Critical value for the index of body fat distribution based on waist and hip circumferences and stature in obese girls

Dislipidemia familiar e fatores associados a alterações no perfil lipídico em crianças

Resumo O objetivo deste artigo é avaliar a prevalência de dislipidemia e os fatores associados em crianças de 4 a 7 anos de idade. Estudo transversal, realizado com 402 crianças de 4 a 7 anos de idade, acompanhadas por um Programa de Apoio a Lactação nos primeiros seis meses de vida. Foram dosados colesterol total, triglicerídeos e lipoproteínas de alta (HDL) e baixa densidades (LDL). Selecionou-se variáveis que poderiam estar associadas ao perfil lipídico, como o histórico familiar de dislipidemia, estado nutricional e o consumo alimentar das crianças. Realizou-se análise de Regressão de Poisson com variância robusta. O nível de significância adotado foi de p < 0,05. Observou-se valores aumentados da LDL em 46,8% (188), colesterol total em 37,6% (151), triglicerídeos em 10,4% (42) e HDL abaixo do desejável em 33,8% (136) das crianças. Houve associação estatisticamente significativa entre o histórico familiar de dislipidemia com colesterol total, LDL e triglicerídeos (p < 0,05 e p < 0,001, respectivamente); Desmame precoce com LDL (p < 0,05); Sedentarismo com LDL e triglicerídeos (p < 0,05 e p < 0,001, respectivamente); bem como HDL com o consumo de bala (p < 0,05). Houve importante prevalência de alterações no perfil lipídico das crianças. São necessárias atividades de educação nutricional e programas voltados para esse grupo.

Body frame size in school children is related to the amount of adipose tissue in different depots but not to adipose distribution

OBJECTIVES

The main aim of this study was to test the hypothesis that body frame size is related to the amount of fat in different adipose tissue depots and to fat distribution in schoolchildren.

METHODS

Children aged between 5 and 10 years were included in this cross-sectional study (n = 565). Body frame size, adiposity markers (anthropometric, skinfolds thickness, and ultrasound measures), and fat distribution indices were analyzed. Correlation coefficients adjusted by reliability were estimated and analyzed by sex; the significance of the difference between two correlation coefficients was assessed using the Fisher z-transformation.

RESULTS

The sample included primarily urban children; 58.6% were normal weight, 16.1% overweight, 19.6% obese, and the rest were underweight. Markers of subcutaneous adiposity, fat mass and fat-free mass, and preperitoneal adiposity showed higher and significant correlations with the sum of the biacromial + bitrochanteric diameter than with the elbow diameter, regardless of sex. The fat distribution conicity index presented significant but weak correlations; and visceral adipose tissue, hepatic steatosis, and the waist-for-hip ratio were not significantly correlated with body frame size measures.

CONCLUSIONS

Body frame size in school children was related to the amount of adipose tissue in different depots, but not adipose distribution. More studies are needed to confirm this relationship and its importance to predict changes in visceral fat deposition during growth.

Systematic review to identify and appraise outcome measures used to evaluate childhood obesity treatment interventions (CoOR): evidence of purpose, application, validity, reliability and sensitivity

BACKGROUND

Lack of uniformity in outcome measures used in evaluations of childhood obesity treatment interventions can impede the ability to assess effectiveness and limits comparisons across trials.

OBJECTIVE

To identify and appraise outcome measures to produce a framework of recommended measures for use in evaluations of childhood obesity treatment interventions.

DATA SOURCES

Eleven electronic databases were searched between August and December 2011, including MEDLINE; MEDLINE In-Process and Other Non-Indexed Citations; EMBASE; PsycINFO; Health Management Information Consortium (HMIC); Allied and Complementary Medicine Database (AMED); Global Health, Maternity and Infant Care (all Ovid); Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); Science Citation Index (SCI) [Web of Science (WoS)]; and The Cochrane Library (Wiley) - from the date of inception, with no language restrictions. This was supported by review of relevant grey literature and trial databases.

REVIEW METHODS

Two searches were conducted to identify (1) outcome measures and corresponding citations used in published childhood obesity treatment evaluations and (2) manuscripts describing the development and/or evaluation of the outcome measures used in the childhood intervention obesity evaluations. Search 1 search strategy (review of trials) was modelled on elements of a review by Luttikhuis et al. (Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009;1:CD001872). Search 2 strategy (methodology papers) was built on Terwee et al.'s search filter (Terwee CB, Jansma EP, Riphagen II, de Vet HCW. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res 2009;18:1115-23). Eligible papers were appraised for quality initially by the internal project team. This was followed by an external appraisal by expert collaborators in order to agree which outcome measures should be recommended for the Childhood obesity Outcomes Review (CoOR) outcome measures framework.

RESULTS

Three hundred and seventy-nine manuscripts describing 180 outcome measures met eligibility criteria. Appraisal of these resulted in the recommendation of 36 measures for the CoOR outcome measures framework. Recommended primary outcome measures were body mass index (BMI) and dual-energy X-ray absorptiometry (DXA). Experts did not advocate any self-reported measures where objective measurement was possible (e.g. physical activity). Physiological outcomes hold potential to be primary outcomes, as they are indicators of cardiovascular health, but without evidence of what constitutes a minimally importance difference they have remained as secondary outcomes (although the corresponding lack of evidence for BMI and DXA is acknowledged). No preference-based quality-of-life measures were identified that would enable economic evaluation via calculation of quality-adjusted life-years. Few measures reported evaluating responsiveness.

LIMITATIONS

Proposed recommended measures are fit for use as outcome measures within studies that evaluate childhood obesity treatment evaluations specifically. These may or may not be suitable for other study designs, and some excluded measures may be more suitable in other study designs.

CONCLUSIONS

The CoOR outcome measures framework provides clear guidance of recommended primary and secondary outcome measures. This will enhance comparability between treatment evaluations and ensure that appropriate measures are being used. Where possible, future work should focus on modification and evaluation of existing measures rather than development of tools de nova. In addition, it is recommended that a similar outcome measures framework is produced to support evaluation of adult obesity programmes.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Self-reported waist circumference: a screening tool for classifying children with overweight/obesity and cardiometabolic risk factor clustering

OBJECTIVES

The objectives of this study were twofold - (i) to assess the agreement between self-reported waist circumference (SRWC) and assessor measured waist circumference (MWC) and (ii) to evaluate the diagnostic ability of SRWC for classifying (i) a clustering of cardiometabolic risk factors (CMRFs) and (ii) overweight/obese status in Hong Kong Chinese children aged 6-18 years.

METHODS

A cross-sectional study with cluster random sampling was conducted. A self-administrated questionnaire, which included demographic data, body weight, body height and waist circumference, was given to children to bring home for completion. Children were asked to return the questionnaire and fast themselves for at least 8 h on the day of the survey. Anthropometric measurements and blood pressure were taken by trained research staff and fasting blood samples were collected for measurements of fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol.

RESULTS

A total of 515 boys and 711 girls were included in the data analysis. Agreement between SRWC and MWC was assessed by intra-class correlation coefficient and it ranged from 0.77 to 0.87. The ability of sex-specific SRWC values to classify children with a clustering of CMRFs and overweight/obesity exhibited moderately high to high sensitivity and specificity, and the area under the receiver operating characteristics ranged from acceptable to excellent (from 0.76 to 0.84).

CONCLUSIONS

SRWC has good agreement with MWC and could be used as a screening tool to classify children with a clustering of CMRFs and overweight/obesity status in Hong Kong Chinese children.

Waist circumference percentiles for Portuguese children and adolescents aged 10 to 18 years

The purposes of this study were to develop age- and sex-specific waist circumference reference data for Portuguese children and adolescents aged 10-18 years and to compare them with those from other countries. This was a school-based study performed in Portugal. A total of 22,003 children and adolescents aged 10-18 years were included in the study. Smoothed sex- and age-specific 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentile curves of waist circumference were estimated using Cole's lambda-mu-sigma method. Waist circumference values increased with age in both boys and girls, and boys had higher values than girls at every age and percentile. In both sexes, the Portuguese values in the 90th percentile were closer to the Bolivian values and considerably lower than those of the American children for all age groups.

CONCLUSION

The data presented provide information for abdominal risk assessment and clinical and lifestyle intervention; our results also provide useful baseline data information for the implementation of a surveillance system required to monitor trends and factors associated with abdominal obesity in children and adolescents.

Use of body mass index and percentage overweight cutoffs to screen Japanese children and adolescents for obesity-related risk factors

BACKGROUND

Cutoffs based on percentage overweight (POW) are used for screening students in Japan; however, body mass index (BMI) is more common in the rest of the world. To screen for risk factors related to obesity among Japanese primary and secondary school students, we compared fasting and postprandial values, and the receiver operating characteristic (ROC) curves for the POW and BMI criteria.

METHODS

The subjects were students aged 10 and 13 years living in Shunan City, Japan between 2006 and 2008 (n = 6566). POW and International Obesity Taskforce (IOTF) BMI criteria were used to screen for obesity-related risk factors. The lower (20%, 18-year-old equivalent: 25 kg/m(2)) and higher (50%, 18-year-old equivalent: 30 kg/m(2)) cutoffs were examined, and ROC curves were drawn.

RESULTS

Fasting cholesterol levels were higher than postprandial levels. The prevalences of overweight/obesity were 6.6% to 10.0% using the lower cutoff and 0.6% to 5.0% using the higher cutoff. Among overweight subjects under fasting conditions, dyslipidemia was present in 12% to 52%, hypertriglyceridemia in 29% to 54%, hyperglycemia in 11% to 21%, and hypertension in 15% to 40%. Although the use of the lower and higher POW cutoffs resulted in lower sensitivity and the higher specificity, the POW and BMI ROC curves largely overlapped. However, for girls aged 10 years, the POW curve for >or=3 risks factors was lower than that of the latter (P = 0.013).

CONCLUSIONS

For Japanese aged 10 and 13 years, both BMI and POW are useful for risk factor screening. However, subjects may be misclassified with dyscholesterolemia if postprandial blood samples are used.

Usefulness of an age-adjusted body shape index in Korean children and adolescents

BACKGROUND

The aim of the present paper was to determine the usefulness of an age-adjusted anthropometric index of body shape for the assessment of obesity in Korean children and adolescents aged 10-15 years.

METHODS

The population sample was composed of 556 boys and 489 girls who completed an interview survey, anthropometry, and medical examination for the Korean National Health and Nutritional Survey conducted in 1998. An age-adjusted anthropometric index, body shape index standard deviation score (BSI-SDS), was derived from waist-to-hip ratio divided by height (WHR/Ht) and its common standard deviation according to Asayama et al. (1997). Serum levels of lipids, glucose, and liver function markers were defined as abnormal if they were above the 90th percentile of the study population. Using logistic regression analysis, the odds ratios of having a lipidemic, diabetic, or liver complication on increasing BSI-SDS were estimated.

RESULTS

For both boys and girls, lipidemic and liver complications had statistically significant odds ratios associated with increasing BSI-SDS. With 1 unit increase in BSI-SDS, the odds ratios of lipidemic complications were 1.5 and 1.3, respectively, for boys and girls, and the odds ratios of liver complications were 1.3 and 1.4, respectively, for boys and girls.

CONCLUSIONS

A new measure developed by Asayama et al., BSI-SDS, is a useful marker of obesity in addition to body mass index among Korean children and adolescents aged 10-15 years.

Association of anthropometric indices with cardiovascular disease risk factors among children and adolescents: CASPIAN Study

BACKGROUND

For the first time in Iran, and to the best of our knowledge in Asia, we assessed the anthropometric indices most closely correlated to cardiovascular disease (CVD) risk factors in a large nationally representative sample of children and adolescents to be used as a simple tool for identifying those at risk.

METHODS

This multi-center study was performed among a representative sample of 4811 school students (2248 boys and 2563 girls) aged 6-18 years, as part of the baseline survey of a national surveillance system. Anthropometric indices and CVD risk factors were measured using standard protocols, and their correlation was analyzed by using Receiver Operator Characteristic (ROC) curves and partial correlation.

RESULTS

The most prevalent CVD risk factors were low HDL-C (28%), followed by hypertriglyceridemia (20.1%), and overweight (17%). The ROC analyses showed that among boys, all anthropometric indices had the same association with CVD risk factors in 6-9.9-year-age group, while in the 10-13.9 and 14-18-year-age groups, respectively waist circumference (WC) and body mass index (BMI) were the best in distinguishing CVD risk factors. Among girls, these indices were respectively BMI and waist to stature ratio (WSR); WC and WSR; and WC. In the partial correlation analysis, in boys, the highest coefficient was found for BMI; BMI and WC; and for WC and WSR; in girls, these indices were BMI; WC and WSR; and BMI respectively.

CONCLUSIONS

In the present study, BMI, WC and WSR were the most appropriate in predicting CVD risk factors. It may be clinically useful in the pediatric population to routinely measure WC and WSR in addition to BMI as a screening tool to identify high-risk youth.

Association between stunting and overweight among 10-15-y-old children in the North West Province of South Africa: the THUSA BANA Study

OBJECTIVE

To investigate the relationship between stunting and overweight among 10-15-y-old children of the North West Province in South Africa.

DESIGN

A single cross-sectional study design was used. The study formed part of the THUSA BANA project.

SUBJECTS

The total study population of the THUSA BANA project comprised of 1257 randomly selected subjects, aged 10-15 y.

MEASUREMENTS

Stunting was described as the height below the 5th percentile for age using the CDC standard percentiles. Furthermore, the definitions of overweight and obesity according to the International Obesity Task Force (IOTF) were used, where the cutoff points for body mass index (BMI) corresponds with the adult BMI of 25 and 30, respectively. Anthropometrical variables namely triceps (TSF) and subscapular skinfolds (SSF), waist circumference, weight, height and BMI of the 10-15-y-old subjects were analysed.

RESULTS

Stunting was most prevalent in the rural areas (girls 23.7% and boys 26.7%) compared with urban areas (girls 11.6%, boys 17.1%). The odds ratio and the 95% CI for the association between stunting and overweight in boys and girls were 0.45 (CI 0.16, 1.30) and 0.50 (CI 0.21, 1.19) respectively. Stunted children, 10-14-y-old and living in rural areas and informal settlements, had significantly lower mean BMI and skinfold thicknesses than nonstunted children. The mean BMI and sum of TSF and SSF (TSF+SSF) were similar in stunted and nonstunted children living in urban areas.

CONCLUSION

There is no significant association between stunting and overweight in 10-15-y-old children in the North West Province. However, there is a tendency for girls older than 14 y to start to gain subcutaneous fat, even though at these ages they were still stunted and underweight. Stunted girls in established urban areas had a higher mean TSF+SSF than stunted girls in informal townships. This tendency in urban stunted girls is evident at the onset of menarche and could predict possible problems of overweight as they get older.

Comparison of anthropometric parameters as predictors of serum lipids in premenopausal women

No single anthropometric parameter has yet been generally accepted as being superior to others in assessing the metabolic risk associated with abdominal obesity. To compare waist circumference (WC) with waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), regarding their association with serum lipids, we studied 166 women aged 20 to 48 yr; 53 were obese [body mass index (BMI) 30-39.9 Kg/m2], 50 were overweight (BMI 25-29.9 Kg/m2) and 63 normal weight (BMI 18.5-24.9 Kg/m2). Height, body weight, waist and hip circumferences, total serum cholesterol (Ch), low (LDL) and high density lipoprotein (HDL)-Ch and triglyceride (TG) concentrations were measured. The correlation coefficients between the concentration of serum lipid fractions and each anthropometric parameter did not differ significantly for any lipid variable when WC, WHR and WHtR were compared in the 166 women. The same applied for the obese and the overweight group, whereas in normal weight women there was significant association only between WC and LDL-Ch and between WHR and Ch/HDL-Ch ratio. Stepwise regression analysis showed that the proportion of variance in serum lipids did not change significantly when WHR or WHR+WHtR were added to WC into the regression model (18%, 18% and 18% for Ch; 13%, 18% and 18% for HDL-Ch; 18%, 18% and 12% for LDL-Ch; 35%, 35% and 37% for TG, respectively). These results indicate that WC is the main parameter associated with serum lipid levels and that the ratios studied do not provide additional substantial information in women who need weight management.

Increased serum cholesteryl ester transfer protein in obese children

OBJECTIVE

To determine whether serum cholesteryl ester transfer protein (CETP), which is one of the physiologically active gene products secreted from adipose tissue, is increased and associated with atherogenic lipoprotein profile in obese children.

RESEARCH METHODS AND PROCEDURES

Subjects were 42 consecutive outpatient Japanese obese children, 29 boys and 13 girls, ranging in age from 5 to 14 years, and 25 age-matched non-obese children, 13 boys and 12 girls, as the control group for measuring CETP mass. Blood was drawn after an overnight fast and, at the same time, and anthropometric measurements including height, body weight, waist girth, hip girth, and triceps and subscapular skinfold thicknesses were taken. Paired samples were obtained from 15 obese children who underwent psychoeducational therapy. Serum CETP mass was assayed by an enzyme-linked immunosorbent assay.

RESULTS

The serum levels of triglyceride, total cholesterol (TC), low-density lipoprotein cholesterol, TC/high-density lipoprotein cholesterol (HDLC), apolipoproteins (apo) B, apo B/apo A(1), and insulin in obese children were significantly higher than the respective reference values. Serum CETP level was approximately 2-fold higher (98.7 +/- 3.6 vs. 50.9 +/- 4.0 nM, means +/- SEM, p < 0.001) in the obese children than in the controls. In 15 obese children, whose percentage of overweight declined during therapy, CETP levels decreased significantly. CETP level was correlated with HDLC, TC/HDLC, and insulin, and with percentage of overweight when the data of the obese and non-obese children were combined.

DISCUSSION

CETP is increased and associated with the atherogenic lipoprotein profile in obese children.