Height-adjusted percentiles evaluated central obesity in children and adolescents more effectively than just waist circumference

Associations of residential greenness with peripheral and central obesity in China

BACKGROUND

Obesity is a well-known risk factor for public health. Recent studies found that greenness exposure may protect against obesity. However, the accumulated evidence on associations of greenness-obesity is inconsistent and most of them are from developed countries.

OBJECTIVES

This study aimed to evaluate the associations of greenness exposure with indicators of peripheral and central obesity.

METHODS

This cross-sectional study was based on a Chinese national Sub-Clinical Outcomes of Polluted Air (SCOPA) prospective cohort across 15 provinces, and 5849 participants with average age of 64.7 were included. Surrounding greenness was estimated with the Enhanced Vegetation Index (EVI), which was calculated at each participant's residential addresses within a 250 m buffer. Weight, height and waist circumference (WC) were measured, and body mass index (BMI) and the waist-to-height ratio% (WHtR%) were calculated based on those measurements. The relationships between EVI and obese outcomes were explored using multiple linear regression and logistic regression models.

RESULTS

Non-linear associations were observed between EVI and obese indicators. Participants living in Quartile 3 benefited more than in Quartile 4 compared to the lowest quartile (Quartile 1) of greenness. For peripheral obesity, participants living in Quartile 3 of EVI_250m had 0.86 kg/m² (β -0.86, 95% CI: -1.10, -0.61) lower BMI, and 46% (OR 0.54, 95% CI: 0.44-0.66) lower odds of peripheral obesity than in Quartile 1. For central obesity, participants living in Quartile 3 of EVI_250m had 1.85 cm (β -1.85, 95% CI: -2.54, -1.15) lower waist circumference, 1.12% (β -1.12, 95% CI: -1.56, -0.67) lower waist-to-height ratio% (WHtR%), and 33% (OR 0.67, 95% CI: 0.57-0.78) lower odds of central obesity than in Quartile 1 of EVI_250m.

CONCLUSIONS

Higher levels of greenness were statistically significant associated with lower obesity risk.

Diagnosis of Waist Muscle Injury after Exercise Based on High-Frequency Ultrasound Image

The low back is the weight-bearing part of the human trunk and has a complex anatomy with a variety of lesions. The traditional diagnostic imaging methods include X-ray, CT, and magnetic resonance imaging (MRI). With the rapid development of ultrasound diagnostic instruments and diagnostic techniques, high-frequency ultrasonography plays a more important role in the diagnosis of musculoskeletal disorders by virtue of its advantages of being safe, noninvasive, inexpensive, repeatable in a short period of time, and real-time imaging, especially for the display of fine structures of soft tissues, which is superior to CT and MRI. In this paper, the puncture needle was punctured near the intervertebral foramen, anti-inflammatory analgesics were injected under ultrasound surveillance. The anti-inflammatory and analgesic drugs mainly consist of local anesthetics and glucocorticoids. Local anesthetics can immediately block the nociceptive transmission of the diseased nerve, improve muscle tension, and eliminate muscle spasm, and glucocorticoids can effectively eliminate edema and inflammation of the lumbar nerve root and its surrounding tissues. The results showed that high-frequency ultrasound, as a noninvasive imaging examination, can clearly display the structure and spatial hierarchy of the skin, superficial fascia, deep fascia, and muscles of the low back, can provide real-time dynamic bilateral contrast observation, which can be the preferred imaging examination method for soft tissue disorders of the low back, and can compensate with general X-ray, CT, and magnetic resonance imaging to provide richer clinical diagnosis and treatment. It can provide richer imaging information for clinical diagnosis and treatment.

Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome

The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.

A combination of mesenchymal stem cells and scaffolds promotes motor functional recovery in spinal cord injury: a systematic review and meta-analysis

OBJECTIVE

There is controversy about the role of scaffolds as an adjunctive therapy to mesenchymal stem cell (MSC) transplantation in spinal cord injury (SCI). Thus, the authors aimed to design a meta-analysis on preclinical evidence to evaluate the effectiveness of combination therapy of scaffold + MSC transplantation in comparison with scaffolds alone and MSCs alone in improving motor dysfunction in SCI.

METHODS

Electronic databases including Medline, Embase, Scopus, and Web of Science were searched from inception until the end of August 2018. Two independent reviewers screened related experimental studies. Animal studies that evaluated the effectiveness of scaffolds and/or MSCs on motor function recovery following experimental SCI were included. The findings were reported as standardized mean difference (SMD) and 95% confidence interval (CI).

RESULTS

A total of 34 articles were included in the meta-analysis. Analyses show that combination therapy in comparison with the scaffold group alone (SMD 2.00, 95% CI 1.53-2.46, p < 0.0001), the MSCs alone (SMD 1.58, 95% CI 0.84-2.31, p < 0.0001), and the nontreated group (SMD 3.52, 95% CI 2.84-4.20, p < 0.0001) significantly improved motor function recovery. Co-administration of MSCs + scaffolds only in the acute phase of injury (during the first 3 days after injury) leads to a significant recovery compared to scaffold alone (SMD 2.18, p < 0.0001). In addition, the cotransplantation of scaffolds with bone marrow-derived MSCs (SMD 1.99, p < 0.0001) and umbilical cord-derived MSCs (SMD 1.50, p = 0.001) also improved motor function following SCI.

CONCLUSIONS

The findings showed that scaffolds + MSCs is more effective than scaffolds and MSCs alone in improving motor function following SCI in animal models, when used in the acute phase of injury.

Post-2000 growth trajectories in children aged 4-11 years: A review and quantitative analysis

Children's body mass index (BMI) growth trajectories are associated with adult health outcomes, and vary by geography and epoch. Understanding these trajectories could help to identify high risk children and thus support improved health outcomes. In this review, we compare and quantitatively analyse BMI level and trajectory data published since 2010. We characterise recent growth in children aged 4-11 years, an age range most frequently targeted for BMI intervention, yet less studied than young childhood or infancy. Through searches in OVID, we identified 54 relevant texts which describe either post-2000 summary BMI values by age and gender in cohorts with sample sizes of over 1000 children, or the results of latent class analyses of BMI trajectories within the 4-11 year age range. Population level median growth curves were projected and visualised as weighted means. These BMI curves, based on data from 729,692 children, can be visually clustered into 'high' and 'low' charting groups with extreme outlying values. Within populations, latent class analyses converge on 3-4 individual child trajectories, two of which predispose adult overweight. These growth pathways diverge early in childhood, yet are not effectively distinguished via isolated BMI measurements taken between 4 and 11 years, meaning some high risk children may currently be poorly identified.

The impact of IGF-I, puberty and obesity on early retinopathy in children: a cross-sectional study

Background

Childhood obesity has been correlated with coronary heart disease, but the correlation with microvascular disease remains unclear. The retinal microcirculation is affected early in the process of atherosclerosis and it offers the opportunity to indirectly study the effects of obesity on small brain vessels. Insulin-like growth factor 1 (IGF-I) is involved in angiogenesis and it has a crucial role in retinal vascularization.

Methods

A single-centre cross-sectional study was performed in 268 children and adolescents (116 males; mean age 13.03 ± 1.9 years,) with overweight/obesity, in order to identify risk factors for early retinopathy.

Results

Nine patients (3.3%) showed signs of retinopathy, defined as arteriovenous crossings and/or papilledema. Body mass index and fat mass, analysed by Dual X-ray Absorptiometry, were not different in patients with or without retinopathy. Patients with retinopathy were pubertal and showed higher waist circumference (107.78 ± 15.83 versus 99.46 ± 10.85 cm; p: 0.027), waist circumference/height ratio (0.66 ± 0.07 versus 0.62 ± 0.05; p: 0.04) and IGF-I SDS (0.03 ± 1.3 versus − 0.66 ± 0.9; p: 0.04). Multivariate analysis (after correction for sex, age, family history of type 2 diabetes mellitus, obesity, cardiovascular disease, hypertension and dyslipidaemia) showed that waist circumference/height ratio and IGF-I SDS were the only variables independently correlated with the presence of retinopathy.

Conclusions

Retinal vascular changes may become evident as an early complication of overweight and obesity, even during childhood and adolescence. Relatively high levels of IGF-I during this phase may act as an additional risk factor for microvascular damage. The screening for retinopathy should be proposed to all children and adolescents with overweight/obesity.

Validation of equations and proposed reference values to estimate fat mass in Chilean university students

OBJECTIVES

(i) To propose regression equations based on anthropometric measures to estimate fat mass (FM) using dual energy X-ray absorptiometry (DXA) as reference method, and (ii)to establish population reference standards for equation-derived FM.

MATERIAL AND METHODS

A cross-sectional study on 6,713 university students (3,354 males and 3,359 females) from Chile aged 17.0 to 27.0years. Anthropometric measures (weight, height, waist circumference) were taken in all participants. Whole body DXA was performed in 683 subjects. A total of 478 subjects were selected to develop regression equations, and 205 for their cross-validation. Data from 6,030 participants were used to develop reference standards for FM. Equations were generated using stepwise multiple regression analysis. Percentiles were developed using the LMS method.

RESULTS

Equations for men were: (i) FM=-35,997.486 +232.285 *Weight +432.216 *CC (R²=0.73, SEE=4.1); (ii)FM=-37,671.303 +309.539 *Weight +66,028.109 *ICE (R2=0.76, SEE=3.8), while equations for women were: (iii)FM=-13,216.917 +461,302 *Weight+91.898 *CC (R²=0.70, SEE=4.6), and (iv) FM=-14,144.220 +464.061 *Weight +16,189.297 *ICE (R²=0.70, SEE=4.6). Percentiles proposed included p10, p50, p85, and p95.

CONCLUSION

The developed equations provide valid and accurate estimation of FM in both sexes. The values obtained using the equations may be analyzed from percentiles that allow for categorizing body fat levels by age and sex.

Age-Period-Cohort Analysis of Obesity and Overweight in Iranian Children and Adolescents

BACKGROUND

To date, few studies looked upon obesity and overweight in children and adolescents through the 3 different temporal dimensions of age, period, and cohort. The current study aimed at evaluating the trends of these health issues among children under 19 years old using the age-period-cohort (APC) analysis.

METHODS

Data gathered through 5 cross sectional studies including 2 national health surveillance (1990 - 91 and 1999), and 3 CASPIAN surveys (2003, 2009, and 2011). Subjects were classified by their body mass index (BMI) into 3 groups of normal (BMI < 85th percentile), overweight-obese (85th percentile < BMI < 95th percentile), and obese (95th percentile < BMI). Intrinsic estimator method was used to analyze the effects of age, period, and birth cohort on obesity and overweight among the subjects.

RESULTS

A total of 80,698 children and adolescents under 19 years old, including 40,419 (50.09%) males and 40,279 (49.91%) females, were evaluated. The prevalence of obesity decreased progressively by age in males and females with minor discrepancies. It increased from 1990 to 2009 in both genders, but from that point on remained quite constant in males and dropped significantly in females. The prevalence of obesity was steady in earlier birth cohorts, but increased significantly after the birth cohorts from 1986 to 1990.

CONCLUSIONS

Environmental factors and social stresses during neonatal and infantile periods (birth cohort effect) along with other variables influencing the children later in their lives (period effect) affect the prevalence of overweight and obesity substantially. Moreover, a decrease in the prevalence of obesity and overweight was observed by age increase (age effect).

Neck Circumference Percentiles of Iranian Children and Adolescents: The Weight Disorders Survey of CASPIAN IV Study

BACKGROUND

Neck circumference (NC), emerging as a key morphological index for pediatric obesity, is associated with obesity- and overweight-related detrimental conditions in children. In this study, we aimed to provide the age- and sex-specific percentile reference values for neck circumference of the Iranian children and adolescents.

METHODS

We used the data gathered through the weight disorders survey of CASPIAN IV study conducted in 2011 - 2012 in Iran, including a total of 21954 Iranian children and adolescents, composed of 10750 girls and 11204 boys, aged 7 - 18 years old. We presented the interval of NC percentile in three age groups of 7 - 10 years, 11 - 14 years, and 15 - 18 years. Finally, age-specific nomograms of NC for both genders in the Iranian and Canadian populations were compared.

RESULTS

The intervals of 90th percentile of NC for boys in the three periods of school age (7 - 10 years), pre-adolescence (11 - 14 years), and adolescence (15 - 18 years) were 24.2 - 30.0 cm, 26.6 - 33.2 cm, and 30.1 - 38.5 cm, respectively. These intervals for girls were 23.7 - 30.1 cm, 26.5 - 33.7 cm, and 28.5 - 36.0 cm, respectively. NC increased with age in both boys and girls and its variability showed an increasing trend with age.

CONCLUSIONS

We demonstrated for the first time the NC reference values for the Iranian children and adolescents aged 7 - 18 years old. Considering the significant differences between our national NC references and the values reported from the Canadian population, it seems logical to use these national percentiles not only for epidemiologic studies but also for routine clinical examinations.