The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study

Obesity and the African-American Adolescent in Mississippi: An Overview

Obesity is one of the most common conditions seen in medical practice, and is one of the most difficult to treat. This condition is often perceived as a cosmetic problem, but it is associated with a number of chronic medical conditions including, but not limited to, heart disease, hypertension, and dyslipidemia. Youth obesity has increased at an alarming rate in the United States and in other developed countries around the world. Given the high prevalence of obesity among adults in the United States, it is not surprising that pediatric obesity is also on the rise. The current trends in obesity among African-American adolescents in the state of Mississippi remain alarming and disheartening. Since obesity starts in early childhood and extends into the adolescent years and possibly into adulthood, behavior modification is the key to preventing the onset of obesity in all population groups.

Evaluation of a training to improve management of pediatric overweight

INTRODUCTION

Despite widespread concern about pediatric obesity, health care professionals report low proficiency for identifying and treating this condition. This paper reports on the evaluation of pediatric overweight assessment and management training for clinicians and staff in a managed care system. The training was evaluated for its impact on assessment practices and utilization of management tools.

METHODS

A delayed-control design was utilized to measure the effects of two 60-minute interactive Continuing Medical education (CME) trainings for the pediatric health care teams. Chart abstraction was conducted at 0-, 3- and 6-months after training, recording the proportion of charts containing the recommended assessment methods and management tools.

RESULTS

The training was associated with a significant increase in the utilization of some tools and practices, including charting BMI-for-age percentile (p < 0.001) and using a nutrition and activity self-history form (p < 0.001). Overall, from baseline to 3-months post training, charting BMI-for-age percentiles increased from zero to 25.2% and utilization of the self-history form increased from zero to 35.3%. These increases were sustained at 6-months post training. Other tools guiding clinician counseling were less widely utilized, although a behavioral prescription pad was used with 20% of overweight patients.

DISCUSSION

A modest investment in clinician and staff training designed to be feasible in a clinical setting was associated with substantial increases in the use of appropriate tools and practices for the assessment and management of pediatric overweight. Such training may help to augment and improve the processes of pediatric health care delivery for addressing overweight. The training provides a viable model for future CME efforts in other health care settings.

Prevalence of the insulin resistance syndrome in obesity

AIMS

To assess prevalence of the insulin resistance syndrome (IRS: obesity, abnormal glucose homoeostasis, dyslipidaemia, and hypertension) in obese UK children and adolescents of different ethnicities and to assess whether fasting data is sufficient to identify IRS in childhood obesity.

METHODS

A total of 103 obese (BMI >95th centile) children and adolescents 2-18 years of age referred for assessment underwent an oral glucose tolerance test, measurement of fasting lipids, and blood pressure determination. Main outcome measures were prevalence of components of IRS by modified WHO criteria, with IRS defined as > or =3 components (including obesity).

RESULTS

There were 67 girls (65%). BMI z-score ranged from 1.65 to 6.15, with 72% having a z-score > or =3.0. Abnormal glucose homoeostasis was identified in 46% (hyperinsulinism in 40%, impaired fasting glucose in 0.8%, impaired glucose tolerance in 11%). No subjects had silent type 2 diabetes. Dyslipidaemia was identified in 30% and hypertension in 32%. Thirty one per cent had obesity alone, 36% had two components, 28% had three, and 5% had all four components. Birth weight, BMI, and family history of IRS were not associated with risk of IRS. Higher age increased the risk of IRS; however the syndrome was seen in 30% of children under 12 years. The use of fasting glucose and insulin data for identifying IRS had a sensitivity of 88% and specificity of 100%.

CONCLUSIONS

One third of obese children and adolescents have the IRS; however type 2 diabetes is rare. Obese children with the IRS may form a high risk group to whom scarce intervention resources should be targeted. Further work is needed to develop appropriate screening programmes for IRS components in significantly obese children.

Adolescent Obesity: Current Trends in Identification and Management

PURPOSE

To discuss the prevalence, identification, and clinical manifestations of adolescent obesity for the advanced practice nurse in primary care.

DATA SOURCES

Selected research and clinical articles.

CONCLUSIONS

Adolescent obesity has been historically attributed to inappropriate diet and exercise; however, recent research also attributes adolescent obesity to genetic factors and metabolic dysfunction. If left untreated, adolescent obesity may result in the metabolic complications of dyslipidemia, hypertension, cardiovascular disease, and early onset of type 2 diabetes.

IMPLICATIONS FOR PRACTICE

Practitioners should focus on using the new body mass index (BMI) national guidelines for early identification of obesity. Essential to the management of this condition are education, parental involvement, behavior modification, and psychological support.

Prevalence of overweight among inner city Hispanic-American children and adolescents

OBJECTIVE

National surveys have pointed to a particularly high risk of pediatric overweight among U.S. Hispanics. However, the data have been primarily from the Mexican-American community. We studied the prevalence of overweight and clinical comorbidities in children and youth of predominantly El Salvadoran ancestry.

RESEARCH METHODS AND PROCEDURES

A sample of 309 Hispanic youth, 6-18 years was surveyed from two inner city Washington, DC, clinics. BMI; triceps skinfold (TSF) and subscapular skinfold thickness (SSSF); bioelectrical impedance analysis (BIA); and blood pressure measures were obtained, along with information regarding physical activity, sedentary behavior, dietary history, family, and personal medical history.

RESULTS

Thirty-eight percent were overweight (BMI > or = 95th percentile) and 22% at risk for overweight (BMI 85-94th percentile). Thirty-four percent had TSF > or = 90th percentile and 29% had SSSF > or = 90th percentile. Fifty-one percent of males and 70% of females had body fat > 30%. Compared to their nonoverweight counterparts, overweight youth had significantly higher systolic blood pressure (111.4 +/- 1.3 vs. 104.5 +/- 0.9 mm Hg, p < 0.0001). Among children younger than 11 years, overweight was associated with onset of adrenarche (23% vs. 10%, p = 0.01). Participation in one or more sports teams was negatively correlated with overweight) p = 0.04).

DISCUSSION

The prevalence of overweight and at risk for overweight in this sample was twice the national average for U.S. children and 1.7 times greater than that of Mexican-American children in national surveys. Overweight was associated with advanced pubertal development, high body fat, elevated blood pressure, and decreased sports participation.

High prevalence of insulin resistance in postpubertal Asian Indian children is associated with adverse truncal body fat patterning, abdominal adiposity and excess body fat

OBJECTIVE

The objectives were to study the relationships of insulin resistance with generalized and abdominal obesity, and body fat patterning in urban postpubertal Asian Indian children.

DESIGN

Cross-sectional, population-based epidemiological study.

SUBJECTS

In all, 250 (155 males and 95 females) healthy urban postpubertal children.

MEASUREMENTS

Anthropometric profile, percentage of body fat (%BF), fasting serum insulin, and lipoprotein profile.

RESULTS

Fasting insulin correlated significantly with body mass index (BMI), %BF, waist circumference (WC), central and peripheral skinfold thicknesses and sum of four skinfold thicknesses (Sigma 4SF) in both sexes, and with systolic blood pressure and waist-to hip circumference ratio (W-HR) in males only. Consistent increase in fasting insulin was noted with increasing values of central skinfold thickness at each tertile of peripheral skinfold thickness, WC, and %BF. Central skinfold thickness correlated with fasting insulin even after adjusting for WC, W-HR, and %BF. The odds ratios (OR) (95% CI) of hyperinsulinemia (fasting insulin concentrations in the highest quartile) were 4.7 (2.4-9.4) in overweight subjects, 8 (4.1-15.5) with high %BF, 6.4 (3.2-12.9) with high WC, 3.7 (1.9-7.3) with high W-HR, 6.8 (3.3-13.9) with high triceps skinfold thickness, 8 (4.1-15.7) with high subscapular skinfold thickness, and 10.1 (5-20.5) with high Sigma 4SF. In step-wise multiple logistic regression analysis, %BF [OR (95% CI): 3.2 (1.4-7.8)] and Sigma 4SF [OR (95% CI): 4.5 (1.8-11.3)] were independent predictors of hyperinsulinemia, similar to insulin resistance assessed by HOMA (homeostatic model of assessment) in the study.

CONCLUSION

A high prevalence of insulin resistance in postpubertal urban Asian Indian children was associated with excess body fat, abdominal adiposity, and excess truncal subcutaneous fat. Primary prevention strategies for coronary heart disease and diabetes mellitus in Asian Indians should focus on the abnormal body composition profile in childhood.

Overweight in children is associated with arterial endothelial dysfunction and intima-media thickening

OBJECTIVE

We sought to study arterial endothelial function and carotid intima-media thickness (IMT), both early markers of atherosclerosis, in overweight compared to normal children.

DESIGN

Case-control comparison.

SUBJECTS

A total of 36 asymptomatic overweight children (body mass index (BMI)>23; mean 25+/-3) aged 9-12 y and 36 age- and gender-matched nonobese healthy children (BMI<21) from a school community.

MEASUREMENTS

The key parameters were: BMI, arterial endothelial function (ultrasound-derived endothelium-dependent dilation) and carotid artery IMT. The secondary parameters measured included body fat content, waist-hip ratio (WHR), blood pressures, blood lipids, insulin and glucose.

RESULTS

The two groups were well matched for blood pressures, cholesterol and glucose levels, but BMI (P<0.0001), body fat (P=0.001), WHR (P<0.05), fasting blood insulin (P=0.001) and triglyceride levels (P<0.05) were higher in obese children. Overweight was associated with impaired arterial endothelial function (6.6+/-2.3 vs 9.7+/-3.0%, P<0.0001) and increased carotid IMT (0.49+/-0.04 mm vs 0.45+/-0.04 mm, P=0.006). The degree of endothelial dysfunction correlated with BMI (P<0.003) on multivariate analysis.

CONCLUSION

Obesity, even of mild-to-moderate degree, is independently associated with abnormal arterial function and structure in otherwise healthy young children.

Ambulatory management of childhood obesity

OBJECTIVE

Childhood obesity is one of the most challenging issues facing healthcare providers today. The aims of this study were to describe the ambulatory management of childhood obesity by pediatricians (PDs) and family physicians (FPs) and to evaluate knowledge of and adherence to published recommendations.

RESEARCH METHODS AND PROCEDURES

A 42-item, self-administered questionnaire was mailed to 1207 randomly selected primary care physicians (PDs = 700, FPs = 507) between September 2001 and January 2002.

RESULTS

Of 339 (28%) responses, 287 were eligible (PDs = 213, FPs = 74). Most respondents were in group or solo practice (87%) in a suburban or urban, non-inner city location (67%). The average age was 48 years (range = 31 to 85 years), and the mean years in practice was 17 (range = 1 to 55 years). Nineteen percent of physicians were aware of national recommendations. Three percent of physicians reported adherence to all recommendations. Knowledge of recommendations was not associated with a greater likelihood of adherence. However, physicians who were aware of recommendations were more likely to have positive attitudes about personal counseling ability (odds ratio = 2.4, confidence interval = 1.3 to 4.4) and the overall efficacy of obesity counseling (odds ratio = 4.3, confidence interval = 1.7 to 10.8). Poor patient motivation, patient noncompliance, and treatment futility were perceived as the most frequently encountered barriers to obesity treatment.

DISCUSSION

Most physicians are not aware of or adherent to national recommendations regarding childhood obesity. Awareness of recommendations was associated with more positive attitudes about personal counseling ability and the effectiveness of obesity counseling in general.

Improvements in heart health behaviors and reduction in coronary artery disease risk factors in urban teenaged girls through a school-based intervention: the PATH program

OBJECTIVES

We sought to assess the effects of a school-based intervention program on cardiovascular disease risk factors in urban girls.

METHODS

We compared heart health knowledge, health behaviors, cardiovascular risk factors, and physical fitness among a group of 442 multiethnic teenaged girls (310 experimental participants vs 132 control participants). Testing was conducted before and after a 12-week program of vigorous exercises integrated with lectures and discussions on diet, exercise, stress, and smoking.

RESULTS

Significant differences in body fat, systolic and diastolic blood pressure, heart health knowledge, and whether breakfast was eaten were observed between experimental participants and control participants.

CONCLUSIONS

An integrated program of exercise and heart health-related lectures and discussions had a beneficial effect on health knowledge, health behaviors, and onset of risk factors for coronary artery disease among urban girls.

Walking the talk: Fit WIC wellness programs improve self-efficacy in pediatric obesity prevention counseling

Six sites of the California Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participated in a staff wellness pilot intervention designed to improve staff self-efficacy in counseling WIC clients about childhood overweight. A pre-post test design with intervention and control groups was used; outcome measures included staff perceptions of the intervention's effects on the workplace environment, their personal habits and health beliefs, and their counseling self-efficacy. Intervention site staff were more likely to report that the workplace environment supported their efforts to make healthy food choices (P <.001), be physically active (P <.01), make positive changes in counseling parents about their children's weight (P <.01), and feel more comfortable in encouraging WIC clients to do physical activities with their children (P <.05).

Feasibility and benefits of a parent-focused preschool child obesity intervention

OBJECTIVES

This field study tested the feasibility and benefits of a program to promote 6 targeted parental behaviors to prevent obesity in children served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

METHODS

Two WIC sites participated in a nonrandomized, controlled 1-year prospective study to assess parents' self-reported behavior changes.

RESULTS

Statistical analyses of preintervention and postintervention assessments of parental behavior demonstrated significant changes in 2 behaviors: frequency of offering the child water and frequency of engaging in active play with the child. In both cases, the intervention proved effective in increasing the desired behavior.

CONCLUSIONS

The findings demonstrate the feasibility of changing parental behaviors through multidimensional education in a WIC clinic setting.

Blood pressure and adiposity in children and adolescents

BACKGROUND

Although obesity is associated with important hemodynamic disturbances, there are few data on population-wide blood pressure (BP) distribution in children and adolescents in this era of endemic pediatric obesity.

METHODS AND RESULTS

We conducted a school-based survey of a representative sample of youth aged 9, 13, and 16 years in Quebec, Canada. Resting BP was measured with an oscillometric device in 3589 subjects (80% response). Additional measures included height, weight, and subscapular and triceps skinfold thickness, an age-appropriate questionnaire, and a fasting blood draw. Mean (SD) systolic/diastolic BP (SBP/DBP) levels in 9-, 13-, and 16-year-olds were 103 (9)/57 (6), 113 (12)/58 (7), and 124 (14)/61 (7) mm Hg in males and 103 (10)/57 (6), 111 (11)/60 (7), and 114 (11)/62 (7) mm Hg in females. The prevalence of high-normal or elevated SBP was 12%, 22%, and 30% among 9-, 13-, and 16-year-old males, respectively, and 14%, 19%, and 17% among same-aged females. The prevalence of high-normal or elevated DBP was <1%. In multiple linear regression analysis, body mass index was consistently associated with SBP and DBP in all age-gender groups.

CONCLUSIONS

Mean SBP and the prevalence of high-normal and elevated SBP are elevated in children and adolescents. Public policy, public health programs, and clinical preventive measures are urgently needed to address the obesity epidemic and its hemodynamic consequences.

Risk factors for cardiovascular disease in pediatric renal transplant recipients

About 1,000 children develop end-stage renal disease (ESRD) each year in the United States and about 5,000 children are currently receiving dialysis. Children who develop ESRD are eligible to receive renal replacement therapy, including renal transplantation. There are inherent risks associated with transplantation, including renal insufficiency, infections, post-transplant lymphoproliferative disorder, and cardiovascular disease (CVD). Potential risk factors for CVD in pediatric renal transplant recipients include renal insufficiency, hyperlipidemia, hyperhomocysteinemia, inflammation, malnutrition, anemia, and hyperglycemia/insulin resistance. Despite evidence that many children may possess various risk factors for CVD post-renal transplantation, there are very few studies that have attempted to assess the link between these risk factors and CVD in pediatric renal transplant recipients.

Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents

OBJECTIVE

To derive optimal body mass index (BMI) and waist circumference thresholds for children and adolescents, to predict risk factor clustering.

DESIGN

Cross-sectional receiver operating characteristic curve analysis.

SETTING

The Bogalusa Heart Study, a community-based study of cardiovascular disease risk factors in early life.

PARTICIPANTS

A total of 2597 black and white children and adolescents, 5 to 18 years of age, who were examined between 1992 and 1994.

MAIN OUTCOME MEASURES

The presence or absence of > or =3 age-adjusted risk factors (low high-density lipoprotein cholesterol level, high low-density lipoprotein cholesterol level, high triglyceride level, high glucose level, high insulin level, and high blood pressure) was predicted from age-adjusted BMI and waist circumference values.

RESULTS

The areas under the receiver operating characteristic curves were significantly different from 0.5 for both BMI and waist circumference for all gender/race groups, ranging from 0.73 to 0.82. The optimal BMI thresholds were at the 53rd and 50th percentiles for white and black male subjects, respectively, and at the 57th and 51st percentiles for white and black female subjects, respectively. Similarly, the optimal waist circumference thresholds were at the 56th and 50th percentiles for white and black male subjects, respectively, and at the 57th and 52nd percentiles for white and black female subjects, respectively. The sensitivity and specificity at the thresholds were similar for all gender/race groups, ranging from 67% to 75%.

CONCLUSIONS

The use of BMI and waist circumference for the prediction of risk factor clustering among children and adolescents has significant clinical utility. In this sample, race and gender differences in the optimal thresholds were minimal.

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.

Changes in the nutritional status of Bolivian women 1994-1998: demographic and social predictors

INTRODUCTION

Bolivia, as one of the poorest Latin American countries, has dealt with the problems of undernutrition for the last 50 y. Little importance has been given to the increase in overweight and obesity among the population, despite the scientific evidence linking overweight and obesity with mortality and morbidity.

OBJECTIVE

To describe the social and demographic determinants of the nutritional status among women in Bolivia between 1989 and 1998 to gain a better understanding of the nutrition transition phenomena and to identify urgent research needs.

METHODOLOGY

Secondary analysis of the raw data of the Bolivian National Demographic and Health Surveys of 1994 and 1998. Changes in the prevalence of underweight, obesity and overweight are described by sociodemographic characteristics of Bolivian women. Social and demographic determinants of nutritional status have been fitted into a logistic model.

RESULTS

The prevalence of overweight (defined as 25< or =BMI<30 kg/m2) among women of reproductive age (20-44 y) increased by 9 percentage points between 1994 and 1998 (P<0.001), while the prevalence of normal BMI decreased by 10 percentage points (P<0.001). The decrease in the prevalence of underweight (defined as BMI <18.5 kg/m2) from 2.4% in 1994 to less than 1% in 1998 was statistically significant (P<0.001). Obesity (defined as BMI> or =30 kg/m2) was positively associated with geographical region (P=0.001), educational level (P<0.001), age (P=0.003) and total number of children (P=0.001) and negatively associated to rural locality (P=0.001) and native languages (P<0.001). Overweight was inversely associated with rural locality (P=0.013) and with Quechua language (P=0.04), while the total number of children (P<0.001) and year of survey (P<0.001) were positively associated. Underweight decreased dramatically (P<0.001), being positively associated with the region of residence (P=0.04) and inversely associated with the total number of children (P=0.006).

CONCLUSION

The present study suggests that the population of Bolivia is in a transitional stage, with overweight becoming as much of a problem as undernutrition.

Secondary prevention of overweight in primary school children: what place for general practice?

At least a quarter of primary school children in Australia are overweight or obese; the long-term impacts are likely to include chronic morbidity and loss of life-years. Universal preventive strategies have so far had limited effectiveness, while secondary and tertiary referral services would be overwhelmed if they attempted to systematically manage a problem with such high prevalence. Primary care services could play an important role in secondary prevention of overweight and mild obesity in children. While reports of child obesity research have burgeoned since 1995, effectiveness trials of primary care interventions in primary-school-aged children have been neglected. Randomised controlled trials of a primary care approach, although challenging, are essential to determine whether it does more good than harm.

Plasma leptin is associated with insulin resistance independent of age, body mass index, fat mass, lipids, and pubertal development in nondiabetic adolescents

OBJECTIVE

The rising epidemic worldwide in overweight and obese children requires urgent attention. Leptin has been found to be associated with body weight control and possibly affects insulin sensitivity. Since insulin resistance is associated with obesity in adults and possibly in adolescents, we set out to investigate the association of plasma leptin level with various anthropometric indices, body fat mass (FM), lipids, and insulin resistance (IR) index in nondiabetic adolescents.

DESIGN

A cross-sectional study from three high schools in Taipei City in Taiwan.

SUBJECTS

A total of 402 nondiabetic subjects (162 boys and 240 girls; age range, 10-19 y; mean age, 15.8+/-1.9 y, and mean body mass index (BMI), 24.8+/-4.6 kg/m(2)) were recruited.

MEASUREMENTS

The fasting plasma leptin, plasma glucose, insulin, lipids, and anthropometric indices including height, weight, waist (WC) and hip circumferences, and waist-to-hip ratio (WHR) were examined. Total body FM and percentage body fat (FM%) were obtained from dual-energy X-ray absorptiometry. The homeostasis model was applied to estimate the degree of IR.

RESULTS

The plasma leptin levels were significantly higher in girls (17.45+/-10.13 ng/ml) than boys (8.81+/-6.71 ng/ml, P<0.001). The plasma leptin levels were positively correlated to BMI, WC, WHR, FM, FM%, and triglycerides (TG). The IR index was positively correlated to BMI, WC, WHR, FM, FM%, TG, and leptin. Using the multivariate linear regression models, we found that plasma leptin remains significantly associated with IR index even after adjusting for age, gender, BMI, FM, WC, Tanner stage, and TG.

CONCLUSION

Plasma leptin was associated with IR index independent of age, gender, BMI, FM, WC, Tanner stage, and TG. Plasma leptin levels in adolescents could be a predictor for the development of the metabolic syndrome disorders and cardiovascular diseases.

Cord plasma concentrations of adiponectin and leptin in healthy term neonates: positive correlation with birthweight and neonatal adiposity

OBJECTIVE

Adiponectin is negatively associated with leptin, insulin and obesity in children and adults. Whereas increases in fetal insulin and leptin are associated with increased weight and adiposity at birth, the role of adiponectin in fetal growth has not yet been determined. The aims of this study were to examine the relationships between adiponectin and insulin, leptin, weight and adiposity at birth in healthy term infants.

DESIGN AND METHODS

Anthropometric parameters including weight, length, circumferences and skinfold thickness were measured, and plasma lipid profiles, insulin, leptin and adiponectin concentrations in cord blood samples from 226 singleton infants born at term after uncomplicated pregnancies were assayed.

RESULTS

Cord plasma adiponectin, leptin and insulin levels correlated significantly and positively with birthweight (P = 0.001, P < 0.001, P < 0.001, respectively) and the sum of skinfold thicknesses (P < 0.001, P < 0.001, P < 0.001, respectively). Mean cord plasma adiponectin and leptin levels, but not insulin level, were significantly higher in large-for-gestational-age (LGA) infants compared with appropriate-for-gestational-age (AGA) infants. Cord plasma leptin concentration, but not adiponectin concentration, was significantly higher in female infants than in male infants (P = 0.003 and P = 0.94, respectively). Cord plasma adiponectin concentration correlated positively with leptin level (P = 0.007) but not with insulin level (P = 0.78).

CONCLUSIONS

High adiponectin levels are present in the cord blood. Cord plasma adiponectin and leptin levels are positively correlated with birthweight and adiposity. This suggests that adiponectin may be involved in regulating fetal growth.

Beverage consumption is not associated with changes in weight and body mass index among low-income preschool children in North Dakota

OBJECTIVE

To examine prospectively the association between beverage consumption (fruit juice, fruit drinks, milk, soda, and diet soda) and changes in weight and body mass index among preschool children.

DESIGN

A prospective cohort study that collected dietary, anthropometric, and sociodemographic data.Subjects/Setting The study population included 1,345 children age 2 to 5 years participating in the North Dakota Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on two visits between 6 to 12 months apart. Statistical analyses We performed linear regression analyses to examine whether beverage consumption was associated with annual change in weight and body mass index. Intakes were measured as continuous (oz/day) and we also dichotomized fruit juice, fruit drinks, and milk at high intakes.

RESULTS

In multivariate regression analyses adjusted for age, sex, energy intake, change in height, and additional sociodemographic variables, weight change was not significantly related to intakes (per ounce) of fruit juice (beta=0.01 lb/year, 95% CI: -0.01 to 0.20, P=.28), fruit drinks (beta=-0.03 lb/year, 95% CI: -0.07 to 0.01, P=.28), milk (beta=0.00 lb/year, 95% CI: -0.02 to 0.02, P=.86), soda (beta=-0.00 lb/year, 95% CI: -0.08 to 0.08, P=.95), or diet soda (beta=0.01 lb/year, 95% CI: -0.11 to 0.13, P=.82). Findings remained null when we examined associations with body mass index and when fruit juice, fruit drinks, and milk were dichotomized at high intake levels in both analyses.

CONCLUSIONS

Our study does not show an association between beverage consumption and changes in weight or body mass index in this population of low-income preschool children in North Dakota.

Special considerations in childhood and adolescent obesity

Child and adolescent obesity is increasingly prevalent in westernized countries. It is associated with significant medical and psychosocial co-morbidities that are both immediate and long-term. While genetic factors influence the susceptibility of a given child to an obesity-conducive environment, the current epidemic is due to massive environmental change over the past few decades leading to a rise in sedentary pursuits, a decrease in physical activity and increased energy intake. Effective management requires a family-focused, developmentally sensitive, behavioural management approach that addresses, for example, eating habits, incidental activity and television viewing. Prevention of childhood obesity will ultimately require multi-faceted, large-scale interventions.

Type 2 Diabetes Mellitus in the Pediatric Population

Type 2 diabetes mellitus, once considered a disease only of adults, is now being diagnosed at an increasingly alarming rate in children. It is still unclear whether the presentation, risk factors, course, and treatment of the disease are the same in children as they are in adults. Pediatric-specific prevalence is being linked to obesity and inactivity, and risk factors include being overweight, family history of the disease, and conditions of insulin resistance such as puberty. Although the clinical presentations of types 1 and 2 diabetes often are different, they can be similar, which makes it difficult to differentiate between the two. Metformin is the only drug approved for the treatment of type 2 diabetes in children, but other drugs are being studied. Prevention is essential. It is critical that health care professionals and the public are educated about this disease and that studies are conducted that focus on children with type 2 diabetes.

Non-curricular approaches for increasing physical activity in youth: a review

BACKGROUND

To prevent obesity, the physical activity of youth should be increased. Since time for school physical education has declined and curricular interventions have had limited effects, alternative non-curriculum approaches need to be tested.

METHODS

A systematic review was conducted to identify research that evaluated the effectiveness of non-curricular interventions on the physical activity of children and adolescents.

RESULTS

Results showed that children were active during school break periods and inexpensive interventions further increased activity during these times. Active travel to school offered potential, but its effectiveness was impaired by traffic congestion and parental fears for child safety. Extracurricular, school-based interventions had problems with low attendance, which might be removed if delivered through existing community organizations. Summer day camps offered potential for increasing activity of youth, but research is required to determine how best to convert camp activity into increased post-camp habitual activity.

CONCLUSIONS

Physical activity can be increased during school break periods, through existing youth organizations, summer day camps, and possibly through active transportation. Future research should focus on further enhancing the effectiveness of these innovative interventions.

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.

Waist circumference percentiles for Canadian youth 11–18 y of age

OBJECTIVE

To develop age- and sex-specific waist circumference reference data for Canadian youth.

DESIGN

Cross-sectional population survey.

SETTING

1981 Canada Fitness Survey.

SUBJECTS

Nationally representative sample of 3064 youth (1540 boys and 1524 girls) 11-18 y of age.

INTERVENTIONS

Waist circumference was measured with a flexible anthropometric tape.

MAIN OUTCOME MEASURES

Smoothed and weighted 5th, 10th, 25th, 50th, 75th, 90th, and 95th waist circumference percentiles derived from LMS regression.

RESULTS

Waist circumference increases with age in both boys and girls, and boys have higher values of waist circumference than girls at every age and percentile level.

CONCLUSIONS

These reference data can be used to identify youth with an elevated risk of developing obesity-related disorders and can serve as a baseline for future studies of temporal trends in waist circumference.

SPONSORSHIP

This research was funded by the Heart and Stroke Foundation of Ontario (Grant #T4946).

Obesidade e síndrome metabólica na infância e adolescência

Nas últimas décadas a prevalência da obesidade vem apresentando um aumento em vários países ao redor do mundo. Este fato é preocupante, já que o excesso de gordura corporal, principalmente a abdominal, está diretamente relacionado com alterações do perfil lipídico, com o aumento da pressão arterial e a hiperinsulinemia, considerados fatores de risco para o desenvolvimento de doenças crônicas, como o diabetes melito tipo 2 e as doenças cardiovasculares. Níveis elevados de leptina e de ácido úrico e a alteração dos fatores fibrinolíticos também têm sido observados em indivíduos obesos. O conjunto destas alterações tem sido descrito como "síndrome metabólica" ou "síndrome da resistência à insulina", já que a hiperinsulinemia tem um papel importante no desenvolvimento dos outros componentes da síndrome metabólica. Entretanto, questiona-se se estas alterações já estão presentes em crianças e adolescentes obesos. Este artigo descreve a fisiopatologia dos componentes da síndrome metabólica e esclarece como este processo ocorre na faixa etária mais jovem.

Measurement of percentage of body fat in 411 children and adolescents: a comparison of dual-energy X-ray absorptiometry with a four-compartment model

OBJECTIVE

Pediatricians are encountering body composition information more frequently, with percentage of body fat (%BF) measurement receiving particular attention as a result of the obesity epidemic. One confounding issue is that different methods may yield different %BF results in the same person. The objective of this study was to compare dual-energy X-ray absorptiometry (DXA) with the criterion 4-compartment model (4-CM) for measurement of %BF in a large pediatric cohort and to assist pediatricians in appropriate interpretation of body composition information by recognizing differences between techniques.

METHODS

Height, weight, anthropometrics, body density by underwater weighing, total body water by deuterium dilution, and bone mineral content and %BF by DXA (Lunar DPX/DPX-L) were measured in 411 healthy subjects, aged 6 to 18 years. Values for %BF by 4-CM and DXA were compared using regression analysis.

RESULTS

The mean +/- standard deviation values for %BF by DXA (22.73% +/- 11.23%) and by 4-CM (21.72% +/- 9.42%) were different, but there was a strong relationship between the 2 methods (R2 = 0.85). DXA underestimated %BF in subjects with lower %BF and overestimated it in those with higher %BF. The relationship between the 2 methods was not affected by gender, age, ethnicity, pubertal stage, height, weight, or body mass index. The standard error of the estimate was 3.66%.

CONCLUSION

This analysis demonstrates a predictable relationship between DXA and 4-CM for %BF measurement. Because of its ease of use, consistent relationship with 4-CM, and availability, we propose that DXA has the capacity for clinical application including prediction of metabolic abnormalities associated with excess %BF in pediatrics.

Eating and body image concerns among average-weight and obese African American and Hispanic girls

Concern has been expressed that African American and Hispanic girls, because of their greater prevalence and degree of overweight, may be at greater risk than Caucasian girls for the development of bulimia nervosa and binge eating disorder. A cross-sectional study was undertaken to document the prevalence of overweight and obesity and to compare overweight and obese girls to average-weight girls with regard to early warning signs of eating disorder development. Participants included 139 predominantly African American and Hispanic girls who were classified as average weight, overweight, or obese in Grades 4 and 5. Overall, 18% of the girls were overweight and an additional 30.9% were obese. Overweight and obese girls had lower body esteem and greater concerns about peer influence than did their average-weight peers. They did not have greater fears of negative evaluation or more disturbed eating attitudes and behaviors. Future research should incorporate instruments more sensitive to disorders of overeating and investigate how eating disorder development differs among girls from various racial and ethnic backgrounds.

Discrepancies between classification systems of childhood obesity

Despite growing concern about weight-related problems among children, no universally accepted classification system for childhood obesity exists. There is a number of proposed international body mass index (BMI)-based systems in use and national variants also exist in many countries. The absence of a universally accepted standard and confusion concerning which classification system to use on national levels complicate monitoring of the development of the obesity epidemic, stratification for selective interventions in public health, screening in clinical practice and comparisons between studies. Some proposed international classification systems have not only been recommended for global monitoring and comparisons between studies, but also for clinical and national epidemiological use in some countries. Possible discrepancies may thereby lead to inefficiencies in health care delivery and prevention programmes. The problems associated with misclassification of individuals at risk may lead to overconsumption of health care resources by lower-risk individuals and underconsumption by higher-risk individuals, which is costly both in terms of foregone health improvements and in terms of wasteful monetary usage. The aim of this paper was to review the specific problems associated with BMI as a measure of adiposity in childhood, the most commonly used classification systems for childhood obesity based on BMI, and how their performance can be evaluated.

Clinical features of the metabolic syndrome in adolescents: minor role of the Trp64Arg beta3-adrenergic receptor gene variant

Obesity and hypertension are increasing medical problems in adolescents. We evaluated the association between being overweight-particularly abdominal fat-and having hypertension and assessed the contribution of the Trp64Arg beta3-adrenergic receptor gene variant. In a population-based study, we determined family history, anthropometric variables, and arterial blood pressure of 934 high school students, out of whom we selected 121 normotensive and 54 hypertensive students. Biochemical measurements included circulating renin and angiotensin-converting enzyme activities, leptin, glucose, insulin and lipid levels, and beta3-adrenergic receptor genotypes. We used Mann-Whitney U test, chi2-test, and Spearman rank-order correlation. In the total population, hypertension prevalence increased across the entire range of body mass index (BMI) percentiles. In the sample, hypertensive students showed higher BMI, waist-to-hip ratio, triglycerides, and insulin resistance and lower HDL-cholesterol than normotensive students did. Age- and sex-adjusted systolic arterial blood pressure was correlated with BMI, waist-to-hip ratio, insulin resistance, and leptin. Leptin was correlated with BMI and homeostasis model assessment method. We found no association among hypertension, BMI, and leptin levels with beta3-adrenergic receptor genotypes. Especially in girls, the waist-to-hip ratio was, however, suggestively higher in Arg64 variant carriers than in noncarriers, independent of hypertension. In fact, there was a significantly (p < 0.01) higher frequency of carriers of the Arg64 variant across the waist-to-hip ratio quartiles. In adolescents of European origin, hypertension is associated with an increased degree of obesity among other characteristics of the metabolic syndrome; the Trp64Arg variant of the beta3-adrenergic receptor gene may favor the central adiposity gain.

Youth blood pressure levels in Samoa in 1979 and 1991-93

Blood pressure (BP) levels were studied in 524 youth ages 4-19.9 years who reside in Samoa. The data were collected in two separate cross-sectional samples taken in 1979 (n = 292) and in 1991-93 (n = 232). BP was compared between these two study samples to evaluate the temporal change in BP among youth in response to the processes of economic modernization in Samoa, and specifically on how temporal increases in body size influenced BP levels. Proportions of youth with elevated BP levels were estimated using the Second Task Force criteria. In males and females 10-19 years, age-adjusted systolic BP was significantly higher in the 1991-93 sample than in the 1979 sample, and the difference became insignificant after adjustment for body mass index. The proportion of those ages 10-19 years with elevated BP ranged from 11-15% in the 1979 study sample and was approximately 25% in the 1991-93 study sample. There appears to be a temporal trend of increasing adiposity and BP in those 10-19 years and the BP differences are attributable to the higher levels of adiposity.

Counseling Latina mothers of preschool children about weight issues: suggestions for a new framework

OBJECTIVE

To assess Latina mothers' health beliefs and attitudes regarding early childhood weight issues and to use the information to update current nutrition education methods.

DESIGN

Data were collected in eight focus group sessions using a semistructured questionnaire.

SUBJECTS/SETTING

Forty-three Latina mothers (and grandmothers) with children aged 2 to 5 years were recruited at five different Special Supplemental Nutrition Program for Women, Infants, and Children sites in California.

ANALYSIS

Transcripts of focus groups were imported into QSR NUD*IST software, facilitating in-depth iterative analysis of emergent themes.

RESULTS

Fifteen emergent themes were identified and organized into four functional domains relevant to nutrition education: health beliefs surrounding weight, impact and cause of overweight, life values and concerns, and strategies for making changes in children's eating and activity patterns. Information from this qualitative study demonstrates that the traditional nutrition counseling paradigm may not be effective with Latina mothers. In addition, cultural beliefs can be barriers to successful prevention and treatment of overweight. To ensure that culturally competent services are provided, educators must be prepared to adjust education approaches according to the cultural background of the clients. Key among the issues was mothers' difficulty acknowledging overweight among their children and their perception that health and weight were poorly associated. Certain cultural values were identified as barriers to adopting healthful behaviors. Mothers were able to identify specific ways in which nutrition education could be improved.

APPLICATIONS/CONCLUSIONS

Our findings suggest that nutrition education efforts targeting Latina mothers of young children can be reframed to better address the belief system and cultural framework of the population, like identifying positive eating behaviors rather than focusing on a child's weight.

Obesity among children attending elementary public schools in São Paulo, Brazil: a case--control study

OBJECTIVES

To describe obesity among students of public schools in São Paulo and to identify risk factors for this nutritional and physical activity disorder.

DESIGN

Case-control study of obese and non-obese schoolchildren to study risk factors for obesity.

SETTING

Anthropometric survey including 2519 children attending eight elementary public schools in São Paulo, Brazil.

SUBJECTS

Schoolchildren aged 7-10 years, of whom 223 were obese (cases; weight-for-height greater than or equal to two standard deviations (>or=2SD) above the median of the National Center for Health Statistics (NCHS) reference population) and 223 were eutrophic (controls; weight-for-height +/-1SD from NCHS median).

MEASUREMENTS

Parents or guardians of the 446 cases and controls were interviewed about the children's eating behaviours and habits.

RESULTS

The prevalence of obesity (weight-for-height >or=2SD) in the surveyed population was 10.5%. A logistic regression model fitted to the case-control dataset showed that obesity was positively associated with the following factors: birth weight >or=3500 g (odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21-2.78), child's appetite at meals (OR 3.81, 95% CI 2.49-5.83), watching television for 4 h per day or longer (OR 2.07, 95% CI 1.32-3.24), mother's schooling >4 years (OR 1.85, 95% CI 1.25-2.75) and parents' body mass index >or=30 kg x m(-2) (OR 2.50, 95% CI 1.43-4.37).

CONCLUSIONS

The explanatory multivariate model points to preventive measures that would encourage knowledge of the children and their guardians in relation to a balanced diet and a less sedentary lifestyle, such as reducing television viewing. Schoolchildren with a birth weight of 3500 g or more or whose parents are obese should receive special attention in the prevention of obesity.

A life course approach to diet, nutrition and the prevention of chronic diseases

OBJECTIVE

To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the life-long influences on the development of disease.

DESIGN

A computer search of the relevant literature was done using Medline-'life cycle' and 'nutrition' and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using 'life cycle', 'nutrition' and 'noncommunicable disease' (NCD), and 'life course'. Several published and unpublished WHO reports were key in developing the background and arguments.

SETTING

International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. RESULTS OF REVIEW: There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under- and over-nutrition.

CONCLUSIONS

The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.

Effect of physical and mental activity on blood pressure

OBJECTIVES

The authors measured and recorded the physical (outdoor playing) and mental (home study) activity behavior and blood pressure amongst school going children and observed their association with the blood pressure levels.

METHOD

It was a cross sectional school-based study from 12 primary schools; selected by stratified random sampling. Participants included 2250 children aged 10 years and above. Explanatory variables were age, sex, outdoor playing (hours/ day) and home-study (hours/ day). Outcome variables were mean and standard deviation (SD) of systolic and diastolic blood pressures in various activity groups. Statistical tools used were proportions, correlation co-efficient (r), coefficient of determination (r2) and Regression analysis.

RESULTS

47.8% boys and 2.5 % girls were engaged in outdoor playing for more than two hours. No trend was observed for systolic blood pressure (SBP) in both the sexes in various activity groups of outdoor playing. Both mean diagnostic blood pressure (DBP) and mean BMI showed decreasing trend in boys. Mean BMI had an inverse relationship with outdoor playing in girls. Correlation of age and weight with both SBP and DBP was highly significant in both the sexes and in all the age groups except that of the 15-year age. Both SBP and DBP were not associated with home study in all sex and age groups except the age group of 10 and 12 years. Both SBP and DBP were significantly associated with the outdoor playing taking the whole sample as one group, but not in different sex or age groups; except that the SBP was significantly correlated with outdoor playing in 10 to 13 years age groups in boys.

CONCLUSION

Boys spent twice the time in outdoor playing than girls. They were spending more time on outdoor playing than on home study. Conversely girls spent more time in home study. A weak negative correlation was observed between outdoor playing and blood pressures. Less time spent in physical activities by the girls may have contributed to their higher BMI. They need behavior change communication for involvement in physical activities.

Correlates of body mass index, weight goals, and weight-management practices among adolescents

The study examined associations among physical activity, cigarette smoking, body mass index, perceptions of body weight, weight-management goals, and weight-management behaviors of public high school adolescents. The CDC Youth Risk Behavior Survey provided a cross-sectional sample (n = 3,089) of public high school students in South Carolina. Logistic regression models were constructed separately for four race-gender groups. Adjusted odds ratios and 95% confidence intervals were calculated to determine the magnitude of associations. Based on self-reported height and weight, 13% of students were overweight, while 15% were at risk for becoming overweight. However, 42% of students were trying to lose weight, and 22% were trying to maintain current weight. Female students were less likely than male students to be overweight, but more likely to be attempting to lose weight. Extreme weight control practices were reported by 27% of the sample. Among Black females trying to lose weight, positive associations were observed for strengthening exercises (OR = 1.55), but that relationship was associated inversely in Black males (OR = .600). Among White females, attempted weight loss was associated with strengthening exercises (OR = 1.72) and cigarette smoking (OR = 1.54). For White males, attempted weight loss was associated positively with vigorous exercise (OR = 1.41) and inversely related to moderate exercise (OR = .617). Effective weight-management practices for adolescents should focus on appropriate eating behaviors, physical activity, and low-fat/calorie diets. Multicomponent weight management interventions should be conducted within a coordinated school health framework.

Increasing prevalence of type 2 diabetes in adolescents

OBJECTIVE

The rising prevalence of obesity in childhood and adolescence in North America has been paralleled by the emergence of type 2 diabetes in the adolescent age group. We have examined trends in the prevalence of type 2 diabetes in adolescents attending a diabetes clinic in Auckland, New Zealand.

METHODS

Surveys of the prevalence of type 2 diabetes in attendees at the adolescent diabetes clinic at the Auckland Diabetes Centre were undertaken in 1996 and 2002. The proportion of type 2 diabetes in incident cases of diabetes diagnosed between these years was also calculated.

RESULTS

The prevalence of type 2 diabetes was 1.8% (2/110) in 1996, and 11.0% (18/163) in 2002 (P = 0.008). Type 2 diabetes accounted for 12.5% (6/48) of incident cases of diabetes in the years 1997-1999, and 35.7% (10/28) of cases in the years 2000-2001, indicating a sharp rise in the incidence (P = 0.017) between the two periods. At diagnosis the mean age of the type 2 diabetes subjects was 15 years and the mean body mass index 34.6 kg/m2. Risk factors for cardiovascular disease were common in the subjects with type 2 diabetes: 85% had dyslipidaemia, 58% had increased albumin excretion rates and 28% had systolic hypertension.

CONCLUSIONS

Obesity-related type 2 diabetes now accounts for a substantial proportion of newly recognized diabetes in the adolescent age group - and this proportion is escalating rapidly. Adverse cardiovascular risk factors are prevalent in this population. Public health measures to curtail the rise of obesity in childhood and adolescence are required urgently.

Ozhirenie v detskom vozraste

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Attitudes, practices, and concerns about child feeding and child weight status among socioeconomically diverse white, Hispanic, and African-American mothers

Parents play an important role in the development of their children's eating behaviors. We conducted 12 focus groups (three white, three African-American, and three Hispanic-American low-income groups; three white middle-income groups) of mothers (N=101) of 2- to less than 5-year-old children to explore maternal attitudes, concerns, and practices related to child feeding and perceptions about child weight. We identified the following major themes from responses to our standardized focus group guide: 12 groups wanted to provide good nutrition, and most wanted children to avoid eating too many sweets and processed foods; 12 groups prepared foods their children liked, accommodated specific requests, and used bribes and rewards to accomplish their feeding goals (sweets were commonly used as bribes, rewards, or pacifiers); and 11 of 12 groups believed their children were prevaricating when they said they were full and mothers encouraged them to eat more. The common use of strategies that may not promote healthful weight suggests work is needed to develop culturally and socioeconomically effective overweight prevention programs. Further study is needed to verify racial/ethnic or income differences in attitudes, practices, and concerns about child feeding and perceptions of child weight.

The relation of obesity throughout life to carotid intima-media thickness in adulthood: the Bogalusa Heart Study

OBJECTIVE

Although obese children are at increased risk for coronary heart disease in later life, it is not clear if this association results from the persistence of childhood obesity into adulthood. We examined the relation of adiposity at various ages to the carotid intima-media thickness (IMT) at age 35 y.

DESIGN

Prior to the determination of IMT by B-mode ultrasound, subjects (203 men, 310 women) had, on average, six measurements of body mass index (BMI) and triceps skinfold thickness (TSF) between the ages of 4 and 35 y. Mixed regression models for longitudinal data were used to assess the relation of these characteristics to adult IMT.

RESULTS

Overall, adult IMT was associated with levels of both BMI and TSF (P<0.001), with the magnitudes of the associations with childhood adiposity comparable to those with adult levels of BMI and TSF. Furthermore, adult obesity modified the association between childhood adiposity and IMT: high IMT levels were seen only among overweight (BMI > or =95th percentile) children who became obese (BMI > or =30 kg/m2) adults (P<0.01 for linear trend). In contrast, IMT levels were not elevated among (1) overweight children who were not obese in adulthood, or among (2) thinner children who became obese adults.

CONCLUSIONS

These results emphasize the adverse, cumulative effects of childhood-onset obesity that persists into adulthood. Since many overweight children become obese adults, the prevention of childhood obesity should be emphasized.

Overweight, ethnicity, and the prevalence of hypertension in school-aged children

OBJECTIVES

To describe the current prevalence of pediatric hypertension and the relationships between gender, ethnicity, overweight, and blood pressure.

METHODS

School-based screening was performed in 5102 children (13.5 +/- 1.7 years) from May through November 2002. Age, gender, ethnicity, weight, and height were ascertained, and body mass index (BMI) was calculated as weight (kg)/height (m2). Overweight was defined as BMI > or =95th percentile. Students with blood pressure >95th percentile on the first screening underwent a second screening 1 to 2 weeks later, and then a third screening if blood pressure was >95th percentile at the second screening.

RESULTS

Ethnicity distribution was 44% white, 25% Hispanic, 22% African American, and 7% Asian. Overall, overweight prevalence was 20%, which varied significantly by ethnicity (31% Hispanic, 20% African American, 15% white, and 11% Asian). The prevalence of elevated blood pressure after first, second, and third screenings was 19.4%, 9.5%, and 4.5%, respectively. Elevated blood pressure on first screening was highest among Hispanics (25%) and lowest among Asians (14%). Ethnic differences in the prevalence of hypertension (elevated blood pressure on 3 screenings) were not significant after controlling for overweight. The prevalence of hypertension increased progressively as the BMI percentile increased from < or =5th percentile (2%) to > or =95th percentile (11%). After adjustment for gender, ethnicity, overweight, and age, the relative risk of hypertension was significant for gender (relative risk: 1.50; confidence interval: 1.15, 1.95) and overweight (relative risk: 3.26; confidence interval: 2.50, 4.24).

CONCLUSIONS

These results confirm an evolving epidemic of cardiovascular risk in youth, as evidenced by an increase in the prevalence of overweight and hypertension, notably among ethnic minority children.

Prevalence of hyperinsulinemia and clinical correlates in overweight children referred for lifestyle intervention

Although not well documented in the literature, there is growing evidence that overweight children may develop hyperinsulinemia. Children (n=171) with a body mass index greater than the 85th percentile for age using the Centers for Disease Control and Prevention growth charts for children were recruited through primary care physician offices for a lifestyle change intervention. Laboratory measurements were obtained. About 30% of these children were identified as hyperinsulinemic, using an insulin-to-glucose ratio of > or =33% or a serum insulin > or =25 microU/mL. When compared with non-hyperinsulinemic children, there were significant differences in cardiovascular risk factors. Dietetics professionals providing medical nutrition therapy to overweight children need to be aware of dietary and physical activity recommendations for individuals with marked hyperinsulinemia.

Food Advertising and Marketing Directed at Children and Adolescents in the US

In recent years, the food and beverage industry in the US has viewed children and adolescents as a major market force. As a result, children and adolescents are now the target of intense and specialized food marketing and advertising efforts. Food marketers are interested in youth as consumers because of their spending power, their purchasing influence, and as future adult consumers. Multiple techniques and channels are used to reach youth, beginning when they are toddlers, to foster brand-building and influence food product purchase behavior. These food marketing channels include television advertising, in-school marketing, product placements, kids clubs, the Internet, toys and products with brand logos, and youth-targeted promotions, such as cross-selling and tie-ins. Foods marketed to children are predominantly high in sugar and fat, and as such are inconsistent with national dietary recommendations. The purpose of this article is to examine the food advertising and marketing channels used to target children and adolescents in the US, the impact of food advertising on eating behavior, and current regulation and policies.