Abstract   Aims and objectives. To examine whether an intervention with carbohydrate- counting at onset of type 1 diabetes in children, has had any effect on metabolic indicators such as HbA1c , BMI-sds and total daily insulin / kg, 2 months and 1 year after onset by age and gender .Background. The pediatric department at the university hospital of Norrland in Umeå (NUS), has since several years a higher average HbA1c among children 0-17 years, compare with pediatric departments in the rest of Sweden.  Therefore, in autumn 2011, an intervention was made to teach children with diabetes and their parents to count carbohydrates from the onset of diabetes. Using this method they can regulate their insulin doses depending on the amount of carbohydrates they are eating. Design. This is an empirical registry study done on the basis of a quantitative method. It is retrospective controlled non- randomized with comparison group .Methods. The study included 46 children aged 0-17 years diagnosed with type 1 diabetes. Those who fell ill in 2009 (n=22) did not learn to use carbohydrate counting and served as a control group. The intervention group were diagnosed 2011-2012, (n=24), began using carbohydrate counting at the onset of diabetes.Results. The study shows with significant security that carbohydrate counting lowers HbA1c two months and one year after onset of type 1 diabetes. No significant difference was found in BMI-sds. The study shows no significant difference in HbA1c between the sexes.Conclusion.  Carbohydrate-counting from onset of diabetes gives a significant reduction of HbA1c without affecting BMI-sds significantly.Relevance to clinical practice. It is important that health professionals continue to teach and support families in carbohydrate counting from the onset of diabetes.Keywords. children, HbA1c, BMI- sds , type 1 diabetes , carbohydrate counting

Introduction: While the influence of parental behavior and economic status on children’s weight status is well-known, little is known about the impact of specific family-related aspects such as parental and grandparental social support. This study investigates the importance of parental and grandparental social support and economic capital for children’s weight status in a clinical sample of preschoolers with obesity. Methods: Baseline data from an obesity intervention study for preschoolers, 4-6 years of age (n = 39, 56 % girls) was used. Among parents, 73% were overweight/obese, 60% had a 3-year high school education and 50% were of non-Swedish origin. Linear regression analyses, simple and multiple, were performed separately for mothers and fathers on indicators of economic capital and social support with child BMI SDS as the dependent variable. Additionally, combined analyses were conducted in which parental income was stratified by emotional support. Results: Low levels of income for both parents and low emotional support from grandparents for fathers were significantly associated with a higher child BMI. Moreover, the association between parental income and the child’s BMI SDS was stronger among those parents who had low emotional support versus those who had high emotional support. Conclusion: The study indicate that both economic capital and social support of parents may influence the level of obesity in their children and that emotional support of grandparents is especially important when parental income is low.

Ziel: Kinder mit Adipositas haben bekanntermaßen eine verringerte Knochendichte und ein höheres Risiko für Frakturen. Dies kann durch reduzierte körperliche Aktivität oder ein metabolisches Phänomen verursacht werden. In dieser Studie untersuchten wir die Zusammenhänge zwischen körperlicher Aktivität und dem Knochenstoffwechsel bei Kindern und Jugendlichen mit und ohne Adipositas. Methoden: Die Ergebnisse von 574 Besuchen von 397 Probanden (191 Mädchen und 206 Jungen im Alter von fünf bis 18 Jahren, Durchschnittsalter: 11,7 ± 2,8 Jahre), darunter 180 Kinder mit Adipositas (mittlerer BMI-SDS 2,5 ± 0,4) und 217 Kinder ohne Adipositas (mittlerer BMI-SDS 0,2 ± 1,0), aus der LIFE-Child-Studie, einer bevölkerungsbasierten Kohorte von Kindern und Jugendlichen mit normalem Gewicht und Adipositas, wurden analysiert. Der Einfluss ihrer täglichen körperlichen Aktivität (MET/Tag, SenseWear-Accelerometer) auf die Serum-SDS-Werte für die Knochenbildung (alkalische Phosphatase, Osteocalcin, Prokollagen Typ I N-Propeptid [P1NP]), den Knochenabbau (Beta-Crosslaps) und die Kalziumhomöostase (Parathormon, OH-25-Vitamin D) wurde mithilfe eines linearen Regressionsmodells untersucht, das geschlechts- und altersbedingte Unterschiede berücksichtigte. Ergebnisse: Bei männlichen Probanden beeinflusste der BMI-SDS signifikant den Zusammenhang zwischen körperlicher Aktivität und den SDS-Werten für PTH, Vitamin D und Beta-Crosslaps. Eine höhere körperliche Aktivität war mit erhöhten PTH-, aber niedrigeren Vitamin-D-SDS-Werten bei Kindern mit Normalgewicht verbunden. Bei Jungen mit Adipositas blieben alle Werte unverändert. Bei weiblichen Probanden hatte der BMI-SDS einen signifikanten Einfluss auf die Assoziation zwischen körperlicher Aktivität und den SDS-Werten für PTH, Vitamin D, P1NP, Beta-Crosslaps und Osteocalcin. Bei adipösen Mädchen war eine höhere körperliche Aktivität mit höheren SDS-Werten für Vitamin D, P1NP und Beta-Crosslaps verbunden. Im Gegensatz dazu war bei Mädchen mit Normalgewicht nur der PTH-SDS-Wert erhöht. Schlussfolgerungen: Der Einfluss der täglichen körperlichen Aktivität auf Marker des Knochenstoffwechsels und kalziotrope Hormone hängt wesentlich von Geschlecht und BMI-SDS ab. Höhere körperliche Aktivität war jedoch nur bei adipösen Mädchen mit einer erhöhten Knochenumsatzrate verbunden. Daher könnte es hilfreich sein, insbesondere Mädchen mit Adipositas zu mehr körperlicher Aktivität zu motivieren, um ihre Knochengesundheit zu verbessern.:1. Einführung 1 1.1 Knochen und deren Stoffwechsel 1 1.2 Knochenstoffwechsel und dessen systemischen Regulierung 3 1.3 Knochenstoffwechsel und physische Aktivität 4 1.4 Knochenstoffwechsel und Fettgewebe 5 1.5 Knochenstoffwechsel und Geschlechtshormone 6 1.6 Marker für Knochenstoffwechsel 8 1.7 Ziele der Arbeit 8 2. Publikation 10 3. Zusammenfassung 19 3.1 Probandencharakteristika 19 3.2 Knochenstoffwechsel nach Geschlecht und BMI SDS 20 3.3 Physische Aktivität 22 3.4 Effekt von physischer Aktivität auf den Knochenstoffwechsel 22 3.5 Schlussfolgerung 23 4. Literaturverzeichnis 24 5. Anlagen 28 5.1 Verzeichnis der verwendeten Abkürzungen und Symbole 28 5.2 Erklärung über den wissenschaftlichen Beitrag des Promovenden zur Publikation 29 5.3 Erklärung über die eigenständige Abfassung der Arbeit 30 5.4 Curriculum vitae mit Publikationen und Vorträgen 31 5.5 Danksagung 33

Abstract Introduction: Obesity amongst children is a major health problem. At the outpatient paediatric clinic at Södertälje hospital in Region Stockholm, there is a large and well-established treatment model against childhood obesity. During spring 2020 all elective care in Region Stockholm, including visits to the obesity team, was cancelled for 3 months due to relocation of health care professionals because of the Covid-19 pandemic. Aim: To investigate whether the first wave of the Covid-19 pandemic affected the outcome of childhood obesity treatment at one outpatient paediatric clinic in Region Stockholm. Methods: A retrospective controlled cohort study comparing two groups regarding results of first year of obesity treatment for children. One group had their first year of treatment during the first wave of the Covid-19 pandemic and the control group before the pandemic. Data was retrieved from BORIS and complemented by a review of medical records. Results: Mean change in BMI SDS after one year of treatment in the Covid group was -0.10 units and in the control group -0.11 (ns). In the Covid group more patients quit the treatment programme and had a smaller number of visits to a nurse compared to controls. Conclusion: This study showed no difference in outcome regarding change in BMI SDS. However, it seems that the cancellation of visits might have affected the number of children lost to follow-up. Therefore, clinics should consider “digi-physical” care (e.g., via telephone, videocalls or other media) to secure the child and parents motivation and participation in the obesity treatment programme.

Background: Overweight and obesity represent huge concerns for children's physical and mental well-being. This study examined the relationship between body mass index (BMI) and health-related quality of life (HRQoL), somatoform complaints, and behavioral problems in children and adolescents. Additionally, the influence of sex, age, and socioeconomic status (SES) on these associations was considered. Methods: In total, we studied 2350 participants between the ages of 4 and 18 years (1213 4- to 10-years-old (child sample) and 1137 11-to 18-year-olds (adolescent sample)). To assess HRQoL, somatoform complaints, and behavioral difficulties, we applied the KIDSCREEN-27, a short form of the Giessen Complaints Questionnaire, and the Strengths and Difficulties Questionnaire (SDQ). The BMI was transformed to BMI standard deviation scores (BMI-SDS), according to German gender- and age-specific reference data. Associations were investigated using linear regression analyses. Each association was checked for interaction with sex, age, and SES. Results: Regarding HRQoL, we found worsening scores in physical well-being and psychological well-being with increasing BMI-SDS. Somatoform complaints were not significantly associated with BMI-SDS. Conduct problems, peer relationship problems, and emotional problems (the latter only in the adolescent sample) were positively associated with BMI-SDS. While we did not observe any significant interactions with sex, we found some significant interactions with age and/or SES. Conclusion: Our findings highlight the importance of mental difficulties in children and adolescents with higher BMI and, consequently, underline the relevance of including psychological interventions in the treatment of overweight or obesity.