Diet and Acanthosis Nigricans over a Two-Year Period in Children of the Pacific Region

BACKGROUND

The impact that dietary carbohydrates have on children developing type 2 diabetes remains controversial. Furthermore, there are limited pediatric longitudinal studies on changes in body mass index (BMI) and diet related to the development of acanthosis nigricans (AN), a risk factor associated with type 2 diabetes.

METHODS

Two 24 h dietary records were collected for 558 children, 2-8 years of age, at baseline and at a 2-year follow-up. Data on age, sex, BMI, and the presence of AN were also collected at each time point from the Children's Healthy Living Program. Logistic regression was used to determine factors associated with the presence of AN at follow-up. Multinominal regression was used to determine factors associated with changes in AN status. Linear regression was used to measure the associations between changes in dietary intake and in the Burke Score for AN.

RESULTS

AN was present in 28 children at baseline and 34 children at follow-up. Adjusting for the presence of AN at baseline, age, sex, study group, baseline BMI, change in BMI z-score, time between assessments, and baseline intake, an increase from baseline for each teaspoon of sugar and serving of carbohydrate-rich food increased the risk for having AN at follow-up by 9% and 8%, respectively (p ≤ 0.05). An increased intake of added sugar (teaspoons) increased the risk of developing AN by 13% (p ≤ 0.01) and an increase in servings of foods rich in starch increased the risk of developing AN by 12% (p ≤ 0.01) compared to children who never had AN. Increasing the intake of fruit was also associated with decreased Burke Scores using multiple regression. However, the intake of energy and macronutrients were not associated with AN.

CONCLUSIONS

Added sugar and foods rich in starch were independently associated with the occurrence of AN, suggesting the type of carbohydrates consumed is a factor in AN occurrence.

Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities

The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are effective clinically based treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori Key Questions.

Observing anthropometric and acanthosis nigrican changes among children over time

This study assessed the anthropometrics and acanthosis nigricans (AN) in a sample of 7,337 children at two assessments. Four groups of children were identified based on the presence of AN at both time points: those who never had the marker, those who gained the marker, those who lost the marker, and those who maintained the marker. Group differences in height, weight, body composition, and the amount of change in these variables over time were explored. Our findings demonstrated that children who maintain or gain the AN marker had the greatest height, weight, and body composition changes over time. It is apparent that the AN marker does disappear in some children and that this is associated with lower weight gain and body composition loss. If interventions can be developed targeting children who present with the marker, it is likely that their risk of developing type 2 diabetes could be reduced.

Increasing body mass index, blood pressure, and Acanthosis Nigricans abnormalities in school-age children

This retrospective quantitative study examined the relationships among gender, Acanthosis Nigricans (AN), body mass index (BMI), and blood pressure (BP) in children attending school Grades 1-9 in Southwest Texas. Of the 34,897 health screening records obtained for the secondary analysis, 32,788 were included for the study. A logistic regression analysis was carried out with AN as the dependent variable, with year, gender, BMI, and BP as independent variables. The results indicate that the rate of children in each grade with three positive markers increased 2% during a 3-year period between 2008 and 2010. In the 5-year period between 2005 and 2010, a clear trend of significantly higher numbers of children with both AN and BMI markers was apparent. Gender played a significant role as females were more likely to have the AN marker than males. Further study is indicated based on the increasing trend of school-age children in Texas with positive markers for AN, increased BMI and BP.