{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:02:46Z","timestamp":1789534966347,"version":"build-2803163510"},"reference-count":44,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: This study aimed to compare grazing behavior scores between adolescents with essential hypertension (HTN) and controls. It also investigated the associations of grazing behavior with obesity, emotion regulation difficulties (ERD), problematic smartphone use, and screen time. Methods: This cross-sectional case\u2013control study enrolled 60 adolescents with essential HTN and 60 controls selected via frequency matching based on age and sex, all aged 12\u201318 years. The diagnosis of essential HTN was confirmed using 24-h ambulatory blood pressure monitoring (ABPM). Grazing behavior, ERD, problematic smartphone use, screen time and body mass index (BMI) were assessed in all participants. Group comparisons and associations between grazing behavior and the study variables were analyzed. Results: The essential HTN and control groups were comparable with respect to age and sex distribution (p &gt; 0.05). The mean BMI in the essential HTN group was 31.18 \u00b1 6.81 kg\/m2, which was significantly higher than that in the control group (23.35 \u00b1 4.47 kg\/m2) (p &lt; 0.001). A significant positive correlation was found between total Grazing Questionnaire (GQ) scores and BMI (r = 0.252; p = 0.006), ERD (r = 0.187; p = 0.041), and problematic smartphone use (r = 0.315; p &lt; 0.001). A statistically significant difference was observed between the essential HTN and control groups in total GQ scores [F(1, 117) = 4.85, p = 0.030, \u03b72p = 0.040]. After adjustment for BMI, participants with hepatic steatosis had significantly higher total GQ scores (p = 0.019, \u03b72p = 0.138), Grazing Behaviors subscale scores (p = 0.046, \u03b72p = 0.107), and Uncontrollability subscale scores (p = 0.025, \u03b72p = 0.123) than those without hepatic steatosis. Conclusions: Adolescents with essential HTN had higher grazing behavior scores than controls after adjustment for BMI. Grazing behavior was also associated with ERD and problematic smartphone use across the study sample. The findings regarding grazing behavior and hepatic steatosis warrant cautious interpretation, as the subgroup analysis was exploratory and included a relatively small number of participants.<\/jats:p>","DOI":"10.3390\/children13091233","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:14:59Z","timestamp":1789146899000},"page":"1233","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Grazing Behavior and Its Associations with Obesity, Emotion Regulation Difficulties, and Problematic Smartphone Use in Adolescents with Essential Hypertension"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8532-9168","authenticated-orcid":false,"given":"Gunes","family":"Isik","sequence":"first","affiliation":[{"name":"Pediatric Nephrology, Sivas Cumhuriyet University, 58140 Sivas, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cansu","family":"Mercan Isik","sequence":"additional","affiliation":[{"name":"Child and Adolescent Psychiatry, Sivas Cumhuriyet University, 58140 Sivas, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masum","family":"Ozturk","sequence":"additional","affiliation":[{"name":"Child and Adolescent Psychiatry, Dicle University, 21280 Diyarbakir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E101","DOI":"10.1161\/HYP.0000000000000228","article-title":"Pediatric Primary Hypertension: An Underrecognized Condition: A Scientific Statement From the American Heart Association","volume":"80","author":"Falkner","year":"2023","journal-title":"Hypertension"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S2352-4642(25)00281-0","article-title":"Global prevalence of hypertension among children and adolescents aged 19 years or younger: An updated systematic review and meta-analysis","volume":"10","author":"Zhou","year":"2025","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1001\/jamapediatrics.2019.3310","article-title":"Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis","volume":"173","author":"Song","year":"2019","journal-title":"JAMA Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e20171904","DOI":"10.1542\/peds.2017-1904","article-title":"Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents","volume":"140","author":"Flynn","year":"2017","journal-title":"Pediatrics"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s13679-025-00666-4","article-title":"Graze Eating and Obesity: A Conceptualization Within the Spectrum of Disordered Eating","volume":"14","author":"Heriseanu","year":"2025","journal-title":"Curr. Obes. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1038\/ijo.2014.110","article-title":"Screen time, adiposity and cardiometabolic markers: Mediation by physical activity, not snacking, among 11-year-old children","volume":"38","author":"Berentzen","year":"2014","journal-title":"Int. J. Obes."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Favieri, F., Marini, A., and Casagrande, M. (2021). Emotional Regulation and Overeating Behaviors in Children and Adolescents: A Systematic Review. Behav. Sci., 11.","DOI":"10.3390\/bs11010011"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.appet.2017.07.012","article-title":"Repetitive eating questionnaire [Rep(eat)-Q]: Enlightening the concept of grazing and psychometric properties in a Portuguese sample","volume":"117","author":"Mitchell","year":"2017","journal-title":"Appetite"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1080\/07315724.2001.10719064","article-title":"Eating Patterns, Dietary Quality and Obesity","volume":"20","author":"Nicklas","year":"2001","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s40519-017-0370-4","article-title":"Is snack consumption associated with meal skipping in children and adolescents? The CASPIAN-IV study","volume":"22","author":"Kelishadi","year":"2017","journal-title":"Eat. Weight. Disord.-Stud. Anorex. Bulim. Obes."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1002\/eat.22862","article-title":"Problematic eating behaviors and psychopathology in patients undergoing bariatric surgery: The mediating role of loss of control eating","volume":"51","author":"Vaz","year":"2018","journal-title":"Int. J. Eat. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kwon, M., Kim, D.-J., Cho, H., and Yang, S. (2013). The Smartphone Addiction Scale: Development and Validation of a Short Version for Adolescents. PLoS ONE, 8.","DOI":"10.1037\/t71126-000"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Orlando, A., Cazzaniga, E., Giussani, M., Palestini, P., and Genovesi, S. (2018). Hypertension in Children: Role of Obesity, Simple Carbohydrates, and Uric Acid. Front. Public Health, 6.","DOI":"10.3389\/fpubh.2018.00129"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1542\/peds.2011-3870","article-title":"Sodium Intake and Blood Pressure Among US Children and Adolescents","volume":"130","author":"Yang","year":"2012","journal-title":"Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Du, L., Hao, J., Yu, K., Su, P., Pu, J., Tang, Z., Liu, F., and Zhou, J. (2025). Relationship between the dietary inflammation index and hypertension in American children and adolescents: Findings from the national health and nutrition examination survey 1999\u20132018. BMC Cardiovasc. Disord., 25.","DOI":"10.1186\/s12872-025-04515-z"},{"key":"ref_16","first-page":"e30051","article-title":"Increased Screen Time as a Cause of Declining Physical, Psychological Health, and Sleep Patterns: A Literary Review","volume":"14","author":"Nakshine","year":"2022","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s41043-023-00437-8","article-title":"Prolonged screen watching behavior is associated with high blood pressure among children and adolescents: A systematic review and dose\u2013response meta-analysis","volume":"42","author":"Farhangi","year":"2023","journal-title":"J. Health Popul. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e69210","DOI":"10.2196\/69210","article-title":"Association Between Excessive Internet Use Time, Internet Addiction, and Physical-Mental Multimorbidity Among Chinese Adolescents: Cross-Sectional Study","volume":"27","author":"Gu","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Shriver, L.H., Dollar, J.M., Calkins, S.D., Keane, S.P., Shanahan, L., and Wideman, L. (2020). Emotional Eating in Adolescence: Effects of Emotion Regulation, Weight Status and Negative Body Image. Nutrients, 13.","DOI":"10.3390\/nu13010079"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2837","DOI":"10.1038\/s41380-021-01053-w","article-title":"Reciprocal control of obesity and anxiety\u2013depressive disorder via a GABA and serotonin neural circuit","volume":"26","author":"Xia","year":"2021","journal-title":"Mol. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Stabouli, S., Erdine, S., Suurorg, L., Jankauskien\u0117, A., and Lurbe, E. (2021). Obesity and Eating Disorders in Children and Adolescents: The Bidirectional Link. Nutrients, 13.","DOI":"10.3390\/nu13124321"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E114","DOI":"10.1161\/HYP.0000000000000215","article-title":"Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association","volume":"79","author":"Flynn","year":"2022","journal-title":"Hypertension"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e499","DOI":"10.3928\/19382359-20181119-01","article-title":"Pediatric Hypertension","volume":"47","author":"Matossian","year":"2018","journal-title":"Pediatr. Ann."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1136\/bmj.292.6512.13","article-title":"Ultrasound scanning in the detection of hepatic fibrosis and steatosis","volume":"292","author":"Saverymuttu","year":"1986","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e2022060640","DOI":"10.1542\/peds.2022-060640","article-title":"Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity","volume":"151","author":"Hampl","year":"2023","journal-title":"Pediatrics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"280","DOI":"10.4274\/jcrpe.2183","article-title":"Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children","volume":"7","author":"Neyzi","year":"2015","journal-title":"J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1017\/bec.2013.6","article-title":"Uncontrolled, Repetitive Eating of Small Amounts of Food or \u2018Grazing\u2019: Development and Evaluation of a New Measure of Atypical Eating","volume":"30","author":"Lane","year":"2013","journal-title":"Behav. Change"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"471","DOI":"10.18863\/pgy.1351056","article-title":"Little and Often Eating: Turkish Adaptation, Validity, and Reliability Study of the Grazing Scale [in Turkish]","volume":"15","author":"Akkaya","year":"2023","journal-title":"Psikiyatr. G\u00fcncel Yakla\u015f\u0131mlar"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1007\/s10862-015-9514-x","article-title":"Development and Validation of a Brief Version of the Difficulties in Emotion Regulation Scale: The DERS-16","volume":"38","author":"Bjureberg","year":"2015","journal-title":"J. Psychopathol. Behav. Assess."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Secinti, D.D., and Sen, E. (2023). Reliability and validity of the brief version of the difficulties in emotion regulation scale in a sample of Turkish adolescents. BMC Psychol., 11.","DOI":"10.1186\/s40359-023-01199-y"},{"key":"ref_31","first-page":"426","article-title":"Ak\u0131ll\u0131 Telefon Ba\u011f\u0131ml\u0131l\u0131\u011f\u0131 \u00d6l\u00e7e\u011fi-K\u0131sa Versiyonunun Ergenler \u0130\u00e7in T\u00fcrk K\u00fclt\u00fcr\u00fcne Uyarlanmas\u0131","volume":"6","author":"Ata","year":"2017","journal-title":"Cumhur. Int. J. Educ."},{"key":"ref_32","first-page":"439","article-title":"Grazing in children: Associations with child\u2019s characteristics and parental feeding practices","volume":"26","author":"Pinheiro","year":"2020","journal-title":"Eat. Weight. Disord.-Stud. Anorex. Bulim. Obes."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/j.2047-6310.2011.00046.x","article-title":"Overweight and obese teenagers: Why is adolescence a critical period?","volume":"7","author":"Alberga","year":"2012","journal-title":"Pediatr. Obes."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s13679-019-0327-1","article-title":"Loss-of-Control Eating and Obesity Among Children and Adolescents","volume":"8","author":"Byrne","year":"2019","journal-title":"Curr. Obes. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.eatbeh.2006.10.001","article-title":"Children\u2019s descriptions of the foods consumed during loss of control eating episodes","volume":"8","author":"Theim","year":"2007","journal-title":"Eat. Behav."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1002\/eat.20630","article-title":"Emotion regulation and binge eating in children","volume":"42","author":"Czaja","year":"2008","journal-title":"Int. J. Eat. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1037\/hea0000389","article-title":"Emotion dysregulation and loss-of-control eating in children and adolescents","volume":"35","author":"Kelly","year":"2016","journal-title":"Health Psychol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Sandel, P., Ma, L., Wang, H., and Pasman, E.A. (2023). You Are What You Eat: A Review on Dietary Interventions for Treating Pediatric Nonalcoholic Fatty Liver Disease. Nutrients, 15.","DOI":"10.3390\/nu15153350"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/s41430-021-00928-z","article-title":"Non-alcoholic fatty liver disease in obese children and adolescents: A role for nutrition?","volume":"76","author":"Bonsembiante","year":"2021","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Lin, G., Xinhe, Z., Haoyu, T., Xing, J., Dan, L., Ningning, W., Jing, S., Xue, W., Zilu, Z., and Yiling, L. (2022). Epidemiology and lifestyle survey of non-alcoholic fatty liver disease in school-age children and adolescents in Shenyang, Liaoning. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03351-w"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1001\/jama.2018.20579","article-title":"Effect of a Low Free Sugar Diet vs Usual Diet on Nonalcoholic Fatty Liver Disease in Adolescent Boys","volume":"321","author":"Schwimmer","year":"2019","journal-title":"JAMA"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/MPG.0000000000001482","article-title":"NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children","volume":"64","author":"Vos","year":"2017","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"S311","DOI":"10.1139\/apnm-2016-0151","article-title":"Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep","volume":"41","author":"Tremblay","year":"2016","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.5664\/jcsm.7374","article-title":"Insufficient Sleep Duration Is Associated With Dietary Habits, Screen Time, and Obesity in Children","volume":"14","author":"Tambalis","year":"2018","journal-title":"J. Clin. Sleep Med."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/9\/1233\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:15:31Z","timestamp":1789532131000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/9\/1233"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":44,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["children13091233"],"URL":"https:\/\/doi.org\/10.3390\/children13091233","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]}}}