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

Cardiometabolic risk factors in South American children: A systematic review and meta-analysis

BACKGROUND

Cardiometabolic risk factors (impaired fasting glucose, abdominal obesity, high blood pressure, dyslipidemia) cluster in children, may predict adult disease burden, and are inadequately characterized in South American children.

OBJECTIVES

To quantify the burden of cardiometabolic risk factors in South American children (0-21 years) and identify knowledge gaps.

METHODS

We systematically searched PubMed, Google Scholar, and the Latin American and Caribbean Health Sciences Literature via Virtual Health Library from 2000-2021 in any language. Two independent reviewers screened and extracted all data.

RESULTS

179 studies of 2,181 screened were included representing 10 countries (n = 2,975,261). 12.2% of South American children experienced obesity, 21.9% elevated waist circumference, 3.0% elevated fasting glucose, 18.1% high triglycerides, 29.6% low HDL cholesterol, and 8.6% high blood pressure. Cardiometabolic risk factor definitions varied widely. Chile exhibited the highest prevalence of obesity/overweight, low HDL, and impaired fasting glucose. Ecuador exhibited the highest prevalence of elevated blood pressure. Rural setting (vs. urban or mixed) and indigenous origin protected against most cardiometabolic risk factors.

CONCLUSIONS

South American children experience high rates of obesity, overweight, and dyslipidemia. International consensus on cardiometabolic risk factor definitions for children will lead to improved diagnosis of cardiometabolic risk factors in this population, and future research should ensure inclusion of unreported countries and increased representation of indigenous populations.

Assessment of a consensus definition of obesity and metabolic health phenotypes in children at different pubertal stages

Not all individuals with obesity develop metabolic complications, which has brought about the concepts of metabolically healthy and unhealthy obesity (MHO/MUO). However, inconsistent definitions of these conditions have limited their understanding. We assessed whether a recently-proposed consensus definition for MHO/MUO correlates with adiposity and reflects metabolic risk parameters during puberty. Low-middle income children from the Growth and Obesity Cohort Study (Santiago, Chile) were included (n = 949; 1692 visits at Tanner (T)2, T4 and/or one-year post menarche (1YPM)). Anthropometry, body composition and metabolic parameters were compared between MUO and MHO, and also in children without obesity. The risk for presenting MUO phenotype was significantly elevated with higher waist-height ratio (T2), zBMI (T2, T4), trunk fat, and C-reactive protein (T4). Elevated cardiometabolic indices were important predictors of the "unhealthy" phenotype allocation in children with or without obesity. Our observations suggest that the consensus definition in children at T2, T4 and 1YPM reflects metabolic risk and central obesity. Metabolic health phenotype allocation by this equation enables easy detection of risk factors that call for action to prevent long-term metabolic derangements in children with obesity and, importantly, also those without obesity.

High DHEAS in girls and metabolic features throughout pubertal maturation

CONTEXT

An association between premature adrenarche and metabolic syndrome at presentation has been described. Our aim was to assess whether the presence of high dehydroepiandrosterone sulphate (DHEAS [HD]) at the adrenarche determines the risk of metabolic syndrome during puberty, taking into account body mass index (BMI) and birth weight.

DESIGN

Prospective observational.

PATIENTS

Five hundred four girls from the Growth and Obesity Chilean Cohort Study were followed from birth through puberty. At age ~7, subjects were classified by DHEAS concentrations into the HD (>75th percentile) or normal DHEAS (ND, ≤75th percentile) subgroups.

MEASUREMENTS

Anthropometrics, semiannual clinical pubertal staging and hormonal and metabolic levels. The relationships among DHEAS at age ~7, metabolic syndrome, and each of its components independently, were analyzed by linear and logistic regression models during puberty and 1-year postmenarche, adjusted by confounders.

RESULTS

Girls with HD at 7 years exhibited higher BMI, more central fat and higher serum androgen and insulin like growth factor (IGF)-I levels throughout puberty. Also, girls with HD had a greater prevalence of hyperglycemia at B2 and B4 breast stages, and of low HDL at B4. At 1 year after menarche, HD girls had a higher prevalence of metabolic syndrome, and those with BMI > 1 SD score had a higher metabolic score and insulin levels than ND girls with similar BMI.

CONCLUSIONS

Our observations suggest that girls with HD at the age of adrenarche may be at greater risk for metabolic syndrome at adolescence, especially in those who are overweight or obese. Our results emphasize the importance of lifestyle interventions for childhood overweight and obesity among girls with HD.

Misreporting of Energy Intake Is Related to Specific Food Items in Low-Middle Income Chilean Adolescents

Background: Misreporting of energy intake (EI) in self-reported dietary assessment is inevitable, and even less is known about which food items are misreported by low-middle income adolescents. We evaluated the prevalence of misreporting of energy intake and its relationship with nutrients and food intake. Methods: We analyzed 24 h dietary recalls collected from 576 adolescents (52.08% boys) from southeastern Santiago. Anthropometrics measurements and information about sociodemographic characteristics were obtained during clinical visits. The method proposed by McCrory et al. was used to identify under-reporters (UnRs), over-reporters (OvRs), or plausible reporters (PRs). Food items were collapsed into 28 categories and every food item was expressed as a percentage of total EI. Logistic regression models were performed to investigate the factors associated with misreporting, and a two-part model was used to estimate the difference in the percentage of EI between UnRs versus PRs, and OvRs versus PRs in each food item. Results: Half of the participants were classified as UnRs and 9% were OvRs. UnR was higher among boys (62%) and adolescents with overweight and obesity (72%). OvR was higher among adolescents with normal weight. UnRs had a lower intake of energy from cookies/cake, chocolate/confectionery, and a higher intake of vegetables and eggs than PRs. OvRs had a higher intake of cookies/cake, chocolate/confectionery, and a lower intake of fruit, white milk, and yogurt than PRs. Conclusions: A high frequency of UnR among boys and participants with excess weight was found in this study. Healthy and unhealthy foods are reported differently between UnRs and OvRs of energy intake, indicating that bias is specific for some food items that adolescents commonly eat.

Usefulness of the waist-to-height ratio for predicting cardiometabolic risk in children and its suggested boundary values

BACKGROUND & AIMS

Only limited information is available on the usefulness of the waist-to-height ratio (WHtR) as an abdominal obesity marker in children. Our aim was to compare the ability of a WHtR >90th percentile, a WHtR ≥0.50, a WHtR ≥0.55 and a BMI z-score ≥2 SD to predict cardiometabolic risk in children followed-up at different ages.

METHODS

We evaluated data from 660 children at 5, 8 and 11 years of age who participated in the Childhood Obesity Project trial in 5 European countries. We classified children with or without cardiometabolic (CMet) risk (yes vs. no) according to the presence of ≥2 parameters (blood pressure, HOMA-IR, triglyceride levels and high-density lipoprotein (HDL) cholesterol levels) ≥90th percentile.

RESULTS

The odds ratio for CMet risk in children at all followed-up ages was statistically significant for all measures. The OR for the WHtR≥0.55 cut-off was 29.1 (5.6, 151.7) at 5 years of age, 11.8 (4.1, 33.8) at 8 year of age and 3.6 (1.7, 7.7) at 11 years of age, compared to the WHtR<0.55 cut-off. The WHtR≥0.55 cut-off showed a higher OR at younger ages than the BMI z-score ≥2SD, WHtR ≥90th percentile and WHtR≥0.50 cut-offs and a higher positive predictive value (82% at 5 years of age compared to 55%, 36% and 41%, respectively).

CONCLUSION

A WHtR≥0.55 is a suitable cut-off for screening children at high cardiometabolic risk in the general young European population.

Body Adiposity and Apolipoproteins in Children and Adolescents: A Meta-Analysis of Prospective Studies

Fundamento

Excesso de adiposidade corporal e doenças cardiovasculares são problemas mundiais com crescente prevalência em crianças e adolescentes, sendo necessário investigar a relação destes, afim de construir estratégias de enfrentamento.

Objetivo

Investigar influência do excesso de adiposidade corporal sobre os níveis séricos de apolipoproteínas B e A1 (ApoB e ApoA1) em crianças e adolescentes.

Métodos

Busca sistemática nas bases de dados Medline/PubMed, Embase, Lilacs, Web of Science, Ovid e Science Direct de coortes consideradas elegíveis, avaliando-se qualidade metodológica e risco de viés; estudos combináveis, com boa qualidade e baixo risco de viés foram analisados com metanálise; a medida sumária utilizada foi a diferença de média ponderada e seu respectivo intervalo de confiança a 95%.

Resultados

8 artigos preencheram os critérios de elegibilidade, incluindo indivíduos com média de idade variando de 9 a 15,7 anos. Para a metanálise, incluíram-se 4 artigos, com total de 7.974 crianças e adolescentes. Observou-se aumento médio de 4,94 mg/dL (IC 95%: 4,22 a 5,67 mg/dL) nos níveis de ApoB naqueles com excesso de adiposidade. Para a ApoA1, identificou-se redução média de -8,13 mg/dL (IC 95%: - 9,09 a -7,17 mg/dL) nos níveis séricos desse marcador em indivíduos com maior adiposidade corporal. Além disso, a influência do excesso de adiposidade corporal sobre os níveis de ApoA1 e ApoB foi maior entre adolescentes do que entre crianças.

Conclusões

O excesso de adiposidade corporal influenciou tanto na redução dos valores de ApoA1 quanto no aumento dos níveis de ApoB em crianças e adolescentes, e tais alterações foram mais relevantes entre adolescentes.(Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Obesity Risk Assessment Tool among 3-5 Year Olds: Validation with Biomarkers of Low-Grade Chronic Inflammation

Background: Many families with young children practice nutrition, parenting, and lifestyle behaviors that set their children on trajectories for unhealthful weight gain. Potential adverse health effects of excessive body fat can result in the secretion of proinflammatory molecules and increased risk of inflammation and metabolic diseases. A pediatric obesity risk assessment tool named Healthy Kids (HK), demonstrated validity in a longitudinal study with child's measured BMI and 36-hour diet, screen, sleep, and activity logs. Our objective was to provide additional evidence of validity with low-income families with literacy issues using an inflammation index composed of four proinflammatory biomarkers. Methods: Parent/child pairs (n = 104) from Head Start and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provided HK, blood samples, and measured heights/weights. Select child inflammatory markers were discretized into two groups of HK scores. Data were analyzed with a mixed model adjusted for children's age and BMI. Results: A significant HK-time interaction effect was shown for the child inflammation index with two data collection points 1 year apart (p_did = 0.039). This index increased over 12 months in children with less healthful behaviors (p = 0.007), but not in children with more healthful profiles (p = 0.58). Conclusions: Children with less healthful HK scores had an elevated inflammation index indicating a low-grade chronic systemic inflammatory state. Taken together with our previously published findings, the HK tool has potential as a rapid and easy-to-administer assessment of the family environment and the child's obesity risk. HK can be useful for federal nutrition programs for evaluation, risk assessment, goal setting, and/or program planning in clinical and community environments.

Dietary Patterns of Adolescents from the Chilean Growth and Obesity Cohort Study Indicate Poor Dietary Quality

Diet during adolescence can have lasting effects on nutritional status, health, and development. We hypothesized that dietary patterns with low-quality nutrition are associated with overweightness. We collected data for 882 Chilean adolescents from the Growth and Obesity Cohort Study (mean age: 12 years). Dietary intake was assessed through 24-h recalls and weight status data were obtained during clinical visits. Dietary patterns were obtained through exploratory factor analysis. Multiple logistic regression models were used to examine cross-sectional associations between dietary patterns and overweight (BMI z-score ≥ 1SD). Four dietary patterns were identified: "Breakfast/Light dinner", "Natural foods", "Western", and "Snacking". "Breakfast/Light dinner", "Western", and "Snacking" patterns provided higher energy and excess nutrients (sodium, saturated fat, and added sugar). Moreover, adolescents with higher adherence to "Western" or " Snacking" patterns (third tertile) had higher odds of being classified as overweight (OR = 1.67; 95%CI: 1.103-2.522 and OR = 1.86; 95%CI: 1.235-2.792, respectively) than those with lower adherence (first tertile). "Natural foods" pattern was also associated with overweightness (OR = 1.83; 95%CI: 1.219-2.754). These dietary patterns were associated with overconsumption of nutrients of public health concern. Three of the four main dietary patterns were associated with overweightness. These results highlight the need of prioritizing adolescents on obesity prevention strategies.

High DHEAS Level in Girls Is Associated with Earlier Pubertal Maturation and Mild Increase in Androgens throughout Puberty without Affecting Postmenarche Ovarian Morphology

OBJECTIVE

To assess whether the presence of high DHEAS (HD) at 7 years determines different timing, sequence, and rate of pubertal events, and whether it is associated with adrenal and/or ovarian hyperandrogenism and changes in ovarian morphology throughout puberty.

METHODS

In a longitudinal study of 504 girls, clinical evaluation was performed every 6 months after 7 years of age to detect Tanner stages; hormonal and anthropometric measurements were conducted at thelarche (B2), breast Tanner 4 (B4), and 1 year after menarche; ultrasonographic evaluation was also performed after menarche. The girls were classified as HD if their DHEAS level was >42.1 µg/dL (>75th percentile) around 7 years.

RESULTS

HD around 7 years is associated with a younger age at thelarche, pubarche, and menarche. Girls with HD had higher androstenedione and total testosterone levels, and a higher free androgen index (FAI), and lower levels of antimüllerian hormone (AMH) at B2, and higher levels of androstenedione and FAI at B4 and after menarche. All these results were significant even after adjusting for body mass index, age at first DHEAS determination, and birth weight. One year after menarche, polycystic ovarian morphology was detected in 7.6 and 7.3% of the HD and the normal DHEAS group, respectively. Ovarian volume was correlated with AMH, testosterone, androstenedione, and LH but not with DHEAS around 7 years.

CONCLUSION

Prepubertal HD in normal girls was associated with earlier thelarche, pubarche, and menarche, and a mild androgen increase throughout puberty. We believe continuous follow-up of this cohort is important to prospectively address the interrelationships between biochemical adrenarche and early growth as determinants of ovarian function.

Predictive anthropometric models of total and truncal body fat in Chilean children

OBJECTIVES

This study aimed to develop predictive anthropometric models for total and truncal body fat in Chilean children using the following anthropometric measurements: weight, height, skinfold thickness, and circumference.

METHODS

This cross-sectional study included 669 Chilean children (12.0 y ± 1.3) in Tanner stage IV from the Growth and Obesity Chilean Cohort Study. Anthropometric measurements and dual-energy X-ray absorptiometry were determined to calculate total and truncal body fat. Prediction models were fitted by linear regression analysis.

RESULTS

The predictive equation for log total body fat (kg) was 0.449 + 0.049 (body mass index in kg/m²) + 0.018 (triceps skinfold in mm) + 0.012 (biceps skinfold in mm) + 0.019 (brachial circumference in cm) + 0.091 (sex: 1 = boy, 2 = girl) + 0.018 (age in y). The predictive equation for log truncal fat (kg) was -2.107 + 0.046 (waist circumference in cm) + 0.010 (subscapular skinfold in mm) + 0.259 (sex: 1 = boy, 2 = girl) + 0.006 (age in y). The test of concordance between the predictive equations of total and truncal body fat with gold standard was r = 0.85 and 0.91, respectively.

CONCLUSIONS

In Chilean children, the high correlation between observed and predicted values enabled us to develop predictive equations for total and truncal body fat for children.

Evaluation of anthropometric measures for assessment of cardiometabolic risk in early childhood

OBJECTIVE

Waist-to-height ratio has been shown to be an important indicator of cardiometabolic risk. There are few studies evaluating this measure against existing measures of adiposity and cardiometabolic markers in early childhood. The objectives were: (i) to determine in young children the ability of waist-to-height ratio, BMI z-score, weight for length, and sum of skin fold thickness to predict cardiometabolic risk and (ii) to examine this association at ages 1, 3 and 5 years.

DESIGN

Prospective cohort study.

SETTING

A university hospital in Toronto, Ontario.

PARTICIPANTS

Infants at 1 (n 406), 3 (n 112) and 5 years of age (n 94) born to mothers with and without gestational diabetes mellitus.

RESULTS

Weight for length and BMI z-score demonstrated the strongest correlations with biochemical measures compared to waist-to-height ratio, including leptin (at 5 years, weight for length z-score: ρ = 0·65, P < 0·001; BMI z-score: ρ = 0·67, P < 0·001) and measures of insulin resistance (at 3 years, weight for length z-score: ρ = 0·25, P = 0·02; BMI z-score: ρ = 0·24, P = 0·02). The magnitude of associations between anthropometric measures and biochemical measures strengthened over time. Weight for length and BMI z-scores were moderately correlated with overall measures of fat mass as measured by dual-energy X-ray absorptiometry (ρ = 0·65, P = 0·00; ρ = 0·61, P = 0·01).

CONCLUSIONS

Waist-to-height ratio was not superior to existing measures in predicting cardiometabolic risk in young children. BMI z-score is a preferred measure of adiposity between birth and 5 years of age.

Obesity and Related Metabolic Biomarkers and Its Association with Serum Levels of Estrogen in Pre-pubertal Chilean Girls

Purpose: Recent reports show that girls with higher body mass index (BMI) have an earlier puberty onset (thelarche). It has been suggested that earlier puberty is a consequence of higher levels of estrogen due to increased aromatization of androgens in adipose tissue. Thus, we aimed to assess the relation between serum levels of estrogen and excess weight (BMI ≥1SD) and central adiposity (>75th percentile for waist circumference) in prepubertal girls at age 7.Materials and Methods: We conducted a cross-sectional study within the Growth and Obesity Cohort Study of 1190 low-middle income children from Santiago, Chile. We selected a random sample of 107 prepubertal girls at age 7. A trained dietitian measured weight, height and waist circumference. Additionally, a fasting blood sample was collected to measure serum levels of estradiol equivalents (via ultrasensitive recombinant cell bioassay), dehydroepiandrosterone sulfate (DHEAS), insulin, insulin-like growth factor 1 (IGF-1), and leptin.Results: Excess weight was observed in 40% of our sample; 11.2% had high central adiposity, and the mean level of estradiol equivalents was 3.6 ± 2.3 pg/ml. In the univariate and multivariate analyzes, we did not observe an association between excess weight, central adiposity and estradiol equivalent levels; however, insulin was inversely associated with the serum level of estradiol equivalents.Conclusions: Our participants had a mean level of estradiol equivalents of 3.6 pg/ml (±2.3 pg/ml) at the pre-pubertal stage. However, with the exception of insulin, we did not observe an association between estradiol equivalents and markers of adiposity and metabolic and hormonal factors.

Relative Fat Mass as an estimator of whole-body fat percentage among children and adolescents: A cross-sectional study using NHANES

We evaluated the ability of the Relative Fat Mass (RFM) to estimate whole-body fat percentage among children and adolescents who participated in the National Health and Nutrition Examination Survey from 1999 through 2006 (n = 10,390). The RFM equation for adults (64 − (20 × height/waist circumference) + (12 × sex)) may be used for adolescents 15 to 19 years of age. For children and adolescents 8 to 14 years of age, we suggest a modified RFM equation, named as the RFMp (RFM pediatric): 74 − (22 × height/waist circumference) + (5 × sex). In both equations, sex equals 0 for boys and 1 for girls. RFMp was more accurate than BMI to estimate whole-body fat percentage (measured by dual energy X-ray absorptiometry, DXA) among girls (percentage of estimates that were <20% of measured body fat percentage, 88.2% vs. 85.7%; P = 0.027) and boys 8 to 14 years of age (83.4% vs. 71.0%; P < 0.001). RFM was more accurate than BMI among boys 15 to 19 years of age (82.3% vs. 73.9%; P < 0.001) but slightly less accurate among girls (89.0% vs. 92.6%; P = 0.002). Compared with BMI-for-age percentiles, RFMp had lower misclassification error of overweight or obesity (defined as a DXA-measured body fat percentage at the 85^th percentile or higher) among boys 8 to 14 years of age (6.5% vs. 7.9%; P = 0.018) but not girls (RFMp: 8.2%; BMI-for-age: 7.9%; P = 0.681). Misclassification error of overweight or obesity was similar for RFM and BMI-for-age percentiles among girls (RFM: 8.0%; BMI-for-age: 6.6%; P = 0.076) and boys 15 to 19 years of age (RFM: 6.9%; BMI-for-age: 7.8%; P = 0.11). RFMp for children and adolescents 8 to 14 years of age and RFM for adolescents 15 to 19 years of age were useful to estimate whole-body fat percentage and diagnose body fat-defined overweight or obesity.

Design of an educational strategy based on Intervention Mapping for nutritional health promotion in Child Care Centers

Early childhood is a critical period for instilling healthy habits to prevent overweight and obesity. This paper describes the development of an educational intervention for the promotion of healthy eating and physical activity among two-to-four-year-old children in public child care centers (CCCs) in Mexico City. Following the Intervention Mapping (IM) protocol, we developed the Bright Futures multidisciplinary intervention. First, a formative research process to identify the personal and environmental determinants of childhood overweight and obesity, behavioral outcomes and performance objectives was conducted. Then, a matrix of change objectives by intersecting the performance objectives with the determinants was integrated. Bright Futures lasted six months and included 24 weekly sessions, each composed of five phases: warm-up, theory, active movements, relaxation, and hydration. Ad hoc interactive teaching materials focused on recreational activities, and formulated plans for the adoption, implementation and process/impact evaluation of the intervention was developed. IM successfully guided the design of a theory-driven and evidence-based intervention for children in CCCs within a socio-ecological and participatory planning framework. This is one of the first studies in Mexico to use IM in the context of CCCs.

Relative Weight Gain Through Age 4 Years Is Associated with Increased Adiposity, and Higher Blood Pressure and Insulinemia at 4-5 Years of Age in Mexican Children

Background

Rapid early weight gain has been associated with increased risk of obesity and cardiometabolic alterations, but evidence in low and middle-income countries is inconclusive.

Objective

We evaluated the relation between relative weight gain from 1 to 48 mo with adiposity and cardiometabolic risk factors at 4-5 y of age, and determined if adiposity is a mediator for cardiometabolic alterations.

Methods

We studied 428 Mexican children with anthropometric and blood pressure (BP) information from birth to 5 y of age from POSGRAD (Prenatal Omega-3 fatty acid Supplementation and child GRowth And Development), of whom 334 provided measures of adiposity and cardiometabolic risk markers at 4 y. We estimated relative weight gain by means of conditional weight-for-height z scores for the age intervals 1-6, 6-12, 12-24, and 24-48 mo. Associations between relative weight gain and adiposity and cardiometabolic risk markers (lipid profile, triglycerides, insulin, glucose, and BP) were analyzed by multivariate multiple linear models and path analysis.

Results

A 1-unit increase in conditional weight-for-height z score within each age interval was positively associated with adiposity at 5 y, with coefficients of 0.43-0.89 for body mass index (BMI) z score, 1.08-3.65 mm for sum of skinfolds, and 1.21-3.87 cm for abdominal circumference (all P < 0.01). Positive associations were documented from ages 6 to 48 mo with systolic BP (coefficient ranges: 1.19-1.78 mm Hg; all P < 0.05) and from ages 12 to 48 mo with diastolic BP (1.28-0.94 mm Hg; P < 0.05) at 5 y. Conditional weight-for-height z scores at 12-24 and 24-48 mo of age were more strongly associated with adiposity and BP relative to younger ages. A unit increase in conditional weight-for-height z scores from 12 to 24 mo was associated with 14% higher insulin levels (P < 0.05) at 4 y. Path analyses documented that the associations of conditional weight gain with BP were mediated by BMI and sum of skinfolds.

Conclusion

Relative weight gain at most periods during the first 4 y of life was associated with greater adiposity and higher systolic and diastolic BP at 5 y. These associations with BP were mediated by adiposity. Relative weight gain from 12 to 24 mo was associated with increased serum insulin concentrations at 4 y, but there were no associations with lipid profiles or glucose concentration.

Designing a food tax to impact food-related non-communicable diseases: the case of Chile

The global shift towards diets high in sugar-sweetened beverages (SSBs) and energy dense ultra-processed foods is linked to higher prevalence of obesity, diabetes and most other noncommunicable diseases (NCDs), causing significant health costs. Chile has the highest SSB consumption in the world, very high junk food intake and very rapid increases in these poor components of the diet plus obesity prevalence. This study's purpose is to compare the effect of different tax schemes for SSBs and ultra-processed foods on nutrient availability, utilizing price-elasticities, which are estimated from a Quadratic Almost Ideal Demand System model, using the 2011-2012 Income and Expenditure survey. We take into account the high proportion of households not purchasing various food and beverage groups (censored nature of data). The food groups considered were: sweets and desserts; salty snacks and chips; meat products and fats; fruits, vegetables and seafood; cereals and cereal products; SSB ready-to-drink; SSB from concentrate; plain water, coffee and tea; and milk, which together represent 90% of food expenditures. The simulated taxes were: (1) 40% price tax on SSBs(22% above the current tax level); (2) a 5 cents per gram of sugar tax on products with added sugar; and (3) 30% price tax on all foods(27% above current tax levels) and beverages (12% above the current tax level) exceeding thresholds on sodium, saturated fat, and added sugar and for which marketing is restricted (based on a Chilean law, effective June 16 2016). Unhealthy foods are price-elastic (-1.99 for salty snacks and chips, -1.06 for SSBs ready-to-drink, and -1.27 for SSBs from concentrate), meaning that the change in consumption is proportionally larger with respect to a change in price. Results are robust to different model specification, and consistent among different socioeconomic sub-populations. Overall, the tax on marketing controlled foods and beverages is associated with the largest reduction in household purchases of sodium, added sugar, saturated fat and calorie purchases. Chile is unique in currently having instituted a small current SSB tax as well as marketing controls and front-of-package labeling of unhealthy foods and beverages. The design of a larger, more comprehensive tax to enhance the overall effect of these policies on healthier diets is a next critical step. This study shows that a large tax on the same foods and beverages already delineated as unhealthy by the marketing controls and front-of-pack labeling should prove to be more effective for promoting a healthier diet.

Body mass-to-waist ratio strongly correlates with skeletal muscle volume in children

Purpose

We hypothesized that body mass-to-waist ratio is strongly associated with the total-body skeletal muscle volume (SMV) in children. The purpose of the present study was to examine this hypothesis.

Methods

By using magnetic resonance imaging, total-body SMV (SMV_MRI) was determined in 70 boys and 53 girls aged 6 to 12 years. Waist was measured at each of the level of umbilicus (Wumb) and the minimum circumference (Wmin), and the ratio of body mass to each of the two measured values was calculated (BM/Wumb and BM/Wmin, respectively). A single regression analysis was used to examine the relationships between SMV_MRI and either BM/Wumb or BM/Wmin. On the basis of the obtained regression equations, SMV_MRI was estimated and referred to as SMV_BM/Wumb or SMV_BM/Wmin.

Results

In both boys and girls, SMV_MRI was highly correlated to BM/Wumb (r = 0.937 for boys and r = 0.939 for girls, P < 0.0001) and BM/Wmin (r = 0.915 and 0.942, P < 0.0001). R² and the standard error of estimate for SMV_BM/Wumb were 0.878 and 706.2 cm³, respectively, in boys and 0.882 and 825.3 cm³, respectively, in girls, and those for SMV_BM/Wmin were 0.837 and 814.0 cm³, respectively, in boys and 0.888 and 804.1 cm³, respectively, in girls. In both boys and girls, there were no significant differences between SMV_MRI and either SMV_BM/Wumb or SMV_BM/Wmin, without systematic errors in Band-Altman plots. There was no significant effect of model on the absolute values of the residuals in both boys and girls.

Conclusion

The current results indicate that body mass-to-waist ratio can be a convenient outcome measure for assessing the total-body skeletal muscle volume in children.

Hair cortisol concentrations exhibit a positive association with salivary cortisol profiles and are increased in obese prepubertal girls

Cortisol, a key mediator of the stress response, has been associated with obesity and metabolic syndrome manifestations as early as in childhood. Scalp hair cortisol has been proposed as a reliable index of long-term circulating cortisol. We aimed to investigate whether obese prepubertal girls have higher scalp hair cortisol than normal-weight controls and whether hair cortisol levels are correlated with salivary cortisol concentrations in these groups. In this cross-sectional study, 25 obese girls and 25 normal-weighted, age-matched girls were enrolled. Anthropometric evaluation, blood chemistry and salivary cortisol measurements were performed, and body mass index (BMI) and areas under the curve with respect to ground (AUCg) were calculated. Hair cortisol determination was performed with liquid chromatography-tandem mass spectrometry. Both hair cortisol concentrations and salivary cortisol AUCs were higher in the obese than the normal-weight girls (p < .001 and p = .002, respectively). A positive correlation between hair cortisol and BMI Z-score was found (rho = .327, p = .025), while hair cortisol correlated positively with salivary cortisol AUCg (rho = .3, p = .048). We conclude that obese prepubertal girls have higher hair and salivary cortisol concentrations than their age-matched lean counterparts. Hair cortisol assessment seems to be a sensitive method of evaluating systemic cortisol exposure, which is supported by our finding that hair cortisol is associated with salivary concentrations of the hormone. Lay Summary: Cortisol is the key hormone of the stress response. Childhood obesity has been associated with cortisol production dysregulation. Our findings suggest a positive association between obesity in prepubertal girls and elevated cortisol concentrations, measured in saliva and hair.

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

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

Prenatal Docosahexaenoic Acid Supplementation Does Not Affect Nonfasting Serum Lipid and Glucose Concentrations of Offspring at 4 Years of Age in a Follow-Up of a Randomized Controlled Clinical Trial in Mexico

BACKGROUND

Docosahexaenoic acid (DHA) has regulatory effects on lipid and glucose metabolism. Differences in DHA availability during specific developmental windows may program metabolic changes.

OBJECTIVE

We investigated the effects of maternal DHA supplementation during pregnancy on the nonfasting serum lipid and glucose concentrations of offspring at 4 y of age.

METHODS

We used data from the Prenatal Omega-3 Fatty Acid Supplementation, Growth, and Development trial, a double-blind randomized controlled trial conducted in Mexico. Pregnant women were supplemented daily with 400 mg DHA or placebo from 18-22 wk of gestation to delivery. The primary outcomes of the trial were offspring growth and neurological development. Nonfasting blood samples were obtained from the offspring at 4 y of age. We analyzed serum total, HDL, non-HDL, and LDL cholesterol; the total-to-HDL cholesterol ratio; apolipoprotein B (apoB); triglycerides; glucose; and insulin as secondary outcomes and compared their concentrations between treatment groups.

RESULTS

Data from 524 offspring were available. The women were compliant with the intervention based on pill counts and changes in cord blood and breast milk DHA concentrations. None of the between-group differences (DHA compared with placebo), adjusted for maternal height and time since last food intake, were significant (P range 0.27-0.83). Means (95% CIs) were as follows: total cholesterol (TC), 1.73 mg/dL (-2.63, 6.09 mg/dL); HDL cholesterol, 0.66 mg/dL (-1.07, 2.39 mg/dL); non-HDL cholesterol, 1.77 mg/dL (-1.83, 5.37 mg/dL); LDL cholesterol, 1.62 mg/dL (-2.21, 5.45 mg/dL); TC:HDL ratio, 0.01 (-0.09, 0.11); apoB, -0.15 mg/dL (-2.78, 2.48 mg/dL); triglycerides, 0.21 mg/dL (-10.93, 10.52 mg/dL); glucose, -0.67 mg/dL (-2.46, 1.11 mg/dL); and insulin, 0.62 μU/mL (-0.88, 2.11 μU/mL).

CONCLUSION

Prenatal DHA supplementation does not affect nonfasting serum lipid and glucose concentrations of offspring at 4 y of age. This trial was registered at clinicaltrials.gov as NCT00646360.

Anthropometric indicators as predictors of total body fat and cardiometabolic risk factors in Chilean children at 4, 7 and 10 years of age

BACKGROUND/OBJECTIVE

To compare the association between anthropometric indicators of global and central obesity as predictors of total body fat (TBF) and cardiometabolic risk factors in children.

SUBJECTS/METHODS

A total of 1044 children were evaluated at 4 years (n=320), 7 years (n=1044) and 10 years (n=483). The following anthropometric indices were determined: body mass index (BMI) for age (BAZ, WHO), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). To estimate TBF we used validated predictive equations. We measured blood sample concentrations of glucose, insulin, triglycerides, total cholesterol, Low-density lipoprotein (LDL) and High-density lipoprotein (HDL), adiponectin, C-reactive protein (CRP) and Insulin-like growth factor-1 (IGF-1).

RESULTS

Adiposity and cardiometabolic markers, particularly those related to glucose metabolism increased from 4 years to 10 years. BAZ and WC were highly correlated to body fat at all ages (all r>0.8) but at 10 years WC was more strongly correlated than BAZ (r=0.94 WC vs r=0.88 BAZ, P<0.05); conversely, WHtR was significantly associated with body fat from 7 years (r=0.85) and 10 years (r=0.88). WHR was unrelated all over the period studied at all ages. Anthropometrical adiposity indicators became associated to cardiometabolic markers only from 7 years on with associations being slightly higher at 10 years, particularly for adiponectin and lipid markers. At all ages, BAZ, WC and WHtR performed similarly as cardiometabolic markers (P<0.05) while WHR was a slightly weaker marker.

CONCLUSIONS

Relationship between anthropometrical indicators of adiposity and cardiometabolic markers becomes stronger from 7 years onwards; BAZ, WC and WHtR perform similarly as markers of cardiometabolic risk at least until 10 years of age.

The Presence and Duration of Overweight Are Associated with Low-Grade Inflammation in Prepubertal Chilean Children

BACKGROUND

Overweight is associated with low-grade inflammation, but it is under debate whether the effect of fat mass accumulation is acute or chronic. We aimed to study the association of overweight duration with low-grade inflammation in children in whom overweight initiation can be established.

METHODS

Observational longitudinal study, including a subsample of 250 Chilean children from the Growth and Obesity Cohort Study followed-up yearly since preschool age (n = 1195). At 4 years, 324 children provided blood. From those, 272 participants were evaluated at 7 years. The current analysis includes 250 children with a blood sample at 4 and 7 years of age and C-reactive protein (CRP) <5 mg/L. Anthropometric data (0-4 years) were obtained from health records and measured thereafter; sex- and age-specific body mass index Z-scores (BAZ) were computed. Among overweight (BAZ ≥ 1) participants at 7 years, the duration of overweight (time since diagnosis) was computed and categorized according to tertiles: <36, 36-<72, or ≥72 months. The independent association between overweight (diagnosis and duration) and low-grade inflammation (CRP ≥ 1 mg/L) was studied (logistic regression models).

RESULTS

Overweight was associated with CRP ≥ 1 mg/L at 7 years [odds ratio (OR) = 2.93 confidence interval (95% CI = 1.60-5.38)], but not at 4 years [OR = 1.26 (95% CI = 0.71-2.26)]. An overweight duration <36 m was independently associated with CRP ≥ 1 mg/L [OR = 3.53 (95% CI = 1.21-10.28)] (reference = normal weight), whereas longer overweight durations (36-<72 or ≥72 m) were not associated with CRP ≥ 1 mg/L [OR = 1.35 (95% CI = 0.41-4.40) and OR = 1.21 (95% CI = 0.35-4.18), respectively].

CONCLUSIONS

Overweight at 7 years of age was associated with low-grade inflammation only in the case of recent onset. Inflammatory disturbances may be associated with the early phases of excess weight.

Prepubertal Adiposity, Vitamin D Status, and Insulin Resistance

OBJECTIVE

To evaluate the following from prepuberty to the puberty-onset: (1) changes in serum 25-hydroxyvitamin-D (25[OH]D), adiposity, and insulin resistance (IR); (2) the effect of prepubertal adiposity on serum 25(OH)D changes; and (3) the combined effect of prepubertal obesity and suboptimal-25(OH)D on IR at puberty-onset.

METHODS

A total of 426 prepubertal children (∼54% girls) were followed during pubertal-onset assessing before and after puberty-onset serum 25(OH)D, adiposity (BMI and waist circumference) and IR indicators (homeostasis-model-assessment of IR [HOMA-IR]). Associations were tested using multiple and logistic regression models adjusted by age, gender, and seasonality.

RESULTS

At puberty-onset, mean serum 25(OH)D decreased (32.2 ± 8.9 Tanner I vs 25.2 ± 8.3 ng/mL Tanner II) and total and central obesity increased (BMI-for-age-z-score ≥2 SD [%]: 16.4 vs 22.1; waist-circumference ≥75th percentile [%]: 27.2 vs 37.1, all P < .05). Children with higher adiposity before puberty onset had higher risk of suboptimal-25(OH)D (<30 ng/mL) in Tanner II (ie, odds ratio = 2.7 [1.1-6.7] for obesity and 2.7 [1.4-5.5] for central-obesity) after adjusting for relevant covariates. Children with higher adiposity and suboptimal-25(OH)D before puberty-onset had higher HOMA-IR compared with their counterparts in Tanner II (HOMA-IR: 2.8 [2.5-3.1] if central-obese and suboptimal-25[OH]D vs 2.1 [1.9-2.3] no central-obesity and optimal-25[OH]D).

CONCLUSIONS

We found that serum 25(OH)D declined with puberty-onset, likely because of adiposity increase. Moreover, children with the combined condition of central-obesity and suboptimal-25(OH)D before puberty-onset had higher pubertal IR. These results highlight the need of ensuring adequate-25(OH)D status before pubertal-onset, particularly in obese children.

Body Mass Index, Waist Circumference, and the Clustering of Cardiometabolic Risk Factors in Early Childhood

BACKGROUND

Obesity has its origins in early childhood; however, there is limited evidence of the association between anthropometric indicators and cardiometabolic risk factors in young children. Our aim was to evaluate the associations between body mass index (BMI) and waist circumference (WC) in relation to cardiometabolic risk factors and to explore the clustering of these factors.

METHODS

A cross-sectional study was conducted in children aged 1-5 years through TARGet Kids! (n = 2917). Logistic regression was used to evaluate associations between BMI and WC z-scores and individual traditional and possible non-traditional cardiometabolic risk factors. The underlying clustering of these measures was evaluated using principal components analysis (PCA).

RESULTS

Child obesity (BMI z-score >2) was associated with high (>90th percentile) leptin [odds ratio (OR) 8.15, 95% confidence interval (CI) 4.56, 14.58] and insulin (OR = 1.76; 95% CI 1.05, 2.94). WC z-score >1 was associated with high insulin (OR 1.59, 95% CI 1.11, 2.28), leptin (OR 5.48, 95% CI 3.48, 8.63) and 25-hydroxyvitamin D < 75 nmol/L (OR 1.39, 95% CI 1.08, 1.79). BMI and WC were not associated with other traditional cardiometabolic risk factors, including non-High Density Lipoprotein (HDL) cholesterol, and glucose. Among children 3-5 years (n = 1035) the PCA of traditional risk factors identified three components: adiposity/blood pressure, metabolic, and lipids. The inclusion of non-traditional risk factors identified four additional components but contributed minimally to the total variation explained.

CONCLUSIONS

Anthropometric indicators are associated with selected cardiometabolic risk factors in early childhood, although the clustering of risk factors suggests that adiposity is only one distinct component of cardiometabolic risk. The measurement of other risk factors beyond BMI and WC may be important in defining cardiometabolic risk in early childhood.

Subcutaneous fat mass in infancy and cardiovascular risk factors at school-age: The generation R study

OBJECTIVE

To examine the associations of infant subcutaneous fat with cardiovascular risk factors at school-age.

METHODS

In a population-based prospective cohort study among 808 children, total subcutaneous fat (sum of biceps, triceps, suprailiacal, and subscapular skinfold thicknesses) and central-to-total subcutaneous fat ratio (sum of suprailiacal and subscapular skinfold thicknesses/total subcutaneous fat) at 1.5 and 24 months were estimated. At 6 years, body mass index, blood pressure, cholesterol, triglycerides, and insulin levels were measured.

RESULTS

Infant subcutaneous fat measures were not associated with childhood blood pressure, triglycerides, or insulin levels. A 1-standard-deviation score (SDS) higher total subcutaneous fat at 1.5 months was, independently of body mass index, associated with lower low-density lipoprotein (LDL)-cholesterol levels at 6 years. In contrast, a 1-SDS higher total subcutaneous fat at 24 months was associated with higher total-cholesterol [difference 0.13 (95% confidence interval (CI) 0.03, 0.23) SDS] and LDL-cholesterol levels [difference 0.12 (95% CI 0.02, 0.21) SDS] at 6 years. There were no associations of central-to-total subcutaneous fat ratio with childhood cholesterol levels.

CONCLUSIONS

These results suggest that infant total subcutaneous fat is weakly associated with cholesterol levels at school-age. Further studies are needed to assess the long-term cardiometabolic consequences of infant body fat.

Associations of Objectively Measured Vigorous Physical Activity With Body Composition, Cardiorespiratory Fitness, and Cardiometabolic Health in Youth: A Review

Background. Increasing evidence suggests that vigorous physical activity (VPA) in youth may yield greater health benefits than moderate (MPA) or moderate-to-vigorous physical activity (MVPA). The purpose of this review was to assess the relationship between PA intensity and body composition, cardiorespiratory fitness (CRF), and cardiometabolic (CM) biomarkers in youth. Methods. We conducted a systematic review of observational studies examining PA intensity and selected health outcomes in youth aged 6 to 18 years. Forty-five articles were selected for final review. Results. VPA was more strongly associated with reduced body fat and central adiposity compared with MPA and/or MVPA. Additionally, VPA was more strongly associated with increased CRF when compared with lower intensities. Findings were inconclusive between all PA intensity levels and CM biomarkers, and several significant relationships observed for VPA were attenuated when controlling for CRF. Conclusions. A potential VPA dose is identified as yielding favorable health benefits in adiposity and fitness. While CM biomarkers were not consistently associated with PA intensity level, the literature suggests VPA may yield health benefits above those received from MPA for reduced adiposity and improved CRF. This review highlights the need for longitudinal observational and experimental studies to determine optimal VPA dose for CM health in youth.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The association of excessive growth with development of general and central obesity at 7 years of age in every period after birth in Chilean children

OBJECTIVE

To determine whether overweight or obesity between 0 and 6 y increases the probability of developing general/central obesity at 7 y.

METHODS

Weight, height, and waist circumference were assessed between 0 and 6 y in 628 Chilean children. Body mass index, incidence of overweight (IOW), incidence of obesity (IOB), and prevalence at birth and 0 to 6, 6 to 24, 24 to 48, and 48 to 72 mo and odds ratio (OR) and 95% confidence interval (95% CI) for developing obesity/central obesity at 84 mo were calculated by sex.

RESULTS

IOW was highest at 6 to 24 mo (20.3% and 21.1% for girls and boys, respectively); IOB was highest at 6 to 24 and 24 to 48 mo (11% and 10%, respectively). OR for developing obesity at 7 y was significant if overweight was present 24 to 48 mo in girls and 6 to 24 mo in boys OR 2.47 [95% CI, 1.5-4] and OR 2.26 [95% CI, 1.30-3.92], respectively, and much higher for children who were obese, OR 6.1 (95% CI, 3.03-12.21) for girls 6 to 24 mo and OR 6.57 (95% CI, 2.55-16.86) for boys 0 to 6 mo. IOW or IOB was not associated with obesity at 84 mo, except for the previous period. Overweight also increased the risk of central obesity very early on, after 6 mo in girls and after birth in boys OR 3.8 [95% CI, 2.3-6.2] and OR 2.5 [95% CI, 2.04-3] at 6 to 24 and 0 to 6 mo, respectively, whereas obesity in all periods was associated with a significantly higher OR of presenting central obesity at 7 y.

CONCLUSION

There is tracking not only of obesity but also of overweight after birth for developing general or central obesity at 7 y. Prevention should begin very early on.

Substitution of whole cows' milk with defatted milk for 4 months reduced serum total cholesterol, HDL-cholesterol and total apoB in a sample of Mexican school-age children (6-16 years of age)

We carried out this study to compare the effect of consuming whole, partially defatted and defatted cows' milk for 4 months on serum concentrations of blood indicators of cardiovascular risk (CVR) in Mexican children and adolescents. Children aged between 6 and 16 years living in indigenous boarding schools in Mexico and who were usual consumers of whole milk were recruited to this study. Totally, thirteen boarding schools were randomly selected to receive full supplies of whole, partially defatted and defatted cows' milk for 4 months. Serum total cholesterol (TC), TAG, HDL-cholesterol, apoA and total apoB, and Lp(a) concentrations were measured before and after the intervention. Comparisons were made with multi-level mixed-effects linear regression models using the difference in differences approach. Compared with the whole milk group, TC, LDL-cholesterol, HDL-cholesterol and total apoB were lower in defatted milk consumers by -0·43, -0·28, -0·16 mmol/l and -0·05 g/l, respectively (all P<0·001). Compared with the whole milk group, the group that consumed partially defatted milk showed a significant decrease in the concentrations of LDL-cholesterol (-0·12, P=0·01), apoA (-0·05 g/l, P=0·01) and total apoB (-0·05 g/l, P=0·001). Defatted milk intake for 4 months reduced some of the serum indicators of CVR.

Anthropometric and Quality-of-Life Parameters in Acute Intermittent Porphyria Patients

The porphyrias are a group of rare metabolic disorders. The incidence and prevalence are low because the acute intermittent porphyria (AIP) is rare. Our aim was to assess the use of anthropometric and quality-of-life parameters in porphyric patients in order to identify predictor factors that might help in characterizing AIP patients.Sixteen AIP patients from Murcia (Spain) were recruited from local health centers in 2008 and 2009. A control group of 16 healthy people was established. Body composition was assessed by bioelectrical impedance analysis (BIA) and anthropometric measurements: body weight; height; knee-heel height; waist, hip, upper arm and calf circumferences (CCs); biacromion and biiliac diameters; bicondylar and biepicondylar width; and triceps, subscapular, supraspinale, and calf skinfold thickness. Anthropometric indicators were obtained from anthropometric measurements. A quality-of-life evaluation was carried out using the EuroQol-5D (EQ-5D) questionnaire and Barthel and Katz indexes. Significant differences in means were tested by unpaired Student t test. Group differences in anthropometric measurements were tested with a 2-way analysis of variance (group × condition: age group, overweight, and adiposity degree). Relative frequencies were obtained for noncontinuous variables. Significant differences in prevalence were calculated by means of χ.AIP patients showed statistically significant differences in terms of knee-heel height, biiliac diameter, CC, triceps skinfold thickness, BIA, ponderal index, endomorphy, and ectomorphy. Only 1 quality-of-life indicator, visual analog scale, in the EQ-5D questionnaire showed significant differences between porphyric and control groups.Some anthropometric parameters and the EQ-5D questionnaire could be used to appreciate the presence or follow the evolution of the disease in AIP patients.

Maternal nutrition in pregnancy and metabolic risks among neonates in a Pakistani population, a pilot study

The aim of this study was to observe the association between maternal undernutrition and metabolic risk indicators in newborns at birth. Fifty-nine expectant mothers between 28 and 40 weeks of gestation were included after obtaining their informed consent. Mothers were divided into undernourished, normally nourished and overnourished groups. A total of 54 deliveries were followed-up, and cord blood samples were collected. Metabolic status at birth was assessed by determining the cord blood concentrations of glucose, insulin and lipids and by measuring insulin resistance through homeostasis model assessment. Metabolic risk indicators in the offspring were compared following mothers’ nutrition status (under and normal nourished groups). We found that concentrations of glucose (5.31±2.01 v. 4.69±2.22 mmol/l, P=0.01), total cholesterol (2.51±1.52 v. 1.84±0.66 mmol/l, P=0.04), triglycerides (0.85±1.12 v. 0.34±0.24 mmol/l, P=0.00) and low-density lipoprotein (LDL)-cholestrol (1.26±0.93 v. 1.02±0.50 mmol/l, P=0.04) were significantly high in the offspring born to undernourished mothers. LDL-cholestrol remained significantly high in the undernourished group even after adjustment for potential confounders. Furthermore, a weak association was observed between maternal body fat mass with serum leptin (r=0.272, P=0.05) and maternal body mass Index with LDL-cholestrol in the cord blood (r=0.285, P=0.05). Our results showed that offspring of undernourished mothers had a relatively higher metabolic risk profile including LDL-cholestrol compared with normal nourished group, suggesting that maternal undernutrition may influence metabolic risk markers of the newborn at birth. We recommend that these results should be confirmed by a longitudinal study with a larger sample size.

Low birth weight followed by postnatal over-nutrition in the guinea pig exposes a predominant player in the development of vascular dysfunction

The association between intrauterine growth restriction (IUGR) and hypertension is well established, yet the interaction between IUGR and other pathogenic contributors remains ill-defined. This study examined the independent and interactive effects of fetal growth reduction resulting in low birth weight (LBW), and postnatal Western diet (WD) on vascular function. Growth reduction was induced in pregnant guinea pigs by uterine artery ablation. LBW and normal birth weight (NBW) offspring were randomly assigned to a control diet (CD) or a WD. In young adulthood, length-tension curves were generated in aortic rings and responses to methacholine (MCh) were evaluated in the carotid and aorta using wire myography. Relative to NBW/CD, aortae of NBW/WD offspring were stiffer, as determined by a leftward shift in the length-tension curve, yet the shift in the LBW/CD curve was considerably greater. Aortic stiffening was most severe in LBW/WD (slope: NBW/CD, 1.97 ± 0.04; NBW/WD, 2.16 ± 0.04; LBW/CD, 2.28 ± 0.05; LBW/WD, 2.34 ± 0.07). Maximal responses (Emax) to MCh were significantly blunted in the aorta of LBW/CD vs. NBW/CD (P < 0.05) and in LBW/WD vs. NBW/WD offspring (P < 0.05); but WD alone had no influence on MCh responses. Emax values for carotid responses to MCh were reduced in LBW/CD vs. NBW/CD (P < 0.05). Thus, aortic stiffening was influenced more by LBW than by a postnatal WD and the most severe stiffening was observed in LBW/WD offspring. In contrast, blunted endothelial responses in LBW/CD offspring were not exacerbated by WD. IUGR may have a greater independent impact on vascular function than a postnatal WD.

Waist-to-height ratio, inflammation and CVD risk in obese children

OBJECTIVE

To evaluate the association between waist-to-height ratio (WHtR) and specific biomarkers of inflammation, CVD risk and endothelial dysfunction in prepubertal obese children.

DESIGN

Prospective, multicentre case-control study matched by age and sex.

SETTING

Children were recruited between May 2007 and May 2010 from primary-care centres and schools in three cities in Spain (Cordoba, Santiago de Compostela and Zaragoza).

SUBJECTS

Four hundred and forty-six (223 normal weight and 223 obese) Caucasian prepubertal children aged 6-12 years.

RESULTS

WHtR was higher in the obese than in the normal-weight children. Blood pressure, waist circumference, weight, height, insulin, plasma lipids, leptin, resistin, abnormal neutrophil and monocyte counts, C-reactive protein, IL-6, IL-8, TNF-α, myeloperoxidase, soluble intercellular adhesion molecule-1, selectin and plasminogen activator inhibitor-1 levels were higher in the obese than in the normal-weight group. Adiponectin and HDL-cholesterol were lower and glucose and metalloproteinase-9 showed no differences. Resistin, TNF-α and active plasminogen activator inhibitor-1 were associated with WHtR, a sensitive indicator of central obesity.

CONCLUSIONS

Our results lead to the hypothesis that changes in biomarker levels of insulin resistance, inflammation and CVD risk before puberty might induce metabolic consequences of obesity in obese children before reaching adulthood.

Early adiposity rebound is associated with metabolic risk in 7-year-old children

BACKGROUND

Early adiposity rebound (AR <5 years) has been consistently associated with increased obesity risk, but its relationship with metabolic markers is less clear; in addition, the biologic mechanisms involved in these associations have not been established.

OBJECTIVE

The objective of this study was to assess the association between timing of AR and metabolic status at age 7 years, evaluating the potential role of adiposity, adipose functionality and skeletal maturation in this association.

DESIGN

We estimated the age of AR from the body mass index (BMI) trajectories from 0 to 7 years in 910 children from the Growth and Obesity Chilean Cohort Study (GOCS). At 7 years, we measured waist circumference (WC) and blood glucose, insulin, triglycerides and high-density lipoprotein-cholesterol levels and constructed a metabolic risk score. We also measured percent fat mass (adiposity), plasma concentrations of leptin and adiponectin (adipose functionality) and bone age using wrist ultrasound (skeletal maturation).

RESULTS

We found that 44% of the children had an AR <5 years. Earlier AR was associated with larger WC (β: 5.10 (95% confidence interval (CI): 4.29-5.91)), higher glucose (β: 1.02 (1.00-1.03)), insulin resistance (β Homeostatic Model Assessment: 1.06 (1.03-1.09)), triglycerides (β: 10.37 (4.01-6.73)) and adverse metabolic score (β: 0.30 (0.02-0.37)). Associations decreased significantly if adiposity was added to the models (i.e. β WC: 0.85 (0.33-1.38)) and, to a lesser extent, when adipokines (i.e. β WC: 0.73 (0.14-1.32)) and skeletal maturation (i.e. β WC: 0.65 (0.10-1.20)) were added.

CONCLUSION

In GOCS children, AR at a younger age predicts higher metabolic risk at 7 years; these associations are mostly explained by increased adiposity, but adipose dysfunction and accelerated skeletal maturation also have a role.

Alarming weight gain in women of a post-transitional country

OBJECTIVE

In post-transitional countries, obesity disproportionally affects women. Longitudinal studies can detect high-risk groups in whom to target actions. We investigated the magnitude and velocity of BMI changes in Chilean women of reproductive age and evaluated whether these trends vary in specific groups.

DESIGN

Longitudinal study. We measured weight and height in 2007 (baseline) and again in 2010 (follow-up); we estimated change in BMI (weight/height2) within the 3-year period and assessed its relationship with age, years of education and parity, collected at baseline and follow-up using a questionnaire.

SETTING

Population-based cohort of low- to middle-income Chilean women.

SUBJECTS

Seven hundred and sixty-one women of reproductive age (mean 32·0 (sd 7·0) years), mothers of children who participate in the Growth and Obesity Cohort Study (GOCS).

RESULTS

At baseline, 61 % of women had BMI ≥ 25·0 kg/m2. After 3 years, women gained on average 2·6 kg and obesity (BMI ≥ 30·0 kg/m2) increased by 23 % (12 % new obesity cases). Women with normal nutritional status gained more BMI than obese women (1·4 v. 0·6 kg/m2, P < 0·001). An increase in parity was positively associated with BMI change, independently of age, nutritional status and education (P < 0·05). Age and education were not associated with BMI change after controlling for other factors (P > 0·05).

CONCLUSIONS

In Chile, a post-transitional country, we observed an alarming increase in obesity among women of reproductive age. Our results indicate that in this population actions need to be targeted at all women irrespective of their nutritional status. A key component of these policies should be avoiding excessive weight gain during pregnancy.

Cardiovascular disease risk in children and adolescents

Atherosclerosis is a global health issue beginning in childhood. Children's early development of cardiovascular disease (CVD) risk factors may include exposure to key biological components responsible for vascular inflammation in young adults. A retrospective medical record review based on the 2008 American Academy of Pediatrics childhood lipid screening recommendations examined current and initial CVD risk factors for 227 at-risk school-aged children during wellness exams to better determine the age when children are most likely to convert from being risk-free to at risk for CVD. An original risk trend algorithm analyzed risk clustering and risk trend progression. Risk onset was young (M=2.88 years), with family risk most prevalent and risk clustering and accumulation noted, perhaps precluding primordial prevention.

High sensitivity C-reactive protein concentrations, birthweight and cardiovascular risk markers in Brazilian children

BACKGROUND/OBJECTIVES

High sensitivity C-reactive protein (hs-CRP) and low birthweight have emerged as predictors of cardiovascular diseases (CVDs). In studies involving adults, higher concentrations of hs-CRP have been associated with low birthweight. This study assessed the relationship between hs-CRP and birthweight, and other risk markers for CVDs in childhood.

SUBJECTS/METHODS

A total of 459 Brazilian children aged 5-8 years were included in the study. hs-CRP was measured by particle-enhanced immunonephelometry. The nutritional status of the children was assessed by BMI and waist circumference. Total cholesterol and fractions, triglycerides and glucose were measured by enzymatic methods. Insulin sensitivity was determined by the homeostasis model assessment (HOMA) method. Blood pressure was measured by the HDI/Pulse Wave CR-2000 equipment (Hypertension Diagnostics, Eagan, MN, USA). A multivariate linear regression analysis investigated the association between hs-CRP and birthweight, and risk markers for CVDs.

RESULTS

There were positive associations between hs-CRP and gender (P=0.001), waist circumference (P<0.001) and systolic blood pressure (SBP) (P=0.03), and negative associations between hs-CRP and age (P<0.001), and high-density lipoprotein cholesterol (HDL-c) (P=0.005) (R²=0.14). Abnormal values of hs-CRP, waist circumference, HDL-c and SBP, respectively, were observed in 27.7, 26.4, 14.4 and 34.7% of the children.

CONCLUSIONS

Opposite to studies involving adults, there was no association between hs-CRP and birthweight, implying that time may strengthen the relationship, considering that hs-CRP-concentration-associated metabolic changes increase from childhood to adulthood. The associations between hs-CRP and waist circumference, HDL-c and SBP in very young ages is a matter of concern, especially in females, in view of the large number of children with abnormal values of these measurements.

Association between WHO cut-offs for childhood overweight and obesity and cardiometabolic risk

OBJECTIVE

To examine the association between cardiovascular risk and childhood overweight and obesity using the BMI cut-offs recommended by the WHO.

DESIGN

Children were classified as normal weight, overweight and obese according to the WHO BMI-for-age reference. Blood pressure, lipids, glucose, insulin, homeostasis model assessment-insulin resistance (HOMA-IR) and uric acid levels were compared across BMI groups. ANOVA and tests of linearity were used to assess overall mean differences across groups. Crude and adjusted odds ratios were calculated for adverse plasma levels of biochemical variables.

SETTING

Paediatric care centres.

SUBJECTS

Children (n 149) aged 8-18 years.

RESULTS

About 37 %, 22 % and 41 % of children were classified respectively as normal weight, overweight and obese. There were significant linear mean differences between BMI groups in systolic blood pressure, HDL-cholesterol, TAG, insulin, HOMA-IR and uric acid. Obese children were 10·6 times more likely than normal-weight children to have hypertension; OR for other associations were 60·2 (high insulin), 39·5 (HOMA-IR), 27·9 (TAG), 16·0 (HDL-cholesterol), 4·3 (LDL-cholesterol) and 3·6 (uric acid). Overweight children were more likely than normal-weight children to have hypertension (OR = 3·5), high insulin (OR = 28·2), high HOMA-IR (OR = 23·3) and high TAG (OR = 16·1). Nearly 92 % and 57 % of the obese and overweight children, respectively, had one or more risk factor.

CONCLUSIONS

Obesity and overweight defined using the WHO BMI-for-age cut-offs identified children with higher metabolic and vascular risk. These results emphasize the importance of prevention of overweight and obesity in childhood to reduce cardiovascular risk.

Caucasian children's fat mass: routine anthropometry v. air-displacement plethysmography

The present paper will use fat mass percentage (FM%) obtained via BOD POD® air-displacement plethysmography (FMADP%) to examine the relative validity of (1) anthropometric measurements/indices and (2) of FM% assessed with equations (FMeq%) based on skinfold thickness and bioelectrical impedance (BIA). In 480 Belgian children (aged 5–11 years) weight, height, skinfold thickness (triceps and subscapular), body circumferences (mid-upper arm, waist and hip), foot-to-foot BIA (Tanita®) and FMADP% were measured. Anthropometric measurements and calculated indices were compared with FMADP%. Next, published equations were used to calculate FMeq% using impedance (equations of Tanita®, Tyrrell, Shaefer and Deurenberg) or skinfold thickness (equations of Slaughter, Goran, Dezenberg and Deurenberg). Both indices and equations performed better in girls than in boys. For both sexes, the sum of skinfold thicknesses resulted in the highest correlation with FMADP%, followed by triceps skinfold, arm fat area and subscapular skinfold. In general, comparing FMeq% with FMADP% indicated mostly an age and sex effect, and an increasing underestimation but less dispersion with increasing FM%. The Tanita® impedance equation and the Deurenberg skinfold equation performed the best, although none of the used equations were interchangeable with FMADP%. In conclusion, the sum of triceps and subscapular skinfold thickness is recommended as marker of FM% in the absence of specialised technologies. Nevertheless, the higher workload, cost and survey management of an immobile device like the BOD POD® remains justified.

Children's understanding of family financial resources and their impact on eating healthily

Socioeconomic inequalities in childhood are linked to childhood and adult health inequalities. They are particularly closely associated with inequalities in nutritional and consequently health status. Recent research links this to the high cost of nutrient-rich and low cost of nutrient-poor foods and explores how parents negotiate food purchase on a limited budget. However, we know little of children's perspectives on the material and social realities of their lives and their involvement in health-relevant behaviour. This contrasts with a growing body of research which emphasises children's active role in making sense of and participating in health practices while growing up and their potential to act in continuity with and as agents of change in family health cultures. This paper explores children's understanding of family finances and how they perceive this to relate to eating healthily. It draws upon data from a qualitative study of 53 children aged 9-10 from two socioeconomically contrasting schools in the North of England during 2010 and 2011. Data were generated in friendship group interviews and debates at school and individual interviews in the home, and analysed thematically. Children incorporated a variety of media information into their understandings and sought explanations from their personal experience. They had sophisticated ideas about the interrelationships between diet, cost and health and were acutely aware of how family finances influenced food purchase. Children proposed different strategies to facilitate eating healthily on a budget, but prioritised state and corporate responsibility in ensuring that eating healthily is affordable. This contrasts with current health-related policy, which does not address cost as a potential barrier to eating healthily in the home. Children also consistently conflated healthy eating with eating fruit and vegetables, highlighting a need to reinforce other important nutritional messages.

Ethnic differences in cardiometabolic risk profile at age 5-6 years: the ABCD study

BACKGROUND

To examine ethnic differences in cardiometabolic risk profile in early age, and explore whether such differences can be explained by differences in body mass index (BMI) or waist circumference (WC).

METHOD

Anthropometric measurements, blood pressure and (in a subsample) fasting blood were collected during a health check of 2,509 children aged 5-6 years. Four ethnic groups were distinguished: Dutch (n=2,008; blood n=1,300), African descent (n=199; blood n=105), Turkish (n=108; blood n=57) and Moroccan (n=194; blood n=94). Ethnic differences in diastolic and systolic blood pressure (DBP/SBP), fasting glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride levels were determined and the explanatory role of BMI and WC was examined with regression analysis.

RESULTS

After adjustment for confounders, African descent children showed higher DBP (β2.22 mmHg; 95%CI:1.09-3.36) and HDL levels (β:0.09 mmol/l; 95%CI:0.03-0.16) compared to Dutch children (reference group). Turkish children showed higher SBP (β:1.89 mmHg; 95%CI:0.25-3.54), DBP (β:2.62 mmHg; 95%CI:1.11-4.13), glucose (β:0.12 mmol/L; 95%CI:0.00-0.25) and triglyceride levels (β:0.13 mmol/L; 95%CI:0.02-0.25). Higher BMI values were found in all non-Dutch groups (differences ranged from 0.53-1.03 kg/m(2)) and higher WC in Turkish (β:1.68 cm; 95%CI:0.99-2.38) and Moroccan (β:1.65 cm; 95%CI:1.11-2.19) children. BMI and WC partly explained the higher SBP/DBP and triglyceride levels in Turkish children.

CONCLUSION

Ethnic differences in cardiometabolic profile exist early in life and are partly explained by differences in BMI and WC. African children showed favourable HDL levels and Turkish children the most unfavourable overall profile, whereas their Moroccan peers have less increased cardiometabolic risk in spite of their high BMI and WC.

Birth weight and obesity risk at first grade of high school in a non-concurrent cohort of Chilean children

Objective

To determine the association of birth weight with obesity risk at first grade of high school in Chilean children after accounting for potential confounding factors.

Design

National non-concurrent cohort of newborns. Sociodemographic information, height, weight and anthropometric measurements at first grade of high school were analysed. Birth weight was classified as macrosomia (≥4000 g), by gestational age and by ponderal index. The relationship between birth weight and obesity at first grade of high school (BMI ≥ 95th percentile of the US Centers for Disease Control and Prevention's reference) was assessed using logistic regression models adjusted for sociodemographic information at delivery.

Setting

First grade of public high school of low and middle socio-economic status in the whole country (about 77 % of Chilean children in this age group).

Subjects

Newborns (n 119 070) and the same number of high-school students.

Results

A positive relationship of high ponderal index (OR = 1·86, 95 % CI 1·69, 2·03), birth weight ≥4000 g (OR = 1·66, 95 % CI 1·54, 1·78) and large for gestational age (OR = 1·69, 95 % CI 1·58, 1·81) with obesity at adolescence (P < 0·001) was found. Macrosomic children had a higher risk of being obese at first grade of high school after controlling for prenatal confounding variables (OR = 1·63, 95 % CI 1·52, 1·76; P < 0·001).

Conclusions

A direct relationship between high birth weight and obesity at first grade of high school was observed in this group of Chilean children. The results highlight the significance of birth weight as a simple tool to be used as an indicator of obesity risk for children by health-care providers.