Childhood obesity

Outcomes of a school-based intervention (RESCATE) to improve physical activity patterns in Mexican children aged 8-10 years

The aim of this study was to evaluate the impact of an intervention program on the patterns of physical activity in 8- to 10-year-old Mexican children from lower socioeconomic status. This study performed a randomized controlled field trial in 498 children aged 8-10 years from 10 public schools of low socioeconomic status in Mexico City. Schools were randomly assigned to intervention (n = 5) or control (n = 5) groups and followed up during 12 months. Physical and sedentary activities were assessed at the beginning of the program and after 6 and 12 months. At the end of follow-up, there was a significant increase in the performance of moderate physical activity (MPA) among children in intervention group who had not performed MPA at baseline any day of the week (40%, P = 0.04) but not in the control group (8%, P = not significant). The intervention group also showed a significant reduction in the proportion of children who spent more than 3 hours a day playing video games (from 23 to 13%, P = 0.01), while control group did not show significant changes. Given these findings, we conclude that intervention was able to modify positively physical activity and reduce time spent on such sedentary activities as video games among those at highest risk studied children.

Prenatal stress and developmental programming of human health and disease risk: concepts and integration of empirical findings

PURPOSE OF REVIEW

The concept of the developmental origins of health and disease susceptibility is rapidly attracting interest and gaining prominence as a complementary approach to understanding the causation of many complex common disorders that confer a major burden of disease; however several important issues and questions remain to be addressed, particularly in the context of humans.

RECENT FINDINGS

In this review we enunciate some of these questions and issues, review empirical evidence primarily from our own recent studies on prenatal stress and stress biology, and discuss putative maternal-placental-fetal endocrine and immune/inflammatory candidate mechanisms that may underlie and mediate short-term and long-term effects of prenatal stress on the developing human embryo and fetus, with a specific focus on body composition, metabolic function, and obesity risk.

SUMMARY

The implications for research and clinical practice are discussed with a summary of recent advances in noninvasive methods to characterize fetal, newborn, infant, and child developmental and health-related processes that, when coupled with available state-of-the-art statistical modeling approaches for longitudinal, repeated measures time series analysis, now afford unprecedented opportunities to explore and uncover the developmental origins of human health and disease.

Epigenomics: maternal high-fat diet exposure in utero disrupts peripheral circadian gene expression in nonhuman primates

The effect of in utero exposure to a maternal high-fat diet on the peripheral circadian system of the fetus is unknown. Using mRNA copy number analysis, we report that the components of the peripheral circadian machinery are transcribed in the nonhuman primate fetal liver in an intact phase-antiphase fashion and that Npas2, a paralog of the Clock transcription factor, serves as the rate-limiting transcript by virtue of its relative low abundance (10- to 1000-fold lower). We show that exposure to a maternal high-fat diet in utero significantly alters the expression of fetal hepatic Npas2 (up to 7.1-fold, P<0.001) compared with that in control diet-exposed animals and is reversible in fetal offspring from obese dams reversed to a control diet (1.3-fold, P>0.05). Although the Npas2 promoter remains largely unmethylated, differential Npas2 promoter occupancy of acetylation of fetal histone H3 at lysine 14 (H3K14ac) occurs in response to maternal high-fat diet exposure compared with control diet-exposed animals. Furthermore, we find that disruption of Npas2 is consistent with high-fat diet exposure in juvenile animals, regardless of in utero diet exposure. In summary, the data suggest that peripheral Npas2 expression is uniquely vulnerable to diet exposure.

Body fat reference curves for healthy Turkish children and adolescents

Childhood obesity is a major worldwide health problem. In addition to body mass index (BMI), body fat percentiles may be used to predict future cardiovascular and metabolic health risks. The aim of this study is to define new age- and gender-specific body fat centiles for Turkish children and adolescents. A total of 4,076 (2,276 girls, 1,800 boys) children and adolescents aged 6-18 years were recruited for this study. Total body fat was measured by a bioelectrical impedance noninvasive method. Body fat percentiles were produced by the LMS method. The body fat percentile curves of boys appear to rise from age 6 to 12 years and then slope downwards to age 15 years and then flatten off. The body fat % percentiles of girls increased until 14 years of age through 75th to 97th percentiles and then slope downwards, but through the third to 50th percentiles, they showed a downward slope after 14 years old.

CONCLUSIONS

Since BMI may not always reflect body fat content, direct assessment of adiposity by a practical method would be significantly useful for clinical decisions. Therefore, this study provides normative data for body fat percentage in healthy Turkish children and adolescents. To this goal we used a practical and clinically applicable method. These references can be useful for evaluation of overweight and obesity.

The lifestyle behaviours and psychosocial well-being of primary school students in Hong Kong

AIMS

To examine the lifestyle behaviours and psychosocial well-being of primary school students in Hong Kong.

BACKGROUND

The establishment of healthy lifestyle habits and maintenance of psychosocial well-being during early adolescence can prevent the morbidity and mortality caused by unhealthy practices.

DESIGN

A cross-sectional study.

METHODS

A questionnaire was used to solicit information on primary school students' lifestyle behaviours and psychosocial well-being using the Chinese version of the Adolescent Lifestyle Questionnaire (C-ALQ).

RESULTS

Out of 249 primary school students, 241 returned their questionnaires (a response rate of 96.8%). Results on the lifestyle behaviours of students indicated that nearly half of them 'play sports at least three times a week' (n = 111, 46.1%), 'try not to eat foods high in fats/salt' (n = 112, 46.5%), 'report unusual bodily changes to nurses, parents, friends or physician' (n = 136, 56.4%) and 'avoid doing drugs' (n = 186, 77.2%). Results for the psychosocial well-being of students showed that nearly half 'use helpful strategies to deal with stress' (n = 104, 43.2%), are 'confident about [their] own beliefs and values in life' (n = 143, 59.3%) and 'enjoy spending time with friends' (n = 169, 70.1%). Male students were found less likely than females to demonstrate 'health awareness' (t = 4.87, p = 0.028) and 'social support'(t = 4.17, p = 0.042) and to have better overall psychosocial well-being (t = 5.43, p = 0.021).

CONCLUSIONS

Primary school students have various health education needs related to lifestyle behavioural choices and the maintenance of psychosocial well-being. Lifestyle choices are formed in early adolescence; therefore, health education must begin as early as possible to influence healthy behaviours.

RELEVANCE TO CLINICAL PRACTICE

School nurses should assess health needs across the school-age population and develop programmes to address these overall needs. School nurses are needed to cater for the needs of students, particularly boys, to establish health programmes for lifelong healthy lifestyles and psychosocial well-being and to monitor their health status.

Identifying the "tipping point" age for overweight pediatric patients

According to the National Health and Nutrition Examination Survey in 2007, nearly half of all American children are either overweight or obese. Retrospective chart review identified patients with the diagnostic codes for overweight, obese, and/or excessive weight gain. Inclusion criteria were current age between 2 and 20 years, a minimum of 5 visits with weight and height measurements, and a body mass index (BMI) at or above the 85th percentile. A total of 184 patients met inclusion criteria. More than half the children became overweight before age 2, and all patients were obese or overweight by age 10. The rate of gain is approximately 1 excess BMI unit/year, therefore causing most children to be overweight by age 2 (R (2) = .53). This study indicates that the critical period for preventing childhood obesity in this subset of identified patients is during the first 2 years of life and for many by 3 months of age.

Prevalence of overweight and obesity among preadolescent schoolchildren in Galicia, Spain

BACKGROUND

Childhood obesity is rising rapidly in many countries. Preadolescents appear to be at particularly high risk. This study estimated the prevalence of overweight and obesity in preadolescent schoolchildren in Galicia, Spain.

METHODS

The heights and weights of a random sample of 2305 Galician schoolchildren aged 10-12 years were measured using calibrated standardized scales and measures. Overweight and obesity were identified using the criteria of the International Obesity Task Force.

RESULTS

The prevalences of obesity and overweight were respectively 9.2% and 31.0% among boys, 8.6% and 28.8% among girls and 8.9% and 29.9% overall. Taking boys and girls together, the combined prevalence of overweight and obesity fell significantly with increasing age. Overweight was more prevalent in rural than urban areas (30.7% vs. 28.4%), as also was obesity (9.8% vs. 7.2%).

CONCLUSIONS

Our study evidences the emergence of the obesity epidemic among preadolescents in Galicia, especially in rural areas. Both overweight and obesity in this age group are more prevalent in Galicia than in other areas of Spain or most other Western nations.

Epidemiology and etiology of obesity in children and youth of Sarajevo Canton

The aims of the study were to estimate the prevalence of excessive weight in infants and school-age children in Sarajevo Canton, to isolate the main causative agents and to propose a strategy for its efficient prevention. The methods included anthropometry and originally designed questionnaire. Calculated body mass index was classified according to the criteria proposed by Centre for Disease Control and Prevention (CDC). The research included 3608 students from elementary and secondary schools from Sarajevo Canton. Nearly 1/5 of subjects had excessive body weight while 12.49% of students were malnourished. Elementary school lower graders had the highest grade of excessive weight, while the secondary school students exhibited the lowest grade of excessive weight. During school hours, about 42.47% of students were fed on bakery produces and snacks. Non-sparkling, thickened juices are frequently consumed beverages (20.65%), second only to water (51.82%). 58.15% of children consume sweets on daily basis. This is even more prominent among secondary school students (80.85%). Only 1/3 of students practice sports on daily basis, while 8.51% of them rarely engage in sports. Elementary school lower grade students had the lowest level of activity while the secondary school students were the most active. As many as 27.56% students spend two hours or more sitting by the computer or TV set. The most significant mediators of excessive weight gain are sedentary life-style, frequent consumption of sweets and thickened juices and unsuitable nutrition during school hours. Continuous preventive and therapeutically activities must be undertaken among as wide population as possible.

[Early screening criteria for children at risk of overweight]

BACKGROUND

Health professionals who monitor the growth of children are also involved in the early detection of overweight. Appropriate tools are required for this purpose.

OBJECTIVE

The study sought to identify predictive markers of the development of subsequent overweight using a simple set of criteria.

METHODS

A consecutive cohort was composed of 1424 grade 4 children in Aquitaine, France, aged 8-9 years. Body mass index (BMI) was calculated during school health assessments at 8-9 years of age. Data from previous assessments at 3-4 and 5-6 years of age were also collected.

RESULTS

Of the 189/1424 children (13.9 %) who were overweight according to the French national cut off for children aged 8-9 years, 67 (33.8 %) were already overweight at 3-4 years and 107 (54.1 %) at 5-6 years. Of the 134 (9.4 %) who were overweight at 5-6 years, 43.3 % were already overweight at 3-4 years and 79.9 % were overweight at 8-9 years. On the other hand, 76 of these 134 children (56.7 %) were not overweight at 3-4 years, so they had become overweight between the two assessments. The combination of the criterion "overweight at 3-4 years or 5-6 years" and "increase in BMI>1kg/m(2) between 3-4 years and 5-6 years" appears to be the best predictor of the risk of overweight at 8-9 years, with good sensitivity (75.3 %) and specificity (87.9 %).

CONCLUSION

A predictive tool based on BMI changes between ages 3-4 years and 5-6 years could be used for the early detection of the risk of developing overweight and obesity. The tool is easy to use, especially for health care in schools. Furthermore, the present findings confirm the value of following up and managing children who are already overweight between the ages of 3 and 6 years.

Estado nutricional de crianças e adolescentes hospitalizados em enfermaria de cirurgia pediátrica

OBJETIVO: Avaliar o estado nutricional, o tempo de internação e as especialidades clínicas de pacientes internados na enfermaria de Cirurgia Pediátrica do Hospital São Paulo da Unifesp-EPM. MÉTODOS: Estudo transversal retrospectivo, com 749 crianças e adolescentes de ambos os gêneros acompanhados por equipe interdisciplinar durante o período de agosto de 2007 a julho de 2008. Foram coletados dados antropométricos, dias de internação e procedimento cirúrgico segundo a especialidade. Para a classificação do estado nutricional, utilizou-se o escore Z do índice de massa corporal (Z IMC) e da estatura/idade (Z E/I) segundo a curva da Organização Mundial de Saúde (OMS, 2007). As crianças foram classificadas segundo diagnóstico estabelecido previamente à cirurgia. Utilizou-se o programa STATA 8.0 para análise dos dados e aplicou-se o teste ANOVA e comparações múltiplas de Bonferroni, considerando-se significante p<0,05. RESULTADOS: A mediana de idade foi sete anos (0 a 18), predominando o gênero masculino (59%) e as internações para cirurgia otorrinolaringológica (18%). Dos pacientes internados, 66% tinham estatura adequada para idade, 43% eutróficos e 31% obesos/sobrepeso. Os pacientes desnutridos permaneceram mais dias internados quando comparados aos obesos/sobrepeso (7,2 versus 4,1 dias; p=0,035). Os lactentes apresentaram maior tempo de internação (p=0,006) e menor valor de Z IMC, comparados aos outros grupos etários (p=0,001). Os lactentes com programação de cirurgia cardíaca apresentaram Z IMC menor em relação às demais especialidades (p=0,002). CONCLUSÕES: O perfil dos pacientes internados condiz com a atual transição nutricional, aumento da prevalência de obesidade concomitante à desnutrição. Entretanto, a desnutrição ainda constitui fator agravante para a permanência hospitalar

The addition of a protein-rich breakfast and its effects on acute appetite control and food intake in 'breakfast-skipping' adolescents

BACKGROUND

Breakfast skipping (BS) is closely associated with overeating (in the evening), weight gain and obesity. It is unclear whether the addition of breakfast, with emphasis on dietary protein, leads to better appetite and energy intake regulation in adolescents.

OBJECTIVE

The purpose of the study was to examine the impact of addition of a normal-protein (PN) breakfast vs protein-rich (PR) breakfast on appetite and food intake in 'breakfast-skipping' adolescents.

SUBJECTS AND DESIGN

A total of 13 adolescents (age 14.3+/-0.3 years; body mass index percentile 79+/-4 percentile; skipped breakfast 5+/-1 x per week) randomly completed 3 testing days that included a PN (18+/-1 g protein), PR (48+/-2 g protein) or BS. Breakfast was 24% of estimated daily energy needs. Appetite, satiety and hormonal responses were collected over 5 h followed by an ad libitum lunch and 24-h food intake assessments.

RESULTS

Perceived appetite was not different following PN vs BS; PR led to greater reductions vs BS (P<0.01) and PN (P<0.001). Fullness was greater following both breakfast meals vs BS (P<0.01) but was not different between meals. Ghrelin was not different among treatments. Greater PYY concentrations were observed following both breakfast meals vs BS (P<0.01) but was not different between meals. Lunch energy intake was not different following PN vs BS; PR led to fewer kcal consumed vs BS (P<0.01) and PN (P<0.005). Daily food intake was not different among treatments.

CONCLUSIONS

Breakfast led to increased satiety through increased fullness and PYY concentrations in 'breakfast skipping' adolescents. A breakfast rich in dietary protein provides additional benefits through reductions in appetite and energy intake. These findings suggest that the addition of a protein-rich breakfast might be an effective strategy to improve appetite control in young people.

Iron stores, liver transaminase levels and metabolic risk in healthy teenagers

BACKGROUND

Iron overload may contribute to the pathogenesis of insulin resistance. We aimed to investigate the relationship among iron stores, liver transaminases and components of the metabolic syndrome in healthy teenagers in a cross-sectional study.

MATERIAL AND METHODS

We determined body mass index (BMI), waist-to-hip-ratio (WHR), blood pressure, liver ultrasound, serum lipids, insulin, fasting glucose, liver transaminase levels, hsCRP, iron parameters in 325 of 341 (95.3%) students (234 men, 16.7 +/- 1.7 years; 91 women, 16.5 +/- 1.7 years) of one single high school. Male and female study participants were allocated to increasing quartiles of body iron stores as assessed by sTfr/ferritin and alanine aminotranspeptidase (ALT) levels, and the distribution of cardiometabolic risk factors along quartiles was analysed. Regression analysis was performed to confirm the independent relationship between parameters.

RESULTS

In male students, BMI, WHR, systolic and diastolic blood pressure, serum triglyceride levels and hsCRP were higher in the top sTfR/ferritin and ALT quartiles compared with the lowest quartiles (P < 0.01 for all parameters). In female students, sTfR/ferritin were not associated with antropomorphic cardiometabolic risk factors but with insulin resistance (HOMA-IR, P = 0.046). Moreover, ALT levels were independently related to BMI, waist and hip circumference, systolic blood pressure, serum triglyceride and insulin concentrations (P < 0.05 for all parameters) in female students.

CONCLUSION

These results provide evidence for linkage among body iron stores, transaminase activity and the prevalence of cardiometabolic risk factors in apparently healthy, non-obese adolescents even within the range of normal laboratory and anthropomorphic values and suggest that iron stores should be investigated as a potentially modifiable risk factor in healthy teenagers.

Evaluation of the overweight/obese child--practical tips for the primary health care provider: recommendations from the Childhood Obesity Task Force of the European Association for the Study of Obesity

The prevalence of obesity among children and adolescents is on the rise. The majority of overweight or obese children are treated by primary health care providers including paediatricians, family practitioners, dieticians, nurses, and school health services - and not by specialists. The majority of obese children have no underlying medical disorder causing their obesity yet a significant proportion might suffer from obesity-related co-morbidities. This text is aimed at providing simple and practical tools for the identification and management of children with or at risk of overweight and obesity in the primary care setting. The tips and tools provided are based on data from the recent body of work that has been published in this field, official statements of several scientific societies along with expert opinion provided by the members of the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO). We have attempted to use an evidence-based approach while allowing flexibility for the practicing clinician in domains where evidence is currently lacking and ensuring that treating the obese child involves the entire family as well.

Treatment of hypertension in children and adolescents

The treatment of hypertension in children and adolescents has been markedly changed in recent years by several factors, including the publication of new consensus recommendations, the obesity epidemic, and the increased availability of information on efficacy and safety of antihypertensive medications in the young. In this review we present an updated approach to the outpatient management of hypertension in the child or adolescent, utilizing representative cases to illustrate important principles as well as possible controversies.

High prevalence of impaired fasting glucose in Chinese children and adolescents with prehypertension/hypertension

AIM

To assess the prevalence of impaired fasting glucose among Chinese children and adolescents with prehypertension/hypertension (PHP/HP), overweight/obesity (OW/OB) or both in the general population.

METHODS

In total, 3409 children and adolescents among the age group of 10-18 years were enrolled. These subjects were then divided into four groups: OW/OB, PHP/HP, OW/OB + PHP/HP and a control group. Fasting plasma glucose (FPG) and lipid levels were measured in children with a body mass index > or =85th percentile and/or blood pressure > or =90th percentile and in 100 subjects randomly selected from the control group. The oral glucose tolerance test was performed in all the subjects with fasting glucose > or =5.6 mmol/L.

RESULTS

Eighty-one impaired fasting glucose subjects and one girl with type 2 diabetes were identified. The prevalence of impaired fasting glucose in PHP/HP (7.03%) was not significantly different from that in the OW/OB + PHP/HP group (8.59%), but was higher than that in the OW/OB group (3.31%).

CONCLUSION

Although the American Diabetes Association does not recommend the FPG test for children and adolescents with PHP/HP, in this study, we found that children and adolescents with PHP/HP have a higher prevalence of impaired fasting glucose than those with OW/OB. Further validation of these findings is warranted and a type 2 diabetes screening protocol for Chinese children and adolescents needs to be established.

A maternal high-fat diet is accompanied by alterations in the fetal primate metabolome

OBJECTIVE

To characterize the serum metabolome of a primate model of in utero high-fat exposure.

STUDY DESIGN

Serum from maternal and fetal (e130) macaque monkeys exposed to either a high-fat or control diet were analyzed by gas chromatography-mass spectrometry. Multivariate data analysis was performed to reduce the generated data set. Candidate metabolites were further analyzed for significance by using the analysis of variance and comparative t tests.

RESULTS

Approximately 1300 chromatographic features were detected. Through multivariate data analysis this number was reduced to 60 possible metabolites. With the use of comparative t tests, 22 metabolites had statistical significance (P < .05) over the entire study. By virtue of maternal high-fat diet alone, fetal phenotypic differences are accompanied by altered metabolite concentrations of 7 metabolites (P < .05).

CONCLUSION

In utero high-fat diet exposure is associated with an altered fetal epigenome and parlays a characteristic modification in the fetal metabolite profile.

Pharmacotherapy in pediatric obesity: current agents and future directions

Childhood obesity is emerging as a major public health threat, with adverse implications on the health of individuals and long-term costs to society. Family-based lifestyle interventions with behavioral modification, diet and exercise form the mainstay of treatment. Pharmacologic treatment may be considered in selected subjects, especially in the presence of significant and severe comorbidities, when lifestyle intervention has failed to achieve weight reduction. Orlistat and sibutramine are FDA-approved for treatment of pediatric obesity; metformin may be considered in the presence of clinically significant insulin resistance. Evidence is lacking on the appropriate duration of medical therapy and optimal combination with lifestyle intervention. Lack of coverage of medications by insurance and high out-of-pocket costs may be limiting factors to some families. Adverse effects necessitate careful monitoring and may lead to discontinuation of medication. Pharmacologic agents with novel mechanisms of action offer hope of improved efficacy, tolerability and safety.

The energy cost of cycling and aerobic performance of obese adolescent girls

In order to assess the energy cost of cycling and aerobic capacity in juvenile obesity, responses to cycle ergometer exercise were studied in 10 pubertal obese (OB) [body mass index (BMI) SD score (SDS): 3.40+/-0.58 SD] adolescent girls (age: 16.0+/-1.2 yr) and in 10 normal-weight (NW, BMI SDS: -0.30+/-0.54) girls of the same age (15.1+/-1.9). To this aim, gas exchange, heart rate (HR), and energy expenditure (EE) were studied during graded cycle ergometer test at 40, 60, 80, 100, and 120 W. The energy cost of cycling was higher in OB, being oxygen uptake (VO2) higher (about 20%) in OB than in NW girls at all workloads (p<0.01-0.001). Estimated maximal VO2 and VO2 at anaerobic threshold were significantly (p<0.05) higher in OB girls [although lower per unit body mass (p<0.01) and similar for unit fat-free mass], and explained the higher oxygen pulse and lower HR for any EE observed during submaximal exercise in OB. While net mechanical efficiency (ME) was significantly lower in OB (p<0.01), delta ME was similar in both groups, indicating no substantial derangement of muscle intrinsic efficiency. It is concluded that, despite a higher cost of cycling, OB girls can rely on a larger aerobic capacity which makes them able to sustain this kind of exercise within a wide range of work loads, with relevant implications when planning protocols of physical activity in the context of interventions for the reduction of juvenile obesity.

Screening of metabolic syndrome in obese children: a primary care concern

OBJECTIVE

To determine the prevalence of metabolic syndrome (MS) in a primary care pediatric setting and to collect clinical and biochemical data, allowing for a prediction of its presence in a supposedly healthy population.

METHODS

Belonging to a pediatric population followed by pediatricians of the Italian National Health Service, 415 subjects with obesity as a unique selection criterion were enrolled. The entire cohort was screened for MS, which was defined as the presence of at least 2 other findings out of obesity: fasting hyperglycemia, low levels of high-density lipoproteins cholesterol, hypertriglyceridemia, and hypertension.

RESULTS

The overall prevalence of MS was 30.8%. Major findings (out of obesity) were low high-density lipoproteins cholesterol levels (46.2%), hypertension (23.6%), hypertriglyceridemia (22.2%), and fasting hyperglycemia (16.6%). Waist-to-height ratio was the only clinical parameter directly related to MS, with the same predictive power of insulin resistance.

CONCLUSIONS

Metabolic syndrome can be present in a significant percentage of "healthy" obese children, and a simple clinical parameter could identify at-risk subjects. This observation justifies the development and implementation of pediatric networks for obesity screening programs.

Prevalence of the metabolic syndrome among obese adolescents enrolled in a multidisciplinary weight management program: clinical correlates and response to treatment

OBJECTIVE

The aim of this study was to determine the prevalence of the metabolic syndrome at baseline and after 6 months of lifestyle modification among obese adolescents referred to a multidisciplinary weight management program.

METHODS

A total of 165 obese adolescents were evaluated at baseline, and measurements were repeated in 57 subjects who completed 6 months of the program. Metabolic syndrome was defined as having three or more of the following: a body mass index (BMI) >97(th) percentile, hypertension, low high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia, and impaired fasting glucose (IFG).

RESULTS

The prevalence of a BMI >97(th) percentile, hypertension, hypertriglyceridemia, low HDL-C, and IFG was 92.7, 54.5, 29.1, 26.7, and 2.4%, respectively. The prevalence of the metabolic syndrome at baseline was 30.3%. After 6 months of lifestyle modification, BMI z scores, percent body fat, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) decreased significantly from baseline; however, there was no significant change in the number of subjects demonstrating >or=three criteria of the metabolic syndrome.

CONCLUSIONS

Approximately one third of the study subjects met the criteria of the metabolic syndrome, emphasizing the growing concern for the future development of premature cardiovascular disease in this high-risk population. Our data suggest that new strategies for lifestyle modification may be needed to improve cardiovascular risk factors significantly among adolescents with obesity.

Pediatricians and screening for obesity with body mass index: does level of training matter?

OBJECTIVES

Pediatric obesity is increasing at epidemic rates in industrialized nations. It is recommended that pediatricians screen all children annually with the use of body mass index (BMI). However, it is unclear whether this recommendation is followed. This study sought to (1) determine the proportion of children screened for obesity with BMI, and (2) test whether attending physicians are more likely than resident physicians to document and plot BMI.

METHODS

We conducted a systematic review of medical records in an urban academic pediatric practice. Participants were children aged 5 to 11 years presenting for health care in 2004. We measured the proportion of subjects with documented and plotted BMI and compared results for attending and resident physicians. We used logistic regression analysis to determine factors associated with documentation of BMI.

RESULTS

Of 397 medical records reviewed, 59.7% contained the 2000 Centers for Disease Control and Prevention growth curve with BMI for age; 5.5% documented BMI, and 4.3% plotted BMI. Resident physicians were more likely to document (13.0% vs. 3.0%, p = 0.0008) and plot (9.0% vs. 2.7%, p = 0.0260) BMI compared with attending physicians. Children with a BMI--95% for age were more likely to have their BMI documented (odds ratio [OR] = 10.7, 95% confidence interval [CI] 3.7, 31.5) and plotted (OR = 7.1, 95% CI 2.3, 21.6).

CONCLUSION

We found the use of BMI to screen for childhood obesity very poor in this academic pediatric practice. Resident physicians were more likely to document and plot BMI than attending physicians.

Quality assessment of clinical practice guidelines for the prevention and treatment of childhood overweight and obesity

BACKGROUND

The prevalence of childhood overweight and obesity is increasing at dramatic rates in children and adolescents worldwide. Clinical practice guidelines (CPGs) are "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." Their objective is to provide explicit recommendations for clinical practice based on current evidence for best practice in the management of diseases.

MATERIALS AND METHODS

The aim of this study was to identify and assess the quality of CPGs for the prevention and treatment of obesity and overweight in childhood. We developed a search to identify CPGs published between January 1998 and August 2007. We considered for inclusion documents that provided recommendations for clinical practice referring to children and adolescents. Three independent appraisers assessed the quality of the1 CPGs using the AGREE (Appraisal of Guidelines Research and Evaluation) instrument. We identified 376 references and selected 22 for further assessment.

RESULTS

The overall agreement among reviewers using the intraclass correlation coefficient was 0.856 (95% confidence interval [CI] 0.731-0.932). Six of the 22 initial guidelines were recommended and a further eight were recommended with conditions or provisos. We concluded that the number of documents with recommendations on the prevention and treatment of childhood obesity published during the 10-year study period was considerable, but only a few of them could be considered as high quality. CPGs were deficient in areas such as applicability, editorial independence and rigor in development.

CONCLUSION

Due to the increasing burden of obesity among children and the potential for long-term comorbidities, clinicians need to be critical in assessing the rigor of how these are developed and their appropriateness for use in the clinician's own practice. There is a need to improve the methodology and the quality of CPGs on childhood obesity to help clinicians and other decision-makers to tackle this disease.

Waist circumference and fat intake are associated with high blood pressure in Mexican children aged 8 to 10 years

BACKGROUND

Elevated blood pressure at a young age is a predictor of blood pressure elevation later in life and has been associated with being overweight. However, it seems that there are other factors related to hypertension in childhood.

OBJECTIVE

To determine the anthropometric, physical activity, and dietary factors associated with both systolic and diastolic hypertension in a group of Mexican school-aged children.

DESIGN

In this cross-sectional descriptive study, blood pressure, anthropometrics, physical activity, and dietary intake (assessed with a multiple-pass 24-hour dietary recall) evaluations were performed on school-aged children from September 2005 to July 2006.

SUBJECTS

Children aged 8 to 10 years (626 boys and 613 girls) from a convenience sample of 23 public schools of low socioeconomic status in Mexico City were included. Systolic and diastolic hypertension were defined as blood pressure > or = 95th percentile for age, sex, and height, without diastolic or systolic prehypertension or hypertension, respectively. Mixed hypertension was defined as the presence of both systolic and diastolic hypertension.

STATISTICAL ANALYSIS

Descriptive statistics, chi(2) tests, analysis of variance, post hoc analysis with Bonferroni method, and logistic regression analysis were performed. Continuous variables are presented as mean+/-standard deviation, categorical variables as percentages, and the association measures as adjusted odds ratios (ORs). A P value < 0.05 was considered statistically significant, and 95% confidence intervals were calculated for adjusted ORs.

RESULTS

The dietary intake analysis showed that both boys and girls had low fiber intake (< 25 g/day) as well as an excessive mean consumption of total and saturated fat (> 35% and > 10% of daily energy, respectively). From the total group of children, 3.6% had systolic hypertension, 14.2% diastolic hypertension, and 22.8% mixed hypertension. The higher values of weight, body mass index, waist circumference, and prevalence of overweight and obesity were more commonly seen among children with mixed hypertension, followed by children in the systolic group. Subjects with diastolic and mixed hypertension had an elevated intake of dietary total fat (37.7% and 38.2% of daily energy intake, respectively). Moreover, an adjusted OR of 1.06 (95% confidence interval 1.01 to 1.11) for systolic hypertension per increase of 1 cm in waist diameter was found and total fat intake > 35% of the daily energy showed an adjusted OR of 2.61 (95% confidence interval 1.27 to 5.36) for diastolic hypertension.

CONCLUSIONS

In a sample of Mexican children of low socioeconomic status, the prevalence of hypertension was high. Waist circumference was the main factor associated with systolic hypertension, and higher intake of total fat was related to diastolic hypertension.

Influence of a lifestyle intervention in preschool children on physiological and psychological parameters (Ballabeina): study design of a cluster randomized controlled trial

BACKGROUND

Childhood obesity and physical inactivity are increasing dramatically worldwide. Children of low socioeconomic status and/or children of migrant background are especially at risk. In general, the overall effectiveness of school-based programs on health-related outcomes has been disappointing. A special gap exists for younger children and in high risk groups.

METHODS/DESIGN

This paper describes the rationale, design, curriculum, and evaluation of a multicenter preschool randomized intervention study conducted in areas with a high migrant population in two out of 26 Swiss cantons. Twenty preschool classes in the German (canton St. Gallen) and another 20 in the French (canton Vaud) part of Switzerland were separately selected and randomized to an intervention and a control arm by the use of opaque envelopes. The multidisciplinary lifestyle intervention aimed to increase physical activity and sleep duration, to reinforce healthy nutrition and eating behaviour, and to reduce media use. According to the ecological model, it included children, their parents and the teachers. The regular teachers performed the majority of the intervention and were supported by a local health promoter. The intervention included physical activity lessons, adaptation of the built infrastructure; promotion of regional extracurricular physical activity; playful lessons about nutrition, media use and sleep, funny homework cards and information materials for teachers and parents. It lasted one school year. Baseline and post-intervention evaluations were performed in both arms. Primary outcome measures included BMI and aerobic fitness (20 m shuttle run test). Secondary outcomes included total (skinfolds, bioelectrical impedance) and central (waist circumference) body fat, motor abilities (obstacle course, static and dynamic balance), physical activity and sleep duration (accelerometry and questionnaires), nutritional behaviour and food intake, media use, quality of life and signs of hyperactivity (questionnaires), attention and spatial working memory ability (two validated tests). Researchers were blinded to group allocation.

DISCUSSION

The purpose of this paper is to outline the design of a school-based multicenter cluster randomized, controlled trial aiming to reduce body mass index and to increase aerobic fitness in preschool children in culturally different parts of Switzerland with a high migrant population.

TRIAL REGISTRATION

Trial Registration: (clinicaltrials.gov) NCT00674544.

A Comparative Study of Parental Behaviors and Children's Eating Habits

Childhood obesity poses a serious threat to the health of our nation. Specifically, the preschool years (3-5 years of age) have been identified as a crucial time to study the determinants of childhood nutrition and obesity. This study investigated the body mass index (BMI) of children ages 3 to 5 years, as well as parenting behaviors and parenting styles and how they possibly influenced children's eating habits and overall BMIs. Results indicated there was a significant difference between parenting styles and children's eating habits, with authoritative parents labeling their children's eating habits as either very good or good and permissive parents labeling their children's eating habits as fair. In addition, results indicated a significant difference between parents' educational levels and personal BMIs. As parents' educational level increased, their BMI levels decreased.

Consequences of Childhood Obesity

Introduction: The incidence of childhood obesity is rising across the globe, and obesity related co-morbidities are increasing concomitantly in the paediatric population. Materials and Meth- ods: PubMed search for research and review papers on complications of childhood obesity was performed. Results: The consequences of childhood obesity can be broadly classified into medical and psychosocial consequences. Medical consequences include metabolic complications such as diabetes mellitus, hypertension, dyslipidaemia and non-alcoholic fatty liver disease, and me- chanical problems such as obstructive sleep apnoea syndrome and orthopaedic disorders. Psychological and social consequences are prevalent but often overlooked. Local data on these complications were also discussed. Conclusion: Childhood obesity is associated with significant morbidities, which not only have immediate impact on the health of the obese children, but also significantly increase the risk of morbidities in adulthood. Key words: Medical consequence, Psychosocial consequence

Obesity in girls and penetrative sexual abuse in childhood

AIM

To assess the relationship between childhood obesity and penetrative sexual abuse in girls.

METHODS

All obese girls referred to a hospital based pediatric endocrine unit were interviewed by a social worker or psychologist. Questions aimed to elicit any history of physical, emotional and sexual abuse are included. Overweight was defined as BM >95th percentile for age and gender. Body mass index (BMI) Z score (BMIZ) was calculated as measured BMI minus mean BMI for age and gender divided by standard deviation. Penetrative abuse was defined if a history was elicited of forced intercourse with any form of oral, vaginal or anal penetration.

RESULTS

A history of penetrative abuse was elicited in 5 out of 145 (3.5%) obese girls, their mean +/- SD age was 11.9 +/- 3.1 years. Abused girls were significantly more obese than the remainder of the patients (BMIZ 4.76 +/- 1.34 vs. 3.39 +/- 1.28 p = 0.02). Forty-two of all girls had BMI Z scores > or =4, and of these four (9.5%) had been abused. All girls had changes in normal daily behaviour including seductive behaviour, seclusion, self-mutilation and new onset day enuresis.

CONCLUSION

In the evaluation of girls with marked obesity, particularly if associated with behavioural changes and failure to respond to therapy, the possible occurrence of penetrative sexual abuse should be considered.

Childhood obesity and medical neglect

The incidence of childhood obesity has increased dramatically, including severe childhood obesity and obesity-related comorbid conditions. Cases of severe childhood obesity have prompted the following question: does childhood obesity ever constitute medical neglect? In our opinion, removal of a child from the home is justified when all 3 of the following conditions are present: (1) a high likelihood that serious imminent harm will occur; (2) a reasonable likelihood that coercive state intervention will result in effective treatment; and (3) the absence of alternative options for addressing the problem. It is not the mere presence or degree of obesity but rather the presence of comorbid conditions that is critical for the determination of serious imminent harm. All 3 criteria are met in very limited cases, that is, the subset of obese children who have serious comorbid conditions and for whom all alternative options have been exhausted. In these limited cases, a trial of enforced treatment outside the home may be indicated, to protect the child from irreversible harm.

A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults

OBJECTIVE

The present review examines efficacious psycho-behavioral interventions in preventing weight gains or reducing weight among US multiethnic and minority adults as few studies were conducted to review such interventions to date.

METHODS

Data were examined from 24 controlled intervention studies, representing 23 programs and involving 13,326 adults. Studies were identified through manual and online search of databases that include MEDLINE, Academic Search Premier, ERIC, PsycARTICLES, SPORTDiscus, and CINAHL Plus.

RESULTS

Whereas one-component (n=5, d=0.08, 90% CI=-0.04, 0.35) and two-component interventions (n=13, d=0.22, 90% CI=0.05, 0.40) showed a low mean effect size, three-component interventions (n=6, d=0.52, 90% CI=0.39, 0.65) showed a moderate effect size. Interventions conducted in individual sessions (n=15, d=0.40, 90% CI=0.24, 0.56) showed a higher mean effect size than group interventions (n=9, d=0.08, 90% CI=-0.04, 0.30) although the confidence intervals overlapped.

CONCLUSIONS

The study results indicate that future obesity prevention interventions targeting multiethnic and minority adults might benefit from incorporating individual sessions, family involvement, and problem solving strategies into multi-component programs that focus on lifestyle changes.

Clinical review: treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials

CONTEXT

The efficacy of treatments for pediatric obesity remains unclear.

OBJECTIVE

We performed a systematic review of randomized trials to estimate the efficacy of nonsurgical interventions for pediatric obesity.

DATA SOURCES

Librarian-designed search strategies of nine electronic databases from inception until February 2006, review of reference lists from published reviews, and content expert advice provided potentially eligible studies.

STUDY SELECTION

Eligible studies were randomized trials of overweight children and adolescents assessing the effect of nonsurgical interventions on obesity outcomes.

DATA EXTRACTION

Independently and in duplicate, reviewers assessed the quality of each trial and collected data on interventions and outcomes.

DATA SYNTHESIS

Of 76 eligible trials, 61 had complete data for meta-analysis. Short-term medications were effective, including sibutramine [random-effects pooled estimate of body mass index (BMI) loss of 2.4 kg/m(2) with a 95% confidence interval (CI) of 1.8-3.1; proportion of between-study inconsistency not due to chance (I(2)) = 30%] and orlistat (BMI loss = 0.7 kg/m(2); CI = 0.3-1.2; I(2) = 0%). Trials that measured the effect of physical activity on adiposity (i.e. percent body fat and fat-free mass) found a moderate treatment effect (effect size = -0.52; CI = -0.73 to -0.30; I(2) = 0%), whereas trials measuring the effect on BMI found no significant effect (effect size = -0.02; CI = -0.21 to 0.18; I(2) = 0%), but reporting bias may explain this finding. Combined lifestyle interventions (24 trials) led to small changes in BMI.

CONCLUSIONS

Limited evidence supports the short-term efficacy of medications and lifestyle interventions. The long-term efficacy and safety of pediatric obesity treatments remain unclear.

Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion

OBJECTIVE

Our objective was to formulate practice guidelines for the treatment and prevention of pediatric obesity.

CONCLUSIONS

We recommend defining overweight as body mass index (BMI) in at least the 85th percentile but < the 95th percentile and obesity as BMI in at least the 95th percentile against routine endocrine studies unless the height velocity is attenuated or inappropriate for the family background or stage of puberty; referring patients to a geneticist if there is evidence of a genetic syndrome; evaluating for obesity-associated comorbidities in children with BMI in at least the 85th percentile; and prescribing and supporting intensive lifestyle (dietary, physical activity, and behavioral) modification as the prerequisite for any treatment. We suggest that pharmacotherapy (in combination with lifestyle modification) be considered in: 1) obese children only after failure of a formal program of intensive lifestyle modification; and 2) overweight children only if severe comorbidities persist despite intensive lifestyle modification, particularly in children with a strong family history of type 2 diabetes or premature cardiovascular disease. Pharmacotherapy should be provided only by clinicians who are experienced in the use of antiobesity agents and aware of the potential for adverse reactions. We suggest bariatric surgery for adolescents with BMI above 50 kg/m(2), or BMI above 40 kg/m(2) with severe comorbidities in whom lifestyle modifications and/or pharmacotherapy have failed. Candidates for surgery and their families must be psychologically stable and capable of adhering to lifestyle modifications. Access to experienced surgeons and sophisticated multidisciplinary teams who assess the benefits and risks of surgery is obligatory. We emphasize the prevention of obesity by recommending breast-feeding of infants for at least 6 months and advocating that schools provide for 60 min of moderate to vigorous daily exercise in all grades. We suggest that clinicians educate children and parents through anticipatory guidance about healthy dietary and activity habits, and we advocate for restricting the availability of unhealthy food choices in schools, policies to ban advertising unhealthy food choices to children, and community redesign to maximize opportunities for safe walking and bike riding to school, athletic activities, and neighborhood shopping.

Metabolic syndrome among prepubertal Brazilian schoolchildren

This was a two-stage cross-sectional study that assessed metabolic syndrome and associated factors among prepubertal schoolchildren. In the first stage, nutritional status, blood pressure, personal (low birth weight) and family antecedents for cardiovascular disease (CVD) were collected. In the second stage, schoolchildren with at least one of these criteria participated: obesity, personal or family history. Metabolic syndrome (MS) was defined by ATP III and WHO definitions. Among 929 (6-10 year old) schoolchildren, 27.7% presented with overweight/obesity, 12.2% hypertension, and personal (9.4%) and family (35.3%) antecedents. 205 children finished the second stage. The frequencies of MS-ATP and MS-WHO were 9.3% and 1.9%. Among the obese, MS was present in 25.8% (ATP) and 5.2% (WHO). Children with normal weight presented: low HDL (23.6%), hyperglycaemia (3.6%), HOMA-IR (0.9%) and MS-ATP (0.9%). In conclusion, overweight/obesity was associated with metabolic syndrome in schoolchildren. It was found that children with normal weight with personal and/or family antecedents presented with HOMA-IR and MS-ATP.

Childhood obesity: concept, feasibility, and interim results of a local group-based, long-term treatment program

OBJECTIVE

The authors performed a group-based program for obese children and adolescents in Bavaria, Germany to enable them to establish a health-oriented lifestyle and to reduce overweight. The authors compared this program with a control approach based on the patients' own initiative.

DESIGN

This is a controlled clinical trial.

SETTING

A nutrition program for outpatients in a German university hospital.

PARTICIPANTS

Seventy-three obese patients aged 7 to 15 years (mean 11.2 years) were recruited by pediatricians and local newspaper reports and randomized into intervention and control groups. Children and adolescents in each group were divided into 3 groups according to age--7-8 years, 9-10 years, and 11-13 years. Children were classified overweight (defined as body mass index (BMI) > 90th percentile for age and gender), obese (BMI > 97th percentile), and extremely obese (BMI > 99.5th percentile), according to the European Childhood Obesity Group and the German Working Group on Pediatric Obesity, congruent with adult standards used to assess overweight and obesity.

INTERVENTION

Thirty-seven patients (age 7-13 years, mean 10.9 years) for the 1-year intervention. This intervention consisted of modules for physical activity, nutritional education, and coping strategies. The program was performed twice each week and incorporated parental participation and medical supervision, including laboratory tests. The obese controls (n = 36, age 8-15 years, mean 11.6 years) received written therapeutic advice during a visit at 0 and 6 months in the outpatient clinic.

MAIN OUTCOME MEASURE

The primary outcome variable was the body mass index (BMI) z score.

ANALYSIS

Analysis of variance and t test were used, and a P value < .05 was considered significant.

RESULTS

There was a reduction of BMI z score in the active treatment group (P < .05), but not for controls. Moreover, the active group showed beneficial effects for body mass index (BMI), fat mass, and systolic blood pressure 12 months after beginning the intervention.

CONCLUSIONS AND IMPLICATIONS

Group-based programs for young, obese patients can be effective tools for establishing a health-oriented lifestyle and reducing the burden of obesity.

Perspectives on pediatric bariatric surgery: identifying barriers to referral

BACKGROUND

Pediatric obesity is a growing problem affecting the health of our youth. We sought to identify the barriers to pediatric bariatric referral at a tertiary referral center.

METHODS

We performed a survey of pediatricians and family practitioners at a single institution to assess their perspectives on pediatric obesity.

RESULTS

A total of 61 physicians completed the survey (response rate 46%). All believed pediatric obesity is a major problem, and 82.0% noted an increase in the incidence during a mean period of 15 years (range 3-25). Of the 61 physicians, 88.5% used nonoperative weight loss techniques, with only 1.8% reporting satisfactory results. However, 42.6% had referred a patient (adult or pediatric) for a bariatric procedure, of whom 84.6% were satisfied with the operative outcomes. Despite the high satisfaction with bariatric procedures, 88.5% would be unlikely or would never refer a child for a bariatric procedure, and 44.3% would be somewhat or very likely to refer an adolescent.

CONCLUSION

Physicians caring for children recognize the growing problem of childhood and adolescent obesity. Despite the poor outcomes with nonoperative methods and the high satisfaction with the outcomes of bariatric procedures, physicians are still reluctant to refer children and adolescents for surgical weight loss procedures.

Pediatric overweight or obesity: does the label really matter?

PURPOSE

To discuss the issue of early identification of overweight and obesity in infants and young children and provide some clinical recommendations based on the current evidence and the World Health Organization's (WHO) newly released guidelines for growth and development.

DATA SOURCES

Comparison of the growth charts from the WHO and the Centers for Disease Control as well as current literature.

CONCLUSIONS

Although healthcare providers and the general public recognize overweight and obesity as serious problems, there is still disagreement on what constitutes obesity in infants and young children and when and how to intervene. More research on interventions and outcomes is particularly needed.

IMPLICATIONS FOR PRACTICE

The primary care provider deals with the sequelae of obesity on a daily basis. Some recommendations are provided for nurse practitioners who care for infants and children based on current evidence and expert opinion.

A review of adolescent obesity: prevalence, etiology, and treatment

Much of adult obesity has its roots in childhood. One of the tragedies of the current obesity epidemic is the significant and increasing prevalence of obesity in the young. One principal predictor of adult obesity is childhood obesity. We describe here the classification, epidemiology, causality, comorbidities, and treatment of adolescent obesity, both pharmacologic and surgical.

Developmental origins of disease and determinants of chromatin structure: maternal diet modifies the primate fetal epigenome

Chromatin structure is epigenetically altered via covalent modifications of histones to allow for heritable gene regulation without altering the nucleotide sequence. Multiple lines of evidence from rodents have established a role for epigenetic remodeling in regulating gene transcription in response to an altered gestational milieu. However, to date, it is unknown whether variations in the intrauterine environment in primates similarly induce changes in key determinants of hepatic chromatin structure. We hypothesized that a maternal high-fat diet would alter the epigenomic profile of the developing offspring, which would result in alterations in fetal gene expression. Age- and weight-matched adult female Japanese macaques were placed on control (13% fat) or high-fat (35% fat) breeder diets and mated annually over a 4-year interval. Fetuses in successive years were delivered near term (e130 of 167 days) and underwent necropsy with tissue harvest. Fetal histones were acid extracted for characterization of H3 modification and chromatin immunoprecipitation (ChIP) with differential display PCR; fetal RNA, DNA, and cytoplasmic and nuclear protein extracts were similarly extracted for comparison. Chronic consumption of a maternal high-fat diet results in a threefold increase in fetal liver triglycerides and histologic correlates of non-alcoholic fatty liver disease. These gross changes in the fetal liver are accompanied by a statistically significant hyperacetylation of fetal hepatic tissue at H3K14 (199.85+/-9.64 vs 88.8+/-45.4; P=0.038) with a trend towards the increased acetylation at H3K9 (140.9+/-38.7 vs 46.6+/-6.53; P=0.097) and at H3K18 (69.0+/-3.54 vs 58.0+/-4.04; P=0.096). However, epigenetic modifications on fetal hepatic H3 associated with gene repression were absent or subtle (P>0.05). Subsequent characterization of key epigenetic determinants associated with H3 acetylation marks revealed similar significant alterations in association with a high-fat maternal diet (e.g., relative fetal histone deacetylase 1 (HDAC1) gene expression 0.61+/-0.25; P=0.011). Consistent with our mRNA expression profile, fetal nuclear extracts from offspring of high-fat diet animals were observed to be significantly relatively deplete of HDAC1 protein (36.07+/-6.73 vs 83.18+/-7.51; P=0.006) and in vitro HDAC functional activity (0.252+/-0.03 vs 0.698+/-0.02; P<0.001). We employ these observations in ChIP differential display PCR to attempt to identify potential fetal genes whose expression is reprogramed under conditions of a high-fat maternal diet. We quantitatively confirm a minimum of a 40% alteration in the expression of several genes of interest: glutamic pyruvate transaminase (alanine aminotransferase) 2 (GPT2) (1.59+/-0.23-fold; P=0.08), DNAJA2 (1.36+/-0.21; P=0.09), and Rdh12 (1.88+/-0.15; P=0.01) are appreciably increased in fetal hepatic tissue from maternal caloric-dense diet animals when compared with control while Npas2, a peripheral circadian regulator, was significantly downmodulated in the offspring of high-fat diet animals (0.66+/-0.08; P=0.03). In this study, we show that a current significant in utero exposure (caloric-dense high-fat maternal diet) induces site-specific alterations in fetal hepatic H3 acetylation. Employing ChIP, we extend these observations to link modifications of H3 acetylation with alterations in gene-specific expression. These results suggest that a caloric-dense maternal diet leading to obesity epigenetically alters fetal chromatin structure in primates via covalent modifications of histones and hence lends a molecular basis to the fetal origins of adult disease hypothesis.

Cardiovascular risk factors and the metabolic syndrome in pediatric nonalcoholic fatty liver disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD), the most common cause of liver disease in children, is associated with obesity and insulin resistance. However, the relationship between NAFLD and cardiovascular risk factors in children is not fully understood. The objective of this study was to determine the association between NAFLD and the presence of metabolic syndrome in overweight and obese children.

METHODS AND RESULTS

This case-control study of 150 overweight children with biopsy-proven NAFLD and 150 overweight children without NAFLD compared rates of metabolic syndrome using Adult Treatment Panel III criteria. Cases and controls were well matched in age, sex, and severity of obesity. Children with NAFLD had significantly higher fasting glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, triglycerides, systolic blood pressure, and diastolic blood pressure than overweight and obese children without NAFLD. Subjects with NAFLD also had significantly lower high-density lipoprotein cholesterol than controls. After adjustment for age, sex, race, ethnicity, body mass index, and hyperinsulinemia, children with metabolic syndrome had 5.0 (95% confidence interval, 2.6 to 9.7) times the odds of having NAFLD as overweight and obese children without metabolic syndrome.

CONCLUSIONS

NAFLD in overweight and obese children is strongly associated with multiple cardiovascular risk factors. The identification of NAFLD in a child should prompt global counseling to address nutrition, physical activity, and avoidance of smoking to prevent the development of cardiovascular disease and type 2 diabetes.