Jovanna Dahlgren

Aims: Overweight and obesity are major public health challenges and well‐established risk factors for cardiovascular disease, cancer and premature mortality. We estimated the economic burden of overweight and obesity in Sweden in 2023 and projected the future economic burden in 2040 under alternative scenarios of increasing prevalence. Materials and Methods: A prevalence‐based cost‐of‐illness approach was used to estimate the economic burden of overweight and obesity in Sweden in 2023 from a societal perspective, including healthcare, social services, pharmaceuticals, productivity losses and informal care. The population attributable fraction method was used to estimate the additional cost burden from overweight and obesity compared to normal weight. Results: The total economic burden was estimated at approximately EUR 7 billion (EUR 664 per capita), with EUR 2.6 billion from overweight and EUR 4.4 billion from obesity. Productivity losses accounted for 71% of total costs, healthcare costs 21% and pharmaceuticals, informal care and social services 8%. Projections to 2040 suggest that demographic changes alone could increase the burden to EUR 7.2 billion, while rising prevalence could raise it to EUR 8.6 billion. A decrease of one percentage point in obesity prevalence would counteract the demographic effects, resulting in a reduction to EUR 7.1 billion in the projection to 2040. Conclusions: The findings highlight the urgent need for effective obesity interventions. Societal strategies promoting healthy lifestyles, targeted prevention and improved access to obesity surgery and evidence‐based treatments may reduce the rising prevalence of obesity. Policymakers should weigh short‐term costs against long‐term savings.

Introduction: The aim was to identify neurodevelopmental diagnoses and problems and the extent of their overlap in children undergoing obesity treatment. Methods: Totally, 139 children (72 girls; mean age 12.7 years, mean BMI SDS 3.1) were recruited from three obesity clinics in Sweden. Motor, executive, perception, memory, language, learning, social, and emotional/behavioural functioning were assessed with an age-normed questionnaire. Scores ≥ the 90th percentile were considered indicative of problems with probable clinical relevance in each domain. Neurodevelopmental diagnoses were subsequently collected from the patients’ records. The proportion of children exceeding the clinical threshold in each domain was compared with the expected population frequency (10%) and between participants with and without neurodevelopmental disorders. Results: The proportion exceeding the 90th percentile was significantly higher than the expected 10% in all domains: ranging from 33.6% (memory functioning) to 54.0% (emotional/behavioral functioning) (p < 0.001). Neurodevelopmental disorders were diagnosed in 52.5% (73/139). Diagnosed children had higher rates and greater overlap of neurodevelopmental problems than children without diagnoses (p < 0.001). Conclusion: Recognizing neurodevelopmental problems in children with obesity may improve understanding of their needs in obesity treatment settings.

Objective: Psychiatric comorbidity frequently presents in anorexia nervosa (AN). Yet, the premorbid mental health status is relatively unknown. The aim of this study was to map out psychiatric morbidity and psychopathology among girls at familial high risk (FHR) of developing AN, thereby detecting possible underlying vulnerabilities preceding the disease. Method: Twenty‐eight daughters of mothers with a history of AN (FHR daughters), aged 6–12, along with 42 comparison daughters without FHR for AN (COMP daughters), were recruited. The mothers completed a battery of parental diagnostic interviews and screening questionnaires regarding psychiatric diagnoses and psychological traits in their daughters, including the Development and Well‐Being Assessment (DAWBA) and the Strengths and Difficulties Questionnaire (SDQ). Results: In comparison to the COMP daughters, the FHR daughters had 27 percentage points higher absolute risk of meeting criteria for ≥ 1 psychiatric diagnoses (32.1% versus 4.8%; unadjusted p = 0.007; adjusted p = 0.035), and 21 percentage points higher risk of ≥ 2 psychiatric diagnoses (unadjusted p = 0.007; adjusted p = 0.035) according to the DAWBA and/or as established by the Child and Adolescent Psychiatry clinics. Among the FHR daughters, anxiety disorders and autism were the most common diagnoses. In addition, the FHR daughters scored significantly higher on the Emotional symptoms subscale of the SDQ ( p = 0.03). Discussion: Increased risks of psychiatric diagnoses and elevated emotional problems were found among girls at FHR for AN. The results may therefore suggest psychiatric morbidity to be a potential risk factor for developing AN.

Context: Mini-puberty is a period when the hypothalamic-pituitary-gonadal (HPG) axis is activated and is believed to create the basis for future fertility. In prematurely born females, delayed HPG axis activity and lower reproduction rates have been reported. However, the secretion dynamics of sex steroids in infant girls have not been fully elucidated, Objective: To study sex steroid secretory dynamics in girls born moderately to late preterm during infancy and to find out whether the degree of prematurity or low birth weight may lead to a disturbed sex steroid profile. Methods: From a population-based longitudinal cohort of 70 girls, born at gestational age 32.0 to 36.9 weeks at Sahlgrenska University Hospital, Gothenburg, Sweden, androgen and estrogen concentrations were analyzed during infancy with high-sensitivity mass spectrometry-based methods. Results: Serum androstenedione and estrone declined continuously during infancy. Testosterone and dihydrotestosterone (DHT) both showed surges around 1 to 2 months chronological age. The surges in estradiol varied individually, with the peak level occurring either before 2 months or at 2 to 3 or 5 to 7 months. At 5 months corrected age, estradiol correlated inversely to gestational age (r = −0.47, P = .000). At 10 months corrected age, gestational age correlated with androstenedione (r = 0.44, P = .002), testosterone (r = 0.32, P = .031), DHT (r = 0.31, P = .043), and estrone (r = 0.43, P = .004). Conclusion: In girls born moderately to late preterm, DHT, estradiol, and testosterone show a postnatal activity with synchronized surges for DHT and testosterone, while estradiol is secreted with an individual dynamic. Androstenedione and estrone show no surge during infancy. Degree of prematurity but not birth weight influences sex steroid secretion.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is overrepresented among children and adults with obesity, but knowledge about how ADHD may affect outcomes following metabolic and bariatric surgery (MBS) is limited. The aim of this study was to examine mental health and weight outcomes after undergoing MBS during adolescence in individuals with and without ADHD. Methods: In a multicenter prospective study, 81 adolescents (13–18 years; mean BMI 45.5 kg/m2) underwent Roux-en-Y gastric bypass between 2006 and 2009. ADHD and autism spectrum disorder (ASD) were assessed using the Adult ADHD Self-Report Scale and Autism Quotient 10, respectively, or clinical diagnosis. BMI, anxiety, depression, and binge eating were measured before MBS and at 1-, 2-, 5-, and 10-year follow-ups. Results: ADHD was present in 33 of 81 participants (41%). At 10-year follow-up, 91% of individuals with ADHD reported anxiety or depression, compared to 21% in the group without ADHD (p = 0.002), despite no reported difference at baseline. A significant time-by-group interaction (p = 0.018) indicated increasing differences between groups over time. Binge eating returned to preoperative levels in the ADHD group (p < 0.001) after 10 years following initial improvement. No significant difference in BMI was observed at 10 years, but weight loss was significantly lower in the ADHD group at 2- and 5-year follow-ups. At the 10-year follow-up, significantly more participants with clinical diagnosis of ADHD had dropped out (56% vs. 25%, p = 0.013). ASD was present in 14 of 81 participants (17%) and showed a high degree of overlap with ADHD (79%). Conclusions: ADHD was associated with higher levels of anxiety, depression, and binge eating 10 years after MBS during adolescence. Weight loss was lower for the ADHD group at 2 and 5 years but not at 10 years, potentially due to a high dropout in the ADHD group at 10 years. Preoperative screening for ADHD in adolescents may improve long-term outcomes by early initiation of treatment for ADHD and tailored postoperative follow-up.

Introduction: The aim of this study was to explore long-term behavioral consequences of early versus delayed cord clamping (CC) in school-aged children. The hypothesis was that early CC would be associated with an increased risk of symptoms associated with attention deficit hyperactivity disorder (ADHD) due to the lower iron stores following early CC compared with delayed CC. Methods: Exploratory, long-term follow-up study of a randomized controlled trial in Sweden. Full-term, vaginally born, neonates to healthy mothers were originally included and randomized to either early (≤10 s) or delayed (≥180 s) CC. At 10 years of age, scores from the screening questionnaire Swanson, Nolan and Pelham Scale IV (SNAP-IV), that identifies symptoms suggestive of ADHD (but do not diagnose ADHD), were compared between groups of early and delayed CC. Results: We assessed 139/382 (36.4%) children, 64 early CC and 75 delayed CC. No significance in total score and subgroup scores of SNAP-IV was seen when comparing early and delayed CC. In the primary outcome, total scores, mean (standard deviation) of early CC was 14.64 (13.94) and for delayed CC 13.59 (13.41), p = 0.65. Conclusion: Timing of umbilical CC and iron status were not associated with symptoms associated with ADHD in 10-year-old children. Studies with higher follow-up rates and in populations with high prevalence of iron deficiency are needed to verify or discard the findings. Understanding if delayed CC has long-lasting neurobehavioral or neurodevelopmental effects can help develop guidelines and program about neonatal care.

The primary aim of this study was to confirm the internal consistency and factor structure of the Swedish version of the Swanson-Nolan-Pelham scale fourth edition (SNAP-IV) for parents and to examine its clinical utility for identifying children diagnosed with attention deficit/hyperactivity disorder (ADHD). Parents of 11-year-old children from a birth cohort in the Halland region of Sweden (N = 981) completed the SNAP-IV assessment. Background data on ADHD diagnoses and medical treatment with stimulants were obtained from the Swedish National Patient Registry. We assessed the factor structure of the SNAP-IV using confirmatory factor analysis with diagonally weighted least squares estimation, and its clinical utility using logistic regression and receiver operating characteristic curve analysis. A three-factor bifactor S-1 model of the Swedish SNAP-IV where all items load onto a general hyperactivity/impulsiveness factor and items specific to inattentiveness and Oppositional Defiant Disorder (ODD) load onto independent factors fit best and exhibited high internal consistency. Excluding ODD items, a similar two-factor bifactor S-1 model fit well. The SNAP-IV demonstrated robust clinical utility for identifying children diagnosed with ADHD as evidenced by significant associations between clinical diagnoses and the SNAP-IV subscales, as well as excellent classification accuracy for both the inattention and hyperactivity/impulsivity subscales when using continuous values. Taken together, the Swedish version of the SNAP-IV parent form was found to be a useful instrument with good criterion validity for assessing ADHD symptoms in 11-year-old children. The clinical application of cutoffs is discussed.

The Nutrients Editorial Office retracts the article, “Is There an Overlap Between Eating Disorders and Neurodevelopmental Disorders in Children with Obesity

Background: Osteocalcin is a metabolic active hormone, which correlates positively with bone formation and inversely with body mass index and waist circumference in adults.Objectives: To investigate whether osteocalcin in infancy and early childhood were related to childhood growth or body composition.Methods: A Swedish longitudinal birth cohort with blood samples from 551 children from birth until 5 years of age. Regular anthropometric measurements were carried out up to 8 years of age and dual‐energy X‐ray absorptiometry (DXA) scans were also performed at 8 years. The results included p‐values and Spearman's rho (ρ).Results: Osteocalcin at 4 months of age correlated inversely and consecutively with weight from 4 to 24 months and to waist circumference from 6 to 24 months in boys. The correlations for girls were limited to weight at 4 months and waist circumference at 6 and 18 months (ρ < 0.3, p = 0.001 to 0.048). The boys' osteocalcin levels at 5 years correlated positively with their height and weight at 5 and 6.5 years (ρ < 0.3, p < 0.01). Meanwhile, the girls' osteocalcin at 3 years showed positive correlations to all weight and height measurements until 8 years of age (ρ < 0.3, p = 0.003 to 0.023). DXA data showed that the boys' osteocalcin at 5 years correlated with the fat‐free mass index (FFMI) (ρ 0.212, p = 0.026) but not the fat mass index (FMI) at 8 years. The opposite was seen for the girls' osteocalcin at 3 years, which correlated with FMI (ρ 0.222, p = 0.020) but not FFMI.Conclusion: Early levels of osteocalcin showed inverse correlations with later weight, height and body composition in infancy and positive correlations during childhood. The weak but consistent correlations suggest that osteocalcin carries information about future growth. Girls with high osteocalcin at 3 and 5 years had a larger fat mass at 8 years, while boys, in contrast, had a larger lean mass. These sex differences need to be further explored.

Aim: This study evaluated feeding problems and gastrointestinal symptoms in children with Silver‐Russell syndrome (SRS), which is a rare epigenetic disorder. It also compared the symptoms experienced during different feeding methods, including percutaneous endoscopic gastrostomy (PEG).Methods: The national expert team for children with SRS at Queen Silvia Children's Hospital, Gothenburg, studied 46 referrals (63% male) who were born with SRS in Sweden from 1984 to 2018. Patient data were extracted from the Paediatric National Growth Hormone Registry.Results: The medical records covered a median of 68% of the time of the patients' childhood, with a median follow‐up of 9 years. Their symptoms were most prevalent during infancy and decreased when they were toddlers. Feeding problems and gastrointestinal symptoms were reported in 91% of the 46 patients, with vomiting in 57% and constipation in 46%. There were 19 children who relied on enteral feeding for their nutrition and 13 of those received PEG. Their body mass index (BMI) increased significantly 2 years after PEG started (p = 0.005).Conclusion: Feeding problems and gastrointestinal symptoms were very common in children with SRS, but partly disappeared during childhood. Providing treatment, such as PEG, normalised the BMIs of children with SRS and reduced their symptoms.