Secular increases in relative weight and adiposity among children over two decades: the Bogalusa Heart Study

The interplay of type 1 diabetes and weight management: A qualitative study exploring thematic progression from adolescence to young adulthood

BACKGROUND

The impact of weight management in persons with type 1 diabetes (T1D) from childhood into adulthood has not been well described. The purpose of the study was to explore qualitative themes presented by young adults with T1D with respect to the dual management of weight and T1D.

METHODS

We analyzed focus group data from 17 young adults with T1D (65% female, age 21.7 ± 2.1 years, HbA1c 8.1% ± 1.5) via inductive qualitative analysis methods. Major themes were compared to themes presented by youth with T1D ages 13-16 years in previously published study in order to categorize thematic progression from early adolescence through adulthood.

RESULTS

Themes from young adults with T1D, when compared to those from youth were categorized as: (a) persistent and unchanged themes, (b) evolving themes, and (c) newly reported themes. Hypoglycemia and a sense of futility around exercise was an unchanged theme. Importance of insulin usage and a healthy relationship with T1D evolved to gather greater conviction. Newly reported themes are unique to integration of adulthood into T1D, such as family planning and managing T1D with work obligations. Young adults also reported negative experiences with providers in their younger years and desire for more supportive provider relationships.

CONCLUSIONS

Issues identified by youth regarding the dual management of T1D and weight rarely resolve, but rather, persist or evolve to integrate other aspects of young adulthood. Individualized and age-appropriate clinical support and practice guidelines are warranted to facilitate the dual management of weight and T1D in persons with T1D.

Leptin as a breast milk component for the prevention of obesity

Leptin ingested as a component of breast milk is increasingly recognized to play a role in the postnatal programming of a healthy phenotype in adulthood. Besides its primary function in controlling body weight, leptin may be an essential nutrient required during lactation to ensure that the system controlling fat accumulation and body composition is well organized from the early stages of development. This review delves into the following topics: (1) the imprinted protective function of adequate leptin intake during lactation in future metabolic health; (2) the consequences of a lack of leptin intake or of alterations in leptin levels; and (3) the mechanisms described for the effects of leptin on postnatal programming. Furthermore, it highlights the importance of breastfeeding and the need to establish optimal or reference intake values for leptin during lactation to design patterns of personalized nutrition from early childhood.

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.

The relationship of obesity to the timing of permanent tooth emergence in Czech children

BACKGROUND

The aim of this study was to investigate the influence of BMI on the timing of permanent tooth emergence in Czech children.

OBJECTIVES

In this cross-sectional study, 1370 Czech children were examined. The age, gender, weight, height, all emerged permanent teeth (except third molars) of each child were all recorded. A tooth is defined as having emerged when at least any part of it has penetrated the gingiva.

METHODS

A logistic regression model was used to calculate the median emergence age per tooth for both genders separately and BMI was used as a factor variable to detect statistically significant differences in the times of tooth emergence within pairs of BMI groups. The data were statistically processed using IBM SPSS Statistics 23 (SPSS Inc., Chicago, IL).

RESULTS

Statistically significant differences were found for the following permanent teeth (using the FDI two-digit system): 13, 14, 15, 16, 17, 41, 44, 45, 46, 47, 33, 35, 37, 21, 24, 25, 26, 27 for girls and 12, 13, 14, 15, 16, 41, 43, 44, 45, 22, 25, 32, 34, 35, 36 for boys. These teeth were observed to emerge earlier in obese children. A similar correlation (although not statistically significant) was observed between the time of emergence of the remaining teeth and the BMI of the child.

CONCLUSION

The data in this research highlight significant differences in emergence times of permanent teeth due to the influence of BMI in Czech children. These findings are important for dental treatment planning.

Secular Changes of Adiposity in Czech Children Aged from 3 to 6 Years: Latent Obesity in Preschool Age

BMI, skinfold thickness, and circumferential measures were assessed in groups of normal healthy Czech boys (n = 1764) and girls (n = 1762) 3-6 years of age in the late 1950s and 1960s (sample C), in the 1990s (sample B), and in 2014-2016 (sample A). During these decades BMI has not changed significantly, and in selected groups (boys 3, 5, and 6, girls 3 and 6 years) it was most recently found to be significantly lower (P ≤ 0.05). Subscapular, suprailiac, triceps, midthigh, and above patella skinfold thicknesses significantly increased in sample A as compared to sample C (P ≤ 0.001). Comparison of the same skinfolds measured in the nineties (sample B) and more recently (sample A) showed similar increase of subcutaneous fat (P ≤ 0.001). The increase of adiposity characterized by skinfolds occurring in spite of not markedly changed BMI indicates significant changes of body composition-latent (also hidden) obesity. The increase of adiposity was relatively greatest on the trunk (P ≤ 0.001)-which is considered a marker of the greatest health risk. The decrease of femoral circumference (P ≤ 0.05) along with simultaneous increase of thigh skinfold (P ≤ 0.01) revealed the decrease of muscle mass in the lower extremity, obviously due to the reduction of weight-transferring physical activity.

Prevalence and risk factors for non-alcoholic fatty liver in children and youth with obesity

Background

Non- Alcoholic Fatty Liver (NAFL) is a spectrum of liver diseases (LD) that ranges from benign fatty infiltration of the liver to cirrhosis and hepatic failure. Hepatic ultrasound (US) and serum alanine aminotransferase (ALT) are often used as markers of NAFL. Our aim is to describe prevalence of NAFL and associated findings on ultrasound (US) and biochemical parameters in a population of children and adolescents with obesity at the Children’s Hospital of Eastern Ontario.

Methods

Children with Obesity (BMI >95th percentile) ages 8–17 years presenting to the Endocrinology and Gastroenterology clinics, without underlying LD were prospectively recruited from 2009 to 2012. Fasting lipid profile, HOMA IR) and serum adiponectin levels were measured. NAFL was defined as ALT > 25 and >22 IU/mL (males and females respectively) and/or evidence of fatty infiltration by US. Logistic regression was performed to assess associations.

Results

97 children with obesity included in the study (Male 43%). Mean age was 12.9 ± 3.2 years (84% were older than 10 y). Mean BMI-Z score was 3.8 ± 1.4. NAFL was identified in 85%(82/97) of participants. ALT was elevated in 61% of patients. Median triglyceride (TG) level was higher in children with NAFL(1.5 ± 0.9 vs. 1.1 ± 0.5 mmol/L, p = 0.01). Total cholesterol, HDL, LDL and Non HDL cholesterol were similar in both groups(p = 0.63, p = 0.98, p = 0.72 and p = 0.37 respectively). HOMA IR was ≥3.16 in 53% of children(55% in those with NAFL and 40% in those without NAFL). Median serum adiponectin was 11.2 μg/ml(IQR 7.3–18.3) in children with NAFL vs. 16.1 μg/ml(IQR 9.0–21.9) in those without NAFL(p = 0.23). Liver US was reported as normal in 30%, mild fatty infiltration in 38%, moderate in 20% and severe in 12%. TG were significantly higher(1.5 mmol/L vs. 1.0 mmol/L, p < 0.01) and HDL-C was lower(1.0 mmol/L vs. 1.1 mmol/L, p = 0.05) in children with moderate and severe NAFL by US. BMI-Z score, HOMA IR, serum adiponectin and HDL levels were not associated with NAFL, however TG were significantly associated(OR = 3.22 (95% CI: 1.01–10.25, p = 0.04)).

Conclusion

NAFL is highly prevalent in obese children and youth. Elevated TG levels are associated with NAFL; these findings may serve as a noninvasive screening tool to help clinicians identify children with obesity needing liver biopsy and/or more aggressive therapeutic interventions.

Secular trends for skinfolds differ from those for BMI and waist circumference among adults examined in NHANES from 1988-1994 through 2009-2010

BACKGROUND

Although the prevalence of a body mass index [BMI (in kg/m²)] ≥30 has tripled among US adults since the 1960s, BMI is only moderately correlated with body fatness. Because skinfolds can more accurately estimate body fatness than can BMI, it is possible that skinfolds could be useful in monitoring secular trends in body fatness.

OBJECTIVE

We examined whether there were similar secular trends for skinfolds (triceps and subscapular), BMI, and waist circumference between US adults.

DESIGN

This study was an analysis of 45,754 adults who participated in the NHANES from 1988-1994 through 2009-2010. Approximately 19% of the subjects were missing ≥1 skinfold-thickness measurement. These missing values were imputed from other characteristics.

RESULTS

Trends in mean levels and in the prevalence of high levels of the 4 body size measures were fairly similar between men, with mean levels increasing by ≥5% from 1988-1994 through 2009-2010. Slightly larger increases were seen in women for BMI and waist circumference (7-8%), but trends in skinfolds were markedly different. The mean triceps skinfold, for example, increased by 2 mm through 2003-2004, but subsequently decreased so that the mean in 2009-2010 did not differ from that in 1988-1994. Compared with obese women in 1988-1994, the mean BMI of obese women in 2009-2010 was 1 higher, but mean levels of both skinfolds were 5-10% lower.

CONCLUSIONS

Although there were fairly similar trends in levels of BMI, waist circumference, and skinfold thicknesses in men in the United States from 1988-1994 through 2009-2010, there were substantial differences in women. Our results indicate that it is unlikely that skinfold thicknesses could be used to monitor trends in obesity.

Spirituality, Religiosity, and Weight Management Among African American Adolescent Males: The Jackson Heart KIDS Pilot Study

Spirituality and religion have been identified as important determinants of health for adults; however, the impact of faith-oriented factors on health behaviors and outcomes among African American adolescent males has not been well studied. The purpose of this study is to examine the relationship between religiosity and spirituality and obesity-related behaviors among 12-19 year old African American males (N = 105) in the Jackson Heart KIDS Pilot Study. Key variables of interest are church attendance, prayer, daily spirituality, weight status, attempts to lose weight, nutrition, physical activity, and stress. Daily spirituality is associated with whether an individual attempts to lose weight. The results from logistic regression models suggest that daily spirituality increases the odds that African American male adolescents attempt to lose weight (OR = 1.22, CI: 1.07-1.41) and have a history of diet-focused weight management (OR = 1.13, CI: 1.02-1.26). Future studies are needed to further explore the association between religion, spirituality, and obesity-related behaviors.

The obesity epidemic in children: Latino children are disproportionately affected at younger ages

Background and objectives

National surveillance clearly illustrates that U.S. children are becoming increasingly overweight. However, the timing of the onset of childhood overweight has not been well-described.

Patients and methods

An accelerated failure time (AFT) model was used to describe the emergence of overweight based on a 12-year collection of height and weight data of over 40,000 children. Race, sex, insurance status and their interactions were specifically examined as predictors of earlier onset of overweight. The outcome of interest was an estimate of the age at which the model predicted that a subgroup would attain a 20% prevalence of overweight.

Results

The three-way interaction of race, sex, and insurance status was a significant predictor of onset of overweight. The model estimated that the publicly insured Latino male subgroup had the earliest onset of overweight, attaining a prevalence of 20% overweight by 4.3 years of age. The emergence of overweight in Latino subjects was significantly earlier than that for black or white subjects, irrespective of sex or insurance status.

Conclusion

Regardless of sex or insurance status, overweight emerges at significantly younger ages in Latino children when compared to black and white children. Substantial numbers of Latino male children are predicted to develop overweight at preschool ages. Obesity prevention may need to be directed toward parents or children well before children enter grade-school.

Insulin resistance, dyslipidemia and cardiovascular changes in a group of obese children

Introduction

Obesity-related comorbidities are present in young obese children, providing a platform for early adult cardiovascular disorders.

Objectives

To compare and correlate markers of adiposity to metabolic disturbances, vascular and cardiac morphology in a European pediatric obese cohort.

Methods

We carried out an observational and transversal analysis in a cohort consisting of 121 obese children of both sexes, between the ages of 6 and 17 years. The control group consisted of 40 children with normal body mass index within the same age range. Markers of adiposity, plasma lipids and lipoproteins, homeostasis model assessment-insulin resistance, common carotid artery intima-media thickness and left ventricular diameters were analyzed.

Results

There were statistically significant differences between the control and obese groups for the variables analyzed, all higher in the obese group, except for age, high-density lipoprotein cholesterol and adiponectin, higher in the control group. In the obese group, body mass index was directly correlated to left ventricular mass (r=0.542; p=0.001), the homeostasis model assessment-insulin resistance (r=0.378; p=<0.001) and mean common carotid artery intima-media thickness (r=0.378; p=<0.001). In that same group, insulin resistance was present in 38.1%, 12.5% had a combined dyslipidemic pattern, and eccentric hypertrophy was the most common left ventricular geometric pattern.

Conclusions

These results suggest that these markers may be used in clinical practice to stratify cardiovascular risk, as well as to assess the impact of weight control programs.

Peer similarity and influence for weight-related outcomes in adolescence: a meta-analytic review

Weight-related problems, including obesity and disordered eating, have emerged as major public health concerns for adolescents. To address these deviations from healthy eating and weight regulation, prevention and intervention efforts have targeted the influence of peers. Yet, evidence that peers influence weight-related outcomes, often inferred from similarity among peers, is inconsistent. This meta-analytic review evaluated peer similarity and influence not only for body size and symptoms of disordered eating, but also for key determinants of obesity (food intake and physical activity levels) and eating pathology (body dissatisfaction and weight control strategies). For each of the six outcomes, data was summarized from 9 to 24 independent studies. Results revealed significant, non-trivial similarity among peers across outcome variables, with the exception of disordered eating. Findings indicated that resemblances among peers were unlikely to be solely the reflection of cognitive biases or the selection of alike friends, but may be partially due to influence. To better understand the influence of peers, further longitudinal research is needed, particularly focusing on the factors that moderate susceptibility to conformity.

Cardiovascular risk factor investigation: a pediatric issue

OBJECTIVES

To correlate cardiovascular risk factors (e.g., hypertension, obesity, hypercholesterolemia, hypertriglyceridemia, hyperglycemia, sedentariness) in childhood and adolescence with the occurrence of cardiovascular disease.

SOURCES

A systematic review of books and selected articles from PubMed, SciELO and Cochrane from 1992 to 2012.

SUMMARY OF FINDINGS

Risk factors for atherosclerosis are present in childhood, although cardiovascular disease arises during adulthood. This article presents the main studies that describe the importance of investigating the risk factors for cardiovascular diseases in childhood and their associations. Significant rates of hypertension, obesity, dyslipidemia, and sedentariness occur in children and adolescents. Blood pressure needs to be measured in childhood. An increase in arterial blood pressure in young people predicts hypertension in adulthood. The death rate from cardiovascular disease is lowest in children with lower cholesterol levels and in individuals who exercise regularly. In addition, there is a high prevalence of sedentariness in children and adolescents.

CONCLUSIONS

Studies involving the analysis of cardiovascular risk factors should always report the prevalence of these factors and their correlations during childhood because these factors are indispensable for identifying an at-risk population. The identification of risk factors in asymptomatic children could contribute to a decrease in cardiovascular disease, preventing such diseases as hypertension, obesity, and dyslipidemia from becoming the epidemics of this century.

Secular changes in BMI and the associations between risk factors and BMI in children born 29 years apart

What is already known about this subject Factors associated with children's body mass index (BMI) include parents' BMIs, birth weight, maternal smoking, sleep duration and television watching. Few studies have attempted to quantify either changes in the association between risk factors and BMI or the contribution of changes in the risk factors to increases in BMI over a generation. What this study adds The magnitude of the association between most risk factors and children's BMIs has not changed over a 29-year period. Increases in the population level of mothers' body mass index (BMI) explains ~20% of the increase in children's BMI whereas the smaller increase in fathers' BMI contributes only 6%. Maternal smoking, despite the decrease in prevalence, contributes ~17%.

OBJECTIVE

Using two cohorts born 29 years apart in Dunedin, New Zealand we aim to examine changes in risk factors and their associations with body mass index (BMI) at ages 3 and 7 years, and estimate their contribution to the secular changes in BMI at age 7 years.

METHODS

Birth weight and anthropometric measures at ages 3, 5 and 7 years were obtained for 974 participants in the Dunedin Multidisciplinary Health and Development Study (DMHDS), born in 1972-1973, and 241 in the Family Lifestyle, Activity, Movement and Eating Study (FLAME), born in 2001-2002. Information about maternal age, education and smoking in pregnancy, as well as breastfeeding, children's television time and time in bed, was obtained by questionnaire.

RESULTS

The increase in BMI over the 29-year period was 0.84 (95% CI 0.61, 1.06) kg m(-2) at age 7. A 1-unit difference in the mother's BMI was associated with a 0.06 (0.03, 0.08) kg m(-2) difference in offspring in both studies; the 3.4 (2.8, 4.0) kg m(-2) increase in the mothers' BMIs accounts for a change of 0.19 kg m(-2) in the children's BMI. The much smaller generational increase in fathers' BMI (0.7 kg m(-2) ) correspondingly had a more limited effect on change in child BMI over time (0.06 kg m(-2) ). Although smoking in pregnancy decreased by 15% (8, 21) its association with BMI increased from 0.20 (-0.01, 0.42) in the DMHDS cohort to 1.24 (0.76, 1.71) kg m(-2) in the FLAME cohort, contributing 0.18 kg m(-2) to the increase in children's BMI.

CONCLUSIONS

Societal factors such as higher maternal BMI and smoking in pregnancy contribute most to the secular increase in BMI, with changes in behavioural factors, including sleep and television viewing, having little effect in this setting.

Change in the body mass index distribution for women: analysis of surveys from 37 low- and middle-income countries

BACKGROUND

There are well-documented global increases in mean body mass index (BMI) and prevalence of overweight (BMI ≥ 25.0 kg/m(2)) and obese (BMI ≥ 30.0 kg/m(2)). Previous analyses, however, have failed to report whether this weight gain is shared equally across the population. We examined the change in BMI across all segments of the BMI distribution in a wide range of countries, and assessed whether the BMI distribution is changing between cross-sectional surveys conducted at different time points.

METHODS AND FINDINGS

We used nationally representative surveys of women between 1991-2008, in 37 low- and middle-income countries from the Demographic Health Surveys ([DHS] n = 732,784). There were a total of 96 country-survey cycles, and the number of survey cycles per country varied between two (21/37) and five (1/37). Using multilevel regression models, between countries and within countries over survey cycles, the change in mean BMI was used to predict the standard deviation of BMI, the prevalence of underweight, overweight, and obese. Changes in median BMI were used to predict the 5th and 95th percentile of the BMI distribution. Quantile-quantile plots were used to examine the change in the BMI distribution between surveys conducted at different times within countries. At the population level, increasing mean BMI is related to increasing standard deviation of BMI, with the BMI at the 95th percentile rising at approximately 2.5 times the rate of the 5th percentile. Similarly, there is an approximately 60% excess increase in prevalence of overweight and 40% excess in obese, relative to the decline in prevalence of underweight. Quantile-quantile plots demonstrate a consistent pattern of unequal weight gain across percentiles of the BMI distribution as mean BMI increases, with increased weight gain at high percentiles of the BMI distribution and little change at low percentiles. Major limitations of these results are that repeated population surveys cannot examine weight gain within an individual over time, most of the countries only had data from two surveys and the study sample only contains women in low- and middle-income countries, potentially limiting generalizability of findings.

CONCLUSIONS

Mean changes in BMI, or in single parameters such as percent overweight, do not capture the divergence in the degree of weight gain occurring between BMI at low and high percentiles. Population weight gain is occurring disproportionately among groups with already high baseline BMI levels. Studies that characterize population change should examine patterns of change across the entire distribution and not just average trends or single parameters.

The Effectiveness of School-Based Nutritional Education Program among Obese Adolescents: A Randomized Controlled Study

The purpose of the study was to determine the change in body weight and body mass index (BMI), as well as diet behaviors at 4 months after intervention between obese adolescent girls who participated in the school-based nutritional education program, addressed by pediatrician, compared to those who attended regular nutritional class. Methods. 49 obese girls were recruited from a secondary school. Those, were randomized into 2 groups of intervention and control. The intensive interactive nutritional program was provided to the intervention group. Weight and height, dietary record and % fat consumption, as well as self-administered questionnaires on healthy diet attitudes were collected at baseline and 4-month follow-up, and then compared between two groups. Results. There was a statistically significant change of BMI in the intervention group by 0.53 ± 1.16 kg/m² (P = 0.016) compared to the control group (0.51 ± 1.57 kg/m², P = 0.063) but no significant change in calorie and % fat consumption between groups. The attitudes on healthy eating behaviors in the intervention group were shown improving significantly (P < 0.001). Conclusions. Interactive and intensive nutritional education program as shown in the study was one of the most successful school-based interventions for obese adolescents.

Weight-Bearing Physical Activity among Girls and Mothers: Relationships to Girls’ Weight Status

OBJECTIVE

To assess weight-bearing physical activity (WBPA) barriers, benefits, self-efficacy, social influence, and behaviors [WBPA and physical activity (PA)] among girls and their mothers according to girls' weight status (nonoverweight vs. overweight).

RESEARCH METHODS AND PROCEDURES

Participants were 9- to 11-year-old girls (n = 295) and their mothers who participated in the baseline assessment of a nutrition and PA intervention trial. Girls' and mothers' WBPA attitudes and mothers' WBPA behaviors were self-reported on questionnaires. Girls' WBPA and total PA behaviors were self-reported using a structured interview (Physical Activity Checklist Interview). Stature and weight were measured by standardized anthropometrics. Overweight status was based on BMI.

RESULTS

Compared with nonoverweight girls, overweight girls were significantly more likely to report barriers to WBPA participation and perceive social influence from family and friends to do more WBPA. They were also significantly less likely to report self-efficacy regarding WBPA and to believe that they did enough WBPA. Compared with mothers of nonoverweight girls, mothers of overweight girls were significantly more likely to report that it is difficult to persuade their daughters to do more WBPA and significantly less likely to report that WBPA was fun for their daughters. Girls' overweight status was not associated with girls' reports of minutes spent per week in PA or WBPA.

DISCUSSION

The present study's findings of lower WBPA self-efficacy, lack of enjoyment of WBPA, and higher perceived social influence to do WBPA among overweight girls suggest that efforts are needed to promote physical competencies and positive perceptions of PA among overweight girls.

Utility of Childhood BMI in the Prediction of Adulthood Disease: Comparison of National and International References

OBJECTIVE

To determine whether the U.S. Centers for Disease Control and Prevention (CDC; CDC Reference) or International Obesity Task Force (IOTF; IOTF Reference) BMI cut-off points for classifying adiposity status in children are more effective at predicting future health risk.

RESEARCH METHODS AND PROCEDURES

The sample (N=1709) included 4- to 15-year-old (at baseline) boys and girls from the Bogalusa Heart Study. Overweight and obesity status were determined using both the CDC Reference and IOTF Reference BMI cut-off points at baseline. The ability of childhood overweight and obesity, determined from the two BMI classification systems, to predict obesity and metabolic disorders in young adulthood (after a 13- to 24-year follow-up) was then compared.

RESULTS

Independently of the classification system employed to determine adiposity based on childhood BMI, the odds of being obese and having all of the metabolic disorders in young adulthood were significantly (p<0.05) higher in the overweight and obese groups by comparison with the nonoverweight groups. Childhood overweight and obesity, determined by both the CDC Reference and IOTF Reference, had a low sensitivity and a high specificity for predicting obesity and metabolic disorders in young adulthood. Overweight and obesity as determined by the CDC Reference were slightly more sensitive and slightly less specific than the corresponding values based on the IOTF Reference.

DISCUSSION

Overweight and obesity during childhood, as determined by both the CDC and IOTF BMI cut-off points, are strong predictors of obesity and coronary heart disease risk factors in young adulthood. The differences in the predictive capacity of the CDC Reference and IOTF Reference are, however, minimal.

An evaluation of mother-centered anticipatory guidance to reduce obesogenic infant feeding behaviors

OBJECTIVE

To evaluate the effect of 2 anticipatory guidance styles (maternal focused [MOMS] and infant focused [Ounce of Prevention]) directed at mothers of infants aged newborn to 6 months on their infant feeding behaviors at 1 year compared with routine advice as outlined in Bright Futures (BF).

METHODS

This is a cluster randomized trial. A total of 292 mother/infant dyads were enrolled at their first well-child visit to 3 urban pediatric clinics in Columbus, Ohio. Intervention-specific brief advice and 1-page handouts were given at each well visit. In addition to infant weights and lengths, surveys about eating habits and infant feeding practices were completed at baseline and 12 months.

RESULTS

Baseline data revealed a group with high rates of maternal overweight (62%) and obesogenic habits. At 12 months, the maternal-focused group gave their infants less juice (8.97 oz vs 14.37 oz, P < .05), and more daily servings of fruit (1.40 vs 0.94, P < .05) and vegetables (1.41 vs 1.03, P < .05) compared with BF mothers. Ounce of Prevention mothers also gave less juice (9.3 oz, P < .05) and more fruit servings (1.26 P < .05) than BF.

CONCLUSIONS

Brief specific interventions added to well-child care may affect obesogenic infant feeding behaviors of mothers and deserves further study as an inexpensive approach to preventing childhood obesity.

Secular trends in BMI and blood pressure among children and adolescents: the Bogalusa Heart Study

OBJECTIVE

The prevalence of obesity among children and adolescents increased by almost threefold from the 1970s to 2000. We examined whether these secular changes in BMI were accompanied by increases in blood pressure levels.

METHODS

A total of 24,092 examinations were conducted among 11,478 children and adolescents (aged 5-17 years) from 1974 to 1993 in the Bogalusa Heart Study (Louisiana).

RESULTS

The prevalence of obesity increased from 6% to 17% during this period. In contrast, only small changes were observed in levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP), and neither mean nor high (based on the 90th percentile from the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents) levels increased over the 20-year period. Within each race-gender group, mean levels of SBP did not change, whereas mean levels of DBP decreased by 2 mm Hg (P < .001 for trend). Levels of BMI were positively associated with levels of SBP and DBP within each of the 7 examinations, and controlling for BMI (along with other covariates) indicated that only ~60% as many children as expected had high levels of blood pressure in 1993.

CONCLUSIONS

Our finding that levels of DBP and SBP among children in this large sample did not increase despite the increases that were seen in obesity indicates that changes in blood pressure levels in a population do not necessarily parallel changes in obesity. Additional study of the potential characteristics that have ameliorated the expected increase in high blood pressure could lead to further reductions in risk.

Endothelial dysfunction, inflammation, and oxidative stress in obese children and adolescents: markers and effect of lifestyle intervention

With an increasing prevalence, pediatric obesity is often a prelude to adulthood obesity, and represents a major public health issue. Comorbidities are very common and severe in obese adults, justifying the search for earlier markers or risk factors for cardiovascular diseases in obese children. Endothelial dysfunction has been found to be present in the early stages of atherosclerosis, and can be non-invasively assessed with widely accepted and well-standardized techniques at the macrocirculation level. Endothelial dysfunction at the microcirculation level is less documented in obese children. Obesity in children has been repeatedly and independently correlated to endothelial dysfunction, inflammation and oxidative stress markers, although the relationship between these factors remains to be investigated. However, this would not only allow substantial improvements in risk stratification, but also provide essential data regarding the evolution of endothelial dysfunction in childhood obesity, especially during puberty when pro-inflammatory and pro-oxidative changes, with relative insulin resistance, occur. Therapeutic strategies such as lifestyle interventions in early childhood obesity appear all the more necessary, optimally including both exercise and diet because of their known effects on inflammatory and oxidative stress markers, potentially reversing endothelial dysfunction.

A changing pattern of childhood BMI growth during the 20th century: 70 y of data from the Fels Longitudinal Study

BACKGROUND

The BMI distribution shifted upward in the United States between the 1960s and the 1990s, but little is known about secular trends in the pattern of BMI growth, particularly earlier in the century and early in childhood.

OBJECTIVE

The objective was to examine differences in BMI growth in children born in 1929-1999.

DESIGN

BMI curves from ages 2 to 18 y were produced for 855 European-American children in the Fels Longitudinal Study born in 1929-1953, 1954-1972, and 1973-1999. Age (A(min)) and BMI (BMI(min)) at adiposity rebound and age (AV(max)), BMI (BMIV(max)), and velocity (V(max)) at maximum velocity were derived; multivariable regression was used to examine whether maternal BMI, infant weight gain, and other covariates mediated the cohort effects on these traits.

RESULTS

BMI curves showed that children born in 1973-1999 had the lowest BMI values until age 5 y but had the largest values from age 8 y onward. In adjusted models, boys and girls born in 1973-1999 had a 0.15-kg/m(2) per year faster V(max) and a 1-kg/m(2) higher BMIV(max) than did children of the same sex born in 1929-1953, and girls had a 0.8-y earlier A(min) (P < 0.01). Maternal BMI and infant weight gain were associated with an obesity-prone pattern of BMI growth but did not account for the observed trends.

CONCLUSIONS

Shifts in the BMI growth rate around the time of pubertal initiation were apparent starting after 1973. The BMI growth curve did not increase monotonically over time; rather, children born during the obesity epidemic were characterized by lower BMI values before the adiposity rebound and by rapid subsequent BMI gain.

Evolution of obesity in a low birth weight cohort

OBJECTIVE

The objective of this study was to determine the evolution of obesity status (OS) in a longitudinal cohort of low birth weight preterm (LBWPT) infants to an age of 8 years, and to determine whether rapid weight gain in the first year of life independently predicts 8-year OS.

STUDY DESIGN

In total, 985 infants (birth weight ≤2500 g, gestation age ≤37 weeks) were recruited from the nursery in an eight-site intervention research program and were evaluated at an age of 3, 5, 6.5 and 8 years. Weight and height were measured by standard protocol at each visit and body mass index was calculated. Obesity status is ≥95% for age and sex. Multiple logistic analyses were performed on 8-year OS with predictor variables including infant race, gender, small for gestational age status, birth weight category, neonatal health index, treatment group and first-year weight gain; maternal education and weight status before conception; and HOME Inventory.

RESULT

Overall, 2.3% were OS at an age of 3 years, 6.1% at an age of 5 years, 7.7% at age 6.5 years and 8.7% at an age 8 years. OS varied by birth weight category at each visit. The infants born ≤1500 g had the lowest prevalence of OS at each age. In the logistic regression, maternal race (Hispanic) (adjusted odds ratio=2.8, confidence interval=1.2 to 6.8), maternal obese status (adjusted odds ratio 3.4, confidence interval=1.5 to 7.8) and first-year weight gain (adjusted odds ratio=2.7, confidence interval=1.9 to 3.9), significantly predicted 8-year OS.

CONCLUSION

OS is common in LBWPT infants during childhood, and prevalence varies by birth weight category. High weight gain in the first year of life is an important predictor of the development of OS in LBWPT children.

Electronic health technology for the assessment of physical activity and eating habits in children and adolescents with overweight and obesity IDA

OBJECTIVE

It was the goal of the trial to study the impact of electronic healthcare technology into treatment.

METHODS

One hundred and twenty-four children/adolescents (females 56%, age 13.5±2.8 years, height 1.64±0.13 m, weight 85.4±23.0 kg, body-mass index (BMI) 31.3±5.2 kg/m(2), BMI-standard deviation score (SDS) 2.50±0.5) were included. To assess physical activity and eating habits, a mobile motion sensor integrated into a mobile phone with digital camera was used.

RESULTS

The children/adolescents had a significant weight reduction of 7.1±3.0 kg. BMI/BMI-SDS decreased (p<0.01). Intensity (14.1±6.4 activity units) and duration of physical activity (290.4±92.6 min/day) were assessed with sensors. Time walking: median 45.5 (range, 2.5-206.5), running 8.0 (range, 0-39.5), cycling 27.7 (range, 0-72.5), car driving 23.7 (range, 0-83.0) min/day. Comparing self-reported physical activity (walking 292.9 (range, 9.6-496.1), running 84.8 (range, 8.4-130.2) min/day) with assessment with sensors there were significant differences (p<0.01). Duration of physical activity documented by children/adolescents was higher than the assessment with motion sensors (walking 292.9 vs 45.5 min, p<0.01, running 84.8 vs 8.0 min, p<0.01). Sensor derived energy intake was higher than recommended (469.14±88.75 kcal vs 489.03±108.25 kcal, p=0.09). Performing multivariate analysis the following parameters showed associations with weight reduction (R-square=0.75): body weight (β=-0.95, p<0.01), C-reactive protein (CRP, β=0.15, p=0.07), physical activity, time spent in activities measured with sensors (β=-0.18, p=0.04), stress management (β=0.16, p=0.06), body fat mass at onset of the trial (β=0.45, p<0.01) and body shape (β=-0.25, p=0.01).

CONCLUSION

The innovative mobile movement detection system is highly accepted by children and adolescents. The system is able to augment existing weight reduction and stabilization strategies.

Serum alanine aminotransferase and its association with metabolic syndrome in children: the bogalusa heart study

BACKGROUND

The aim of this study was to examine the distribution of alanine aminotrasferase (ALT) and its association with metabolic syndrome variables and their clustering in apparently healthy children.

METHODS

A cross-sectional study of 1,524 preadolescents (age, 4-11 years, 62% white, 51% male) and 1,060 adolescents (age, 12-18 years, 58% white, 51% male) enrolled in the Bogalusa Heart Study was performed.

RESULTS

ALT levels showed a significant race (whites > blacks) difference in preadolescents and a gender (males > females) difference in adolescents. Both preadolescents and adolescents in the age, race, and gender-specific top versus bottom quartiles of ALT had significant increases in the prevalence of adverse levels (>75th percentile specific for age, race, and gender) of body mass index (BMI), systolic blood pressure, total cholesterol to high-density lipoprotein cholesterol (HDL-C) ratio (adolescents only), insulin resistance index (HOMA-IR), and clustering of all four of these metabolic syndrome variables. In multivariate analyses, BMI was the major independent predictor of ALT in both preadolescents and adolescents; other independent predictors were total cholesterol to HDL-C ratio, HOMA-IR, white race in preadolescents and male gender in adolescents. With respect to the ability of ALT to identify children with clustering of the metabolic syndrome variables, area under the receiver operating characteristic curve analysis (c-statistics) adjusted for age, race, and gender yielded a value of 0.67 for preadolescents and 0.82 for adolescents.

CONCLUSION

An elevation in serum ALT within the reference range relate adversely to all of the major components of metabolic syndrome and their clustering in children and, thus, may be useful as a biomarker of the presence of metabolic syndrome and related risk in pediatric population, especially adolescents.

Serum E-selectin levels in Indian children and adolescents: relation to clinical and biochemical parameters

BACKGROUND

An adverse pattern of blood lipids and atherosclerosis begin in childhood. Unfortunately, data for children and adolescents, particularly those in the Indian population, are scarce. The present study aims to evaluate the levels of serum E-selectin in Indian children and adolescents and its correlation with anthropometric and biochemical parameters.

METHODS

The study groups included 338 school children and adolescents. There were 96 obese children, 97 overweight children and 42 children with congenital heart disease who were compared with 103 normal controls, aged 10-17 years. Serum E-selectin and serum leptin were analyzed with enzyme-linked immunosorbent assay kits. Lipid profile and fasting glucose were analyzed using an autoanalyzer.

RESULTS

Serum E-selectin levels were significantly increased in obese (65.3 ± 8.39 ng/mL) and overweight (56.01 ± 6.96 ng/mL) subjects (P < 0.001). However, these levels were lower in children with congenital heart disease (40.99 ± 6.54 ng/mL) than in controls (43.79 ± 6.71 ng/mL).

CONCLUSION

Serum E-selectin levels showed good positive association with body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, leptin, total cholesterol, triglycerides and low-density lipoprotein cholesterol and showed negative correlation with fasting glucose and no significant association with high-density lipoprotein cholesterol. These findings indicate that higher E-selectin levels can induce endothelial activation and play an essential role in the earliest stage of the atherosclerotic process in obese and overweight children. Regular camps at schools to counsel the identified overweight and obese children and to encourage physical exercise would help to reduce the risk of these children being prone to major cardiovascular anomalies in adulthood.

Hyperinsulinemia and metabolic syndrome at mean age of 10 years in black and white schoolgirls and development of impaired fasting glucose and type 2 diabetes mellitus by mean age of 24 years

The objective of the study was to evaluate preteen insulin and metabolic syndrome (MS) as independent predictors of impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM) in black and white females by mean age of 24 years. This was a prospective cohort study. There were 8 measures of fasting glucose and insulin from mean age of 10 years through mean age of 24 years, and insulin also at mean age of 25 years. Childhood MS was defined by at least 3 abnormal values among waist circumference, triglyceride, high-density lipoprotein cholesterol, blood pressure, and glucose. Hyperinsulinemia was defined by insulin greater than or equal to race-specific 75th percentile. Patients with type 1 diabetes mellitus were excluded. The study was held in schools and in an outpatient clinical center. Participants were schoolgirls (260 white, 296 black). There was no intervention. The outcome measures were IFG (fasting glucose of at least 100 to 125 mg/dL) and T2DM (fasting glucose of at least 126 mg/dL). By the age of 24 years, there were 11 cases of T2DM (2%) and 108 cases of IFG (19%). By the age of 24 years, IFG + T2DM was present in 18% of women (73/412) who had normal insulin-no MS at the age of 10 years vs 28% (34/122) of those with high insulin-no MS at the age of 10 years (P = .014) and 67% (10/15) of those with high insulin + MS at the age of 10 years (P < .0001). By stepwise logistic regression, significant, independent, positive predictors of IFG + T2DM were first insulin measure in childhood, age at last sampling, childhood MS, change in body mass index over 15 years, and, separately, initial glucose of at least 100 mg/dL and average of all insulin quartile ranks over 15 years. The correlation between childhood insulin z score and insulin z score 15 years later was r = .30, P < .0001. Insulin and MS at a mean age of 10 years plus change in body mass index over 15 years, and 15-year average insulin rank independently predict IFG + T2DM by mean age of 24 years, suggesting avenues for primary prevention.

Excessive maternal transmission of diabetes in Japanese families with young-onset type 2 diabetes and insulin secretion defect according to clinical features

The aim of the study is to identify the clinical characteristics of Japanese patients with young-onset type 2 diabetes (YT2D). Family history of diabetes and clinical data were collected for 30 unrelated males (from 11 to 20 years old at age of onset) and 20 females (from 10 to 20 years old at age of onset) with YT2D diagnosed at ≤ 20 years of age. Fasting C-peptide levels were measured in all, and glucagon stimulation tests were performed twice in six of them over several years. Moreover, 858 people with type 2 diabetes (T2D) diagnosed at >20 years of age were randomly recruited in order to compare the transmission pattern of them. Among the study subjects, 68% reported at least one parent with diabetes. Diabetes was more frequent among mothers than fathers of probands (P = 0.020), although this tendency was not observed in T2D diagnosed at >20 years of age. Fasting C-peptide levels of patients with diabetes duration of ≥ 10 years were significantly lower than for patients with diabetes duration of <10 years (0.61 ± 0.26 vs. 0.84 ± 0.43 nmol/l, P = 0.036). The fasting C-peptide levels among male patients with a family history of diabetes were also significantly lower than those without a family history (0.56 ± 0.25 vs. 0.83 ± 0.37 nmol/l, P = 0.034), while all female subjects had a family history of diabetes. Glucagon stimulation tests showed the following data; 0 min: 0.56 ± 0.31 vs. 0.39 ± 0.22 nmol/l, 3 min: 1.41 ± 0.77 vs. 0.87 ± 0.47 nmol/l, 6 min: 1.37 ± 0.80 vs. 0.79 ± 0.35 nmol/l, 10 min: 1.06 ± 0.60 vs. 0.81 ± 0.49 nmol/l, and 30 min: 0.58 ± 0.30 vs. 0.50 ± 0.19 nmol/l, respectively. These results demonstrated that YT2D among Japanese people occurring in excess with maternal transmission is associated with β-cell dysfunction at the onset of diabetes and as the disease advances.

Identification of determinants for weight reduction in overweight and obese children and adolescents

We conducted a pilot trial of electronic technology integrated into the treatment of children and adolescents who are overweight or obese. A total of 30 patients (mean age 14 years, mean BMI 32.7 kg/m(2)) were admitted to our hospital to participate in a structured treatment and teaching programme (STTP). To assess physical activity and eating habits, a mobile motion sensor board (MoSeBo) or a sensor for physical activity, integrated into a mobile phone with digital camera (DiaTrace) was used. Over an average period of four days of monitoring, the mean intensity (15.4 activity units) and duration of physical activity (267 min/d) were recorded with the mobile sensors. The mean time spent walking was 64 min/d, running 11 min/d, cycling 24 min/d and car driving 21 min/d. There were significant differences (P < 0.001) between self-reported physical activity and objective assessment: in general the duration of physical activity documented by children and adolescents was much higher than the objective assessment. Similarly, the real caloric intake was higher than the self-estimates (P = 0.085). A multivariate analysis showed that the following variables were significantly associated with weight reduction in the hospital STTP (R-squared = 0.59): high motivation, intrafamilial conflicts, duration of physical activity assessed with the MoSeBo/DiaTrace system, and the body fat mass at onset of therapy. All children and adolescents included in the trial completed it. Although the MoSeBo/DiaTrace system was used for a relatively short period in each patient, the high acceptance demonstrated that it could be integrated into therapy easily.

The pediatric obesity epidemic continues unabated in Bogalusa, Louisiana

OBJECTIVES

To examine 35-year trends in the prevalence of overweight and obesity among children and adolescents from Bogalusa, Louisiana.

PATIENTS AND METHODS

Height and weight were measured for 11653 children and adolescents between 5 and 17 years of age in 8 cross-sectional surveys. The Bogalusa Heart Study contributed data from 1973-1994, and routine school screening provided 2008-2009 data. Trends in mean BMI, mean gender-specific BMI-for-age z scores, prevalence of overweight/obesity (BMI > or = 85th percentile), and prevalence of obesity (BMI > or = 95th percentile) according to age, race, and gender were examined.

RESULTS

Since 1973-1974, the proportion of children and adolescents aged 5 to 17 years who are overweight (overweight plus obese) has more than tripled, from 14.2% to 48.4% in 2008-2009. Similarly, the proportion of obese children and adolescents has increased more than fivefold from 5.6% in 1973-1974 to 30.8% in 2008-2009. The prevalence of overweight or obesity, and secular changes, were similar among black and white boys and girls.

CONCLUSIONS

In semirural Bogalusa, the childhood obesity epidemic has not plateaued, and nearly half of the children are now overweight or obese.

[Prevalence of metabolic syndrome in adolescents: a systematic review]

The present study aimed to review the literature on the prevalence of metabolic syndrome and its components in adolescents (10-19 years old). The search was conducted in online databases (MEDLINE and SciELO), references from retrieved articles, and contacts with authors. Only original articles using either the criteria of the World Health Organization (WHO) or the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP-III) were considered. Sixteen studies met the inclusion criteria. Eight studies were undertaken in low to medium-income countries, but none of them in Brazil. Prevalence of metabolic syndrome in studies using the NCEP-ATP III criteria ranged from 4.2% to 15.4%. Prevalence in studies using the WHO criteria was slightly higher: 4.5% to 38.7%. High triglyceride level was the most frequent component of the metabolic syndrome, with prevalence ranging from 4.9% to 75.0%, while high blood glucose showed the lowest prevalence. In conclusion, although there are few available studies, metabolic syndrome in adolescents is a highly prevalent health issue. The exact prevalence of metabolic syndrome in Brazilian adolescents is unknown.

Prediction of fatness by standing 8-electrode bioimpedance: a multiethnic adolescent population

The objective of this study was to validate an 8-electrode bioimpedance analysis (BIA(8)) device (BC-418; Tanita, Tokyo, Japan) for use in populations of European, Maori, Pacific Island, and Asian adolescents. Healthy adolescents (215 M, 216 F; 129 Pacific Island, 120 Asian, 91 Maori, and 91 European; age range 12-19 years) were recruited by purposive sampling of high schools in Auckland, New Zealand. Weight, height, sitting height, leg length, waist circumference, and whole-body impedance were measured. Fat mass (FM) and fat-free mass (FFM) derived from the BIA(8) manufacturer's equations were compared with measurements by dual-energy X-ray absorptiometry (DXA). DXA-measured FFM was used as the reference to develop prediction equations based on impedance. A double cross-validation technique was applied. BIA(8) underestimated FM by 2.06 kg (P < 0.0001) and percent body fat (%BF) by 2.84% (P < 0.0001), on average. However, BIA(8) tended to overestimate FM and %BF in lean and underestimate FM and %BF in fat individuals. Sex-specific equations developed showed acceptable accuracy on cross-validation. In the total sample, the best prediction equations were, for boys: FFM (kg) = 0.607 height (cm)(2)/impedance ( ohm) + 1.542 age (y) + 0.220 height (cm) + 0.096 weight (kg) + 1.836 ethnicity (0 = European or Asian, 1 = Maori or Pacific) - 47.547, R(2) = 0.93, standard error of estimate (SEE) = 3.09 kg; and, for girls: FFM (kg) = 0.531 height (cm)(2)/impedance ( ohm) + 0.182 height (cm) + 0.096 weight (kg) + 1.562 ethnicity (0 = non-Pacific, 1 = Pacific) - 15.782, R(2) = 0.91, SEE = 2.19 kg. In conclusion, equations for fatness estimation using BIA(8) developed for our sample perform better than reliance on the manufacturer's estimates. The relationship between BIA and body composition in adolescents is ethnicity dependent.

End-stage renal disease in young black males in a black-white population: longitudinal analysis of the Bogalusa Heart Study

Background

Risk factors in childhood create a life-long burden important in the development of cardiovascular (CV) disease in adulthood. Many risk factors for CV disease (e.g., hypertension) also increase the risk of renal disease. However, the importance of childhood risk factors on the development of chronic kidney disease and end-stage renal disease (ESRD) is not well characterized.

Methods

The current observations include data from Bogalusa Heart Study participants who were examined multiple times as children between 1973 and 1988.

Results

Through 2006, fifteen study participants subsequently developed ESRD in adulthood; seven with no known overt cause. Although the Bogalusa Heart Study population is 63% white and 37% black and 51% male and 49% female, all seven ESRD cases with no known overt cause were black males (p < 0.001). Mean age-adjusted systolic and diastolic blood pressure in childhood was higher among the ESRD cases (114.5 mmHg and 70.1 mmHg, respectively) compared to black (103.0 mmHg and 62.3 mmHg, respectively) and white (mean = 103.3 mmHg and 62.3 mmHg, respectively) boys who didn't develop ESRD. The mean age-adjusted body mass index in childhood was 23.5 kg/m² among ESRD cases and 18.6 kg/m² and 18.9 kg/m² among black and white boys who didn't develop ESRD, respectively. Plasma glucose in childhood was not significantly associated with ESRD.

Conclusion

These data suggest black males have an increased risk of ESRD in young adulthood. Elevated body mass index and blood pressure in childhood may increase the risk for developing ESRD as young adults.

The timing of the rise in U.S. obesity varies with measure of fatness

There are several ways to measure fatness and obesity, each with its own strengths and weaknesses. The primary measure for tracking the prevalence of obesity has historically been body mass index (BMI). This paper compares long-run trends in the prevalence of obesity when obesity is defined using skinfold thickness instead of BMI, using data from the full series of U.S. National Health Examination Surveys. The results indicate that when one uses skinfold thickness rather than BMI to define obesity, the rise in the prevalence of obesity is detectable 10-20 years earlier. This underscores the importance of examining multiple measures of fatness when monitoring or otherwise studying obesity.

School-based interventions on childhood obesity: a meta-analysis

BACKGROUND

Over the past decade, childhood obesity has been recognized as an increasing health problem worldwide. It is a predictor of obesity during adulthood, which is strongly linked to chronic lifestyle diseases.

PURPOSE

This paper aims to evaluate the effectiveness of school-based programs in the prevention and management of childhood obesity.

METHODS

A comprehensive literature search was undertaken for RCTs and clinical controlled trials on school-based interventions that addressed childhood obesity, published between 1995 and 2007. The papers included for the meta-analysis were those in which ORs or standardized mean differences and their 95% CIs were reported or could be calculated from available data.

RESULTS

Meta-analysis showed that the odds of participants' being overweight and obese in the school-based intervention programs compared with the control arm were significantly protective in the short term (OR=0.74, 95% CI=0.60, 0.92). Interventions that were conducted for more than 1 year had a higher OR of decreasing the prevalence of obesity. However, intervention programs were not effective in decreasing BMI compared with control treatments, with a weighted mean difference of -0.62 (95% CI=-1.39, 0.14).

CONCLUSIONS

This meta-analysis showed that there was convincing evidence that school-based interventions are effective, at least short-term, in reducing the prevalence of childhood obesity. Longer-running programs were more effective than shorter programs.

Ethnic differences in subcutaneous adiposity and waist girth in children and adolescents

The purpose of this study was to examine ethnic differences in adiposity as measured by sum of skinfolds (SKF) and waist circumference (WC) in children and adolescents, after statistical adjustment for the BMI and age. A cross sectional sample of 3,218 (55% white, 49% male) children and adolescents aged 5-18 years who participated in the Bogalusa Heart Study (1992-1994) were included in these analyses. Sex-specific ANOVAs, adjusted for BMI and age, for each 2-year age group compared measures of adiposity (SKF and WC) between ethnic groups. No significant differences in the proportions of children and adolescents who were overweight and obese by ethnicity or sex were found. Mean SKF in normal weight (P < 0.0001) and overweight (P < 0.0001) categories was higher for white than black children of both sexes. Across most age categories, white boys and girls had significantly higher SKF than black boys and girls, respectively (P <or= 0.05). Across most age categories, white boys had significantly higher WC than black boys (P <or= 0.05) with no difference in the girls, when adjusted for BMI and age. Measures of adiposity in childhood and adolescence were significantly higher in white children compared to black children, when adjusted for BMI and age. Throughout childhood and adolescence, white boys and girls had higher SKF and white boys had higher WC. Differences in adiposity between ethnic groups should be considered in disease risk assessment and stratification as they are observed even for a given BMI level.

Children with type 2 diabetes mellitus are at greater risk of macrovascular complications

BACKGROUND

Type 2 diabetes mellitus (DM) is a risk factor for macrovascular complications in adults. Recently young-onset type 2 DM has increased worldwide and the increase of macrovascular complications in the young is worrisome.

METHODS

Plasma values for plasminogen activator inhibitor-1 (PAI-1) as a marker for promotion, and adiponectin as a marker for inhibition of atherosclerosis, were compared in 33 patients with type 1 DM (16 boys, 17 girls; age 14.9 +/- 3.7 years, mean +/- standard deviation) with those of 43 patients with type 2 DM (15 boys, 28 girls; age 16.5 +/- 3.5 years).

RESULTS

The PAI-1 level was significantly higher (19.3 +/- 8.1 vs 32.9 +/- 17.2 ng/ml; P < 0.001) and the adiponectin level was significantly lower (10.1 +/- 3.8 vs 7.4 +/- 3.7 microg/ml; P < 0.005) in the type 2 DM group. In obese patients, the PAI-1 level was significantly higher (P < 0.005) and the adiponectin level was lower (P= 0.15) in the type 2 DM group. Also, in the non-obese subjects, the PAI-1 level was significantly higher (P < 0.05) and the adiponectin level was lower (P= 0.11) in the type 2 DM group.

CONCLUSIONS

Even in young patients, type 2 DM is a risk factor for macrovascular complications compared with type 1 DM.

Retinal vessel response to flicker light in children and adolescents with type 1 diabetes mellitus and overweight or obesity

It was the goal of the trial to assess cardiovascular risk factors in children and adolescents with type 1 diabetes mellitus or overweight/obesity. All children and adolescents (n=77 [n=45 patients with diabetes mellitus, n=32 patients with overweight/obesity]) admitted to our hospital during the period from 01/07 to 31/08/2006 were included in the trial. Socio-demographic and laboratory data (age, sex, diabetes duration, BMI, BMI-SDS, HbA1c, fasting blood glucose, oGTT in patients with overweight/obesity, lipids, CRP, TSH, creatinine, and microalbuminuria) were assessed. The diameter of a retinal arterial and a venous segment was measured continuously on-line with a Dynamic Vessel Analyzer, carotid intima-media thickness (IMT) was measured, and 24-h-blood pressure monitoring was applied.

RESULTS

Flicker light stimulation induces a comparable arterial dilatation in patients with type 1 diabetes and overweight/obesity. Univariate ANOVA in patients with type 1 diabetes shows an influence of diastolic blood pressure on arterial dilatation. Other factors such as BMI, age, diabetes duration, smoking, sex, HbA1c and insulin dose/kg had no effect.

CONCLUSIONS

In children and adolescents with diabetes or overweight/obesity retinal vascular alterations seem to be more sensitive and already present before the occurrence of classic cardiovascular markers.

The transition to post-industrial BMI values among US children

The trend in the BMI values of US children has not been estimated very convincingly because of the absence of longitudinal data. Our objective is to estimate time series of BMI values by birth cohorts instead of measurement years. We use five regression models to estimate the BMI trends of non-Hispanic US-born black and white children and adolescents ages 2-19 between 1941 and 2004. The increase in BMIZ values during the period considered was 1.3 sigma (95% CI: 1.16 sigma; 1.44 sigma) among black girls, 0.8 sigma for black boys, 0.7 sigma for white boys, and 0.6 sigma for white girls. This translates into an increase in BMI values of some 5.6, 3.3, 2.4, and 1.5 units, respectively. While the increase in BMI values started among the birth cohorts of the 1940s among black girls, the rate of increase tended to accelerate among all four ethnic/gender groups born in the mid-1950s to early-1960s. Some regional evidence leads to the conjecture that the spread of automobiles and radios affected the BMI values of boys already in the interwar period. We suppose that the changes in lifestyle associated with the labor saving technological developments of the 20th century are associated with the weight gains observed. The increased popularity of television viewing was most prominently associated with the contemporaneous acceleration in BMI gain.

Motivators of and Barriers to Engaging in Physical Activity: Perspectives of Low-Income Culturally Diverse Adolescents and Adults

Background

Obesity rates are rising in the United States, especially among low-income and racial/ethnic minority individuals. Exploring motivators and barriers relative to engaging in physical activity is imperative.

Purpose

The purpose of this study was to identify motivators and barriers relative to engagement in physical activity as reported by culturally diverse low-income adolescents and adults.

Methods

A total of 91 adolescent (11 to 15 years of age) and adult (18 years of age or older) participants who self-identified as African American, Hispanic, or non-Hispanic White engaged in age group-, race/ethnicity-, and gender-concordant focus groups.

Results

Qualitative data analysis indicated that the motivators and barriers most commonly identified among the adolescent and adult focus groups were: social influence; time and priorities; physical environment; fun and enjoyment; inherently physical activities; weight concerns; fatigue, physical discomfort and current fitness level; and immediate positive feelings.

Discussion

Findings were generally similar across age group, gender and race/ethnicity. Age group-specific, gender-specific and race/ethnicity-specific motivators and barriers were related to how commonly the motivators and barriers were identified among each group.

Translation to Health Education Practice

Implications for increasing physical activity among low-income culturally diverse adolescents and adults are discussed.

Prevalence and correlates of obesity in schoolchildren from the city of Bursa, Turkey

BACKGROUND AND OBJECTIVES

The prevalence of childhood obesity has been dramatically increasing worldwide. This study was performed to examine the prevalence and etiological factors of obesity in children aged 6-12 years and to investigate the relative contribution of exogenous factors with respect to sociodemographic data.

METHODS

A total of 5368 children aged 6-12 years in eight urban elementary schools located in Bursa, the fourth largest city of Turkey, were included in this cross-sectional study. A dietary record for three days and a questionnaire for the assessment of socio-economic and demographic parameters were completed by the parents at home. The height and weight of the children were measured and relative weight and body mass index (BMI) were calculated.

RESULTS

The prevalence of overweight, obesity and severe obesity according to BMI were 12.4%, 7.8% and 2.2%, respectively. The female/male ratio among obese children was 1.24. Eighty percent of obese children had one or both parents obese. Age, gender, presence of obesity in parents, higher educational level of the parents, consumption of soft beverages such as soda and juice, physical activity level and higher income of the family were found as the contributing factors to obesity.

CONCLUSION

The prevalence of obesity is increasing in Turkey in parallel to the trend in many countries. There are consistent and predictable sociodemographic parameters that are associated with or may impose a risk factor for obesity. Identification of these risk factors will provide areas to target in the prevention and management of this common problem.

Waist circumference predicts cardiovascular risk in young Australian children

AIM

It has been shown that compared with healthyweight children, overweight and obese primary school-aged children have a higher incidence of hyperinsulinism, dyslipidaemia and hypertension. It is therefore important to investigate clinically relevant markers of cardiovascular risk in children. Waist circumference is a simple, non-invasive anthropometric measure, but its association with cardiovascular risk profile in young Australian children is not clear.

METHODS

This study presents cross-sectional data from the Growth and Development Study. The sample included 70 healthy weight children, 50 overweight children and 28 obese children (n = 148, 9.6 +/- 1.9 years). All children had a medical assessment which included a physical examination (waist circumference, blood pressure), and investigations including glycated haemoglobin, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, insulin, glucose and total homocysteine levels. An oral glucose tolerance test was performed in a subgroup of children (n = 119). Body mass index (BMI) was determined and BMI Z-scores calculated.

RESULTS

In a multilevel model, waist circumference was the only significant anthropometric predictor of lipid profile (high-density lipoprotein beta = -0.01, P < 0.05; triglycerides beta = 0.01, P < 0.005), systolic blood pressure (beta = 0.29, P < 0.05), fasting insulin (beta = 0.16, P < 0.005), insulin concentrations throughout the oral glucose tolerance (60 min beta = 1.07, P < 0.005; 120 min beta = 1.42, P < 0.001) and insulin resistance (homeostasis model assessment (HOMA-IR): beta = 0.03, P < 0.05), with increasing waist circumference associated with increasing cardiovascular risk. In contrast, BMI Z-score was only predictive of 120-min glucose concentrations during the OGTT (beta = 0.34, P < 0.05).

CONCLUSIONS

Waist circumference is a better anthropometric indicator than BMI Z-score of cardiovascular risk in Australian primary school-aged children. Even in young children, measurement of waist circumference represents a simple, non-invasive screening tool to identify children with an increased cardiovascular risk profile.

MRI in identifying hepatic steatosis in obese children and relation to ultrasonography and metabolic findings

OBJECTIVES

The aim of this study was to identify nonalcoholic fatty liver in obese children by magnetic resonance imaging (MRI) and to compare the findings with the data from ultrasonography and from clinical and laboratory testing.

PATIENTS AND METHODS

Sixty obese children, 6 to 14 years old, underwent hepatic MRI and abdominal ultrasonography. Biochemistry determinations included serum aminotransferases, lipid profile, glucose, and insulin. Anthropometry included body mass index, total and trunk fat, and fat-free mass obtained by dual-energy radiographic absorptiometry. Hepatic steatosis, judged as hepatic fat fraction by MRI, was >or=9%.

RESULTS

By MRI, 14 (23%) children had hepatic steatosis; of those, 5 had a fat fraction of 9% to 18%, and 9 had a fat fraction >18%. At univariate analysis, fat fraction was positively associated with being male, serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltransferase, body mass index z score, insulin, systolic pressure, and total and trunk fat mass. Hepatic steatosis was independently associated with alanine aminotransferase (P < 0.01). Overall, liver echogenicity on ultrasonography correlated well with fat fraction by MRI (correlation coefficient 0.527, P < 0.0001). Among the 27 children with increased liver echogenicity, 13 (48%) had hepatic fat fraction >or=9%, and 89% of children with echogenicity graded 2 or 3 had fat fraction >18%. All of the children (n = 9) with fat fraction >18% had increased liver echogenicity, and in 8 of them it was graded 2 or 3, but the MRI fat fraction ranged greatly (28%-45%).

CONCLUSIONS

In obese children, nonalcoholic hepatic steatosis may be associated with the metabolic syndrome. Ultrasonography may be valuable in identifying high hepatic fat accumulation, but its ability to identify lower fat accumulation in the liver is scanty compared with MRI.

Adiponectin levels, cardiometabolic risk factors and markers of subclinical atherosclerosis in children

BACKGROUND

Low levels of adiponectin have been associated with metabolic risk factors (RF) and cardiac disease. Minimal data is available about the relationship between adiponectin and subclinical atherosclerosis.

OBJECTIVES

To determine the relationship of adiponectin to cardiometabolic RF, C-reactive protein (CRP), anthropometric parameters of obesity, and subclinical atherosclerosis in children.

METHODS

Cross-sectional study in 103 children. We determined body mass index (BMI), waist circumference, percent fat mass, systolic and diastolic blood pressures, fasting lipid profile, glycemia and insulinemia, and CRP. Subclinical atherosclerosis was determined by carotid intima-media thickness (IMT) and flow-mediated dilation of the brachial artery (FMD).

RESULTS

Mean age of the group was 12.4+/-1.9 years (47% girls; 20.4% prepubertal; 45 eutrophic, 23 overweight and 35 obese). Adiponectin levels were not statistically significantly different in eutrophic children versus obese+overweight: 17.7+/-5.6 and 15.9+/-5.3 microg/mL, respectively. Adiponectin levels in boys were no different from those in girls. Adiponectin correlated significantly with age, BMI, zBMI, waist circumference, systolic and diastolic blood pressures, HDL, insulinemia, and HOMA index. No statistically significant association with adiponectin was found for CRP, FMD or IMT. After adjusting by sex, pubertal status, and degree of obesity, the adiponectin levels associated significantly with HDL cholesterol and the HOMA index (r(2)=0.34, p<0.0001).

CONCLUSIONS

Adiponectin levels were inversely correlated with anthropometric parameters of obesity and insulin resistance and directly correlated with HDL levels. However, no relationship with subclinical atherosclerosis was demonstrated in this study.

Impact of increasing adiposity in hyperlipidemic children

Despite lifestyle management, children with high-risk hyperlipidemias may become overweight, and this may further adversely impact their lipid profile. Regression analysis was used to determine changes over time in adiposity and their association with lipid profiles and other risk factors for hyperlipidemic children followed in a lipid disorder clinic. 184 patients were included. Median age at presentation was 7 years (2-17 years), and median duration of follow-up was 9 years (5-20 years). Mean initial total cholesterol was 6.9+/-1.6 mmol/L, low-density lipoproteins were 5.2+/-1.7 mmol/L, high-density lipoproteins were 1.2 +/- 0.4 mmol/L, triglycerides were 1.1+/-0.8 mmol/L, and body mass index z score was +0.4+/-1.0. A significant increase in body mass index z score (+0.032/year, P< .001) was observed. There was an associated significant increase in total cholesterol and triglyceride levels and decrease in high-density lipoprotein levels over time. Worsening adiposity is prevalent in hyperlipidemic children and adversely affects their lipid profiles and cardiovascular risk.

Impact of childhood metabolic syndrome components on the risk of elevated uric acid in adulthood: the Bogalusa Heart Study

BACKGROUND

Cross-sectional studies indicate metabolic syndrome is a risk factor for elevated serum uric acid. However, longitudinal data on this association are limited.

METHODS

Bogalusa Heart Study participants (n = 517) were examined as children, aged 5 to 17 years, and as adults 13 to 21 years later. Childhood metabolic syndrome components included the highest quartile (specific for year of age, race, sex, and study year) of body mass index, insulin resistance, blood pressure, and triglycerides and lowest quartile of HDL cholesterol. Metabolic syndrome was defined as the presence of 3 or more of these components and elevated serum uric acid, in adulthood, as values at or above the 90 percentile (specific for race and sex).

RESULTS

For males, after multivariate adjustment, the odds ratios (95% confidence interval) of elevated serum uric acid associated with high blood pressure, low HDL-cholesterol, high triglycerides, insulin resistance, and high body mass index were 2.61 (1.13, 6.03), 1.47 (0.57, 3.80), 1.30 (0.55, 3.08), 2.87 (1.23, 6.71), and 3.25 (1.36, 7.74), respectively. The analogous odds ratios for females were 2.12 (0.99, 4.54), 0.38 (0.14, 1.04), 1.16 (0.54, 2.46), 1.78 (0.83, 3.79), and 3.55 (1.73, 7.31), respectively. Males and females with the metabolic syndrome in childhood were 2.60 (1.08, 6.27) and 3.01 (1.34, 6.75) times more likely to have elevated serum uric acid as adults, respectively.

CONCLUSIONS

Metabolic syndrome and high body mass index in childhood were predictors of elevated uric acid in adulthood.