Body Size and Cardiovascular Risk Factors in a Preschool Population

Birth History and Cardiovascular Disease Risk Among Youth With Significant Obesity

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

The Relative Reinforcing Value of Cookies Is Higher Among Head Start Preschoolers With Obesity

The relative reinforcing value (RRV) of food measures how hard someone will work for a high-energy-dense (HED) food when an alternative reward is concurrently available. Higher RRV for HED food has been linked to obesity, yet this association has not been examined in low-income preschool-age children. Further, the development of individual differences in the RRV of food in early childhood is poorly understood. This cross-sectional study tested the hypothesis that the RRV of HED (cookies) to low-energy-dense (LED; fruit) food would be greater in children with obesity compared to children without obesity in a sample of 130 low-income 3- to 5-year-olds enrolled in Head Start classrooms in Central Pennsylvania. In addition, we examined individual differences in the RRV of food by child characteristics (i.e., age, sex, and reward sensitivity) and food security status. The RRV of food was measured on concurrent progressive-ratio schedules of reinforcement. RRV outcomes included the last schedule reached (breakpoint) for cookies (cookie Pmax) and fruit (fruit Pmax), the breakpoint for cookies in proportion to the total breakpoint for cookies and fruit combined (RRV cookie), and response rates (responses per minute). Parents completed the 18-item food security module to assess household food security status and the Behavioral Activation System scale to assess reward sensitivity. Pearson's correlations and mixed models assessed associations between continuous and discrete child characteristics with RRV outcomes, respectively. Two-way mixed effects interaction models examined age and sex as moderators of the association between RRV and Body Mass Index z-scores (BMIZ). Statistical significance was defined as p < 0.05. Children with obesity (17%) had a greater cookie Pmax [F (1, 121) = 4.95, p = 0.03], higher RRV cookie [F (1, 121) = 4.28, p = 0.04], and responded at a faster rate for cookies [F (1, 121) = 17.27, p < 0.001] compared to children without obesity. Children with higher cookie response rates had higher BMIZ (r = 0.26, p < 0.01); and RRV cookie was positively associated with BMIZ for older children (5-year-olds: t = 2.40, p = 0.02) and boys (t = 2.55, p = 0.01), but not younger children or girls. The RRV of food did not differ by household food security status. Low-income children with obesity showed greater motivation to work for cookies than fruit compared to their peers without obesity. The RRV of HED food may be an important contributor to increased weight status in boys and future research is needed to better understand developmental trajectories of the RRV of food across childhood.

Clinic and Home-Based Behavioral Intervention for Obesity in Preschoolers: A Randomized Trial

OBJECTIVE

To test the hypotheses that an innovative skills-based behavioral family clinic and home-based intervention (LAUNCH) would reduce body mass index z score (BMIz) compared with motivational interviewing and to standard care in preschool-aged children with obesity.

STUDY DESIGN

Randomized controlled trial with children between the ages of 2 and 5 years above the 95^th percentile for body mass index for age and sex recruited from 27 pediatrician offices across 10 recruitment cycles between March 12, 2012 and June 8, 2015. Children were randomized to LAUNCH (an 18-session clinic and home-based behavioral intervention), motivational interviewing (delivered at the same frequency as LAUNCH), or standard care (no formal intervention). Weight and height were measured by assessors blinded to participant assignment. The primary outcome, BMIz at month 6 after adjusting for baseline BMIz, was tested separately comparing LAUNCH with motivational interviewing and LAUNCH with standard care using regression-based analysis of covariance models.

RESULTS

A total of 151 of the 167 children randomized met intent-to-treat criteria and 92% completed the study. Children were 76% White and 57% female, with an average age of 55 months and BMI percentile of 98.57, with no demographic differences between the groups. LAUNCH participants demonstrated a significantly greater decrease in BMIz (mean = -0.32, SD = ±0.33) compared with motivational interviewing (mean = -0.05, SD = ±0.27), P < .001, ω² = 0.74 and compared with standard care (mean = -0.13, SD = ±0.31), P < .004, ω² = 0.75.

CONCLUSIONS

In preschool-age children, an intensive 6-month behavioral skills-based intervention is necessary to reduce obesity.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01546727.

The Longitudinal Association Between Early Childhood Obesity and Fathers' Involvement in Caregiving and Decision-Making

OBJECTIVE

Fathers have increased their involvement in child caregiving; however, their changing role in childhood obesity is understudied. This study assessed the longitudinal association between changes in obesity among children aged 2 to 4 years and changes in fathers' involvement with raising children.

METHODS

Longitudinal data from the Early Childhood Longitudinal Study-Birth Cohort were used to conduct child fixed-effects linear and logistic regression analyses to assess the association between changes in childhood obesity-related outcomes (sugar-sweetened beverage consumption, screen time, BMI z score, overweight/obesity, obesity) and fathers' involvement with raising children (caregiving and influencing child-related decisions). Fixed-effects models control for all time-invariant characteristics. Analyses were controlled for time-varying confounders, including child age, maternal and paternal employment, and family poverty status.

RESULTS

Children whose fathers increased their frequency of taking children outside and involvement with physical childcare experienced a decrease in their odds of obesity from age 2 to age 4. Obesity-related outcomes were not associated with fathers' decision-making influence.

CONCLUSIONS

Increases in fathers' involvement with some aspects of caregiving may be associated with lower odds of childhood obesity. Encouraging fathers to increase their involvement with raising children and including fathers in childhood obesity prevention efforts may help reduce obesity risk among young children.

Effect of maternal zinc supplementation on the cardiometabolic profile of Peruvian children: results from a randomized clinical trial

Zinc is an essential micronutrient for the development of the fetal renal, cardiovascular and metabolic systems; however, there is limited evidence of its effects on the postnatal cardiometabolic function. In this study, we evaluated the effect of maternal zinc supplementation during pregnancy on the cardiometabolic profile of the offspring in childhood. A total of 242 pregnant women were randomly assigned to receive a daily supplement containing iron+folic acid with or without zinc. A follow-up study was conducted when children of participating mothers were 4.5 years of age to evaluate their cardiometabolic profile, including anthropometric measures of body size and composition, blood pressure, lipid profile and insulin resistance. No difference in measures of child cardiometabolic risk depending on whether mothers received supplemental zinc during pregnancy. Our results do not support the hypothesis that maternal zinc supplementation reduces the risk of offspring cardiometabolic disease.

Federal Food Assistance Programs and Cardiovascular Risk Factors in Low-Income Preschool Children

Childhood obesity remains a significant public health concern. Children from lower income households have a greater risk of being obese. Low-income families generally have less access to healthy, affordable food choices and turn to federal food assistance programs. Few studies have examined the impact of food assistance programs on childhood obesity rates. This study explored the association between BMI, blood lipid levels, and three food assistance programs (WIC, reduced lunch, and food stamps) in a sample of predominantly low-income, minority preschool children enrolled in a city-wide preschool program. Screenings were performed at on-site health fairs conducted at nine schools in disadvantaged areas. Screenings included vital signs, a finger stick, head-to-toe exam, vision screening, dental screening, and hearing screening. Of the sample of 229 preschool children, 23.1 % were obese, almost three times the national rate in preschoolers. Children whose families received WIC benefits weighed significantly less than those who did not receive benefits. In addition, 20.6 % of the children screened had elevated systolic blood pressures. Of the sample, 33 % had unhealthy triglyceride levels and 46 % had unhealthy HDL levels with those that received WIC benefits having significantly lower levels of LDL cholesterol This study confirms that low-income, minority children in the South continue to be disproportionately affected by overweight and obesity. In addition, the results of this study indicate WIC as a potential public health initiative to combat the childhood obesity epidemic and reduce other cardiovascular risk factors, such as blood lipids and blood pressure.

Association between anthropometric indices and cardiometabolic risk factors in pre-school children

BACKGROUND

The world health organization (WHO) and the Identification and prevention of dietary- and lifestyle-induced health effects in children and infants- study (IDEFICS), released anthropometric reference values obtained from normal body weight children. This study examined the relationship between WHO [body mass index (BMI) and triceps- and subscapular-skinfolds], and IDEFICS (waist circumference, waist to height ratio and fat mass index) anthropometric indices with cardiometabolic risk factors in pre-school children ranging from normal body weight to obesity.

METHODS

A cross-sectional study with 232 children (aged 4.1 ± 0.05 years) was performed. Anthropometric measurements were collected and BMI, waist circumference, waist to height ratio, triceps- and subscapular-skinfolds sum and fat mass index were calculated. Fasting glucose, fasting insulin, homeostasis model analysis insulin resistance (HOMA-IR), blood lipids and apolipoprotein (Apo) B-100 (Apo B) and Apo A-I were determined. Pearson's correlation coefficient, multiple regression analysis and the receiver-operating characteristic (ROC) curve analysis were run.

RESULTS

51% (n = 73) of the boys and 52% (n = 47) of the girls were of normal body weight, 49% (n = 69) of the boys and 48% (n = 43) of the girls were overweight or obese. Anthropometric indices correlated (p < 0.001) with insulin: [BMI (r = 0.514), waist circumference (r = 0.524), waist to height ratio (r = 0.304), triceps- and subscapular-skinfolds sum (r = 0.514) and fat mass index (r = 0.500)], and HOMA-IR: [BMI (r = 0.509), waist circumference (r = 0.521), waist to height ratio (r = 0.296), triceps- and subscapular-skinfolds sum (r = 0.483) and fat mass index (r = 0.492)]. Similar results were obtained after adjusting by age and sex. The areas under the curve (AUC) to identify children with insulin resistance were significant (p < 0.001) and similar among anthropometric indices (AUC > 0.68 to AUC < 0.76).

CONCLUSIONS

WHO and IDEFICS anthropometric indices correlated similarly with fasting insulin and HOMA-IR. The diagnostic accuracy of the anthropometric indices as a proxy to identify children with insulin resistance was similar. These data do not support the use of waist circumference, waist to height ratio, triceps- and subscapular- skinfolds sum or fat mass index, instead of the BMI as a proxy to identify pre-school children with insulin resistance, the most frequent alteration found in children ranging from normal body weight to obesity.

Changes in parent motivation predicts changes in body mass index z-score (zBMI) and dietary intake among preschoolers enrolled in a family-based obesity intervention

OBJECTIVES

To examine whether changes in parent motivation over the course of a pediatric obesity intervention are significantly associated with long-term changes in treatment outcomes. 

METHODS

 Study hypotheses were tested with a secondary data analysis of a randomized controlled trial (N = 42). Study analyses tested whether baseline to posttreatment change in total score for a self-report parent motivation measure (Parent Motivation Inventory [PMI]) was significantly associated with baseline to 6-month follow-up changes in body mass index z-score (zBMI), dietary variables, and physical activity. 

RESULTS

 Increases in PMI were significantly associated with decreased zBMI, decreased consumption of sugar-sweetened beverages and sweets, and increased consumption of artificially sweetened beverages. 

CONCLUSIONS

 Given that increases in parent motivation were associated with some treatment benefits, future research should evaluate the impact of directly assessing and targeting parent motivation on weight outcomes for preschoolers participating in a weight management program.

A pilot randomized controlled trial of a behavioral family-based intervention with and without home visits to decrease obesity in preschoolers

OBJECTIVE

Tested two family-based behavioral treatments for obesity in preschool children, one meeting the Expert Committee guidelines for Stage 3 obesity intervention criteria (LAUNCH-clinic) and one exceeding Stage 3 (LAUNCH with home visit [LAUNCH-HV]), compared with a Stage 1 intervention, pediatrician counseling (PC).

METHODS

In all, 42 children aged 2-5 years with a body mass index (BMI) percentile of ≥95th were randomized. A total of 33 met intent-to-treat criteria. Assessments were conducted at baseline, Month 6 (posttreatment), and Month 12 (6-month follow-up). 

RESULTS

 LAUNCH-HV demonstrated a significantly greater decrease on the primary outcome of change in BMI z-score (BMIz) pre- to posttreatment compared with PC (p = .007), whereas LAUNCH-clinic was not significantly different from PC (p = .08). Similar results were found for secondary outcomes. 

CONCLUSIONS

 LAUNCH-HV, but not LAUNCH-clinic, significantly reduced BMIz compared with PC by posttreatment, indicating the need for intensive behavioral intervention, including home visitation, to address weight management in obese preschool children.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

Background

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

Method

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

Result

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

Conclusions

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

The community-based healthy-lifestyle intervention for rural preschools (CHIRP) study: design and methods

The CHIRP study is a two-arm, pilot randomized controlled trial assessing the effectiveness of a behavioral family weight management intervention in an important and at-risk population, overweight young children, 3 to 6 years of age, and their parents from underserved rural counties. Participants will include 96 parent-child dyads living in rural counties in north central Florida. Families will be randomized to one of two conditions: (a) behavioral family based intervention or (b) a waitlist control. Child and parent participants will be assessed at baseline (month 0), post-treatment (month 4), and follow-up (month 10). Assessments and intervention sessions will be held at the Cooperative Extension office in each participating rural county. The primary outcome measure is change in child body mass index (BMI) z-score. Additional key outcome measures include child dietary intake, physical activity, and parent BMI. This study is unique because (1) it is one of the few randomized controlled trails examining a behavioral family intervention to address healthy habits and improved weight status in young overweight and obese children, (2) addresses health promotion in rural settings, and (3) examines intervention delivery in real world community settings through the Cooperative Extension Service offices. If successful, this research has potential implications for medically underserved rural communities and preventative health services for young children and their families.

Infant feeding practices of young mothers

PURPOSE

To specifically examine infant feeding practices in a sample of young mothers.

STUDY DESIGN AND METHODS

A cross-sectional, descriptive/exploratory design with author-developed measures was used to assess maternal demographics, and knowledge of and practices related to infant (6-12 months of age) feeding.

RESULTS

Numerous inappropriate feeding practices were identified in this sample of predominately low-income, African American young mothers (n = 67). More than half (52%) of the mothers had a BMI ≥ 25, with 27% having a BMI ≥ 30. Most mothers attempted to breastfeed (53%), but only 25% breastfed beyond 6 months. Inappropriate food choices for infants (such as french fries), practices such as putting cereal in their babies' bottles (82%), and starting solid foods before 6 months of age (64%) were reported. In this study, a shift from a balanced diet including adequate fruits and vegetables toward less nutrient-dense foods occurred when infants were approximately 7 to 9 months of age.

CLINICAL IMPLICATIONS

Most mothers in this study were overweight themselves, and had initiated less than optimal feeding practices in their young children. Given the identified relationship between a mother's diet and her infant's diet over time, it is clear that nurses should consider developing interventions to both promote early healthy infant feeding practices and assist young mothers to improve their nutrition simultaneously. Nurses can also target grandmothers and other family members who provide infant care in attempting to improve family nutrition.

A pilot randomized controlled trial of a clinic and home-based behavioral intervention to decrease obesity in preschoolers

We evaluated the efficacy of a 6-month clinic and home-based behavioral intervention (Learning about Activity and Understanding Nutrition for Child Health; LAUNCH) to reduce obesity in preschool children ≥95th BMI percentile compared to enhanced standard of care (Pediatrician Counseling; PC). LAUNCH was a family-based behavioral intervention that taught parents to use child behavior management strategies to increase healthy eating and activity for their children and themselves. PC presented the same diet and activity recommendations, but was delivered in a one-time PC session. Eighteen children aged 2-5 years (mean 4.71 ± 1.01) with an average BMI percentile of 98 (±1.60) and an overweight parent were randomized to LAUNCH or PC. Assessments were conducted at baseline, 6 months (end of LAUNCH treatment) and 12 months (6 months following LAUNCH treatment). LAUNCH showed a significantly greater decrease on the primary outcomes of child at month 6 (post-treatment) BMI z (-0.59 ± 0.17), BMI percentile (-2.4 ± 1.0), and weight gain (-2.7 kg ± 1.2) than PC and this difference was maintained at follow-up (month 12). LAUNCH parents also had a significantly greater weight loss (-5.5 kg ± 0.9) at month 6 and 12 (-8.0 kg ± 3.5) than PC parents. Based on the data from this small sample, an intensive intervention that includes child behavior management strategies to improve healthy eating and activity appears more promising in reducing preschool obesity than a low intensity intervention that is typical of treatment that could be delivered in primary care.

A Comparison of Blood Pressure, Body Mass Index, and Acanthosis Nigricans in School-Age Children

The purpose of this retrospective quantitative study was to examine the relationships among acanthosis nigricans (AN), body mass index (BMI), blood pressure (BP), school grade, and gender in children attending elementary school located in South West Texas. Data were collected by attending school district nurses. Researchers reviewed 7,026 previously collected records from a state mandated public school health screening program in elementary school Grades 3, 5, 7, and 9, conducted by school nurses. Of 7,026 records, 6,867 were included for the secondary analysis. A logistic regression analysis was carried out with the AN marker as the dependant variable and school grade, gender, BMI, and BP as the independent variables. The results of the study suggest that a direct relationship exists between the AN marker, BMI, and BP in school-age children. Further study is warranted based on the number of school-age children who are now found to be obese.

Obesity indicators and cardiometabolic status in 4-y-old children

BACKGROUND

In adults and adolescents, obesity is positively associated with cardiovascular disease risk factors; however, evidence in preschool children is scarce.

OBJECTIVE

The objective was to assess the relations between obesity indicators and cardiometabolic risk factors in 324 Chilean children 4 y of age.

DESIGN

We collected anthropometric measurements and calculated general indicators of obesity [weight, body mass index (BMI), sum of 4 skinfold thicknesses, percentage fat, and body fat index] and central obesity (waist circumference, waist-to-hip ratio, waist-to-height ratio, and truncal fatness based on skinfold thickness). We measured blood sample concentrations of C-reactive protein, interleukin-6, homeostasis model assessment of insulin resistance, triglycerides, and total, LDL, and HDL cholesterol. We used correlation and multiple linear regression analyses.

RESULTS

The prevalence of obesity (BMI-for-age z score >2, World Health Organization 2006), central obesity (> or = 90th percentile, third National Health and Nutrition Examination Survey), and lipid disorders was high (13%, 11%, and > or = 20%, respectively), and 70% of the children had at least one cardiometabolic risk factor. Most correlations between obesity and central obesity indicators were moderate to strong (0.40 < r < 0.96). Obesity was positively but weakly associated with C-reactive protein in both sexes and with homeostasis model assessment of insulin resistance only in girls (all r < 0.3, P < 0.05). Obesity indicators were unrelated to interleukin-6 and lipid concentrations (P > 0.05). Overall, obesity indicators explained, at most, 8% of the variability in cardiometabolic risk factors.

CONCLUSIONS

Obesity and central obesity were common, and most of the children had at least one cardiometabolic risk factor, particularly lipid disorders. Obesity and central obesity indicators were highly intercorrelated and, overall, were weakly related to cardiometabolic status. At this age, body mass index and waist circumference were poor predictors of cardiometabolic status.

[Is bariatric surgery in adolescents appropriate?]

Current recommendations for bariatric surgery are limited to patients older than 18 years. Two studies in 2007 showed that bariatric surgery improves survival in adults. Medical management of severe obesity in adolescents is all too often ineffective. For these reasons, early surgical intervention for adolescents with morbid obesity may be expected to prevent or avoid comorbidities, decrease mortality, and improve the quality of life. Several studies have demonstrated the feasibility of adolescent bariatric surgery with morbidity comparable to that seen in adult series. The earlier the surgery, the better the result in terms of prevention or reversal of comorbid conditions. In the USA, a consensus definition of adolescents eligible for bariatric surgery specifies attainment of Tanner Stage IV of sexual maturity and achievement of 95% of axial growth. Just as in adults, bariatric surgery in adolescents requires prolonged follow-up; it is important that such surgery be performed in centers specialized in adult bariatric surgery having the necessary multidisciplinary structure.

Increasing physical activity in preschool: a pilot study to evaluate animal trackers

OBJECTIVE

This report describes a pilot study to evaluate Animal Trackers (AT), a preschool program designed to (1) increase structured physical activity (PA) during the preschool day; (2) increase practice of gross motor skills; (3) provide teachers with an easy-to-use PA program regardless of teacher experience; and (4) implement a teacher walking intervention.

DESIGN

Pilot observational study in volunteer preschools.

SETTING

Nine preschools in New Mexico.

PARTICIPANTS

Two-hundred seventy 3- to 5-year-old children and 32 teachers.

INTERVENTION

Daily 10-minute classroom activities for children.

MAIN OUTCOME MEASURE

Implementation and duration of AT activities, teacher preparation time, and added weekly time spent in structured PA.

ANALYSIS

Process evaluation to track program implementation, and pre-post measures to assess outcomes.

RESULTS

AT activities were implemented 4.1 times per week (11.4 minutes/activity), with 7 minutes teacher preparation time. Overall, AT added 47 minutes of structured PA per week for children.

CONCLUSIONS AND IMPLICATIONS

The AT program increased structured PA time in preschools. Teachers felt that AT was developmentally appropriate; that children enjoyed the activities; and that the children's motor skills improved. Results of the pilot study are encouraging, since research suggests that even small increases in PA could help prevent obesity.

The relationship between obesity and blood pressure differs by ethnicity in Sydney school children

BACKGROUND

The objective of this study was to investigate the relationship between obesity and high systolic blood pressure (SBP) in Southeast Asian (SEAsian) and Australian children living in Australia.

METHODS

SBP, country of birth, and obesity indices (body mass index (BMI), waist circumference (WC), and percent body fat (%TBF)) were recorded in 1,232 9-year-old children from Sydney schools and remeasured 3 years later (n = 628). The relationship between SBP and obesity (both at baseline and longitudinally) was investigated by regression analyses.

RESULTS

Children of SEAsian origin had a significantly higher risk of high SBP with increases in obesity indices compared to those of Australian origin. At 9 years old, SBP increased 1.51 mm Hg for each of BMI increase for SEAsian children compared to 1.05 mm Hg for Australian children (P(interaction) = 0.03). These same significant analysis of variance (ANOVA) interactions were seen with WC (P(interaction) = 0.02) and %TBF (P(interaction) = 0.04) as predictors of SBP. These differences by ethnic background were also reflected in the 3-year longitudinal analysis where SEAsian children showed higher risk of increasing SBP with BMI increase (SBP increased 1.70 mm Hg for each unit of BMI increase for SEAsian children compared to 0.80 mm Hg for Australian children (P(interaction) = 0.02)) or with WC increase (P(interaction) = 0.01), whereas these increases were small and nonsignificant in Australian children.

CONCLUSION

These findings suggest that SEAsian children living in Australia are at higher risk of increasing SBP than their Australian counterparts when they become overweight or obese.

A Prospective Study of Weight and Metabolic Syndrome in Young Hispanic Children

OBJECTIVE: Examine weight in young Hispanic children over a two-year period; investigate the relationships among overweight, physical activity, caloric intake, and family history in the development of the metabolic syndrome (MS). METHODS: Forty-seven children (ages 5-8) from diverse Hispanic backgrounds recruited from elementary schools were evaluated. Laboratory analyses, anthropometric data, and measures of physical activity and caloric intake were included. RESULTS: The majority of the children were overweight at baseline (66%) and at follow-up (72%). Children who were overweight at baseline were more likely to exhibit MS at follow-up than were those who were not overweight at baseline. CONCLUSIONS: Overweight appears to be an independent predictor of MS among Hispanic children.

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

OBJECTIVE

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

DESIGN

Qualitative focus group study.

SETTING

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

PARTICIPANTS

Thirty-five teachers in 5 focus groups.

INTERVENTION

Two experienced focus group facilitators elicited comments from each group.

MAIN OUTCOME MEASURE

Identification of themes for future nutrition education programming.

ANALYSIS

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

RESULTS

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

CONCLUSIONS AND IMPLICATIONS

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

Elevated atherogenic lipoproteins in childhood: Risk, prevention, and treatment

Elevated low-density lipoprotein cholesterol (LDL-C) level in childhood is an increasing problem, mainly due to a rising prevalence secondary to the childhood obesity epidemic and better recognition and screening. Vascular changes and impaired endothelial function associated with elevated LDL-C are apparent even in early childhood. Secondary adiposity-related cases are at higher risk due to the clustering of risk factors besides overweight, such as the atherogenic lipid triad, change in the atherogenic properties of the LDL-C particle itself, and the presence of insulin resistance. Prevention should focus on maintaining a healthy lifestyle, including a restricted fat and cholesterol diet, encouraging physical activity, and decreasing sedentary pursuits to maintain an appropriate weight in children. For children and adolescents found to have elevated LDL-C, management should focus on the pursuit of a healthy lifestyle mirroring that for prevention for at least 6 months. Additional dietary therapy, such as plant stanol and sterol esters, have also been shown to modestly reduce LDL-C levels. If the adoption of a healthy lifestyle is not sufficient to reduce LDL-C, lipid-lowering drugs should be considered in selected patients. Current drugs of choice are statins and potentially ezetimibe. Long-term treatment with statins has been shown to markedly reduce carotid intima-media thickness in children and adolescents, particularly when started early. Current evidence supports early and efficient treatment for affected children.

Pediatric Obesity: Impact and Surgical Management

The incidence of children in the United States who are overweight or obese is increasing at an alarming rate, and many obesity-related complications are now being described in children. There appears to be no current pharmacologic treatment or surgical procedure that is both safe and effective for millions of obese children. Bariatric surgery may be useful, however, in carefully selected obese children with associated serious comorbidities unresponsive to medical or dietary interventions. The complications of pediatric obesity are discussed, as well as current medical and surgical management of this disorder.

Improvement in risk factors for metabolic syndrome and insulin resistance in overweight youth who are treated with lifestyle intervention

OBJECTIVE

To evaluate the prevalence of risk factors that are associated with the metabolic syndrome and insulin resistance in overweight youth and to determine the effect of a short-term, family-centered, lifestyle intervention on various associated anthropometric and metabolic measures.

METHODS

Overweight youth who were between 8 and 16 years of age participated in a 12-week, family-centered, lifestyle intervention program. Anthropometric and metabolic measures were assessed before the program in all participants (n = 109) and after the program in a subset of the participants (n = 43).

RESULTS

At baseline, 49.5% of youth had multiple risk factors associated with the metabolic syndrome, based on a modified definition of the National Cholesterol Education Program, and 10% had impaired fasting glucose and/or impaired glucose tolerance. Measures of insulin resistance correlated significantly with the risk factors of the metabolic syndrome. Forty-three youth had pre- and postintervention evaluations that showed statistically significant improvements in body mass index, systolic blood pressure, lipids (total, low-density lipoprotein cholesterol, and triglycerides), postprandial glucose, and leptin levels.

CONCLUSION

Overweight youth have multiple risk factors associated with the metabolic syndrome. A 12-week lifestyle program may have a positive effect on reducing risk factors for the metabolic syndrome and insulin resistance in overweight youth.