Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence

Differences between recumbent length and stature measurement in groups of 2- and 3-y-old children and its relevance for the use of European body mass index references

OBJECTIVE

To compare length and stature measurements of young children and to examine the relevance of any difference for comparison with body mass index (BMI) references designed for use from birth to adulthood.

SUBJECTS

A total of 426 2-y-old and 525 3-y-old children included in the Dortmund Nutritional and Anthropometrical Longitudinally Designed (DONALD) Study.

DATA ANALYSIS

Length and stature were measured to the nearest millimetre using a stadiometre. Agreement between both measurements at age 2 and 3 y, respectively, was determined by mean differences and by comparison with the German BMI reference.

RESULTS

The average length of 2-y-old girls and boys was 88.3 (3.1) and 89.9 (3.2) cm, mean differences (stature minus length) were -0.47 (0.65) and -0.45 (0.64) cm. The corresponding BMI values were 16.18 (1.3) and 16.46 (1.2) kg/m2, with mean differences of +0.17 (0.24) and +0.16 (0.23). According to stature, 9.4% of the girls and 10.8% of the boys were overweight (>90th percentile), while length classified 7.1 and 9.4% as overweight. Similar mean differences between length and stature were observed at age 3 y: -0.53 (0.62) and -0.47 (0.65) cm in height and +0.17 (0.20) and +0.14 (0.20) kg/m2 in the BMI of girls and boys, respectively. According to stature, 7.6 and 7.3% were overweight as opposed to 5.4 and 4.8% using length. The observed differences increased with higher BMI levels.

CONCLUSION

Changing measurements from length to stature results in an upward shift of BMI, not reflected in current European BMI references. This small but systematic error may result in misinterpretation of individual BMI levels or trend observations.

Fat chance: genetic syndromes with obesity

Although obesity shows high heritability, we are aware of only a small number of genes that affect adipose mass in humans. Genetic syndromes with obesity represent unique opportunities to gain insight into the control of energy balance. The majority of obesity syndromes can be distinguished by the presence of mental retardation. We performed a systematic search of such syndromes and reviewed the literature with a focus on distinguishing clinical features, the characteristics of their obesity, and the underlying pathogenetic mechanisms. We predict that the study of these conditions will shed light on common forms of obesity.

Relationship of child-feeding practices to overweight in low-income Mexican-American preschool-aged children

OBJECTIVE

The purpose of this research was to examine the relationship of child-feeding practices and other factors to overweight in low-income Mexican-American preschool-aged children.

DESIGN

Cross-sectional survey with anthropometric measurements of mothers and target children. Trained bilingual staff interviewed the parents to collect data on child-feeding strategies, food patterns, child's health history, parental acculturation level, food insecurity, and other household characteristics. Subjects and setting Complete data were available from 204 low-income Mexican-American parents residing in California with at least one child aged 3 to 5 years. Outcomes measured Risk of overweight was defined as body mass index (BMI) (measured as weight [in kilograms]/height [in meters](2)) >/=85th percentile and overweight was defined as BMI >/=95th percentile. The Student t test, chi(2) test, and logistic regression were used.

RESULTS

Three variables were positively related to risk of overweight: birth weight (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.11 to 4.82), mother's BMI >/=30 (OR, 2.05; 95% CI, 1.11 to 3.79), and juice intake (OR, 2.33; 95% CI, 1.09 to 4.98). Being enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children was negatively related to risk of overweight (OR, 0.40; 95% CI, 0.21 to 0.75). Additional variables related to overweight were monthly income >$1,500 (OR, 2.33; 95% CI, 1.00 to 5.42) and child takes food from the refrigerator between meals (OR, 0.32; 95% CI, 0.13 to 0.76).

CONCLUSIONS

The results of this study suggest that biological and socioeconomic factors are more associated with overweight in Mexican-American preschool-aged children than most of the self-reported child-feeding strategies.

Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy

OBJECTIVE

Knowing risk factors at birth for the development of childhood obesity could help to identify children who are in need of early obesity prevention efforts. The objective of this study was to determine whether children whose mothers were obese in early pregnancy were more likely to be obese at 2 to 4 years of age.

METHODS

A retrospective cohort study was conducted of 8494 low-income children who were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Ohio and were followed from the first trimester of gestation until 24 to 59 months of age. Measured height and weight data from WIC were linked to birth certificate records for children who were born in the years 1992-1996. Obesity among 2- to 4-year-olds was defined as a body mass index (BMI) > or =95th percentile for age and gender. Mothers were classified as obese (BMI > or =30 kg/m2) or nonobese (BMI <30 kg/m2) on the basis of BMI measured in the first trimester of the child's gestation.

RESULTS

The prevalence of childhood obesity was 9.5%, 12.5%, and 14.8% at 2, 3, and 4 years of age, respectively, and 30.3% of the children had obese mothers. By 4 years of age, 24.1% of children were obese if their mothers had been obese in the first trimester of pregnancy compared with 9.0% of children whose mothers had been of normal weight (BMI 18.5 and <25 kg/m2). After controlling for the birth weight, birth year, and gender of the children plus the mothers' age, race/ethnicity, education level, marital status, parity, weight gain, and smoking during pregnancy, the relative risk of childhood obesity associated with maternal obesity in the first trimester of pregnancy was 2.0 (95% confidence interval [CI]: 1.7-2.3) at 2 years of age, 2.3 (95% CI: 2.0-2.6) at 3 years of age, and 2.3 (95% CI: 2.0-2.6) at 4 years of age.

CONCLUSION

Among low-income children, maternal obesity in early pregnancy more than doubles the risk of obesity at 2 to 4 years of age. In developing strategies to prevent obesity in preschoolers, special attention should be given to newborns with obese mothers.

Position of the American Dietetic Association: Dietary guidance for healthy children ages 2 to 11 years

It is the position of the American Dietetic Association that children ages 2 to 11 years should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. The health status of American children has generally improved over the past three decades. However, the number of children who are overweight has more than doubled among 2- to 5-year-old children and more than tripled among 6- to 11-year-old children, which has major health consequences. This increase in childhood overweight has broadened the focus of dietary guidance to address children's over consumption of energy-dense, nutrient-poor foods and beverages and physical activity patterns. Health promotion will help reduce diet-related risks of chronic degenerative diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This position paper reviews what US children are eating and explores trends in food and nutrient intakes as well as the impact of school meals on children's diets. Dietary recommendations and guidelines and the benefits of physical activity are also discussed. The roles of parents and caregivers in influencing the development of healthy eating behaviors are highlighted. The American Dietetic Association works with other allied health and food industry professionals to translate dietary recommendations and guidelines into achievable, healthful messages. Specific recommendations to improve the nutritional well-being of children are provided for dietetics professionals, parents, and caregivers.

Prevalence and covariates of obesity in Lebanon: findings from the first epidemiological study

OBJECTIVE

To estimate the prevalence of overweight and obesity and examine associated covariates in the Lebanese population.

RESEARCH METHODS AND PROCEDURES

A cross-sectional survey of a representative sample of 2104 individuals, 3 years of age and older. Anthropometric measurements and dietary assessments were conducted following standard methods and techniques. Overweight and obesity (classes I to III) were defined according to internationally standardized criteria for classification of BMI.

RESULTS

For children 3 to 19 years of age, prevalence rates of overweight and obesity were higher overall for boys than girls (22.5% vs. 16.1% and 7.5% vs. 3.2%, respectively). For adult men and women (age > or = 20 years), the prevalence of overweight was 57.7% and 49.4%, respectively. In contrast, obesity (BMI > or = 30 kg/m(2)) was higher overall among women (18.8%) than men (14.3%), a trend that became more evident with increasing obesity class. BMI, percentage of body fat, and waist circumference increased to middle age and declined thereafter. Whereas lack of exercise associated significantly with obesity among children, obesity in older adults was more prevalent among the least educated, nonsmokers, and those reporting a family history of obesity.

DISCUSSION

The results from this national population-based study in Lebanon show high prevalence rates of overweight and obesity comparable with those observed in developed countries such as the United States. While further studies are needed to examine the underlying social and cultural factors associated with lifestyle and nutritional habits, now is the time to institute multicomponent interventions promoting physical activity and weight control nationwide.

Predictors of children's body mass index: a longitudinal study of diet and growth in children aged 2–8 y

OBJECTIVE

To identify longitudinal variables related to children's body mass index (BMI) (kg/m(2)) at age 8 y.

DESIGN

A longitudinal design, with nine interviews per child from ages 2 to 8 y.

SUBJECTS

In all, 70 white children (37 males, 33 females) who were continuous participants since infancy in the longitudinal study. Families were primarily middle and upper socioeconomic status.

MEASUREMENTS

At each interview, children's height and weight were measured, and mothers provided 3 days of the child's intake data (a 24-h recall and 2 days of food records).

ANALYSES

Analyses used were means+/-s.d., correlations, repeated measures analysis of variance, and forward stepwise regression. BMI at each interview was calculated and age of adiposity rebound was determined.

RESULTS

Children's BMI at 8 y was negatively predicted by age of adiposity rebound and positively predicted by their BMI at 2 y. Additionally, each model included one longitudinal dietary variable; mean protein and fat intakes recorded between 2 and 8 y were positive predictors of BMI at 8 y; mean carbohydrate intake over the same time period was negatively related to BMI at 8 y. R(2) values indicated that these three-variable models predicted 41-43% of the variability in BMI among children. BMI of 23% of the children exceeded the 85th CDC percentile.

CONCLUSIONS

The results of this study show that factors in early life are associated with children's BMI at age 8 y.

Chicago project uses ecological approach to obesity prevention

CLOCC may be useful as a model for local, cooperative, overweight-prevention efforts that involve researchers, clinicians, and public health advocates in complementary and shared work. It employs an ecological approach and is guided by an understanding of critical periods in the development of overweight in childhood.

Dietary, evolutionary, and modernizing influences on the prevalence of type 2 diabetes

An evolutionary perspective is used to elucidate the etiology of the current epidemic of type 2 diabetes estimated at 151 million people. Our primate legacy, fossil hominid, and hunting-gathering lifestyles selected for adaptive metabolically thrifty genotypes and phenotypes are rendered deleterious through modern lifestyles that increase energy input and reduce output. The processes of modernization or globalization include the availability and abundance of calorically dense/low-fiber/high-glycemic foods and the adoption of sedentary Western lifestyles, leading to obesity among both children and adults in developed and developing countries. These trends are projected to continue for a number of decades.

Prevalence of overweight and obesity in Greek school-aged children and adolescents

The aim of the present study, which was part of the Health Behavior in School Aged Children (HBSC) study, was to provide national estimates for overweight and obesity in Greek school-aged children and adolescents. A nationwide multistage procedure was followed to obtain a representative sample of children and adolescents aged 11.5, 13.5 and 15.5 y. The resultant sample consisted of 4299 students, 51.3% girls and 48.7% boys. Self-reported weight and height data were used. According to the body mass index cutoff points adopted by the International Obesity Task Force (IOTF), 9.1% of girls and 21.7% of boys were classified as overweight, and 1.2% of girls and 2.5% of boys as obese. Corresponding values using CDC growth charts were 8.1% of girls and 18.8% of boys for overweight, and 1.7% of girls and 5.8% of boys for obese. Compared to most other western countries, the prevalence of obesity is lower in Greek children aged 11-16 y.

Application of laparoscopy for bariatric surgery in adolescents

An epidemic increase in adolescent obesity in the United States has resulted in significant obesity-related comorbidities, previously seen only in adults. Although bariatric surgery is an acceptable alternative for weight loss in severely obese adults, no conclusions have been made about the appropriateness of bariatric surgery for individuals younger than 18 years old. Nonetheless, bariatric surgery is increasingly being performed on adolescents with clinically severe obesity and experience suggests that it is effective and safe. Application of the principles of adolescent growth, development, and compliance is essential to avoid adverse physical, cognitive, and psychosocial outcomes following bariatric surgery. Bariatric surgery should be part of a multidisciplinary approach to the management of adolescents with clinically severe obesity and should be performed by specialists dedicated to pediatric care, in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery.

Unopposed orexic pathways in the developing fetus

Fetal swallowing has important roles in fetal gastrointestinal development, and perhaps fetal somatic growth and maturation. Ingestive behavioral responses must develop in utero to provide for acquisition of water and food intake during the neonatal period. At birth, the rat, ovine and human fetus have developed mechanisms to acquire food via intact mechanisms of taste, suckling and swallowing. Our preliminary studies suggest that in sheep and likely in human fetuses, putative orexic-mediated ingestive responses are present near term gestation. We hypothesize that both orexic (appetite) and satiety mechanisms develop during the last third of gestation and the related neurotransmitters involved in this process are functional. The potential in utero imprinting of orexic mechanisms may influence infant, childhood and ultimately adult appetite "set-points". Thus, dysfunctional appetite, and perhaps obesity, may result from maternal environmental influences during critical stages of development.

BMI in the Trois-Rivières study: child-adult and child-parent relationships

This study evaluated intraindividual child-adult and interindividual child-parent relationships of body mass index (BMI) using data from the Trois-Rivières semilongitudinal study of growth and development. Intraindividual correlations between age 12 and 35 years were substantial (r(2) = 36% of variance in women, 30% of variance in men). Interindividual child-parent correlations for mothers and fathers age 36.6 +/- 0.4 and 39.5 +/- 0.4 years, respectively, were very low to low for daughters age 12 years (r = 0.09, NS and 0.34, P < 0.001 vs. father and mother, respectively) but all very low for sons age 12 years (r = 0.07, NS and 0.16, NS vs. father and mother, respectively). A multiple regression analysis predicted adult BMI from the individual's BMI at 10, 11, 12 years plus the maternal and paternal BMIs as calculated from self-reported heights and weights. The BMI at age 12 years was a better predictor of adult BMI than the parental BMI in both men and women (P < 0.001) and multivariate analysis revealed that this index at age 12 years was the sole significant predictor of adult BMI for both men and women. The results from our study do not support the hypothesis that parental BMI is a stronger predictor of adult BMI than childhood BMI. However, useful information for the prediction and prevention of adult overweight can be obtained from the BMI at age 12 years. Our results suggest that environmental influences may be the major factor in the present obesity epidemic.