Body mass index, triceps skinfold and waist circumference in screening for adiposity in male children and adolescents

The effect of 10 weeks of karate training on the development of motor skills in children who are new to karate

This study investigated the effect of a 10-week karate training program on the motor skill development of 5-7-year-old children new to karate with two different test batteries. A total of 28 participants were included in the study: 18 in the Karate group and 10 in the control group. The karate group was subjected to a fundamental karate training (kihon) program consisting of 90-minute sessions four days a week for ten weeks in addition to physical education classes at their schools. In contrast, the control group did not participate in any sportive activities except physical education classes in their schools. Data were collected using the Eurofit test battery and the TGMD-2 test. In the pre-post test comparison of the anthropometric measurements of the karate group, no significant difference was found in the control group. In contrast, a significant difference was obtained in height, body mass index, and body fat percentage. In the post-test analysis of the two independent groups, there were statistically significant differences in favor of the karate group regarding height and body fat percentage (p < 0.005). In the pre-post analysis of the Eurofit test and the TGMD-2 for the karate group, all parameters showed statistically significant improvements (p < 0.001), while the control group showed no statistical difference. After comparing the karate and control groups, the Eurofit Test and TGMD-2 post-test results showed significantly higher scores (statistically significant differences) in all parameters for the karate group. In conclusion, the study shows that the 10-week karate training program positively affected the motor development of the participating children.

Neck circumference cut-off points for detecting overweight and obesity among school children in Northern Cyprus

BACKGROUND

Neck circumference is one of the anthropometric parameters that is widely used in practical applications, clinical and epidemiological studies in children. It is aimed to determine the neck circumference cut-off points and to use them in the detection of overweight and obesity in children living in Northern Cyprus.

SUBJECTS

This cross-sectional study was conducted between October 2019 and January 2020, and covered a sample of 692 children (367 girls and 325 boys) aged 6-10 years attending primary schools in the Northern Cyprus.

METHODS

Body weight, height, neck circumference, waist circumference, subscapular and triceps skinfold tickness were measured. BF% was calculated with Slaughter equations. World Health Organization BMI cut-off points for age and gender percentiles were used to categorize obesity. BMI, WHtR, NC, body fat were calculated. The Pearson Correlation co-efficient between NC and the other anhtropometric measurements were calculated. Receiver operating characteristics analysis, sensitivity, specificity, PV + ve PV- was used to determine the optimal NC cut-off points for identifying children with overweight and obesity.

RESULTS

NC was a statistically significant positive and strong relationship with body weight, BMI, waist circumference and hip circumference (p < 0,005). NC cut-off values to define overweight and obesity were calculated as 26,9 cm in girls (AUC: 0,851, 95% CI: 0,811-0,891, sensitivity 70,50%, specificity 84,65%) and 27,9 cm in boys (AUC: 0,847, 95% CI: 0,805-0,888, sensitivity 76,4%, specificity 79,3%). The ROC curves accurately define overweight and obesity of the whole cohort regardless of age for both sexes of children.

CONCLUSIONS

The cut-off points for neck circumference were found to be 27,9 cm for boys and 26,9 cm for girls in determining overweight and obesity in children aged 6-10 years. The NC cut-off points obtained in this study can be used to define overweight and obesity in children in epidemiological studies. It is considered to shed light on studies that will examine the relationship between neck circumference and diseases with more people in future studies.

Prenatal and childhood exposure to chlordecone and adiposity of seven-year-old children in the Timoun mother-child cohort study in Guadeloupe (French West Indies)

BACKGROUND

Exposure to persistent environmental organic pollutants may contribute to the development of obesity among children. Chlordecone is a persistent organochlorine insecticide with estrogenic properties that was used in the French West Indies (1973-1993) and is still present in the soil and the water and food consumed by the local population. We studied the association between prenatal and childhood exposure to chlordecone and the adiposity of prepubertal children.

METHODS

Within the Timoun Mother-Child Cohort Study in Guadeloupe (French West Indies), 575 children had a medical examination at seven years of age, including adiposity measurements. A Structural Equation Modeling approach was used to create a global adiposity score from four adiposity indicators: the BMI z-score, percentage of fat mass, sum of the tricipital and subscapular skinfold thickness, and waist-to-height ratio. Chlordecone concentrations were measured in cord blood at birth and in the children's blood at seven years of age. Models were adjusted for prenatal and postnatal covariates. Sensitivity analyses accounted for co-exposure to PCB-153 and pp'-DDE. Mediation analyses, including intermediate birth outcomes, were conducted.

RESULTS

Prenatal chlordecone exposure tended to be associated with increased adiposity at seven years of age, particularly in boys. However, statistical significance was only reached in the third quartile of exposure and neither linear nor non-linear trends could be formally identified. Consideration of preterm birth or birth weight in mediation analyses did not modify the results, as adjustment for PCB-153 and pp'-DDE co-exposures.

CONCLUSION

Globally, we found little evidence of an association between chlordecone exposure during the critical in utero or childhood periods of development and altered body-weight homeostasis in childhood. Nevertheless, some associations we observed at seven years of age, although non-significant, were consistent with those observed at earlier ages and would be worth investing during further follow-ups of children of the Timoun Mother-Child Cohort Study when they reach puberty.

Mediterranean Diet and Genetic Determinants of Obesity and Metabolic Syndrome in European Children and Adolescents

Childhood obesity and metabolic syndrome (MetS) are multifactorial diseases influenced by genetic and environmental factors. The Mediterranean Diet (MD) seems to modulate the genetic predisposition to obesity or MetS in European adults. The FTO gene has also been shown to have an impact on the MD benefits to avoid obesity or MetS. Since these interaction effects have been scarcely analyzed in European youth, the aim was to describe the gene–MD interplay, analyzing the impact of the genetic factors to reduce the obesity and MetS risk through MD adherence, and the MD impact in the obesity and MetS genetic profile. From the limited evidence on gene–MD interaction studies in European youth, a study showed that the influence of high MD adherence on adiposity and MetS was only observed with a limited number of risk alleles; the gene–MD interplay showed sex-specific differences, being higher in females. Most results analyzed in European adults elucidate that, the relationship between MD adherence and both obesity and MetS risk, could be modulated by obesity genetic variants and vice versa. Further research is needed, to better understand the inter-individual differences in the association between MD and body composition, and the integration of omics and personalized nutrition considering MD.

Predictive capacity and cut-off points of adiposity indices for body fat prediction according to adolescent periods

Overweight is increasing in the adolescent population and became a public health problem in the world. This study aimed to identify the body adiposity indices (BAI) with the best capacity to predict excess fat tissue and propose cut-off points for them, according to sex and adolescence period. This is a cross-sectional study. We calculated BMI, conicity index (CI), BAI, body roundness index (BRI), waist:height ratio (WtHR) and waist:hip ratio. Predictive capacity and cut-off points of adiposity indices were established by ROC (receiver operating characteristic) curves. We determined AUC-ROC and CI, stratified by sex and adolescence period. The best index to identify excess body fat in 10-13-year-old female adolescents was the WtHR (AUC = 0·92), like the BAI in girls aged from 14 to 16 years old (AUC = 0·87) and 17 to 19 years old (AUC = 0·80). In male adolescents aged from 10 to 13 years old and 14 to 16 years old, the best index was the WtHR (AUC = 0·93 and AUC = 0·8, respectively), like the BAI in boys aged from 17 to 19 years old (AUC = 0·95). The use of indices with specific cut-off points for each period of adolescence and according to sex is important for the reliable diagnosis of excess body fat. It is advisable to use indices together to obtain a more accurate assessment. Thus, the WtHR and BAI are reproducible and reliable, with high sensitivity and specificity values, and can be used together with the BMI.

Prevalence of overweight, obesity and abdominal obesity in Health Sciences Faculty students

OBJECTIVES

This study was carried out in order to determine the prevalence of obesity among the students of the Faculty of Health Sciences and to evaluate the anthropometric measurements of the students.

MATERIALS AND METHODS

The population of the study was in total 984 volunteering undergraduate students from Ankara University Faculty of Health Sciences, Child Development, Midwifery, Nursing, Health Management and Social Work departments. The sociodemographic characteristics of the students were obtained with the help of the questionnaire and the anthropometric measurements by the researchers. SPSS package program was used for descriptive statistics, chi-square test and multiple logistic regression analysis for assessment of data.

RESULTS

16.5% of the students participating in the study were overweight and 4.5% were obese. Approximately half of the students who are overweight and obese reported staying in the dormitory. Average BMI value in males is 23.1 kg/m² and 22.3 kg/m² in females. 29.1% of females are at risk in terms of abdominal obesity and 30.6% of males in terms of waist/height ratio. Male gender and presence of an obese person in the family increases the risk of being overweight or obese.

CONCLUSIONS

Risky health behaviors are observed among university students and in order to avoid such behaviors, it is necessary to provide training especially on subjects such as nutrition and physical activity. Adopting the right nutritional habits and healthy lifestyle is important in individuals who will be the future healthcare professionals, for both their and future generations' health.

Growth and Body Composition in PKU Children-A Three-Year Prospective Study Comparing the Effects of L-Amino Acid to Glycomacropeptide Protein Substitutes

Protein quality and quantity are important factors in determining lean body (muscle) mass (LBM). In phenylketonuria (PKU), protein substitutes provide most of the nitrogen, either as amino acids (AA) or glycomacropeptide with supplementary amino acids (CGMP-AA). Body composition and growth are important indicators of long-term health. In a 3-year prospective study comparing the impact of AA and CGMP-AA on body composition and growth in PKU, 48 children were recruited. N = 19 (median age 11.1 years, range 5–15 years) took AA only, n = 16 (median age 7.3 years, range 5–15 years) took a combination of CGMP-AA and AA, (CGMP50) and 13 children (median age 9.2 years, range 5–16 years) took CGMP-AA only (CGMP100). A dual energy X-ray absorptiometry (DXA) scan at enrolment and 36 months measured LBM, % body fat (%BF) and fat mass (FM). Height was measured at enrolment, 12, 24 and 36 months. No correlation or statistically significant differences (after adjusting for age, gender, puberty and phenylalanine blood concentrations) were found between the three groups for LBM, %BF, FM and height. The change in height z scores, (AA 0, CGMP50 +0.4 and CGMP100 +0.7) showed a trend that children in the CGMP100 group were taller, had improved LBM with decreased FM and % BF but this was not statistically significant. There appeared to be no advantage of CGMP-AA compared to AA on body composition after 3-years of follow-up. Although statistically significant differences were not reached, a trend towards improved body composition was observed with CGMP-AA when it provided the entire protein substitute requirement.

Establishing a proof of concept for the effects of low-carbohydrate, high-fat diet (LCHFD) and physical activity on body composition in type 2 diabetes

Overweight and obesity are both a risk factor for developing and exacerbating type 2 diabetes (T2D). While the most common diet used to treat overweight and obesity focus on high-carbohydrate, low-fat, energy deficit diets, recently, low-carbohydrate, high-fat diets (LCHFD) have become popular in targeting obesity. This proof-of-concept study attempted to determine if an LCHFD could improve body composition variables, or if a concurrent treatment of LCHFD and physical activity would create an interference effect in individuals with T2D. Overweight and obese with T2D (n = 39) were assigned into either a 16-week combined physical activity and LCHFD group (ConG), LCHFD-only group (DieG) or control group (NonG). No statistically significant (p > 0.01) changes were found in body mass in the ConG (2.0%, F = 0.039, P = 0.846) and DieG (2.5%, F = 0.188, P = 0.669); for body mass index in the ConG (2.2%, F = 0.046, P = 0.832) and DieG (2.3%, F = 0.098, P = 0.758.); and waist-to-hip ratio in the ConG (0%, F = 0.002, P = 0.968) and DieG (0%, F = 0.023, P = 0.882). However, clinically significant changes were observed in HbA1c in the ConG male group (23% decrease); percentage body fat for the ConG (16.7%, F = 1.682, P = 0.208, g = 0.534) and DieG (13.0%, F = 0.638, P = 0435, g = 0.361); for waist circumferences in the ConG (5.4%, F = 0.686, P = 0.416, g = 0.341) and DieG (6.3%, F = 1.327, P = 0.264, g = 0.520); and for hip circumference in the ConG (5.8%, F = 0.993, P = 0.329, g = 0.410) and DieG (7.0%, F = 2.668, P = 0.119, g = 0.737). Results indicate that moderate clinically significant changes in body composition are achievable with LCHFD and/or daily walking in obese adults living with T2D. However, more robust research is required to determine the effects of LCHFD, with or without concurrent physical activity, on obesity and other diabetic complication markers.

Sex Differences in the Relationship Between Childhood Self-Regulation and Adolescent Adiposity

OBJECTIVE

Research suggests that higher childhood self-regulation (CSR) predicts lower adiposity in adolescence. However, it is unclear whether this relationship differs by sex or by baseline weight status. Thus, this study investigated these questions in a longitudinal, community-based cohort.

METHODS

The cohort included 221 girls and 214 boys. At age 9, CSR was assessed via parent/teacher reports of effortful control, and childhood BMI z scores (BMIz) were calculated from staff measurements. Late-adolescent waist-to-height ratio was based on staff measurements at age 18.

RESULTS

CSR has a small inverse correlation with concurrent childhood BMIz in girls, but not in boys. Prospectively, however, CSR has a small inverse association with late-adolescent weight-to-height ratio in both sexes, after adjusting for childhood BMIz and other childhood predictors. This prospective association is marginally stronger for girls with higher (vs. lower) childhood BMIz.

CONCLUSIONS

CSR inversely predicts changes in adiposity across adolescence in both sexes, with some evidence that this association is stronger for girls with higher (vs. lower) childhood adiposity. However, this inverse association between CSR and adiposity may emerge earlier in girls. Future research should examine the causal status of CSR and its relationship to behaviors (e.g., diet).

Evaluation of temporomandibular disorders and oral health-related quality of life with obese patients

Objective: The aim of this study was to investigate the relationship between temporomandibular disorders and oral health impact profile in healthy, overweight, and obese patients.Methods: This study was carried out on 1528 individuals divided into three groups as healthy, overweight, and obese patients. Diagnostic Criteria for Temporomandibular Disorders, Fonseca's questionnaire, and Oral Health Impact Profile-14 (OHIP-14) forms were used.Results: Gender, classification, pain, temporomandibular joint noise, and open-lock of the jaw of healthy, overweight, and obese groups were found to be related. The differences in the Fonseca and the OHIP-14 total scores according to the groups were found to be statistically significant. The correlation between the Fonseca total score and age was positive and significant.Conclusion: In the obese patients, both total Fonseca and OHIP-14 values were found to be higher. Also, the presence of pain in the obese patients was found to be higher.

Relative Fat Mass as an estimator of whole-body fat percentage among children and adolescents: A cross-sectional study using NHANES

We evaluated the ability of the Relative Fat Mass (RFM) to estimate whole-body fat percentage among children and adolescents who participated in the National Health and Nutrition Examination Survey from 1999 through 2006 (n = 10,390). The RFM equation for adults (64 − (20 × height/waist circumference) + (12 × sex)) may be used for adolescents 15 to 19 years of age. For children and adolescents 8 to 14 years of age, we suggest a modified RFM equation, named as the RFMp (RFM pediatric): 74 − (22 × height/waist circumference) + (5 × sex). In both equations, sex equals 0 for boys and 1 for girls. RFMp was more accurate than BMI to estimate whole-body fat percentage (measured by dual energy X-ray absorptiometry, DXA) among girls (percentage of estimates that were <20% of measured body fat percentage, 88.2% vs. 85.7%; P = 0.027) and boys 8 to 14 years of age (83.4% vs. 71.0%; P < 0.001). RFM was more accurate than BMI among boys 15 to 19 years of age (82.3% vs. 73.9%; P < 0.001) but slightly less accurate among girls (89.0% vs. 92.6%; P = 0.002). Compared with BMI-for-age percentiles, RFMp had lower misclassification error of overweight or obesity (defined as a DXA-measured body fat percentage at the 85^th percentile or higher) among boys 8 to 14 years of age (6.5% vs. 7.9%; P = 0.018) but not girls (RFMp: 8.2%; BMI-for-age: 7.9%; P = 0.681). Misclassification error of overweight or obesity was similar for RFM and BMI-for-age percentiles among girls (RFM: 8.0%; BMI-for-age: 6.6%; P = 0.076) and boys 15 to 19 years of age (RFM: 6.9%; BMI-for-age: 7.8%; P = 0.11). RFMp for children and adolescents 8 to 14 years of age and RFM for adolescents 15 to 19 years of age were useful to estimate whole-body fat percentage and diagnose body fat-defined overweight or obesity.

Waist circumference as high blood pressure predictor in school age children

Childhood hypertension is becoming more common with the increasing numbers of child obesity, which has encouraged new studies to identify a good anthropometric marker for high blood pressure levels. The objective this study was to identify the best anthropometric predictor of risk of hypertension in children between 8-10 years of age. The Children were evaluated for socioeconomic status and their blood pressure (BP), weight, height, waist circumference (WC) and percentage of body fat (PBF) were measured. The study included 445 children, of which 50.1% were females. The prevalence of obesity defined by body mass index (BMI) was 14.6%. Increased BP was found in 3.4% and 2.2% of the children, considering the pre-hypertension and hypertension classifications respectively. The arithmetic mean of BP value correlated significantly with BMI, WC and PBF. After height control, the correlations that were maintained significant were between WC and systolic blood pressure (SBP) and between WC and diastolic blood pressure (DBP). The variable with the highest predictive power of the occurrence of hypertension was WC. The results indicate that, in this population of children between 8 and 10 years old, WC is a measurement of higher value in predicting increased BP.

Antenatal Synthetic Glucocorticoid Exposure at Human Therapeutic Equivalent Doses Predisposes Middle-Age Male Offspring Baboons to an Obese Phenotype That Emerges With Aging

INTRODUCTION

Women threatening premature delivery receive synthetic glucocorticoids (sGC) to accelerate fetal lung maturation, reducing neonatal mortality and morbidity. Few investigations have explored potential long-term offspring side effects. We previously reported increased pericardial fat and liver lipids in 10-year-old (human equivalent 40 years) male baboons exposed to 3 antenatal sGC courses. We hypothesized middle-aged sGC male offspring show obesity-related morphometric changes.

METHODS

Pregnant baboons received courses of 2 betamethasone injections (175 μg·kg-1·d-1 intramuscular) at 0.6, 0.64, and 0.68 gestation. At 10 to 12.5 years, we measured morphometrics and serum lipids in 5 sGC-exposed males and 10 age-matched controls. We determined whether morphometric parameters predicted amount of pericardial fat or lipids. Life-course serum lipids were measured in 25 males (7-23 years) providing normal regression formulas to compare sGC baboons' lipid biological and chronological age.

RESULTS

Birth weights were similar. When studied, sGC-exposed males showed a steeper weight increase from 8 to 12 years and had increased waist and hip circumferences, neck and triceps skinfolds, and total and low-density lipoprotein cholesterol. Triceps skinfold correlated with apical and midventricular pericardial fat thickness, hip and waist circumferences with insulin.

CONCLUSIONS

Triceps skinfold and waist and hip circumferences are useful biomarkers for identifying individuals at risk for obesity and metabolic dysregulation following fetal sGC exposure. Prenatal sGC exposure predisposes male offspring to internal adiposity, greater body size, and increased serum lipids. Results provide further evidence for developmental programming by fetal sGC exposure and call attention to potential emergence of adverse life-course effects.

Vitamin D receptor gene polymorphisms are associated with triceps skin fold thickness and body fat percentage but not with body mass index or waist circumference in Han Chinese

Background

Evidence shows that low serum vitamin D concentrations account for an increased risk of obesity by inducing vitamin D receptor (VDR) hypofunction. Although the correlation between single nucleotide polymorphisms (SNPs) of VDR gene and obesity-related anthropometric measures (such as body mass index [BMI] and waist circumference[WC]) has already been tested, there are only few studies on the association between direct measures of body fat percentage (BFP) and triceps skinfold thickness and the SNPs of VDR. The aim of the present study was to evaluate the effect of VDR gene polymorphism on multiple obesity indexes in Han Chinese, including BMI, WC, BFP and triceps skinfold thickness.

Methods

In this cross-sectional study, five hundred and seventeen healthy Chinese adults were enrolled in the trial. Four loci in VDR gene (rs2228570 [FokI], rs2189480, rs2239179 and rs7975232[ApaI]) were genotyped by TaqMan probe assays. Obesity indexes including BMI, WC, BFP and triceps skinfold thickness were used to evaluate the relationship to the VDR SNPs. Multiple logistic regression, linear regression and general multifactor dimensionality reduction (GMDR) were performed to analyze the correlation of VDR gene and obesity indexes.

Results

None of the VDR SNPs were associated with BMI and WC, the C allele of FokI and the T allele of ApaI were associated with an increase in BFP (β = 0.069,P = 0.007; β = 0.087, P = 0.022 respectively); the G allele of rs2239179 and the T allele of ApaI were associated with an increase in triceps skin fold thickness (β = 0.074, P = 0.001; β = 0.122, P < 0.001 respectively). In regards to adiposity-related metabolic parameters, we found that the GT genotype of ApaI was associated with higher level of total cholesterol (TC) (P = 0.013) and Low-density lipoprotein cholesterol (LDL-C) (P = 0.001).

Conclusions

Though we failed to prove that VDR SNPs were in correlation with BMI and WC, we did establish the association between VDR variants and BFP, as well as triceps skinfold thickness. Data obtained suggested that the VDR variants play an important role in regulating adipose tissue activity and adiposity among Han Chinese.

Electronic supplementary material

The online version of this article (10.1186/s12944-019-1027-2) contains supplementary material, which is available to authorized users.

Triponderal mass index rather than body mass index: An indicator of high adiposity in Italian children and adolescents

OBJECTIVE

The aims of this study were to compare body mass index (BMI) and triponderal mass index (TMI) as predictors of fat mass percentage (FM%) and to develop TMI cutoffs for screening high adiposity. Therefore, TMI- and BMI-based references against FM% criterion for indicating adiposity in Italian children and adolescents were compared.

METHODS

This was a cross-sectional study conducted at the University of Rome Tor Vergata, Human Nutrition Unit, from 2008 to 2015. The sample included 485 children and adolescents from 8 to 17 y of age from central-southern Italy. Body weight (kg) and height (m) were assessed to calculate BMI and TMI. FM% was assessed by dual-energy x-ray absorptiometry. The prevalence of high adiposity was based on the 75th percentile of FM%, according to Ogden et al. curves. Statistical tests such as Mann-Whitney, Kruskal-Wallis, polynomial regression, receiver operating characteristics curve, and Cohen's κ, were performed using SPSS version 24 and MedCalc version 18.

RESULTS

Prevalence of high adiposity according to FM% was 50.2% (95% confidence interval [CI], 43.2-57.2) in boys and 43.2% (95% CI, 37.3-49.2) in girls. TMI rather than BMI could better predict FM% for both sexes (boys R² = 0.67 and girls R² = 0.79 versus boys R² = 0.44 and girls R² = 0.74, respectively). TMI was found to present a significantly higher area under the curve than BMI for indicating high adiposity in children and adolescents. TMI sex- and age-specific cutoffs were responsible by better classification of adiposity, followed by the International Obesity Task Force, World Health Organization, and Cacciari reference curves.

CONCLUSION

TMI is a useful screening tool in pediatric clinical practice and epidemiologic studies concerning childhood obesity.

Body composition and blood pressure in 6-year-old singletons born after pre-implantation genetic testing for monogenic and structural chromosomal aberrations: a matched cohort study

STUDY QUESTION

Does Day 3 embryo biopsy for pre-implantation genetic testing for monogenic (PGT-M) and structural chromosomal aberrations (PGT-SR) affect body composition and blood pressure readings of 6-year-old singletons?

SUMMARY ANSWER

This study of 87 PGT-M and PGT-SR conceived singletons showed no differences in anthropometric measurements and blood pressure readings in comparison with a matched cohort of peers born after ICSI without embryo biopsy.

WHAT IS KNOWN ALREADY

While neonatal outcomes after PGT conception have been found comparable to those after ICSI without embryo biopsy, only a few studies have reported outcomes after PGT at older ages. Moreover, embryo biopsy is also applied in couples who opt for PGT-M and PGT-SR and hence are not necessarily infertile. Health parameters and in particular body composition data in this group of children are lacking.

STUDY DESIGN SIZE DURATION

This single-centre matched-pair cohort study evaluated body composition of 6-year-old children born after fresh blastocyst embryo transfer with or without embryo biopsy performed at Day 3 for the purpose of PGT-M and PGT-SR. For each child born after embryo biopsy, a singleton born after transfer of a fresh ICSI embryo at the blastocyst stage and reaching the age of 6 years between May 2011 and June 2017 was matched as closely as possible for gender, age, maternal educational level and birth order.

PARTICIPANTS/MATERIALS SETTING METHODS

Anthropometry (weight, height, BMI, skinfold thickness, waist and mid-upper arm circumference) and blood pressure readings in a longitudinally followed cohort of 87 singletons conceived by PGT-M and PGT-SR and a pairwise matched sample of 87 children conceived by ICSI are described. Results are adjusted for current, neonatal and parental characteristics.

MAIN RESULTS AND THE ROLE OF CHANCE

From the 124 eligible PGT-M and PGT-SR families, 110 could be reached of whom 23 refused and 87 (87/110 = 79%) participated. All anthropometric measurements, including z-scores of BMI, waist and mid-upper arm circumference, were comparable between the PGT-M and PGT-SR (-0.23; 0.27; 0.17, respectively) and ICSI (-0.29; 0.11; 0.11, respectively) groups (all P > 0.05). Furthermore, indices of peripheral (triceps) and central (subscapular) adiposity derived from skinfold thickness were comparable (PGT-M and PGT-SR: 14.7 mm; 11.6 mm and ICSI: 15.5 mm; 11.5 mm) as well as the percentage total body fat mass derived from these (PGT-M and PGT-SR: 13.7% and ICSI: 13.9%) (all P > 0.05). Z-scores for blood pressure were also comparable between the PGT and ICSI groups (all P > 0.05). Results did not change when adjusted for neonatal (birthweight, birth order), current (age) and parental (smoking during pregnancy, parental BMI) characteristics. Hospitalization rate and surgical intervention rate were not different for PGT-M and PGT-SR children compared to matched peers born after ICSI.

LIMITATIONS REASONS FOR CAUTION

Although our study describes the largest cohort of singletons born after embryo biopsy worldwide, we were only able to detect moderate differences in anthropometrics and blood pressure with our sample size.

WIDER IMPLICATIONS OF THE FINDINGS

Although Day 3 embryo biopsy followed by blastocyst transfer is not associated with adverse outcomes regarding anthropometry and blood pressure, future studies should focus on outcomes in children born after trophectoderm biopsy and/or transfer of warmed embryos after vitrification.

STUDY FUNDING/COMPETING INTERESTS

This study was supported by Methusalem grants and by grants from Wetenschappelijk Fonds Willy Gepts; all issued by the Vrije Universiteit Brussel (VUB). All co-authors, except M.B. declared no conflict of interest. M.B. has received consultancy fees from MSD, Serono Symposia and Merck. The Universitair Ziekenhuis Brussel (UZ Brussel) and the Centre for Medical Genetics have received several educational grants from IBSA, Ferring, Organon, Shering-Plough, Merck for establishing the database for follow-up research and organizing the data collection.

Prevalence and Perception of Childhood Obesity in California's Farmworker Communities

In California's central valley, childhood obesity rates are above the national average. The majority of families living in the rural, agricultural communities of this region are immigrant of Mexican heritage, and face numerous social and environmental challenges. Demographic and anthropometric data were collected from a population of Mexican-heritage children 3-8 years (N = 609) and families (N = 466) living in two central valley communities. Overall, 45 % of children and 82 % of mothers were classified as overweight or obese. Multivariable analyses indicated that mother's BMI and acculturation level were positively associated with child BMI z-score. Most children classified as overweight or obese (92 % and 53 %, respectively) were perceived as having 'normal' weight by their mothers. Childhood obesity remains a major public health issue in Mexican-heritage, central valley communities. Our model indicates that mother's BMI is predictor of child obesity, and parents tend to underestimate their child's weight status. These findings highlight a need for family-targeted and culturally-tailored approaches to address relevant perceptions of obesity and risk factors in these communities.

The association between self-rated health and different anthropometric and body composition measures in the Chinese population

BACKGROUND

To analyze the strength of association between self-rated health and six anthropometric and body composition measures to explore the best indicator.

METHODS

Analyses were based on the cross-sectional data from the China Kadoorie Biobank Study and approximately 300,000 adults were analyzed. Logistics regression was used to analyze the association between self-rated health (good or poor) and anthropometric and body composition measures (height, weight, body mass index (BMI), waist circumference (WC), hip circumference (HC) and body fat percentage, waist-to-hip ratio and waist-to-height ratio). Stratified analyses were undertaken to understand the effect modification of socioeconomic status on the association.

RESULT

Odds ratio of self-rated better health had an inverted U-shape association with weight, BMI, WC and body fat, with weight levels increasing until around 73.8 and 65.7 kg for male and female, BMI around 26.8 kg/m2, WC around 85.8 and 87.6 cm, body fat around 24.3 and 36.3%, and then declining thereafter. Height and HC also indicated a slightly inverted U-shape association. The strongest association was observed after adjustment was weight, with one standard deviation greater weight associated with 10.2% and 10.6% increased odds in male and female.

CONCLUSIONS

Being underweight and overweight are both risk factors for poor self-rated health in males and females, and weight is the best indicator of self-rated health compared with other measures.

Simple tests for the diagnosis of childhood obesity: a systematic review and meta-analysis

There is a need to accurately quantify levels of adiposity in order to identify overweight and obesity in children. This systematic review aimed to identify all diagnostic accuracy studies evaluating simple tests for obesity and adiposity, including body mass index (BMI), skin-fold thickness and waist circumference, compared against high-quality reference tests. Twenty-four cohort studies including 25,807 children were included. BMI had good performance when diagnosing obesity: a sensitivity of 81.9% (95% confidence interval [CI]: 73.0 to 93.8) for a specificity of 96.0% (95% CI: 93.8 to 98.1). It was less effective at diagnosing overweight (sensitivity: 76.3%, 95% CI: 70.2 to 82.4; specificity: 92.1% 95% CI: 90.0 to 94.3). When diagnosing obesity, waist circumference had similar performance (sensitivity: 83.8%; specificity: 96.5%). Skin-fold thickness had slightly poorer performance (sensitivity: 72.5%; specificity: 93.7%). Few studies considered any other tests. There was no conclusive evidence that any test was generally superior to the others. BMI is a good simple diagnostic test for identifying childhood adiposity. It identifies most genuinely obese and adipose children while misclassifying only a small number as obese. There was no conclusive evidence that any test should be preferred to BMI, and the extra complexity of skin-fold thickness tests does not appear to improve diagnostic accuracy.

The use of measures of obesity in childhood for predicting obesity and the development of obesity-related diseases in adulthood: a systematic review and meta-analysis

BACKGROUND

It is uncertain which simple measures of childhood obesity are best for predicting future obesity-related health problems and the persistence of obesity into adolescence and adulthood.

OBJECTIVES

To investigate the ability of simple measures, such as body mass index (BMI), to predict the persistence of obesity from childhood into adulthood and to predict obesity-related adult morbidities. To investigate how accurately simple measures diagnose obesity in children, and how acceptable these measures are to children, carers and health professionals.

DATA SOURCES

Multiple sources including MEDLINE, EMBASE and The Cochrane Library were searched from 2008 to 2013.

METHODS

Systematic reviews and a meta-analysis were carried out of large cohort studies on the association between childhood obesity and adult obesity; the association between childhood obesity and obesity-related morbidities in adulthood; and the diagnostic accuracy of simple childhood obesity measures. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and a modified version of the Quality in Prognosis Studies (QUIPS) tool. A systematic review and an elicitation exercise were conducted on the acceptability of the simple measures.

RESULTS

Thirty-seven studies (22 cohorts) were included in the review of prediction of adult morbidities. Twenty-three studies (16 cohorts) were included in the tracking review. All studies included BMI. There were very few studies of other measures. There was a strong positive association between high childhood BMI and adult obesity [odds ratio 5.21, 95% confidence interval (CI) 4.50 to 6.02]. A positive association was found between high childhood BMI and adult coronary heart disease, diabetes and a range of cancers, but not stroke or breast cancer. The predictive accuracy of childhood BMI to predict any adult morbidity was very low, with most morbidities occurring in adults who were of healthy weight in childhood. Predictive accuracy of childhood obesity was moderate for predicting adult obesity, with a sensitivity of 30% and a specificity of 98%. Persistence of obesity from adolescence to adulthood was high. Thirty-four studies were included in the diagnostic accuracy review. Most of the studies used the least reliable reference standard (dual-energy X-ray absorptiometry); only 24% of studies were of high quality. The sensitivity of BMI for diagnosing obesity and overweight varied considerably; specificity was less variable. Pooled sensitivity of BMI was 74% (95% CI 64.2% to 81.8%) and pooled specificity was 95% (95% CI 92.2% to 96.4%). The acceptability to children and their carers of BMI or other common simple measures was generally good.

LIMITATIONS

Little evidence was available regarding childhood measures other than BMI. No individual-level analysis could be performed.

CONCLUSIONS

Childhood BMI is not a good predictor of adult obesity or adult disease; the majority of obese adults were not obese as children and most obesity-related adult morbidity occurs in adults who had a healthy childhood weight. However, obesity (as measured using BMI) was found to persist from childhood to adulthood, with most obese adolescents also being obese in adulthood. BMI was found to be reasonably good for diagnosing obesity during childhood. There is no convincing evidence suggesting that any simple measure is better than BMI for diagnosing obesity in childhood or predicting adult obesity and morbidity. Further research on obesity measures other than BMI is needed to determine which is the best tool for diagnosing childhood obesity, and new cohort studies are needed to investigate the impact of contemporary childhood obesity on adult obesity and obesity-related morbidities.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42013005711.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Percentile reference values for anthropometric body composition indices in European children from the IDEFICS study

INTRODUCTION

To characterise the nutritional status in children with obesity or wasting conditions, European anthropometric reference values for body composition measures beyond the body mass index (BMI) are needed. Differentiated assessment of body composition in children has long been hampered by the lack of appropriate references.

OBJECTIVES

The aim of our study is to provide percentiles for body composition indices in normal weight European children, based on the IDEFICS cohort (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS).

METHODS

Overall 18,745 2.0-10.9-year-old children from eight countries participated in the study. Children classified as overweight/obese or underweight according to IOTF (N=5915) were excluded from the analysis. Anthropometric measurements (BMI (N=12 830); triceps, subscapular, fat mass and fat mass index (N=11,845-11,901); biceps, suprailiac skinfolds, sum of skinfolds calculated from skinfold thicknesses (N=8129-8205), neck circumference (N=12,241); waist circumference and waist-to-height ratio (N=12,381)) were analysed stratified by sex and smoothed 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th and 99th percentile curves were calculated using GAMLSS.

RESULTS

Percentile values of the most important anthropometric measures related to the degree of adiposity are depicted for European girls and boys. Age- and sex-specific differences were investigated for all measures. As an example, the 50th and 99th percentile values of waist circumference ranged from 50.7-59.2 cm and from 51.3-58.7 cm in 4.5- to <5.0-year-old girls and boys, respectively, to 60.6-74.5 cm in girls and to 59.9-76.7 cm in boys at the age of 10.5-10.9 years.

CONCLUSION

The presented percentile curves may aid a differentiated assessment of total and abdominal adiposity in European children.

Exploratory Study Examining Clinical Measures of Adiposity Risk for Predicting Obesity in Adolescents with Physical Disabilities

OBJECTIVE

The purposes of this study were to assess the accuracy of clinical measures for predicting adiposity when compared with a criterion standard of body fat percentage measured by dual-energy X-ray absorptiometry and to determine the most appropriate cut points for classifying obesity for each measure in adolescents with physical disability.

DESIGN

Body mass index, triceps skinfolds, and waist, arm, and leg circumferences were collected on 29 adolescents aged 14-17 yrs with spinal cord injury, cerebral palsy, or spina bifida. Percentage of body fat was measured using dual-energy X-ray absorptiometry. Multiple linear regression models were used to assess the ability of measures to predict percentage of body fat. Receiver operating characteristic curves were used to identify optimal cut points for each measure.

RESULTS

Although all clinical measures correlated with body fat as measured by dual-energy X-ray absorptiometry, current cut points are not adequate in this group. Using a body mass index of 20 kg/m (boys) and 19 kg/m (girls) was optimal but still misclassified a significant number of participants as nonobese in this group. Using the optimal cut points for waist circumference, which were 83 cm (boys) and 78 cm (girls), was the best predictor.

CONCLUSIONS

Body mass index, triceps skinfolds, and waist, leg, and arm circumferences are valid measures for estimating obesity in adolescents with physical disability, but further research is needed to validate disability-specific cut points.

Diagnostic performance of body mass index to identify obesity as defined by body adiposity in children and adolescents: a systematic review and meta-analysis

BACKGROUND

The ideal means of identifying obesity in children and adolescents has not been determined although body mass index (BMI) is the most widely used screening tool.

OBJECTIVE

We performed a systematic review and meta-analysis of studies assessing the diagnostic performance of BMI to detect adiposity in children up to 18 years.

METHODS

Data sources were EMBASE, MEDLINE, Cochrane, Database of Systematic Reviews Cochrane CENTRAL, Web of Science and SCOPUS up to March 2013. Studies providing measures of diagnostic performance of BMI and using body composition technique for body fat percentage measurement were included.

RESULTS

Thirty-seven eligible studies that evaluated 53 521 patients, with mean age ranging from 4 to 18 years were included in the meta-analysis. Commonly used BMI cut-offs for obesity showed pooled sensitivity to detect high adiposity of 0.73 (confidence interval [CI] 0.67-0.79), specificity of 0.93 (CI 0.88-0.96) and diagnostic odds ratio of 36.93 (CI 20.75-65.71). Males had lower sensitivity. Moderate heterogeneity was observed (I(2) = 48%) explained in meta-regression by differences across studies in race, BMI cut-off, BMI reference criteria (Center for Disease Control vs. International Obesity Task Force) and reference standard method assessing adiposity.

CONCLUSION

BMI has high specificity but low sensitivity to detect excess adiposity and fails to identify over a quarter of children with excess body fat percentage.

[Anthropometric indicators of obesity in the prediction of high body fat in adolescents]

OBJECTIVE:

To determine the anthropometric indicators of obesity in the prediction of high body fat in adolescents from a Brazilian State.

METHODS:

The study included 1,197 adolescents (15-17 years old). The following anthropometric measurements were collected: body mass (weight and height), waist circumference and skinfolds (triceps and medial calf). The anthropometric indicators analyzed were: body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and conicity index (C-Index). Body fat percentage, estimated by the Slaughter et al equation, was used as the reference method. Descriptive statistics, U Mann-Whitney test, and ROC curve were used for data analysis.

RESULTS:

Of the four anthropometric indicators studied, BMI, WHtR and WC had the largest areas under the ROC curve in relation to relative high body fat in both genders. The cutoffs for boys and girls, respectively, associated with high body fat were BMI 22.7 and 20.1kg/m², WHtR 0.43 and 0.41, WC 75.7 and 67.7cm and C-Index 1.12 and 1.06.

CONCLUSIONS:

Anthropometric indicators can be used in screening for identification of body fat in adolescents, because they are simple, have low cost and are non-invasive.

Childhood obesity-an insight into preventive strategies

Childhood obesity is now a global problem throughout the world. The major factors affecting weight regulation and the development of obesity in children are the result of a large number of biological, behavioral, social, environmental, and economic factors and the complex interactions between them that promote a positive energy balance. The changes in the dietary habits with the adoption of sedentary life style increases manifold obesity-related diseases and their complications. An obese child later on grows up to become an obese adult. Therefore, the role of primary prevention along with methodical diet control, behavioral changes, and physical activity are the important strategies against the battle of childhood obesity.

[Waist circumference, waist/height ratio, and neck circumference as parameters of central obesity assessment in children]

Objective:

To analyze studies that assessed the anthropometric parameters waist circumference (WC), waist-to-height ratio (WHR) and neck circumference (NC) as indicators of central obesity in children.

Data sources:

We searched PubMed and SciELO databases using the combined descriptors: "Waist circumference", "Waist-to-height ratio", "Neck circumference", "Children" and "Abdominal fat" in Portuguese, English and Spanish. Inclusion criteria were original articles with information about the WC, WHR and NC in the assessment of central obesity in children. We excluded review articles, short communications, letters and editorials.

Data synthesis:

1,525 abstracts were obtained in the search, and 68 articles were selected for analysis. Of these, 49 articles were included in the review. The WC was the parameter more used in studies, followed by the WHR. Regarding NC, there are few studies in children. The predictive ability of WC and WHR to indicate central adiposity in children was controversial. The cutoff points suggested for the parameters varied among studies, and some differences may be related to ethnicity and lack of standardization of anatomical site used for measurement.

Conclusions:

More studies are needed to evaluate these parameters for determination of central obesity children. Scientific literature about NC is especially scarce, mainly in the pediatric population. There is a need to standardize site measures and establish comparable cutoff points between different populations.

Reliability of anthropometric measurements in European preschool children: the ToyBox-study

The ToyBox-study aims to develop and test an innovative and evidence-based obesity prevention programme for preschoolers in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. In multicentre studies, anthropometric measurements using standardized procedures that minimize errors in the data collection are essential to maximize reliability of measurements. The aim of this paper is to describe the standardization process and reliability (intra- and inter-observer) of height, weight and waist circumference (WC) measurements in preschoolers. All technical procedures and devices were standardized and centralized training was given to the fieldworkers. At least seven children per country participated in the intra- and inter-observer reliability testing. Intra-observer technical error ranged from 0.00 to 0.03 kg for weight and from 0.07 to 0.20 cm for height, with the overall reliability being above 99%. A second training was organized for WC due to low reliability observed in the first training. Intra-observer technical error for WC ranged from 0.12 to 0.71 cm during the first training and from 0.05 to 1.11 cm during the second training, and reliability above 92% was achieved. Epidemiological surveys need standardized procedures and training of researchers to reduce measurement error. In the ToyBox-study, very good intra- and-inter-observer agreement was achieved for all anthropometric measurements performed.

Dissociations among direct and indirect indicators of adiposity in young wrestlers

The purposes of this study were to: (a) examine the age-related patterns of differences in height (HT), body mass (BM), percent body fat (% fat), body mass index (BMI), and skinfolds (SF) in 11- to 18-year-old wrestlers; (b) determine the coherence of direct (% fat) and indirect (BMI and SFs) indicators of adiposity in the wrestlers; and (c) compare the age-related patterns and mean values for HT, BM, BMI, subscapular, and triceps SF for the wrestlers to those of national samples of boys from the National Health and Nutrition Examination Survey (NHANES) database. One hundred thirty wrestlers were divided into 8 independent yearly age groups (AG): AG11-AG18 years. Height, BM, BMI, subscapular SF, triceps SF, medial calf SF, thigh SF, sum of SFs, and % fat were assessed. There were no differences between the wrestlers and NHANES samples for age-related patterns of BMI (0.61 and 0.63 kg·m·y), subscapular SF (0.47 and 0.37 mm·y), or triceps SF (-0.31 and -0.39 mm·y). Furthermore, the wrestlers displayed no differences in % fat between age groups. The results indicated that: (a) dissociations existed between the direct and indirect indicators of adiposity; (b) the wrestlers were similar in height but had smaller upper-body SFs when compared with NHANES samples; and (c) participation in wrestling (1-8 years) had no adverse effects on the normal age-related growth patterns for HT, but favorable effects on measures of adiposity.

Agreement Analysis among Measures of Thinness and Obesity Assessment in Iranian School Children and Adolescents

Purpose

This study investigated the agreement of four anthropometric-based measurements including weight-for-height (WH), body mass index-for-age (BMI), mid-upper arm circumference-for-age (MUAC) and triceps skinfold thickness-for-age (TST) to identify underweight and overweight children and adolescents.

Methods

Two data sets were used in this research. The first one was a multistage random sample of 2397 healthy school children in pre-pubertal stage in Shiraz. The second data set consisted of 487 healthy students in pubertal stage and 558 students in post-pubertal stage. The parametric LMS method was used to construct reference centiles curves for each measure. The Kappa statistic was applied to examine the pairwise agreement of the four indices for detecting thinness and obesity.

Results

Generally, the pairwise agreement of adiposity measures was higher for identifying obesity than thinness. There was an excellent agreement between WH and BMI for detecting both thin and obese children in almost all subgroups (P<0.001). MUAC had an excellent agreement with BMI in pre-pubertal individuals (P<0.001). However, TST had a weak agreement with the other three indices for detecting thinness and weak to good agreement for classification of obesity.

Conclusion

The performance of the four anthropometric-based measurements varied by sex and maturity level. MUAC as a simple and low-cost screening tool can also be used as an alternative to BMI for obesity assessment among pre-pubertal groups.

Anthropometric parameters in screening for excess of adiposity in Argentinian and Spanish adolescents: evaluation using receiver operating characteristic (ROC) methodology

BACKGROUND

Various anthropometric parameters have been proposed for defining overweight in adolescence, but few studies have evaluated their diagnostic accuracy in comparative terms, using samples from different regions.

AIM

To compare the performance of anthropometric parameters in determining the excess of adiposity in Argentinian and Spanish adolescents.

SUBJECTS AND METHODS

The sample is composed of 1781 Argentinian and 1350 Spanish subjects, aged 12-17 years. Excess adiposity was defined as percentage BF in the 90th percentile or higher. ROC curves established the validity of parameters to define excess adiposity.

RESULTS

Descriptive statistics showed differences between the Argentinian and Spanish samples. ROC curves indicate that all the parameters analysed had, in the Spanish and Argentinian samples, a positive and elevated association with excess of adiposity. The waist-to-height ratio had the highest value of the area under ROC curve (AUC), while conicity index and waist-to-hip ratio had the lowest.

CONCLUSIONS

Differences exist with respect to size and body composition between the Argentinian and Spanish samples. ROC curves reflect a general pattern of variation. Waist-to-hip ratio and conicity index are less desirable in the diagnosis of excess adiposity and the most desirable is waist-to-height ratio.

Body mass index, waist circumference, body fat, fasting blood glucose in a sample of moroccan adolescents aged 11-17 years

Objectives. The study aimed to assess the relationship between body fat and each of body mass index (BMI) and waist circumference (WC), and to test the effectiveness of fat mass (FM), percent of body fat (PBF), BMI, and WC in predicting high levels of fasting blood glucose (FBG). Methods. A total of 167 adolescents aged 11–17 years were recruited from Rabat region. BMI and WC were determined using standard equipments. FM and PBF were derived from isotope dilution technique. FBG was determined by the hexokinase method. Results. Regardless of the weight status, BMI showed a strong positive correlation with FM and PBF in both genders. WC was significantly correlated with FM in boys and girls, and with PBF in different groups of girls and boys of the study sample. However, there was no significant relationship between WC and PBF in normal weight and overweight-obese groups of boys. FBG was highly correlated with FM and PBF in girls of the study sample and in overweight-obese girls. Similar significant relationship between FBG and both BMI and WC was observed in overweight-obese girls, while there was no significant association between FBG and other variables in boys and normal-weight girls. Conclusion. BMI and WC were closely associated with FM and PBF, respectively. However, the degree of these associations depends on gender and weight status. BMI may provide a better proxy estimate of overall adiposity than WC; nevertheless, both of them would appear to be a reasonable surrogate for FM and PBF as screening tools to identify adolescents at risk of developing excess body fat and high level of FBG.

Waist circumference and risk of elevated blood pressure in children: a cross-sectional study

Background

Increasing childhood obesity has become a major health threat. This cross-sectional study reports associations between schoolchildren's waist circumference (WC) and risk of elevated blood pressure.

Methods

We measured height, weight, neck and waist circumference, and blood pressure in regular health examinations among children in grade 1 (ages 6-7 years) at six elementary schools in Taipei County, Taiwan. Elevated blood pressure was defined in children found to have mean systolic or diastolic blood pressure greater than or equal to the gender-, age-, and height-percentile-specific 95th-percentile blood pressure value.

Results

All 2,334 schoolchildren were examined (response rate was 100% in the six schools). The mean of systolic and diastolic blood pressure increased as WC quartiles increased (p < 0.0001). The prevalence of elevated blood pressure for boys and girls within the fourth quartile of waist circumference was 38.9% and 26.8%, respectively. In the multivariate logistic regression analyses, the adjusted odds ratios of elevated blood pressure were 1.78 (95% confidence interval [CI] = 1.13-2.80), 2.45 (95% CI = 1.56-3.85), and 6.03 (95% CI = 3.59-10.1) for children in the second, third, and fourth waist circumference quartiles compared with the first quartile. The odds ratios for per-unit increase and per increase of standard deviation associated with elevated blood pressure were 1.14 (95% CI = 1.10-1.18) and 2.22 (95% CI = 1.76-2.78), respectively.

Conclusions

Elevated blood pressure in children was associated with waist circumference. Not only is waist circumference easier to measure than blood pressure, but it also provides important information on metabolic risk. Further research is needed on effective interventions to identify and monitor children with increased waist circumference to reduce metabolic and blood pressure risks.

A nutritional intervention study with hydrolyzed collagen in pre-pubertal spanish children: influence on bone modeling biomarkers

AIM

The aim of the study was to investigate the influence of dietary intake of commercial hydrolyzed collagen (Gelatine Royal) on bone remodeling in pre-pubertal children.

METHODS

A randomized double-blind study was carried out in 60 children (9.42 +/- 1.31 years) divided into three groups according to the amount of partially hydrolyzed collagen taken daily for 4 months: placebo (G-I, n=18), collagen (G-II, n=20) and collagen+calcium (G-III, n=22) groups. Analyses of the following biochemical markers were carried out: total and bone alkaline phosphatase (tALP and bALP), osteocalcin, tartrate-resistant acid phosphatase (TRAP), type I collagen carboxy-terminal telopeptide, lipids, calcium, 25-hydroxyvitamin D, insulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone, free thyroxin and intact parathormone.

RESULTS

There was a significantly greater increase in serum IGF-1 in G-III than in G-II (p < 0.01) or G-I (p < 0.05) during the study period, and a significantly greater increase in plasma tALP in G-III than in G-I (p < 0.05). Serum bALP behavior significantly (p < 0.05) differed between G-II (increase) and G-I (decrease). Plasma TRAP behavior significantly differed between G-II and G-I (p < 0.01) and between G-III and G-II (p < 0.05).

CONCLUSION

Daily dietary intake of hydrolyzed collagen seems to have a potential role in enhancing bone remodeling at key stages of growth and development.

Validity of body mass index and waist circumference to detect excess fat mass in children aged 7-14 years

BACKGROUND/OBJECTIVES

To evaluate the screening performance of body mass index (BMI) and waist circumference (WC) for excess adiposity. In addition, the diagnostic accuracy of cutoffs from different international and national reference systems based on BMI and WC was investigated.

SUBJECTS/METHODS

Data from 2132 Jena children aged 7-14 years conducted in 2005/2006 were analyzed. Receiver operating characteristic (ROC) curves were constructed to assess BMI and WC, as screening measures for excess adiposity (derived from skinfolds). Sensitivity, specificity and positive predictive values (PPVs) were calculated for two BMI-based classification systems (IOTF and German reference) and sample-based WC cutoffs.

RESULTS

The BMI as well as the WC performed well in detecting excess fat mass, indicated by areas under the ROC curve (AUC) close to 1.0, with slightly greater AUCs for BMI than for WC in both sexes. The specificity of all reference systems was high for both sexes (95 to 98%). However, their sensitivities were low (53-67% in boys; 51-67% in girls). PPV were higher for the German reference and the sample-based WC cutoffs than for the IOTF reference, and higher in girls than in boys.

CONCLUSIONS

The setting in which the reference system should be used is important for the selection of the reference system. The results support the use of the BMI-based references for monitoring in epidemiological studies. The sample-based cutoffs for WC should be refined for clinical use on national level.

Nationally representative waist circumference percentiles in German adolescents aged 11.0-18.0 years

OBJECTIVE

The aim of this study was to develop age- and sex-specific percentile curves for waist circumference (WC) in German adolescents.

METHODS

A cross-sectional population-based study (German Health Interview and Examination Survey for Children and Adolescents [KiGGS]) was carried out in a large nationally representative sample of 3 345 males and 3 221 females aged 11.0 to 18.0 years from May 2003 to May 2006. Smoothed percentile curves of WC were derived by the LMS method.

RESULTS

Girls had lower WC values than boys at any age and percentile. WC increased with age in both boys and girls. The curves show a fairly linear pattern for males, but for females they begin to level off after the age of 13 years.

CONCLUSIONS

The presented WC percentile curves are based on a representative sample of adolescents living in Germany and standardized measurements. We propose their use for clinical practice to monitor abdominal obesity in adolescents, although there is a need for future studies correlating cut-offs with health outcomes. The German curves could contribute to the feasibility of combining representative data from several countries to establish an international reference for WC.

Antropometria como ferramenta de avaliação do estado nutricional coletivo de adolescentes

A antropometria tem sido apontada como o parâmetro mais indicado para avaliar o estado nutricional coletivo. A avaliação nutricional coletiva de adolescentes possui uma dinâmica muito peculiar por se tratar de um momento de intensas mudanças fisiológicas e psicossociais, diretamente associadas à dinâmica nutricional deste grupo. O acompanhamento dessa dinâmica e de suas variáveis intervenientes e interativas é, portanto, um tema de discussão extremamente relevante. Esta revisão tem por objetivo apresentar as aplicações de parâmetros antropométricos à avaliação do estado nutricional de adolescentes. Conclui-se que, enquanto não houver metodologia simples de avaliação da composição corporal, para estudos epidemológicos deve-se manter o uso do índice de massa corporal, associado ou não às variáveis de dobra cutânea e perímetros. Apesar das dificuldades e limitações, as evidências apontam para uma fundamental incorporação das informações sobre a maturação sexual à avaliação do estado nutricional coletivo de adolescentes. Além disso, as investigações devem atentar mais aos parâmetros de definição da população que estará sendo estudada, cuidando, para permitir a comparação entre os estudos.

Neck circumference: an additional tool of screening overweight and obesity in childhood

Obesity, particularly in the upper part of body, is a major health problem. Central obesity is related to cardiovascular disease and metabolic disorders. There are various techniques for assessing upper body fat content for the overweight and obese subjects other than waist circumference (WC). We tried to find out if neck circumference (NC) alone can be used to assess overweight and obesity. Four hundred twelve overweight and obese patients (208 girls and 204 boys) and 555 healthy children (284 girls and 271 boys) aged 6-18 years were recruited for this present study. There were significant and positive correlations between BMI-WC, BMI-NC, and WC-NC (p < 0.001). NC cutoffs for overweight and obesity were determined for each age and pubertal period. NC cutoffs of boys were increased from 28.0 to 38.0. This range was 27.0-34.5 for girls in the same range. We also calculated NC cutoffs for prepubertal and pubertal periods (respectively, 29.0 and 32.5 for boys and 28.0-31.0 for girls).

CONCLUSION

NC is a reliable and easy to use tool to determine overweight and obesity in children, and NC is not as good as WC in determining overweight and obesity, both providing similar information.

Reference curves for triceps and subscapular skinfold thicknesses in US children and adolescents

BACKGROUND

Skinfold thicknesses have long been considered important and valid measurements of subcutaneous fat. Nevertheless, there are no current skinfold reference data for US children and adolescents.

OBJECTIVE

We developed new percentile reference curves for triceps and subscapular skinfold thicknesses by using the same national samples as those included in the reference curves for body mass index (BMI) in the Centers for Disease Control and Prevention 2000 Growth Charts.

DESIGN

We included triceps and subscapular skinfold-thickness measurements for 32,783 individuals who also had complete data for BMI. The LMS method was used to derive 10 smoothed skinfold-thickness percentile reference curves and to generate the L, M, and S parameters that allow the calculation of standardized z scores.

RESULTS

The new reference curves exhibit established age- and sex-related patterns of development, including dramatic prepubescent increases in subcutaneous fatness in boys at the highest percentiles. Comparisons of smoothed medians for race-ethnicity groups confirm greater subcutaneous fatness in white children than in black age mates at the triceps site but similar median subscapular skinfold thicknesses. Median skinfold thicknesses for children considered overweight (> or =85th percentile) or obese (> or =95th percentile) on the basis of BMI cutoffs do not follow closely the skinfold percentile reference channels across age, especially in boys, which suggests a certain degree of independence between BMI and skinfold thickness at the upper extremes of the BMI distribution.

CONCLUSIONS

The age- and sex-standardized skinfold percentiles and z scores will be appropriate for a wide range of research applications that consider measures of subcutaneous fat. Because they were developed by using the same children as those used for the 2000 BMI curves of the Centers for Disease Control and Prevention, they provide an important new complementary assessment tool that should be appropriate for almost all US children and adolescents.

Challenges of accurately measuring and using BMI and other indicators of obesity in children

BMI is an important indicator of overweight and obesity in childhood and adolescence. When measurements are taken carefully and compared with appropriate growth charts and recommended cutoffs, BMI provides an excellent indicator of overweight and obesity that is sufficient for most clinical, screening, and surveillance purposes. Accurate measurements of height and weight require that adequate attention be given to data collection and management. Choosing appropriate equipment and measurement protocols and providing regular training and standardization of data collectors are critical aspects that apply to all settings in which BMI will be measured and used. Proxy measures for directly measured BMI, such as self-reports or parental reports of height and weight, are much less preferred and should only be used with caution and cognizance of the limitations, biases, and uncertainties attending these measures. There is little evidence that other measures of body fat such as skinfolds, waist circumference, or bioelectrical impedance are sufficiently practicable or provide appreciable added information to be used in the identification of children and adolescents who are overweight or obese. Consequently, for most clinical, school, or community settings these measures are not recommended for routine practice. These alternative measures of fatness remain important for research and perhaps in some specialized screening situations that include a specific focus on risk factors for cardiovascular or diabetic disease.

Relation of body mass index and skinfold thicknesses to cardiovascular disease risk factors in children: the Bogalusa Heart Study

BACKGROUND

Adverse levels of cardiovascular disease (CVD) risk factors are related to skinfold thicknesses and body mass index (BMI) among children, but the relative strengths of these associations are unknown.

OBJECTIVE

The objective was to determine whether the sum of the triceps and subscapular skinfold thicknesses (SF sum) is more strongly related to levels of 6 risk factors (triglycerides, LDL and HDL cholesterol, insulin, and systolic and diastolic blood pressure) than is BMI.

DESIGN

Cross-sectional analyses of schoolchildren examined in the Bogalusa Heart Study from 1981 to 1994 (n = 6866) were conducted. A risk factor summary index was derived by using principal components analysis.

RESULTS

After race, sex, study period, and age were controlled for, almost all comparisons indicated that BMI was more strongly related to risk factor levels than was the SF sum. Although the differences were generally small, many were statistically significant. Associations with the risk factor summary, for example, were r = 0.50 for BMI and r = 0.47 for SF sum (P < 0.001 for difference). Furthermore, an adverse risk factor summary was observed among 62% of the children with the highest (upper 5%) BMI levels but among only 54% of children with the highest SF sum levels.

CONCLUSIONS

BMI is at least as accurate as SF sum in identifying children and adolescents who are at metabolic risk. Because of the training and errors associated with skinfold-thickness measurements, the advantages of BMI should be considered in the design and interpretation of clinical and epidemiologic studies.

Harmonization process and reliability assessment of anthropometric measurements in a multicenter study in adolescents

OBJECTIVE

To describe the standardization process and reliability of anthropometric and bioelectrical impedance analysis (BIA) measurements. We examined both intra- and interobserver errors for skinfolds, circumferences and BIA.

METHODS

For the intraobserver error assessment, first of all, 202 adolescents in the pilot study (110 boys, 92 girls, aged 13.64+/-0.78 years) were assessed. For the second intraobserver and interobserver assessments, 10 adolescents were studied (5 boys and 5 girls).

RESULTS

The pilot study's intraobserver technical errors of measurement (TEMs) were between 0.12 and 2.9 mm for skinfold thicknesses, and between 0.13 and 1.75 cm for circumferences. Intraobserver reliability for skinfold thicknesses was greater than 69.44% and beyond 78.43% for circumferences. The final workshop's intraobserver TEMs for skinfold thicknesses and circumferences were smaller than 1; for BIA resistance TEMs were smaller than 0.1 Omega and for reactance they were smaller than 0.2 Omega. Intraobserver reliability values were greater than 95, 97, 99 and 97% for skinfold thicknesses, circumferences, BIA resistance and reactance, respectively. Interobserver TEMs for skinfold thicknesses and circumferences ranged from 1 to 2 mm; for BIA they were 1.16 and 1.26 Omega for resistance and reactance, respectively. Interobserver reliability for skinfold thicknesses and circumferences were greater than 90%, and for BIA resistance and reactance they were greater than 90%.

CONCLUSIONS

After the results of the pilot study, it was necessary to optimize the quality of the anthropometric measurements before the final survey. Significant improvements were observed in the intraobserver reliabilities for all measurements, with interobserver reliabilities being higher than 90% for most of the measurements.The Healthy Lifestyle in Europe by Nutrition in Adolescence Study aims to describe total body fat percentage and anthropometric indices of body fat distribution in European adolescents.

Truncal and abdominal fat as determinants of high triglycerides and low HDL-cholesterol in adolescents

We examined whether abdominal and truncal adiposity, assessed with simple anthropometric indices, determines serum triglycerides and high-density lipoprotein (HDL)-cholesterol levels independently of total adiposity amount in adolescents. A total of 547 Spanish adolescents (284 males and 263 females) aged 13-18.5 years were included in this study. Measures of truncal adiposity included subscapular to triceps ratio, and trunk-to-total skinfolds ratio (TTS%). Waist circumference was used as a surrogate of abdominal adiposity, and BMI was used as a measure of total adiposity. The results of the regression models indicated that levels of triglycerides were positively associated with waist circumference and TTS% after controlling for age and Tanner stage in both sexes. Once BMI was entered in the model, these associations remained significant for waist circumference in females. HDL-cholesterol levels were negatively associated with waist circumference in both sexes, and with subscapular to triceps ratio and TTS% in males, after controlling for age and Tanner stage. Once BMI was entered in the model, these associations remained significant for subscapular to triceps ratio and for TTS% in males. The results of this study suggest that in male adolescents, truncal adiposity is negatively associated with levels of HDL-cholesterol, whereas in females, abdominal adiposity is positively associated with levels of triglycerides independently of total adiposity. These findings highlight the deleterious effect of both truncal and abdominal fat depots on the lipid profile already from the first decades of life.

Nutritional status of an economically-privileged convenience sample of urban children in Guatemala City

BACKGROUND

The worldwide pandemic of overweight and obesity has now reached low-income tropical societies.

OBJECTIVE

To determine whether overweight or obesity is present among children from middle-class Guatemala City homes.

METHODS

A total of 363 children, 173 boys and 190 girls aged 72-131 months, were included for height, weight, and abdominal circumference at its narrowest point (natural waist).

RESULTS

Overall, 58.6% of subjects presented a body mass index within the normal Center for Disease Control and Prevention curve limits, whereas 3.9% fell below this range (low weight), 17.4% were in the risk of overweight range, and 20.1% were classified as overweight. The mean natural waist circumference was 62.6+/-0.9 cm. The waist-circumference-to-height ratio had a median of 0.47, with 36.9% of all children having a waist-circumference-to-height ratio exceeding the proposed 0.5 upper limit.

CONCLUSIONS

Nutrition transition has reached the juvenile population of this Central American republic, at least in its urban, privileged groups.

Metabolic risk-factor clustering estimation in obese children

The purpose of this study was to apply the new approach for Metabolic Individual Risk-factor And Clustering Estimation (MIRACLE) score in a group of Spanish obese children and adolescents and to describe its relationship with other metabolic risk factors. 153 children with simple obesity were studied: 79 males and 74 females, mean age 11.2 +/- 2.2. Obesity was defined when BMI was higher than the age and sex specific equivalent to 30 kg/m2 in adults. MIRACLE score included: family history (early cardiovascular disease, type 2 diabetes, and hypertension), individual history (small for gestational age and ethnic origin), clinical features (BMI, waist circumference > 90th percentile and blood pressure > 95th percentile) and metabolic abnormalities (glucose intolerance or type 2 diabetes). It was assigned a value of 1 to "presence" and 0 to" absence" in every patient. The children were considered as having metabolic risk when at least 5 items were present. Triglycerides, HDL-cholesterol, apolipoprotein B, apolipoprotein A1, glucose and HOMA index, were measured too. The most frequent clinical features of MIRACLE score were: excess waist circumference (95.4%) and hypertension (41.8%). Family history criteria were frequent (55.3% for type 2 diabetes, 39.1% for hypertension and 31.3% for early cardiovascular disease). Individual risk factors were not frequent. Glucose intolerance was detected in 22.2% of the obese patients. A MIRACLE score > or = 5 was found in 37.4% of the children studied, being associated with a significant risk of dyslipidemia (triglycerides, p = 0.040; HDL-cholesterol, p = 0.006; LDL-cholesterol p = 0.038; apolipoprotein B, p = 0.008) only in females. In conclusion, the MIRACLE score is useful in order to detect metabolic risk in obese children but it seems necessary to improve the score, by including other features of the metabolic syndrome like lipid profile or indirect indicators of insulin resistance.