{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:14:28Z","timestamp":1777979668147,"version":"3.51.4"},"reference-count":41,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Childhood obesity is a major global health concern and is increasingly recognized as a factor influencing skeletal development. Emerging evidence suggests that excess adiposity may alter craniofacial growth patterns, with potential implications for orthodontic diagnosis and treatment planning. However, the extent to which obesity affects craniofacial morphology in growing individuals remains incompletely understood. This study aims to evaluate the association between body mass index (BMI) and craniofacial morphology in children and adolescents using selected sagittal and linear parameters, and to assess the independent effects of age and sex. Materials and Methods: This cross-sectional orthodontic study included 130 subjects aged \u2264 19 years. Anthropometric measurements were recorded, and BMI was used to classify participants as normal weight, overweight, or obese. Standardized lateral cephalometric radiographs were analyzed using skeletal and soft-tissue parameters. Statistical analyses included normality testing, one-way ANOVA with post hoc comparisons, and multivariate modeling. Results: Obesity was significantly associated with increased sagittal skeletal dimensions. Mandibular body length, mandibular unit length, SNB angle, and maxillary unit length demonstrated progressive increases across BMI categories (p &lt; 0.05). In contrast, vertical growth parameters showed no significant differences. Soft-tissue analysis revealed reduced facial convexity and lower facial height ratios in obese subjects. Age was strongly associated with increases in linear jaw dimensions, whereas sex differences were limited primarily to skeletal size rather than morphological relationships. Conclusions: Childhood obesity is associated with enhanced sagittal craniofacial growth, particularly involving mandibular structures, while vertical skeletal patterns remain largely unaffected. These findings highlight the importance of incorporating BMI assessment into orthodontic evaluation and suggest that obesity may influence growth timing, facial morphology, and airway-related risk factors.<\/jats:p>","DOI":"10.3390\/medicina62050884","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T10:01:30Z","timestamp":1777975290000},"page":"884","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Childhood Obesity and Craniofacial Growth: A Cross-Sectional Orthodontic Cephalometric Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5433-1137","authenticated-orcid":false,"given":"Sorana Maria","family":"Bucur","sequence":"first","affiliation":[{"name":"Department of Dentistry, Faculty of Medicine, Dimitrie Cantemir University of T\u00e2rgu Mure\u0219, 3-5 Bodoni Sandor Street, 540545 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6823-8138","authenticated-orcid":false,"given":"Dorin Ioan","family":"Coco\u0219","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, \u201cDun\u0103rea de Jos\u201d University, 800008 Gala\u021bi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristian Doru","family":"Olteanu","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dental Medicine, University of Medicine and Pharmacy Iuliu Hatieganu, Str. Avram Iancu 31, 400083 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mioara","family":"Decusar\u0103","sequence":"additional","affiliation":[{"name":"Department of Dentistry, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 47 Domneasc\u0103 Str., 800008 Gala\u021bi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana","family":"P\u0103curar","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dentistry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 38 Gheorghe Marinescu Street, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5193-4944","authenticated-orcid":false,"given":"Eugen Silviu","family":"Bud","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dentistry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu Mure\u0219, 38 Gheorghe Marinescu Street, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/S0140-6736(02)09678-2","article-title":"Childhood obesity: Public-health crisis, common-sense cure","volume":"360","author":"Ebbeling","year":"2002","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1017\/S1368980017003743","article-title":"Secular trends in regional differences in nutritional biomarkers and self-reported dietary intakes among American adults: National Health and Nutrition Examination Survey (NHANES) 1988\u20131994 to 2009\u20132010","volume":"21","author":"Kant","year":"2018","journal-title":"Public Health Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.2105\/AJPH.94.9.1496","article-title":"Childhood obesity in New York City elementary school students","volume":"94","author":"Thorpe","year":"2004","journal-title":"Am. J. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Vourdoumpa, A., Paltoglou, G., and Charmandari, E. (2023). The genetic basis of childhood obesity: A systematic review. Nutrients, 15.","DOI":"10.3390\/nu15061416"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1007\/s13300-025-01734-7","article-title":"Comprehending the epidemiology and aetiology of childhood obesity: Integrating life course approaches for prevention and intervention","volume":"16","author":"Verma","year":"2025","journal-title":"Diabetes Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"134202","DOI":"10.1155\/2012\/134202","article-title":"Childhood obesity and obstructive sleep apnea","volume":"2012","author":"Narang","year":"2012","journal-title":"J. Nutr. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/S2213-8587(22)00047-X","article-title":"Obesity in children and adolescents: Epidemiology, causes, assessment, and management","volume":"10","author":"Jebeile","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1111\/cdev.12548","article-title":"The social and emotional lives of overweight, obese, and severely obese children","volume":"87","author":"Harrist","year":"2016","journal-title":"Child Dev."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Verdecchia, A., Su\u00e1rez-Fern\u00e1ndez, C., Men\u00e9ndez Diaz, I., Sanz, V.G., Spinas, E., and Cobo, T. (2025). Obesity and overweight conditions in children and adolescents (6\u201318 years) and their impact on craniofacial morphology: A systematic review. Children, 12.","DOI":"10.3390\/children12030377"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"cjad043","DOI":"10.1093\/ejo\/cjad043","article-title":"Influence of BMI percentile on craniofacial morphology and development in adolescents. Part II: Elevated BMI is associated with larger final facial dimensions","volume":"46","author":"Hancock","year":"2024","journal-title":"Eur. J. Orthod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1093\/sleep\/33.8.1075","article-title":"Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea","volume":"33","author":"Lee","year":"2010","journal-title":"Sleep"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"cjaf069","DOI":"10.1093\/ejo\/cjaf069","article-title":"Influence of body mass index on facial soft tissue morphology in growing non-obese children","volume":"47","author":"Kaminkova","year":"2025","journal-title":"Eur. J. Orthod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1111\/ocr.70008","article-title":"Deep learning-based evaluation of skeletal maturation: A comparative analysis of five hand-wrist methods","volume":"28","year":"2025","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Nokes, B., Schueler, A., Darquenne, C., Schmickl, C.N., Wojeck, B.S., Moore, S., Deyoung, P., McGinnis, L., Theilmann, R.J., and Gruenberg, E. (2025). The impact of obesity on upper airway anatomy as assessed by magnetic resonance imaging and obstructive sleep apnea endotypic traits. Front. Physiol., 16.","DOI":"10.3389\/fphys.2025.1648767"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.ortho.2021.01.002","article-title":"Correlation between craniofacial structures, anthropometric measurements, and nasopharyngeal dimensions in black adolescents","volume":"19","author":"Marwah","year":"2021","journal-title":"Int. Orthod."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"660","DOI":"10.2471\/BLT.07.043497","article-title":"Development of a WHO growth reference for school-aged children and adolescents","volume":"85","author":"Onyango","year":"2007","journal-title":"Bull. World Health Organ."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1053\/j.sodo.2005.04.005","article-title":"The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics","volume":"11","author":"Baccetti","year":"2005","journal-title":"Semin. Orthod."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"133","DOI":"10.2319\/111517-787.1","article-title":"The cervical vertebral maturation method: A user\u2019s guide","volume":"88","author":"McNamara","year":"2018","journal-title":"Angle Orthod."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s40368-023-00850-x","article-title":"Effects of endocrine disorders on maxillary and mandibular growth in Colombian children and adolescents: A cross-sectional study","volume":"25","author":"Alfaro","year":"2024","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1093\/ejo\/cjaa056","article-title":"Influence of BMI percentile on craniofacial morphology and development in children and adolescents","volume":"43","author":"Danze","year":"2021","journal-title":"Eur. J. Orthod."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Verdecchia, A., Torre, I.C., Diaz, I.M., Sanz, V.G., Mesa, Y.G., Cobo, T., and Gallardo, V.P. (2025). Analysis of the relationship between body mass index (BMI) and dento-skeletal maturation: A cross-sectional case-control study. Dent. J., 13.","DOI":"10.3390\/dj13010008"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ke, D., Lu, D., Cai, G., Zhang, J., Wang, X., and Suzuki, K. (2020). Accelerated skeletal maturation is associated with overweight and obesity as early as preschool age: A cross-sectional study. BMC Pediatr., 20.","DOI":"10.1186\/s12887-020-02353-w"},{"key":"ref_23","first-page":"S70","article-title":"Mandibular condylar cartilage in development and diseases: A PTHrP-centric view","volume":"28","author":"Tran","year":"2025","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.joca.2011.12.013","article-title":"Insulin-like growth factor-1 boosts the developing process of condylar hyperplasia by stimulating chondrocyte proliferation","volume":"20","author":"Chen","year":"2012","journal-title":"Osteoarthr. Cartil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/ocr.12524","article-title":"IGF-1 TMJ injections enhance mandibular growth and bone quality in juvenile rats","volume":"25","author":"Joshi","year":"2022","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1111\/bph.14181","article-title":"Adipokines and inflammation: Is it a question of weight?","volume":"175","author":"Francisco","year":"2018","journal-title":"Br. J. Pharmacol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1007\/s00774-014-0569-7","article-title":"Roles of leptin in bone metabolism and bone diseases","volume":"33","author":"Chen","year":"2015","journal-title":"J. Bone Miner. Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"7761","DOI":"10.3390\/jcm13247761","article-title":"Condylar Parameters and Mandibular Movement Patterns in Bruxers Using an Optical Jaw Tracking System","volume":"13","author":"Taut","year":"2024","journal-title":"J. Clin. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"104964","DOI":"10.1016\/j.archoralbio.2020.104964","article-title":"Childhood obesity may accelerate timing of human facial growth","volume":"121","author":"Gordon","year":"2021","journal-title":"Arch. Oral Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.ajodo.2021.07.018","article-title":"Craniofacial form differences between obese and nonobese children","volume":"162","author":"Vora","year":"2022","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"a019117","DOI":"10.1101\/cshperspect.a019117","article-title":"The Systemic Control of Growth","volume":"7","author":"Boulan","year":"2015","journal-title":"Cold Spring Harb. Perspect. Biol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1111\/j.0014-3820.2006.tb01204.x","article-title":"Evolution of intrinsic growth rate: Metabolic costs drive trade-offs between growth and swimming performance in Menidia menidia","volume":"60","author":"Arnott","year":"2006","journal-title":"Evolution"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/j.identj.2025.02.021","article-title":"Craniofacial, Dental, and Upper Airway Morphologic features of Severely Obese Adults with Obstructive Sleep Apnea","volume":"75","author":"Xia","year":"2025","journal-title":"Int. Dent. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"9007","DOI":"10.1038\/s41598-017-08444-6","article-title":"Muscle and adipose tissue morphology, insulin sensitivity and beta-cell function in diabetic and nondiabetic obese patients: Effects of bariatric surgery","volume":"7","author":"Camastra","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1093\/ejo\/cjaa032","article-title":"The impact of obesity on orthodontic treatment outcome in adolescents: A prospective clinical cohort study","volume":"43","author":"Saloom","year":"2021","journal-title":"Eur. J. Orthod."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Voltan, C., Concer, F., Pecoraro, L., Pietrobelli, A., Piacentini, G., and Zaffanello, M. (2024). Exploring the Complex Interplay of Obesity, Allergic Diseases, and Sleep-Disordered Breathing in Children. Children, 11.","DOI":"10.20944\/preprints202403.1806.v1"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e70060","DOI":"10.1111\/jsr.70060","article-title":"Prevalence of Altered Craniofacial Morphology in Children With OSA","volume":"34","author":"Huynh","year":"2025","journal-title":"J. Sleep Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1002\/ar.22918","article-title":"Variation in timing, duration, intensity, and direction of adolescent growth in the mandible, maxilla, and cranial base: The Fels longitudinal study","volume":"297","author":"Nahhas","year":"2014","journal-title":"Anat. Rec."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Kim, N.-H., Lee, J.-H., Lee, S., Choi, Y.J., Chung, C.J., Lee, K.-J., and Kim, K.-H. (2025). Growth Velocity and the Pubertal Growth Spurt Across Skeletal Maturity Stages in Class II Malocclusion: A Longitudinal Analysis. Children, 12.","DOI":"10.3390\/children12121612"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"89","DOI":"10.22514\/jocpd.2024.129","article-title":"Sex differences in craniofacial parameters of children and adolescents: A comparative study with the maturation of cervical vertebrae using a cephalometric method","volume":"48","author":"Gu","year":"2024","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.sdentj.2020.11.003","article-title":"Application of additional anthropometric and functional methods in children undergoing orthodontic treatment using braces","volume":"33","author":"Dudnik","year":"2020","journal-title":"Saudi Dent. J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/884\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T10:46:57Z","timestamp":1777978017000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/5\/884"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["medicina62050884"],"URL":"https:\/\/doi.org\/10.3390\/medicina62050884","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]}}}