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Wiegand S, Keller KM, Lob-Corzilius T, Pott W, Reinehr T, Röbl M, Stachow R, Tuschy S, Weidanz I, Widhalm K, de Zwaan M, Holl RW. Predicting weight loss and maintenance in overweight/obese pediatric patients. Horm Res Paediatr 2015; 82:380-7. [PMID: 25531074 DOI: 10.1159/000368963] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 10/03/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pediatric lifestyle interventions have positive short-term effects on obese patients. Studies on long-term effects are still scarce in Europe. We investigated long-term weight patterns and sociodemographic predictors of a weight change in a large Central European (Germany, Austria and Switzerland) overweight pediatric cohort. METHODS The APV (Adiposity Patients Verlaufsbeobachtung) database was retrospectively analyzed; 157 specialized childhood obesity centers contributed standardized data of 29,181 patients [body mass index (BMI) ≥ 90th percentile; 5-25 years old] presenting between 2000 and 2012. BMI standard deviation scores (BMI-SDS) were analyzed in a 2-year follow-up and grouped according to BMI-SDS changes. Multiple logistic regression analyses were conducted to assess associations between sociodemographic factors and weight patterns. RESULTS 2-year follow-up data were available in 3,135 patients (54.6% female). Five distinct weight trajectories 'rapid weight loss' (n = 735, 23.4%), 'delayed success' (n = 697, 22.2%), 'cycling weight' (n = 43, 1.4%), 'initial weight loss' and 'weight rebound' (n = 383, 12.2%) and 'no weight loss throughout' (n = 1,277, 40.7%) best characterized long-term BMI-SDS changes. Younger and male patients were more likely to reduce weight and maintain weight loss. CONCLUSIONS Our results suggest that an intervention before the onset of puberty seems promising for long-term weight maintenance in overweight children. Thus, new concepts are needed to improve long-term treatment success in patients with lower success rates.
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Affiliation(s)
- Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité University Medicine, Berlin, Germany
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102
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Future therapeutic targets for the treatment and prevention of cholesterol gallstones. Eur J Pharmacol 2015; 765:366-74. [DOI: 10.1016/j.ejphar.2015.08.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 08/24/2015] [Accepted: 08/26/2015] [Indexed: 01/11/2023]
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103
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Mohamedali B, Yost G, Bhat G. Obesity as a Risk Factor for Consideration for Left Ventricular Assist Devices. J Card Fail 2015; 21:800-5. [DOI: 10.1016/j.cardfail.2015.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/15/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
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104
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Sabin JA, Moore K, Noonan C, Lallemand O, Buchwald D. Clinicians' Implicit and Explicit Attitudes about Weight and Race and Treatment Approaches to Overweight for American Indian Children. Child Obes 2015; 11:456-65. [PMID: 26186413 PMCID: PMC4692112 DOI: 10.1089/chi.2014.0125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Obesity is one of the most serious health problems among American Indian/Alaska Native (AI/AN) children. We investigated Indian Health Service (IHS) primary care providers' implicit and explicit attitudes about weight and race and their association with treatment approaches to overweight in children. METHODS We conducted an online survey of long-term primary care clinicians in two western regions of the IHS. We used the existing Weight Attitude Implicit Association Test (IAT) and developed a new Native American Attitude IAT to measure implicit attitudes. Explicit attitudes about weight and race were assessed through self-report. We assessed self-rated treatment approaches to childhood overweight. We used linear regression models to evaluate the association of attitudes about weight and race with treatment approaches. RESULTS Our sample included 75 clinicians (56% response rate) who, on average, saw 74 patients per week. Fifty-five percent of clinicians reported that 30-60% of their child and adolescent patients were overweight or obese, and 25% of clinicians reported that 60-100% of their patients were overweight or obese. We found strong implicit bias favoring thin people (Cohen's d=1.44) and weak implicit bias favoring whites (Cohen's d=0.35). We found no association between implicit or explicit bias scores and self-reported treatment of childhood overweight. Continuing education on obesity was associated with self-rated success and competence in weight management. CONCLUSIONS Weight and race bias exists among long-term IHS clinicians, but may not influence treatment approaches for overweight AI/AN children. Further research should assess the effect of clinicians' attitudes on real-world weight management.
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Affiliation(s)
- Janice A. Sabin
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA
| | - Kelly Moore
- Centers for American Indian and Alaska Native Health, University of Colorado, Aurora, CO
| | - Carolyn Noonan
- Center for Clinical and Epidemiological Research, University of Washington, Seattle, WA
| | - Odile Lallemand
- Center for Clinical and Epidemiological Research, University of Washington, Seattle, WA
| | - Dedra Buchwald
- Department of Epidemiology and Medicine, University of Washington, Seattle, WA
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Abstract
One-third of North American children are overweight or obese. Pathologic obesity accounts for only a small percentage of these cases. The vast majority are the result of a complex interaction of genetic and hormonal, nutritional, physical activity, and physical and social environmental factors. Obesity increases the risk for various cardiometabolic, pulmonary, and psychosocial complications for children, which often continues into adulthood. Multidisciplinary care, focusing on family-centered behavior change, is an evidence-based, essential part of the treatment, along with pharmacologic and surgical options for more complex cases. Prevention and early intervention strategies are key to reversing the obesity epidemic.
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Affiliation(s)
- Muskaan Gurnani
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Catherine Birken
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Jill Hamilton
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
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106
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Gowin M, Cheney M, Gwin S, Franklin Wann T. Health and Fitness App Use in College Students: A Qualitative Study. AMERICAN JOURNAL OF HEALTH EDUCATION 2015. [DOI: 10.1080/19325037.2015.1044140] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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107
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Hourigan SK, Torbenson M, Tibesar E, Scheimann AO. The full spectrum of hepatic steatosis in children. Clin Pediatr (Phila) 2015; 54:635-42. [PMID: 25567295 DOI: 10.1177/0009922814566927] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We aim to identify the spectrum of etiologies of steatosis in pediatric liver biopsies. METHODS Information was collected from 155 children with steatosis on liver biopsy, including anthropometrics, laboratory, and radiologic data. Biopsies were reviewed by a liver pathologist. RESULTS The 4 major diagnoses associated with hepatic steatosis were nonalcoholic fatty liver disease (37%), metabolic disease (9%), oncologic disease (8%) and viral hepatitis (7%). Patients with nonalcoholic fatty liver disease were older (P = .0001) and more likely to have a body mass index z score >2 (P < .0001). Patients with a metabolic diagnosis were younger (P = .0002). Radiologic imaging of the liver yielded normal results in 44 of 108 of children (30%); 7 of these had >66% macrovesicular fatty change on biopsy, and 3 had severe fibrosis/cirrhosis. CONCLUSIONS The range of causes of steatosis in pediatric liver biopsies is broad. Not all patients, even with advanced liver disease, had abnormalities with liver imaging, emphasizing the role for liver biopsy in certain cases.
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Affiliation(s)
- Suchitra K Hourigan
- Division of Pediatric Gastroenterology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA Division of Pediatric Gastroenterology, Pediatric Specialists of Virginia, Fairfax, VA, USA
| | | | - Eric Tibesar
- Division of Pediatric Gastroenterology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ann O Scheimann
- Division of Pediatric Gastroenterology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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108
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Larsen AL, McArdle JJ, Robertson T, Dunton G. Four Dietary Items of the School Physical Activity and Nutrition (SPAN) Questionnaire Form a Robust Latent Variable Measuring Healthy Eating Patterns. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:253-258. [PMID: 25648582 PMCID: PMC5854156 DOI: 10.1016/j.jneb.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 12/05/2014] [Accepted: 12/18/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Evaluate the factor structure and stability of 4 dietary items (fruit, fruit juice, vegetables, and milk) from the School Physical Activity and Nutrition questionnaire-elementary school version. METHODS Secondary analysis of intervention data from third graders measured at pre-intervention, post-intervention (10 weeks), and 3-month follow-up. The researchers conducted structural equation modeling invariance analysis to test the stability of the factor structure of the 4 items. RESULTS Data from 1,147 students. Fit indices revealed good fit for a single factor remaining stable across time (χ(2)/degrees of freedom [DF] = 59.75/59, P = .45), gender (χ(2)/DF = 149.72/128, P = .09), and study groups (χ(2)/DF = 143.04/128, P = .17). CONCLUSIONS AND IMPLICATIONS A healthy food factor consisting of the 4 items can be used in future data analysis. This offers several advantages in analysis, including the use of latent change scores that are more powerful, more informative, and more easily interpreted than traditional approaches.
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Affiliation(s)
- Andrew L Larsen
- Department of Psychology, University of Southern California, Los Angeles, CA.
| | - John J McArdle
- Department of Psychology, University of Southern California, Los Angeles, CA
| | | | - Genevieve Dunton
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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109
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Paredes-Turrubiarte G, González-Chávez A, Pérez-Tamayo R, Salazar-Vázquez BY, Hernández VS, Garibay-Nieto N, Fragoso JM, Escobedo G. Severity of non-alcoholic fatty liver disease is associated with high systemic levels of tumor necrosis factor alpha and low serum interleukin 10 in morbidly obese patients. Clin Exp Med 2015; 16:193-202. [PMID: 25894568 DOI: 10.1007/s10238-015-0347-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/02/2015] [Indexed: 02/06/2023]
Abstract
Morbid obesity has been shown to increase the risk to develop hepatic steatosis, also referred to as non-alcoholic fatty liver disease (NAFLD). Emerging evidence suggests that the severity of NAFLD may associate with increased serum levels of inflammatory markers as well as decreased concentration of mediators with anti-inflammatory actions, such as tumor necrosis factor alpha (TNF-α) and interleukin (IL) 10, respectively. We thus examined the serum levels of TNF-α and IL-10 in 102 morbidly obese women and men (body mass index > 40 kg/m(2)), exhibiting different grades of NAFLD. Blood glucose, glycated hemoglobin, insulin, the homeostatic model assessment of insulin resistance (HOMA-IR), total cholesterol, triglycerides, high- and low-density lipoproteins, parameters of liver function, TNF-α, and IL-10 were measured in each subject. The stage of NAFLD was estimated by abdominal ultrasound imaging. In comparison with morbidly obese subjects without steatosis, morbidly obese patients with NAFLD showed increased age (39.23 ± 9.80 years), HOMA-IR (6.74 ± 1.62), total cholesterol (219.7 ± 9.58 mg/dl), aspartate aminotransferase (36.25 ± 3.24 UI/l), gamma-glutamyl transpeptidase (37.12 ± 3.41 UI/l), and TNF-α (37.41 ± 1.72 pg/ml) as well as decreased serum levels of IL-10 (61.05 ± 2.43 pg/ml). Interestingly, the systemic levels of TNF-α increased, while IL-10 decreased in accordance with the severity of NAFLD, which supports a role for systemic inflammatory mediators in promoting steatosis progression. Further clinical prospective studies need to be addressed to elucidate the role of TNF-α and IL-10 in the development of NAFLD while also establishing their clinical utility in the assessment of morbidly obese patients at higher risk to develop severe steatosis.
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Affiliation(s)
| | - Antonio González-Chávez
- Department of Internal Medicine, General Hospital of Mexico "Dr. Eduardo Liceaga", 06720, Mexico, D.F., Mexico.
| | - Ruy Pérez-Tamayo
- Unit of Experimental Medicine, School of Medicine, National University of Mexico, General Hospital of Mexico "Dr. Eduardo Liceaga", 06720, Mexico, D.F., Mexico
| | - Beatriz Y Salazar-Vázquez
- Unit of Experimental Medicine, School of Medicine, National University of Mexico, General Hospital of Mexico "Dr. Eduardo Liceaga", 06720, Mexico, D.F., Mexico
| | - Vito S Hernández
- Departament of Physiology, School of Medicine, National University of Mexico, 04510, Mexico, D.F., Mexico
| | - Nayeli Garibay-Nieto
- Department of Human Genetics, General Hospital of Mexico "Dr. Eduardo Liceaga", 06720, Mexico, D.F., Mexico
| | - José Manuel Fragoso
- Department of Molecular Biology, National Institute of Cardiology "Ignacio Chávez", 14080, Mexico, D.F., Mexico
| | - Galileo Escobedo
- Unit of Experimental Medicine, School of Medicine, National University of Mexico, General Hospital of Mexico "Dr. Eduardo Liceaga", 06720, Mexico, D.F., Mexico.
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110
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Habib-Mourad C, Ghandour LA. Time to act: lessons learnt from the first pilot school-based intervention study from Lebanon to prevent and reduce childhood obesity. Front Public Health 2015; 3:56. [PMID: 25927063 PMCID: PMC4397838 DOI: 10.3389/fpubh.2015.00056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/21/2015] [Indexed: 01/08/2023] Open
Abstract
Today, childhood overweight and obesity are serious public health problems that the world faces. Obese children suffer from both short-term and long-term health consequences, and poorer adult health. Despite the rising prevalence of childhood obesity in the Eastern Mediterranean Region, including Lebanon, no intervention research studies have been undertaken. This paper summarizes the main challenges and lessons learned emanating from the first evidence-based multicomponent school intervention aimed at promoting Healthy Eating and Physical Activity in Lebanese School children (Health-E-PALS). Health-E-PALS, which includes three components (class curriculum, family involvement, and food service) and relies on interactive fun learning activities, achieved an increase in students' nutritional knowledge and self-efficacy, and a decrease in their purchase and consumption of high energy dense snacks and beverages. Recommendations for future school-based programs are also highlighted.
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Affiliation(s)
- Carla Habib-Mourad
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut , Beirut , Lebanon
| | - Lilian A Ghandour
- Department of Epidemiology and Population Health, American University of Beirut , Beirut , Lebanon
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111
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Liu GC, Hannon T, Qi R, Downs SM, Marrero DG. The obesity epidemic in children: Latino children are disproportionately affected at younger ages. Int J Pediatr Adolesc Med 2015; 2:12-18. [PMID: 30805430 PMCID: PMC6372366 DOI: 10.1016/j.ijpam.2015.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/20/2014] [Indexed: 01/19/2023]
Abstract
Background and objectives National surveillance clearly illustrates that U.S. children are becoming increasingly overweight. However, the timing of the onset of childhood overweight has not been well-described. Patients and methods An accelerated failure time (AFT) model was used to describe the emergence of overweight based on a 12-year collection of height and weight data of over 40,000 children. Race, sex, insurance status and their interactions were specifically examined as predictors of earlier onset of overweight. The outcome of interest was an estimate of the age at which the model predicted that a subgroup would attain a 20% prevalence of overweight. Results The three-way interaction of race, sex, and insurance status was a significant predictor of onset of overweight. The model estimated that the publicly insured Latino male subgroup had the earliest onset of overweight, attaining a prevalence of 20% overweight by 4.3 years of age. The emergence of overweight in Latino subjects was significantly earlier than that for black or white subjects, irrespective of sex or insurance status. Conclusion Regardless of sex or insurance status, overweight emerges at significantly younger ages in Latino children when compared to black and white children. Substantial numbers of Latino male children are predicted to develop overweight at preschool ages. Obesity prevention may need to be directed toward parents or children well before children enter grade-school.
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Affiliation(s)
- Gilbert C Liu
- Child and Adolescent Health Research Design and Support, University of Louisville, Louisville, KY, USA
| | - Tamara Hannon
- Division of Weight Management and Wellness, Children's Hospital of Pittsburg, Pittsburg, PA, USA
| | - Rong Qi
- Division of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stephen M Downs
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David G Marrero
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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112
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Cason-Wilkerson R, Goldberg S, Albright K, Allison M, Haemer M. Factors influencing healthy lifestyle changes: a qualitative look at low-income families engaged in treatment for overweight children. Child Obes 2015; 11:170-6. [PMID: 25715107 PMCID: PMC4382822 DOI: 10.1089/chi.2014.0147] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Childhood obesity disproportionately affects low-income minority populations, yet there is a paucity of literature about effective interventions in this population. This study sought to understand the experience of low-income majority Hispanic families engaged in obesity treatment. METHODS We conducted six focus groups (2=English, 4=Spanish) with families who completed a community-based, family-oriented obesity treatment program, using standard qualitative focus group interview methods. Transcripts were recorded, transcribed, and analyzed for thematic content. Two coders using the software program ATLAS.ti (v.7.0; Scientific Software Development GmbH, Berlin, Germany) coded each transcript independently; reflexive team analysis with three study team members was used to reach a consensus. RESULTS Participants (n=37) indicated high program satisfaction. Parents reported buying less junk/fast food, increased consumption of fruits and vegetables, preparing and eating more meals as a family, and increasing their families' physical activity (PA). Four barrier and facilitator themes emerged. Barrier themes were time and financial cost, parent's lack of time and energy, influence of family members, and challenges regarding physical environment. Facilitator themes were skill building around healthy eating and parenting, family involvement, and long-term health concerns. Unanticipated findings, parents reported, were that changes resulted in children sleeping better, feeling happier, and less irritability. CONCLUSIONS Despite low-income families experiencing barriers to lifestyle changes to manage obesity, they made positive dietary changes and increased PA by learning specific skills and including the whole family in those changes. Additionally, some unexpected benefits were noted, including improved sleep, less irritability, and children appearing happier. Future studies should consider using these parent-identified outcomes as secondary measures of program effectiveness.
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Affiliation(s)
| | - Shauna Goldberg
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Karen Albright
- Children's Outcomes Research Program, The Children's Hospital, Aurora, CO.,Colorado Health Outcomes Program, University of Colorado, Anschutz Medical Campus, Aurora, CO.,Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Mandy Allison
- Children's Outcomes Research Program, The Children's Hospital, Aurora, CO
| | - Matthew Haemer
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO
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113
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Millimet DL, Tchernis R. Persistence in body mass index in a recent cohort of US children. ECONOMICS AND HUMAN BIOLOGY 2015; 17:157-176. [PMID: 25466866 DOI: 10.1016/j.ehb.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 10/16/2014] [Accepted: 10/20/2014] [Indexed: 06/04/2023]
Abstract
While childhood obesity has become a significant public health concern over the last few decades, and underweight children continue to be a concern, knowledge pertaining to the origins of or persistence in childhood anthropometric measures is incomplete. Here, we utilize several nonparametric metrics to assess the evolution of weight and body mass index (BMI) across the entire distribution during early childhood. We find that movements within the distribution of weight - both upward and downward - are quite high prior to primary school and then decline noticeably. For BMI, we find that movements within the distribution - both upward and downward - are highest at the start of kindergarten and at the start of middle school. However, there are important sources of heterogeneity, including race, gender, and age that should prove insightful to researchers and policymakers. For instance, comparing males versus females who are initially in the bottom quartile of the distribution of BMI, we find that males have a higher probability of moving up at least 10 percentile points between kindergarten and eighth grade (53% versus 50%). Comparisons among racial groups indicate that whites who are initially in the top quartile of the distribution of BMI have a higher probability of moving down at least 10 percentile points between kindergarten and eighth grade than blacks and Hispanics (46% versus 37% and 40%, respectively).
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114
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Basterfield L, Reilly JK, Pearce MS, Parkinson KN, Adamson AJ, Reilly JJ, Vella SA. Longitudinal associations between sports participation, body composition and physical activity from childhood to adolescence. J Sci Med Sport 2015; 18:178-82. [PMID: 24704422 PMCID: PMC4364369 DOI: 10.1016/j.jsams.2014.03.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 02/08/2014] [Accepted: 03/06/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Several important research questions have been addressed: (1) What are the cross-sectional associations between sports club participation, objectively measured physical activity, and adiposity? (2) Do measures of physical activity and adiposity predict subsequent sports club participation? (3) Does sports club participation predict subsequent measures of physical activity and adiposity? and (4) Do changes in sports club participation predict changes in objective measures of physical activity and adiposity? DESIGN Longitudinal and cross-sectional. METHODS Data from the Gateshead Millennium Study birth cohort (n=609 at age 7 years) were analysed for associations between adiposity, sports club participation and accelerometer-measured physical activity from ages 7y to 9y to 12y. RESULTS Seventy-two per cent of 9 year olds and 63% of 12 year olds took part in a sports club. Sports club participation was significantly associated with overall accelerometer-measured physical activity at 12y (coefficient=0.0.09; 95% CI: 0.01-0.16) but not 9y. An inverse relationship between fat mass (estimated from bioelectric impedance) and sport club participation, and between fat mass and accelerometer-measured physical activity was observed at 12y, but not 9y. Sports club participation at 9y was highly predictive of participation at 12y. Sports club participation was significantly associated with socioeconomic status; fewer children from poorer areas took part. CONCLUSIONS Sports club participation in adolescence may be associated with decreased levels of adiposity. Furthermore, the potential benefits of sports club participation for adiposity are likely generated from continuous participation in sports, rather than any long-term protective effects.
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Affiliation(s)
- Laura Basterfield
- Institute of Health & Society and Human Nutrition Research Centre, Newcastle University, UK
| | - Jessica K Reilly
- Institute of Health & Society and Human Nutrition Research Centre, Newcastle University, UK
| | - Mark S Pearce
- Institute of Health & Society, Newcastle University, UK
| | - Kathryn N Parkinson
- Institute of Health & Society and Human Nutrition Research Centre, Newcastle University, UK
| | - Ashley J Adamson
- Institute of Health & Society and Human Nutrition Research Centre, Newcastle University, UK.
| | - John J Reilly
- Physical Activity for Health Group, University of Strathclyde, UK
| | - Stewart A Vella
- Interdisciplinary Educational Research Institute, Faculty of Social Sciences, University of Wollongong, Australia
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115
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Wright JA, Whiteley JA, Laforge RG, Adams WG, Berry D, Friedman RH. Validation of 5 stage-of-change measures for parental support of healthy eating and activity. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:134-42.e1. [PMID: 25579067 PMCID: PMC4355107 DOI: 10.1016/j.jneb.2014.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the validity of 5 parental stage-of-change (SOC) measures: (1) providing 5 servings/d of fruits and vegetables (FV), (2) limiting television (TV) to 2 h/d, (3) helping children achieve 1 h/d physical activity (PA), (4) limiting sugary drinks (SD) to 1 serving/wk, and (5) limiting fruit juice (FJ) to 4-6 oz/d. DESIGN Cross-sectional instrument development study. Construct validity was evaluated by examining whether parental self-efficacy, parental readiness ladder (ladder), and child's behavioral levels (eg, FV consumption) exhibited a theoretically consistent pattern across the SOC. SETTING/PARTICIPANTS Convenience sample (n = 283) of parents of children aged 4-10 years. MEASURES Survey assessed SOC, ladder, and child's behavioral level score for each topic (FV, TV, PA, SD, and FJ), and parental self-efficacy for measure except TV. ANALYSIS Analysis of variance with Tukey-Kramer post hoc tests examined whether variables differed by SOC. RESULTS Percentages of parents in the pre-action SOC were 34% (PA), 39% (FV), 42% (SD), 45% (TV), and 63% (FJ). Parental self-efficacy, ladder, and child's behavioral level differed significantly by SOC for each topic area (P < .001). Maintenance SOC was significantly higher than pre-action SOC. CONCLUSIONS AND IMPLICATIONS Measured variables exhibited a theoretically consistent pattern across SOC, suggesting construct validity and potential usefulness for obesity prevention efforts.
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Affiliation(s)
- Julie A Wright
- Department of Exercise and Health Sciences, University of Massachusetts-Boston, Boston, MA; Section of General Internal Medicine, Boston University School of Medicine, Boston, MA.
| | - Jessica A Whiteley
- Department of Exercise and Health Sciences, University of Massachusetts-Boston, Boston, MA
| | - Robert G Laforge
- Department of Psychology, University of Rhode Island, Kingston, RI
| | - William G Adams
- Department of General Pediatrics, Boston University School of Medicine, Boston, MA
| | - Donna Berry
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Robert H Friedman
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
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116
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Marsch S, Bacher A, Ettenhuber C, Gräwert T, Mückter H, Seidel D, Vogeser M, Laupitz R, Fischer M, Bacher U, Eisenreich W. The complex isotopologue space of glucose as a framework for the study of human intermediary metabolism. ISOTOPES IN ENVIRONMENTAL AND HEALTH STUDIES 2015; 51:11-23. [PMID: 25622148 DOI: 10.1080/10256016.2014.1001845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The positional distributions of stable isotopes in metabolites provide specific fingerprints of the pathways and fluxes that have occurred in the organisms under study. In particular, modern nuclear magnetic resonance (NMR) spectroscopy enables the detailed assignment of isotope patterns in natural products, for example, in metabolites obtained from labelling experiments using (13)C-enriched precursors, such as glucose, acetate or CO2. In this study, the transient (13)C-isotopologue composition of blood glucose from an adult human volunteer after intravenous supply of [U-(13)C6]glucose was determined by high-resolution (13)C NMR spectroscopy. The non-linear progression curves displaying the relative amounts of eight (13)C-glucose isotopologues reflected the contributions of glucose metabolism by glycolytic cycling, the pentose phosphate pathway and anaplerotic reactions involving the citric acid cycle. The pilot study suggests that the experimental setting can be useful in analysing under non-invasive conditions the impact of physiological and pharmacological constraints on glucose turnover in humans.
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Affiliation(s)
- Silke Marsch
- a Lehrstuhl für Biochemie , Technische Universität München , Garching , Germany
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Rosemond TN, Blake CE, Jenkins KA, Buff SM, Moore JB. Dietary Improvements Among African American Youth: Results of an Interactive Nutrition Promotion Program. AMERICAN JOURNAL OF HEALTH EDUCATION 2015. [DOI: 10.1080/19325037.2014.977409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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118
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Robinson TN, Matheson DM. Environmental strategies for portion control in children. Appetite 2014; 88:33-8. [PMID: 25485874 DOI: 10.1016/j.appet.2014.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
Evidence from laboratory and field studies indicates that large portions lead to greater food and energy intake relative to small portions. However, most children and adults demonstrate limited abilities to estimate and control the amounts of food they serve and consume. Five potential environmental strategies appear promising for improving portion control in children: (1) using tall, thin, and small volume glasses and mugs, (2) using smaller diameter and volume plates, bowls and serving utensils, (3) using plates with rims, (4) reducing total television and other screen watching and (5) reducing or eliminating eating while watching television and/or other screens. Further experimental research in real world settings is needed to test these interventions as strategies for portion control and their roles in prevention and treatment of obesity.
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Affiliation(s)
- Thomas N Robinson
- Solutions Science Lab, Division of General Pediatrics, Department of Pediatrics and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, MSOB X129, Stanford, CA 94305, USA.
| | - Donna M Matheson
- Solutions Science Lab, Division of General Pediatrics, Department of Pediatrics and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, MSOB X129, Stanford, CA 94305, USA
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119
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Schuster MA, Elliott MN, Bogart LM, Klein DJ, Feng JY, Wallander JL, Cuccaro P, Tortolero SR. Changes in obesity between fifth and tenth grades: a longitudinal study in three metropolitan areas. Pediatrics 2014; 134:1051-8. [PMID: 25384494 DOI: 10.1542/peds.2014-2195] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite epidemic childhood obesity levels, we know little about how BMI changes from preadolescence to adolescence and what factors influence changes. METHODS We studied 3961 randomly selected public school students and 1 parent per student in 3 US metropolitan areas in fifth and again in tenth grades. In each grade, we measured child and parent height/weight and calculated BMI category. We examined whether baseline sociodemographic characteristics, child health-related factors, and parental obesity were significantly associated with exit from and entry into obesity from fifth to tenth grade. RESULTS Fifth- and tenth-graders were 1%/2% underweight, 53%/60% normal weight, 19%/18% overweight, and 26%/20% obese, respectively. Among obese tenth-graders, 83% had been obese as fifth-graders and 13% had been overweight. Sixty-five percent of obese fifth-graders remained obese as tenth-graders, and 23% transitioned to overweight. Multivariately, obese fifth-graders who perceived themselves to be much heavier than ideal (P = .01) and those who had lower household education (P = .006) were less likely to exit obesity; by contrast, overweight fifth-graders were more likely to become obese if they had an obese parent (P < .001) or watched more television (P = .02). CONCLUSIONS Obese fifth-graders face challenges in reducing obesity, especially when they lack advantages associated with higher socioeconomic status or when they have a negative body image. Clinicians and others should educate parents on the importance of preventing obesity very early in development. Children who are not yet obese by fifth grade but who have an obese parent or who watch considerable television might benefit from monitoring, as might children who have negative body images.
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Affiliation(s)
- Mark A Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; RAND Corporation, Santa Monica, California;
| | | | - Laura M Bogart
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - David J Klein
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Jeremy Y Feng
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jan L Wallander
- Psychological Sciences, University of California, Merced, California; and
| | - Paula Cuccaro
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Susan R Tortolero
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
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120
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Abdolahi H, Iraj B, Mirpourian M, Shariatifar B. Association of neck circumference as an indicator of upper body obesity with cardio-metabolic risk factors among first degree relatives of diabetes patients. Adv Biomed Res 2014; 3:237. [PMID: 25538923 PMCID: PMC4260287 DOI: 10.4103/2277-9175.145740] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background: The aim of the present study was to determine the relation between neck circumferences (NC), as an indicator of upper body obesity, with anthropometric and cardio-metabolic factors among the first degree relatives of diabetes patients. Materials and Methods: This cross-sectional study was performed on first degree relatives of diabetes patients (n = 213). Weight, height, waist circumference (WC), hip circumference (HC), systolic blood pressure (SBP), diastolic blood pressure (DBP) and NC were measured. Laboratory data included oral glucose tolerance test (OGTT) results, high density lipoprotein (HDL), low density lipoprotein, triglyceride (TG) and total cholesterol. Results: There was no difference in NC among different results of OGTT in men or women. Factors including weight, body mass index (BMI), WC and HC were strongly associated with NC in both genders (r = 0.420-0.711). NC was weakly associated with SBP in women (r = 0.195) and moderately with DBP in men (r = 0.314). Regarding lipid profile, HDL and TG were associated with NC only in women (r = −0.268-0.325). Conclusions: NC has a significant correlation with gender and anthropometric variables including BMI, weight and waist and HCs in both men and women but it does not differ significantly in patients with different status in OGTT.
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Affiliation(s)
- Hadi Abdolahi
- Departments of Internal Medicine and Endocrinology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Mirpourian
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Shariatifar
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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121
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Effectiveness of a child's fable on the cognition of preschools when used to address childhood obesity. J Pediatr Nurs 2014; 29:547-54. [PMID: 25150619 DOI: 10.1016/j.pedn.2014.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 11/23/2022]
Abstract
The study investigated the effectiveness of a child's fable on the cognition of preschoolers when used to address childhood obesity. A single group, pretest/posttest design was used with 57 preschool children. Analysis of variance compared pre-existing differences between the four classes with respect to pre-test scores. A repeated measures t-test analyzed changes in scores as a result of the intervention. Following the fable intervention, students showed a significant difference (0.5) between their pre- and post-test scores, indicating this method to an effective learning strategy in this setting and age population.
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Abstract
BACKGROUND In the past decades, the obesity epidemic in children of all ages has been an important research field for detecting the metabolic causes and consequences of obesity, the major focus being on insulin and adipocytokine levels. Metabolic work-up in obese children is recommended in the age group as young as 2-6 years. There is evidence that birth weight can be a factor causing obesity later in life accompanied by metabolic complications. METHODS Insulin, leptin, and adiponectin levels were analyzed in 269 obese children and 60 controls, as well as 110 newborn children with different birth weight and different length of gestation, using standard methods. RESULTS In 53.6% of the obese children, complications of obesity such as diabetes mellitus, obesity, hyperlipidemia, heart attack or stroke were found in family members. The peak insulinemia on OGTT was significantly higher in the pubertal compared to the prepubertal group (110.5± 75.9 μU/mL versus 72.2±62.7 μU/mL) (p<0.005). Glucose intolerance was confirmed in 24%. The leptin level was significantly higher and the adiponectin level was lower in pubertal obese children compared to the prepubertal children and controls (p<0.05). In newborns the leptin and adiponectin levels were in correlation with anthropometric parameters: body weight (BW), body length (BL), BW/BL, BMI, and the pondered index (p<0.05). CONCLUSION Obese children have high insulinemia in all ages, reaching its peak towards puberty. The leptin and adiponectin levels might be indicators of the metabolic syndrome. Our findings in newborns might influence the nutritional approach in the future in order to prevent complications of obesity.
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123
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Achat HM, Stubbs JM. Socio-economic and ethnic differences in the prevalence of overweight and obesity among school children. J Paediatr Child Health 2014; 50:E77-84. [PMID: 22530877 DOI: 10.1111/j.1440-1754.2012.02474.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To trial the collection of measurements to provide population-based prevalence of overweight and obesity in school children in western Sydney and examine the association between healthy weight and ethnicity and socio-economic status (SES) in a socio-economically and culturally diverse population. METHODS A cross-sectional population-based survey of 2341 children in Years 4 and 7 (mean ages 9 and 12 years, respectively) in 2007. RESULTS Nineteen percent of children were overweight and a further 6% were obese. The prevalence of combined overweight and obesity was similar for boys and girls (26% vs. 24%, P= 0.35). SES was significantly associated with the prevalence of unhealthy weight: the odds of being overweight or obese were 1.79 times (95% confidence interval (CI) 1.35 to 2.36) higher for children from the lowest quartile than for children from the highest quartile. Compared to children from an English speaking background, children from a non-English speaking background were significantly more likely to be overweight or obese (21% vs. 31%, P < 0.001). The prevalence of combined overweight and obesity was significantly higher for children from a Pacific Island (odds ratio (OR) 2.66, 95% CI 1.63 to 4.33), Middle Eastern (OR 1.63, 95% CI 1.22 to 2.17) or European (OR 1.67, 95% CI 1.12 to 2.49) background than for English speaking background children. CONCLUSION Large jumps in the prevalence of overweight and obesity in children observed from the 1980s appear to be diminishing, with comparable prevalence reports in 2004 and 2007. Ethnicity and SES are each independently associated with the prevalence of unhealthy weight in children.
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Affiliation(s)
- Helen M Achat
- Epidemiology, Sydney West Area Health Service, North Parramatta, New South Wales, Australia
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124
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Grondhuis SN, Aman MG. Overweight and obesity in youth with developmental disabilities: a call to action. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:787-799. [PMID: 24020517 DOI: 10.1111/jir.12090] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/15/2013] [Indexed: 06/02/2023]
Abstract
Elevated weight status has become a leading problem for adults and children around the world, regardless of the presence or lack of disability. Youth with intellectual and developmental disabilities are more vulnerable than the typical population to overweight in recent decades, and these individuals often experience overweight and obesity at higher rates than their typically developing peers. Young people with disabilities have many circumstances, beyond those of typically developing children, which increase their risk for greater body mass. These include greater medication use, having syndromes with obesity as an associated symptom, and possessing altered eating habits related to their disability. We discuss obesity-related health risks, possible weight management options, recommendations for weight maintenance or loss, and future research. Although most professionals who work with youth having developmental disabilities do not have great expertise in nutrition and weight management, we must collectively recognise the importance of weight issues for quality of life of these individuals and work with them in maintaining healthy lifestyles. Intervention options, both for caregivers and for health professionals, are discussed.
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Affiliation(s)
- S N Grondhuis
- The Nisonger Center, The Ohio State University, Columbus, OH, USA
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125
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Abstract
Obesity in childhood is a very common disorder with an increasing prevalence. It is one of the most serious public health challenges. The objectives of the present paper are to increase the awareness of the problem of obesity in childhood, its serious complications and the need for prevention. Overweight and obese children are likely to remain obese into adulthood and more likely to develop serious complications including health problems such as diabetes and CVD, as well as psychological and social challenges. Overweight and obesity are largely preventable. In adults it is difficult to reduce excessive weight gain once it has become established, thus children should be considered the priority population for intervention strategies and prevention. Nutrition, exercise, weight gain in infancy, genetic and environmental factors, all contribute to the aetiology. Prevention and treatment of obesity in childhood requires education and empowerment of families relating to diet and exercise, along with the regulation and control of food marketing and clear nutritional labelling. The eating and physical activity behaviour of a child is strongly influenced by environmental and social factors. Therefore treatment will have only limited success in an environment where adequate physical activity is inhibited and the consumption of high-energy food is stimulated. Government investment in a health promotion programme addressing the issue of obesity in the population as a whole, with particular emphasis on the prevention and management of obesity in childhood is vital. The family doctor and multidisciplinary team play an important role. Regular visits to the family doctor, including growth assessment, will help motivate the family to restrict energy intake and to increase exercise. Therefore the prevention of childhood obesity needs high priority.
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126
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Bonfrate L, Wang DQH, Garruti G, Portincasa P. Obesity and the risk and prognosis of gallstone disease and pancreatitis. Best Pract Res Clin Gastroenterol 2014; 28:623-35. [PMID: 25194180 DOI: 10.1016/j.bpg.2014.07.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/02/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023]
Abstract
Obesity is a risk factor for the formation of cholesterol gallstones and exposes patients to increased risk of gallstone-related complications and cholecystectomy. Rapid weight loss achieved by very low calorie diets or bariatric surgery is also a risk factor for cholelithiasis in obese patients, and therapy should take into account the higher prevalence of gallstones, the possibility of more frequent complications and the need for prophylactic treatment with oral ursodeoxycholic acid during weight loss. Obesity is also frequent in children and adolescents, and the burden of cholesterol cholelithiasis is increasing in this population. The chance to develop acute pancreatitis and the severity of the disease are higher in obese subjects because of specific pathogenic factors, including supersaturated bile and crystal formation, rapid weight loss, and visceral obesity. All health policies aimed at reducing the incidence of obesity worldwide will decrease the incidence of gallstones and gallstone-related complications. The pathophysiological scenarios and the therapeutic implications for obesity, gallstone disease, and pancreatitis are discussed.
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Affiliation(s)
- Leonilde Bonfrate
- Residency Programme in Internal Medicine, University of Bari Medical School, 70124 Bari, Italy.
| | - David Q-H Wang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
| | - Gabriella Garruti
- Department of Emergency and Organ Transplants, Section of Endocrinology, Andrology and Metabolic Diseases, University of Bari Medical School, 70124 Bari, Italy.
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
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127
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Ramcharitar-Bourne A, Nichols S, Badrie N. Correlates of adiposity in a Caribbean pre-school population. Public Health Nutr 2014; 17:1796-804. [PMID: 23866843 PMCID: PMC10282291 DOI: 10.1017/s1368980013001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 05/01/2013] [Accepted: 06/13/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate ethnic and anthropometric correlates of adiposity among a nationally representative, multi-ethnic, Trinidadian pre-school population. DESIGN Cross-sectional study conducted between June 2008 and July 2009. SETTING Government and privately owned Early Childhood Care and Education Centres in Trinidad. SUBJECTS A total of 596 pre-school children (aged 31-73 months) from thirty-four schools had their weight, height, mid-upper arm circumference, waist circumference, biceps and triceps skinfold thicknesses measured by a registered dietitian using standard procedures. Percentage body fat was estimated using a foot-to-foot bioelectric impedance analyser (Tanita 531, Tokyo, Japan). Date of birth, religion and ethnicity were extracted from school records and pre-schoolers' ethnicity was categorized as East Indian, African, Mixed (a combination of two or more ethnicities), Chinese or Caucasian. RESULTS Anthropometric variables explained significantly more of the variance in adiposity among girls (67·4-88·1 %) than boys (24·4-39·2 %; P < 0·0 0 1). Pre-schoolers of African descent were significantly taller, heavier and had higher abdominal fat and mid-upper arm circumference than their East Indian and Mixed counterparts (all P < 0·001). The overall prevalence of excess adiposity (≥25 % body fat) as determined by bioelectrical impedance was 14·6 %, while 2·9 % of the children were undernourished according to WHO weight-for-age criteria. Differences in anthropometry were non-existent between children attending government and private pre-schools. CONCLUSIONS Gender, ethnicity and anthropometry all explained excess adiposity in these pre-schoolers. These findings highlight the need to elucidate the mechanisms that may be involved in explaining these differences, particularly those of ethnic origin.
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Affiliation(s)
- Anisa Ramcharitar-Bourne
- Department of Agricultural Economics and Extension, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Selby Nichols
- Department of Agricultural Economics and Extension, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Neela Badrie
- Department of Food Production, The University of the West Indies, St. Augustine, Trinidad and Tobago
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128
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Tran BX, Ohinmaa A, Kuhle S, Johnson JA, Veugelers PJ. Life course impact of school-based promotion of healthy eating and active living to prevent childhood obesity. PLoS One 2014; 9:e102242. [PMID: 25025581 PMCID: PMC4099303 DOI: 10.1371/journal.pone.0102242] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 06/17/2014] [Indexed: 11/18/2022] Open
Abstract
Background The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) is a comprehensive school health program that is proven feasible and effective in preventing obesity among school aged children. To support decision making on expanding this program, evidence on its long-term health and economic impacts is particularly critical. In the present study we estimate the life course impact of the APPLE Schools programs in terms of future body weights and avoided health care costs. Method We modeled growth rates of body mass index (BMI) using longitudinal data from the National Population Health Survey collected between 1996–2008. These growth rate characteristics were used to project BMI trajectories for students that attended APPLE Schools and for students who attended control schools (141 randomly selected schools) in the Canadian province of Alberta. Results Throughout the life course, the prevalence of overweight (including obesity) was 1.2% to 2.8% (1.7 on average) less among students attending APPLE Schools relative to their peers attending control schools. The life course prevalence of obesity was 0.4% to 1.4% (0.8% on average) less among APPLE Schools students. If the APPLE Schools program were to be scaled up, the potential cost savings would be $33 to 82 million per year for the province of Alberta, or $150 to 330 million per year for Canada. Conclusions These projected health and economic benefits seem to support broader implementation of school-based health promotion programs.
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Affiliation(s)
- Bach Xuan Tran
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Stefan Kuhle
- Department of Pediatrics, Obstetrics & Gynecology, Dalhousie University, Halifax, NS, Canada
| | - Jeffrey A. Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Paul J. Veugelers
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Zuckerman KE, Hill AP, Guion K, Voltolina L, Fombonne E. Overweight and obesity: prevalence and correlates in a large clinical sample of children with autism spectrum disorder. J Autism Dev Disord 2014; 44:1708-19. [PMID: 24488158 PMCID: PMC4058357 DOI: 10.1007/s10803-014-2050-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Autism Spectrum Disorders (ASDs) and childhood obesity (OBY) are rising public health concerns. This study aimed to evaluate the prevalence of overweight (OWT) and OBY in a sample of 376 Oregon children with ASD, and to assess correlates of OWT and OBY in this sample. We used descriptive statistics, bivariate, and focused multivariate analyses to determine whether socio-demographic characteristics, ASD symptoms, ASD cognitive and adaptive functioning, behavioral problems, and treatments for ASD were associated with OWT and OBY in ASD. Overall 18.1% of children met criteria for OWT and 17.0% met criteria for OBY. OBY was associated with sleep difficulties, melatonin use, and affective problems. Interventions that consider unique needs of children with ASD may hold promise for improving weight status among children with ASD.
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Affiliation(s)
- Katharine E Zuckerman
- Division of General Pediatrics and Child and Adolescent Health Measurement Initiative, Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines Rd., Mail Code CDRC-P, Portland, OR, 97239-3098, USA,
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130
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Abstract
With the childhood prevalence of obesity and asthma increasing, it is important for pediatric professionals to appreciate that obesity modifies the diagnosis and management of asthma. These disease modifications present challenges to clinical management, including decreased responsiveness to controller therapy and decreased quality of life compared with normal-weight asthmatic children. While consensus guidelines do not currently suggest specific changes in asthma management for obese patients, management of some patients may be improved with consideration of the latest evidence. This article briefly summarizes what is known regarding the complex relationship between obesity and asthma in children, and discusses practical issues associated with the diagnosis and effective clinical management of asthma in obese children. On average, obese patients with asthma do not respond as well to inhaled corticosteroid therapy. Management approaches including weight loss and routine exercise are safe, and may improve important asthma outcomes. Asthma providers should learn to facilitate weight loss for their obese patients. In addition, pharmacologic interventions for weight loss in obese asthma, though not currently recommended, may soon be considered.
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Affiliation(s)
- Jason E. Lang
- Center for Pharmacogenomics & Translational Research, Nemours Children’s Hospital, 13535 Nemours Parkway, Orlando, FL 32827, , Phone: 407-567-7535 Fax: 407-650-7663
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131
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Sanders LM, Perrin EM, Yin HS, Bronaugh A, Rothman RL. "Greenlight study": a controlled trial of low-literacy, early childhood obesity prevention. Pediatrics 2014; 133:e1724-37. [PMID: 24819570 PMCID: PMC4035594 DOI: 10.1542/peds.2013-3867] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Children who become overweight by age 2 years have significantly greater risks of long-term health problems, and children in low-income communities, where rates of low adult literacy are highest, are at increased risk of developing obesity. The objective of the Greenlight Intervention Study is to assess the effectiveness of a low-literacy, primary-care intervention on the reduction of early childhood obesity. At 4 primary-care pediatric residency training sites across the US, 865 infant-parent dyads were enrolled at the 2-month well-child checkup and are being followed through the 24-month well-child checkup. Two sites were randomly assigned to the intervention, and the other sites were assigned to an attention-control arm, implementing the American Academy of Pediatrics' The Injury Prevention Program. The intervention consists of an interactive educational toolkit, including low-literacy materials designed for use during well-child visits, and a clinician-centered curriculum for providing low-literacy guidance on obesity prevention. The study is powered to detect a 10% difference in the number of children overweight (BMI > 85%) at 24 months. Other outcome measures include observed physician-parent communication, as well as parent-reported information on child dietary intake, physical activity, and injury-prevention behaviors. The study is designed to inform evidence-based standards for early childhood obesity prevention, and more generally to inform optimal approaches for low-literacy messages and health literacy training in primary preventive care. This article describes the conceptual model, study design, intervention content, and baseline characteristics of the study population.
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Affiliation(s)
- Lee M. Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, California
| | - Eliana M. Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - H. Shonna Yin
- Department of Pediatrics, School of Medicine/Bellevue Hospital Center, New York University, New York, New York; and
| | - Andrea Bronaugh
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Russell L. Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
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Small L, Bonds-McClain D, Melnyk B, Vaughan L, Gannon AM. The preliminary effects of a primary care-based randomized treatment trial with overweight and obese young children and their parents. J Pediatr Health Care 2014; 28:198-207. [PMID: 23511090 PMCID: PMC3690141 DOI: 10.1016/j.pedhc.2013.01.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 01/04/2013] [Accepted: 01/17/2013] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Twenty-three percent of preschoolers are overweight/obese, which puts these children at risk for the development of chronic health comorbidities. The purpose of this randomized control pilot study was to determine the feasibility and preliminary effects of a theoretically based, primary care intervention on the physical outcomes of 60 overweight/obese preschool/early school-aged 4- to 8-year-old children. METHODS After recruitment and baseline assessment, parent-child dyads were randomly assigned to either the treatment or the control condition. Four intervention sessions were conducted with the parents in their child's primary health care office. The impact of the intervention was evaluated by assessing child anthropometric measures (e.g., waist, waist-by-height ratio, and body mass index [BMI]) immediately, 3 months, and 6 months after the intervention period. RESULTS Analysis of variance models suggested that children in the experimental group were found to have reduced waist circumference and waist-by-height ratio immediately after the intervention that persisted for 3 and 6 months (f = 0.33, 0.35, respectively). BMI and BMI percentile were not differentially affected. DISCUSSION These promising findings suggest that a primary care-based, parent-focused overweight/obesity treatment program is feasible and demonstrated positive preliminary effects, improving the children's overall health trajectory.
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133
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Lim H, Xue H, Wang Y. Association between obesity and metabolic co-morbidities among children and adolescents in South Korea based on national data. BMC Public Health 2014; 14:279. [PMID: 24666605 PMCID: PMC3976357 DOI: 10.1186/1471-2458-14-279] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 02/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background Childhood obesity has become a serious public health threat worldwide due to its many short- and long-term adverse health effects. We assessed the association between weight status and metabolic co-morbidities among South Korean children using nationally representative data. Methods Data from the 2007-2008 Korea National Health and Nutrition Examination Surveys for 1,526 children aged 10-19 years were used. Logistic regression models were fit to examine the association between weight status [overweight, 85th percentile ≤ BMI <95th percentile; obese, BMI ≥95th percentile; and central obesity, waist circumference ≥90th percentile, based on 2007 Korean National Growth Charts] and metabolic outcomes. Results More obese children had metabolic co-morbidities than normal-weight children (P < 0.05). Boys had higher means BMI than girls, WC, and BP, while girls had higher means of total blood cholesterol and HDL-cholesterol (P < 0.05). Attributable risk of metabolic syndrome was high due to overweight and obesity: 91.1% for central obesity and 29.6% for high TG. Obese children had increased risk of having high BP (adjusted odds ratio (OR): 1.90; 95% CI: 1.05-3.45), dyslipidemia (OR: 6.21; 95% CI: 3.59-10.75), high TG (OR: 6.87; 95% CI: 4.05-11.64), low HDL (OR: 4.46; 95% CI: 2.23-8.89), and ≥2 co-morbidities (OR: 26.97; 95% CI: 14.95-48.65) compared to normal-weight subjects, while the associations between weight status and metabolic outcomes were stronger in boys. Conclusions Obesity was strongly associated with metabolic co-morbidities in South Korean children.
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Affiliation(s)
| | | | - Youfa Wang
- Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Lowndes J, Sinnett S, Pardo S, Nguyen VT, Melanson KJ, Yu Z, Lowther BE, Rippe JM. The effect of normally consumed amounts of sucrose or high fructose corn syrup on lipid profiles, body composition and related parameters in overweight/obese subjects. Nutrients 2014; 6:1128-44. [PMID: 24642950 PMCID: PMC3967182 DOI: 10.3390/nu6031128] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/27/2014] [Accepted: 02/28/2014] [Indexed: 02/07/2023] Open
Abstract
The American Heart Association (AHA) has advocated that women and men not consume more than 100 and 150 kcal/day, respectively, from added sugars. These levels are currently exceeded by over 90% of the adult population in the United States. Few data exist on longer-term metabolic effects when sucrose and High Fructose Corn Syrup (HFCS), the principal sources of added dietary sugars, are consumed at levels typical of the general population. Sixty five overweight and obese individuals were placed on a eucaloric (weight stable) diet for 10-weeks, which incorporated sucrose- or HFCS-sweetened, low-fat milk at 10% or 20% of calories in a randomized, double-blinded study. All groups responded similarly (interaction p > 0.05). There was no change in body weight in any of the groups over the 10-week study, or in systolic or diastolic blood pressure. Likewise, there were no changes in total cholesterol, triglycerides, low-density lipoprotein (LDL), or apolipoprotein B (Apo B). We conclude that (1) when consumed as part of a eucaloric diet fructose--when given with glucose (as normally consumed) does not promote weight gain or an atherogenic lipid profile even when consumed at two to four times the level recently recommended by the AHA. (2) There were no differences between HFCS and sucrose on these parameters.
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Affiliation(s)
- Joshua Lowndes
- Rippe Lifestyle Institute, 215 Celebration Place, Suite 300, Celebration, FL 34747, USA.
| | - Stephanie Sinnett
- Rippe Lifestyle Institute, 215 Celebration Place, Suite 300, Celebration, FL 34747, USA.
| | - Sabrina Pardo
- Rippe Lifestyle Institute, 215 Celebration Place, Suite 300, Celebration, FL 34747, USA.
| | - Von T Nguyen
- Rippe Lifestyle Institute, 215 Celebration Place, Suite 300, Celebration, FL 34747, USA.
| | - Kathleen J Melanson
- Energy Balance Laboratory, Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, USA.
| | - Zhiping Yu
- Department of Nutrition and Dietetics, University of North Florida, 1 UNF Drive, Jacksonville, FL 32256, USA.
| | - Britte E Lowther
- Britte Lowther, 4302 39th Street West, Apt # 11, Bradenton, FL 34015 , USA.
| | - James M Rippe
- Rippe Lifestyle Institute, 215 Celebration Place, Suite 300, Celebration, FL 34747, USA.
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135
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Laurent JS. A qualitative exploration into parental recognition of overweight and obesity in pre-adolescents: a process of discovery. J Pediatr Health Care 2014; 28:121-7. [PMID: 23419505 DOI: 10.1016/j.pedhc.2012.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 12/12/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The purpose of this study is to describe influential factors as parents become aware that their pre-adolescent is overweight/obese. METHODS A grounded theory approach was used, and 17 parents of obese pre-adolescents were interviewed. RESULTS Within the concept of discovery ("How did you come to realize your pre-adolescent was overweight or obese?"), five central themes emerged. The theme of predisposition emerged as most parents believed there was some type of predisposition for their pre-adolescent to be overweight/obese. Parents avoided using the words overweight, obese, or fat to describe their pre-adolescent's body habitus, thus leading to the theme "husky build." "Compared to others" was identified as a theme since most parents described how they compared their overweight pre-adolescent with other pre-adolescents. The health care provider emerged as a theme because the role of the health care provider played a pivotal role in the discovery process for parents. Finally, parental buy-in involved acceptance that their pre-adolescent was overweight and recognition that this status signaled a problem and a potential health threat for their pre-adolescent. DISCUSSION Parents do not rely solely on visual cues. Several factors are involved in the awareness process of parents whose pre-adolescents are clinically obese. The input from the health care provider played a significant role.
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136
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Salvy SJ, Bowker JC. Peers and Obesity during Childhood and Adolescence: A Review of the Empirical Research on Peers, Eating, and Physical Activity. ACTA ACUST UNITED AC 2014; 4. [PMID: 28090396 PMCID: PMC5228616 DOI: 10.4172/2165-7904.1000207] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obesity during childhood and adolescence is a growing problem in the United States, Canada, and around the world that leads to significant physical, psychological, and social impairment. In recent years, empirical research on factors that contribute to the development and maintenance of obesity has begun to consider peer experiences, such as peer rejection, peer victimization, and friendship. Peer experiences have been theoretically and empirically related to the “Big Two” contributors to the obesity epidemic, eating and physical activity, but there has not been a comprehensive review of the extant empirical literature. In this article, we review and synthesize the emerging theoretical and empirical literatures on peer experiences in relation to: (a) eating (food consumption and food selection); and (b) physical activity, during childhood and adolescence. A number of limitations and issues in the theoretical and empirical literatures are also discussed, along with future research directions. In conclusion, we argue that the involvement of children and adolescents’ peer networks in prevention and intervention efforts may be critical for promoting and maintaining positive behavioral health trajectories.
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Affiliation(s)
| | - Julie C Bowker
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, USA
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Jung C, Figulla HR, Lichtenauer M, Franz M, Pernow J. Increased levels of circulating arginase I in overweight compared to normal weight adolescents. Pediatr Diabetes 2014; 15:51-6. [PMID: 23763571 DOI: 10.1111/pedi.12054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/03/2013] [Accepted: 05/09/2013] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND AIMS Overweight and the metabolic syndrome have become major problems, especially in children and adolescents. Obesity at a young age increases the risk for cardiovascular diseases and diabetes mellitus later in life. An early event in the development of cardiovascular disease is endothelial dysfunction which is found in obese young individuals. Increased activity of the enzyme arginase has been described as a central mechanism for endothelial dysfunction, especially in patients with diabetes mellitus. The aim of the study was to determine plasma levels of arginase in overweight adolescents. METHODS Sixty-six male German adolescents (age: 15.2 ± 1.1 years old) were included. Thirty-one of them were overweight (>90th age-specific weight percentile). Plasma arginase I and tumor necrosis factor alpha (TNFα) were determined. In addition, clinical data were recorded and anthropometrical measurements of obesity were performed. RESULTS Overweight adolescents had a higher systolic blood pressure, lower high-density lipoprotein and increased levels of high-sensitive C-reactive protein (CRP). Circulating arginase I was elevated in overweight adolescents (95.8 ± 68.2 ng/ml) compared to normal weight adolescents (39.3 ± 26.9 ng/ml, p < 0.001) and correlated with markers of obesity. There was no difference between the two groups regarding TNFα. CONCLUSIONS We demonstrate that arginase I levels are increased in obese adolescents. Knowing the important role for arginase in endothelial dysfunction, elevated levels of arginase I may represent a link between obesity, endothelial dysfunction and related comorbidities.
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Affiliation(s)
- Christian Jung
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Clinic of Internal Medicine I, Friedrich-Schiller-University, Jena, Germany
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Guven B, Demirpence S, Yilmazer MM, Carti OU, Tavli V, Mese T, Oner T. Arterial function and anatomy in obese children with cardiovascular risk factors. Pediatr Int 2013; 55:696-702. [PMID: 23829461 DOI: 10.1111/ped.12177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited data are available related to the effects of cardiovascular risk factors on abdominal arterial stiffness using carotid and brachial artery indices. Therefore, we aimed to determine arterial changes in obese children and investigate any relation with cardiovascular risk factors. METHODS Thirty-eight obese children (mean body mass index: 28.35 ± 4.65 kg/m(2) ) and 34 age- and sex-matched healthy subjects underwent ultrasound measurements of abdominal, carotid and brachial arteries. Aortic strain, pressure strain elastic modulus (Ep), pressure strain normalized by diastolic blood pressure (Ep*), carotid intima-media thickness, carotid artery compliance, brachial artery flow-mediated dilatation, and well-known cardiovascular risk factors were assessed in the obese children. RESULTS Obese children had significantly higher Ep and Ep* parameters than the healthy controls (mean: 242.6 [107.1-666.6], 164.2 [110.6-231.5]; P < 0.001, and mean: 3.39 [1.76-7.5], 2.64 [1.46-4.2]; P < 0.001, respectively). Ep and Ep* were significantly correlated with the homeostasis model assessment of insulin resistance (r = 0.587, P = 0.001; r = 0.467, P = 0.004, respectively). Receiver-operator curve analysis of Ep for identification of children with cardiovascular risk factors showed that the area under the curve for hyperinsulinemia was 0.80 (P < 0.001) and for hypertriglyceridemia was 0.62 (P < 0.01). CONCLUSIONS Abdominal arterial stiffness parameters as well as carotid intima-media thickness and brachial arterial flow-mediated dilatation assessment were similarly useful in identifying obese children with cardiovascular risk factors. Insulin resistance is related with the augmented rigidity of the aortic wall in obese children.
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Affiliation(s)
- Baris Guven
- Department of Pediatric Cardiology, Izmir Dr Behcet Uz Children's Hospital, Izmir, Turkey
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Robinson TN, Matheson D, Desai M, Wilson DM, Weintraub DL, Haskell WL, McClain A, McClure S, Banda JA, Sanders LM, Haydel KF, Killen JD. Family, community and clinic collaboration to treat overweight and obese children: Stanford GOALS-A randomized controlled trial of a three-year, multi-component, multi-level, multi-setting intervention. Contemp Clin Trials 2013; 36:421-35. [PMID: 24028942 PMCID: PMC3844020 DOI: 10.1016/j.cct.2013.09.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/28/2013] [Accepted: 09/02/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To test the effects of a three-year, community-based, multi-component, multi-level, multi-setting (MMM) approach for treating overweight and obese children. DESIGN Two-arm, parallel group, randomized controlled trial with measures at baseline, 12, 24, and 36 months after randomization. PARTICIPANTS Seven through eleven year old, overweight and obese children (BMI ≥ 85th percentile) and their parents/caregivers recruited from community locations in low-income, primarily Latino neighborhoods in Northern California. INTERVENTIONS Families are randomized to the MMM intervention versus a community health education active-placebo comparison intervention. Interventions last for three years for each participant. The MMM intervention includes a community-based after school team sports program designed specifically for overweight and obese children, a home-based family intervention to reduce screen time, alter the home food/eating environment, and promote self-regulatory skills for eating and activity behavior change, and a primary care behavioral counseling intervention linked to the community and home interventions. The active-placebo comparison intervention includes semi-annual health education home visits, monthly health education newsletters for children and for parents/guardians, and a series of community-based health education events for families. MAIN OUTCOME MEASURE Body mass index trajectory over the three-year study. Secondary outcome measures include waist circumference, triceps skinfold thickness, accelerometer-measured physical activity, 24-hour dietary recalls, screen time and other sedentary behaviors, blood pressure, fasting lipids, glucose, insulin, hemoglobin A1c, C-reactive protein, alanine aminotransferase, and psychosocial measures. CONCLUSIONS The Stanford GOALS trial is testing the efficacy of a novel community-based multi-component, multi-level, multi-setting treatment for childhood overweight and obesity in low-income, Latino families.
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Affiliation(s)
- Thomas N Robinson
- Solutions Science Lab, Department of Pediatrics and Stanford Prevention Research Center, Stanford University School of Medicine, Medical School Office Building, 1265 Welch Road, 1st Floor, Stanford, CA 94305 USA; Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 770 Welch Road, Suite 100, Palo Alto, CA 94304, USA; Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Medical School Office Building, 1265 Welch Road, Stanford, CA 94305, USA; Center for Policy Outcomes and Prevention, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital at Stanford, 117 Encina Commons, Suite. 182, Stanford, CA 94305, USA; Center for Healthy Weight, Stanford University School of Medicine and Lucile Packard Children's Hospital at Stanford, Medical School Office Building, 1265 Welch Road, 1st Floor, Stanford, CA 94305, USA.
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Price JH, Khubchandani J, McKinney M, Braun R. Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States. BIOMED RESEARCH INTERNATIONAL 2013; 2013:787616. [PMID: 24175301 PMCID: PMC3794652 DOI: 10.1155/2013/787616] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/08/2013] [Indexed: 01/08/2023]
Abstract
Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services.
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Affiliation(s)
- James H. Price
- Health Education and Public Health, University of Toledo, Toledo, OH 43606, USA
| | | | - Molly McKinney
- Public Health, Eastern Kentucky University, Richmond, KY 40475, USA
| | - Robert Braun
- Health Sciences, Otterbein University, Westerville, OH 43081, USA
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Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, Urbina EM, Ewing LJ, Daniels SR. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 2013; 128:1689-712. [PMID: 24016455 DOI: 10.1161/cir.0b013e3182a5cfb3] [Citation(s) in RCA: 707] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks.
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Rieder J, Khan UI, Heo M, Mossavar-Rahmani Y, Blank AE, Strauss T, Viswanathan N, Wylie-Rosett J. Evaluation of a community-based weight management program for predominantly severely obese, difficult-to-reach, inner-city minority adolescents. Child Obes 2013; 9:292-304. [PMID: 23865528 PMCID: PMC3728727 DOI: 10.1089/chi.2012.0147] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Few interventions targeting severely obese minority youth have been implemented in community-based settings. We evaluate a 9-month multicomponent, community-based program for obese, inner-city adolescents. METHODS Of 5250 estimated eligible adolescents, 349 were recruited; they had a mean age of 15 ± 2 years, mean BMI %ile 98.9 ± 1.5, and comprised 52% African American and 44% Hispanic. Longitudinal trends of anthropometric measures were compared 1 year before enrollment (T-12), at baseline (T0) and after program completion (T9). Dietary and physical activity behaviors were compared at T0 and T9. Anthropometric changes were compared at T9 and 18 months (T18) in completers and noncompleters. RESULTS A majority of participants were severely obese (67%) and expressed low readiness to change behaviors (82%). For intervals T-12 to T0 versus T0 to T9, there were significant decreases in rates of gain in BMI (0.13 vs. 0.04, p < 0.01), BMI percentile (0.0002 vs. -0.0001, p < 0.01), percent overweight (0.001 vs. -0.001, p < 0.01), and BMI z-score (0.003 vs. -0.003, p < 0.01). Significant increases in vegetable and fruit consumption and in vigorous physical activity participation were observed. From T9 to T18, except for a significant increase in BMI (38.3 ± 7.4 vs. 39.0 ± 7.5, p < 0.01) in completers, all other anthropometric measures remained unchanged in completers and noncompleters. CONCLUSIONS We demonstrate modest clinical improvements and increased healthy lifestyle behaviors in predominantly severely obese, difficult-to-reach, ethnic minority adolescents attending a community-based weight management program. The loss of clinical improvements 9 months after program completion implies that extending the duration of such a program may prevent long-term weight regain in severely obese adolescents.
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Affiliation(s)
- Jessica Rieder
- Children's Hospital at Montefiore, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Unab I. Khan
- Children's Hospital at Montefiore, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Moonseong Heo
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Arthur E. Blank
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Temima Strauss
- Children's Hospital at Montefiore, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Nisha Viswanathan
- Children's Hospital at Montefiore, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Judith Wylie-Rosett
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
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Bennasar-Veny M, Lopez-Gonzalez AA, Tauler P, Cespedes ML, Vicente-Herrero T, Yañez A, Tomas-Salva M, Aguilo A. Body adiposity index and cardiovascular health risk factors in Caucasians: a comparison with the body mass index and others. PLoS One 2013; 8:e63999. [PMID: 23734182 PMCID: PMC3667028 DOI: 10.1371/journal.pone.0063999] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/07/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Several studies have shown a relation between the adipose tissue accumulation and a higher risk for developing metabolic and cardiovascular diseases. Thus, body fat content and, mainly, the fat distribution or adiposity could be considered as important indicators of health risk. In spite of presenting several limitations, BMI is the most widely used and accepted index for classifying overweight and obesity. The aim of the study was to evaluate the correlations between Body Adiposity Index (BAI), BMI and other adiposity indexes such as WC, WHR and WHtR with cardiovascular and metabolic risk factors. Furthermore, the behavior of BAI and BMI regarding the ability to discriminate overweight or obese individuals was also analyzed. RESEARCH METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional study was conducted in Spanish Caucasian adult workers. Participants in the study (29.214 men and 21.040 women, aged 20-68 years) were systematically selected during their work health periodic examinations. BAI, BMI, WHR, WHtR, body weight, hip and waist circumference (WC) as well as systolic and diastolic blood pressure were measured. Serum levels of high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG) and glucose were also determined. Results of the study indicated that BAI was less correlated with cardiovascular risk factors and metabolic risk factors than other adiposity indexes (BMI, WC and WHtR). The best correlations were found for WHtR. In addition, the BAI presented lower discriminatory capacity than BMI for diagnosing metabolic syndrome (MS) using both IDF and ATP III criteria. A different behavior of the BAI in men and women when considering the ability to discriminate overweight or obese individuals was also observed. CONCLUSIONS The adiposity indexes that include the waist circumference (WHtR and WC) may be better candidates than BAI and BMI to evaluate metabolic and cardiovascular risk in both clinical practice and research.
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Affiliation(s)
- Miquel Bennasar-Veny
- Research Group on Evidence, Lifestyles and Health, Universitat Illes Balears, Palma, Spain.
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144
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Sung-Chan P, Sung YW, Zhao X, Brownson RC. Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials. Obes Rev 2013; 14:265-78. [PMID: 23136914 DOI: 10.1111/obr.12000] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 09/19/2012] [Accepted: 09/26/2012] [Indexed: 11/26/2022]
Abstract
Effective interventions are needed to address the growing epidemic of childhood obesity. In the past 35 years, family-based approach has gradually developed as a preferred intervention. This review aimed to examine the methodological rigour and treatment effectiveness of family-based interventions according to intervention types and theoretical orientations. A total of 15 randomized controlled trials (RCTs) of family-based lifestyle interventions for children and adolescents aged 2-19 years were included. The adapted Methodological Quality Rating Scales (MQRS) and a four-grade qualitative scoring scheme were adopted to evaluate the methodological rigour and the effectiveness of treatment, respectively. The average MQRS score was 7.93 out of 14 points. Ten of the 15 RCTs had well aligned their research questions with appropriate research methods. The overall short-term outcome of the15 RCTs were satisfactory with an average score of 3.1. Family-based interventions rooted in behaviour theory achieved better results than those theoretically connected to family systems theory in terms of treatment effectiveness. Results suggest future studies to improve the methodological design and continue to explore the potential of the family systems approach.
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Affiliation(s)
- P Sung-Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
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Rigamonti AE, Agosti F, Compri E, Giunta M, Marazzi N, Muller EE, Cella SG, Sartorio A. Anorexigenic postprandial responses of PYY and GLP1 to slow ice cream consumption: preservation in obese adolescents, but not in obese adults. Eur J Endocrinol 2013; 168:429-36. [PMID: 23239758 DOI: 10.1530/eje-12-0867] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Eating slowly increases the postprandial responses of some anorexigenic gut hormones in healthy lean subjects. As the rate of food intake is positively associated with obesity, the aim of the study was to determine whether eating the same meal at different rates evokes different postprandial anorexigenic responses in obese adolescent and adult subjects. DESIGN AND METHODS Eighteen obese adolescents and adults were enrolled. A test meal was consumed on two different sessions by each subject, meal duration taking either 5 min (fast feeding) or 30 min (slow feeding). Circulating levels of glucagon-like peptide 1 (GLP1), peptide YY (PYY), glucose, insulin, and triglycerides were measured over 210 min. Visual analog scales were used to evaluate the subjective feelings of hunger and satiety. RESULTS fast feeding did not stimulate GLP1 release in obese adolescent and adults, whereas slow feeding increased circulating levels of GLP1 only in obese adolescents. Plasma PYY concentrations increased both in obese adolescents and in adults, irrespective of the eating rate, but slow feeding was more effective in stimulating PYY release in obese adolescents than in adults. simultaneously, slow feeding evoked a higher satiety only in obese adolescents compared with fast feeding but not in obese adults. in obese adolescents, slow feeding decreased hunger (only at 210 min). irrespective of the eating rate, postprandial responses of insulin and triglycerides were higher in obese adults than in obese adolescents. CONCLUSION Slow feeding leads to higher concentrations of anorexigenic gut peptides and favors satiety in obese adolescents, but this physiological control of food intake is lost in obese adults.
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Affiliation(s)
- A E Rigamonti
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Via Vanvitelli 32, 20129 Milan, Italy.
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Wildermuth SA, Mesman GR, Ward WL. Maladaptive eating patterns in children. J Pediatr Health Care 2013; 27:109-19. [PMID: 23414976 DOI: 10.1016/j.pedhc.2011.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 07/22/2011] [Accepted: 07/26/2011] [Indexed: 11/25/2022]
Abstract
Given the increasing frequency of obesity and related maladaptive eating patterns in pediatric populations, health care professionals in a variety of settings must find ways to treat persons who are obese and have maladaptive eating patterns. The authors summarized literature related to binge eating disorder, boredom eating, emotional eating, and night eating syndrome and developed educational handouts designed for children/adolescents and their families who present with these eating problems. These educational handouts may be used by primary care physicians, psychologists, psychiatrists, nurses, and other specialists in medical settings. They are free for use in educational purposes, with permission from the authors, but are not intended to replace appropriate health care and follow-up.
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Lakshman R, Zhang J, Zhang J, Koch FS, Marcus C, Ludvigsson J, Ong KK, Sobko T. Higher maternal education is associated with favourable growth of young children in different countries. J Epidemiol Community Health 2013; 67:595-602. [PMID: 23450064 DOI: 10.1136/jech-2012-202021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Childhood growth affects long-term health and could contribute to health inequalities that persist throughout life. METHODS We compared growth data of 4-year-old to 6-year-old children born 1997-2002 in UK (n=15,168), Sweden (n=6749) and rural China (n=10,327). SD scores (SDS) were calculated against the WHO Growth Standard. Obesity and overweight were defined by the International Obesity Taskforce cut-offs, and stunting, underweight and thinness by height, weight or body mass index (BMI)<-2 SDS. Associations with maternal education were standardised by calculating the Slope Index of Inequality (SII). RESULTS Mean SDS height, weight and BMI in the UK (-0.01, 0.42, 0.62, respectively) and Sweden (0.45, 0.59, 0.45) were higher than in China (-0.98, -0.82, -0.29). Higher maternal education was consistently associated with taller offspring height SDS (SII: UK 0.25; Sweden 0.17; China 1.06). Underweight and stunting were less common in the UK (prevalence: 0.6% and 2.2%, respectively) and Sweden (0.3% and 0.6%) than in China (9.5% and 16.4%), where these outcomes were inversely associated with maternal education (SII: -25.8% and -12.7%). Obesity prevalence in the UK, Sweden and China was 4.8%, 3.7% and 0.4%, respectively. Maternal education was inversely associated with offspring obesity in the UK (SII: -3.3%) and Sweden (-2.8%), but not in China (+0.3%). CONCLUSIONS Higher maternal education was associated with more favourable growth in young children: lower obesity and overweight in the UK and Sweden, and lower stunting and underweight in rural China. Public health strategies to optimise growth in early childhood need to acknowledge socioeconomic factors, but possibly with a different emphasis in different settings.
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King KM, Ogletree RJ, Fetro JV, Brown SL, Partridge JA. Predisposing, Reinforcing and Enabling Predictors of Middle School Children's After-school Physical Activity Participation. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2011.10599181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kristi M. King
- a Department of Health and Sport Sciences , University of Louisville , Louisville , KY , 40292
| | - Roberta J. Ogletree
- b Department of Health Education and Recreation , Southern Illinois University Carbondale , Carbondale , IL , 62901
| | - Joyce V. Fetro
- c Department of Health Education and Recreation , Southern Illinois University Carbondale , Carbondale , IL , 62901
| | - Stephen L. Brown
- d Department of Health Education and Recreation , Southern Illinois University Carbondale , Carbondale , IL , 62901
| | - Julie A. Partridge
- e Department of Kinesiology , Southern Illinois University Carbondale , Carbondale , IL , 62901
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Affiliation(s)
- Anna E. Olvera
- a Research and Education Department , Scott and White memorial Hospital , 2401 S. 31st St., Temple , TX , 76508
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Mâsse LC, Perna F, Agurs-Collins T, Chriqui JF. Change in school nutrition-related laws from 2003 to 2008: evidence from the school nutrition-environment state policy classification system. Am J Public Health 2013; 103:1597-603. [PMID: 23327259 DOI: 10.2105/ajph.2012.300896] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined state laws affecting the school food environment and changes in these laws between 2003 to 2008. METHODS We used the Westlaw legal database to identify state-codified laws, with scoring derived from the updated School Nutrition-Environment State Policy Classification System, obtained from the Classification of Laws Associated With School Students Web site. RESULTS States significantly changed their school nutrition laws from 2003 to 2008, and many increased the stringency of the laws targeting competitive foods (snacks and entrées sold in competition with the school meal) and beverages sold in school and for in-school fundraising. Many states enacted laws that mandated the establishment of a coordinating or advisory wellness team or council. Stronger laws were enacted for elementary grades. We found tremendous variability in the strength of the laws and plenty of room for improvement. CONCLUSIONS State law governing school nutrition policies significantly changed from 2003 to 2008, primarily affecting the competitive food environment in schools. The extent to which changes in school nutrition laws will lead to desired health outcomes is an area for additional research.
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Affiliation(s)
- Louise C Mâsse
- Department of Pediatrics, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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