{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T12:36:59Z","timestamp":1772195819705,"version":"3.50.1"},"reference-count":89,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Minister of Science"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Children\u2019s behavior and lifestyle are changing rapidly, potentially exceeding the capacity of physiological adaptation. Contemporary lifestyles may negatively affect spinal development and contribute to dysfunction and premature degeneration. Despite the increasing prevalence of postural changes, cervical spine disorders in adolescents remain under-researched. Methods: This narrative review is based on a comprehensive search of PubMed\/MEDLINE and Scopus. The search strategy included a broad review of anatomical and biomechanical literature from the past 25 years and a focused review of studies from the last 15 years to reflect recent generational changes. Results: The immature spine has distinct structural and biomechanical characteristics that increase susceptibility to maladaptive responses to unbalanced forces. High screen time is associated with sedentary behavior and increased consumption of ultra-processed foods, which may affect metabolic health and musculoskeletal development. Childhood and adolescent obesity are increasingly prevalent and may influence spinal development, including through myosteatosis. Data on the consequences of cervical and lumbar lordosis loss in adolescents remain limited. Although degenerative spinal disorders are well recognized in adults, their identification in younger populations may be inadequate. Conclusions: Modern lifestyle factors pose a growing risk to children\u2019s spinal health through complex interactions among behavioral, metabolic, and biomechanical mechanisms. The developing spine\u2019s vulnerability and the coexistence of multiple, interrelated risk factors support the need for integrated preventive strategies rather than single-factor interventions. Future studies should focus on models capturing these interactions and their long-term consequences.<\/jats:p>","DOI":"10.3390\/children13030341","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T10:41:02Z","timestamp":1772188862000},"page":"341","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Modern Lifestyles on Spinal Health in the Pediatric Population: A Narrative Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Katarzyna","family":"Zaborowska-Sapeta","sequence":"first","affiliation":[{"name":"Department of Rehabilitation and Orthopaedics, School of Medicine, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland"},{"name":"Regional Specialized Children\u2019s Hospital in Olsztyn, 10-561 Olsztyn, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5889-2043","authenticated-orcid":false,"given":"Patrycja","family":"Tymi\u0144ska-W\u00f3jcik","sequence":"additional","affiliation":[{"name":"Department of Electrical Devices and High Voltage Technology, Lublin University of Technology, Nadbystrzycka 38A, 20-618 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0056-4984","authenticated-orcid":false,"given":"Anelise","family":"Sonza","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Postgraduate Program in Human Movement Sciences, Santa Catarina State University, Florianopolis 88035-001, Santa Catarina, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3187-9279","authenticated-orcid":false,"given":"Marek","family":"Kluszczy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Jagiellonian University, 31-007 Krakow, Poland"},{"name":"Pediatric Rehabilitation Department, University Children\u2019s Hospital of Krakow, Wielicka 265, 30-663 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2274-8867","authenticated-orcid":false,"given":"Agnieszka","family":"Skowro\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Human Physiology and Pathophysiology, School of Medicine, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1080\/00140139.2022.2146208","article-title":"Severity of slouched posture during smartphone use is associated with the musculoskeletal discomfort, daily usage, and school year among adolescents","volume":"66","author":"Tsang","year":"2023","journal-title":"Ergonomics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.15386\/mpr-2507","article-title":"Cervicogenic visual dysfunction: An understanding of its pathomechanism","volume":"96","author":"Leung","year":"2023","journal-title":"Med. Pharm. Rep."},{"key":"ref_3","first-page":"e57361","article-title":"Effectiveness of nonpharmacological measures on improving headache score, strength, pain, and quality of life in cervicogenic headaches: A systematic review","volume":"16","author":"Patil","year":"2024","journal-title":"Cureus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"554","DOI":"10.2519\/jospt.2022.10819","article-title":"Three in every 10 school-aged children in Brazil report back pain in any given year: A 12-month prospective cohort study of prevalence, incidence, and prognosis","volume":"52","author":"Santos","year":"2022","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.berh.2017.04.003","article-title":"The prevalence, risk factors, prognosis, and treatment for back pain in children and adolescents: An overview of systematic reviews","volume":"30","author":"Kamper","year":"2016","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Calvo-Mu\u00f1oz, I., G\u00f3mez-Conesa, A., and S\u00e1nchez-Meca, J. (2013). Prevalence of low back pain in children and adolescents: A meta-analysis. BMC Pediatr., 13.","DOI":"10.1186\/1471-2431-13-14"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s12969-024-01007-w","article-title":"Prevalence of spine pain among Tunisian children and adolescents and related factors","volume":"22","author":"Fazaa","year":"2024","journal-title":"Pediatr. Rheumatol. Online J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s43390-020-00182-6","article-title":"Adolescent idiopathic scoliosis detection and referral trends: Impact on treatment options","volume":"9","author":"Anthony","year":"2021","journal-title":"Spine Deform."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1016\/S0140-6736(18)30480-X","article-title":"What low back pain is and why we need to pay attention","volume":"391","author":"Hartvigsen","year":"2018","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Yang, N., Di, J., Wang, W., and Feng, H. (2025). Global burden of low back pain from 1990 to 2021: A comprehensive analysis of risk factors and trends using the Global Burden of Disease Study 2021. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-23178-1"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s00586-011-1983-3","article-title":"The growing spine: How spinal deformities influence normal spine and thoracic cage growth","volume":"21","author":"Dimeglio","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_12","first-page":"3","article-title":"Growth and maturation of the spine from birth to adolescence","volume":"89","author":"Labrom","year":"2007","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1053\/j.semss.2015.01.005","article-title":"Normal growth of the spine and skeletal maturation","volume":"27","author":"Sanders","year":"2015","journal-title":"Semin. Spine Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.nec.2016.07.003","article-title":"Pediatric thoracolumbar spine trauma","volume":"28","author":"Srinivasan","year":"2017","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Costa, L., de Reuver, S., and Kan, L. (2021). Ossification and fusion of the vertebral ring apophysis as an important part of spinal maturation. J. Clin. Med., 10.","DOI":"10.3390\/jcm10153217"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1007\/s00256-018-2909-5","article-title":"Radiographic morphology of normal ring apophyses in the immature cervical spine","volume":"47","author":"Woo","year":"2018","journal-title":"Skeletal Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"707","DOI":"10.5435\/00124635-201312000-00001","article-title":"Pediatric thoracolumbar spine trauma","volume":"21","author":"Daniels","year":"2013","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1053\/jpsu.2001.20720","article-title":"Pediatric cervical spine injuries: Defining the disease","volume":"36","author":"Patel","year":"2001","journal-title":"J. Pediatr. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1111\/jcmm.12377","article-title":"Mechanotransduction in intervertebral discs","volume":"18","author":"Tsai","year":"2014","journal-title":"J. Cell. Mol. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"C1","DOI":"10.1152\/ajpcell.00559.2003","article-title":"Cell mechanics and mechanotransduction: Pathways, probes, and physiology","volume":"287","author":"Huang","year":"2004","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1055\/s-0039-1693976","article-title":"Vertebrae, vertebral end plates, and disks: Concepts and specific pathologies","volume":"23","author":"Gersing","year":"2019","journal-title":"Semin. Musculoskelet. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Pickering, E., Pivonka, P., and Little, J.P. (2021). Toward patient specific models of pediatric IVDs: A parametric study of IVD mechanical properties. Front. Bioeng. Biotechnol., 9.","DOI":"10.3389\/fbioe.2021.632408"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"021011","DOI":"10.1115\/1.4031793","article-title":"An anisotropic multiphysics model for intervertebral disk","volume":"83","author":"Gao","year":"2016","journal-title":"J. Appl. Mech."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1097\/BRS.0000000000004795","article-title":"Morphologic changes of the intervertebral disk during growth","volume":"49","author":"Moens","year":"2024","journal-title":"Spine"},{"key":"ref_25","first-page":"10","article-title":"Histology and pathology of the human intervertebral disc","volume":"88","author":"Roberts","year":"2006","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1016\/j.otsr.2019.11.034","article-title":"MRI evaluation of the hydration status of non-pathological lumbar intervertebral discs in a pediatric population","volume":"106","author":"Bolzinger","year":"2020","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e1049","DOI":"10.1002\/jsp2.1049","article-title":"Aquaporin expression in the human and canine intervertebral disc during maturation and degeneration","volume":"2","author":"Snuggs","year":"2019","journal-title":"JOR Spine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s005860050217","article-title":"The vertebral end-plate: What do we know?","volume":"9","author":"Moore","year":"2000","journal-title":"Eur. Spine J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2324","DOI":"10.1097\/BRS.0b013e3181b4df92","article-title":"What influence does sustained mechanical load have on diffusion in the human intervertebral disc? An in vivo study using serial postcontrast magnetic resonance imaging","volume":"34","author":"Ranganathan","year":"2009","journal-title":"Spine"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Zhan, J.-W., Wang, S.-Q., Feng, M.-S., Wei, X., Yu, J., and Yin, X.-L. (2020). Constant compression decreases vascular bud and VEGFA expression in a rabbit vertebral endplate ex vivo culture model. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0234747"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2342","DOI":"10.1016\/j.jbiomech.2013.07.014","article-title":"What have we learned from finite element model studies of lumbar intervertebral discs in the past four decades?","volume":"46","author":"Schmidt","year":"2013","journal-title":"J. Biomech."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1016\/j.jbiomech.2012.08.044","article-title":"Cell viability in intervertebral disc under various nutritional and dynamic loading conditions: 3d finite element analysis","volume":"45","author":"Zhu","year":"2012","journal-title":"J. Biomech."},{"key":"ref_33","first-page":"85","article-title":"Pathological changes in the lumbar intervertebral discs among professional field hockey players","volume":"56","author":"Ogurkowska","year":"2016","journal-title":"J. Sports Med. Phys. Fit."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"56898","DOI":"10.12775\/QS.2025.37.56898","article-title":"The association between physical activity and the development of degenerative spine disease: A review","volume":"37","author":"Chodkowski","year":"2025","journal-title":"Qual. Sport"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"391","DOI":"10.31189\/2165-7629-13-s2.391","article-title":"Upright bipedal exercise training improves intervertebral disc health: A systematic review and meta-analysis","volume":"13","author":"Samanna","year":"2024","journal-title":"J. Clin. Exerc. Physiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1007\/s40279-015-0444-2","article-title":"Can exercise positively influence the intervertebral disc?","volume":"46","author":"Belavy","year":"2016","journal-title":"Sports Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"102769","DOI":"10.1016\/j.otsr.2020.102769","article-title":"Sagittal balance of the spine","volume":"107","author":"Kariman","year":"2021","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1007\/s00586-019-06083-1","article-title":"Sagittal balance of the spine","volume":"28","author":"Thompson","year":"2019","journal-title":"Eur. Spine J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1007\/s00586-011-1924-1","article-title":"Sagittal parameters of the spine: Biomechanical approach","volume":"20","author":"Roussouly","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"070805","DOI":"10.1115\/1.4043650","article-title":"Spinal balance\/alignment\u2014Clinical relevance and biomechanics","volume":"141","author":"Shah","year":"2019","journal-title":"J. Biomech. Eng."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"E259","DOI":"10.1097\/BSD.0b013e318261f346","article-title":"Analysis of sagittal spinal alignment in 181 asymptomatic children","volume":"25","author":"Lee","year":"2012","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1007\/s10439-014-1160-z","article-title":"The assessment of the spinal curvatures in the sagittal plane of children using an ultrasound-based motion analysing system","volume":"43","author":"Takacs","year":"2015","journal-title":"Ann. Biomed. Eng."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"676","DOI":"10.2106\/JBJS.22.00977","article-title":"Spinal sagittal alignment changes during childhood: Results of a national cohort analysis of 1,059 healthy children","volume":"105","author":"Pesenti","year":"2023","journal-title":"J. Bone Jt. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.3233\/BMR-191727","article-title":"Sagittal standing spinal alignment and back pain in 8 to 12-year-old children from the Region of Murcia, Spain: The ISQUIOS Program","volume":"33","author":"Andujar","year":"2020","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_45","unstructured":"Rideout, V., Peebles, A., Mann, S., and Robb, M.B. (2022). Common Sense Census: Media Use by Tweens and Teens, 2021, Common Sense."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"100596","DOI":"10.1016\/j.puhip.2025.100596","article-title":"Age of first digital device use and screen media use at age 15: A cross-sectional analysis of 384,591 participants from 55 countries","volume":"9","author":"Slater","year":"2025","journal-title":"Public Health Pract."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"fmab092","DOI":"10.1093\/tropej\/fmab092","article-title":"Predictors for Screen Time Exposure among Children between 3 and 5 Years Old in Southern Brazil","volume":"67","author":"Frata","year":"2021","journal-title":"J. Trop. Pediatr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"117","DOI":"10.28982\/josam.8082","article-title":"The relationship between intervertebral disc pathologies and the use of digital devices and lack of physical activity in adolescents","volume":"8","author":"Hantal","year":"2024","journal-title":"J. Surg. Med."},{"key":"ref_49","first-page":"1467","article-title":"Prevalence and factors related to nomophobia: Arising issues among young adults","volume":"13","author":"Vagka","year":"2023","journal-title":"Eur. J. Investig. Health Psychol. Educ."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Jahrami, H., Trabelsi, K., Boukhris, O., Hussain, J.H., Alenezi, A.F., Humood, A., Saif, Z., Pandi-Perumal, S.R., and Seeman, M.V. (2023). The prevalence of mild, moderate, and severe nomophobia symptoms: A systematic review, meta-analysis, and meta-regression. Behav. Sci., 13.","DOI":"10.3390\/bs13010035"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"100589","DOI":"10.1016\/j.ijchp.2025.100589","article-title":"The longitudinal impact of screen media activities on brain function, architecture and mental health in early adolescence","volume":"25","author":"Dong","year":"2025","journal-title":"Int. J. Clin. Health Psychol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1080\/00140139.2022.2047229","article-title":"Comparing the effect of the posture of using smartphones on head and neck angles among college students","volume":"65","author":"Faeze","year":"2022","journal-title":"Ergonomics"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"In, T.S., Jung, J.H., Jung, K.S., and Cho, H.Y. (2021). Spinal and pelvic alignment of sitting posture associated with smartphone use in adolescents with low back pain. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18168369"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2561","DOI":"10.1152\/physrev.00022.2022","article-title":"The physiology of sedentary behavior","volume":"103","author":"Pinto","year":"2023","journal-title":"Physiol. Rev."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Zhao, X., Yang, Y., Yue, R., and Su, C. (2023). Potential causal association between leisure sedentary behaviors, physical activity and musculoskeletal health: A Mendelian randomization study. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0283014"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"278","DOI":"10.3961\/jpmph.24.614","article-title":"Association of sedentary lifestyle with skeletal muscle strength and mass in US adolescents: Results from the National Health and Nutrition Examination Survey (2011\u20132014)","volume":"58","author":"Oh","year":"2025","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"C1068","DOI":"10.1152\/ajpcell.00425.2021","article-title":"Disuse-induced skeletal muscle atrophy in disease and non-disease states in humans: Mechanisms, prevention, and recovery strategies","volume":"322","author":"Nunes","year":"2022","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S2352-4642(19)30323-2","article-title":"Global trends in insufficient physical activity among adolescents: A pooled analysis of 298 population-based surveys with 1.6 million participants","volume":"4","author":"Guthold","year":"2020","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Joergensen, A.C., Strandberg-Larsen, K., and Andersen, P.K. (2021). Spinal pain in pre-adolescence and the relation with screen time and physical activity behavior. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04263-z"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4103\/ijpvm.ijpvm_101_24","article-title":"The relationship between mobile phone addiction and changes in spinal column angles of male high school students with endomorphic body type","volume":"16","author":"Seyedahmadi","year":"2025","journal-title":"Int. J. Prev. Med."},{"key":"ref_61","first-page":"e38034","article-title":"Pediatric text neck syndrome","volume":"15","author":"Chu","year":"2023","journal-title":"Cureus"},{"key":"ref_62","unstructured":"Ahn, M.E., and Park, S.M. (2008). Prevention and Treatment Device of Turtle Neck Syndrome. (Republic of Korea Patent 10-0869693)."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"David, D., Giannini, C., Chiarelli, F., and Mohn, A. (2021). Text neck syndrome in children and adolescents. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18041565"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Yong, M.S., and Lee, H.Y. (2025). Does forward head posture influence muscle tone, stiffness, and elasticity in university students?. J. Clin. Med., 14.","DOI":"10.3390\/jcm14061888"},{"key":"ref_65","first-page":"355","article-title":"Quantitative study of muscle spindles in suboccipital muscles of human foetuses","volume":"49","author":"Kulkarni","year":"2001","journal-title":"Neurol. India"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Martinez-Merinero, P., Nunez-Nagy, S., Achalandabaso-Ochoa, A., Fernandez-Matias, R., Pecos-Martin, D., and Gallego-Izquierdo, T.J. (2020). Relationship between forward head posture and tissue mechanosensitivity: A cross-sectional study. J. Clin. Med., 9.","DOI":"10.3390\/jcm9030634"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"385","DOI":"10.12965\/jer.2040612.306","article-title":"Upper cervical spine dysfunction and dizziness","volume":"16","author":"Sung","year":"2020","journal-title":"J. Exerc. Rehabil."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Li, Y., Yang, L., Dai, C., and Peng, B. (2022). Proprioceptive cervicogenic dizziness: A narrative review of pathogenesis, diagnosis, and treatment. J. Clin. Med., 11.","DOI":"10.3390\/jcm11216293"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"545","DOI":"10.14740\/jmc4025","article-title":"Cervical radiculopathy as a hidden cause of angina: Cervicogenic angina","volume":"13","author":"Chun","year":"2022","journal-title":"J. Med. Cases"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Hauser, R.A., Matias, D., and Rawlings, B. (2024). The ligamentous cervical instability etiology of human disease from the forward head-facedown lifestyle: Emphasis on obstruction of fluid flow into and out of the brain. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1430390"},{"key":"ref_71","first-page":"000254","article-title":"Hauser\u2019s laws on the ligamentous structural causes of chronic disabling symptoms of human diseases","volume":"7","author":"Hauser","year":"2024","journal-title":"Open J. Neurol. Brain Disord."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/obr.12107","article-title":"Ultra-processed products are becoming dominant in the global food system","volume":"14","author":"Monteiro","year":"2013","journal-title":"Obes. Rev."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1017\/S1368980010003241","article-title":"Increasing consumption of ultra-processed foods and likely impact on human health: Evidence from Brazil","volume":"14","author":"Monteiro","year":"2010","journal-title":"Public Health Nutr."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Al-Jawaldeh, A., Taktouk, M., and Nasreddine, L. (2020). Food consumption patterns and nutrient intakes of children and adolescents in the Eastern Mediterranean Region: A call for policy action. Nutrients, 12.","DOI":"10.3390\/nu12113345"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Morais, R., Rodrigues, M., Ferreira, F., Barros, R., Padrao, P., Ortigao, M., Tavares, M., and Moreira, P. (2024). Ultra-processed foods and nutritional intake of children and adolescents from Cantagalo, S\u00e3o Tom\u00e9 and Pr\u00edncipe. Children, 11.","DOI":"10.3390\/children11091089"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Gomes, G.M., Souza, R.C.V., dos Santos, T.N., and dos Santos, L.C. (2024). Screen exposure in 4-year-old children: Association with development, daily habits, and ultra-processed food consumption. Int. J. Environ. Res. Public Health, 21.","DOI":"10.3390\/ijerph21111504"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1016\/j.jand.2024.04.015","article-title":"Screen time use and ultra-processed food consumption in adolescents: A focus group qualitative study","volume":"124","year":"2024","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1038\/s41413-020-00127-9","article-title":"Ultra-processed food targets bone quality via endochondral ossification","volume":"9","author":"Zaretsky","year":"2021","journal-title":"Bone Res."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Travinsky-Shmul, T., Beresh, O., Zaretsky, J., Griess-Fishheimer, S., Rozner, R., Kalev-Altman, R., Penn, S., Shahar, R., and Monsonego-Ornan, E. (2021). Ultra-processed food impairs bone quality, increases marrow adiposity and alters gut microbiome in mice. Foods, 10.","DOI":"10.3390\/foods10123107"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Kong, W., Xie, Y., Hu, J., Ding, W., and Cao, C. (2024). Higher ultra processed foods intake is associated with low muscle mass in young to middle-aged adults: A cross-sectional NHANES study. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1280665"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1007\/s00394-021-02737-3","article-title":"Ultra-processed food intake is associated with grip strength decline in middle-aged and older adults: A prospective analysis of the TCLSIH study","volume":"61","author":"Zhang","year":"2021","journal-title":"Eur. J. Nutr."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Zhang, B., Shi, H., Cai, W., Yang, B., and Xiu, W. (2025). Metabolic syndrome in children and adolescents: Definitions, epidemiology, pathophysiology, interventions, and challenges. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1512642"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Teraguchi, M., Yoshimura, N., Hashizume, H., Muraki, S., Yamada, H., Oka, H., Minamide, A., Ishimoto, Y., Nagata, K., and Kagotani, R. (2016). Metabolic syndrome components are associated with intervertebral disc degeneration: The Wakayama Spine Study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0147565"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Li, S., Du, J., Huang, Y., Gao, S., Zhao, Z., Chang, Z., Zhang, X., and He, B. (2024). From hyperglycemia to intervertebral disc damage: Exploring diabetic-induced disc degeneration. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1355503"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Huang, Z., Chen, J.J., Su, Y.-C., Guo, M., Chen, Y., Zhu, Y., Nie, G., Ke, R., Chen, H., and Hu, J. (2022). Impact of dyslipidemia on the severity of symptomatic lumbar spine degeneration: A retrospective clinical study. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.1033375"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"4","DOI":"10.7570\/jomes.2019.28.1.4","article-title":"The impact of childhood obesity on skeletal health and development","volume":"28","author":"Dimitri","year":"2019","journal-title":"J. Obes. Metab. Syndr."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Hasan, S., Naseer, S., Zamzam, M., Mohilldean, H., Wagoner, C., Hasan, A.I., Saleh, E.S., Uhley, V., and Kamel-ElSayed, S. (2024). Nutrient and hormonal effects on long bone growth in healthy and obese children: A literature review. Children, 11.","DOI":"10.3390\/children11070817"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.2337\/diabetes.51.4.1022","article-title":"Assessment of skeletal muscle triglyceride content by 1H nuclear magnetic resonance spectroscopy in lean and obese adolescents: Relationships to insulin sensitivity, total body fat, and central adiposity","volume":"51","author":"Sinha","year":"2002","journal-title":"Diabetes"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1007\/s11154-025-09941-0","article-title":"Poor muscle quality: A hidden and detrimental health condition in obesity","volume":"26","author":"Vieira","year":"2025","journal-title":"Rev. Endocr. Metab. Disord."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/341\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T11:17:25Z","timestamp":1772191045000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/341"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":89,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["children13030341"],"URL":"https:\/\/doi.org\/10.3390\/children13030341","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]}}}