Screening cognitive and academic problems in Duchenne Muscular Dystrophy: Validity and reliability of the Kempenhaeghe Learning Questionnaire.

Childhood obesity has become a major public health challenge, with its prevalence rising sharply in recent decades and affecting millions of children worldwide []. Various factors, including sex, age, and urbanization level influenced obesity trends, with children from rural areas being at higher risk of being overweight or obese []. The condition has serious and complex health consequences, increasing the risk of chronic diseases, such as type 2 diabetes, cardiovascular conditions, as well as psychological issues such as anxiety and low self-esteem [–]. Childhood overweight and obesity also have significant socioeconomic implications, as children from lower-income families were more often living with overweight or obesity, further exacerbating health inequalities [, ]. Children and adolescents with obesity are significantly more likely to remain obese in adulthood, with severe obesity posing an even greater risk for cardiometabolic complications and premature mortality [, ]. The development of childhood obesity is increasingly understood to involve complex interactions between genetic predisposition and environmental factors, with emerging evidence highlighting the critical role of epigenetic mechanisms []. Genetic factors contribute approximately 40–70% of the variation in body mass index, with genome-wide association studies identifying numerous obesity-susceptibility genes, including FTO, MC4R, and TMEM18 []. However, the dramatic rise in childhood obesity prevalence over recent decades suggests that environmental factors acting through epigenetic modifications play a crucial role in gene expression regulation. Epigenetic changes, including DNA methylation and histone modifications, can be influenced by early-life exposures such as maternal nutrition, stress, and environmental toxins, potentially programming metabolic pathways that predispose children to obesity [, ]. These epigenetic modifications can be inherited across generations, providing a mechanism for the transgenerational transmission of obesity risk and helping explain familial clustering patterns beyond traditional genetic inheritance []. In some Mediterranean countries, the growing prevalence of childhood obesity has become a significant concern, with Croatia standing out in Europe for having one of the highest obesity rates [–]. In Croatia, maternal education has been identified as a key factor, with children of mothers having lower educational attainment facing a greater risk of being overweight or obese [–]. Effective management of childhood obesity requires a comprehensive approach involving the patient, family, school, community, and government, with a focus on lifestyle changes, including a healthy diet and increased physical activity [, ].