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Messner A, Nairz J, Kiechl S, Winder B, Pechlaner R, Geiger R, Knoflach M, Kiechl-Kohlendorfer U. Comparison of body mass index and fat mass index to classify body composition in adolescents-The EVA4YOU study. Eur J Pediatr 2024; 183:2203-2214. [PMID: 38386029 PMCID: PMC11035421 DOI: 10.1007/s00431-024-05474-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
The objectives of this study were to develop age- and sex-specific reference percentiles for fat mass index (FMI) and fat-free mass index (FFMI) in adolescents aged 14 to 19 years and to determine differences in overweight/obesity classification by FMI and body mass index (BMI). The EVA4YOU study is a single-center cross-sectional study conducted in western Austria. Cardiovascular risks including anthropometric measurements and bioelectrical impedance analysis were assessed in adolescents (mean age 17 years). FMI and FFMI were calculated as the ratio of fat mass (FM) and fat-free mass (FFM) to the square of height and compared to study population-specific BMI percentiles. One thousand four hundred twenty-two adolescents were included in the analysis. Girls had a significantly higher mean FM and FMI and a significantly lower mean FFM, FFMI (p < 0.001, each), and mean BMI (p = 0.020) than boys. Body composition classification by FMI and BMI percentiles shows a concordance for the < 75th and > 97th percentile, but a significant difference in percentile rank classifications between these two cut-off values (all p < 0.05). Based on FMI, 15.5% (221/1422) of the whole population and 29.4% (92/313) of those between the 75th and 97th percentiles are classified one category higher or lower than those assigned by BMI. CONCLUSION Classification of normal or pathologic body composition based on BMI and FMI shows good accordance in the clearly normal or pathologic range. In an intermediate range, FMI reclassifies categories based on BMI in more than a quarter of adolescents. Cut-off values to differentiate normal from pathologic FMI values on a biological basis are needed. TRIAL REGISTRATION The study is registered at www. CLINICALTRIALS gov (Identifier: NCT04598685; Date of registration: October 22, 2020). WHAT IS KNOWN • Chronic non-communicable diseases (NCDs) are the leading cause of morbidity and mortality globally, with major risk factors including unhealthy diets, harmful behaviors, and obesity. Obesity in children and adolescents is a key risk factor for later NCDs, which is commonly measured by Body Mass Index (BMI). • BMI can be misleading as it doesn't distinguish between fat mass (FM) and fat-free mass (FFM), leading to potential misclassification of obesity in children. Previous studies have already suggested the use of the Fat Mass Index (FMI) and Fat-Free Mass Index (FFMI) as a more accurate measures of body composition. WHAT IS NEW • This study adds the first age- and sex-specific reference values for FMI and FFMI in Austrian adolescents using bioelectrical impedance analysis (BIA) as a safe and secure measurement method of a large representative cohort. • We found percentile misclassification between BMI and FMI when categorizing for obesity, especially in intermediate categories of body composition. Furthermore, when comparing the new reference values for FMI and FFMI to existing ones from the US, UK, and Germany we could show a good alignment within the European cohorts and major differences with American values, indicating and confirming the difference of FMI and FFMI for different populations of different ethnical background, living on different continents.
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Affiliation(s)
- Alex Messner
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria
- Department of Pediatrics II, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Johannes Nairz
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria
- Department of Pediatrics II, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
- Department of Pediatrics III, Medical University of Innsbruck, Innsbruck, Austria
| | - Sophia Kiechl
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Bernhard Winder
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria
- Department of Vascular Surgery, Feldkirch Hospital, Feldkirch, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Ralf Geiger
- Department of Pediatrics III, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- VASCage, Centre on Clinical Stroke Research, Innsbruck, Austria.
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Bridger Staatz C, Kelly Y, Lacey RE, Blodgett JM, George A, Arnot M, Walker E, Hardy R. Socioeconomic position and body composition in childhood in high- and middle-income countries: a systematic review and narrative synthesis. Int J Obes (Lond) 2021; 45:2316-2334. [PMID: 34315999 PMCID: PMC8528703 DOI: 10.1038/s41366-021-00899-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/24/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The relation between socioeconomic position (SEP) and obesity measured by body mass index (BMI), a measure of weight for height, has been extensively reviewed in children, showing consistent associations between disadvantaged SEP and higher BMI in high-income countries (HICs) and lower BMI in middle-income countries (MICs). Fat mass (FM), a more accurate measure of adiposity, and fat-free mass (FFM) are not captured by BMI, but have been shown to track from childhood to adulthood, and be important for cardiovascular health and functional outcomes in later life. It is not clear whether body composition is associated with SEP. We systematically reviewed the association between SEP and body composition in childhood. METHODS A systematic review was carried out following PRISMA guidelines. The protocol was pre-registered with PROSPERO (CRD42019119937). Original studies in the English language, which examined the association between SEP and body composition in childhood, were included. An electronic search of three databases was conducted. Two independent reviewers carried out screening, data extraction and quality assessment. Due to heterogeneity in results, a narrative synthesis was conducted. Heterogeneity in findings according to SEP, sex, body composition measure and country income level was investigated. RESULTS 50 papers were included, the majority from HICs. No papers were from low-income countries. Disadvantage in childhood was associated with greater FM and lower FFM in HICs, but with lower FM and lower FFM in MICs. When measures of FFM indexed to height were used there was no evidence of associations with SEP. In HICs, more studies reported associations between disadvantaged SEP and higher FM among girls comparative to boys. CONCLUSIONS Inequalities in FM are evident in HICs and, in the opposite direction, in MICs and follow similar trends to inequalities for BMI. Inequalities in height are likely important in understanding inequalities in FFM.
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Affiliation(s)
- Charis Bridger Staatz
- Social Research Institute, Institute of Education, University College London, London, UK.
| | - Yvonne Kelly
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rebecca E Lacey
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Joanna M Blodgett
- Institute of Sport Exercise and Health, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - Anitha George
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Megan Arnot
- Department of Anthropology, University College London, London, UK
| | - Emma Walker
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rebecca Hardy
- Social Research Institute, Institute of Education, University College London, London, UK
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Morales E, Torres-Castillo N, Garaulet M. Infancy and Childhood Obesity Grade Predicts Weight Loss in Adulthood: The ONTIME Study. Nutrients 2021; 13:nu13072132. [PMID: 34206431 PMCID: PMC8308354 DOI: 10.3390/nu13072132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/03/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
We examined the relationships between intergenerational obesity, weight and size at birth, and obesity from infancy to adolescence with weight loss in response to a dietary intervention. We studied 4264 participants (3369 women; mean age 41.5 ± 12.9 years) of the ONTIME study. Participants followed a weight-loss treatment based on a Mediterranean diet. Associations between grandparental and parental obesity grade, birth weight and size, and obesity grade in infancy, childhood and adolescence with total weight loss in response to treatment were assessed, using multivariate linear regression models. A lower weight loss (kg) in response to treatment was found among participants who were obese during infancy (beta coefficient -2.13 kg; 95% CI, -3.96, -0.30; p = 0.023). Furthermore, obesity during infancy and also during childhood was associated with a slower weekly rate of weight loss during treatment (p < 0.05). In conclusion, obesity in infancy and in childhood impairs the weight-loss response to dietary treatments in adulthood. Tackling obesity throughout early life may improve the effectiveness of weight-loss interventions in adulthood.
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Affiliation(s)
- Eva Morales
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain;
- Department of Public Health Sciences, University of Murcia, 30100 Murcia, Spain
| | - Nathaly Torres-Castillo
- Department of Molecular Biology and Genomics, Institute for Translational Nutrigenetics and Nutrigenomics, Health Sciences University Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico;
| | - Marta Garaulet
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain;
- Department of Physiology, Regional Campus of International Excellence, University of Murcia, 30100 Murcia, Spain
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
- Correspondence: ; Tel.: +34-868883930
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Tantawy SA, Kamel DM, Alsayed N, Rajab E, Abdelbasset WK. Correlation between body mass index, neck circumference, and waist-hip ratio as indicators of obesity among a cohort of adolescent in Bahrain: A preliminary cross-sectional study. Medicine (Baltimore) 2020; 99:e19950. [PMID: 32332676 PMCID: PMC7440259 DOI: 10.1097/md.0000000000019950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Neck circumference (NC) is an attractive method for determining overweight and obesity in school age children because it is inexpensive and culturally acceptable. However, this technique has not been assessed for its accuracy in school children from countries of the Gulf Cooperation Council, which have high prevalence of overweight and obesity.The aim of this preliminary study was to investigate the correlation between the body mass index (BMI), NC, and waist-hip ratio and demographic characteristics among 10- to 18-year-old adolescent school children in Bahrain.BMI was calculated using Center of Disease Control and Prevention Children's BMI Tool for Schools. Data was collected for a total of n = 397 adolescents from 4 different private schools with an average age of 12.91 years; 57.7% were male and 42.3% female.In this sample of adolescents, 50.1% were either overweight (21.4%) or obese (28.7%). BMI was significantly associated with waist-hip ratio (P < .01), gender (P < .05), and age (P < .01). Multiple linear regressions revealed that NC was significantly associated with age (P < .001) and less so with gender (P = .071) and BMI was significantly associated with NC (P < .01), gender (P < .01), and age (P < .05). Analysis of the receiver operating characteristic for males and females combined showed fair sensitivity and specificity (Area under the curve (AUC) = 0.707; 95% CI: 0.656, 0.758).NC is weakly correlated with BMI, and only a fair instrument for identifying overweight/obesity based on receiver operating characteristic curve analysis. Therefore, NC could only be used as an adjunct screening tool for weight status in this sample.
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Affiliation(s)
- Sayed A. Tantawy
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Department of Physiotherapy, Center of Radiation Oncology and Nuclear Medicine
| | - Dalia M. Kamel
- Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
- Department of Physiotherapy for Women's Health, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Noor Alsayed
- Department of Mathematical Sciences, College of Arts and Science, Ahlia University
| | - Ebrahim Rajab
- School of Medicine, Royal College of Surgeons in Ireland, Adliya, Bahrain
| | - Walid Kamal Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Kingdom of Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
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Delvecchio M, Pastore C, Valente F, Giordano P. Cardiovascular Implications in Idiopathic and Syndromic Obesity in Childhood: An Update. Front Endocrinol (Lausanne) 2020; 11:330. [PMID: 32582026 PMCID: PMC7296059 DOI: 10.3389/fendo.2020.00330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/28/2020] [Indexed: 01/02/2023] Open
Abstract
Childhood obesity is a modern worldwide epidemic with significant burden for health. It is a chronic metabolic disorder associated with multiple cardiovascular risk factors such as dyslipidemia, hypertension, stroke, and insulin resistance. Many obese adolescents remain obese into adulthood, with increased morbidity and mortality. As childhood obesity is a risk factor for adult obesity, the childhood obesity-related disorders account for an increased risk of cardiovascular consequences in adults, in addition to the effects already exerted by the fat mass in adulthood. Several papers have already described the cardiovascular implications of idiopathic obesity, while few data are available about syndromic obesity, due to the small sample size, not homogeneous phenotypes, and younger age at death. The aim of this mini-review is to give a comprehensive overview on knowledge about cardiovascular implications of idiopathic and syndromic obesity to allow the reader a quick comparison between them. The similarities and differences will be highlighted.
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Affiliation(s)
- Maurizio Delvecchio
- Metabolic Disorders and Diabetes Unit, “Giovanni XXIII” Children Hospital, AOU Policlinico di Bari, Bari, Italy
- *Correspondence: Maurizio Delvecchio
| | - Carmela Pastore
- “B. Trambusti” Pediatric Unit, “Giovanni XXIII” Children Hospital, AOU Policlinico di Bari, Bari, Italy
| | - Federica Valente
- Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Paola Giordano
- “B. Trambusti” Pediatric Unit, “Giovanni XXIII” Children Hospital, AOU Policlinico di Bari, Bari, Italy
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Rupérez AI, Olza J, Gil-Campos M, Leis R, Bueno G, Aguilera CM, Gil A, Moreno LA. Cardiovascular risk biomarkers and metabolically unhealthy status in prepubertal children: Comparison of definitions. Nutr Metab Cardiovasc Dis 2018; 28:524-530. [PMID: 29571590 DOI: 10.1016/j.numecd.2018.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/31/2018] [Accepted: 02/08/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS The early onset of cardio-metabolic abnormalities, known as metabolically unhealthy (MU) status, is highly associated with obesity and cardiovascular disease (CVD), as well as with increased morbidity and mortality later in life. Given the lack of a consensus MU classification for prepubertal children, we aimed to compare available MU definitions in terms of their association with CVD risk biomarkers. METHODS AND RESULTS A total of 930 prepubertal children (622 with overweight/obesity, 462 males) aged 5-10.9 years were recruited, anthropometric measures were taken and biomarkers were analyzed. Children were classified using eight MU definitions based on different cut-offs for blood pressure, triacylglycerides, high-density lipoprotein cholesterol, glucose and homeostasis model assessment for insulin resistance (HOMA-IR). MU prevalence in children with overweight/obesity ranged between 30% and 60% across definitions. Plasma concentrations of resistin, leptin, myeloperoxidase (MPO) and total plasminogen activator inhibitor 1 (tPAI-1) were higher, and those of adiponectin were lower, in MU compared to MH children with overweight/obesity. Linear regression analyses confirmed the contribution of MPO and tPAI-1 concentrations to MU status, with most significant results derived from definitions that use age and sex-specific criteria and that account for HOMA-IR. CONCLUSION Plasma concentrations of MPO and tPAI-1 are increased in prepubertal MU children irrespective of having normal-weight or overweight/obesity. Inclusion of age and sex-specific cut-offs for cardio-metabolic components as well as insulin resistance criteria increases the quality of MU definitions as seen by their stronger association with CVD biomarkers concentrations.
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Affiliation(s)
- A I Rupérez
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, University of Zaragoza, Food and Agriculture Institute of Aragón (IA2), Health Research Institute of Aragón (ISS Aragón), Zaragoza, Spain.
| | - J Olza
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, University of Granada, Biomedical Research Institute ibs, Granada, Spain; CIBER Obesity and Nutrition Physiopathology (CIBEROBN), Madrid, Spain
| | - M Gil-Campos
- CIBER Obesity and Nutrition Physiopathology (CIBEROBN), Madrid, Spain; Paediatric Research and Metabolism Unit, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMBIC), Córdoba, Spain
| | - R Leis
- CIBER Obesity and Nutrition Physiopathology (CIBEROBN), Madrid, Spain; Unit of Investigation in Nutrition, Growth and Human Development of Galicia, Paediatric Department, Health Research Institute of Santiago (IDIS), University of Santiago de Compostela, Galicia, Spain
| | - G Bueno
- CIBER Obesity and Nutrition Physiopathology (CIBEROBN), Madrid, Spain; Paediatric Department, Lozano Blesa University Hospital, University of Zaragoza, Food and Agriculture Institute of Aragón (IA2), Health Research Institute of Aragón (ISS Aragón), Zaragoza, Spain
| | - C M Aguilera
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, University of Granada, Biomedical Research Institute ibs, Granada, Spain; CIBER Obesity and Nutrition Physiopathology (CIBEROBN), Madrid, Spain
| | - A Gil
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, University of Granada, Biomedical Research Institute ibs, Granada, Spain; CIBER Obesity and Nutrition Physiopathology (CIBEROBN), Madrid, Spain
| | - L A Moreno
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, University of Zaragoza, Food and Agriculture Institute of Aragón (IA2), Health Research Institute of Aragón (ISS Aragón), Zaragoza, Spain; CIBER Obesity and Nutrition Physiopathology (CIBEROBN), Madrid, Spain
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Holm JC. [Obesity must be taken seriously]. Ugeskr Laeger 2017; 179:V69285. [PMID: 28874248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Pedersen DC, Pearson S, Baker JL. [The implications of using different body mass index references in children and adolescents]. Ugeskr Laeger 2017; 179:V11160779. [PMID: 28416073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
To classify children as overweight or obese, their body mass index (BMI) must be compared with a growth reference and be accompanied by a clinical assessment. In Denmark, there is a lack of consensus on which BMI reference to use; a mix of national and international references are used in clinics, hospitals and research institutions. In this article, the implications of using different references are illustrated with Danish data. The comparisons show that the references yield different prevalences of overweight in a non-predictable way, making comparisons and monitoring challenging.
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Cullinan J, Cawley J. Parental misclassification of child overweight/obese status: The role of parental education and parental weight status. Econ Hum Biol 2017; 24:92-103. [PMID: 27915138 DOI: 10.1016/j.ehb.2016.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/20/2016] [Accepted: 11/07/2016] [Indexed: 06/06/2023]
Abstract
Childhood overweight and obesity is a major public health challenge for policymakers in many countries. As the most common supervisors of children's activities, parents have a potentially important role to play in obesity prevention. However, a precondition for parents to improve their children's diets, encourage them to be more physically active, or take them to see a doctor about their weight is for the parent to first recognize that their child is overweight or obese. This paper examines the extent of parental misclassification of child weight status, and its correlates, focusing on the role of parental education and the parent's own obesity status. We find evidence that, among non-obese parents, those who are better-educated report their child's weight status more accurately, but among obese parents, the better-educated are 45.18% more likely than parents with lower secondary education to give a false negative report of their child's overweight/obesity; this may reflect social desirability bias.
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Affiliation(s)
- John Cullinan
- JE Cairnes School of Business & Economics, National University of Ireland, Galway, Ireland.
| | - John Cawley
- Department of Policy Analysis and Management and Department of Economics, Cornell University, Ithaca, NY 14853, United States.
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Gawlik A, Shmoish M, Hartmann MF, Malecka-Tendera E, Wudy SA, Hochberg Z. Steroid Metabolomic Disease Signature of Nonsyndromic Childhood Obesity. J Clin Endocrinol Metab 2016; 101:4329-4337. [PMID: 27504851 DOI: 10.1210/jc.2016-1754] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
CONTEXT The profile of urinary steroids as measured by gas chromatography-mass spectrometry defines a subject's "steroidal fingerprint." OBJECTIVE Here, we clustered steroidal fingerprints to characterize patients with nonsyndromic childhood obesity by "steroid metabolomic signatures." HYPOTHESIS Nonsyndromic obesity is a symptom of different diseases and conditions, some of them will have their own signature. DESIGN A total of 31 steroid metabolites were quantified by gas chromatography-mass spectrometry, and their excretion rates were z-transformed. Using MetaboAnalyst 3.0, we divided the subjects into 5 distinctive groups by k-means clustering. Steroidal fingerprints and clinical/biochemical data of patients in each cluster were analyzed. PATIENTS A total of 87 obese children (44 females), aged 8.5-17.9 years, were clinically characterized, and their 24-hour urine was collected. RESULTS Cluster 1 (n = 39, 21 females) had normal steroid profile. Cluster 2 (n = 20, 11 females) showed mild, nonspecific elevation of C19 and C21 steroids, females' resistance to polycystic ovary morphology, and hirsutism. Cluster 3 (n = 7 female), with relative 21-hydroxylase insufficiency, was characterized by partial or full polycystic ovary syndrome. Cluster 4 (n = 4 males), showed markedly elevated C21 steroids and imbalance in the 11β-hydroxysteroid dehydrogenase system, higher insulin, increased frequency of glucose/insulin index more than 0.3, γ-glutamyl transpeptidase activity, systolic blood pressure, and tendency to liver steatosis. Cluster 5 (n = 17, 5 females) had elevated dehydroepiandrosterone and 17-OH-pregnenolone metabolites, suggesting 3β-hydroxysteroid dehydrogenase insufficiency but no clinically unique phenotype. Z-score body mass index values were not significantly different between the clusters. CONCLUSIONS We defined a novel concept of disease-specific steroid metabolomic signature based on urinary steroidal gas chromatography-mass spectrometry. Clustering by software designed for metabolic data analysis reclassified childhood obesity into 5 groups with distinctive signatures; groups require further definition and may require cluster-specific therapeutic strategies.
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Affiliation(s)
- Aneta Gawlik
- Department of Pediatrics, Pediatric Endocrinology and Diabetes (A.G., E.M.-T.), School of Medicine in Katowice, Medical University of Silesia, 40752 Katowice, Poland; Bioinformatics Knowledge Unit (M.S.), Lorry I. Lokey Interdisciplinary Center for Life Sciences and Engineering, Technion-Israel Institute of Technology, Haifa 31096, Israel; Steroid Research and Mass Spectrometry Unit (M.F.H., S.A.W.), Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, 35392 Giessen, Germany; and Faculty of Medicine (Z.H.), Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Michael Shmoish
- Department of Pediatrics, Pediatric Endocrinology and Diabetes (A.G., E.M.-T.), School of Medicine in Katowice, Medical University of Silesia, 40752 Katowice, Poland; Bioinformatics Knowledge Unit (M.S.), Lorry I. Lokey Interdisciplinary Center for Life Sciences and Engineering, Technion-Israel Institute of Technology, Haifa 31096, Israel; Steroid Research and Mass Spectrometry Unit (M.F.H., S.A.W.), Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, 35392 Giessen, Germany; and Faculty of Medicine (Z.H.), Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Michaela F Hartmann
- Department of Pediatrics, Pediatric Endocrinology and Diabetes (A.G., E.M.-T.), School of Medicine in Katowice, Medical University of Silesia, 40752 Katowice, Poland; Bioinformatics Knowledge Unit (M.S.), Lorry I. Lokey Interdisciplinary Center for Life Sciences and Engineering, Technion-Israel Institute of Technology, Haifa 31096, Israel; Steroid Research and Mass Spectrometry Unit (M.F.H., S.A.W.), Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, 35392 Giessen, Germany; and Faculty of Medicine (Z.H.), Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Ewa Malecka-Tendera
- Department of Pediatrics, Pediatric Endocrinology and Diabetes (A.G., E.M.-T.), School of Medicine in Katowice, Medical University of Silesia, 40752 Katowice, Poland; Bioinformatics Knowledge Unit (M.S.), Lorry I. Lokey Interdisciplinary Center for Life Sciences and Engineering, Technion-Israel Institute of Technology, Haifa 31096, Israel; Steroid Research and Mass Spectrometry Unit (M.F.H., S.A.W.), Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, 35392 Giessen, Germany; and Faculty of Medicine (Z.H.), Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Stefan A Wudy
- Department of Pediatrics, Pediatric Endocrinology and Diabetes (A.G., E.M.-T.), School of Medicine in Katowice, Medical University of Silesia, 40752 Katowice, Poland; Bioinformatics Knowledge Unit (M.S.), Lorry I. Lokey Interdisciplinary Center for Life Sciences and Engineering, Technion-Israel Institute of Technology, Haifa 31096, Israel; Steroid Research and Mass Spectrometry Unit (M.F.H., S.A.W.), Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, 35392 Giessen, Germany; and Faculty of Medicine (Z.H.), Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Ze'ev Hochberg
- Department of Pediatrics, Pediatric Endocrinology and Diabetes (A.G., E.M.-T.), School of Medicine in Katowice, Medical University of Silesia, 40752 Katowice, Poland; Bioinformatics Knowledge Unit (M.S.), Lorry I. Lokey Interdisciplinary Center for Life Sciences and Engineering, Technion-Israel Institute of Technology, Haifa 31096, Israel; Steroid Research and Mass Spectrometry Unit (M.F.H., S.A.W.), Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, 35392 Giessen, Germany; and Faculty of Medicine (Z.H.), Technion - Israel Institute of Technology, Haifa 31096, Israel
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Medehouenou TCM, Ayotte P, St-Jean A, Meziou S, Roy C, Muckle G, Lucas M. Overweight and Obesity Prevalence Among School-Aged Nunavik Inuit Children According to Three Body Mass Index Classification Systems. J Adolesc Health 2015; 57:31-6. [PMID: 26095406 PMCID: PMC4477285 DOI: 10.1016/j.jadohealth.2015.03.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Little is known about the suitability of three commonly used body mass index (BMI) classification system for Indigenous children. This study aims to estimate overweight and obesity prevalence among school-aged Nunavik Inuit children according to International Obesity Task Force (IOTF), Centers for Disease Control and Prevention (CDC), and World Health Organization (WHO) BMI classification systems, to measure agreement between those classification systems, and to investigate whether BMI status as defined by these classification systems is associated with levels of metabolic and inflammatory biomarkers. METHODS Data were collected on 290 school-aged children (aged 8-14 years; 50.7% girls) from the Nunavik Child Development Study with data collected in 2005-2010. Anthropometric parameters were measured and blood sampled. Participants were classified as normal weight, overweight, and obese according to BMI classification systems. Weighted kappa (κw) statistics assessed agreement between different BMI classification systems, and multivariate analysis of variance ascertained their relationship with metabolic and inflammatory biomarkers. RESULTS The combined prevalence rate of overweight/obesity was 26.9% (with 6.6% obesity) with IOTF, 24.1% (11.0%) with CDC, and 40.4% (12.8%) with WHO classification systems. Agreement was the highest between IOTF and CDC (κw = .87) classifications, and substantial for IOTF and WHO (κw = .69) and for CDC and WHO (κw = .73). Insulin and high-sensitivity C-reactive protein plasma levels were significantly higher from normal weight to obesity, regardless of classification system. Among obese subjects, higher insulin level was observed with IOTF. CONCLUSIONS Compared with other systems, IOTF classification appears to be more specific to identify overweight and obesity in Inuit children.
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Affiliation(s)
- Thierry Comlan Marc Medehouenou
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada
| | - Pierre Ayotte
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada; Institut national de santé publique du Québec, Québec, Canada; Department of Social and Preventive Medicine, Université Laval, Québec, Canada
| | - Audray St-Jean
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada
| | - Salma Meziou
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada
| | - Cynthia Roy
- Institut national de santé publique du Québec, Québec, Canada
| | - Gina Muckle
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada; School of Psychology, Université Laval, Québec, Canada
| | - Michel Lucas
- Population Health and Optimal Health Practices Research Unit, Centre hospitalier universitaire de Québec Research Center, Québec, Canada; Department of Social and Preventive Medicine, Université Laval, Québec, Canada.
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Kêkê LM, Samouda H, Jacobs J, di Pompeo C, Lemdani M, Hubert H, Zitouni D, Guinhouya BC. Body mass index and childhood obesity classification systems: A comparison of the French, International Obesity Task Force (IOTF) and World Health Organization (WHO) references. Rev Epidemiol Sante Publique 2015; 63:173-82. [PMID: 26002984 DOI: 10.1016/j.respe.2014.11.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 08/05/2014] [Accepted: 11/14/2014] [Indexed: 11/18/2022] Open
Abstract
AIM This study aims to compare three body mass index (BMI)-based classification systems of childhood obesity: the French, the International Obesity Task Force (IOTF) and the World Health Organization (WHO) references. METHODS The study involved 1382 schoolchildren, recruited from the Lille Academic District in France in May 2009 aged 8.4±1.7 years (4.0-12.0 years). Their mean height and body mass were 131.5±10.9cm and 30.7±9.2kg, respectively, resulting in a BMI of 17.4±3.2kg/m(2). The weight status was defined according to the three systems considered in this study. The agreement between these references was tested using the Cohen's kappa coefficient. RESULTS The prevalence of overweight was higher with the WHO references (20.0%) in comparison with the French references (13.8%; P<0.0001) and the IOTF (16.2%; P≤0.01). A similar result was found with obesity (WHO: 11.6% vs. IOTF: 6.7%; or French references: 6.7%; P<0.0001). Agreement between the three references ranged from "moderate" to "perfect" (0.43≤κ≤1.00; P<0.0001). Kappa coefficients were higher when the three references were used to classify children as obese (0.63≤κ≤1.00; P<0.0001) as compared to classification in the overweight (obesity excluded) category (0.43≤κ≤0.94; P<0.0001). When sex and age categories (4-6 years vs. 7-12 years) were considered to define the overweight status, the lowest kappa coefficient was found between the French and WHO references in boys aged 7-12 years (κ=0.28; P<0.0001), and the highest one in girls aged 7-12 years between the French references and IOTF (κ=0.97; P<0.0001). As for obesity, agreement between the three references ranged from 0.60 to 1.00 (P<0.0001), with the lowest values obtained in the comparison of the WHO references against French references or IOTF among boys aged 7-12 years (κ=0.60; P<0.0001). CONCLUSION Overall, the WHO references yield an overestimation in overweight and/or obesity within this sample of schoolchildren as compared to the French references and the IOTF. The magnitude of agreement coefficients between the three references depends on of both sex and age categories. The French references seem to be in rather close agreement with the IOTF in defining overweight, especially in 7-12-year-old children.
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Affiliation(s)
- L M Kêkê
- UFR ingénierie et management de la santé, université de Lille, Loos 59120, France; Luxembourg Institute of Health (LIH), CIEC, Strassen, Luxembourg
| | - H Samouda
- Luxembourg Institute of Health (LIH), Population Health Department, 1445 Strassen, Luxembourg
| | - J Jacobs
- Luxembourg Institute of Health (LIH), Population Health Department, 1445 Strassen, Luxembourg
| | - C di Pompeo
- UFR ingénierie et management de la santé, université de Lille, Loos 59120, France; EA 2694, santé publique : épidémiologie et qualité des soins, université de Lille, 59000 Lille, France; Service de santé publique, agglomération de Maubeuge-Val-de-Sambre, 59600 Maubeuge, France
| | - M Lemdani
- EA 2694, santé publique : épidémiologie et qualité des soins, université de Lille, 59000 Lille, France; Département de biomathématiques, faculté des sciences biologiques et pharmaceutiques, université Lille, Lille, France
| | - H Hubert
- UFR ingénierie et management de la santé, université de Lille, Loos 59120, France; EA 2694, santé publique : épidémiologie et qualité des soins, université de Lille, 59000 Lille, France
| | - D Zitouni
- EA 2694, santé publique : épidémiologie et qualité des soins, université de Lille, 59000 Lille, France; Département de biomathématiques, faculté des sciences biologiques et pharmaceutiques, université Lille, Lille, France
| | - B C Guinhouya
- UFR ingénierie et management de la santé, université de Lille, Loos 59120, France; EA 2694, santé publique : épidémiologie et qualité des soins, université de Lille, 59000 Lille, France.
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Farpour-Lambert NJ, Baker JL, Hassapidou M, Holm JC, Nowicka P, O'Malley G, Weiss R. Childhood Obesity Is a Chronic Disease Demanding Specific Health Care--a Position Statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO). Obes Facts 2015; 8:342-9. [PMID: 26469067 PMCID: PMC5644867 DOI: 10.1159/000441483] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/04/2015] [Indexed: 12/26/2022] Open
Abstract
Childhood obesity is one of the greatest health challenges of the 21st century. The EASO COTF is convinced that classifying obesity as a chronic disease in children and adolescents is a crucial step for increasing individual and societal awareness, and for improving early diagnosis and intervention. Such a classification will enhance the development of novel preventive and treatment approaches, health care policies and systems, and the education of healthcare workers. The management of obesity prior to the appearance of co-morbidities may prevent their escalation into significant medical and psychosocial problems, and reduce their economic and societal impact. Childhood is a unique window of opportunity to influence lifetime effects on health, quality of life, prevention of non-communicable chronic diseases and disabilities. The Convention on the Rights of the Child by UNICEF states that parties shall strive to ensure that no child is deprived of his or her right of access to health care services. The EASO COTF is aiming to address these issues via educational activities for health care workers, identification of research agendas, and the promotion of collaborations among clinicians, researchers, health institutions, organizations and states across Europe.
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Affiliation(s)
- Nathalie J. Farpour-Lambert
- Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
- *Nathalie J. Farpour-Lambert, Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, 1211 Geneva 14, Switzerland,
| | - Jennifer L. Baker
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria Hassapidou
- Alexander Technological Educational Institute of Thessaloniki, Department of Nutrition and Dietetics, Thessaloniki, Greece
| | - Jens Christian Holm
- The Children's Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - Paulina Nowicka
- Division of Pediatrics, Karolinska Institute, Stockholm, Sweden
| | - Grace O'Malley
- Physiotherapy Department; Temple Street Children's University Hospital, Dublin, Ireland
| | - Ram Weiss
- Department of Human Metabolism and Nutrition and the Department of Pediatrics, The Hadassah Hebrew University School of Medicine Jerusalem, Israel
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Lemelin L, Haggerty J, Gallagher F. [Comparison of three weight classification systems for preschool children in a region of Quebec]. Sante Publique 2013; 25:571-578. [PMID: 24418419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Overweight in children is a serious public health problem. The use of different weight classification systems in research and clinical practice results in variable the estimate of prevalences of overweight, which complicates follow-up of this health problem in the population. The study compared three child body weight classification systems by estimating the prevalence of overweight established by each system. METHOD In 2010, a study was conducted in 259 five-year-old children at the time of routine childhood vaccination. The children's height and weight were measured. The prevalence of overweight was determined and compared to the International Obesity Task Force (IOTF), the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) criteria. RESULTS According to the IOTF, 16.6% of children of the study were overweight (obesity 3.1%). According to the CDC, 24.3% of children were overweight (obesity 9.1%) and according to WHO, the prevalence was 26.3% (obesity 6.2%). According to the IOTF criteria, obesity affected more girls than boys (2.7% vs. 0.4%), whereas similar proportions were observed with the other two systems. CONCLUSION This study demonstrates that the prevalence of overweight in children varies considerably depending on the classification system used. These results support the need to consider the system used in clinical practice and in research when monitoring the course of the prevalence of this health problem.
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Rerksuppaphol S, Rerksuppaphol L. Optimal cut-off points of weight for height, waist circumference and waist-to-height ratio for defining overweight and obesity in Thai school-aged children. J Res Health Sci 2013; 13:13-18. [PMID: 23772011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/15/2013] [Accepted: 03/09/2013] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The Body Mass Index (BMI) is widely used to diagnose overweight and obesity. However, there are limitations on the use of BMI and development of alternative measures can be of clinical importance. This study aimed to compare specificity and sensitivity of weight for height (W/H), waist circumference (WC) and waist-to-height ratio (WHTR) with BMI-for-age in diagnosing overweight and obesity in Thai school-age children. METHODS This was a cross-sectional study. Children between the ages of 6 and 13 who attended elementary schools were potential participants of the study. BMI, W/H, WC, and WHTR were calculated for each participant. The optimal cut-off points for the diagnosis of overweight and obesity by W/H, WC and WHTR were generated by the receiver operating characteristic curves (ROC). RESULTS Using BMI cut-off points introduced by WHO, the overall prevalence of overweight and obesity in the study population was 24.6% and 12.9% respectively. W/H, WC, and WHTR all showed acceptable sensitivity and specificity in diagnosing overweight and obesity when compared to BMI-for-age results. W/H had a particularly high correlation with BMI-for-age. CONCLUSION Cut-off points of 112% and 125% W/H are validated to determine overweight and obesity in Thai school-aged children.
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Affiliation(s)
- Sanguansak Rerksuppaphol
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Nakorn Nayok, Thailand.
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