Prevalence and correlates of obesity in preschool children

Birth History and Cardiovascular Disease Risk Among Youth With Significant Obesity

Children born prematurely have greater lifetime risk for hypertension. We aimed to determine (1) the association between prematurity and cardiovascular disease (CVD) risk factors among 90 children with obesity and elevated blood pressure and (2) if dietary sodium intake modified these associations. Multivariable regression analysis explored for associations between prematurity (<37 weeks gestation; early gestational age) and low birth weight (<2.5 kg) with hypertension, left ventricular mass index (LVMI), and left ventricular hypertrophy (LVH). Effect modification by dietary sodium intake was also explored. Patients were predominately male (60%), black (78%), adolescents (13.3 years), and with substantial obesity (body mass index: 36.5 kg/m2). Early gestational age/low birth weight was not an independent predictor for hypertension, LVMI, or LVH. There was no effect modification by sodium load. Our results suggest the increased CVD risk conferred by prematurity is less significant at certain cardiometabolic profiles. Promoting heart-healthy lifestyles to prevent pediatric obesity remains of utmost importance to foster cardiovascular health.

Targeting Parenting Quality to Reduce Early Life Adversity Impacts on Lifespan Cardiometabolic Risk

Mounting evidence that early life adversity (ELA) exposures confer risk for cardiometabolic disease over the lifespan motivated this narrative review to examine parenting quality as a potential intervention target to reduce ELA exposures or mitigate their impact as a way of reducing or preventing cardiometabolic disease. We describe findings from the limited number of family-based intervention studies in ELA-exposed children that have tested parenting impacts on cardiometabolic health outcomes. We then describe the implications of this work and make recommendations for future research that will move this field forward.

Changes in body mass index associated with head start participation

OBJECTIVES

The goal of this study was to determine if Head Start participation is associated with healthy changes in BMI.

METHODS

The sample included children participating in Head Start between 2005 and 2013 and children from 2 comparison groups drawn from a Michigan primary care health system: 5405 receiving Medicaid and 19,320 not receiving Medicaid. Change in BMI z score from the beginning to the end of each of 2 academic years and the intervening summer was compared between groups by using piecewise linear mixed models adjusted for age, gender, and race/ethnicity.

RESULTS

The total sample included 43,748 children providing 83,239 anthropometric measures. The Head Start sample was 64.9% white, 10.8% black, and 14.4% Hispanic; 16.8% of the children were obese and 16.6% were overweight at the initial observation. Children who entered Head Start as obese exhibited a greater decline in the BMI z score during the first academic year versus the comparison groups (β = -0.70 [SE: 0.05] vs -0.07 [0.08] in the Medicaid group [P < .001] and -0.15 [SE: 0.05] in the Not Medicaid group [P < .001]); patterns were similar for overweight children. Head Start participants were less obese, less overweight, and less underweight at follow-up than children in the comparison groups.

CONCLUSIONS

Preschool-aged children with an unhealthy weight status who participated in Head Start had a significantly healthier BMI by kindergarten entry age than comparison children in a primary care health system (both those receiving and those not receiving Medicaid).

Correlates of adiposity in a Caribbean pre-school population

OBJECTIVE

To evaluate ethnic and anthropometric correlates of adiposity among a nationally representative, multi-ethnic, Trinidadian pre-school population.

DESIGN

Cross-sectional study conducted between June 2008 and July 2009.

SETTING

Government and privately owned Early Childhood Care and Education Centres in Trinidad.

SUBJECTS

A total of 596 pre-school children (aged 31-73 months) from thirty-four schools had their weight, height, mid-upper arm circumference, waist circumference, biceps and triceps skinfold thicknesses measured by a registered dietitian using standard procedures. Percentage body fat was estimated using a foot-to-foot bioelectric impedance analyser (Tanita 531, Tokyo, Japan). Date of birth, religion and ethnicity were extracted from school records and pre-schoolers' ethnicity was categorized as East Indian, African, Mixed (a combination of two or more ethnicities), Chinese or Caucasian.

RESULTS

Anthropometric variables explained significantly more of the variance in adiposity among girls (67·4-88·1 %) than boys (24·4-39·2 %; P < 0·0 0 1). Pre-schoolers of African descent were significantly taller, heavier and had higher abdominal fat and mid-upper arm circumference than their East Indian and Mixed counterparts (all P < 0·001). The overall prevalence of excess adiposity (≥25 % body fat) as determined by bioelectrical impedance was 14·6 %, while 2·9 % of the children were undernourished according to WHO weight-for-age criteria. Differences in anthropometry were non-existent between children attending government and private pre-schools.

CONCLUSIONS

Gender, ethnicity and anthropometry all explained excess adiposity in these pre-schoolers. These findings highlight the need to elucidate the mechanisms that may be involved in explaining these differences, particularly those of ethnic origin.

Cardiovascular disease risk factors are elevated in urban minority children enrolled in head start

BACKGROUND

The prevalence of obesity and overweight persists in the preschool population, despite some prevention and treatment advances, particularly in minorities. Investigating the prevalence of dyslipidemia and the effect of family health may also guide the focus of intervention efforts.

METHODS

Anthropometric data were collected from urban minority preschool children (n=161; 42% female) enrolled in USDA Head Start. Blood was collected by finger prick and analyzed with the Cholestech LDX Analyzer (Cholestech Corporation, Hayward, CA). Caregivers provided a self-reported family health history for cardiovascular diseases (CVDs).

RESULTS

By BMI percentile, 8% of the children were underweight (UW), 54% healthy weight (HW), 10% overweight (OW), and 28% obese (OB). One of every 5 children had borderline or high-risk levels for total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides based on the National Cholesterol Education Program categories. In OW/OB children only, BMI was positively correlated with TC (r(61)=0.428; p=0.001) and LDL (r(58)=0.395; p=0.005). Child BMI was also associated with family comorbid diseases (r(159)=0.177; p=0.025). UW/HW children with a family history of CVD had significantly higher LDL than UW/HW children without a family history of CVD (p=0.001). Step-wise regression analysis revealed that BMI (p=0.005) plus family history of heart attack (p=0.018) were significant predictors of blood TC levels.

CONCLUSION

Continued efforts to treat and prevent elevated weight are urgently needed for minority preschoolers. Attention to CVD screening may be an important target in school, community, and healthcare arenas for minority populations regardless of weight status.

Cutaneous manifestations in children with diabetes mellitus and obesity

Obesity and diabetes are chronic diseases that affect people all over the world, and their incidence is increasing in both children and adults. Clinically, they affect a number of organs, including the skin. The cutaneous manifestations caused or aggravated by obesity and diabetes are varied and usually bear some relation to the time that has elapsed since the onset of the disease. They include soft fibromas, acanthosis nigricans, striae, xerosis, keratosis pilaris, plantar hyperkeratosis, fungal and bacterial skin infections, granuloma annulare, necrobiosis lipoidica, psoriasis, and atopic dermatitis. In this review article we present the skin changes found in children with diabetes mellitus and obesity and related syndromes and highlight the importance of the skin as a tool for establishing clinical suspicion and early diagnosis of systemic disease.

Elevated arterial blood pressure and body mass index among Nigerian preschool children population

Background

Arterial blood pressure tends to rise with growth and development. Elevated blood pressure (EBP) in children usually occurs during the first two decades of life, and the children with hypertension tend to grow into adulthood with the high level of blood pressure. The prevalence of hypertension in children is increasing, the causes likely to be of different combination of factors. In this study we ascertained the prevalence of EBP in pre-school children in Enugu metropolis, South-East Nigeria and also determined its association with some factors like the Body Mass Index (BMI), urinalysis finding, family history, gender, age and socioeconomic class.

Method

A Stratified method of sampling was used to select subjects from registered nursery schools (Pre- elementary school) within Enugu metropolis. Physical examination of the recruited pupils was done with emphasis on arterial blood pressure, anthropometric measurements and urinalysis.

Result

Six hundred and thirty children (630) were studied out of which 345 (54.8%) were males and 285 (45.2%) were females. Sustained EBP (mainly systolic) were recorded in 12 pupils (1.9%) giving a prevalence of 1.9% of the pre-school population. The twelve (1.9%) pupils were all 5 years of age (p value = 0.001) and 11 (1.72%) of them were of under-weight BMI. The prevalence of obesity is 0.5% and that of under-weight is 92% of the studied population. There is no association between EBP and obesity (p value = 0.679). All the pupils with EBP had protein-free urine and no hematuria.

Conclusions

EBP and under-weight malnutrition is common in children in 5 years age group. EBP in preschool children is not influenced by their body mass index, urinalysis finding, gender, family history of hypertension or socioeconomic class.

Changes in body mass index z score over the course of the academic year among children attending Head Start

OBJECTIVE

We tested the hypothesis that among 3- to 5-year-old children attending Head Start, body mass index z score will decline during the academic year and increase during the summer.

METHODS

We used retrospective longitudinal growth data collected over 5 academic years from 1914 children (51% boys, 62% white) enrolled in a Michigan Head Start program. Changes in body mass index (BMI) z score, calculated as annual rate of change, during 2 academic years and the intervening summer were assessed by piecewise linear regression analysis. Potential covariates were gender, single-parent status, program year, race/ethnicity, age at initial enrollment, and family income (divided by household size).

RESULTS

Mean BMI z score at the start of Head Start enrollment was 0.52 (95% confidence interval [95% CI] 0.39 to 0.65). Mean annual rates of BMI z score change were: -0.07 (95% CI -0.28 to 0.14) during the first year of enrollment, 0.62 (95% CI -0.0005 to 1.23) over the summer, and -0.82 (95% CI -1.50 to -0.13) during the second year of enrollment. The effect was most robust among girls of minority race/ethnicity.

CONCLUSIONS

Head Start is associated with a shifting of BMI z scores toward the norm among low-income preschool-aged children, particularly among girls of minority race/ethnicity.

Head Start teachers' perceptions of children's eating behavior and weight status in the context of food scarcity

OBJECTIVE

To describe Head Start teachers' perceptions of mealtime, feeding, and overweight risk in Head Start students.

DESIGN

Qualitative focus group study.

SETTING

Five Head Starts in a greater metropolitan area in the Northeast.

PARTICIPANTS

Thirty-five teachers in 5 focus groups.

INTERVENTION

Two experienced focus group facilitators elicited comments from each group.

MAIN OUTCOME MEASURE

Identification of themes for future nutrition education programming.

ANALYSIS

Participant comments were transcribed and common themes identified by 7 readers.

RESULTS

Teachers felt (1) empowered to shape the content of children's diets; (2) that meals served at Head Start were chaotic; (3) uncertain how to address children's voracious appetites, since children often were from homes with limited food resources; (4) skeptical about the definition of overweight; (5) that children's eating behaviors and their weight status were not connected; and (6) uncomfortable addressing overweight with students' families.

CONCLUSIONS AND IMPLICATIONS

Teachers' skepticism about overweight, uncertainty around managing the seemingly voracious eating behavior of children perceived as hungry as a result of inadequate food at home, and discomfort in addressing overweight with families may all represent nutrition education opportunities. Tailoring prevention programs such that they evoke support and agreement from these teachers as well as harnessing strengths, such as teachers' confidence in shaping children's eating behaviors, will be important.

Body Size and Cardiovascular Risk Factors in a Preschool Population

Data on weight, height, blood pressure, and blood lipids were obtained for 1215 children entering New York Head Start preschools from 1995-1997. In this population, 17% were overweight and 15% were obese; the risk was greatest in Hispanic children. Overall, 13% had high blood pressure. African-American children were at increased risk of elevated blood pressure but had a more favorable lipid profile (high high-density lipoprotein cholesterol level and low triglycerides level) than white or Hispanic children. Body size was a significant predictor of elevated blood pressure, low high-density lipoprotein cholesterol, and increased triglycerides. The association between obesity and blood pressure was evident in white and Hispanic children only. Neither ethnicity nor obesity was associated with total cholesterol level. Obese preschoolers had approximately three times the risk of having high systolic blood pressure and twice the risk of low high-density lipoprotein cholesterol level compared with nonobese children, indicating that at-risk populations can be identified and primary prevention begun at a young age.

Child control of food choices in Head Start families

OBJECTIVE

To describe parents' perceived feeding practices of their Head Start children as related to 6 feeding constructs based on the literature about the division of mealtime responsibilities.

DESIGN

A qualitative study involving 45-minute audiotaped and transcribed discussion groups with items that probed constructs of interest.

SETTING

Five discussion groups were conducted in local, urban Head Start sites in a north central state.

PARTICIPANTS

Head Start staff recruited 29 limited-income parents.

PHENOMENA OF INTEREST

Parental comments were coded into categories related to the 6 feeding constructs and perceived barriers to their implementation.

ANALYSIS

Researchers independently coded the discussion group transcripts based on common themes and feeding constructs. Codes were discussed until consensus was reached and data analyzed using Ethnograph 5.0.

RESULTS

Parents frequently reported that their children decided which foods were offered for meals and snacks. Most parents reported such child control of foods to be a barrier to pleasant meal times.

IMPLICATIONS

Nutrition educators can suggest solutions to improve parental self-efficacy for practicing mealtime responsibilities, such as offering a choice of several healthy foods from which a child might choose. The importance of planned meal and snack times might be promoted based on aiding children's appetites at meals and reducing mealtime conflicts.

Childhood obesity and insulin-resistant syndrome

Childhood obesity has become a national concern, health threat, and is increasing at an alarming rate. Obesity is associated with many comorbidities that last into adulthood. Insulin-resistant syndrome (IRS) is developing in growing numbers of obese children. Pediatric nurses play a unique and important role in identifying which children are at risk for obesity and IRS. This article gives current information on what tools to use, how to identify those children, and the interventions needed.

Evaluation of the institutionalization of the coordinated approach to child health (CATCH) in a U.S./Mexico border community

El Paso Coordinated Approach to Child Health (El Paso CATCH) was evaluated in 24 schools for outcome measures of moderate to vigorous physical activity (MVPA) during physical education (PE), content of PE lessons, content of school meals, and numerous process measures. Chi-square analyses compared frequency data across time for activity during PE and percentage fat in school meals. Descriptive summaries were used for process questionnaire results. Data were also compared to CATCH program goals. For most intervention schools, El Paso CATCH significantly increased MVPA, decreased fat in school meals, and decreased sodium in school breakfasts. However, some schools were not meeting the fat content goals for school lunches, and no schools met the vigorous physical activity (VPA) goals for PE or the sodium goals for school lunches.

Preventing pediatric obesity: assessment and management in the primary care setting

PURPOSE

To review the literature on and discuss the role of the primary care provider in assessing and managing overweight children before they become obese.

DATA SOURCES

Selected research, national guidelines and recommendations, and the professional experience of the authors.

CONCLUSIONS

The focus of primary care involves early detection and family interventions that are designed for lifestyle modifications, specifically for improved nutrition and an increase in regular physical activity, to achieve optimal child health. Early identification and management of children who exceed a healthy weight for height, gender, and age will prevent the increasing incidence of pediatric obesity. Early prevention and management of pediatric overweight and obesity will also decrease the potential for associated medical and psychosocial problems.

IMPLICATIONS FOR PRACTICE

Pediatric obesity has risen dramatically in the United States during the last two decades; it is a significant child health problem that is preventable and largely under-diagnosed and under-treated. It is essential to discuss prevention of obesity with parents at every well-child visit; treatment should be initiated when patterns of weight gain exceed established percentiles for increasing height for age and gender.

Prevalence of overweight in a triethnic pediatric population of San Antonio, Texas

OBJECTIVES

To investigate the prevalence of overweight among different ethnic and gender groups of children and adolescents in the San Antonio, Texas, area and to compare the prevalence with that of the US national figures.

DESIGN

Cross-sectional study

SUBJECTS

A total of 7208 schoolchildren in kindergarten through 12th grade. There were 4215 Mexican American (MA) (58.5%), 2040 non-Hispanic white (NHW) (28.3%) and 953 African American (AA) (13.2%) subjects.

MEASUREMENTS

Weight, height and skinfold thicknesses.

RESULTS

The body mass index (BMI, kg/m2) values of MA boys were almost consistently and significantly (P<0.05) larger than NHW boys and showed a tendency to be larger than AA boys, beginning as early as age 6 and continuing through age 17. Although rarely significant, a similar trend in ethnic difference was also noted for girls, with the smallest BMI seen in NHW girls. The subscapular skinfold thickness (SST) for MA boys and girls was significantly (P<0.05) larger than that for NHW counterparts and showed a tendency to be larger than AA counterparts. No significant ethnic differences were present in the triceps skinfold thickness (TST) for girls, but MA boys' TST were occasionally larger (P<0.05) than other ethnic-gender groups. Girls' TST were frequently larger (P<0.05) than boys for each ethnic groups. Using the population data from the National Health and Nutrition Examination Survey (NHANES) I as reference, the prevalence of overweight (BMI> or =95th percentile) was greater in MA (15-28%) and AA (11-29%) boys and girls than in NHW (7-17%) counterparts. The combined prevalence of overweight and 'at risk of overweight' (BMI>85th percentile) was much larger in MA boys (40-50%), MA girls (34-52%), and AA girls (33-51%) than other subgroups. The onset of overweight is quite early, starting at 5-6 y of age, especially in girls. Compared to the data from national surveys, the prevalence of overweight found in this study is higher than reported nationally. We found a marked increase in the skinfold thickness, especially SST for boys, but the increase is less for girls.

CONCLUSIONS

The prevalence of overweight is higher in MA boys and girls and AA girls than other ethnic-gender groups in the San Antonio, Texas, area. The prevalence of childhood overweight in the San Antonio area is higher than national figures. The findings of increasing prevalence and early onset of childhood overweight are concerning, because these are known risk factors for diabetes and diseases of many other organ systems. Measures to prevent, reduce or treat childhood obesity are urgently needed.

Risk factors of obesity in preschool children in China: a population-based case--control study

OBJECTIVE

To identify the risk factors of obesity in preschool children in China.

DESIGN

A nationwide case-control study in eight cities in China.

SUBJECTS

A total of 748 boys and 574 girls (age 0.1 - 6.9 y), including the obese and non-obese. One obese child was matched with one non-obese child by sex and age.

MEASUREMENTS

Weight, height and other measurements were taken for all the subjects. The information on child activity, feeding pattern and family background was collected by our study team from the parents and the kindergarten teacher.

RESULTS

Birth weight > or =4.0 kg, high eating speed, obesity among the child's relatives > or =25%, mother's body mass index (BMI) > 25 kg/m2 and father's BMI > 25 kg/m2 were identified as the major significant (P < 0.05) risk factors of obesity in preschool children in China.

CONCLUSION

Family history of obesity, high birth weight and eating speed were identified as the risk factors of obesity in preschool children in China. Our results show the need for family therapy as part of an intervention program for childhood obesity, which includes behavior modification.

Parental risk factors for infant obesity

PURPOSE

To facilitate an understanding of the influence of parental characteristics on the development of infant obesity.

DESIGN

Conducted in collaboration with a NIH-funded study of infant growth, this study employed a longitudinal prospective design.

METHODS

Anthropometric measures were obtained monthly and home visits were conducted five times through 15 months of age. The sample was 630 infants and their families. Information about parental characteristics was obtained from the Demographic and Perinatal Data Questionnaire, developed by the investigators of the NIH study. The modified version of Holmes and Rahe Recent Life Change Questionnaire was used to assess family stress.

RESULTS

Parental characteristics predictive of obesity varied across age, and included the maternal variables of weight, weight gain, age, and smoking. Father's presence in the home, parental education, marital status, and socioeconomic status were not significant.

CLINICAL IMPLICATIONS

The findings in this research contribute insights into parental risk factors for early obesity. Recommendations include eliminating prenatal smoking and controlling prepregnancy weight and pregnancy weight gain.

Blood pressure is associated with body mass index in both normal and obese children

Obesity is associated with elevated blood pressure (BP) both in adults and children. Childhood obesity has become a severe health problem, especially during the last few decades. So far there has not been any large-scale study specifically focusing on the association between obesity and BP in early life. The aim of this study is to examine systematically the association between obesity and BP in preschool Chinese children in mainland China. In 1996, measurements of weight, height, and BP values were collected in a nationwide, case-control study of 748 boys and 574 girls who ranged in age from 0.1 to 6.9 years in 8 cities in mainland China. One obese child and 1 nonobese child were matched for gender and age. The BP differences of the mean-matched pair were approximately 5 mm Hg for systolic blood pressure (SBP) and approximately 4 mm Hg for diastolic blood pressure (DBP) (P<0.05); a higher value was noted in obese children. The BP value of 19.4% children in the obese group and 7.0% children in the nonobese group was higher than the 95th percentile value (P<0.0001), which is defined as high BP by the Task Force on Blood Pressure Control in Children. Both SBP and DBP were significantly (P<0.05) positively related to body mass index (BMI) values (P<0.05) for children in obese and nonobese groups after adjustment for age, gender, and height. To be specific, an increase of 1 BMI unit was associated with, on average, an increase of 0.56 mm Hg and 0.54 mm Hg in SBP and DBP, respectively, for obese children. In nonobese children, the increase in SBP and DBP was 1.22 mm Hg and 1.20 mm Hg, respectively. An increase in the BMI is conclusively associated with elevated SBP and DBP in nonobese children. Furthermore, an increase in the adjusted BMI was associated with an increase in SBP and DBP in obese and nonobese children.