Vesselka Duleva

Background: Obesity-related cardiometabolic disorders have been linked to alterations in selected gut microbiome components, yet clinically relevant microbial signatures remain incompletely defined. Objectives: This study investigated associations between selected gut bacterial taxa and cardiometabolic risk phenotypes in individuals with obesity. Methods: In this cross-sectional study, 100 adults with obesity were stratified according to metabolic syndrome status. Gut microbiome composition was assessed using targeted multiplex real-time PCR of functionally relevant bacterial taxa. Associations with anthropometric and cardiometabolic parameters were examined using correlation analysis, ROC curves, and multivariable logistic regression models. Results: Reduced relative abundance of Lachnospiraceae was associated with metabolic syndrome, lower Faecalibacterium abundance with arterial hypertension, and increased Prevotella abundance with dyslipidemia. ROC analyses identified cohort-specific discriminative thresholds with moderate accuracy. Conclusions: Selected taxon-specific gut microbiome signatures are associated with cardiometabolic risk phenotypes in obesity. These findings are exploratory and require validation in longitudinal and independent cohorts.

Excess sodium consumption leads to an increase in blood pressure and a greater risk of cardiovascular disease (CVD). The aim of this pilot study is to determine the significance of the genetic variant rs10177833 in the sodium bicarbonate co-transporter gene SLC4A5 and to assess the potential of this single nucleotide polymorphism as a molecular-genetic marker for salt sensitivity in the Bulgarian population. DNA from each volunteer was isolated using the ready-to-use Universal Genomic DNA Purification Kit and genotyped for rs10177833 (A>C) in the SLC4A5 gene by a single nucleotide polymorphism (SNP) genotyping assay. Urinary sodium concentration was determined by atomic absorption spectrometry. The results show that 97% of all volunteers were successfully genotyped and that urinary sodium excretion was determined. Fifty-one percent of the participants had the AA genotype, 37% were heterozygous, and 11% were carriers of two polymorphic C alleles. A statistically significant relationship was found between genotype, urinary sodium excretion, and increased blood pressure.

Background and objectives: Maintaining a balanced diet and regular exercise is especially important for first graders. Poor nutrition compromises the quality of life, school attainment, and growth and sets suboptimal dietary habits later in life. The aim of the present study is to assess negative dietary practices among first graders in Bulgaria. Methods: A cross-sectional survey of a nationally representative sample of 3051 7-year-old students was conducted in 2019. The research was carried out in strict compliance with the protocol developed by the WHO (World Health Organization) as part of the WHO European Childhood Obesity Surveillance Initiative (COSI). As part of the study, a questionnaire was presented to the families of the first graders to assess the frequency of food consumption by the children. Results: A quarter (25.3%) of the students did not consume breakfast on a daily basis. The majority did not eat fresh fruits (62.9%) and vegetables every day, excluding potatoes (66.3%). Furthermore, 18% of the children consumed dairy products less than once a week or never. Additionally, 14.8% had fruit juice every day. One-fifth (19.7%) of the students drank soft drinks most of the days or every day of the week (>4 days/week). Many children never consumed or consumed less than once a week protein-rich foods like meat (8.9%), fish (62.3%), eggs (26.4%), and legumes (25.9%). Most days or every day of the week (>4 days/week), a quarter (24.2%) of the children had salty snacks like chips, and half of them (49.7%) had sweet snacks like candies and cakes. Discussion: The results of the present study clearly demonstrate a suboptimal dietary model for first graders in Bulgaria. Only one-third of the children consumed fresh fruits and vegetables daily. The frequency of intake of soft drinks and salty and sweet snacks is too high. The frequency of consumption of protein-rich foods like fish, eggs, and legumes is suboptimal. First graders should become a special target group for policymakers in Bulgaria.

Summary: In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross‐sectional study describes urban–rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6–9 years from 19 countries participating in the fourth round (2015–2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food‐frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30–80% and 30–90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR‐range: 1.1–2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population‐based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.

Consuming a healthy diet in childhood helps to protect against malnutrition and noncommunicable diseases (NCDs). This cross-sectional study described the diets of 132,489 children aged six to nine years from 23 countries participating in round four (2015–2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children’s parents or caregivers were asked to complete a questionnaire that contained indicators of energy-balance-related behaviors (including diet). For each country, we calculated the percentage of children who consumed breakfast, fruit, vegetables, sweet snacks or soft drinks “every day”, “most days (four to six days per week)”, “some days (one to three days per week)”, or “never or less than once a week”. We reported these results stratified by country, sex, and region. On a daily basis, most children (78.5%) consumed breakfast, fewer than half (42.5%) consumed fruit, fewer than a quarter (22.6%) consumed fresh vegetables, and around one in ten consumed sweet snacks or soft drinks (10.3% and 9.4%, respectively); however, there were large between-country differences. This paper highlights an urgent need to create healthier food and drink environments, reinforce health systems to promote healthy diets, and continue to support child nutrition and obesity surveillance.

Background: One of the current public health problems in Bulgaria is the high prevalence of overweight and obesity in childhood. The family environment affects many aspects of children’s health and well-being. The unfavourable socio-economic characteristics of the family environment might be a risk for overweight and obesity in childhood. Methods: A national representative survey was conducted in Bulgaria in 2016 as part of the WHO European Childhood Obesity Surveillance Initiative (COSI). 3379 schoolchildren were recruited. The average age of the sample was 7.7 years, equally distributed by gender - girls 50.11% (n = 1693) and boys 49.89% (n = 1686). The data from the filled in Family form was analysed with SPSS using descriptive statistical methods. Results: The study identified the following risk factors of the family environment for the development of overweight in childhood: the proportion of parents with elementary or primary education was significant - about a quarter, nearly one third of the surveyed households were experiencing financial difficulties, 14.1% of the women and 11.6% of the men were unemployed in the last 1 year. There was a high incidence of co-morbidity among family members: hypertension - 27.7%, diabetes mellitus - 14.4% and hypercholesterolemia - 13.6%. Among the surveyed parents 28.4% of the women and 68% of the men were overweight. Only 13.5% of the parents estimated the weight status of their child as overweight (with objectively measured overweight among 29.2% of the recruited children). A significant proportion of the children were not breastfed (17.3%) or the duration of exclusive breastfeeding was not optimal for 67.8% of the exclusively breastfed children. Conclusions: Identifying family risk factors associated with overweight in childhood is important for the public health and provides opportunities to develop policies for improvement of the nutritional and health status of children. Key messages: To tackle the childhood obesity epidemic the family risk factors should be addressed. The awareness of the children and parents should be raised through targeted information materials and campaigns.

It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children (n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and weight status varied per group. In South Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated with higher risk of overweight/obesity when compared with the cluster ‘Physically active and healthy diet’. Few or no associations were observed in North Europe and West-Central Asia, respectively. These findings support the hypothesis that unfavorable weight status is associated with a particular combination of energy balance-related behavior patterns, but only in some groups of countries.

Both sleep duration and screen time have been suggested to affect children’s diet, although in different directions and presumably through different pathways. The present cross-sectional study aimed to simultaneously investigate the associations between sleep duration, screen time and food consumption frequencies in children. The analysis was based on 10 453 children aged 6–9 years from five European countries that participated in the World Health Organization European Childhood Obesity Surveillance Initiative. Logistic multilevel models were used to assess associations of parent-reported screen time as well as sleep duration (exposure variables) with consumption frequencies of 16 food items (outcome variables). All models were adjusted for age, sex, outdoor play time, maximum educational level of parents and sleep duration or screen time, depending on the exposure under investigation. One additional hour of screen time was associated with increased consumption frequencies of ‘soft drinks containing sugar’ (1.28 [1.19;1.39]; odds ratio and 99% confidence interval), ‘diet/light soft drinks’ (1.21 [1.14;1.29]), ‘flavoured milk’ (1.18 [1.08;1.28]), ‘candy bars or chocolate’ (1.31 [1.22;1.40]), ‘biscuits, cakes, doughnuts or pies’ (1.22 [1.14;1.30]), ‘potato chips (crisps), corn chips, popcorn or peanuts’ (1.32 [1.20;1.45]), ‘pizza, French fries (chips), hamburgers’(1.30 [1.18;1.43]) and with a reduced consumption frequency of ‘vegetables (excluding potatoes)’ (0.89 [0.83;0.95]) and ‘fresh fruits’ (0.91 [0.86;0.97]). Conversely, one additional hour of sleep duration was found to be associated with increased consumption frequencies of ‘fresh fruits’ (1.11 [1.04;1.18]) and ‘vegetables (excluding potatoes)’ (1.14 [1.07;1.23]). The results suggest a potential relation between high screen time exposure and increased consumption frequencies of foods high in fat, free sugar or salt whereas long sleep duration may favourably be related to children’s food choices. Both screen time and sleep duration are modifiable behaviours that may be tackled in childhood obesity prevention efforts.