports court (0.662) were observed. Negative associations were seen with sex (-0.212) age (-0.387), extracurricular PA (-0.492), and playground (-0.557). Additionally, the centrality indicators highlighted extracurricular PA (1.789) as the variables with the highest betweenness values, and BMI with the highest closeness (2.239) and strength (1.230) values. Extracurricular PA and the presence of playgrounds in school´s environment are associated with healthier weight in low-income children. (PA approach crosssectional cross sectional study 1200 1 200 1,20 8.1±1.0 8110 8 0 (8.1±1. old municipality (BMI overweight s conducted software 0.847, 0847 0.847 , 847 (0.847) 0.349, 0349 0.349 349 (0.349) 0.564, 0564 0.564 564 (0.564) 0.662 0662 662 (0.662 observed 0.212 0212 212 (-0.212 0.387, 0387 0.387 387 (-0.387) 0.492, 0492 0.492 492 (-0.492) 0.557. 0557 0.557 . 557 (-0.557) Additionally 1.789 1789 789 (1.789 values 2.239 2239 2 239 (2.239 1.230 1230 230 (1.230 lowincome low income 120 20 1,2 8.1±1. 811 (8.1±1 084 0.84 84 (0.847 034 0.34 34 (0.349 056 0.56 56 (0.564 0.66 066 66 (0.66 0.21 021 21 (-0.21 038 0.38 38 (-0.387 049 0.49 49 (-0.492 055 0.55 55 (-0.557 1.78 178 78 (1.78 2.23 223 23 (2.23 1.23 123 (1.23 12 1, 8.1±1 81 (8.1± 08 0.8 (0.84 03 0.3 3 (0.34 05 0.5 5 (0.56 0.6 06 6 (0.6 0.2 02 (-0.2 (-0.38 04 0.4 4 (-0.49 (-0.55 1.7 17 7 (1.7 2.2 22 (2.2 1.2 (1.2 8.1± (8.1 0. (0.8 (0.3 (0.5 (0. (-0. (-0.3 (-0.4 (-0.5 1. (1. 2. (2. 8.1 (8. (0 (-0 (1 (2 8. (8 ( (-

Resumo O objetivo deste artigo é analisar a relação entre ambiente de atividade física (AF) nas escolas, sexo, idade e obesidade em crianças, usando uma abordagem de rede. Trata-se de um estudo transversal com 1.200 crianças (8,1±1,0 anos) de oito escolas públicas do mesmo município. Peso e estatura foram avaliadas para cálculo do Índice de Massa Corporal (IMC) e classificadas como peso saudável ou sobrepeso. Para avaliar o ambiente de AF na escola, foi aplicado um questionário por meio de entrevista com o gestor da escola. A associação entre o ambiente de AF na escola e a obesidade foi testada por meio Análise de Redes realizada no software Jasp. Foram observadas associações positivas entre o IMC e as aulas de Educação Física (0,847), professor de educação física (0,349), duração do intervalo (0,564) e quadra poliesportiva (0,662). Associações negativas foram observadas com sexo (-0,212), idade (-0,387), AF extracurricular (-0,492) e playground (-0,557). Adicionalmente, os indicadores de centralidade destacaram a AF extracurricular (1,789) como a variável com o maior valor de intermediação, e o IMC com o maior valor de proximidade (2,239) e força (1,230). A AF extracurricular e a presença de playgrounds no ambiente escolar estão associadas a um peso mais saudável em crianças de baixa renda. (AF rede Tratase Trata se 1200 1 200 1.20 8,1±1,0 8110 8 0 (8,1±1, anos município (IMC sobrepeso Jasp 0,847, 0847 0,847 , 847 (0,847) 0,349, 0349 0,349 349 (0,349) 0,564 0564 564 (0,564 0,662. 0662 0,662 . 662 (0,662) 0,212, 0212 0,212 212 (-0,212) 0,387, 0387 0,387 387 (-0,387) 0,492 0492 492 (-0,492 0,557. 0557 0,557 557 (-0,557) Adicionalmente 1,789 1789 789 (1,789 intermediação 2,239 2239 2 239 (2,239 1,230. 1230 1,230 230 (1,230) renda 120 20 1.2 8,1±1, 811 (8,1±1 084 0,84 84 (0,847 034 0,34 34 (0,349 0,56 056 56 (0,56 066 0,66 66 (0,662 021 0,21 21 (-0,212 038 0,38 38 (-0,387 0,49 049 49 (-0,49 055 0,55 55 (-0,557 1,78 178 78 (1,78 2,23 223 23 (2,23 123 1,23 (1,230 12 1. 8,1±1 81 (8,1± 08 0,8 (0,84 03 0,3 3 (0,34 0,5 05 5 (0,5 06 0,6 6 (0,66 02 0,2 (-0,21 (-0,38 0,4 04 4 (-0,4 (-0,55 1,7 17 7 (1,7 2,2 22 (2,2 1,2 (1,23 8,1± (8,1 0, (0,8 (0,3 (0, (0,6 (-0,2 (-0,3 (-0, (-0,5 1, (1, 2, (2, (1,2 8,1 (8, (0 (-0 (1 (2 8, (8 ( (-

Resumen: México ocupa el primer lugar en obesidad infantil en el mundo, por lo que resulta importante identificar variables asociadas al consumo alimentario. El objetivo del presente trabajo fue establecer si la forma en que el consumo de alimentos se modifica en función de las normas sociales alimentarias y la publicidad alimentaria que recibe la población infantil escolar. Se diseñó un estudio multivariado predictivo utilizando sistemas de lógica difusa tipo dos de intervalo (IT2 FLS), y comparando su ajuste con modelos convencionales, como la regresión lineal múltiple (RLM). Se trabajó con las respuestas emitidas por 196 niños en un estudio previo y almacenadas en una base de datos, seleccionando solo las que correspondieron a las variables de interés para el estudio. Las normas sociales a evitar, el número de comidas y la compra de alimentos por la publicidad alimentaria permitieron predecir el consumo alimentario de los niños mediante IT2 FLS. En RLM las horas de comidas tuvo mayor capacidad predictiva que el número de comidas. El IT2 FLS proporcionó un mayor coeficiente de determinación (R2 = 0.649), que el de la RLM (R2 = 0.370). El consumo alimentario, al ser un fenómeno multicausal y complejo, puede ser mejor predicho al utilizar métodos de análisis que manejen de forma más flexible la incertidumbre, como lo hace la IT2 FLS.

Abstract: Mexico ranks first in childhood obesity in the world, so it is important to identify variables associated with food consumption. The objective of this work was to establish whether the way in which food consumption is modified depending on social food norms and food advertising received by school children. A predictive multivariate study was designed using interval type two fuzzy logic systems (IT2 FLS), and comparing its fit with conventional models, such as multiple linear regression (RLM). We worked with the responses issued by 196 children in a previous study and stored in a database, selecting only those that corresponded to the variables of interest for the study. The social norms to avoid, the number of meals and the purchase of food through food advertising made it possible to predict children’s food consumption through IT2 FLS. In RLM, mealtimes had a greater predictive capacity than the number of meals. The IT2 FLS provided a higher coefficient of determination (R2 = 0.649) than that of the RLM (R2 = 0.370). Food consumption, being a multicausal and complex phenomenon, can be better predicted by using analysis methods that manage uncertainty more flexibly, as the IT2 FLS does.

Resumo O objetivo deste artigo é analisar a relação entre ambiente de atividade física (AF) nas escolas, sexo, idade e obesidade em crianças, usando uma abordagem de rede. Trata-se de um estudo transversal com 1.200 crianças (8,1±1,0 anos) de oito escolas públicas do mesmo município. Peso e estatura foram avaliadas para cálculo do Índice de Massa Corporal (IMC) e classificadas como peso saudável ou sobrepeso. Para avaliar o ambiente de AF na escola, foi aplicado um questionário por meio de entrevista com o gestor da escola. A associação entre o ambiente de AF na escola e a obesidade foi testada por meio Análise de Redes realizada no software Jasp. Foram observadas associações positivas entre o IMC e as aulas de Educação Física (0,847), professor de educação física (0,349), duração do intervalo (0,564) e quadra poliesportiva (0,662). Associações negativas foram observadas com sexo (-0,212), idade (-0,387), AF extracurricular (-0,492) e playground (-0,557). Adicionalmente, os indicadores de centralidade destacaram a AF extracurricular (1,789) como a variável com o maior valor de intermediação, e o IMC com o maior valor de proximidade (2,239) e força (1,230). A AF extracurricular e a presença de playgrounds no ambiente escolar estão associadas a um peso mais saudável em crianças de baixa renda.

Abstract This article aims to analyse the relationship between physical activity (PA) environment at schools, sex, age, and obesity in children, using a network approach. This is a cross-sectional study, with 1,200 children (8.1±1.0 years old) from eight public schools in the same municipality. Weight and height measurements were assessed to calculate the Body Mass Index (BMI) and classified as healthier weight or overweight. To assess the PA environment at school, a interview with the school´s manager was conducted. The association between the PA environment at school and obesity was tested using a Network Analysis performed on the Jasp software. Positive associations between BMI and Physical Education classes (0.847), physical education teacher (0.349), break duration (0.564), and indoor sports court (0.662) were observed. Negative associations were seen with sex (-0.212) age (-0.387), extracurricular PA (-0.492), and playground (-0.557). Additionally, the centrality indicators highlighted extracurricular PA (1.789) as the variables with the highest betweenness values, and BMI with the highest closeness (2.239) and strength (1.230) values. Extracurricular PA and the presence of playgrounds in school´s environment are associated with healthier weight in low-income children.

Abstract Some reports from EsSalud (2020) indicated that certain habits linked to health had a negative impact on children between the ages of 6 and 12 during the covid-19 period. As such, this research aimed to investigate the state of the art and the promotion of healthy habits in primary schools in Peru. Not finding precedents, this inquiry focused on articles published between 2018 and 2022, on healthy habits in schoolchildren from 6 to 12 years of age at the primary level in Peru. Regarding the methodology; the research was descriptive with a qualitative approach; A bibliographic review was made on websites and databases such as; Sciencie, Scielo, Scopus del Perú and Renati, using search equations; with keywords and logical operators. Regarding the results, 54 articles were selected; 8 on physical activity, 32 on healthy eating, 10 on healthy hygiene habits and 4 on sleep quality. Finally, the investigation discovered that schoolchildren present deficiencies in their eating, hygienic, recreational and physical habits, this due to multiple factors such as; false beliefs, bad practices, lack of basic services; drinking water, personal hygiene items; toothpastes, soaps, and abuse of processed foods. The results collect valid proposals to improve the healthy habits of schoolchildren, and range from promoting physical exercise, offering healthy diets to monitoring the regulation of food products and advertisements.

Resumen Algunos informes de EsSalud (2020) indicaron que ciertos hábitos ligados a la salud impactaron negativamente en los niños de 6 a 12 años de edad durante el periodo del covid-19. Por eso, esta investigación tuvo como objetivo indagar sobre el estado de la cuestión y la promoción de hábitos saludables en los colegios de educación primaria en el Perú. Al no encontrarse antecedentes, esta indagación se centró en artículos publicados entre los años 2018 y 2022 sobre los hábitos saludables en los escolares de 6 a 12 años del nivel primario en el Perú. En cuanto a la metodología, la investigación fue descriptiva, con enfoque cualitativo. En concreto, se hizo una revisión bibliográfica en sitios web y bases de datos como Sciencie, Scielo, Scopus del Perú y Renati, para lo cual se usaron ecuaciones de búsqueda con palabras claves y operadores lógicos. En cuanto a los resultados, se seleccionaron 54 artículos: 8 de actividad física, 32 de alimentación saludable, 10 de hábitos de higiene saludable y 4 sobre la calidad del sueño. Finalmente, la investigación descubrió que los escolares presentan deficiencias en sus hábitos alimenticios, higiénicos, de esparcimiento y físicos debido a múltiples factores, como falsas creencias, malas prácticas, carencia de servicios básicos, agua potable, artículos de aseo personal, dentífricos, jabones y abuso de alimentos procesados. Los datos recogen propuestas válidas para mejorar los hábitos saludables de los escolares, los cuales van desde promover el ejercicio físico y ofrecer dietas saludables hasta monitorear la regulación de productos y propagandas alimenticias.

Resumo Alguns relatórios de EsSalud (2020) indicaram que certos hábitos ligados à saúde tiveram um impacto negativo em crianças entre 6 e 12 anos durante o período de covid-19. Assim, esta pesquisa teve como objetivo investigar o estado da arte e a promoção de hábitos saudáveis nas escolas primárias do Peru. Como não foram encontrados precedentes, esta pesquisa se concentrou em artigos publicados entre 2018 e 2022, sobre hábitos saudáveis em escolares de 6 a 12 anos de idade no nível primário no Peru. Em relação à metodologia; a pesquisa foi descritiva com abordagem qualitativa; Foi feita uma revisão bibliográfica em sites e bases de dados como; Sciencie, Scielo, Scopus del Perú e Renati, usando equações de busca; com palavras-chave e operadores lógicos. Quanto aos resultados, foram selecionados 54 artigos; 8 em atividade física, 32 em alimentação saudável, 10 em hábitos saudáveis de higiene e 4 em qualidade do sono. Por fim, a investigação descobriu que os escolares apresentam deficiências em seus hábitos alimentares, higiênicos, recreativos e físicos, devido a múltiplos fatores como; falsas crenças, más práticas, falta de serviços básicos; água potável, artigos de higiene pessoal; cremes dentais, sabonetes e abuso de alimentos processados. Os resultados coletam propostas válidas para melhorar os hábitos saudáveis dos escolares, e vão desde a promoção de exercícios físicos, oferta de alimentação saudável até o monitoramento da regulamentação de produtos alimentícios e propagandas.

Abstract Objectives: This paper aims to review data on the association of obesity and iron deficiency in children and adolescents, exposing the possible involvement of hepcidin and interleukin-6 (IL-6), obesity’s inflammation biomarkers. Data source: Articles from PUBMED and WEB OF SCIENCE database with no chronological limit were reviewed to write this systematic review. Keywords such as children, obesity, iron deficiency, and hepcidin were used. After deleting duplicated and review articles, 91 were screened, and 39 were selected as eligible. Sixteen articles were included because they involved serum hepcidin levels in obese children and adolescents as outcomes. Summary of findings: Finally, those 16 articles were organized in two tables: one includes therapeutic interventions, and the other does not. As hepcidin was discovered in 2000, the first articles that presented serum hepcidin’s quantification in obese children and adolescents, homeostasis iron markers, and their possible association with obesity’s inflammatory environment began to be published in 2008. Conclusions: Obesity’s chronic inflammation state leads to the production of IL-6, which acts as a signaling molecule for hepcidin synthesis, resulting in iron deficiency, which is common in obese children and adolescents who respond inadequately to iron supplementation. On the other hand, that population responds adequately to therapeutic intervention programs that lead to weight loss, guaranteeing iron homeostasis improvement. Therefore, perhaps it is time to discuss serum hepcidin level quantification as part of evaluating children and adolescents with iron deficiency, which could guide clinical choices that might lead to better therapeutic outcomes. Objectives interleukin6 interleukin 6 interleukin- IL6, IL6 IL , (IL-6) obesitys s biomarkers source used 9 screened 3 eligible outcomes findings Finally 1 tables interventions not 2000 hepcidins markers 2008 Conclusions Obesitys Obesity 6, IL-6 synthesis supplementation hand loss improvement Therefore (IL-6 200 IL- (IL- 20 (IL 2

Abstract Objective To investigate the relationship between the biopsychosocial environment and eating habits and behaviors that lead to the selection and consumption of certain food from the earliest stages of life. To clarify whether there is an interaction between genetic and epigenetic factors, and how they shape eating habits. Data source A narrative review based on research in PubMed and Web of Science electronic databases was carried out over the last 10 years, searching the title and summary fields using the keywords Children OR adolescents Feeding Behavior eating OR Dietary Habits OR Eating Behavior OR Eating Habits OR Children obesity. Data synthesis The generational transmission of eating habits is related to the home, community, and school environments, mainly during the first years of life, and can exert the modulation of habits during all stages of life. During childhood, the family's role in consolidating eating habits is very broad and ranges from choosing foods to prioritizing family meals, including the lifestyle. Conclusions Eating habits are transmitted from parents to children in different ways: environmental, emotional, social, and educational. In cases of obesity, a greater association of genetic influence can be observed. life factors 1 obesity home community environments childhood familys s meals lifestyle ways environmental emotional social educational observed

Abstract Objective To present the different aspects that may be involved in the genesis and maintenance of obesity in children and adolescents. Data source Narrative review of articles published in the PubMed, Scielo, Lilacs, Scopus and Google Scholar databases, using the search terms: overweight, obesity, pre-conception, prenatal, infants, schoolchildren, children, and adolescents. The search was conducted in studies written in Portuguese, English and Spanish, including narrative, integrative or systematic reviews, meta-analyses, cross-sectional, case-control and cohort studies, published between 2003 and 2023. Data synthesis A total of 598 studies were initially screened and 60 of them, which showed the main biopsychosocial aspects related to greater risks of excessive adiposity in the pediatric age, were included in the review. The data were presented taking into account the incidence of risk factors and their consequences in six periods: pre-conception, pre-natal, infant, preschool, school age, and adolescence. Conclusions The causal factors described in the scientific literature that have been shown to be related to obesity in childhood and adolescence are presented. adolescents PubMed Scielo Lilacs databases terms overweight preconception, preconception pre conception, conception pre-conception prenatal infants schoolchildren Portuguese Spanish narrative reviews metaanalyses, metaanalyses meta analyses, analyses meta-analyses crosssectional, crosssectional cross sectional, sectional cross-sectional casecontrol case control 200 2023 59 6 them age periods natal, natal pre-natal infant preschool 20 202 5 2

Abstract Objectives To present observational studies investigating associations between the consumption of ultra-processed foods and health outcomes in childhood and adolescence. Data source Observational, cross-sectional, or longitudinal studies were considered, and identified in the Scopus, Web of Science, Pubmed and Scielo databases, without date restrictions. Data synthesis The most frequent combinations of risk factors in children and adolescents involved an unhealthy diet, with regular consumption of ultra-processed foods to the detriment of a diet based on fresh or minimally-processed foods and insufficient levels of physical activity; records on alcohol and tobacco use were identified. Combined, these practices contribute to the findings that indicate an increase in the prevalence of obesity in children and adolescents and a sedentary lifestyle, with a decrease in physical activity, in addition to representing a risk for the development of chronic non-communicable diseases, such as cardiovascular diseases and periodontal disease in childhood and adolescence. Conclusions The present study maps the current literature on the topic and indicates the direction of the approach for health promotion and prevention of NCDs in children and adolescents. Among the different risk factors that negatively affect the full development of this population, frequently eating breakfast and practicing physical activity is most strongly associated with a lower consumption of ultra-processed foods and should be part of an integrated approach to promoting eating practices that favor the reduction of diseases also in adult life. ultraprocessed ultra processed adolescence Observational crosssectional, crosssectional cross sectional, sectional cross-sectional considered Scopus Science databases restrictions minimallyprocessed minimally Combined lifestyle noncommunicable non communicable population life

ABSTRACT. Obesity is a problem with increasing affection in societies such as Spain, where projections point to the existence of 26 million people affected by the year 2030. This research analyzes the degree of specialization that the Spanish on line media show when addressing this problem in your information. To do this, we have resorted, on the one hand, to content analysis and, on the other, to the theory of agenda setting. The news published by the on line editions ofABC,El País,La VanguardiaandEl Mundo, as well as byEl ConfidencialandEl Diarioin which some mention is made (n=2.760) have been analyzed as well as those in which it is addressed as the main theme. The results show a growing appearance of the subject in the Spanish media. However, on most occasions when they mention it, they do not do so to address it as the health problem it represents, which would entail the regular inclusion of these news in specific sections directly linked to health or science. On the contrary, information in which some allusion is made to obesity is included in very different sections. At the same time, and in connection with the previous conclusion, there are few journalistic pieces that address childhood obesity, to which the WHO has paid special attention. Hence it can be concluded that the media address obesity with little journalistic specialization.

RESUMEN. La obesidad es un problema con cada vez mayor incidencia en sociedades como la española, donde las proyecciones apuntan a la existencia de 26 millones de personas afectadas para el año 2030. Esta investigación analiza el grado de especialización que los cibermedios españoles muestran cuando abordan este problema en sus informaciones. Para ello se ha acudido, por un lado, al análisis de contenido y, por otro, a la teoría de laagenda setting. Se han analizado las noticias publicadas porABC,El País,La VanguardiayEl Mundo en su edición electrónica, así como por El Confidencia.comyEl Diario.esen las que se le hace alguna mención (n=2,760) y en las que es abordada como tema principal. Los resultados muestran una creciente aparición de la temática en los medios de comunicación españoles. Sin embargo, en la mayoría de las ocasiones en las que la mencionan no lo hacen para abordarla como el problema de salud que representa, lo que conllevaría la inclusión habitual de estas noticias en secciones específicas vinculadas directamente con la salud o la ciencia. Por el contrario, las informaciones en las que se hace alguna alusión a la obesidad son incluidas en muy diversas secciones. Al mismo tiempo, y en conexión con la conclusión anterior, son escasas las piezas periodísticas donde se aborda la obesidad infantil, ante la que la OMS ha puesto especial atención. De ahí se puede concluir que los medios abordan la obesidad con una escasa especialización periodística.

RESUMO. A obesidade é um problema com afecção crescente em sociedades como a espanhola, onde as projeções apontam para a existência de 26 milhões de pessoas afetadas até o ano 2030. Esta pesquisa analisa o grau de especialização que a cibermídia espanhola mostra ao abordar esse problema em sua informação. Para isso, recorremos, por um lado, à análise de conteúdo e, por outro, à teoria do agendamento. Foram analisadas as notícias publicadas porABC,El País,La VanguardiaeEl Mundo em suas edições online, bem como El Confidencial.comeEl Diario.esnas quais é feita alguma menção (n=2.760), bem como aquelas em que é abordada como tema principal. Os resultados mostram uma crescente presença do tema na mídia espanhola. No entanto, na maioria das vezes, quando o mencionam, não o fazem para abordá-lo como o problema de saúde que representa. Pelo contrário, a informação em que é feita alguma menção à obesidade está incluída em muitas secções diferentes. Ao mesmo tempo, e em ligação com a conclusão anterior, são poucas as peças jornalísticas que abordam a obesidade infantil, às quais a OMS tem dado especial atenção. Assim, pode-se concluir que a mídia aborda a obesidade com pouca especialização jornalística.

Resumo Os índices de sobrepeso e de obesidade infantil crescem de forma alarmante na Espanha, afetando mais fortemente as famílias pobres face a ingestão de artigos de alto valor calórico e baixo valor nutricional. A pandemia do Covid-19 agravou este cenário. Assegurar o acesso universal e gratuito à alimentação escolar vem sendo apontado como estratégia para o enfrentamento desta questão, bem como para combater a fome e a desigualdade social. A pesquisa que ensejou a elaboração deste artigo desenvolveu-se em Espanha entre 2019-2020. Explora os paradoxos e desafios que envolvem a alimentação escolar neste país europeu e os impasses relativos à criação de programas de tipo “home-grown school feeding”. A pesquisa em tela se situa no âmbito da sociologia da alimentação. Dentre as conclusões, mostra que a pobreza, fome e insegurança alimentar não são aspectos conjunturais, mas problemas de natureza estrutural, cujo enfrentamento requer um marco político e institucional consistente. nutricional Covid19 Covid 19 Covid-1 cenário questão social desenvolveuse desenvolveu 20192020. 20192020 2019 2020. 2020 2019-2020 homegrown home grown feeding. feeding . feeding” conclusões pobreza conjunturais estrutural consistente Covid1 1 Covid- 2019202 201 202 2019-202 201920 20 2019-20 20192 2 2019-2 2019-

Abstract Childhood overweight and obesity rates are growing at an alarming rate in Spain, affecting poor families more strongly as they consume high-calorie, low-nutritional items. The Covid-19 pandemic has exacerbated this scenario. Ensuring universal and free access to school meals has been suggested as a strategy for tackling this issue, as well as fighting hunger and social inequality. The research that led to the elaboration of this article was carried out in Spain between 2019-2020. It explores the paradoxes and challenges that surround school feeding in this European country and the impasses related to the creation of “home-grown school feeding” type programs. The research on screen is located within the scope of the sociology of food. Among the conclusions, it shows that poverty, hunger and food insecurity are not conjunctural aspects, but problems of a structural nature, the confrontation of which requires a consistent political and institutional framework. highcalorie, highcalorie high calorie, calorie high-calorie lownutritional low nutritional items Covid19 Covid 19 Covid-1 scenario issue inequality 20192020. 20192020 2019 2020. 2020 2019-2020 homegrown home grown programs conclusions poverty aspects nature framework Covid1 1 Covid- 2019202 201 202 2019-202 201920 20 2019-20 20192 2 2019-2 2019-

Abstract Longitudinal study, whose objective was to present a better strategy and statistical methods, and demonstrate its use with the data across the 2013-2015 period in schoolchildren aged 7 to 11 years, covered with the same food questionnaire (WebCAAFE) survey in Florianopolis, southern Brazil. Six meals/snacks and 32 foods/beverages yielded 192 possible combinations denominated meal/snack-Specific Food/beverage item (MSFIs). LASSO algorithm (LASSO-logistic regression) was used to determine the MSFIs predictive of overweight/obesity, and then binary (logistic) regression was used to further analyze a subset of these variables. Late breakfast, lunch and dinner were all associated with increased overweight/obesity risk, as was an anticipated lunch. Time-of-day or meal-tagged food/beverage intake result in large number of variables whose predictive patterns regarding weight status can be analyzed by machine learning such as LASSO, which in turn may identify the patterns not amenable to other popular statistical methods such as binary logistic regression. study 20132015 2013 2015 2013-201 1 years WebCAAFE (WebCAAFE Florianopolis Brazil mealssnacks meals snacks 3 foodsbeverages foods beverages 19 meal/snackSpecific mealsnackSpecific meal/snack Specific meal snack Foodbeverage Food beverage MSFIs. . (MSFIs) LASSOlogistic overweightobesity overweight obesity (logistic breakfast risk Timeofday Time day mealtagged tagged foodbeverage 2013201 201 2013-20 snackSpecific mealsnack (MSFIs 201320 20 2013-2 20132 2 2013-

Resumo Estudo longitudinal cujo objetivo foi apresentar melhores estratégia e métodos estatísticos e demonstrar sua utilização com os dados do período 2013-2015 em escolares de 7 a 11 anos, contemplados com o mesmo questionário alimentar (WebCAAFE) em Florianópolis, Sul do Brasil. Seis refeições/lanches e 32 alimentos/bebidas resultaram em 192 combinações possíveis denominadas item refeição/lanche-alimentos/bebidas específicos (MSFIs). O algoritmo LASSO (LASSO-regressão logística) foi usado para determinar os MSFIs preditivos de sobrepeso/obesidade e, em seguida, a regressão binária (logística) foi usada para analisar um subconjunto dessas variáveis. Café da manhã, almoço e jantar tardios foram todos associados ao aumento do risco de sobrepeso/obesidade, assim como um almoço antecipado. O consumo de alimentos/bebidas marcados na hora do dia ou na refeição resulta em um grande número de variáveis cujos padrões preditivos em relação ao status do peso podem ser analisados por LASSO. Essa análise pode identificar os padrões não passíveis de outros métodos estatísticos populares, como a regressão logística binária. 20132015 2013 2015 2013-201 1 anos WebCAAFE (WebCAAFE Florianópolis Brasil refeiçõeslanches refeições lanches 3 alimentosbebidas alimentos bebidas 19 refeição/lanchealimentos/bebidas refeiçãolanchealimentosbebidas refeição/lanche lanche MSFIs. . (MSFIs) LASSOregressão sobrepesoobesidade sobrepeso obesidade seguida (logística manhã antecipado populares 2013201 201 2013-20 lanchealimentos refeiçãolanche (MSFIs 201320 20 2013-2 20132 2 2013-

Abstract Objectives: to estimate the role of maternal overweight and obesity before pregnancy as predictors of childhood asthma in a population of Peruvian children under five years. Methods: we carried out a retrospective cohort study of children aged five years or less and their mothers from the Regional Hospital of Ayacucho and the María Auxiliadora Hospital in Lima, Peru. We included children who were born between 2013 and 2014 and follow them up until 2018 and 2019, respectively. The diagnosis of overweight and obesity of the mother before pregnancy and asthma in the child were registered in their clinical histories. Crude (cRR) and adjusted relative risks (aRR) and 95% confidence intervals (CI95%) were obtained using a generalized lineal model of the Poisson family with link log and robust variances. Results: we evaluated 431 medical records and found that 20.9% of the children had asthma, 26.7% of the mothers were overweight, and 20.2% were obese before pregnancy. In the adjusted regression model, overweight (aRR=2.94; CI95%= 1.54-5.60) and maternal obesity (aRR=5.10; CI95%= 2.73-9.51) were predictors of an increased risk of childhood asthma. Conclusions: maternal overweight and maternal obesity increased the risk of her children developing asthma threeand five-fold, respectively. Objectives Methods Lima Peru 201 2019 respectively histories cRR (cRR aRR (aRR 95 CI95% CI95 CI (CI95% variances Results 43 209 20 9 20.9 267 26 7 26.7 202 2 20.2 aRR=2.94 aRR294 94 (aRR=2.94 1.545.60 154560 1.54 5.60 1 54 5 60 1.54-5.60 aRR=5.10 aRR510 10 (aRR=5.10 2.739.51 273951 2.73 9.51 73 51 2.73-9.51 Conclusions fivefold, fivefold fold, fold five-fold CI9 (CI95 4 20. 26. aRR=2.9 aRR29 (aRR=2.9 545 1.545.6 15456 154 1.5 560 5.6 6 1.54-5.6 aRR=5.1 aRR51 (aRR=5.1 739 2.739.5 27395 273 2.7 951 9.5 2.73-9.5 (CI9 aRR=2. aRR2 (aRR=2. 1.545. 1545 15 1. 56 5. 1.54-5. aRR=5. aRR5 (aRR=5. 2.739. 2739 27 2. 9. 2.73-9. (CI aRR=2 (aRR=2 1.545 1.54-5 aRR=5 (aRR=5 2.739 2.73-9 aRR= (aRR= 1.54- 2.73-

Resumen Objetivos: estimar el papel del sobrepeso y la obesidad materna antes del embarazo como predictores de asma infantil en una población de niños peruanos menores de cinco años. Métodos: realizamos un estudio de cohorte retrospectivo de niños de cinco años o menos y sus madres del Hospital Regional de Ayacucho y del Hospital María Auxiliadora de Lima, Perú. Se incluyeron niños nacidos entre 2013 y 2014 y se les dio seguimiento hasta 2018 y 2019, respectivamente. El diagnóstico de sobrepeso y obesidad de la madre antes del embarazo y asma en el niño fueron registrados en sus historias clínicas. Los riesgos relativos crudos (cRR) y ajustados (RRa) y los intervalos de confianza del 95% (IC95%) se obtuvieron mediante un modelo lineal generalizado de la familia de Poisson con log de enlace y varianzas robustas. Resultados: se evaluaron 431 historias clínicas y se encontró que el 20,9% de los niños tenían asma, el 26,7% de las madres tenían sobrepeso y el 20,2% eran obesas antes del embarazo. En el modelo de regresión ajustada, el sobrepeso (aRR=2,94; IC95%= 1,54-5,60) y obesidad materna (RRa=5,10; IC95%= 2,73-9,51) fueron predictores de un mayor riesgo de asma infantil. Conclusiones: el sobrepeso materno y la obesidad materna aumentaron tres y cinco veces el riesgo de que sus hijos desarrollaran asma, respectivamente. Objetivos Métodos Lima Perú 201 2019 respectivamente cRR (cRR RRa (RRa 95 IC95% IC95 IC (IC95% robustas Resultados 43 209 20 9 20,9 267 26 7 26,7 202 2 20,2 ajustada aRR=2,94 aRR294 aRR 94 (aRR=2,94 1,545,60 154560 1,54 5,60 1 54 5 60 1,54-5,60 RRa=5,10 RRa510 10 (RRa=5,10 2,739,51 273951 2,73 9,51 73 51 2,73-9,51 Conclusiones IC9 (IC95 4 20, 26, aRR=2,9 aRR29 (aRR=2,9 545 1,545,6 15456 154 1,5 560 5,6 6 1,54-5,6 RRa=5,1 RRa51 (RRa=5,1 739 2,739,5 27395 273 2,7 951 9,5 2,73-9,5 (IC9 aRR=2, aRR2 (aRR=2, 1,545, 1545 15 1, 56 5, 1,54-5, RRa=5, RRa5 (RRa=5, 2,739, 2739 27 2, 9, 2,73-9, (IC aRR=2 (aRR=2 1,545 1,54-5 RRa=5 (RRa=5 2,739 2,73-9 aRR= (aRR= 1,54- RRa= (RRa= 2,73- (aRR