Search Results (455)

Overweight in childhood, adolescence and adulthood is now a world-wide epidemic. A variety of preventive and therapeutic measures are being developed with partial success. Since the pioneering studies of D.J. Barker linking maternal famine in pregnancy to long—term undesirable effects on the offspring—the “metabolic syndrome” that stems from long-lasting epigenetic changes, it became evident that there are many undesirable events which affect in-utero fetal growth and development. They often persist postnatally, through childhood and adulthood. The purpose of this review is to discuss the prenatal factors that may have long term effects on postnatal weight gain and obesity that are important contributors to the “obesity” epidemic. These prenatal undesired factors are pregestational and gestational diabetes, pre-pregnancy maternal obesity, excessive weight gain in pregnancy, placental dysfunction and maternal hormonal imbalances. They may affect fetal growth, generally causing excessive growth (macrosomia) and sometimes diminished growth (small for gestational age). These prenatal conditions are associated with epigenetic changes that may contribute to insulin resistance and subsequent metabolic alterations leading to increased food intake, overweight, and obesity. Studies also demonstrate that increased exposure in pregnancy to teratogens, like endocrine disruptors and cigarette smoking, may also affect prenatal and postnatal growth and adiposity. However, many the studies demonstrating the role of these factors are often weakened, as they mainly demonstrate associations and do not sufficiently consider possible confounding factors such as postnatal age, nutrition and lifestyle. Better understanding of these prenatal factors may support more effective prevention and management strategies for childhood overweight and obesity. Full article

Background/Objectives: Adolescence is a critical developmental stage marked by increased susceptibility to engaging in risky health behaviors, including the use of alcohol, energy drinks (EDs), and tobacco products. Methods: A cross-sectional sample of 1249 individuals aged 10–24 years was analyzed, stratified into two age groups (<16 and >16 years). The study sample comprised volunteers living in Rome, Italy, who were recruited for the ALIMA (ALImentazione Multiculturale negli Adolescenti) study. Categorical variables were analysed using the Pearson chi-square test and p < 0.05 was considered statistically significant. Results: Alcohol consumption was higher among participants aged ≥16 years (62.2%) than among those age <16 years (39.9%), without significant gender difference, with binge drinking also more common, especially among older males. ED use was widespread, more frequent in males, and often associated with alcohol consumption. Smoking prevalence differed by age group, reaching 41.5% among participants over 16 years of age, with higher rates among younger females. Finally, 17.3% reported combined use of alcohol, EDs, and tobacco, with significant gender differences in both age groups. Conclusions: These findings highlight a clear age-related escalation and co-occurrence of substance-use behaviors, with emerging gender differences in specific patterns. The results underscore the need for integrated, age-targeted prevention strategies addressing multiple substance use simultaneously to reduce long-term health risks and promote adolescent well-being. Full article

Background: Intestinal parasitic infections are common in tropical settings and may influence immune regulation, allergic responses, and respiratory health. In children with sickle cell disease (SCD), respiratory morbidity is multifactorial, and the contribution of intestinal parasites remains uncertain. This study assessed whether documented intestinal parasitic infections, particularly helminth infections, were associated with asthma-like respiratory phenotypes and clinical morbidity in children with SCD in French Guiana. Methods: We conducted a multicenter cross-sectional analysis of children and adolescents younger than 18 years with confirmed SCD who were being followed by the pediatric SCD centers of Saint-Laurent-du-Maroni, Cayenne, and Kourou between January 2022 and December 2025. Clinical, respiratory, and parasitological data were extracted from routine-care medical records. Intestinal parasitic infection was defined as at least one documented stool parasitology result identifying Strongyloides stercoralis, hookworm, or Entamoeba histolytica, according to the variables consistently available in the database. Respiratory outcomes included physician-diagnosed asthma, bronchial obstruction, bronchodilator reversibility, and an asthma-like respiratory phenotype. Results: Among 233 included children, 105 (45.1%) had at least one documented intestinal parasitic infection and 82 (35.2%) had a helminth infection. Hookworm was the most common parasite (75/233, 32.2%), followed by Entamoeba histolytica (33/233, 14.2%) and Strongyloides stercoralis (24/233, 10.3%). An asthma-like respiratory phenotype was observed in 32/105 infected children (30.5%) versus 44/128 non-infected children (34.4%). Bronchial obstruction and bronchodilator reversibility were also similar between groups. After adjustment for age, sex, genotype, hydroxyurea treatment, rural residence, site of follow-up, and environmental tobacco smoke exposure, intestinal parasitic infection was not associated with asthma-like respiratory phenotype (adjusted OR: 0.94, 95% CI: 0.51–1.72; p = 0.844), recurrent hospitalization, or history of acute chest syndrome. Conclusions: In this routine-care multicenter pediatric SCD cohort from French Guiana, intestinal parasitic infections were common but were not associated with respiratory phenotype or selected morbidity outcomes. Because testing and respiratory assessment were not systematic, these findings should be interpreted as showing that routine parasitological status alone could not identify children with respiratory morbidity. Prospective studies with standardized repeated parasitological, immunological, environmental, and respiratory assessments are needed. Full article

Background/Objectives: Early childhood is an important period when growth and adiposity patterns emerge and may persist into later childhood. Children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) face elevated obesity risk. We characterized BMI-for-age z-score (BMIz) trajectories from 24 to 60 months and their child-, caregiver-, and household-level correlates. Methods: This was a secondary analysis of the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2) public-use dataset. We analyzed 5,583 BMIz observations from 2,247 dyads; adjusted models used 4,314 observations from 1,738 children. Linear mixed-effects models tested individual, interpersonal, and household predictors. Restriction and pressure-to-eat were lagged, time-varying exposures. Results: Mean BMIz was elevated at all waves (0.46 to 0.56). Obesity prevalence rose from 15.4% to 18.5%. Unconditionally, BMIz was stable from 24 to 48 months and rose by 60 months. Adjusted models linked higher BMIz to higher birth weight, Hispanic or Latino ethnicity, birth complications, maternal overweight or obesity, paternal overweight, prenatal smoking, adolescent maternal age, and lower maternal education. Male sex was associated with lower BMIz. Prior-wave restriction was associated with higher, and pressure to eat with modestly lower, subsequent BMIz. Household indicators showed no independent association. Conclusions: Caregiver and perinatal characteristics and feeding practices were the most consistent modifiable correlates of late-preschool BMIz. These observational, complete-case findings warrant caution. The 48–60-month window may be a promising period to target for WIC-based obesity prevention. Full article

Introduction: In recent years, electronic cigarettes, including disposable e-cigarettes and tobacco heating devices, have grown in popularity, especially among young people and young adults. Although e-cigarettes are touted as a “safer” alternative to traditional cigarettes, a growing body of evidence indicates that vaping can cause serious health problems, especially in the respiratory and cardiovascular systems. Aim of the Study: The aim of the study was to assess the prevalence of disposable e-cigarettes and other nicotine products among adolescents and young adults, as well as to examine the factors associated with regular smoking and nicotine dependence across individual nicotine-containing products. Material and Methods: The survey was conducted among residents of southern Poland. A total of 625 (100%) people were examined. Among them were: 350 women and 275 men. The subjects were aged between 14 and 29 years (Median and 25th–75th percentile: 19; 16–23). The study used an original questionnaire, the completion of which was anonymous and voluntary. The questions included in the survey concerned the smoking status of the respondents, the main sources of nicotine intake and general information such as age, gender, place of residence, employment or education, and financial stability of the family. The survey used the Fagerström test to examine the degree of nicotine dependence among the subjects. Results: A total of 34% (212; 33.92%) of the surveyed group of adolescents and young adults were smokers, most of whom used disposable e-cigarettes (69; 32.55%). In addition, 60% (368; 58.88%) of respondents reported having tried disposable e-cigarettes. Smokers, of both traditional cigarettes and e-cigarettes, accounted for 14% (88; 14.08%) of the study group. The results of the study showed a statistically significant effect of the age of the participants on the method of nicotine intake (p = 0.013). In the younger group, e-cigarettes were more often used, while in the older group, the use of heated tobacco products and traditional cigarettes dominated. Respondents’ median age at the first use of nicotine products was 16 years. Factors such as living in the city, lower financial stability, and having a parent who smoked during childhood were significantly associated with a higher likelihood of regular nicotine product use. Among the regular users, a high level of nicotine dependence was observed in 28.64% (n = 61) of individuals, with the largest proportion occurring among those using electronic cigarettes (39.37%; n = 50). Conclusions: 1. In the study group of adolescents and young adults, disposable e-cigarettes were the most used nicotine-containing product. 2. Parental smoking and male gender were positively associated with the likelihood of smoking, whereas primary education and financial stability were inversely associated with tobacco use. 3. Electronic cigarette users exhibited the highest average nicotine dependence scores. Multivariate analysis confirmed that male gender, the type of nicotine product used, and place of residence were independently associated with higher Fagerström test scores. Full article

Background: Adolescent tobacco, e-cigarette, and alcohol use are important public health concerns in China. However, the associations of specific types and cumulative exposure to childhood family violence with different substance use outcomes remain insufficiently understood. This study examined these associations among Chinese adolescents. Methods: We analyzed data from a cross-sectional school-based survey of 41,146 students aged 10–19 years conducted from October 2022 to March 2023 in a mountainous city in western Guangdong Province, China. Childhood family violence was assessed using the validated Chinese Family Violence Questionnaire and a cumulative exposure index. Descriptive analyses and logistic regression models were conducted, with adjustment for demographic and environmental factors. Results: The mean age of participants was 14.8 years, and 51.7% were female. Overall, 25.1% of adolescents reported at least one type of childhood family violence. Verbal insults (18.6%) and emotional neglect (16.3%) were the most frequently reported types and were consistently associated with tobacco, e-cigarette, and alcohol use (adjusted odds ratios [ORs] = 1.4–1.5, p < 0.001). A cumulative exposure pattern was also observed. Compared with adolescents reporting no childhood family violence, those exposed to three or more types had higher odds of tobacco use (OR = 3.81; 95% CI: 3.42–4.23), e-cigarette use (OR = 3.90; 95% CI: 3.39–4.48), and alcohol use (OR = 3.95; 95% CI: 3.59–4.35). Peer smoking and access to tobacco products were also significantly associated with substance use. Conclusions: Childhood family violence, particularly verbal insults and emotional neglect, was associated with adolescent tobacco, e-cigarette, and alcohol use. The findings highlight the importance of considering emotional maltreatment, cumulative adversity, peer influences, and access to tobacco products in future prevention research and practice. Full article

This study evaluated the effectiveness of a youth-developed vaping intervention created by the Airdrie Board of Youth Affairs (ABYA) in changing Grade 7 and 8 students’ knowledge, attitudes, and harm perceptions regarding e-cigarette use. The vaping video trial followed a preceding local education program on smoking harms. A total of 107 students were randomly assigned to either the intervention group (ABYA video) or the control group (expert-developed video). Four instruments were used: the Video Survey, Personal Information Questionnaire, Knowledge and Attitudes Regarding E-cigarette Ingredients, Safety, and Addictive Properties (KAS), and the E-cigarette Harm Perception and Reduction (EHI). Pre- and post-intervention data were analyzed using t-tests and Mann–Whitney U tests. Compared with controls, the intervention group showed a significantly larger mean decrease in total EHI scores (mean change 9.05 vs. 2.06; t(105) = 3.34, p = 0.001; Cohen’s d = 0.65), indicating that the youth-developed video increased the perceived risk of vaping relative to cigarettes to a greater extent than the expert-developed video. Students also rated the ABYA video significantly higher on a 5-point scale for overall enjoyment (3.13 vs. 2.33; p < 0.001; Cohen’s d = 0.81) and for perceived increase in knowledge about vaping (3.34 vs. 2.84; p = 0.023; Cohen’s d = 0.44). The KAS instrument showed low internal consistency in this sample, so item-level KAS findings were treated as exploratory. Notably, unlike the expert-developed video, which explicitly acknowledged uncertainty, the ABYA video conveyed a clearer and more direct message, which may have contributed to its greater appeal while also carrying a risk of overstating absolute risk of e-cigarettes relative to cigarettes. Overall, these findings suggest that grassroots, youth-led interventions may be an effective approach for adolescent vaping education and may offer advantages over traditional expert-developed messaging in some contexts. Full article

Background/Objectives: Adolescence is a critical period for the adoption of health-risk behaviors and the development of non-communicable diseases (NCDs). Schools represent a strategic setting for health promotion interventions; however, Italian studies simultaneously assessing NCD-prevention knowledge and lifestyle behaviors in the same adolescent population remain scarce. The study aimed to evaluate improvements in knowledge regarding nutrition and other lifestyle-related behaviors among Italian adolescents following a school-based educational intervention. Secondary objectives included describing lifestyle behaviors within the study population and exploring participants’ evaluation of the intervention. Methods: A quasi-experimental pre-post study was conducted between March and May 2025 in five lower secondary schools. A total of 410 adolescents aged 11–16 years were enrolled through a two-stage cluster sampling procedure. The intervention, lasting approximately two hours, was delivered by a trained nurse-researcher and addressed four health domains: nutrition, physical activity, screen exposure, and substance use. Results: Following the intervention, a measurable increase in overall knowledge scores (mean increase: +3.9 points) was observed, with 88.9% of participants showing improvement. The largest improvements were observed in nutrition-related knowledge and awareness of passive smoking harms. Despite these gains, unhealthy behaviors remained prevalent, including low adherence to physical activity recommendations (36.1%), suboptimal dietary quality (39.9%), and high screen exposure. A linear regression model identified five independent determinants of higher knowledge improvement: older age, female gender, higher screen exposure, having at least one employed parent, and lower pre-intervention test scores. The intervention was positively evaluated, with high levels of satisfaction, clarity, and perceived usefulness. Conclusions: Nevertheless, the persistent gap between knowledge and behavior underscores the need to integrate motivational and environmental components, gender-sensitive approaches, and longitudinal evaluations to foster sustainable, healthy choices and contribute to NCD prevention. Full article

This study examined whether family functioning and impulsivity differentiate offense categories or represent shared vulnerability factors among justice-involved adolescents. A cross-sectional survey was conducted in two juvenile correctional facilities and included 159 incarcerated male adolescents aged 13–18 years (mean 16.3 ± 1.1). Participants completed a case report form, the Family Assessment Scale (FAS), and the UPPS Impulsive Behavior Scale. Offenses were classified as property crimes (42%), crimes against persons (31%), sexual offenses (17%), and drug-related crimes (10%). Substance use was highly prevalent (smoking 86.8%; alcohol 61.0%), and 34.6% had experienced repeat incarceration, most frequently in property and drug-related offenses (p < 0.001). Peer influence was the most commonly reported reason for delinquency (44.7%). Family dysfunction was common across the sample, particularly in domains related to parental involvement and behavioral control with some variation across offense categories. In contrast, impulsivity levels were elevated but did not significantly differ between crime categories. These findings support a shared vulnerability perspective, suggesting that dysfunctional family environments and substance-related risk contexts operate across offenses, while impulsivity may represent a general risk rather than an offense-specific determinant. These results highlight the importance of family-centered and developmentally informed interventions in juvenile justice settings. Full article

Osteosarcoma is the most common primary bone tumor in children, adolescents, and young adults, and metastasis remains the main determinant for a poor outcome. We conducted an exploratory retrospective cohort study using formalin-fixed, paraffin-embedded tissue from 97 patients with histopathologically confirmed osteosarcoma treated between 2005 and 2019 to evaluate telomere maintenance mechanisms. To assess alternative lengthening of telomeres (ALT), colocalization of telomeric DNA and promyelocytic leukemia protein (TEL–PML) was evaluated as a tissue-based proxy. TEL–PML colocalization was assessed using combined PML immunofluorescence and telomere DNA PNA-FISH. Furthermore, telomerase reverse transcriptase (TERT) expression was evaluated by immunohistochemistry in relation to metastasis and disease progression. Logistic regression models were adjusted for age, sex, and smoking. TEL–PML was evaluable in 45/97 cases, including 10 positive and 35 negative tumors; the remaining samples were non-evaluable because of non-determinable signal or predominant necrosis. TERT immunohistochemistry was scorable in 58/97 cases, of which 33 were positive. TEL–PML evaluability was associated with amputation specimens, whereas TERT positivity was associated with non-osteoblastic histology and was inversely associated with age. Neither TEL–PML nor TERT was significantly associated with metastasis, recurrence, or death. Exploratory time-to-metastasis curves suggested an earlier increase of metastatic events among TEL–PML-positive cases. However, the small number of positive tumors precludes definitive prognostic interpretation. These hypothesis-generating findings indicate that TEL–PML assessment is feasible in osteosarcoma, but it is strongly influenced by tissue adequacy. On the other hand, TERT immunohistochemistry appears to reflect subtype- and age-related heterogeneity rather than providing robust outcome stratification in this cohort. Full article

Background/Objectives: This study evaluated the effectiveness of Cotinus coggygria (Smoke Tree) Flower Water mouthwash in reducing halitosis and improving oral hygiene parameters among adolescents undergoing fixed orthodontic treatment. Methods: A double-blind, randomized, placebo-controlled, parallel-group clinical trial was conducted with 30 individuals undergoing treatment with fixed orthodontic appliances. Participants were allocated (1:1) into two groups: Group A received the Cotinus coggygria mouthwash, while Group B received the placebo mouthwash. Hydrogen sulfide (H₂S) concentration in breath, measured by the OralChroma^TM II device, was the primary outcome. Secondary outcomes included dimethyl sulfide [(CH₃)₂S] and methyl mercaptan (CH₃SH) levels, assessed with the same device, and oral hygiene status evaluated using the Modified Silness & Löe Plaque (PI-M) as well as the Silness & Löe Gingival (GI) indices. Normality of the data distribution was assessed using the Shapiro–Wilk test. Statistical analyses were conducted using the Mann–Whitney U test and Student’s t-test. Results: A statistically significant reduction in H₂S levels was observed in the C. coggygria group compared to placebo (p = 0.014). Median H₂S levels decreased from 147.00 ppb at baseline (T0) to 35.00 ppb at follow-up (T1) after 2 weeks. A statistically significant reduction in total VSC levels was also observed in the C. coggygria group compared to placebo (p < 0.001). Median total VSC levels decreased from 254.00 ppb at baseline (T0) to 105.00 ppb at follow-up (T1) after 2 weeks. No significant differences were found between groups for the other volatile sulfur compounds. A Significant improvements were noted in periodontal parameters in favor of the C. coggygria group. The Gingival Index decreased from 2.0 to 1.3 (p < 0.001; 95% CI: −0.7 to −0.2), and the Plaque Index (PI-M) decreased from 1.6 to 1.0 (p = 0.001; 95% CI: −0.7 to −0.3). Conclusions: Cotinus coggygria mouthwash appeared to be an effective adjunct for managing halitosis and improving oral hygiene parameters in adolescents undergoing fixed orthodontic treatment. No adverse effects were reported. Full article

Background/Objectives: Childhood non-cystic fibrosis (non-CF) bronchiectasis is clinically heterogeneous. We aimed to describe fractional exhaled nitric oxide (FeNO) levels in affected children and examine associations with etiology, spirometry, and CT-defined disease extent. Methods: This single-center prospective observational study included 100 clinically stable children aged 6–18 years with CT-confirmed non-CF bronchiectasis evaluated between September 2014 and December 2015. FeNO was measured before spirometry using an online single-breath electrochemical technique. Chest CT was reviewed at the lobar level, with the lingula counted separately, and disease extent was summarized by the number of involved lobar regions. Associations were assessed using Spearman correlation and non-parametric tests. Results: Mean age was 14.9 ± 2.0 years, 55% were male, and mean FeNO was 20.9 ± 14.0 ppb. FeNO correlated positively with FEV1 (% predicted), FVC (% predicted), and FEF25–75 (% predicted) (all p < 0.01). FeNO was higher in males and adolescents than in females and younger children, respectively. FeNO did not differ by CT-defined lobar extent. It was lower in primary ciliary dyskinesia than in asthma overlap. Overall, 82% of the cohort received an ICS-containing maintenance regimen and household tobacco smoke exposure was present in 58%. Conclusions: FeNO was associated with selected functional indices and etiologic subgroups, but not with CT-defined structural extent, suggesting a greater role in clinical phenotyping than in reflecting radiologic burden. Rather than reflecting overall disease severity, FeNO may be more relevant as a marker of T2-leaning airway inflammatory phenotype in selected children with non-CF bronchiectasis. These findings should be interpreted as exploratory and hypothesis-generating, particularly for etiologic subgroup comparisons and for FeNO interpretation in the setting of treatment and environmental confounding. Full article

Adolescent vaping has become a persistent health and behavioural challenge in schools, yet many institutions lack reliable tools to detect and respond to concealed e-cigarette use. This study addresses this problem by evaluating the real-world performance of a low-cost “Internet of Things” (IoT) vape detection system deployed across 37 high-risk restroom and change-room locations at a large Australian Independent school. The aim was to determine whether an IoT-based environmental monitoring platform could accurately identify vaping events, support timely staff intervention, and provide actionable insights into student behaviour patterns. A longitudinal case study design was used, collecting continuous particulate matter (PM_2.5 and PM₁₀) data at one-minute intervals over an 18-month period, where PM_2.5 and PM₁₀ refer to particulate matter with aerodynamic diameters ≤ 2.5 µm and ≤10 µm, respectively, reported in micrograms per cubic metre (µg/m³. Threshold-based alerting, cloud-based data processing, and school-led Closed-circuit television (CCTV) verification were combined to assess detection accuracy, temporal trends, and operational responses. The system recorded more than 300 vaping-related incidents, with clusters aligned to predictable times of day and higher prevalence among senior students. Operational detection performance was high, with alert events characterised by rapid, concurrent PM_2.5 and PM₁₀ excursions consistent with vaping-related aerosol profiles, although staff responsiveness declined over time due to alert fatigue and competing priorities. A major environmental smoke event demonstrated the need for context-aware logic to reduce false positives. The findings demonstrate that real-time aerosol monitoring is not only technically reliable but also highly effective in detecting vaping within school environments. These perspectives help explain why user engagement, alert fatigue, and institutional follow-through are as critical as sensor accuracy itself. Ultimately, the effectiveness of vape detection relies on strong organisational commitment, well-defined response workflows, and alignment with broader wellbeing and policy strategies. When these elements are in place, such systems can evolve from simple detection tools into intelligent, integrated components of school health governance. Full article

Background: Most individuals develop smoking habits in adolescence, highlighting the need for a smoking prevention program targeted at this age group. The use of “Implementation Intentions” (If-Then plans) about how to refuse a cigarette combined with anti-smoking messages has been shown to be effective in the UK. However, there is a scarcity of data regarding school-based smoking prevention interventions among adolescents available to countries with high tobacco consumption rates, like Greece. Objectives: To describe the cultural adaptation procedure and the evaluation protocol for the school-based “Implementation Intentions” program aimed at reducing tobacco use susceptibility among Greek adolescents aged 13–16 in school settings. Methods: The present study is part of the EU-funded FRESHAIR4Life Program. We will use a mixed-methods approach with a pre- and post-intervention design in six conveniently selected secondary schools in Heraklion, Crete, Greece, to measure the intervention’s Reach, Effectiveness, Adoption, Implementation, and Maintenance using the RE-AIM framework. The study plans to involve three Master Trainers (MTs), 20–25 school teachers (to be trained by the MTs), and approximately 480 students. Participating schools will receive the “Implementation Intentions” intervention, which is based on a goal-setting technique where individuals commit to perform a particular behavior when a specific context arises. The study will consist of five sequential phases: Phase I involves training three Master Trainers (MTs) using the International Primary Care Respiratory Group (IPCRG’s) Teach-the-Teacher (TtT) curriculum, specifically focused on the implementation of our intervention. In Phase II, workshops will be held to co-create and culturally adapt the intervention. Phase III will involve teachers trained by MTs on delivering the intervention. In Phase IV, teachers will deliver the intervention among students in their schools. Data will be collected pre- and post-intervention through surveys, session logs, fidelity observations, feedback forms, and follow-up interviews or focus groups (Phase V). Quantitative data will be analyzed descriptively and by using paired t-tests and multiple linear regression analyses, while qualitative data will undergo thematic analysis. Discussion: The study protocol’s potential benefits extend beyond educating Greek adolescents on the risks associated with smoking. Active participation will empower and motivate young people to make informed, healthy choices. We expect the results could help create more effective, context-specific interventions, support policy changes aimed at decreasing the prevalence of adolescent smoking in Crete, Greece, and potentially be used by other countries as well. Full article

Background/Objectives: We aimed to identify eating habits associated with hepatic fat fraction (HFF) and assess effect modification by an established genetic variant for fatty liver disease, PNPLA3 rs738409, among 381 general-risk adolescents. Methods: Dietary intake was assessed using the Block Kids Food Frequency Questionnaire and HFF was measured via magnetic resonance imaging (MRI) at age ~16 years. We first characterized naturally occurring dietary patterns using principal component analysis followed by reduced-rank regression with HFF as the response variable to identify a dietary pattern that is both relevant to the population and associated with HFF. Next, we investigated associations of the dietary pattern with HFF using linear regression models that accounted for maternal gestational diabetes, education, and prenatal smoking and child sex, age, Tanner stage, and BMI. Finally, we tested for a dietary pattern and PNPLA3 rs738409 interaction and stratified by genotype if P-interaction < 0.05. Results: The participants were 16.7 ± 1.2 years (range: 12.6–19.6 years). Half were female (50.4%) and 52.0% identified as non-Hispanic White. The dietary pattern of interest was composed of vegetables, fruit, nuts and seeds, oatmeal, sports bars, crackers and sandwiches, and beef, and was inversely associated with HFF (−0.48 [95% CI: −0.81, −0.16]). Stratified analyses revealed the strongest inverse association observed between the diet pattern score and HFF in the high-risk-variant (GG) group (−2.19 [−4.35, −0.03]), followed by the intermediate-risk (CG) group (−0.43 [−0.77, −0.10]), but not the low-risk (CC) group (−0.32 [−0.77, 0.13]). Conclusions: A diet high in vegetables, fruit, nuts and seeds, oatmeal, sports bars, crackers and sandwiches, and beef—potentially capturing an active, on-the-go lifestyle—is associated with lower HFF during adolescence, especially among individuals at genetic risk. Full article