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

A mediational model of obesity related disordered eating: The roles of childhood emotional abuse and self-perception

The extant literature indicates negative self-perceptions are a risk factor for disordered eating (DE) and DE is a risk factor for overweight and obesity. While childhood emotional abuse (EA) is often linked to DE and obesity, it is typically not included in comprehensive models of these health problems. Further investigation of interactions among EA, self-perception, and DE is needed to refine treatments for overweight, obesity, and DE. This study evaluated a model of DE and weight difficulties in which negative self-perception mediate the relationship between EA and DE, and DE predicts body mass index (BMI) in a population of emerging adults. Further, this study investigated the utility of history of EA for prediction of DE and classification of individuals with and without DE. Self-report questionnaires on childhood trauma, psychopathology, and eating behaviors were administered to 598 undergraduate students. Latent variable analysis confirmed the hypothesized model. Recursive partitioning determined that individuals reporting a high level of EA likely meet criteria for night eating syndrome (NES) or binge eating disorder (BED), and history of EA has a moderate to high level of specificity as a predictor of BED and NES. These findings confirm the necessity of evaluating EA and DE in emerging adults with weight difficulties, and the importance of assessing self-perception and DE in individuals with a history of EA. Future studies should investigate the utility of addressing EA and self-perception in interventions for DE and obesity and to determine whether these findings can be generalized to a clinical population.

Maternal and postnatal high-fat diet consumption programs energy balance and hypothalamic melanocortin signaling in nonhuman primate offspring

Maternal high-fat-diet (HFD) consumption during pregnancy decreased fetal body weight and impacted development of hypothalamic melanocortin neural circuitry in nonhuman primate offspring. We investigated whether these impairments during gestation persisted in juvenile offspring and examined the interaction between maternal and early postnatal HFD consumption. Adult dams consumed either a control diet (CTR; 15% calories from fat) or a high-saturated-fat diet (HFD; 37% calories from fat) during pregnancy. Offspring were weaned onto a CTR or HFD at ~8 mo of age. Offspring from HFD-fed dams displayed early catch-up growth and elevated body weight at 6 and 13 mo of age. Maternal and postnatal HFD exposure reduced the amount of agouti-related peptide fibers in the paraventricular nucleus of the hypothalamus. Postnatal HFD consumption also decreased the amount of agouti-related peptide fibers in the arcuate nucleus of the hypothalamus. Postnatal HFD was associated with decreased food intake and increased activity. These results support and extend our previous findings of maternal diet effects on fetal development and reveal, for the first time in a nonhuman primate model, that maternal HFD-induced disturbances in offspring body weight regulation extended past gestation into the juvenile period. Maternal HFD consumption increases the risk for offspring developing obesity, with the developmental timing of HFD exposure differentially impacting the melanocortin system and energy balance regulation. The present findings provide translational insight into human clinical populations, suggesting that profound health consequences may await individuals later in life following intrauterine and postnatal HFD exposure.

Proatherogenic Lipid Profile in Early Childhood: Association with Weight Status at 4 Years and Parental Obesity

OBJECTIVES

To determine lipid profiles in early childhood and evaluate their association with weight status at 4 years of age. Additionally, we evaluated whether the risk of overweight or having an altered lipid profile was associated with parental weight status.

STUDY DESIGN

Five hundred eighty two mothers and their 4-year-old children from 2 Spanish population-based cohorts were studied. Weight status in children at 4 years of age was classified as overweight or obese using the International Obesity Task Force criteria. Plasma total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were determined in children and lipid ratios were calculated. A proatherogenic lipid profile was defined as having the 3 lipid ratios in the third tertile.

RESULTS

A total of 12.9% of children were overweight and 6.4% were obese. Weight status at 4 years of age was related to maternal prepregnancy body mass index, paternal body mass index, gestational diabetes, and birth weight, but not with other sociodemographic characteristics of the mother. We found no association with gestational age, sex of the child, or breastfeeding. The risk of overweight/obesity was increased 4.17-fold if mothers were overweight/obese (95% CI 1.76-9.88) and 5.1-fold (95% CI 2.50-10.40) if both parents were overweight/obese. There were 133 children (22.8%) with a proatherogenic lipid profile. The risk of a proatherogenic lipid profile was increased 2.44-fold (95% CI 1.54-3.86) if they were overweight/obese at 4 years of age and 2-fold if the father was overweight/obese (95% CI 1.22-3.35).

CONCLUSIONS

Four-year-old overweight/obese children have higher lipid risk profiles. Offspring of overweight/obese parents have an increased risk for obesity and a proatherogenic lipid profile.

Changes in Body Mass Index During a 3-Year Elementary School-Based Obesity Prevention Program for American Indian and White Rural Students

BACKGROUND

Childhood obesity is a significant but largely modifiable health risk, disproportionately affecting socioeconomically disadvantaged, racial/ethnic minority, and rural children. Elementary school-aged children typically experience the greatest increases in excess weight gain and therefore are important targets for reducing adolescent and adult obesity while improving children's health. Our study evaluated outcomes of a 3-year elementary school-based program for reducing obesity in American Indian and White students attending eight rural schools in the U.S. upper Midwest.

METHOD

Researchers measured body mass indexes (BMI) and other health indicators and behaviors of 308 beginning third-grade students and then again at the end of students' third, fourth, and fifth grades. The primary focus of this study is a mixed multilevel longitudinal model testing changes in age- and gender-adjusted BMI z scores ( zBMI).

RESULTS

There was a significant decrease in zBMI across the 3-year study period. Ethnicity analyses showed that White students had overall decreases in zBMI whereas American Indian students' zBMIs remained stable across the program. Comparisons with children from an age- and cohort-matched national sample provided support for the effectiveness of the school program in reducing BMI and obesity during the study period.

CONCLUSION

An elementary school-based health program that addresses a range of students' obesity-related health behaviors, the school health environment, and that involves educators and parents is an effective intervention for reducing or stabilizing BMI in rural White and American Indian students. School health programs for students living in rural communities may be especially effective due to greater school and community cohesiveness, and valuing of the school's primary role in improving community health.

Body mass index associations between mother and offspring from birth to age 18: the Fels Longitudinal Study

BACKGROUND

Parental obesity is a known determinant of childhood obesity. Previous research has shown a strong maternal influence on body mass index (BMI) during infancy and early childhood.

OBJECTIVES

The purpose of this research was to investigate the BMI associations between mother and offspring from birth to age 18 years.

METHODS

Participants were selected from the Fels Longitudinal Study. The current study sample includes 427 (215 mother/son and 212 mother/daughter) mother/child pairs. These pairs are repeatedly measured at multiple age groups in children, resulting in a total of 6,263 (3,215 mother/son, 3,048 mother/daughter) observations for data analysis. Inclusion criteria were children with measured height and weight for BMI collected at ages 0 to 18 years and their mother with BMI data. Maternal influences of BMI on offspring BMI from birth to early adulthood were analyzed by Spearman correlations and linear regression analyses.

RESULTS

Mother/son BMI correlations became statistically significant (p ≤ 0.05) at age 5-6 years and were significant through puberty and into early adulthood at age 18 years. Mother/daughter correlations became significant at age 1.5 years and also continued through adolescence, puberty and early adulthood at age 18 years. Associations persisted after the study sample was grouped into life stages and adjusted for decade of birth and parity.

CONCLUSIONS

The mother/daughter relationship was more strongly correlated than the mother/son relationship and also became statistically significant at an earlier age than boys.

Association between dietary inflammatory index and inflammatory markers in the HELENA study

BACKGROUND

Previous research has shown that diet is associated with low-grade systemic inflammation among adults. However, no study has yet been conducted to explore the association between inflammatory potential of diet and low-grade systemic inflammation among adolescents whose dietary behavior may be different from adults.

METHODS AND RESULTS

We examine the predictive ability of 24-h recall-derived dietary inflammatory index (DII) scores on inflammation among 532 European adolescents in the HELENA cross-sectional study. The DII is a literature-derived dietary index developed to predict inflammation. The DII was calculated per 1000 calories and was tested against C-reactive protein, ILs-1,2,4,10, TNF-α, ICAM, vascular cell adhesion molecule (VCAM), and IFN-γ. All inflammatory markers had nonnormal distributions and therefore were log transformed. Analyses were performed using multivariable linear regression, adjusting for age, sex, city, BMI, smoking, and physical activity. Pro-inflammatory diet (higher DII scores) was associated with increased levels of various inflammatory markers: TNF-α, IL-1, 2, IFN-γ,  and vascular cell adhesion molecule (bDIIt3vs1 = 0.13, 95% CI: 0.001, 0.25; 0.13, 95% CI 0.001, 0.25; 0.40, 95% CI: 0.03, 0.77; 0.53, 95% CI: 0.05, 1.01; 0.07, 95% CI: 0.01, 0.13, respectively).

CONCLUSION

These results reinforce the fact that diet, as a whole, plays an important role in modifying inflammation in adolescents.

Acculturation and weight change in Asian-American children: Evidence from the ECLS-K:2011

Despite relatively low rates of overweight and obesity among Asian-American children, disparities exist based on acculturation, socioeconomic status, and Asian ethnicity. The purpose of this study was to examine the association between acculturation and weight change in Asian-American children. Secondary aims were to compare changes by Asian ethnic group and acculturation x socioeconomic status. Participants included 1200 Asian-American children from the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11, a longitudinal study of U.S. children attending kindergarten in 2010-2011. Multinomial logistic regressions were conducted to predict weight change based on body mass indices in kindergarten (spring 2011) and second grade (spring 2013): consistently healthy weight, consistently overweight/obese, healthy weight change, and unhealthy weight change. Models included demographic, household, socioeconomic status, and acculturation measures, specifically mother's English proficiency and percentage of life spent in the U.S. Overall, 72.3% of children were at healthy weights in kindergarten and second grade. Of all Asian ethnic groups, Filipino children had the highest rate of being consistently overweight/obese (24.8%) and the lowest rate of being consistently healthy weight (62.9%). In addition, mother's English proficiency predicted unhealthy weight change (OR: 0.83; 95% CI: 0.75-0.92) and healthy weight change (OR: 0.75; 95% CI: 0.65-0.86), relative to "consistently healthy weight." English proficiency also predicted being consistently overweight/obese for children with less educated mothers. Findings enhance our understanding of obesity disparities within Asian Americans and highlight the need to disaggregate the population. Obesity interventions are needed for Filipino children and families with low socioeconomic status but high English proficiency.

Entrenched obesity in childhood: findings from a national cohort study

PURPOSE

Given the high levels of obesity among U.S. children, we examine whether obesity in childhood is a passing phenomenon or remains entrenched into adolescence.

METHODS

Data are from the prospective nationally representative Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 (analytic sample = 6600). Anthropometrics were measured six times during 1998-2007. Overweight and obesity were defined using CDC cut-points. Entrenched obesity was defined as obesity between ages 5-9 coupled with persistent obesity at ages 11 and 14.

RESULTS

Almost 30% of children experienced obesity at some point between ages 5.6 and 14.1 years; 63% of children who ever had obesity between ages 5.6 and 9.1 and 72% of those who had obesity at kindergarten entry experienced entrenched obesity. Children with severe obesity in kindergarten or who had obesity at more than 1 year during early elementary were very likely to experience obesity through age 14, regardless of their sex, race, or socioeconomic backgrounds.

CONCLUSIONS

Prevention should focus on early childhood, as obesity at school entry is not often a passing phenomenon. Even one timepoint of obesity measured during the early elementary school years may be an indicator of risk for long-term obesity.

Longitudinal changes in anthropometry and body composition in university freshmen

OBJECTIVE

We investigated predictors of weight gain in college freshmen.

PARTICIPANTS

A longitudinal cohort study followed a representative sample of freshmen (N = 264) from 8/2011 to 6/2012.

METHODS

Repeated measurements of anthropometry, dual-energy X-ray absorptiometry (DXA), physical activity, and diet were collected. We investigated predictors of 9-month weight gain using regression models.

RESULTS

172 participants completed follow-up: 75% gained >0.5 kg. Mean weight change was +2.3 kg (SD 3.2) and +2.0 kg (SD 3.2) and mean adiposity change was +1.3% (SD 1.6) and +0.7% (SD 2.2) in men and women, respectively. In participants gaining >0.5 kg, weight increased 5.6% and body fat increased 1.6%. Anthropometric change in men occurred in the first semester, while women increased in both semesters. Leaner DXA-defined body composition at baseline was consistently associated with greater weight gain (p-values 0.029-0.049).

CONCLUSIONS

Freshman weight gain is common and reflects increased adiposity. Leaner body composition at the beginning of college predicted greater weight gain in men and women during the first year of college.

A longitudinal cohort study examining determinants of overweight and obesity in adulthood

OBJECTIVES

Adulthood overweight and obesity are multifaceted conditions influenced by a combination of biological, environmental and socio-cultural factors across the lifespan. Using a longitudinal study design, we aimed to identify determinants of adulthood overweight and obesity, in relation to: 1) childhood and life course factors, 2) geographical differences in air quality, and 3) gender-specific factors, in a cohort followed from childhood into adulthood.

METHODS

Childhood data were acquired (1978-1986) from children residing in four distinct Hamilton neighbourhoods (Ontario, Canada), including air-quality assessments. Adulthood data were obtained (2006-2007) from successfully retraced participants (n = 315) using comprehensive self-administered questionnaires. Multivariate logistic regressions were used to evaluate determinants of adulthood overweight (BMI: 25-29.9 kg/m2) and obesity (BMI: ≥30).

RESULTS

The prevalence of normal weight decreased drastically at follow-up in adulthood, while that of overweight and obesity increased. Both overweight and obesity in adulthood were associated with male gender and occupational exposures to contaminants. Childhood residence in Hamilton neighbourhoods with better air quality was associated with lesser odds of adulthood overweight, whereas adulthood obesity was strongly linked to childhood weight gain (overweight or obesity). Among females, childhood weight status predicted overweight and obesity in adulthood, with always living in Hamilton, lack of additional health insurance, negative self-appraisal and high blood pressure during adulthood identified as other significant predictors. Among males, prolonged occupational exposures to contaminants emerged as a unique determinant of adulthood weight gain.

CONCLUSION

Adulthood overweight and obesity are associated with childhood and life course determinants, including childhood weight status, residential air quality and occupational contaminant exposures, in a gender-specific manner.

Improving Urban Minority Girls' Health Via Community Summer Programming

Summertime has emerged as a high-risk period for weight gain among low-income minority youth who often experience a lack of resources when not attending school. Structured programming may be an effective means of reducing risk for obesity by improving obesogenic behaviors among these youth. The current multi-method study examined sedentary time, physical activity, and dietary intake among low-income urban minority girls in two contexts: an unstructured summertime setting and in the context of a structured 4-week community-based summer day camp program promoting physical activity. Data were analyzed using paired-sample t tests and repeated-measure analyses of variance with significance at the p < .05 level. Results evidenced no significant differences in total calories and fat consumed between the unstructured and structured settings. Participants exhibited significant increases in fruit consumption and physical activity and significant decreases in sedentary time of over 2 h/day and dairy consumption when engaged in structured summer programming. All improvements were independent of weight status and age, and African-American participants evidenced greater changes in physical activity during programming. The study concludes that structured, community-based summertime programming may be associated with fewer obesogenic behaviors in low-income urban youth and may be a powerful tool to address disparities in weight gain and obesity among high-risk samples.

Paediatric obesity and cardiovascular risk factors - A life course approach

Childhood obesity is increasingly prevalent worldwide, and Portugal presents one of the highest prevalence of obesity and overweight among the European countries. Since childhood obesity is a risk factor for obesity in adulthood, the high prevalence of overweight and obesity in paediatric age currently experienced is expected to lead to even higher prevalence of obesity in adulthood in future decades. It is well known that the prenatal period and infancy are critical or sensitive periods for obesity development, but a growing body of evidence also suggests a relevant role of childhood and adolescence. The exposure to some factors during these periods or specific time frames within these periods may confer additional risk for obesity development. Paediatric obesity is associated with cardiovascular risk factors both in the short or medium-term, but also in the long term, conferring additional risk for future adult health. However, it is not clear whether the relation between paediatric obesity and adult health is independent of adult adiposity. There is a moderate to high tracking of obesity from paediatric age into adulthood, which may partially explain the association with adult outcomes. Therefore, there has been increasing interest on life course frameworks to study the effect of the dynamics of adiposity across paediatric age on adult outcomes, namely on the cardiovascular disease risk. The use of this approach to study determinants and consequences of obesity raises methodological challenges to summarize the exposure to adiposity/obesity across the life span, being the identification of growth trajectories and the quantification of the duration of obesity among the most used methods. However, further investigation is still needed to explore the best methods to summarize exposure to adiposity and its variation across time.

Are K-12 school environments harming students with obesity? A qualitative study of classroom teachers

PURPOSE

Weight bias can negatively impact health, and schools may be risky environments for students with obesity. We aimed to explore teachers' perceptions of the school experiences and academic challenges of students with obesity.

METHODS

We conducted interviews with 22 teachers in the Northeast, mid-Atlantic, and Midwest in July-August 2014. All interviews were transcribed verbatim, coded, and analyzed for important themes by two researchers using the immersion/crystallization approach.

RESULTS

Most teachers felt that students with obesity were more likely to have academic difficulties. Two main perceptions of the reasons for these difficulties emerged: (1) obesity led to lower self-esteem that caused students to participate less, and (2) poorer nutrition, increased screen time, and reduced physical activity were simultaneously causing obesity and poorer academic performance. A few teachers described colleagues who felt students with obesity were not as motivated to work hard in school as their peers. Many teachers described school health promotion efforts focused on weight reduction that could exacerbate weight stigma and risk of disordered eating.

CONCLUSIONS

Students with obesity, particularly girls, may be at risk for negative social and academic experiences in K-12 schools and may be perceived as struggling academically by their teachers.

Effect of equipotent doses of bupivacaine and ropivacaine in high-fat diet fed neonatal rodent model

OBJECTIVES

The increase in the prevalence of obesity presents a significant health and economic problem. Obesity has been reported to be a major contributor to variety of chronic diseases. Childhood obesity has been rising over the past decades leading to various complications in health. Millions of infants and children undergo surgery every year on various health grounds. The present investigation was undertaken to evaluate the effect of spinal anesthesia of equipotent doses of ropivacaine and bupivacaine on over-weight neonatal rats.

METHODS

The Sprague-Dawley rat pups were overfed on high fat diet to induce obesity. Behavioral assessments for sensory and motor blockade was made by evaluating thermal and mechanical withdrawal latencies at various time intervals following intrathecal injections of bupivacaine (5.0mg·kg^-1) and ropivacaine (7.5mg·kg^-1) in P14 rats. Spinal tissue was analyzed for apoptosis by determination of activated caspase-3 using monoclonal anti-activated caspase-3 and Fluoro-Jade C staining. Long-term spinal function in P30 rat pups was evaluated.

RESULTS

Exposure to intrathecal anesthesia in P14 increased thermal and mechanical latencies and was observed to increase apoptosis as presented by increase in activated caspase-3 and Fluro-Jade C positive cells. Significant alterations in spinal function were observed in high fat diet-fed pups as against non-obese control pups that were on standard diet. Bupivacaine produced more pronounced apoptotic effects on P14 pups; ropivacaine however produced long lasting effects as evidenced in motor function tests at P30.

CONCLUSION

Ropivacaine and bupivacaine induced spinal toxicity that was more pronounced in over-fed rat pups as against normal controls.

Why do parents enrol in a childhood obesity management program?: a qualitative study with parents of overweight and obese children

Background

Despite the high prevalence of childhood overweight and obesity enrolment to weight management programs remains difficult, time consuming, costly and has limited effectiveness. The aim of this paper was to explore parents’ perspectives on factors that influence their decision to enrol in a program to address their child’s weight.

Methods

Semi-structured qualitative telephone interviews were undertaken with 21 parents of primary school aged children above the healthy weight range who had enrolled in a healthy lifestyle program. Questions were developed and analysed using the Theory of Planned Behaviour. They addressed parental reasons for enrolment, expectations of the program and apprehensions regarding enrolling.

Results

Prior to deciding to enrol, parents tended to be aware of the child’s weight status, had attempted to address it themselves and had sought help from a number of people including health professionals. Parental decision to enrol was influenced by their evaluation of their previous attempts and their child’s emotional state.

Conclusions

Awareness of their child’s weight status is an important first step in parents taking action at this health issue however it is unlikely to be sufficient on its own. Parental decision to join a childhood obesity management program can be complex and is likely to be made after numerous and unsuccessful attempts to address the child’s weight. Strategies to encourage parents to enrol in programs should include activities beyond awareness of weight status.

Health professionals should use contact time with parents to raise awareness of the child’s weight status and to provide encouragement to address overweight and obesity. Parents must be supported in their attempts to address their child’s overweight and obesity whether they choose to manage it themselves or within a program.

Learning about Activity and Understanding Nutrition for Child Health (LAUNCH): Rationale, design, and implementation of a randomized clinical trial of a family-based pediatric weight management program for preschoolers

Obesity affects nearly 2 million preschool age children in the United States and is not abating. However, research on interventions for already obese preschoolers is limited. To address this significant gap in the literature, we developed an intervention targeting obesity reduction in 2 to 5year olds, Learning about Activity and Understanding Nutrition for Child Health (LAUNCH). This paper describes the rationale, design, participant enrollment, and implementation of a 3-arm randomized, parallel-group clinical trial comparing LAUNCH to a motivational-interviewing intervention (MI) and standard care (STC), respectively. Whereas LAUNCH was designed as a skills based intervention, MI focused on addressing the guardian's motivation to make changes in diet and activity and providing tools to do so at the guardian's level of readiness to implement changes. Child body mass index z-score was the primary outcome, assessed at pretreatment, posttreatment (Month 6), and 6 and 12month follow-ups (Months 12 and 18). Mechanisms of weight change (e.g., dietary intake, physical activity) and environmental factors associated with weight (e.g., foods available in the home, caregiver diet) were also assessed. This study is unique because it is one of the few randomized controlled trials to examine a developmentally informed, clinic and home skills based behavioral family intervention for preschoolers who are already obese. Being obese during the preschool years increases the likelihood of remaining obese as an adult and is associated with serious health conditions; if this intervention is successful, it has the potential to change the health trajectories for young children with obesity.

Does adolescent obesity affect surgical presentation and radiographic outcome for patients with adolescent idiopathic scoliosis?

The purpose of this study was to test a hypothesis that overweight patients with adolescent idiopathic scoliosis present with larger curves and achieve less surgical correction than do healthy weight counterparts. A total of 251 individuals were grouped by BMI into overweight (BMI% ≥85) and healthy weight (BMI% <85) groups. Overweight patients demonstrated significantly larger intraoperative blood loss (P=0.041), although there was no significant difference in the number of intraoperative transfusions. Major curves and surgical correction were similar between the two groups. A greater postoperative thoracic kyphosis at latest follow-up may suggest a worsening sagittal profile in these individuals postoperatively.

Comparison of the Clinical and Biochemical Profile of Metabolic Syndrome Between Obese Children Below and Above 10-Years Old Attending Paediatric Clinic Hospital Universiti Sains Malaysia from 2006 to 2015

Objectives

We aim to compare the clinical and biochemical profile of metabolic syndrome between obese children below and above 10 years attending Paediatric clinic Hospital Universiti Sains Malaysia (HUSM) from 2006 to 2015. This is to determine if age, particularly the transition to puberty, modifies the prevalence of components of metabolic syndrome in obese children.

Methodology

The medical records of 84 obese children under 18 years of age seen at Paediatric clinic HUSM from 2006 to 2015 were reviewed. Demographic (age, gender, ethnicity), anthropometric (weight and height), clinical [body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP)] and biochemical [serum total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), fasting plasma glucose (FPG)] parameters were recorded, analyzed and compared.

Results

Majority of subjects in both age groups were boys, with 68.2% <10 years old. Mean age was 9.69 years (±3.36). The clinical and biochemical parameters of metabolic syndrome were similar between those <10 years old and >10 years, with the exception of BMI, waist circumference, SBP and TG level. Multivariate regression analysis showed that the parameters of metabolic syndrome significantly associated with age ≥10 years were systolic hypertension (adjusted OR 7.17, 95% CI, 1.48 to 34.8) and BMI >30 kg/m² (adjusted OR 3.02, 95% CI, 1.16 to 7.86).

Conclusion

There were similar clinical and biochemical parameters of metabolic syndrome in both age groups. The proportions of children with metabolic syndrome were similar regardless of age group. The overall prevalence rate of metabolic syndrome was 27.3%. In view of the alarming presence of components of metabolic syndrome even in children less than 10 years of age, efforts aimed at the prevention of childhood obesity in the community should be intensified.

Prevalence of childhood obesity in the state of Kuwait

BACKGROUND

Overweight and obesity have reached an epidemic in Kuwait, with the highest rate of adult obesity in the region. National estimates of childhood obesity in Kuwait are scarce. The purpose of this study is to evaluate the prevalence of overweight and obesity among school children in Kuwait.

METHODS

This is a cross-sectional study of a representative sample of 6-18 years old school children, randomly selected from 244 schools in Kuwait. Anthropometric data was measured from 6574 students in September 2012-June 2013. Overweight and obesity have been defined in accordance with the Centres for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF) and World Health Organization (WHO) 2007 criteria.

RESULTS

The prevalence estimate overweight was based on the three different systems (CDC = 17.7%, IOTF = 23.3%, WHO = 21.6%). The prevalence of obesity was (CDC = 33.9%, IOTF = 28.2%, WHO = 30.5%). Boys had a higher percentage of obesity regardless of the classification system used.

CONCLUSIONS

The prevalence of childhood obesity is alarmingly high in the State of Kuwait and exceeds the prevalence rates reported from neighbouring countries and from North America.

Usefulness of soluble urokinase plasminogen activator receptor (suPAR) as an inflammatory biomarker in obese children

OBJECTIVE

Soluble urokinase plasminogen activator receptor (suPAR) has emerged as a relatively new biomarker that reflects increased inflammatory status and been associated with cardiovascular risk. We wanted to investigate the predictive value and usefulness of suPAR as an inflammatory biomarker in obese children.

METHODS AND RESULTS

Of the total 136 participants, 76 (36 male, 40 female) were in obese group and 60 (24 male, 36 female) were in control group. The median age was 12.05 (6.16-17.30) years old for obese group, and 12.83 (8.00-16.75) years old for control group. Obese children had statistically significantly higher heart rate, systolic and diastolic blood pressure, EAT and LV mass than control group (p<0.01). The median suPAR level in obese group was not statistically different than in control group (0.54 vs. 0.59, p=0.26). The median hsCRP level in obese group was found statistically significantly higher than in control group (1.97 vs. 0.41, p<0.01). A significant positive correlation between hsCRP and BMI in the obese participants was found (r=0.45, p<0.01), but not a relationship between suPAR and BMI (r=-0.21, p>0.05).

CONCLUSION

Our research did not demonstrate the usefulness of suPAR as an inflammatory biomarker and a predictive value for future atherosclerosis in obese children. Further studies with larger sample size are required to determine whether suPAR is useful as an inflammatory biomarker in childhood obesity.

Freshman 15 in England: a longitudinal evaluation of first year university student's weight change

Background

Weight change in first year university students, often referred to as ‘Freshman 15’, has been shown to be a common problem in North America. Studies have reported weight gain to be between 1 kg and 4 kg over the academic year and a recent meta-analysis found a mean gain of 1.34 kg and that 61 % of students gained weight. A limited number of studies have investigated weight change in England and large scale studies are needed to understand better weight change trends and to conduct subgroup analyses. This is important in the context of rising obesity prevalence, especially as behaviours and unhealthy weight in early adulthood often remains over the lifetime.

Methods

We recruited students across 23 universities in England to complete a web-based survey at three time points in 2014–2015: beginning of academic year, December, end of academic year. Students were asked to self-report height and weight. We calculated weight change of each student between time points and conducted t-tests and pared analysis of variance to investigate the effect of time, sex and initial BMI. We also investigated weight change amongst weight gainers and in weight losers separately.

Results

We followed 215 students over three time points and found a mean weight change of 0.98 kg (95%CI 0.49–1.47) over a mean length of 34 weeks of follow-up. The weight change rate was not significantly different over different terms. Over 51 % of the sample gained more than 0.5 kg by the end of the academic year, with a mean gain of 3.46 kg. Female weight gainers had a significantly lower baseline weight than non-weight gaining females. Twenty-five percent of the sample lost more than 0.5 kg with a mean of −3.21 kg. Within weight losers, males lost significantly more weight than females.

Conclusion

Our findings reinforce that the first year of university is a crucial time in the life of students during which the majority tend to gain weight. However, we also found that 25 % lost weight, indicating that 75 % of students undergo a meaningful weight change in their first year. Universities must recognise their role in promoting healthy weight maintenance.

Energetic stress: The reciprocal relationship between energy availability and the stress response

The worldwide epidemic of metabolic syndromes and the recognized burden of mental health disorders have driven increased research into the relationship between the two. A maladaptive stress response is implicated in both mental health disorders and metabolic disorders, implicating the hypothalamic-pituitary-adrenal (HPA) axis as a key mediator of this relationship. This review explores how an altered energetic state, such as hyper- or hypoglycemia, as may be manifested in obesity or diabetes, affects the stress response and the HPA axis in particular. We propose that changes in energetic state or energetic demands can result in "energetic stress" that can, if prolonged, lead to a dysfunctional stress response. In this review, we summarize the role of the hypothalamus in modulating energy homeostasis and then briefly discuss the relationship between metabolism and stress-induced activation of the HPA axis. Next, we examine seven mechanisms whereby energetic stress interacts with neuroendocrine stress response systems, including by glucocorticoid signaling both within and beyond the HPA axis; by nutrient-induced changes in glucocorticoid signaling; by impacting the sympathetic nervous system; through changes in other neuroendocrine factors; by inducing inflammatory changes; and by altering the gut-brain axis. Recognizing these effects of energetic stress can drive novel therapies and prevention strategies for mental health disorders, including dietary intervention, probiotics, and even fecal transplant.

Effects of heterogeneous risk factors on psychological distress in adolescents with autism and victimization experiences in Taiwan

PURPOSE

To investigate the prevalence of various types of bullying victimization among adolescents with autism spectrum disorder (ASD) and examine the effects of victimization on the mental health of adolescents with ASD.

METHODS

The sample was collected from the Special Needs Education Longitudinal Study (SNELS) database released in 2011. Variables comprising seven psychological distress (PD) items and four types of bullying victimization and family-, school-, and peer-related factors were included in a multivariate regression analysis.

RESULTS

Exclusion and verbal bullying were most frequently reported, 72.4% of students with ASD experiencing exclusion bullying and 66% of them experiencing verbal bullying. Among the victims, delayed bedtime, use of medication, and conflicts with parents significantly increased PD. By contrast, good relationships with parents and friends and liking school environments relieved PD symptoms. Furthermore, delayed bedtime after 12 a.m. enhanced the effects of exclusion victimization on PD in the participants.

CONCLUSIONS

Our results indicated that bullying victimization among adolescents with ASD was a risk factor for their psychological well-being. Nevertheless, good parent-adolescent and interpeer relationships improved their mental health. Our results can serve as a reference in implementing strategies for motivating parents and teachers to pay more attention to the needs of adolescents with ASD. Implications for Rehabilitation More than 80% of adolescents with autism experience at least one type of bullying victimization. Bullying victimization attributes to a major factor influencing mental health of adolescents with autism. Good parent-adolescent and interpeer relationships can play beneficial roles in improving mental health of the adolescents.

Maternal Dietary Vitamin D Does Not Program Systemic Inflammation and Bone Health in Adult Female Mice Fed an Obesogenic Diet

Obesity is associated with systemic inflammation and impaired bone health. Vitamin D regulates bone metabolism, and has anti-inflammatory properties and epigenetic effects. We showed that exposure to high dietary vitamin D during pregnancy and lactation beneficially programs serum concentration of lipopolysaccharide (LPS) and bone structure in male offspring fed an obesogenic diet. Here we assessed if this effect is also apparent in females. C57BL/6J dams were fed AIN93G diet with high (5000 IU/kg diet) or low (25 IU/kg diet) vitamin D during pregnancy and lactation. Post-weaning, female offspring remained on their respective vitamin D level or were switched and fed a high fat and sucrose diet (44.2% fat, 19.8% sucrose) until age seven months when glucose response, adiposity, serum LPS, and bone mineral, trabecular and cortical structure, and biomechanical strength properties of femur and vertebra were assessed. There was no evidence for a programming effect of vitamin D for any outcomes. However, females exposed to a high vitamin D diet post-weaning had higher bone mineral content (p = 0.037) and density (p = 0.015) of lumbar vertebra. This post-weaning benefit suggests that in females, bone mineral accrual but not bone structure is compromised with low vitamin D status in utero until weaning in an obesogenic context.

Using the Intervention Mapping protocol to develop a family-based intervention for improving lifestyle habits among overweight and obese children: study protocol for a quasi-experimental trial

Background

In light of the high prevalence of childhood overweight and obesity, there is a need of developing effective prevention programs to address the rising prevalence and the concomitant health consequences. The main aim of the present study is to systematically develop and implement a tailored family-based intervention for improving lifestyle habits among overweight and obese children, aged 6–10 years old, enhancing parental self-efficacy, family engagement and parent-child interaction. A subsidiary aim of the intervention study is to reduce the prevalence of overweight and obesity among those participating in the intervention study.

Methods/design

The Intervention Mapping protocol was used to develop a tailored family-based intervention for improving lifestyle habits among overweight and obese children. In order to gather information on local opportunities and barriers, interviews with key stakeholders and a 1-year pilot study was conducted. The main study has used a quasi-experimental controlled design. Locally based Healthy Life Centers and Public Health Clinics are responsible for recruiting families and conducting the intervention. The effect of the study will be measured both at completion of the 6 months intervention study and 6 and 18 months after the intervention period.

An ecological approach was used as a basis for developing the intervention. The behavioral models and educational strategies include individual family counselling meetings, workshops focusing on regulation of family life, nutrition courses, and physical activity groups providing tailored information and practical learning sessions. Parents will be educated on how to use these strategies at home, to further support their children in improving their behaviors.

Discussion

A systematic and evidence-based approach was used for development of this family-based intervention study targeting overweight and obese children, 6–10 years old. This program, if feasible and effective, may be adjusted to local contexts and implemented in all municipal health care institutions in Norway.

Trial registration

NCT02247219. Prospectively registered on October 26, 2014.

[Effect of equipotent doses of bupivacaine and ropivacaine in high-fat diet fed neonatal rodent model]

OBJECTIVES

The increase in the prevalence of obesity presents a significant health and economic problem. Obesity has been reported to be a major contributor to variety of chronic diseases. Childhood obesity has been rising over the past decades leading to various complications in health. Millions of infants and children undergo surgery every year on various health grounds. The present investigation was undertaken to evaluate the effect of spinal anesthesia of equipotent doses of ropivacaine and bupivacaine on over-weight neonatal rats.

METHODS

The Sprague-Dawley rat pups were overfed on high fat diet to induce obesity. Behavioral assessments for sensory and motor blockade was made by evaluating thermal and mechanical withdrawal latencies at various time intervals following intrathecal injections of bupivacaine (5.0mg·kg^-1) and ropivacaine (7.5mg·kg^-1) in P14 rats. Spinal tissue was analyzed for apoptosis by determination of activated caspase-3 using monoclonal anti-activated caspase-3 and Fluoro-Jade C staining. Long-term spinal function in P30 rat pups was evaluated.

RESULTS

Exposure to intrathecal anesthesia in P14 increased thermal and mechanical latencies and was observed to increase apoptosis as presented by increase in activated caspase-3 and Fluro-Jade C positive cells. Significant alterations in spinal function were observed in high fat diet-fed pups as against non-obese control pups that were on standard diet. Bupivacaine produced more pronounced apoptotic effects on P14 pups; ropivacaine however produced long lasting effects as evidenced in motor function tests at P30.

CONCLUSION

Ropivacaine and bupivacaine induced spinal toxicity that was more pronounced in over-fed rat pups as against normal controls.

Childhood Risk Factors and Pregnancy-Induced Hypertension: The Bogalusa Heart Study

BACKGROUND

Pregnancy-induced hypertension (PIH) causes increased risk of maternal, fetal, and neonatal morbidity and mortality. Identification of risk factors for PIH in early life is central to the development of prevention strategies.

METHODS

A cohort of 703 women aged 25.5-51.3 years from the Bogalusa Heart Study were included. PIH were defined as self-reported hypertension during pregnancy and a blood pressure level <140/90mm Hg without antihypertensive medication (n = 131) at the subsequent examinations. Body mass index (BMI), systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterol, and triglycerides measured during childhood (4-17 years) were considered. General linear models were used to examine differences in childhood between those who did and those who did not develop PIH. Logistic regression models were used to estimate odds ratios for PIH associated with childhood risk factors.

RESULTS

Compared to women who did not develop PIH, those who developed PIH had higher BMI (20.2 vs. 19.2kg/m(2), P = 0.0002) and systolic blood pressure (104.1 vs. 103.3mm Hg, P = 0.008) in childhood. After adjustment for other variables, childhood BMI was the only risk factor associated with PIH, with each standard deviation increase in childhood BMI being associated with an odds ratio of 1.35 (95% confidence interval: 1.08-1.68) for PIH. The odds of PIH increased significantly as childhood BMI increased from the bottom quartile to the top quartile (P for trend = 0.006).

CONCLUSIONS

Elevated childhood BMI is a significant risk factor for PIH in adulthood, which underscores the importance of body weight control in childhood for prevention of PIH.

Long-term changes in childhood malnutrition are associated with long-term changes in maternal BMI: evidence from Bangladesh, 1996-2011

BACKGROUND

Nutritional transition (from under- to overnutrition) among women of reproductive age (15-49 y) is becoming increasingly common in many developing countries, including Bangladesh. However, the influence of this transition on the nutritional status of children <5 y of age (U5s) is unknown.

OBJECTIVES

The aim was to determine whether a nutritional transition has taken place in the past 15 y (1996-2011) among U5s and their mothers in Bangladesh and to examine how the association between maternal body mass index (BMI) and malnutrition in U5s has changed over time.

DESIGN

We analyzed data assembled from 5 Demographic and Health Surveys conducted between 1996 and 2011 in Bangladesh to describe the nutritional status of 28,941 U5s and their mothers. A Poisson regression model was used to examine the associations between maternal BMI and stunting, underweight, and wasting in U5s over time.

RESULTS

A nutritional transition among mothers of U5s was observed between 1996 and 2011. The height- or length-for-age and weight-for-age z score distributions of U5s showed consistent improvement; however, there was no indication of a nutritional transition. An interaction was found between maternal BMI categorized as underweight [BMI (kg/m²) <18.5], healthy BMI (BMI: 18.5-24.9), and overweight or obese (BMI ≥25) and year of survey on the risks of stunting and underweight in children. In 1996, children of underweight mothers had a 5% higher risk of being stunted than those born to healthy-BMI mothers (RR: 1.05; 95% CI: 1.00, 1.10); in 2011, children of underweight mothers had a 21% higher risk of being stunted (RR: 1.21; 95% CI: 1.13, 1.30). Maternal overweight or obesity was associated with a reduced risk of malnutrition in children.

CONCLUSIONS

A nutritional transition among U5s has yet to occur in Bangladesh. However, our results indicate that improvement in maternal BMI in the past 15 y was accompanied by a reduction in malnutrition in U5s.

Adolescent obesity in contextual settings: a scoping study of multilevel and hierarchical examinations

Multilevel/hierarchical obesity studies analyze adolescent and family, neighbourhood and social settings' characteristics to generate data needed to design prevention interventions. This scoping study summarizes such studies' characteristics and key findings to provide information to decision makers, which allows them to quickly grasp the state of the evidence and potential policy implications for adolescent obesity prevention. PubMed, CINAHLplus, PsychINFO and Sociological Abstracts were searched for peer-reviewed studies spanning 1 January 2000-31 August 2014. Inclusion criteria included (i) outcome weight status, physical activity and weight status, or physical activity alone if the aim was obesity prevention; (ii) 12- to 19-year-old participants in a cross-sectional study, a separate analysis in a cross-sectional study or a longitudinal follow-up. Nineteen studies were published in the United States of America; four in Canada; two in Spain, China and Vietnam, respectively; and one in Germany. Self-efficacy, parental physical activity support, perceived neighbourhood support, social cohesion and access to recreational facilities were associated with increased activity levels; neighbourhood physical disorder and perceived lack of safety associated with reduced physical activity levels. Overweight or obesity was associated with sugar-sweetened beverage intake and household availability thereof; reduced odds were reported with fruit and vegetable intake and household availability of these, daily breakfast and family meal frequency. Potential adolescent obesity risk regulators may be found at the individual, family or social contextual levels.

Regional differences in the prevalence of underweight, overweight and obesity among 13-year-old adolescents in Greece

Background and objectives

To assess regional differences in the weight status and abdominal obesity among 13-year-old Greek adolescents.

Design and setting

Cross-sectional, nationwide study in Greece.

Patients and methods

A representative sample of 4833 13-year-old adolescents (50.7% boys) was recruited throughout the nine regional districts of Greece from 2010 to 2012. Basic anthropometry measurements (weight, height, and waist circumference) were obtained. Abdominal obesity and weight status were assessed according to the International Obesity Task Force criteria.

Results

The majority of the sample had a healthy body weight (60.3%), 4.1% were underweight, 27.2% were overweight, and 8.5% were obese. For boys, the highest prevalence of underweight was recorded in Epirus, normal body weight on the Ionian Islands, overweight in Central Greece and Macedonia, and obesity on the Ionian Islands. Among girls, the highest underweight prevalence was on the Ionian Islands, normal body weight in Macedonia, overweight in Central Greece and Macedonia, and obesity in Crete. Abdominal obesity affected 12.9% of the sample, with the greatest prevalence among Cretan boys and Thracian girls. Additionally, residing on the Greek islands was associated with a higher prevalence of central adiposity.

Conclusion

Greek 13-year-old adolescents who are subjected to geographical changes exhibit high obesity and abdominal obesity rates. This study provides evidence to design regionally tailored interventions that aim to tackle and prevent the disease among the nine regional districts in Greece.

Obesity in young adulthood and later disability pension: A population-based cohort study of 366,929 Swedish men

Background: The prevalence of obesity has increased threefold among Swedish men during recent decades. Knowledge from Sweden on how obese men manage in working life and become disability pensioners is sparse. The aim of this nationwide and population-based cohort study was to investigate to what extent body mass index (BMI) in young adulthood predicts later disability pension. Method: All Swedish men born 1952—59, who had their weight and height measured at age 18 years in the compulsory military conscription examinations, were followed up longitudinally from 1990 to 2001 with regard to receiving disability pension. Data on own socioeconomic position (1985), education and marital status (1990), parental socioeconomic position (1960), and education (1970) were obtained from censuses. For 366,929 men (81% of the eligible men) the hazard ratio for receiving disability pension was calculated with Cox regression controlling for own education, parental education, childhood and adult socioeconomic position, marital status, morbidity, and type of municipality. Results: Obesity in young adulthood increased the risk for disability pension later in life (1.35, 95% CI 1.19, 1.52) compared with men of normal weight. The relationship between BMI and disability pension was J-shaped with higher risks for underweight (1.14, 95% CI 1.09, 1.20) and obese men. Conclusions: Obese men in Sweden are at higher risk of receiving disability pension. The relationship between BMI and disability pension is J-shaped. An important future task is to estimate the societal costs due to disability pension of obese people.

Parent-related mechanisms underlying the social gradient of childhood overweight and obesity: a systematic review

BACKGROUND

Low socio-economic status (SES) is a significant risk factor for childhood overweight and obesity (COWOB) in high-income countries. Parents to young children buffer and accentuate social and cultural influences, and are central to the development of this disease. An understanding of the parent-related mechanisms that underlie the SES-COWOB relationship is needed to improve the efficacy of prevention and intervention efforts.

OBJECTIVE

A systematic review of relevant literature was conducted to investigate the mechanisms by which levels of SES (low, middle and high) are associated to COWOB, by exploring mediation and interaction effects.

METHOD

Six electronic databases were searched yielding 5155 initial records, once duplicates were removed. Studies were included if they investigated COWOB, SES, parent-related factors and the multivariate relationship between these factors. Thirty studies were included. Factors found to be mediating the SES-COWOB relationship or interacting with SES to influence COWOB were categorized according to an ecological systems framework, at child, parent, household and social system level factors.

RESULTS

High parent body mass index, ethnicity, child-care attendance, high TV time (mother and child), breastfeeding (early weaning), food intake behaviours and birthweight potentially mediate the relationship between SES and COWOB. Different risk factors for COWOB in different SES groups were found. For low SES families, parental obesity and maternal depressive symptoms were strong risk factors for COWOB, whereas long maternal working hours and a permissive parenting style were risk factors for higher SES families. None of the studies investigated parental psychological attributes such as attitudes, beliefs, self-esteem and so on as potential mechanisms/risk factors.

CONCLUSIONS

Families from different SES groups have different risk and protective factors for COWOB. Prevention and intervention efforts may have improved efficacy if they are tailored to address specific risk factors within SES.

Overweight and obesity in Slovak high school students and body composition indicators: a non-randomized cross-sectional study

BACKGROUND

Physical development can be considered as an indicator of the overall health status of the youth population. Currently, it appears that the increasing trend of the prevalence of obesity among children and youths has stopped in a number of countries worldwide. Studies point to the fact that adolescence is a critical period for the development of obesity. Body mass index (BMI) seems to be an orientation parameter in the assessment of prevalence of obesity which is not sufficient for more accurate identification of at risk individuals. The purpose of this study was to evaluate association between BMI percentile zones as health-risk for being overweight and obese and body composition indicators in high-school students from the Prešov (Slovakia) region.

METHODS

A non-randomized cross-sectional study in high school students from the Prešov (Slovakia) region was conducted. The research sample consisted of 1014 participants (boys n = 466, girls n = 549). Body composition was measured using direct segmental multi-frequency bioelectrical impedance analysis (DSM-BIA). To examine the association between obesity and selected body composition indicators, Kruskal-Wallis ANOVA and Eta(2) were used. The relationship between selected body composition indicators and percentile BMI zones was determined using the Kendall tau correlation.

RESULTS

In groups with different BMI percentile zones (normal weight, overweight, obese), ANOVA showed significant differences for girls and boys (p ˂.05) with high effect size (η(2) ˂.26) in body weight, body fat mass index, body fat percentage, fat free mass index, fat-free mass percentage, visceral fat area, waist-to-hip ratio, waist circumference, protein mass and mineral mass. The highest degree of correlation among boys was between BMI values indicating overweight and obesity and fat free mass index and waist circumference, respectively (τ = .71, τ = .70, respectively). In girls, the highest correlation was found between classification of BMI percentile zones and waist circumference (t = .78).

CONCLUSION

The characteristics of body composition are very useful determinants of health and nutrition status. Our data revealed a direct association between BMI value and chosen body composition indicators. The most accurate indicator of overweight and obesity in our study appears to be waist circumference for both male and female population.

Review: Obesity and cardiometabolic syndrome in children

The cardiometabolic syndrome is highly prevalent among overweight youth. The risk of developing the cardiometabolic syndrome is likely triggered or exacerbated by concurrent obesity, unhealthy lifestyle/eating habits, and hormonal changes (puberty). Current screening recommendations include measurement of blood pressure, fasting insulin and glucose, and total cholesterol. However, limiting assessments to these measures underestimates cardiometabolic risk in overweight youth, particularly minorities. Early identification of cardiometabolic risk in its incipient stages may justify early and more aggressive intervention to prevent progression and complications. This review provides rationale for additional assessments to determine cardiometabolic risk in overweight youth and recommends treatment options.

Effects of Child Care Intervention on Physical Activity and Body Composition

INTRODUCTION

This study evaluated whether intervening with child care providers would increase physical activity (PA) and reduce adiposity in preschoolers.

METHODS

This was a two-arm, parallel group, cluster RCT whereby six child care centers were randomly assigned in equal numbers to intervention (n=40 children) or control (n=43 children). Participants were aged 3-5 years and attended licensed child care centers. Child care providers received two 3-hour train-the-trainer workshops and a training manual at program initiation aimed at increasing structured and unstructured PA through active play. Control child care centers implemented their standard curriculum. PA and sedentary behavior were measured by accelerometry, and body composition was measured using bioelectrical impedance at baseline and 6 months. Data were collected in 2011-2012 and analyzed in April 2015.

RESULTS

Linear mixed-effects modeling showed that at 6 months, children in the intervention group demonstrated greater increases in minutes per preschool day spent in overall PA (22.5 minutes, 95% CI=8.9, 36.1, p=0.002), and light-intensity PA (16.1 minutes, 95% CI=5.2, 26.7, p=0.004), but changes between groups in moderate to vigorous PA did not differ. The intervention group showed greater reductions in body fat percentage (-1.9%, 95% CI=-3.5, -0.3, p=0.023) and fat mass (-0.3 kg, 95% CI=-0.7, -0.1, p=0.018), but groups did not differ on fat-free mass, BMI, or z-BMI.

CONCLUSIONS

Provider-led intervention in child care centers increased preschoolers' PA and reduced adiposity, therefore may represent a viable approach to promoting PA and related health benefits in preschool-aged children.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02293278.

Parental Perceptions of Weight During the First Year of Life

BACKGROUND

More than half of parents underestimate their overweight child's weight; however, previous research focuses on children older than 2 years of age. The objective of this study was to assess whether parents of 2- to 12-month-old infants are able to accurately perceive their children's weight status.

METHODS

We performed a cross-sectional analysis of data collected from the Greenlight study, a cluster randomized obesity prevention trial, at 4 pediatric clinics serving diverse and low-income populations. Infants' length and weight were measured at well-child checks, and parents completed questionnaires including demographic characteristics and perception of their children's weight. Weight-for-length (WFL) percentile at the fifth to ≤95 was considered healthy weight and WFL percentile >95th was considered overweight. We used chi-squared tests to compare accuracy according to weight category and performed logistic regression analysis to assess accuracy at each time point.

RESULTS

Approximately 85% to 90% of infants (n = 853 at 2 months, n = 563 at 12 months) were at a healthy WFL at all measurement times, and parents of these infants were more likely to have an accurate perception of their child's weight (accuracy 89%-95%) than overweight children (accuracy 7%-26%; P < .001 across time points). Approximately 10% of healthy weight infants were perceived as underweight by their parents at all time points. At 12 months, mothers who were overweight were significantly more likely to underestimate their child's weight status (P = .008).

CONCLUSIONS

In our diverse and low-income sample, parents of overweight infants infrequently know that their infants are overweight. Future studies should examine how perception is related to feeding habits and weight status over time.

Body fat percentage is more associated with low physical fitness than with sedentarism and diet in male and female adolescents

BACKGROUND

Obesity is a multifactorial disease and our understanding of this disease is still incomplete.

PURPOSE

The aim of this investigation was to examine the associations between body fat percentage and physical fitness, diet and active/sedentary behaviors in female and male adolescents.

METHODS

A cross-sectional study was carried out on a sample of 1389 Spanish adolescents (706 boys and 683 girls) aged between 14 and 17years. Individual body fat percentage was measured by means of bioelectrical impedance analysis and participants' physical fitness was determined by measuring cardiorespiratory fitness (20-m shuttle run test), muscular strength (handgrip dynamometry), muscular endurance (curl-up and 90° push up repetition tests) and muscular flexibility (sit-and-reach test). Daily physical activity, sedentary time and diet were estimated using validated and self-reported questionnaires. The participants were divided into quartiles based on their body fat percentage.

RESULTS

Boys and girls included in Q3 and Q4 presented lower values for cardiorespiratory fitness than Q1 (P<0.05). Boys and girls included in Q4 also presented lower values for muscular endurance than Q1 (P<0.05). Only boys in Q4 presented lower levels of physical activity than Q1 (P<0.05). Physical activity, physical fitness and diet can explain 30% of the variance for body fat percentage in boys and 17% in girls.

CONCLUSIONS

Female and male adolescents with a higher body fat percentage presented lower cardiorespiratory and muscular endurance fitness than leaner counterparts.

Weight Gain in Infancy and Overweight or Obesity in Childhood across the Gestational Spectrum: a Prospective Birth Cohort Study

This study aimed to investigate the optimal degree of weight gain across the gestational spectrum in 1971 children enrolled at birth and followed up to age 7 years. Weight gain in infancy was categorized into four groups based on weight gain z-scores: slow (<-0.67), on track (-0.67 to 0.67), rapid (0.67 to 1.28), and extremely rapid (>1.28). Underweight and overweight or obesity (OWO) were defined as a body mass index ≤5(th) and ≥85(th) percentile, respectively, for age and gender. In our population, OWO was far more common than underweight (39.7% vs. 3.6%). Weight gain tracked strongly from age 4 to 24 months, and was positively associated with OWO and an unfavorable pattern of metabolic biomarkers, although the degree of weight gain for the risk was different across gestational categories. Extremely rapid weight gain led to a particularly high risk of OWO among children born early term and late preterm: odds ratio: 3.3 (95% confidence interval: 1.9 to 5.5) and 3.7 (1.8 to 7.5), respectively, as compared to those with on track weight gain. Our findings suggest that monitoring and ensuring optimal weight gain across the entire gestational spectrum beginning from birth represents a first step towards primary prevention of childhood obesity.

Neonatal adiposity increases with rising cord blood IGF-1 levels

OBJECTIVE

Infants with higher adiposity at birth may be at greater risk of developing obesity later in life. IGF-1 is important for intrauterine growth and may be a useful early life marker of adiposity, and thus later obesity risk. The aim of this study was to determine the relationship between cord blood IGF-1, neonatal anthropometrics and markers of neonatal adiposity.

DESIGN, PATIENTS AND MEASUREMENTS

A cross-sectional study design was utilized to study a multiethnic cohort of full-term neonates born to healthy mothers with normal glucose tolerance at a large university hospital. Neonatal cord blood was collected after birth and assayed for IGF-1, leptin and C-peptide. Neonatal body composition was measured between 24 and 72 h of life using the method of air displacement plethysmography.

RESULTS

Cord blood IGF-1 was positively and significantly associated with markers of neonatal adiposity in models adjusted for maternal age at delivery, race, maternal prepregnancy BMI, gestational age at delivery and neonatal sex: birthweight (r = 0·62, P < 0·001), leptin (r = 0·33, P = 0·018), fat mass (r = 0·52, P < 0·001) and percent body fat (r = 0·51, P < 0·001). Cord blood IGF-1 was not associated with cord blood C-peptide.

CONCLUSIONS

Cord blood IGF-1 is strongly associated with all measures of neonatal adiposity suggesting that IGF-1 may be an important contributor to in utero neonatal fat accumulation.

Associations between parent-child relationship quality and obesogenic risk in adolescence: a systematic review of recent literature

Adolescence is a period of significant cognitive, social and physiological change, presenting unique risk factors for weight gain. Childhood obesity research has traditionally focused on the influence of parent-level factors on children's eating and weight status. Increasingly, emphasis is turning towards the reciprocal nature of the parent-child relationship and its influence on health behaviour. A systematic literature review was conducted to investigate the relationship between parent-child relationship quality (defined as the felt emotional bond between parent and child) and obesogenic risk (weight status, eating attitudes and behaviours, level of physical activity and sedentary behaviour) in adolescence; 26 papers were included in the review. The results neither support nor challenge an association between parent-child relationship quality and weight, with study design flaws and limited measurement of the parent-child relationship precluding robust conclusions. The review does however suggests that several aspects of the parent-child relationship are important in understanding eating attitudes and behaviours, including the felt emotional bond between the parent and child, the child's perception of how much the parent cares for them and the mother's sensitivity towards the child. The need for further longitudinal research into the association between parent-child relationship quality and obesity risk across this developmental period is discussed.

Prediction of Preadolescent Overweight and Poor Cardiometabolic Outcome in Children up to 6 Years of Age: Research Protocol

Background

Dynamic risk estimations may enable targeting primary prevention of overweight and overweight-related adverse cardiometabolic outcome in later life, potentially serving as a valuable addition to universal primary prevention. This approach seems particularly promising in young children, as body mass index (BMI) changes at a young age are highly predictive of these outcomes, and parental lifestyle interventions at a young age are associated with improved long-term outcome.

Objective

This paper describes the design of our study, which aims to develop digitized tools that can be implemented in the Dutch Child Health Care (CHC) system or by pediatricians for children up to 6 years of age. These tools will enable (1) dynamically predicting the development of overweight, hypertension or prehypertension, low high-density lipoprotein cholesterol (HDL-C) values, and high total cholesterol to HDL-C ratio by early adolescence and (2) identifying children who are likely to have poor cardiometabolic outcome by the age of 5-6 years and by the age of 10 years.

Methods

Data will be obtained from the Generation R (n=7893) and Prevention and Incidence of Asthma and Mite Allergy (PIAMA; n=3963) cohorts, two Dutch prenatally recruited cohorts. We will select candidate predictors that can be assessed during the first visit and/or during subsequent visits to the CHC center or pediatrician, including sex; parental age, education level, and BMI; smoking exposure; ethnicity; birth weight; gestational age; breastfeeding versus formula feeding; and growth data through the age of 6 years. We will design dynamic prediction models that can be updated with new information obtained during subsequent CHC visits, allowing each measurement to be added to the model. Performance of the model will be assessed in terms of discrimination and calibration. Finally, the model will be validated both internally and externally using the combined cohort data and then converted into a computer-assisted tool called ProCOR (Prediction Of Child CardiOmetabolic Risk).

Results

This is an ongoing research project financed by the Dutch government. The first results are expected in 2016.

Conclusions

This study may contribute to the national implementation of digitized tools for assessing the risk of overweight and related cardiometabolic outcome in young children, enabling targeted primary prevention, ultimately yielding relevant health gains and improved resource allocation.

Overweight and Underweight Prevalence Trends in Children from Romania - Pooled Analysis of Cross-Sectional Studies between 2006 and 2015

AIM

High-quality national representative data on obesity in Romanian children are needed to shape public health policies. To provide a unified data landscape on national prevalence, trends and other factors associated with underweight, overweight, and obesity in Romanian children aged 6-19 years, across the last decade (2006-2015).

METHODS

Using a common protocol, we selected published and unpublished studies that measured Romanian children in schools between 2006 and 2015. Children's BMI was classified using the current WHO, IOTF, and CDC references.

RESULTS

25,060 children from 8 Romanian counties were included in the analysis. The prevalence of underweight children was 5%/4.5%/8.5% (WHO/IOTF/CDC), while the prevalence of overweight (including obese) children was 28.3%/23%/23.2% (WHO/IOTF/CDC). The prevalence of overweight children did not change significantly over the last decade (chi-square test p = 0.6). Male gender (odds ratio (OR) 1.37; 95% CI 1.29-1.45, compared to female); prepubertal age (OR = 3.86; 95% CI 3.41-4.36,compared to postpubertal age), and urban environment (OR 1.12; 95% CI 1.01-1.26, compared to rural environment) had higher risk for overweight.

CONCLUSION

While the prevalence of underweight children was low, almost one in four children in Romania was overweight or obese (according to WHO criteria) between 2006 and 2015. This prevalence remained relatively stable over the last decade. Male gender, prepubertal age, and urban environment, were the most relevant risk factors associated with overweight status in Romanian children.