Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years

Assessing Disparities about Overweight and Obesity in Pakistani Youth Using Local and International Standards for Body Mass Index

Background/Objectives: Obesity is currently considered a public health problem in both developed and developing countries. Gender- and age-specific body mass index (BMI) growth standards or references are particularly effective in monitoring the global obesity pandemic. This study aimed to report disparities in age-, gender- and ethnic-specific statistical estimates of overweight and obesity for 2-18 years aged Pakistani children and adolescents using the World Health Organization (WHO), the Center for Disease Control (CDC) 2000 references, the International Obesity Task Force (IOTF) and Pakistani references for BMI. Methods: The study used secondary data of 10,668 pediatric population, aged 2-18 years. Demographic information like age (years), gender, city and anthropometric examinations, i.e., height (cm) and weight (kg) were used in this study. The recommended age- and gender-specific BMI cut-offs of the WHO, CDC 2000 and the IOTF references were used to classify the children sampled as overweight and obese. For the Pakistani reference, overweight and obesity were defined as BMI-for-age ≥ 85th percentile and BMI-for-age ≥ 95th percentile, respectively. Cohen's κ statistic was used to assess the agreement between the international references and local study population references in the classification of overweight/obesity. Results: The statistical estimates (%) of the participants for overweight and obesity varied according to the reference used: WHO (7.4% and 2.2%), CDC (4.9% and 2.1%), IOTF (5.2% and 2.0%) and Pakistan (8.8% and 6.0%), respectively; suggesting higher levels of overweight and obesity prevalence when local study references are used. The Kappa statistic shows a moderate to excellent agreement (κ ≥ 0.6) among three international references when classifying child overweight and obesity and poor agreement between local references and the WHO (0.45, 0.52), CDC (0.25, 0.50) and IOTF references (0.16, 0.31), for overweight and obesity, respectively. Conclusions: The results of the study showed a visible difference in the estimates of excess body weight after applying the WHO, CDC, IOTF and local BMI references to the study population. Based on the disparity results and poor agreement between international references and the local study reference, this study recommends using local BMI references in identifying children with overweight and obesity.

Nutrition and Health in Arab Adolescents (NaHAR): Study protocol for the determination of ethnic-specific body fat and anthropometric cut-offs to identify metabolic syndrome

The prevalence of adolescent obesity in the Middle-East is considered among the highest in the world. Obesity in adolescents is associated with several cardiometabolic abnormalities, the constellation of which is referred to as the metabolic syndrome (MetS). This multi-country cross-sectional study aims to determine the optimal cut-off values for body fat (BF); body mass index (BMI) z-score; waist circumference (WC) percentile, and mid-upper arm circumference (MUAC) for the prediction of MetS among adolescents from Kingdom of Saudi-Arabia (KSA), Kuwait, Jordan, Lebanon and Syria. A secondary objective is to examine the validity of Bioelectrical Impendence Vector Analysis (BIVA) in estimating BF against the deuterium dilution technique (DDL). In each country, a sample of 210 adolescents will be recruited. Data collection will include demographics, socioeconomic, lifestyle and dietary data using a multi-component questionnaire; anthropometric measurements will be obtained and body composition will be assessed using the DDL and BIVA; blood pressure and biochemical assessment will be performed for the identification of the MetS. Receiver operating characteristic analyses will be undertaken to determine optimal cut-off values of BMI, WC, MUAC and BF in identifying those with MetS. Odds ratios (OR) and their respective 95% confidence interval (CI) for the association of the anthropometric measurements with MetS will be computed based on multiple logistic regression analysis models. The Bland and Altman approach will be adopted to compare BIVA against the reference DDL method for the determination of body composition parameters. This study responds to the need for ethnic-specific anthropometric cut-offs for the identification of excess adiposity and associated cardiometabolic risks in the adolescent population. The adoption of the generated cut-offs may assist policy makers, public health professionals and clinical practitioners in providing ethnic-specific preventive and curative strategies tailored to adolescents in the region.

Relationship between normal weight central obesity and arterial stiffness in Chinese adults with hypertension

BACKGROUND AND AIMS

Normal weight central obesity (NWCO) is a category of obesity that is characterized by having a normal BMI and presence of abdominal obesity. Recently, studies have reported that NWCO was associated with the cardiovascular diseases. The researches exploring the relationship between NWCO and arterial stiffness are limited. So this study intended to investigate the relationship between NWCO and arterial stiffness in Chinese adults with hypertension.

METHODS AND RESULTS

This study is a sub-study of the China H-type Hypertension Registry Study. We included 8580 Chinese hypertensive patients with normal weight (18.5 kg/m2 ≤BMI <24 kg/m2). Central obesity was defined as waist-height ratio ≥0.5, and participants were categorized into two groups: NWCO and normal weight and no central obesity (NWNO). Using the brachial-ankle pulse wave conduction velocity (baPWV) assessed the arterial stiffness. Multiple linear regression analysis was used to evaluate relationship between NWCO and baPWV. Multiple logistic regression analysis was used to evaluate relationship between NWCO and arterial stiffness. Of 8580 participants, 4327 (50.4 %) were NWCO. The multiple linear regression analysis demonstrated that people with NWCO had higher baPWV value (total people: β = 38.33, 95%CI 22.82-53.84; men: β = 39.87, 95%CI 18.43-61.32; women: β = 29.65, 95%CI 7.20-52.09) compared with NWNO. The baPWV ≥1800 cm/s was defined as arterial stiffness, and the multiple logistic regression analysis showed that people with NWCO associated higher arterial stiffness risk (total people: OR = 1.25, 95%CI 1.12-1.39; men: OR = 1.29, 95%CI 1.11-1.50; women: OR = 1.18, 95%CI 1.01-1.38).

CONCLUSION

NWCO is significantly related to increased risk of arterial stiffness in Chinese adults with hypertension.

Value of waist-to-hip ratio as a predictor of metabolic syndrome in adolescents with obesity

BACKGROUND AND AIM

Metabolic syndrome is present in 7% of adolescents and 19 to 35% in obese adolescents, and the cause of this condition has not been fully understood. Early identification of the risk involved could be an initial step in preventing a metabolic syndrome. Increased waist circumference, which is a parameter of central obesity, is also risk factor for this condition. This study aims to determine the possibility cut-off value of waist-to-hip (WHR) as a predictor of metabolic syndrome.

METHODS

We studied 208 obese adolescents between the ages of 13 to 18 years from junior and senior high schools who living in rural dan urban areas in East Java. These obese adolescents were divided into two groups, namely with and without a metabolic syndrome. Anthropometric measurements, including waist-to-hip ratio (WHR), were carried out to analyze the cut-off values between the two groups.

RESULTS

208 obese adolescents (51.4% males and 48.6% females) without the metabolic syndrome and 104 obese adolescents with metabolic syndrome were evaluated. There was a significant relationship between WHR and metabolic syndrome in obese adolescents (r = 0.203, P = 0.003). Those adolescents with a high WHR value > 0.891 had twice risk to develop metabolic syndrome compared to those with lower (OR 2.033; 95% CI = 1.165-3.545).

CONCLUSIONS

Increased waist-to-hip ratio > 0.89 in adolescents was associated with higher risk to develop metabolic syndrome and can be proposed as a predictor for metabolic syndrome in obese adolescents.

Population-based references for waist and hip circumferences, waist-to-hip and waist-to-height ratios for children and adolescents, and evaluation of their predictive ability

Childhood obesity is a public health problem globally as well as in Poland. This paper aimed to provide age- and sex-specific waist circumference, hip circumference, waist-to-height ratio and waist-to-hip ratio normative values for Polish children and adolescents aged 3 - 18 years for more precise monitoring of abdominal fat accumulation. The waist circumference, hip circumference, waist-to-height ratio and waist-to-hip ratio references were constructed with the lambda-mu-sigma (LMS) method using data from two nationally representative health surveys: the OLA study and the OLAF study, the largest available paediatric surveys in Poland which provided measured height, weight, waist, hip and blood pressure for 22,370 children and adolescents aged 3 - 18 years. The predictive ability of newly established references for overweight/obesity as defined by the International Obesity Task Force criteria and elevated blood pressure was tested with receiver operating characteristic. Abdominal obesity cut-offs linked to adult cardiometabolic cut-offs were established. Reference values for waist circumference, hip circumference, waist-to-height ratio and waist-to-hip ratio are presented, as well as waist circumference, waist-to-height ratio and waist-to-hip ratio cut-off values linked to adult's cut-offs of cardiometabolic risk. The predictive value for overweight and obesity of population-based waist, hip and waist-to-height ratio references was outstanding-area under the receiver operating characteristic curve > 0.95 in both sexes, whereas with regard to the elevated blood pressure predictive ability was low-area under the receiver operating characteristic curve < 0.65.   Conclusion: This paper presents the first waist, hip, waist-to-height ratio and waist-to-hip ratio references for Polish children and adolescents aged 3-18 years. The 90th and 95th percentile and cut-offs linked to adult thresholds for cardiometabolic risk are proposed as cut-offs for abdominal obesity. What is Known: • Waist circumference, waist-to-height ratio and waist-to-hip ratio are used to assess abdominal obesity in children and adults. • In Poland, there is no abdominal obesity and hip circumference references for children and adolescents from 3 to 18 years of age. What is New: • Population-based references of central obesity indices and hip references for children and youth aged 3-18 years and cardiometabolic risk thresholds for children and adolescents linked to adult's cut-offs were established.

Recreational screen time trajectories during early childhood and imaging-measured body composition at age 7 in the Odense child cohort

BACKGROUND

Children spend increasing amounts of time on recreational screen media, which may lead to an obesogenic environment.

OBJECTIVES

We investigated the association of trajectories of screen time across ages 3, 5 and 7 years with body composition at age 7 in the Odense Child Cohort.

METHODS

Data were collected in the Municipality of Odense, Denmark, between 2010 and 2019. Group-based trajectory modelling was applied to group participants into four trajectories of prospective parent-reported screen time. Body composition was assessed using dual-energy x-ray absorptiometry with calculated fat-mass index (FMI) as the primary outcome. Primary models were linear multivariable regression models adjusted for participants' sex, age, birthweight, maternal origin, maternal education, maternal body-mass-index, and maternal age. Further models were adjusted for additional possible confounders. Selection bias was addressed by inverse probability weighting.

RESULTS

In total, 803 children (48.2% female) were included in the primary analysis. Participants with screen time at all time points were assigned to four trajectory groups [constant low screen time (12.7%), low increase (36.3%), high increase between ages 3 and 5 (33.5%) and high increase in screen time (17.5%)]. Sample characteristics differed across missing data status and trajectories. Mean FMI (kg/m² ) and standard deviation (SD) were 3.7 (SD 1.3) and 3.9 (SD 1.6) for the constant low versus high screen time, respectively. No differences in FMI were found between screen time trajectory groups at age 7 (adjusted mean difference 0.1 kg/m² , 95% confidence interval -0.3, 0.5 for constant low versus high screen time). No consistent associations between screen time groups and secondary body composition outcomes were found.

CONCLUSIONS

Results from this study do not suggest that recreational screen time from age 3 to 7 years is associated with adiposity or other measures of body composition.

Reference growth curves to identify weight status (underweight, overweight or obesity) in children and adolescents: systematic review

The identification of somatic growth, through reference curves, can be used to create strategies and public policies to reduce public health problems such as malnutrition and obesity and to identify underweight, overweight and obesity. The purpose of this systematic review was to identify studies providing reference growth curves for weight status in children and adolescents. A systematic search was conducted in eight databases and in gray literature (Google scholar). To assess the risk of bias/methodological quality of studies, the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-sectional Studies (NHLBI) was used. Overall, 86 studies that met the inclusion criteria were included. Through the values   of reference growth curves for the identification of underweight, overweight and obesity, it was possible to verify that there is great variability among percentiles for the identification of underweight, overweight and obesity. The most prevalent percentiles for underweight were P3 and P5; for overweight, the most prevalent was P85 and the most prevalent percentiles for obesity were P95 and P97. The most prevalent anthropometric indicators were Body Mass Index (BMI), Waist Circumference (WC), Body Mass (BM) for age and height for age. Conclusion: Such data can demonstrate that the optimal growth must be reached, through the standard growth curves, but that the reference curves demonstrate a cut of the population growth, raising possible variables that can influence the optimal growth, such as an increase in the practice of physical activities and an awareness of proper nutrition.

Association Between Obesity and Blood Pressure Among Iranian Children and Adolescents: A Sub-analysis from the SHED LIGHT Study

Childhood obesity has become a major non-communicable disease worldwide. It is associated with an increased risk of cardiometabolic factors, including diabetes and hypertension (HTN). The purpose of this study was to evaluate the association between obesity and HTN among Iranian children and adolescents. Cross-sectional data from the SHED LIGHT study performed in Tehran urban area were used in this report. The anthropometric values and blood pressure were analyzed. The obesity status was identified based on body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). The blood pressure status was defined using percentiles for height, age, and sex. A total of 14,641 children with a mean age of 12.28 ± 3.1 years (6-18) were assessed, and 52.8% of them were boys. The prevalence of HTN was higher among obese compared to healthy weight subjects (p < 0.001). HTN had the strongest association with the central obesity by WC (odds ratio [OR] 4.098, 95% confidence interval [CI] 3.549-4.732), generalized obesity by BMI (OR 3.000, 95% CI 2.749-3.274), and central obesity by WHtR (OR 2.683, 95% CI 2.451-2.936). Moreover, parental university education, having studied in private schools, and the smaller number of household children increased the risk of obesity. The rate of HTN was high among children and adolescents with generalized and central obesities. HTN, elevated blood pressure, boy gender, and socioeconomic status were associated with obesity, emphasizing on the importance of screening and implementing lifestyle changes to decrease future risk of cardiovascular diseases.

Determinants of Waist-to-Height Ratio and Its Relation to Hypertension among School Children in India: A Multicenter Study

OBJECTIVE

To study the factors associated with waist-to-height ratio (WHtR) among school children aged 5-15 y and its association with hypertension.

METHODS

In this cross-sectional study, data on background characteristics, socioeconomic status (SES), anthropometric parameters, and blood pressure were obtained from school children from three states of India. WHtR ≥ 0.5 was defined as obesity and hypertensives were defined based on Fourth Report criteria. Descriptive statistics were applied and multiple linear regression was done to identify factors associated with WHtR. A receiver operating characteristics (ROC) analysis was used to evaluate the predictive ability of WHtR to predict hypertension RESULTS: The mean WHtR among the 12,068 students was 0.40 (± 0.05) and it showed a U-shaped distribution with age with trough at 10 y of age for both genders. Mean WHtR was higher among residents of Manipur, among boys and hypertensives. WHtR was positively associated with weight > 30 kg, male gender, schools with high SES, Manipur and Goa region, and negatively associated with age > 10 y. The area under the ROC curve of WHtR for diagnosis of hypertension was low 0.544 (95% CI 0.532, 0.556).

CONCLUSION

There is a nonlinear relation between age, gender, and WHtR, which varies by geographical region and HT. This would need to be kept in mind while using it to identify obesity in children, though its discriminant value for hypertension is low.

Trends in Abdominal Obesity and Central Adiposity Measures by Dual-Energy X-Ray Absorptiometry Among US Children: 2011-2018

OBJECTIVE

Previous studies that have reported trends on abdominal obesity among US children were usually based on anthropometric assessments. However, little is known about the recent trends in central adiposity measures by DXA and abdominal obesity since 2011-2012.

STUDY DESIGN

A serial cross-sectional analysis of US population-weighted data among children from NHANES 2011 to 2018 was conducted.

RESULTS

Between 2011-2012 and 2017-2018, there was a relatively stable trend among children aged 8-19 years in trunk fat and trunk fat percentage. During the same time periods, there were no significant changes in prevalence of abdominal obesity by waist circumference (18.6 vs. 21.1%) among those aged 2-19 years, and abdominal obesity by WHtR (34.1 vs. 36.2%) among those aged 6-19 years. However, a significant increase trend among boys aged 2-19 years was found in prevalence of abdominal obesity by waist circumference (16.1-22.7%; P = 0.004). For Mexican American youth and non-Hispanic Asian boys, there is a significant increase in mean trunk fat percentage and waist circumference.

CONCLUSION

Between 2011-2012 and 2017-2018, there have been no significant changes in central adiposity measured by DXA and prevalence of abdominal obesity among US children. Our study further supports that there is an urgent need to improve their lifestyle to reduce abdominal obesity for US children, especially for Mexican American youth and non-Hispanic Asian boys.

Waist circumference, waist-to-height ratio and BMI percentiles in children aged 5 to 19 years in India: A population-based study

OBJECTIVE

Nationally representative percentiles for waist circumference (WC), waist-to-height-ratio (WHtR), and body mass index (BMI) are not available for children and adolescents in India.

METHODS

Using LMS method, age- and gender-specific reference growth charts were constructed for WC (n = 68,261), WHtR (n = 68,261), and BMI (n = 67,741) from children/adolescents aged 5-19 years who participated in a nationally representative survey. General obesity, indicating overall obesity, was defined as age-sex-specific BMI z-scores ≥ 95th percentile. Central obesity was defined in three ways: WC ≥ 90th percentile, WHtR ≥ 0.5, and both WC ≥ 90th percentile and WHtR ≥ 0.5.

FINDINGS

WC and BMI percentiles for boys and girls are lower than those previously reported from India and several other countries. The BMI percentiles are lower than the WHO 2007 reference population. The prevalence of general obesity using India specific BMI centiles was 2.9% (95% CI: 2.6-3.2). The prevalence of central obesity was 6.1% (95% CI: 5.7-6.6) using WC ≥ 90th percentile, 5.3% (95% CI: 5.0-5.7) using WHtR ≥ 0.5, and 3.6% using both criteria. Three-fourth of children with general obesity also had central obesity based on WC ≥ 90th.

CONCLUSIONS

Indian children are thinner than Caucasian and other Asian children, and the global WHO reference population. Using India specific reference, the prevalence of central obesity is higher than general obesity with a significant overlap between the two.

Prevalence of Obesity/Abdominal Obesity and Related Factors in Pediatric ALL Survivors

OBJECTIVE

Obesity has been increasingly recognized in pediatric acute lymphoblastic leukemia (ALL) survivors. The aim of the current study was to determine the prevelance and related factors of obesity/abdominal obesity and evaluate the association between nutrition and overweight/obesity after cancer treatment in pediatric ALL survivors.

METHOD

An observational retrospective cohort study was performed among 67 volunteers (aged 5-15). Participants completed 3 consecutive days (2 weekdays and 1 weekend day) recording food consumption and physical activity simultaneously. Weight, height, and waist circumference measurements were performed in remission period, and retrospective data were obtained from patient records. We examined data at three periods: diagnosis, end of treatment, and remission. Subjects were classified into four groups according to body mass index for age z score (BAZ): underweight, normal weight, overweight, and obese. Abdominal obesity was defined waist-to-height ratio ≥ 0.5.

RESULTS

Prevalence of overweight, obesity, and abdominal obesity were 25.3%, 23.9%, 38.8%, respectively in remission. BAZ at diagnosis and at treatment completion, dietary energy intake, and physical activity were associated with an increased risk of being overweight/obese in remission (p < .05). Gender, age at diagnosis, cranial radiotherapy, and treatment risk category were not significant (p > .05).

CONCLUSIONS

As in obesity, abdominal obesity was found an important problem in pediatric ALL survivors. Therefore, nutritional targets are needed to prevent obesity. Survivors should be closely monitored in terms of nutritional status during and after treatment and informed about and supported for healthy lifestyle (balanced and adequate nutrition, increase in physical activity).

Diagnostic Performance of Neck Circumference and Cut-off Values for Identifying Overweight and Obese Pakistani Children: A Receiver Operating Characteristic Analysis

OBJECTIVE

Neck circumference (NC) is considered to be an alternative screening method for obesity. The aims were: (1) to examine the correlation between body mass index (BMI) and NC; and (2) to determine diagnostic performance including the best cut-off values of NC for identification of overweight and obese Pakistani children.

METHODS

The study sample was 7,921 children, aged 5-14 years, by cross-sectional survey carried-out in four major cities of Pakistan. Receiver operating characteristic analysis was used to investigate the diagnostics performance of NC and to determine the optimal cut-off points for identifying children with overweight and obesity.

RESULTS

The mean of each anthropometric variable (i.e., height, weight, BMI and NC) increased with age in both sexes. In the whole sample, NC had a strong positive correlation (r=0.61, p<0.01) with BMI. NC optimal cut-off points for identifying overweight and obesity in Pakistani boys ranged between 25.00 to 30.35 cm and the corresponding values for the girls were 24.00 to 31.62 cm. In the prepubertal period, NC cut-off points indicative overweight, in both boys and girls were 26.36 cm and 25.27 cm, respectively; the corresponding values for obesity were 26.78 cm and 25.02 cm. During puberty, the cut-off values for overweight and obesity respectively were 28.32 cm and 28.57 cm in boys and 28.70 cm and 28.82 cm in girls.

CONCLUSION

NC may be used as a simple and widely applicable measure for identification of overweight and obesity with reasonable accuracy in Pakistani children.

Waist Circumference Percentiles and Cut-Off Values for Obesity in a Large Sample of Students from 6 To 10 Years Old Of The São Paulo State, Brazil

Fundamento

A prevalência da obesidade vem aumentando sistematicamente na população, inclusive nas crianças e adolescentes, ao redor do mundo.

Objetivos

Descrever curvas percentílicas de referência para a circunferência abdominal (CA) nas crianças brasileiras e fornecer pontos de corte da CA para identificar crianças com risco de obesidade.

Métodos

Um estudo multicêntrico, prospectivo, tranversal foi realizado em crianças com idades entre 6 e 10 anos, matriculadas no ensino fundamental de escolas públicas e particulares de 13 cidades do estado de São Paulo. A estatura, o peso e a CA foram medidos em duplicata em 22.000 crianças (11.199 meninos). Para estabelecer o melhor ponto de corte da CA para o diagnóstico da obesidade, foram calculadas curvas ROC com crianças classificadas como com peso normal e obesas, de acordo com as curvas do IMC, estratificadas por gênero e idade, e o índice Youden foi utilizado como a eficácia potencial máxima desse biomarcador. Valores de p < 0,05 foram considerados estatisticamente significativos.

Resultados

Os valores da CA aumentaram com a idade, tanto nos meninos quanto nas meninas. A prevalência de obesidade em cada grupo variou de 17% (6 anos de idade) a 21,6 % (9 anos de idade), dentre os meninos, e de 14,1% (7 anos de idade) a 17,3 % (9 anos de idade), dentre as meninas. As análises ROC mostraram o percentil 75 como ponto de corte para o risco de obesidade, e o diagnóstico de obesidade está classificado no percentil 85 ou acima.

Conclusão

Curvas de referência da CA específicas para idade e sexo em crianças brasileiras e pontos de corte para o risco de obesidade podem ser usados em triagem nacional e estudos intervencionais para reduzir a carga da obesidade no Brasil. (Arq Bras Cardiol. 2020; 114(3):530-537)

Developing waist circumference, waist-to-height ratio percentile curves for Pakistani children and adolescents aged 2-18 years using Lambda-Mu-Sigma (LMS) method

Objectives Children from different countries and with different ethnic backgrounds have a distinct pattern of central fat deposition. Therefore, it is essential to develop population-specific percentiles of waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-height ratio exponent (WHtR (exp)) for the evaluation of central obesity. The objective of this study was to develop age-and-gender-specific smoothed WC and WHtR percentile curves for the Pakistani children and adolescents aged 2-18 years. Methods A cross-sectional data-set from a multi-ethnic anthropometric survey was considered. A sample of 10,668 healthy subjects (boys = 51.92%; and girls = 48.08%), aged 2-18 years was studied. Height (cm) and WC (cm) of each subject was measured under standard procedure and WHtR & WHtR (exp) were calculated. Age-and-gender-specific smoothed curves were obtained using the lambda-mu-sigma (LMS) method and compared with percentile curves obtained from different countries. Results Except few early ages, the WC values increased with age in both sexes. Both boys and girls had approximately similar WC during 6-11 years of age and after age of 11, the boys had larger WC than the girls had. For WHtR, the centile curves showed a continuous decrease by 16 years of age and then increased gradually. WHtR of the girls in various ages were having similar or higher than those of the boys. In comparison of WC 50th and 90th percentiles with other countries, it was found that except few ages, the Pakistani children had larger WC than the other reference populations and the results of WHtR were also comparable to the other nations. Conclusions We present new reference data of WC, WHtR and WHtR (exp) using a representative sample of the Pakistani children aged 2-18 years. These reference values can be used provisionally for early detection of central obesity and its associated risks in the Pakistani children.

Waist circumference centiles for UK South Asian children

OBJECTIVES

To develop waist circumference (WC) centile curves for UK South Asian children, to make comparisons with published centiles for British, indigenous Indian and Pakistani children, as well as to make anthropometric comparisons with their UK white peers.

DESIGN

Cross-sectional study.

SETTING

School-aged children from London boroughs (main measures: 2004-2007).

PARTICIPANTS

1562 (652 boys, 910 girls) UK South Asian and 1120 (588 boys, 532 girls) UK white children aged 4.0-13.9 years.

INTERVENTIONS

WC, height, weight and body mass index (BMI).

MAIN OUTCOME MEASURES

The outcome measures were smoothed WC centile curves, constructed using the LMS (L = skewness, M = median, S = coefficient of variation) method. SD scores (SDS) were generated using UK90 and British (WC) growth references.

RESULTS

WC increased with age for both sexes, rising more steeply at the upper centiles after the age of 6 years. Overall, UK South Asian children, similar to indigenous South Asian populations, had higher WC values than the British WC references. However, compared with their UK white peers, UK South Asian children had significantly (p<0.001) lower mean WC (UK white SDS=0.74 and SDS=0.64 vs UK South Asian SDS=0.32 and SDS=0.21 for boys and girls, respectively). Obesity prevalence was greater using WC than BMI for both ethnicities. At the 90th centile, for UK South Asian children, prevalence was 21.5% vs 24.4% for boys and 17% vs 24.5% for girls based on BMI and WC, respectively.

CONCLUSIONS

These curves represent the first WC centiles for UK South Asian children up to the age of 14 years. With a continued rise in childhood obesity, they provide a useful historical control for future comparisons.

Waist to height ratio as a screening tool for identifying childhood obesity and associated factors

Objective:

To investigate the prevalence of obesity and associated factors during childhood in Southeastern Turkey. Another objective was to determine the cut-off points of Waist to Height Ratio (WHtR) values for defining obesity/abdominal obesity.

Methods:

The community-based descriptive cross-sectional study was conducted in Gaziantep Turkey between November 2011 and December 2011 with 2718 primary school/high schools students aged 6-17 years. The SPSS 22.00 was used for the analysis of data.

Results:

The prevalence of overweight, obesity, abdominal obesity, was 13.2%, 4.2% ,26.4%, respectively. There was a reverse relationship between BMI/WC values and sleep durations (p<0.05). The BMI/WC values were higher in students with computer usage time ≥1 hours in a day (p<0.05). Parental obesity status has an effective role on the WC/BMI values of children (p<0.05). The WHtR was a good predictor of diagnosis on obesity and abdominal obesity (AUC=0.928, p<0.0001; AUC=0.920, p<0.0001; respectively). The optimal cut-off values for obesity and abdominal obesity were detected as 0.5077, 0.4741, respectively.

Conclusions:

The WHtR can be used for diagnosis of obesity/abdominal obesity. Parental obesity, short sleep duration and computer use more than one hour per day are risk factors for the development of obesity in children and adolescents.

Utility of waist circumference-to-height ratio as a screening tool for generalized and central obesity among Iranian children and adolescents: The CASPIAN-V study

BACKGROUND

Waist-to-height ratio (WHtR) is regarded as a simple anthropometric index for evaluating central adiposity because of its independence of age, gender, and ethnicity.

OBJECTIVE

The purpose of this study was to determine the optimal WHtR cutoff value in screening obesity and to compare it with other obesity indicators including body mass index (BMI) and waist circumference (WC) in Iranian children and adolescents.

METHODS

This large survey was conducted on 14 274 Iranian children and adolescents as a national school-based surveillance study (CASPIAN) in 2015. The receiver operating characteristic curve analysis was performed to estimate the optimal cut-off points of WHtR for the prediction of general and central obesity. The area under curve (AUC) was used to compare the ability of WHtR cut-off points, BMI and WC percentiles to discriminate students with and without obesity according to age and sex.

RESULTS

The optimal WHtR cutoff value for predicting general obesity was 0.49 and 0.48 for boys and girls, respectively and for central obesity according to WC ≥ 90th percentile was 0.50 for both genders. AUC values of WHtR for predicting general and central obesity were 87% and 96%, which indicates its strong predictive ability. For central obesity, the AUCs of WHtR were superior to those of WC percentiles. The kappa agreement coefficient was 0.55 between WC ≥ 90th percentile and WHtR ≥ 0.5.

CONCLUSIONS

The WHtR ≥ 0.5 as a simple and useful screening tool is better than WC, for predicting general and central obesity in different age and sex groups of Iranian children and adolescents.

Using height-corrected definition of metabolic syndrome in children and adolescents

Metabolic syndrome (MS) is common among children and adolescents. Age- and gender-specific references or age-, gender- and height-specific references were used in pediatric MS definitions. More recently, an increasing number of studies documented that the ratio of waist circumference (WC) to height (WHtR) and blood pressure to height (BPHR) were easy anthropometric indexes for detection of obesity and hypertension in children and adolescents. For these reasons, height-corrected MS definition was proposed. WHtR and BPHR were used as alternatives to WC and BP in the definition of MS. In the present review, we discuss the possibility of the height-corrected MS definition for identifying MS in children.

Improved utilization of waist-to-height ratio in cardiometabolic risk counselling in children: Application of DMAIC strategy

RATIONALE, AIMS, AND OBJECTIVES

Waist circumference (WC) and waist-to-height ratio (WHtR) are superior surrogate markers of central obesity than body mass index. However, WC is not measured routinely in paediatric clinics. The objective of this study was to implement measurement of WC during routine assessment of children in an ambulatory outpatient clinic setting and subsequent dissemination of cardiometabolic risk counselling in children with central obesity (defined as WHtR ≥0.5).

METHOD

Prospective cohort of patients aged 6 to 20 years. Study period was divided into three phases: baseline (3 months), process improvement (2 months), and implementation (6 months). Define-Measure-Analyse-Improve-Control (DMAIC) strategy was applied. Measurement of WC was implemented as a component of the physical examination in patients. Outcome measures were (1) improvement in frequency of WC measurement and (2) utilization of WHtR in cardiometabolic risk counselling.

RESULTS

Waist circumference was not measured in any patient during baseline phase (n = 551). During process improvement phase, of the total 347 patients, WC was measured in 35% vs target of 30%. In the implementation phase, WC was measured in 37% patients (365 out of 964). Of these 365 patients, 175 (48%) had elevated WHtR, and 73% of them (n = 128) were counselled about their increased cardiometabolic risk.

CONCLUSIONS

Application of an evidence-based DMAIC protocol led to significant improvement in assessment for central obesity in an ambulatory clinic practice and appropriate counselling regarding cardiometabolic risk reduction in children and adolescents with central obesity over an 8-month period. Meticulous planning and execution, frequent reinforcement, and integrating feedback from the involved multi-disciplinary team were important factors in successful implementation of this quality improvement project.

Recent therapeutic trends and promising targets in triple negative breast cancer

Breast cancer accounts for 25% of all types of cancer in women, and triple negative breast cancer (TNBC) comprises around 15~20% of breast cancers. Conventional chemotherapy and radiation are the primary systemic therapeutic strategies; no other FDA-approved targeted therapies are yet available as for TNBC. TNBC is generally characterized by a poor prognosis and high rates of proliferation and metastases. Due to these aggressive features and lack of targeted therapies, numerous attempts have been made to discover viable molecular targets for TNBC. Massive cohort studies, clinical trials, and in-depth analyses have revealed diverse molecular alterations in TNBC; however, controversy exists as to whether many of these changes are beneficial or detrimental in caner progression. Here we review the complicated tumorigenic processes and discuss critical findings and therapeutic trends in TNBC with a focus on promising therapeutic approaches, the clinical trials currently underway, and potent experimental compounds under preclinical and evaluation.

Waist circumference and waist-to-height ratio in Chinese pre-school children: results from the 5th National Survey in 2015

BACKGROUND

Waist circumference (WC) and waist-to-height ratio (WHtR) distributions have been described in Chinese pre-school children only in local areas.

AIM

To report reference data of WC and WHtR in a nationally representative sample of Chinese pre-school children.

SUBJECTS AND METHODS

A total of 53,172 children aged 3-7 years were surveyed as part of the 5th National Survey in 2015. WC and WHtR percentile values were calculated for each age- and sex-specific group. Urban-suburban rural differences of WC and WHtR were examined. Comparisons of WC and WHtR with other Chinese studies and foreign studies were assessed.

RESULTS

Eleven conventional percentile values of WC and WHtR were obtained for urban and suburban rural children. Urban-suburban rural differences of WC ranged from -0.2 cm to 0.6 cm for both boys and girls across all age groups and the differences of WHtR ranged from -0.01 to 0.01. Median WC and WHtR curves were generally in the middle of other Chinese studies. Median WC and WHtR curves in China were generally lower than other countries that were compared.

CONCLUSION

The presented percentile values of WC and WHtR may be useful to monitor growth and development and to assess abdominal fat distribution of younger children.

Evaluation of anthropometric parameters of central obesity in Pakistani children aged 5-12 years, using receiver operating characteristic (ROC) analysis

Background Different anthropometric parameters have been proposed for assessing central obesity in children, but the ability of these anthropometric parameters to correctly measure central obesity in Pakistani children is questionable and needs to be assessed. The aims of this investigation were to examine the diagnostic performance of anthropometric parameters as indicators of central obesity in Pakistani children as measured by waist circumference (WC) and to determine the sex-specific best cut-off values for these parameters that would identify obese children. Methods Anthropometric measurements - height, weight, WC, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), conicity index (CI) and neck circumference (NC) - from a cross-sectional sample of 5964 Pakistani children aged 5-12 years were analyzed. Receiver operating characteristics (ROC) analysis was used to examine the diagnostic performance and to determine the optimal cut-off point of each anthropometric parameter for identifying centrally obese children. Results It was found that WC had a significantly positive correlation with all studied anthropometric parameters. The ROC curve analysis indicated that all the parameters analyzed had good performance but WHtR had the highest value of the area under the curve (AUC). Optimal cut-off points associated with central obesity for boys and girls were, respectively, 0.47 and 0.48 for WHtR, 1.20 and 1.23 for CI, 0.96 and 0.96 for WHR and 26.36 and 26.54 cm for NC. Conclusions The sex-specific cut-off points for WHtR, CI, WHR and NC can be used to detect central obesity in Pakistani children.

Chronic Stress in Children and Adolescents: A Review of Biomarkers for Use in Pediatric Research

PROBLEM

Incorporating biomarkers of chronic stress into pediatric research studies may help to explicate the links between exposure to adversity and lifelong health, but there are currently very few parameters to guide nurse researchers in choosing appropriate biomarkers of chronic stress for use in research with children and adolescents.

METHODS

Biomarkers of chronic stress are described, including primary mediators (glucocorticoids, catecholamines, and cytokines) and secondary outcomes (neurologic, immune, metabolic, cardiovascular, respiratory, and anthropometric) of the chronic stress response.

RESULTS

Evidence of the use of each biomarker in pediatric research studies is reviewed. Recommendations for pediatric researchers, including selection of appropriate biomarkers, measurement considerations, potential moderators, and future directions for research, are presented.

DISCUSSION

A wide range of biomarkers is available for use in research studies with children. While primary mediators of chronic stress have been frequently measured in studies of children, measurement of secondary outcomes, particularly immune and metabolic biomarkers, has been limited. With thoughtful and theoretically based approaches to selection and measurement, these biomarkers present an important opportunity to further explore the physiologic pathways linking exposure to chronic stress with later health and disease.

CONCLUSION

The incorporation of chronic stress biomarkers into pediatric research studies may provide valuable insight into the mechanisms through which stressful environments "get under the skin" and ultimately inform efforts to promote health and reduce inequities among children exposed to adversity.

Waist circumference in 6–12-year-old children: The Health Oriented Pedagogical Project (HOPP)

Aims: With overweight and obesity increasing worldwide, it has become ever more important to monitor the development and distribution of adiposity in children. This study investigated how the measurements of waist circumference (WC) and waist-to-height ratio (WHtR) in children 6–12 years old relate to earlier studies. Methods: In 2015, 2271 children (boys, n = 1150) were measured for height, weight, and WC. Parental education level was used as a measure of socioeconomic status. Results: A significant increase in WC with age was revealed for both sexes ( p < .0001). Boys at 10 and 12 years had a larger WC than girls; otherwise no difference between sexes was found. The WHtR decreased with age for girls ( p < .0001); 14% of the sample displayed a WHtR ≥ 0.50. Comparison with earlier studies showed a higher WC and WHtR despite no change in weight and body mass index. Conclusion: WC and WHtR are recommended as tools for identifying central obesity in children. The results indicate increased WC in 6–12-year-old children compared with earlier findings.

Mid-upper-arm circumference as a screening measure for identifying children with elevated body mass index: a study for Pakistan

Purpose

Mid-upper-arm circumference (MUAC) is considered an alternative screening method for obesity. The aims of this investigation were to examine the ability of MUAC to correctly identify children with elevated body mass index (BMI) and to determine the best MUAC cutoff point for identification of children with high BMI.

Methods

Anthropometric measurements (height, weight, and MUAC) from a cross-sectional sample of 7,921 Pakistani children aged 5–14 years were analyzed. Pearson correlation coefficients between MUAC and other anthropometric measurements were calculated. Receiver operating characteristic curve analysis was used to determine the optimal MUAC cutoff point for identifying children with high BMI.

Results

Among 7,921 children, the mean (±standard deviation) age, BMI, and MUAC were 10.00 (±2.86 years), 16.16 (±2.66 kg/m²), and 17.73 (±2.59 cm), respectively. The MUAC had a strong positive correlation with BMI. The optimal MUAC cutoff points indicating elevated BMI in boys ranged from 16.76 to 22.73, while the corresponding values in girls ranged from 16.38 to 20.57.

Conclusion

MUAC may be used as a simple indicator of overweight/obesity in children, with reasonable accuracy in clinical settings.

WAIST-TO-HEIGHT RATIO INDEX OR THE PREDICTION OF OVERWEIGHT IN CHILDREN

Objective:

To identify a low-cost abdominal adiposity index that has a higher accuracy in predicting excess weight in children aged four to seven years old.

Methods:

A cross-sectional study with a sample of 257 children aged 4 to 7 years old. Indicators of abdominal adiposity assessed were: waist circumference (WC), waist-to-height ratio (WHR) and central fat percentage (measured by dual energy X-ray absorptiometry - DEXA). Overweight children were classified using body mass index by age (BMI/age). In the analysis, the prevalence ratio (PR) using Poisson regression with a robust variance was estimated, and a receiver operating characteristic (ROC) curve was built, with a statistical significance of p<0.05.

Results:

The prevalence of overweight children was 24.9% and a higher median of all abdominal adiposity indicators was observed in the overweight group. Children with increased values of WC (PR=4.1; 95%CI 2.86-5.86), WHR (PR=5.76; 95%CI 4.14-8.02) and a central fat percentage (PR=2.48; 95%CI 1.65-3.73) had a higher prevalence of being overweight. Using the ROC curve analysis, the WHR index showed a higher area under the curve, when compared to the WC and to the central fat percentage estimated by DEXA for predicting the classification of being overweight.

Conclusions:

Given the results, WHR is suggested for the screening of overweight children.

Using LMS tables to determine waist circumference and waist-to-height ratios in Colombian children and adolescents: the FUPRECOL study

BACKGROUND

Waist circumference (WC) and waist-to-height ratio (WHtR) are often used as indices predictive of central obesity. The aims of this study were: 1) to obtain smoothed centile charts and LMS tables for WC and WHtR among Colombian children and adolescents; 2) to evaluate the utility of these parameters as predictors of overweight and obesity.

METHOD

A cross-sectional study was conducted of a sample population of 7954 healthy Colombian schoolchildren [3460 boys and 4494 girls, mean age 12.8 (±2.3) years]. Weight, height, body mass index (BMI), WC and WHtR were measured, and percentiles were calculated using the LMS method (Box-Cox, median and coefficient of variation). Appropriate cut-off points of WC and WHtR for overweight and obesity, according to International Obesity Task Force definitions, were selected using receiver operating characteristic (ROC) analysis. The discriminating power of WC and WHtR is expressed as area under the curve (AUC).

RESULTS

Reference values for WC and WHtR are presented. Mean WC increased and WHtR decreased with age for both genders. A moderate positive correlation was observed between WC and BMI (r = 0.756, P < 0.01) and between WHtR and BMI (r = 0.604, P < 0.01). ROC analysis revealed strong discrimination power in the identification of overweight and obesity for both measures in our sample population. Overall, WHtR was a slightly better predictor of overweight/obesity (AUC 95% CI 0.868-0.916) than WC (AUC 95% CI 0.862-0.904).

CONCLUSION

This paper presents the first sex and age-specific WC and WHtR percentiles for Colombian children and adolescents aged 9.0-17.9 years. The LMS tables obtained, based on Colombian reference data, can be used as quantitative tools for the study of obesity and its comorbidities.

Waist-to-height ratio and its associations with body mass index in a sample of Tuscan children in primary school

BACKGROUND

Visceral obesity in children increases the risk of developing cardiovascular diseases. To evaluate overweight children, in addition to Body Mass Index (BMI), waist-to-height ratio (WHtR) can be used to predict cardiometabolic risk. The goal of this study is to describe WHtR in a sample of Tuscan children.

METHODS

A sample of children living in the province of Pistoia, Tuscany, was measured for the following anthropometric parameters: weight, height, and waist circumference. BMI and WHtR were calculated. For the latter indicator, a threshold of 0.5 was considered as a cardiovascular risk predictor. The subjects were classified into underweight, normal weight, overweight, and obese using Cole's cut-offs.

RESULTS

The number of children enrolled were 1575 (821 males; 754 females), aged 6-11 years. Of them, 64.3% were normal weight, 4.9% underweight, 22.3% overweight, and 8.5% obese. Moreover, 12.8% had a WHtR ≥0.5 (85.7% males; 88.7% females). The average WHtR value was 0.45 ± 0.045, and was significantly different as per gender (F = 0.45 vs. M = 0.46). WHtR was significantly correlated with BMI (r = 0.766).

CONCLUSION

The average WHtR value was in line with previous studies conducted among children of similar age groups. Large-scale perspective studies are needed to validate the Italian WHtR cut-offs for children.

Association of cardiac autonomic modulation with physical and clinical features of young people with type 1 diabetes

OBJECTIVE

The objective of this study was to verify possible associations between heart rate variability indices and physical activity, body composition, and metabolic and cardiovascular parameters in individuals with type 1 diabetes.

METHOD

A total of 39 young patients with type 1 diabetes were included. Body composition, physical activity, cardiovascular parameters, and metabolic parameters were assessed. For the heart rate variability analysis, heart rate was recorded beat-by-beat using a Polar S810i heart rate monitor for 30 minutes, with the volunteers in the supine position; subsequently, the following indices were considered: standard deviation of all normal RR intervals; root-mean square of differences between adjacent normal RR intervals in a time interval; percentage of adjacent RR intervals with a difference of duration >50 ms; high frequency component in milliseconds squared; high frequency component in normalised units; standard deviation of the instantaneous variability beat-to-beat; and standard deviation of the long-term variability. The association between the heart rate variability indices and independent variables was verified through linear regression in unadjusted and adjusted models (considering gender and age). The statistical significance was set at 5% and the confidence interval at 95%.

RESULTS

High values of at-rest heart rate were associated with reduced parasympathetic activity and global heart rate variability, and higher values of waist-to-hip ratio were related to lower parasympathetic activity, independent of age or gender.

CONCLUSION

For young patients with type 1 diabetes, increases in at-rest heart rate values are associated with reduced parasympathetic activity and global heart rate variability, whereas higher waist-to-hip ratio values are related to lower parasympathetic activity, both independent of age and gender.

[Anthropometric indices among schoolchildren from a municipality in Southern Brazil: a descriptive analysis using the LMS method]

OBJECTIVE:

To describe the percentile values for body mass index (BMI), waist circumference (WC) and waist-to-height (WHtR) of children from Colombo, Brazil, and compare them with data of children from other countries.

METHODS:

This was a cross-sectional study with a random sample of 2,035 children aged 6-11 years. Age- and sex-specific smoothed percentiles curves for BMI, WC and WHtR were created using the LMS method. Values of 10^th, 50^th and 90^th percentiles from Brazilian children were compared with data from other countries.

RESULTS:

There was a trend of increasing BMI and WC with age in both sexes. WHtR remained constant with advancing age in boys and girls. Comparison of the growth pattern among countries showed clear differences. Southern Brazil boys and girls had elevated 90^th percentile values for BMI, which was similar to German children and higher than the North American and World Health Organization percentile values. However, children from this study had intermediate values for WC and WHtR in comparison to children from other countries.

CONCLUSIONS:

Elevated BMI values were observed among southern Brazilian children, but WC and WHtR percentile values were lower in southern Brazilian children than in children from other countries. Interventions at different levels should be made to avoid a probable increase of nutritional disorders (especially general obesity) in the next years.

BMI, Waist Circumference Reference Values for Chinese School-Aged Children and Adolescents

Background: Childhood obesity has become one of the most serious public health challenges in the 21st century in most developing countries. The percentile curve tool is useful for monitoring and screening obesity at population level, however, in China, no official recommendations on childhood body mass index (BMI) and waist circumference (WC) reference percentiles have been made in practice. Aims: to construct the percentile reference values for BMI and WC, and then to calculate the prevalence of overall and abdominal obesity for Chinese children and adolescents. Methods: A total of 5062 anthropometric records for children and adolescents aged from 7 to 18 years (2679 boys and 2383 girls) were included for analysis. The participants were recruited as part of the national representative “China Health and Nutrition Survey” (CHNS). Age, gender, weight, height, and WC were assessed. Smoothed BMI and WC percentile curves and values for the 3rd, 5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, 95th and 97th percentiles were constructed by using the Lambda-Mu-Sigma (LMS) method. The prevalence estimates of the overall and abdominal obesity were calculated by using the cut-offs from our CHNS study and the previous “Chinese National Survey on Students’ Constitution and Health” (CNSSCH) study, respectively. The difference between prevalence estimates was tested by a McNemar test, and the agreement between these prevalence estimates was calculated by using the Cohen’s kappa coefficient. Results: The prevalence values of overall obesity based on the cut-offs from CHNS and CNSSCH studies were at an almost perfect agreement level in boys (κ = 0.93). However, among girls, the overall obesity prevalence differed between the studies (p < 0.001) and the agreement was weaker (κ = 0.76). The abdominal obesity prevalence estimates were significant different according to the two systems both in boys and girls, although the agreement reached to 0.88, which represented an almost perfect agreement level. Conclusions: This study provided new BMI and WC percentile curves and reference values for Chinese children and adolescents aged 7–18 years, which can be adopted in future researches. Large longitudinal study is still needed to reveal the childhood growth pattern and validate the inconsistence between different percentile studies.

Gender and urban-rural difference in anthropometric indices predicting dyslipidemia in Chinese primary school children: a cross-sectional study

BACKGROUND

Childhood dyslipidemia is a critical factor of lifelong health. Therefore, screening and controlling dyslipidemia from childhood is a practical healthy strategy. However, few studies have examined the performance of anthropometric predictors of dyslipidemia in Chinese children, let alone the potential gender and urban-rural disparity. Thus, we evaluated anthropometric indices predicting dyslipidemia by genders and living areas in Chinese children.

METHODS

Data were from a health and nutrition survey conducted in seven urban areas and two rural areas in China between 2011 and 2012. The serum lipid levels of the participants were compared between genders and living areas. The body mass index z-score (BMI z-score), waist-hip ratio (WHR), waist-height ratio (WHtR), and mid-upper arm height ratio (MaHtR) were used as predictors. The receiver operating characteristic (ROC) analysis was performed to investigate the ability of anthropometric indices predicting dyslipidemia.

RESULTS

A total of 773 participants (average age = 9.3 ± 1.7 y) were included. The prevalence of dyslipidemia was 10.9%. Anthropometric indices were all significantly related to blood lipid profiles in boys after adjustment for age. The areas under the ROC curves (ACUs) were significantly larger than 0.5 in boys (ranged between 0.66-0.73), and were larger in rural boys (ranged between 0.68 and 0.94). MaHtR and WHR were associated with the highest specificity (93.8%) and highest sensitivity (100%), respectively.

CONCLUSION

Using anthropometric indices, screening for dyslipidemia may be more appropriate in boys than in girls in China, especially in rural boys. The BMI z-score, WHR, WHtR, and MaHtR were all significantly associated with dyslipidemia in boys; using WHR and MaHtR as indicators achieved the highest sensitivity and specificity, respectively.

Plasma concentrations of retinol in obese children and adolescents: relationship to metabolic syndrome components

Objective:

To evaluate obese children and adolescents' retinol plasma levels and to correlate them with metabolic syndrome components.

Methods:

Cross-sectional study with 61 obese children and adolescents (body mass index Z score - ZBMI>+2). Pubertal development, arterial blood pressure, body weight and height for nutritional classification and waist circumference were obtained. A 15mL blood sample was collected (after a 12-hour fasting in a low luminosity room) for retinol determination (cut-off inadequate if <30µg/dL), lipid profile (HDL-c, LDL-c, and triglycerides), oral glucose tolerance test (fasting and 120 minutes) and for high sensitivity C-reactive protein. Spearman correlation and multiple linear regression were used in the statistical analysis.

Results:

Mean age was 10.7±2.7 years. There was a predominance of male gender 38/61 (62%) and pre-pubertal 35/61 (57%) subjects. The average plasmatic retinol was 48.5±18.6ug/dL. Retinol deficiency and severe obesity were observed in 6/61 (10%) and 36/61 (59%), respectively. Glucose level at 120 minutes was the independent and predictive variable of plasma retinol levels [β=-0.286 (95%CI -0.013 - -0.001)].

Conclusions:

An independent and inverse association between plasma retinol levels and glucose tolerance was observed, suggesting an important contribution of this vitamin in the morbidities associated to obesity in children and adolescents.

A 12-week randomized double-blind parallel pilot trial of Sinetrol XPur on body weight, abdominal fat, waist circumference, and muscle metabolism in overweight men

Overweight and obesity are associated to increased risk of developing non-communicable diseases that might dramatically affect life expectancy according World Health Organization. Overweight, obesity, and decline in physical activity are correlated to a significant propensity to lose skeletal muscle mass as a result of prolonged inflammation and oxidative stress whereas cohort surveys and clinical investigations have demonstrated health benefits of Citrus-based polyphenols to reverse such regression. Overweight men were included in a double-blind, randomized, parallel pilot trial where they received daily for a 12-week period 900 mg of a Citrus-based polyphenol extract, Sinetrol® XPur. Body composition, anthropometric, and blood parameters were assessed before and at the end of the intervention period. After 12 weeks, while the silhouette slimmed down, metabolic parameters were significantly improved and skeletal muscle catabolism held back. These data suggest that over a 12-week period, the efficacy of the supplement improve both overweight process and correlated skeletal muscle mass metabolism.

Prevalence and factors associated with central obesity in schoolchildren in Santa Catarina, Brazil

Objective: The aims of this article are to estimate the prevalence and to identify the sociodemographic factors and food consumption associated with central obesity in schoolchildren 6-10 years old of the State of Santa Catarina, Brazil. Methods: It consists in a cross-sectional population-based study involving 4,963 schoolchildren enrolled in the public and private sectors. The dependent variable is central obesity investigated by measuring waist circumference and classified according to percentiles/gender/age. Bivariate and multivariate analyzes were also performed. Results: The prevalence of central obesity was 4,9% (CI95%=4,3;5,5), being more prevalent in boys with statistical significance (p=0,003). The other variables investigated (age the schoolchildren, type of school, maternal education, protective and risk food consumption, number of daily meals) were not associated with outcome. Among the schoolchildren who had central obesity (n=243), 99.3% of the boys and 99.0% of the girls also showed overweight/obesity. Conclusion: The prevalence of central obesity was lower than that reported in national and international studies. In this scenario, the gender (male) variable was strongly associated with the outcome. The identified prevalence is a major concern in nutrition and medical science as the central obesity may remain in adulthood and show strong association with cardiovascular risk. It is noteworthy that there is a need for obesity prevention campaigns that encourage children and their parents to adopt a healthier life style. Finally, other studies should be conducted in order to examine potential factors linked to central obesity.

Abdominal obesity and metabolic syndrome burden in adolescents--Penn State Children Cohort study

To investigate the association between abdominal obesity and metabolic syndrome (MetS) burden in a population-based sample of adolescents, we used data from 421 adolescents who completed the follow-up examination in the Penn State Children Cohort study. Dual-energy x-ray absorptiometry (DXA) was used to assess abdominal obesity, as measured by android/gynoid fat ratio (A/G ratio), android/whole body fat proportion (A/W proportion), visceral (VAT) and subcutaneous fat (SAT) areas. Continuous metabolic syndrome score (cMetS), calculated as the sum of the age and sex-adjusted standardized residual (Z-score) of five established MetS components, was used to assess the MetS burden. Linear regression models were used to analyze the impact of DXA measures on cMetS components. All models were adjusted for age, race, sex, and general obesity. We found abdominal obesity is significantly associated with increased cMetS. With 1 standard deviation (SD) increase in A/G ratio, A/W proportion, VAT area, and SAT area, cMetS increased by 1.34 (SE=0.17), 1.25 (SE=0.19), 1.67 (SE=0.17), and 1.84 (SE=0.20) units, respectively. At individual component level, strongest association was observed between abdominal obesity and insulin resistance (IR) than lipid-based or blood pressure-based components. VAT and SAT had a stronger impact on IR than android ratio-based DXA measurements. In conclusion, abdominal obesity is associated with higher MetS burden in adolescent population. The association between abdominal obesity and IR measure is the strongest, suggesting the key impact of abdominal obesity on IR in adolescents MetS burden.

Anthropometric indices among schoolchildren from a municipality in Southern Brazil: a descriptive analysis using the LMS method

OBJECTIVE: To describe the percentile values for body mass index (BMI), waist circumference (WC) and waist-to-height (WHtR) of children from Colombo, Brazil, and compare them with data of children from other countries.METHODS: This was a cross-sectional study with a random sample of 2,035 children aged 6-11 years. Age- and sex-specific smoothed percentiles curves for BMI, WC and WHtR were created using the LMS method. Values of 10th, 50th and 90th percentiles from Brazilian children were compared with data from other countries.RESULTS: There was a trend of increasing BMI and WC with age in both sexes. WHtR remained constant with advancing age in boys and girls. Comparison of the growth pattern among countries showed clear differences. Southern Brazil boys and girls had elevated 90th percentile values for BMI, which was similar to German children and higher than the North American and World Health Organization percentile values. However, children from this study had intermediate values for WC and WHtR in comparison to children from other countries.CONCLUSIONS: Elevated BMI values were observed among southern Brazilian children, but WC and WHtR percentile values were lower in southern Brazilian children than in children from other countries. Interventions at different levels should be made to avoid a probable increase of nutritional disorders (especially general obesity) in the next years.

Waist Circumference, Waist-to-Height Ratio and Body Mass Index of Thai Children: Secular Changes and Updated Reference Standards

BACKGROUND

The prevalence of obesity in pediatric age group has been increasing globally. Body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) are commonly used to define obesity. The cut-off references for these parameters vary between racial and ethnic groups. We aimed to measure the secular changes and update the reference standards for these three parameters for Thai children in this study.

MATERIALS AND METHODS

We completed a cross-sectional survey of 3,885 school children 6.0-12.99 y of age in Ongkharak district of central Thailand during May to June 2013. Weight, height and WC were recorded by trained staff using sensitive and calibrated instruments. BMI and WHtR were calculated by standard formulae. The summary estimates were described by gender and whole year age groups. Age and gender specific smoothened percentile curves were created by using least mean squares method. The data was compared with that from a 2008 cohort from the same area.

RESULTS

Age and gender specific percentile data and curves of WC, WHtR and BMI have been provided for Thai children. BMI and WC increased but WHtR changed relatively little with age in both genders. In comparison to 2008, WC and WHtR have increased consistently across all age groups and both genders. The 75th percentile for WHtR corresponded closely to 0.50 in both genders which has been the suggested cut-off.

CONCLUSION

Since 2008, there have been significant increase in WC and WHtR across all age groups and in both genders in Thai children. These indicate increasing prevalence of central obesity and upcoming cardio-metabolic health problems. This needs to be tackled urgently by creating awareness and promotion of healthy diets and physical activities in school children. WC and WHtR should be routinely measured in paediatric examination for early diagnosis of central obesity.

Waist-to-hip ratio, dyslipidemia, glycemic levels, blood pressure and depressive symptoms among diabetic and non-diabetic Chinese women: a cross-sectional study

OBJECTIVES

To explore the relationship between depressive symptoms and waist-to-hip ratio, dyslipidemia, glycemic levels or blood pressure among diabetic and non-diabetic Chinese women.

METHODS

11,908 women aged ≥40 years were enrolled in this cross-sectional study, including 2,511 with type 2 diabetes and 9,397 without. Depressive symptoms (defined as having mild-to-severe depressive symptoms) were assessed by the Patient Health Questionnaire-9 (PHQ-9) diagnostic algorithm. The prevalence and the odds ratios (ORs) with 95% confidence intervals (CIs) for having depressive symptoms were estimated using logistic regression analysis.

RESULTS

The age-adjusted prevalence of depressive symptoms was significantly higher in non-diabetic subjects with waist-to-hip ratio (WHR) ≥0.9 (8.6%, age-adjusted OR 1.51 [95% CI 1.17, 1.95]), total cholesterol (TC)>6.22 mmol/L (8.8%, 1.58 [1.16, 2.15]), and Hemoglobin A1c (HbA1c) ≥6.00 mmol/L (7.7%, 1.69 [1.34, 2.14]), while it was significantly lower in non-diabetic subjects with diastolic blood pressure (DBP) between 80 to 89 mmHg (6.2%, 0.78 [0.64, 0.95]). These relationships remained significant even after controlling for multiple factors (WHR ≥0.9: multivariable-adjusted OR 1.39 [95% CI 1.07, 1.80]; TC>6.22 mmol/L: 1.56 [1.14, 2.12]; HbA1c ≥6.00 mmol/L: 1.64 [1.30, 2.08]; DBP 80-89 mmHg: 0.78 [0.64, 0.95]). However, no significant trend between depressive symptoms and WHC, TC, HbA1c, DBP was observed in diabetic women, and no significant trend relationship between depressive symptoms and BMI, WC, TG, or SBP was observed in both non-diabetic and diabetic women. Moreover, the prevalence of depressive symptoms was significantly higher in previously-diagnosed diabetes, compared with non-diabetic subjects, while no significant differences were observed between newly-diagnosed diabetes and non-diabetic subjects.

CONCLUSION

The present study showed a relationship between WHR, TC, HbA1c, DBP and depressive symptoms among non-diabetic women, while no significant relationship between them was observed among diabetic women, even after controlling for multiple confounding factors.

[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.

Metabolic syndrome among children and adolescents from Southern Italy: contribution from the Calabrian Sierras Community Study (CSCS)

Among 1657 children and adolescents aged 6 to 14 years (787, 47% girls and 870, 53% boys) from primary and secondary schools in a 14-town Southern Italian community, HDL cholesterol (54 ± 15 mg/dl), triglycerides (61 ± 29 mg/dl), blood glucose (78 ± 10 mg/dl), systolic (101 ± 11 mm Hg) and diastolic (62 ± 10 mm Hg) blood pressures, waist circumference (WC) (66 ± 10 cm) and WC/height (0.46 ± 0.006) and triglycerides/HDL cholesterol (1.31 ± 0.99) ratios were measured. The distributions were similar in both genders. Age did not affect triglycerides/HDL cholesterol ratio, whereas there was a slightly positive correlation (p<0.00001) between WC/height and triglycerides/HDL cholesterol ratios. We present individual gender and age specific percentile distributions (as Supplementary materials). Using percentile cut-offs (≤ 10th for HDL cholesterol and ≥ 90th for the other components), there were 183 (11%) children or adolescents with low HDL cholesterol, 162 (9.77%) with high triglycerides, 178 (10.74%) with high blood glucose, 178 (10.74%) with high WC, 244 (20.76%) with high systolic or diastolic BP and 126 (7.6%) with high systolic and diastolic BP. Abnormally high BP was seen in 470 (28.36%) children or adolescents. Using abnormal percentile values of 3 of 5 of its components, metabolic syndrome (MS) was diagnosed in 70 (4.2%) subjects, similarly in both genders. To assess out-of-limit distributions of all 5 individual MS components in children and adolescents gender- and age-distributions derived from local epidemiological data should be used: these distributions are presented and they might now be used both for comparative and applicative purposes at least in Southern Europe.

Toward body composition reference data for infants, children, and adolescents

Growth charts for weight and height have provided the basis for assessment of children's nutritional status for over half a century, with charts for body mass index (BMI) introduced in the 1990s. However, BMI does not provide information on the proportions of fat and lean mass; and within the past decade, growth charts for children's body composition have been produced by using techniques such as skinfold thicknesses, body circumferences, bioelectrical impedance analysis (BIA), and dual-energy X-ray absorptiometry (DXA). For public health research, BIA and skinfold thicknesses show negligible average bias but have wider limits of agreement than specialized techniques. For patients, DXA is the best individual method, but multicomponent models remain ideal because they address perturbations in lean mass composition. Data can be expressed in age- and sex-specific SD scores, in some cases adjusting for height. Most such reference data derive from high-income countries, but techniques such as air-displacement plethysmography allow infant body composition growth charts to be developed in low- and middle-income settings, where the data may improve understanding of the effects of low birth weight, wasting, and stunting on body composition. Recent studies suggest that between-population variability in body composition may derive in part from genetic factors, suggesting a universal human body composition reference may not be viable. Body composition growth charts may be extended into adult life to evaluate changes in fat and lean mass through the entire life course. These reference data will improve the understanding of the association between growth, body composition, health, and disease.

Percentiles of waist-hip ratio and the relationship with blood pressure among children and adolescents in Shandong, China

BACKGROUND

Anthropometric indices such as waist circumference (WC), waist-to-height ratio (WHtR) and waist-hip ratio (WHR) have been recognized as useful alternatives to visceral fat measurement in epidemiological studies. WHR has been used extensively in adults. However, there are very few published data for WHR among children and adolescents.

AIM

The present study examined the distribution of WHR and the relationship with blood pressure (BP) among children and adolescents in Shandong, PR China.

SUBJECTS AND METHODS

Data for this study were obtained from a large cross-sectional survey of schoolchildren carried out in 2010. A total of 38,822 students (19,456 boys and 19,366 girls) aged 7-17 years participated in this study. WC, Hip circumference (HC), systolic blood pressure (SBP) and diastolic blood pressure (DBP) of all subjects were measured; WHR was calculated as WC divided by HC. Abdominal obesity was defined by previously published WHR references based on Chinese children and adolescents living in Beijing. All subjects were divided into two groups (group 1 with WHR <85th; group 2 with WHR ≥85th) according to the percentiles of WHR and comparisons of the SBP and DBP between the two groups were made.

RESULTS

The WHR levels in Shandong boys and girls were lower than those from German and Pakistani. The overall prevalence of abdominal obesity was 9.53% (95% CI = 9.12-9.95%) for boys and 9.82% (95% CI = 9.40-10.24%) for girls, no statistical differences between the two genders were observed (p > 0.05). In both boys and girls, the Z-scores of SBP and DBP were all significantly lower in group 1 than in group 2 (p < 0.01), indicating that children and adolescents with high WHR tended to have higher BP values.

CONCLUSION

WHR is useful in identifying children and adolescents at risk of developing high BP. These findings, together with the known tracking of BP from adolescence into adulthood, highlight the importance of preventing overweight and obesity among children and adolescents in order to prevent the development of hypertension in adults.

Dietary, lifestyle and socio-economic correlates of overweight, obesity and central adiposity in Lebanese children and adolescents

The Eastern Mediterranean region is characterized by one of the highest burdens of paediatric obesity worldwide. This study aims at examining dietary, lifestyle, and socio-economic correlates of overweight, obesity, and abdominal adiposity amongst children and adolescents in Lebanon, a country of the Eastern Mediterranean basin. A nationally representative cross-sectional survey was conducted on 6-19-year-old subjects (n = 868). Socio-demographic, lifestyle, dietary, and anthropometric data (weight, height, waist circumference) were collected. Overweight and obesity were defined based on BMI z-scores. Elevated waist circumference (WC) and elevated waist to height ratio (WHtR) were used as indices of abdominal obesity. Of the study sample, 34.8% were overweight, 13.2% were obese, 14.0% had elevated WC, and 21.3% had elevated WHtR. Multivariate logistic regression analyses showed that male gender, maternal employment, residence in the capital Beirut, sedentarity, and higher consumption of fast food and sugar sweetened beverages were associated with increased risk of obesity, overweight, and abdominal adiposity, while regular breakfast consumption, higher intakes of milk/dairies and added fats/oils were amongst the factors associated with decreased risk. The study's findings call for culture-specific intervention strategies for the promotion of physical activity, healthy lifestyle, and dietary practices amongst Lebanese children and adolescents.

A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease

This article is a comprehensive review on developmental origins of health and disease regarding various factors related to the origins of cardiovascular diseases from early life. It presents a summary of the impacts of various factors such as epigenetics; gene-environment interaction; ethnic predisposition to cardiovascular diseases and their underlying risk factors; prenatal factors; fetal programming; maternal weight status and weight gain during pregnancy; type of feeding during infancy; growth pattern during childhood; obesity; stunting; socioeconomic status; dietary and physical activity habits; active, secondhand, and thirdhand smoking, as well as environmental factors including air pollution and global climate change on the development and progress of cardiovascular diseases and their risk factors. The importance of early identification of predisposing factors for cardiovascular diseases for primordial and primary prevention of cardiovascular diseases from early life is highlighted.

Dual burden of body weight among Iranian children and adolescents in 2003 and 2010: the CASPIAN-III study

INTRODUCTION

Our aim was to compare changes of body mass index (BMI) and waist circumference (WC) curves of Iranian children by comparing the results of two national surveys of a surveillance program, i.e. CASPIAN-I (2003-2004) and CASPIAN-III (2009-2010). The second objective was to evaluate the prevalence of obesity, overweight and underweight among 10-18-year-old Iranian children and adolescents.

MATERIAL AND METHODS

This study was performed among students who were selected by multistage random cluster sampling from urban and rural areas of 27 provinces of Iran, as part of a national survey of school student high risk behavior entitled CASPIAN-III, conducted in 2009-2010.

RESULTS

We evaluated 5088 school students (50.2% boys). In rural areas, underweight was more common in boys and overweight and obesity in girls. In urban areas underweight and obesity were more common in boys, whereas overweight was more common in girls. The highest prevalence of underweight (23.5%) was seen in students aged 13 years and the lowest (11.4%) in those aged 18 years. Underweight was significantly more common in rural than in urban areas (22.1% vs. 15.8%, respectively, p < 0.0001) and overweight/obesity was more common in urban than in rural areas. Compared with the findings in 2003-2004, the overall prevalence of elevated body mass index (16.6%) including obesity (9.1%) and overweight (7.5%) as well as underweight (17.5%) increased from 2003 to 2010.

CONCLUSIONS

In recent years, the double burden of nutritional disorders has increased among Iranian children and adolescents, especially in rural areas. This change may be related to epidemiologic transition, notably in terms of nutrition transition and rapid changes in lifestyle habits. This finding is an important issue for policy-makers for interventional preventive programs.