Meta-Analysis of the Association between Body Mass Index and Health-Related Quality of Life among Children and Adolescents, Assessed Using the Pediatric Quality of Life Inventory Index

Objective To explore the relationships between body mass index and overall, physical, and psychosocial health-related quality of life (HRQoL) in children and adolescents. Study design A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Medline, Embase, PsycINFO, and the Web of Knowledge were searched for relevant articles. Inclusion was restricted to participants under 20 years of age, assessed using the Pediatric Quality of Life Inventory. Random-effects meta-analysis, meta-regression, and cumulative meta-analysis were conducted. Heterogeneity was assessed using the I2 statistic, and potential publication and small study bias were evaluated using funnel plots and the Egger test. Results Eleven eligible studies provided 35 estimates of effect size, derived from a total of 13 210 study participants. Based on self-reports, children and adolescents with above-normal body mass index had significantly lower total, physical, and psychosocial HRQoL, with a clear dose relationship across all categories. In obese children and adolescents, the overall score was reduced by 10.6 points (95% CI, 14.0-7.2; P