Heli Viljakainen

Background: Although obesity and mental health problems represent two of the most pressing public health challenges, their developmental interplay remains insufficiently understood. Thus, we examined how depressive and anxiety symptoms, self-esteem, and psychological resilience are associated with weight development during adolescence. Methods: We included 1280 11-year-old children from the Finnish Health in Teens cohort, following 814 of them for 4.3 years. Mental health was assessed with validated self-administered scales at age 11. Psychological resilience was determined by complete mental health after exposure to stressful life events. Body mass index z -score (BMIz) and waist-to-height ratio (WtHr) were calculated at ages 11 and 16. Results: In models adjusted for sex, age, physical activity, dietary pattern, puberty status, caregivers’ BMI and education level, depressive symptoms were associated with higher baseline BMIz but smaller increases in mean BMIz thereafter ( p = 0.030). High self-esteem was associated with lower baseline BMIz, yet with steeper increases over follow-up (adjusted model, p = 0.021). Anxiety symptoms and resilience were not associated with BMIz after adjustments. Similar patterns were observed for WtHr. Conclusion: Findings highlight that mental health is associated with physical growth in adolescence, emphasizing the need to consider mental health in understanding and addressing patterns of weight development and their underlying dynamics. Impact: This study provides up-to-date, longitudinal evidence on how mental health shapes subsequent weight development during the critical and rapid growth period of adolescence. Both positive and negative dimensions of mental health play a role in shaping adolescent weight development, with evidence that some youths experiencing mental health difficulties exhibited smaller increases in BMI z -score, even when starting from a higher baseline BMI. It should be acknowledged that in contemporary society, adolescents with mental health difficulties may not necessarily present immediate excessive weight gain but instead follow stable or even declining weight trajectories.

Inadequate physical activity (PA) and increased sedentary time are key drivers of cardiometabolic disorders related to being overweight, and metabolomics offers a promising novel approach to study their associations. The aim of this systematic review was to assess the evidence on metabolites associated with PA and/or sedentary time among children and adolescents in different weight groups, integrating both intervention and observational studies to provide a comprehensive and broad synthesis of existing evidence. Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines, three databases (PubMed, Web of Science, and Scopus) were systematically searched for studies published from inception to December 2023 conducted in children and adolescents aged ≤ 18 years including metabolomics analyses focusing on PA, sedentary time, or cardiorespiratory fitness. Fifteen studies were included, and half of the studies were conducted in overweight individuals. Notable PA‐induced or PA‐associated alterations were seen in lipid, branched‐chain amino acid and ammonia metabolism, and the citric acid and glucose‐alanine cycles. The directions of the alterations seemed consistent across children and adolescents with normal body weight and overweight, but not in trained peers. Several metabolites and metabolite groups were identified as markers of higher PA and better cardiorespiratory fitness, reflecting favorable metabolic states in children and adolescents. However, there is still a great need for more in‐depth metabolomics studies using state‐of‐the‐art techniques in the fields of pediatric exercise science and public health. Training status, exercise modalities, and pubertal development are important covariates to consider in future studies.

Introduction: Overeating – eating beyond nutritional needs or consuming large amounts quickly – is linked to weight gain. We studied whether self-reported (SR) or parent-reported (PR) overeating in children is cross-sectionally associated with differences in meal patterns and food consumption and longitudinally predicts changes in body mass index z score (BMIz) during adolescence. Methods: This study included 5,827 children (mean age 11.2 years) from the Finnish Health in Teens cohort. At baseline, parents reported their child’s tendency to overeat, while children self-reported overeating, specific dietary factors, and physical activity. BMIz were calculated at baseline and after 2.7 years. Longitudinal associations were analysed using general linear models with backward stepwise model selection to identify the minimal adequate model. Results: The prevalence of SR overeating was 4.2%, PR overeating 9.3%, and their combination 0.8%. Irregular meal patterns and frequent unstructured snacking were more common among children with SR or both SR and PR overeating, and they consumed sugary products and fast food more frequently than children with only PR overeating or no overeating. Compared with children without overeating, the BMIz increase was 0.28 (95% CI 0.10–0.46) units higher for both SR and PR overeating, 0.15 (95% CI 0.07–0.23) units higher for SR overeating, and 0.08 (95% CI 0.03–0.14) units higher for PR overeating. The model was adjusted for sex, age, physical activity, and BMIz at baseline. Since meal patterns and food consumption were excluded during the modelling, they did not predict BMIz change. Conclusion: SR overeating was a stronger predictor of BMIz increase than PR overeating, while having both was the most predictive. Interventions should focus on addressing overeating to aid in weight management during adolescence.

Introduction: Salivary matrix metalloproteinase-8 (MMP-8) concentration is considered a biomarker of oral health in adults, but studies in pediatric populations, especially with longitudinal data, are scarce. Methods: We examined the associations of caries experience (DFT index) and gingivitis/calculus (CPITN) retrieved from public dental records with repeated salivary MMP-8 concentrations. Salivary MMP-8 were measured from 403 Finnish adolescents (50.1% girls) at the mean (SD) age of 11.4 (0.4) and 13.8 (0.5) years, using an ELISA kit. Oral health was determined on average 42 (27) days after saliva collection at baseline. The DFT index was categorized into no caries experience (DFT = 0) and having caries experience (DFT >0), and CPITN into no gingivitis/calculus (CPITN = 0) or having gingivitis/calculus (CPITN >0). Results: Of the participants, 19.1% presented with caries experience, and 69.5% had gingivitis/calculus. The mean MMP-8 increased during follow-up by 0.125 ng/mL (95% CI: 0.05; 0.20, p = 0.006). MMP-8 at the two time points correlated weakly in all participants (r = 0.137, p = 0.006), especially in girls (r = 0.204, p = 0.004). The change in MMP-8 was not associated with caries experience or gingivitis/calculus in all participants or in gender-specific analyses (repeated measures ANOVA p > 0.05). Puberty status and medication use were not related to MMP-8 concentration. Conclusions: Oral health indices retrieved from public health records were not associated with changes in MMP-8 concentrations in early adolescents over a 2-year follow-up. Salivary MMP-8 may not be a suitable biomarker of oral health in pediatric populations.

Impact – This study provides up-to-date, longitudinal evidence on how mental health shapes subsequent weight development during the critical and rapid growth period of adolescence. – Both adverse and protective dimensions of mental health play a role in shaping adolescent weight development, with evidence that some youths experiencing mental health difficulties exhibited smaller increases in BMI z-score, even when starting from a higher baseline weight status. –It should be acknowledged that in contemporary society, adolescents with emerging mental health difficulties may not necessarily present immediate excessive weight gain but instead follow stable or even declining weight trajectories. Although obesity and mental health problems represent two of the most pressing public health challenges, their developmental interplay remains insufficiently understood. Thus, we examined how depressive and anxiety symptoms, self-esteem, and psychological resilience are associated with weight development during adolescence. We included 1280 11-year-old children from the Finnish Health in Teens cohort, following 814 of them for 4.3 years. Mental health was assessed with validated self-administrated scales at age 11. Psychological resilience was determined by psychological health after exposure to stressful life events. Body mass index z-score (BMIz) and waist-to-height ratio (WtHr) were calculated at ages 11 and 16. Depressive and anxiety symptoms were associated with higher baseline BMIz but smaller increases in mean BMIz during follow-up (p = 0.009, p = 0.005, respectively). High self-esteem was associated with lower baseline BMIz, yet with steeper increases over follow-up (p = 0.002). Resilient adolescents showed lower baseline BMIz compared with non-resilient adolescents but exhibited greater increases during follow-up (p = 0.005). Similar trends were observed for WtHr. These findings highlight that mental health is associated with physical growth in adolescence, emphasising the need to consider mental health when seeking to understand and address patterns of weight development and their underlying dynamics.

Overeating is a complex appetite trait, cross-sectionally linked to an elevated weight in children. However, little is known about longitudinal associations. Therefore, we studied how a tendency towards overeating predicts weight development between 8 and 16 years of age. In this study among 4517 children from the Finnish Health in Teens cohort, parents reported their child’s tendency to overeat when children were on average 11.2 (SD 0.8) years old. Children were then categorised as overeating, possibly overeating, or not overeating. Height and weight measurements from two data collection periods were combined with growth data from a national health register, and age- and sex-standardised body mass index z-scores (BMIz) were calculated using the International Obesity Task Force reference. Children also reported their lifestyle factors, including food consumption, physical activity, screen time, and sleep patterns. We examined the association between overeating and BMIz using a linear mixed model, adjusting for age, sex, specific food consumption frequencies, physical activity, screen time, and sleep duration. We further analysed whether associations differed by age, food consumption frequencies, or physical activity. The average BMIz in the overeating group was 1.18 (95% CI 1.10─1.26) units higher compared with those without overeating, but remained stable as age increased. Among those without overeating, BMIz increased 0.043 units per year of age (p < 0.001). Physical activity, but not food consumption, modified the association between overeating and BMIz (p for interaction = 0.038). In the lowest third of physical activity (≤ 5 h/week), BMIz was 1.28 units higher (95% CI 1.15─1.41) in the overeating compared with the no overeating group, while in the highest third (≥ 9 h/week) the effect size was 1.08 (95% CI 0.93─1.24). In conclusion, children with a parent-reported tendency to overeat exhibited an elevated, but stable mean BMIz across adolescence. Public health programmes tackling the obesity epidemic should consider the differences in appetite self-regulation among children.

Background: Children’s eating behaviors, including a tendency towards overeating, are strongly influenced by the family. Children prone to overeating are at a high risk of excessive weight gain, which can lead to further adverse health outcomes. Therefore, identifying factors that contribute to overeating is crucial for promoting healthy weight development. Given the inconsistencies in previous research, mostly involving young children, we investigated the child and parental characteristics associated with overeating in preadolescence.Methods: The cross-sectional study included 5,973 preadolescents aged 9–12 years from the Finnish Health in Teens (Fin-HIT) cohort. A tendency towards overeating was based on a parent-reported question. We utilized extensive parent questionnaire and Medical Birth Register data, and used ordinal and stepwise logistic regression to identify the independent determinants of overeating.Results: The proportion of preadolescents with a parent-reported tendency towards overeating was 10% (n = 606). In the multivariable model, boys had higher odds of overeating (OR 1.30, 95% CI 1.06–1.58) compared with girls. Preadolescents with overweight and obesity had 9- and 30-fold odds (95% CI 7.31–11.29 and 20.07–44.54, respectively) of overeating compared with healthy-weight preadolescents. Furthermore, parental depression and emotional feeding increased the odds of overeating in the preadolescent (OR 1.48, 95% CI 1.08–2.02 and OR 1.27, 95% CI 1.03–1.57).Conclusion: Along with child weight status and sex, parental depression and emotional feeding were independently associated with overeating in preadolescence. Therefore, it is important to support parents’ mental health and their healthy feeding practices. Our findings can be targeted to manage overeating and prevent overweight in children and adolescents.

Background: Binge eating, a type of disordered eating, is relatively common among youth and predisposes them to many adverse health outcomes. Diverse psychological and social factors may be associated with binge eating. The aim of this study was to examine child and parental psychosocial determinants of binge eating and its impact on indicators of obesity. Methods: The sample consisted of 10 679 Finnish adolescents who participated in the Fin-HIT cohort study. The participants were 9–12 years at baseline, and they were followed-up for 2.6 years on average. At baseline, children’s anthropometry was measured, and they reported binge eating, disordered eating attitudes and behaviors, self-esteem, and body shape satisfaction with validated questionnaires. Parents reported their own weight satisfaction, dieting, and depressive symptoms at baseline. Adjusted logistic and linear regressions were used in the analyses. Results: Self-esteem was associated with lower odds (OR 0.88, 95% CI 0.85–0.91), and overall disordered eating attitudes and behaviors were associated with higher odds (OR 1.08, 95% CI 1.06–1.10) of binge eating. Additionally, child and parent body dissatisfaction were associated with binge eating but not in the fully adjusted model where the child’s BMI was additionally considered. None of the parental factors were associated with binge eating in the fully adjusted model. Binge eating was associated with higher BMI z-scores and waist circumferences both cross-sectionally and longitudinally. Conclusions: In support of previous findings, we found that low self-esteem, body dissatisfaction and other disordered eating attitudes and behaviors are associated with binge eating, but our results also highlight the impact of weight status as a potential moderator when the determinants of binge eating are examined. More studies on the role of parental factors in adolescent binge eating are needed.