Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3-19 y

INDICATORS OF ADIPOSITY ASSOCIATED WITH LOW BODY ESTEEM IN ADOLESCENTS

OBJECTIVE

To investigate the association between weight status and anthropometric indicators of adiposity with body esteem.

METHODS

Cross-sectional study including 305 adolescents from a public school in Rio de Janeiro, Brazil. Data were collected by a self-administered questionnaire and anthropometric measurements. The Body-Esteem Scale for Adolescents and Adults was used to evaluate total body esteem and the "appearance", "weight", and "attribution" domains. Body mass index (weight/stature2) was applied to assess weight status and waist circumference, the central body adiposity. The association between indicators of adiposity and body esteem was assessed using Student's t-test or Mann-Whitney's test and linear regression models, stratified by sex and age group.

RESULTS

Overweight/obesity was observed in 46% of younger adolescents (10 to 13 year-old girls, 10 to 14 year-old boys), 38% of older boys (15 to 18 year old), and 16% of older girls (14 to 18 year old). For both boys and girls in the younger age group, body mass index and waist circumference (as continuous variables) were inversely associated with total body esteem and weight domain. Overweight/obesity was associated with the appearance body esteem domain only among younger male adolescents; no association was found between either the body mass index or waist circumference and the attribution domain.

CONCLUSIONS

Indicators of adiposity were associated with low body esteem. These findings underscore the fact that considering adolescents' feelings concerning their body and appearance is important to promote a healthy control of weight.

HYPERTRIGLYCERIDEMIC WAIST AND ASSOCIATED FACTORS IN CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS

Objective:

To assess the frequency of the hypertriglyceridemic waist phenotype and its associated factors in children and adolescents with type 1 diabetes mellitus.

Methods:

This is an observational analytical study with individuals with type 1 diabetes mellitus, aged 5 to 18 years, of both genders, followed in a university hospital in the Brazilian Northeast. Weight, height, and waist circumference were measured, and the lipid profile and glycated hemoglobin were analyzed. The hypertriglyceridemic waist phenotype was defined by the simultaneous presence of increased waist circumference (≥90^th percentile for age and gender) and elevated serum triglyceride levels (≥75 mg/dL for children and ≥90 mg/dL for adolescents). We also investigated the family history of cardiovascular diseases and diabetes, as well as sociodemographic and behavioral variables. In the statistical inference tests, the proportions were compared by Pearson’s chi-square test ­and/­or Fisher’s exact test, being significant p<0.05.

Results:

A total of 102 patients were evaluated, most of them females (54.9%) and adolescents (66.7%). The frequency of hypertriglyceridemic waist was 23.5%, which was associated with females (p=0.043), overweight (p=0.023), hypercholesterolemia (p=0.002), high LDL (p=0.001), and borderline VLDL (<0.001).

Conclusions:

The frequency of the hypertriglyceridemic waist phenotype was associated with females, atherogenic lipid profile, and overweight, indicating the importance of the nutritional monitoring of this population, aiming at reducing future cardiovascular diseases.

Sleep Hours: Risk behavior in adolescents from different countries

The aim of this study was to verify sleep hours and associated factors among Brazilian and Spanish students. A cross-sectional study with students aged 11 to 16 years-old was carried out in Paranavaí, Brasil (n = 264) and Cáceres, Spain (n = 233) between 2013 and 2015. Sleeping hours were verified regarding time in minutes, sleep in weekdays, weekends and after lunch/Siesta. All data were checked for normality by the Kolmogorov-Smirnov test. Mann-Whitney U test, Chi-square test (X2) and Odds Ratio estimates were used (p < 0.05). High prevalence in both groups of sleeping 8 hours or more a night at the weekend. The prevalence of sleeping on weekdays, > 8 hours, 6 to 8 hours and < 6 hours among Spanish and Brazilian students, respectively. Nearly a quarter of each group responded that makes the siesta. Spanish students had 3 times higher chance to sleep < 8 hours a night in weekdays, among students from 14 to 16 years old and among the underactive. At the weekends the chance of sleeping < 8 hours is 2 times greater among the Spanish students. Simple guidelines could help so that sleep habits do not affect school development, such as practicing physical activity regularly, sleeping at least 8 hours a night, avoid excessive access to technology at night.

Bariatric interventions in obesity treatment and prevention in pediatric acute lymphoblastic leukemia: a systematic review and meta-analysis

Most children are surviving acute lymphoblastic leukemia (ALL) today. Yet, the emergence of cardiometabolic comorbidities in this population may impact long-term outcomes including the quality of life and lifespan. Obesity is a major driver of cardiometabolic disorders in the general population, and in ALL patients it is associated with increased risk of hypertension, dysglycemia, and febrile neutropenia when compared with lean ALL patients undergoing therapy. This systematic review aims to assess the current evidence for bariatric interventions to manage obesity in children with ALL. The primary outcome for this systematic review was the change in BMI z-score with implementation of the interventions studied. Literature searches were conducted in several databases. Ten publications addressing the study question were included in this review, and five studies were used in the meta-analysis to assess the impact of the bariatric interventions on obesity. The BMI z-score did not change significantly with the interventions. However, the quality of evidence was low, which precluded the recommendation of their use. In conclusion, prospective, rigorous, adequately powered, and high-quality longitudinal studies are urgently needed to deliver effective lifestyle interventions to children with ALL to treat and prevent obesity. These interventions, if successful, may improves cardiometabolic health outcomes and enhance the quality of life and life expectancy in children with ALL.

Prevalence of overweight, obesity and abdominal obesity in the Spanish population aged 3 to 24 years. The ENPE study

INTRODUCTION AND OBJECTIVES

The aim of this study was to assess the prevalence of excess weight and abdominal obesity (AO), based on individual anthropometric measurements, according to various criteria in the Spanish population aged 3 to 24 years and to analyze their distribution by age and sex.

METHODS

We analyzed data from the ENPE study. This analysis included the population aged 3 to 24 years (n=1601). Anthropometric measurements were taken in participants' homes by trained observers following standardized international protocols. We defined overweight and obesity according to the International Obesity Task Force, World Health Organization, and Orbegozo 2011 criteria, and AO according to a waist-to-height index ≥ 0.5, Taylor criteria, and the 90th percentile of Orbegozo 2011.

RESULTS

The prevalence of excess weight (overweight+obesity) exceeded 30% with all the criteria used. The prevalence of excess overweight (International Obesity Task Force) was estimated at 34.1% (95%CI, 31.8-36.4) and obesity at 10.3% (95%CI, 8.9-11.9). The estimated prevalence of AO (waist-to-height index ≥ 0.5) was 31.2% (95%CI, 29.0-33.5), and 20.9% (95%CI, 18.1-22.1) satisfied all 3 criteria. A total of 16% (95%CI, 13.8-17.8) were overweight and had concomitant AO.

CONCLUSIONS

The prevalence of overweight, obesity and AO in the Spanish population aged 3 to 24 years old is high and is higher in men than in women. When distinct criteria were used, the prevalence of AO was approximately 30%. Among persons classified as obese by the 3 criteria, 71.6% were also classified as having AO according to distinct cutoffs.

Beyond BMI: waist circumference and social environment is associated with motor performance ability in kindergartners

BACKGROUND

The aim of the current study was to examine the relationship between anthropometric characteristics (i.e. body height, body weight, body mass index [BMI] and waist circumference [WC]) with motor performance ability [MPA], social environmental factors of the district (i.e. employment status/working life, education, social situation/heterogeneity and home environment), where the respective kindergarten was located, as well as other potential health determinants in a representative sample of kindergartners.

METHODS

We analyzed data of 434 children aged 3 to 6 years which were obtained from a community-based cross-sectional health study conducted in the city of Mainz, Germany. Body height and weight, BMI and WC standard deviation scores [SDS] were calculated relative to the international proposed cut-offs of the IOTF. MPA was collected with multiple test items to determine coordination, speed strength, muscular endurance and speed. The life situation index [LSI] was used to assess the social environment of the district of the kindergarten. Adjusted for covariates, correlation and logistic regression analyses were conducted to estimate the effect of WC on MPA.

RESULTS

Below-average MPA was found in 46% of the sample. While there was no relationship to BMI (odds ratio [OR]: 1.09, 95% confidence interval [95% CI]: 0.83-1.44; p = 0.538), WC SDS was positively associated with below-average MPA (OR: 1.41, 95% CI: 1.01-1.95; p = 0.041). Further results show that the social environment of the district of the kindergarten was independently related to below-average MPA (OR: 2.72, 95% CI: 1.29-5.75; p = 0.009).

CONCLUSION

The findings suggest that WC rather than BMI is linked to measurements of MPA already in kindergartners and furthermore, there seems to be an independent association between MPA and the social environment of the district of the respective kindergarten.

Changes in nutritional status in adolescents surviving leukemia and lymphoma

ABSTRACT Objective To examine the changes in the nutritional status of adolescents aged 10-19 years after a minimum 12 months interval following oncological treatment for leukemias and lymphomas. Methods Longitudinal design quantitative study conducted at Hospital de Clínicas, Porto Alegre. Adolescents aged 10-19 years after a minimum 12 months interval following oncological treatment for leukemias and lymphomas were included. The measures of weight, height, brachial circumference, triceps skinfold thickness, arm muscle circumference and abdominal circumference were collected. Results The sample comprised 50 adolescents who had survived leukemias and lymphomas. In the follow up 38% of the patients were classified as overweight according to the body mass index for their age. There was a significant increase in body mass index for age between the beginning and the end of treatment and follow up (p=0.013) in female individuals, compared to males. The results indicate a reduction in the Z-score means of height for age, with significant differences between the beginning of treatment and follow up (p=0.016); and end of treatment and follow up (p=0.006) in patients of both genders Conclusion The anthropometric indicators show an important frequency of excess weight and increased tricipital skinfold, as well as a significant increase of the body mass index for age and also a growth deficit among the survivors.

Using compositional principal component analysis to describe children's gut microbiota in relation to diet and body composition

BACKGROUND

Gut microbiota data obtained by DNA sequencing are complex and compositional because of large numbers of detectable taxa, and because microbiota characteristics are described in relative terms. Nutrition researchers use principal component analysis (PCA) to derive dietary patterns from food data. Although compositional PCA methods are not commonly used to describe patterns from complex microbiota data, this approach would be useful for identifying gut microbiota patterns associated with diet and body composition.

OBJECTIVES

To use compositional PCA to describe the principal components (PCs) of gut microbiota in 5-y-old children and explore associations between microbiota components, diet, and BMI z-score.

METHODS

A fecal sample was provided by 319 children aged 5 y. Their primary caregiver completed a validated 123-item quantitative FFQ. Body composition was determined using DXA, and a BMI z-score was calculated. Compositional PCA identified characterizing taxa and weightings for calculation of gut microbiota PC scores at the genus level, and was examined in relation to diet and body size.

RESULTS

Three gut microbiota PCs were found. PC1 (negative loadings on uncultured Christensenellaceae and Ruminococcaceae) was related to lower BMI z-scores and longer duration of breastfeeding (per month) (β = -0.14; 95% CI: -0.26, -0.02; and β = 0.02; 95% CI: 0.003, 0.34, respectively). PC2 (positive loadings on Fusicatenibacter and Bifidobacterium; negative loadings on Bacteroides) was associated with a lower intake of nuts, seeds, and legumes (β = -0.05 per gram; 95% CI: -0.09, -0.01). When adjusted for fiber intake, PC2 was also associated with higher BMI z-scores (β = 0.12; 95% CI: 0.01, 0.24). PC3 (positive loadings on Faecalibacterium, Eubacterium, and Roseburia) was associated with higher intakes of fiber (β = 0.02 per gram; 95% CI: 0.003, 0.04) and total nonstarch polysaccharides (β = 0.02 per gram; 95% CI: 0.003, 0.04).

CONCLUSIONS

Our results suggest that specific gut microbiota components determined using compositional PCA are associated with diet and BMI z-score.This trial was registered at clinicaltrials.gov as NCT00892983.

Study of bodyweight and eating attitude among female university members in the Kingdom of Saudi Arabia: A comparison between different methods of weight assessment

Background:

The economic transition in Saudi Arabia imposed negative consequences leading to an increase in the prevalence of obesity and its sequelae. Despite the commitment of high authorities in KSA to combat obesity, so far 25% of Saudis are still obese. The association between obesity, disordered eating attitude, and body image needs to be addressed.

Aim:

To explore the relationship between obesity, eating attitude, and body image satisfaction among students and employees at Princess Nourah University (PNU) and to compare the different modalities of assessing body weight.

Methods:

A cross-sectional study using a convenient sampling technique comprised of 550 participants. Obesity was assessed by anthropometric measurements and body composition monitor (BF511). Eating attitude test (EAT26) was used to determine eating attitude while body image satisfaction score was determined using body shape questionnaire (BSQ).

Results:

Around 382 (69.5%) students and 168 employees participated in the study. Obesity was significantly higher among employees (48.2%) vs students (27.7%) (P < 0.001). Body fat composition showed significant positive correlations ranging from weak-to-moderate (0.13 to 0.44) with other body measurements for students and employees. The disordered eating attitude was maximized among obese compared to other BMI groups (P < 0.05). Percentage of disordered eating attitude score correlated positively with BMI: 35.2% vs 52.3% among underweight and obese, respectively (P = 0.001). There was no statistical difference in eating attitudes between students and employees. BSQ score correlates positively with BMI (P < 0.001), it was 36.73 ± 18.68 vs 57.92 ± 18.50 for underweight and obese, respectively. The effect of BMI on body image score was 19.1%.

Discussion and Conclusion:

Obesity remains a significant health problem among Saudi females. Increased BMI is associated with increased disordered food attitude and the effect of BMI on body image score was minimal.

Effects of MK-7 Supplementation on Glycemic Status, Anthropometric Indices and Lipid Profile in Patients with Type 2 Diabetes: A Randomized Controlled Trial

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a prevalent disorder which accounts for 90-95% of diabetic patients. The aim of this study was to assess the effects of menaquinone (MK-7) supplementation on glycemic indices, anthropometric indices and lipid profile, among patients with T2DM.

METHODS

In this double-blind placebo-controlled randomized clinical trial, 60 men and women with T2DM were allocated equally into either the MK-7 (200 µg/day) or the placebo group. Physical activity level and dietary intake were assessed using the international physical activity questionnaire-short form (IPAQ-SF) and a 3-day food record, pre- and post-intervention. Anthropometric measures, blood pressure, glycemic indices and lipid profile including fasting blood sugar (FBS), hemoglobin A1c (HBA1C), fasting insulin (FI), homeostatic model assessment insulin resistance index (HOMA-IR), triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) were measured at baseline and after twelve weeks.

RESULTS

Forty-five patients completed the trial. There were no significant between-group differences for calorie intake, macronutrient intake, physical activity level or anthropometric measures at baseline and at the end of the study. Dietary vitamin K intake increased significantly at the end of the study in the MK-7 (p: 0.02) and placebo (p: 0.001) groups, but intergroup differences were not significant (p: 0.86). FBS (p: 0.01), HbA1c (p: 0.002), fasting insulin (p: 0.01) and HOMA-IR (p: 0.007) decreased significantly in the MK-7 group. Furthermore, after adjustment for the baseline values and changes of vitamin K intake at the end of study, FBS and HbA1C showed significant intergroup changes, and they were significantly lower in the MK-7 group compared to the placebo group. Lipid profile (TG, TC, LDL-C, HDL-C and LDL-C/HDL-C) did not change significantly within or between groups.

CONCLUSION

MK-7 supplementation seems to be effective in the improvement of glycemic indices, but not the lipid profile of patients with T2DM.

CLINICAL TRIAL REGISTRATION

The present study was prospectively registered at the Iranian Registry of Clinical Trials on May 2019 (ID: IRCT20100123003140N22).

Waist circumference as a prognostic index of childhood abdominal obesity: findings in the Spanish population

Introduction

Introduction: early detection of childhood obesity plays a crucial role in the prevention of diseases during adulthood. At present, the most commonly used screening tool for detecting overweight/obesity in children is the percentile for age of body mass index, although this rate is unable to provide information about fat distribution. An emerging marker of abdominal fat distribution is waist circumference (WC). Objective: the aim of this study was to evaluate the differences between the different diagnostic criteria available to define overweight and obesity in order to establish the optimal WC cut-off values for the Spanish children population. Methods: a cross-sectional study was carried out in 8,241 schoolchildren aged 3 to 12 years from Villanueva de la Cañada (Madrid, Spain). WC (cm), weight (kg) and height (cm) were measured according to the recommendations of the Society for the Advancement of Kineanthropometry (ISAK). The values obtained for the diagnostic criteria (Spanish Orbegozo Foundation (OF), the International Obesity Task Force (IOTF), and the World Health Organization (WHO) were compared using McNemar's test for paired proportions. The kappa coefficient (κ) was used to assess the degree of agreement of the three classifications. We analyzed the validity of body mass index (BMI) and WC using the receiver operating characteristic (ROC) curve analysis. The Youden index was used to determine cut-off values for WC that identify childhood obesity Results: overweight and obesity prevalences were calculated according to the OF, IOTF, and WHO criteria. There was a "substantial" agreement for the overweight and obesity categories between the Spanish criteria and IOTF (κ = 0.636), while agreement was "slight" between the Spanish criteria and those of WHO (κ = 0.198). The estimated cut-off WC criteria ranged from 54.5 to 88.0, varying according to sex and age. Conclusion: the proposed WC cut-off values, stated for the first time in a young Spanish population, are a simple and valid alternative as diagnostic criteria of abdominal obesity.

Child behaviour and subsequent changes in body weight, composition and shape

Objective

Studies have found an association between child behavioural problems and overweight, but the existing evidence for this relationship is inconsistent, and results from longitudinal studies are sparse. Thus, we examined the association between behavioural problems and subsequent changes in body mass index (BMI) and anthropometry over a follow-up period of 1.3 years among children aged 2–6 years.

Design

The study was based on a total of 345 children from The Healthy Start Study; all children were healthy weight but predisposed to develop overweight. The Danish version of the Strengths and Difficulties Questionnaire (SDQ), classified as SDQ Total Difficulties (SDQ-TD) and SDQ Prosocial Behaviour (SDQ-PSB), was used to assess child behaviour. Linear regression analyses were used to examine associations between SDQ scores and subsequent change in BMI z-score, body fat percentage, waist circumference and waist-hip ratio, while taking possible confounding factors into account.

Results

We found an association between SDQ-PSB and subsequent change in BMI z-score (β: 0.040 [95% CI: 0.010; 0.071, p = 0.009]). However, there was no evidence of an association between SDQ-PSB and measures of body composition or body shape.

Conclusions

Among 2 to 6 years old children predisposed to overweight, the association between SDQ-scores and weight gain is either absent or marginal. The SDQ-PSB score may be associated with subsequent increases in BMI z-score, but this association does not seem driven by an increased relative fat accumulation.

Longitudinal changes in body composition and waist circumference by self-reported levels of physical activity in leisure among adolescents: the Tromsø study, Fit Futures

BACKGROUND

It is not clear how physical activity affects body composition in adolescents. Physical activity levels are often reduced during this period, and the relative proportion of body fat mass and lean mass undergo natural changes in growing adolescents. We aimed to examine whether self-reported physical activity in leisure time at baseline or change in activity during follow-up affect changes in four measures of body composition; body mass index (kg/m2), waist circumference, fat mass index (fat mass in kg/m2) and lean mass index (lean mass in kg/m2).

METHODS

We used data from the Tromsø Study Fit Futures, which invited all first year students in upper secondary high school in two municipalities in northern Norway in 2010-2011. They were reexamined in 2012-2013. Longitudinal data was available for 292 boys and 354 girls. We used multiple linear regression analyses to assess whether self-reported level of physical activity in leisure time at baseline predicted changes in body composition, and analysis of covariance to assess the effects of change in level of activity during follow-up on change in body composition. All analyses were performed sex-specific, and a p-value of < 0.05 was considered statistically significant.

RESULTS

There were no associations between self-reported leisure time physical activity in the first year of upper secondary high school and changes in any of the considered measure of body composition after 2 years of follow up, with the exception of waist circumference in boys (p = 0.05). In boys, change in fat mass index differed significantly between groups of activity change (p < 0.01), with boys adopting activity or remaining physically active having less increase in fat mass index than the consistently inactive. In girls, change in lean mass index differed significantly between groups of activity change (p = 0.04), with girls adopting physical activity having the highest increase.

CONCLUSIONS

Self-reported leisure time physical activity does not predict changes in body composition in adolescents after 2 years of follow up. Change in the level of physical activity is associated with change in fat mass index in boys and lean mass index in girls.

Identification of a 1p21 independent functional variant for abdominal obesity

OBJECTIVES

Aiming to uncover the genetic basis of abdominal obesity, we performed a genome-wide association study (GWAS) meta-analysis of trunk fat mass adjusted by trunk lean mass (TFMadj) and followed by a series of functional investigations.

SUBJECTS

A total of 11,569 subjects from six samples were included into the GWAS meta-analysis.

METHODS

Meta-analysis was performed by a weighted fixed-effects model. In silico replication analysis was performed in the UK-Biobank (UKB) sample (N = 331,093) and in the GIANT study (N up to 110,204). Cis-expression QTL (cis-eQTL) analysis, dual-luciferase reporter assay and electrophoresis mobility shift assay (EMSA) were conducted to examine the functional relevance of the identified SNPs. At last, differential gene expression analysis (DGEA) was performed.

RESULTS

We identified an independent SNP rs12409479 at 1p21 (MAF = 0.07, p = 7.26 × 10-10), whose association was replicated by the analysis of TFM in the UKB sample (one-sided p = 3.39 × 10-3), and was cross-validated by the analyses of BMI (one-sided p = 0.03) and WHRadj (one-sided p = 0.04) in the GIANT study. Cis-eQTL analysis demonstrated that allele A at rs12409479 was positively associated with PTBP2 expression level in subcutaneous adipose tissue (N = 385, p = 4.15 × 10-3). Dual-luciferase reporter assay showed that the region repressed PTBP2 gene expression by downregulating PTBP2 promoter activity (p < 0.001), and allele A at rs12409479 induced higher luciferase activity than allele G did (p = 4.15 × 10-3). EMSA experiment implied that allele A was more capable of binding to unknown transcription factors than allele G. Lastly, DGEA showed that the level of PTBP2 expression was higher in individuals with obesity than in individuals without obesity (N = 20 and 11, p = 0.04 and 9.22 × 10-3), suggesting a regulatory role in obesity development.

CONCLUSIONS

Taken together, we hypothesize a regulating path from rs12409479 to trunk fat mass development through its allelic specific regulation of PTBP2 gene expression, thus providing some novel insight into the genetic basis of abdominal obesity.

Anthropometric and Biochemical Predictors for Hypertension in a Cross-Sectional Study in Zanzibar, Tanzania

Background: Aim of this study was to describe the proportion of hypertension among Zanzibari of different age-groups and to detect possible correlates of this non-communicable disease.

Methods: In 2013 a cross-sectional survey was conducted in Unguja Island, Zanzibar. A total of 235 randomly selected households, including 1,229 (2 to 95 years) eligible study participants, were examined. Association between objectively assessed obesity markers, salt intake and hypertension were investigated. Estimates of 24 h sodium and potassium excretion from a single morning spot urine specimen were calculated and used as surrogate for salt intake. The association between overweight/obesity and hypertension in different age-groups was assessed in multilevel logistic regression models. Further associations between salt intake and hypertension were analyzed.

Results: Measures of systolic and diastolic blood pressure as well as proportion of overweight/obesity and hypertension both increased with age. Overweight and obesity were significantly associated with hypertension in adults. Moreover, thinness seems to be associated with hypertension as well. We observed a significantly reduced chance of hypertension for higher urinary sodium-to-potassium compared to a lower ratio in children.

Conclusion: Overweight/obesity and hypertension were highly prevalent (>47% of adults >40 years are overweight or obese and >69% are hypertensive in the same age group) in our sample. Weight status was confirmed as a correlate of high blood pressure in our sample from Zanzibar, Tanzania. To early and effectively prevent related severe cardiovascular outcomes, screening strategies but also monitoring strategies are required for this population.

The Relationship between Lifestyle Factors and Obesity Indices among Adolescents in Qatar

Background: Physical inactivity, sedentary behaviour and an unhealthy diet are factors that may increase weight and general and/or abdominal obesity. Objective: To evaluate the relationship between general and abdominal obesity and lifestyle factors among adolescents in Qatar. Methods: The study data are based on the Arab Teens Lifestyle Study (ATLS). The target population consisted of 1184 adolescents aged between 14 and 18 years old (563 boys and 621 girls), randomly selected through multistage sampling. A validated questionnaire was used to collect data on lifestyle indicators. Anthropometric indicators, which included body weight, height and waist circumference (WC), were measured according to standardised procedures. International Obesity Task Force (IOTF) age- and sex-specific body mass index (BMI) reference values were used to define overweight and obesity. Abdominal obesity was defined by the 'waist-to-height ratio' (WHtR > 0.5) and by sex- and age-specific WC cutoff values. Results: Females were more inactive than males (63.7% vs. 36.3%; p < 0.001). The proportion of adolescents who reported screen time of over 2 h per day was 82.5%. Females engaged in more sedentary behaviour than males (53.4% vs. 46.4%, p = 0.009). Being male (OR: 1.3; CI: 1.0-1.7) and skipping breakfast (OR: 1.5; CI: 1.2-2) were significantly associated with overweight/obesity. In contrast, high intake of fast food, fries, sweets and cake were negative predictors of general and abdominal obesity. Conclusions: The findings revealed the prevalence of unhealthy lifestyle habits among adolescents in Qatar and indicated relationships between certain dietary habits and obesity. The findings of this study may help in advocating for the implementation of an intervention that includes lifestyle changes targeting adolescents.

Biochemical profile, eating habits, and telomere length among Brazilian children and adolescents

OBJECTIVES

Lifestyle, obesity, and eating habits are emerging as determinants for the instability of telomeres. The increase in childhood and adolescent obesity and the association of biochemical profiles and dietary components with telomere length (TL) makes it an important issue in nutritional research. The aim of the present study was to investigate TL and its association with ethnic background, adiposity, clinical and biochemical parameters, and dietary patterns among Brazilian children and adolescents.

METHODS

A cross-sectional study encompassing 981 children and adolescents between 7 and 17 y of age was performed. Dietary intake habits, anthropometry, and clinical data were collected. TL analysis was performed by quantitative polymerase chain reaction.

RESULTS

Children presented significantly longer TL than adolescents (P = 0.046). Participants who self-declared as black, mulatto, or brown (P < 0.001) also showed longer TL than those who were white. Regarding biochemical parameters, individuals with altered glucose levels had shorter TL than normoglycemic participants in the total sample (P = 0.014). Such difference remained statistically significant in adolescents (P = 0.019). Participants who reported eating fruits and vegetables regularly had longer TL than those who did not (P < 0.001).

CONCLUSION

The results suggested that both biochemical parameters and the intake of antioxidant-rich food, such as fruits and vegetables, are associated with the stability of telomere biology among young Brazilians.

Relação entre composição corporal e dislipidemias em crianças e adolescentes

Resumo Verificou-se a relação entre diferentes índices antropométricos e os lipídios plasmáticos. Os dados foram coletados de 2014 a 2016 em 854 escolares (6-18 anos). Foram aferidas a circunferência da cintura (CC), o percentual de gordura corporal (%G) por bioimpedância, o índice de massa corporal (IMC) e relação da cintura/estatura (RCE). Em sangue coletado em jejum mediu-se o colesterol total (CT), HDLc, e triglicerídeos e calculou-se o colesterol não HDL (Não HDLc). Os dados são apresentados por média ± desvio padrão, porcentagens. A comparação de médias foi feita pelo teste t ou ANOVA seguida de teste de Tukey. A associação entre variáveis foi testada por regressão linear. O estudo foi aprovado pelo Comitê de Ética da Universidade Federal do Espírito Santo. Meninos obesos tinham CT, Não HDLc e LDLc mais elevados do que os eutróficos. Em meninas este achado foi apenas para o Não HDLc. Crianças com o %G e RCE inadequados apresentaram LDLc e Não HDLc maiores (p < 0,001), os quais associaram-se positivamente (p < 0,001) com as frações lipídicas (CT e Não HDLc). O excesso de gordura corporal elevou em 21% a probabilidade de ocorrência de colesterol acima da referência (170 mg/dL). O excesso de gordura corporal associou-se com o perfil lipídico aterogênico (maior Não HDLc), principalmente em meninos.

Go Girls!-Dance-Based Fitness to Increase Enjoyment of Exercise in Girls at Risk for PCOS

Weight loss can reduce the hyperandrogenemia associated with polycystic ovary syndrome (PCOS) in peripubertal girls. Yet, adolescent girls have the lowest rates of physical activity and enjoyment of exercise. We created a dance-based support group (Go Girls!) to entice physical activity and improve enjoyment. Girls ages 7-21 over the 85th BMI percentile were recruited and attended once-weekly sessions for 3-6 months. We assessed changes in Physical Activity Enjoyment Scale (PACES), anthropometrics, laboratory data, and amounts of home exercise at 0, 3, and 6 months. Sixteen girls completed either 3 or 6 months. PACES scores were surprisingly high at baseline and remained high. Systolic blood pressure percentile decreased post-intervention. Although no group differences were observed, the majority of individual girls had decreased waist circumference, triglycerides, and metabolic syndrome severity score. Forty percent had decreased free testosterone levels. More girls enjoyed physical education class, got exercise outside of school, and made other lifestyle changes. This dance-based support group was enjoyed by girls and demonstrated health benefits. Continued efforts to engage girls in physical activity are necessary to protect girls from the consequences of obesity, including PCOS and metabolic syndrome. Dance exercise remains a promising tool to encourage physical activity in girls.

Physical Activity, Body Mass, and Adherence to the Mediterranean Diet in Preschool Children: A Cross-Sectional Analysis in the Split-Dalmatia County (Croatia)

Physical activity, body mass, and dietary habits are known to be important determinants of overall health status, but there is an evident lack of studies that examine these issues specifically in preschool children. The aim of this study was to identify associations that may exist between adhering to the Mediterranean diet (MD), levels of physical activity (PA), and body composition indices in apparently healthy preschool children from southern Croatia. Participants were 5- to 6-year-old preschoolers from the Mediterranean part of the country (the Split-Dalmatia County; n = 260, 126 females). Adherence to the MD was observed by the Mediterranean Diet Quality Index (KIDMED), PA level was evaluated by the Preschool-age Children’s Physical Activity Questionnaire (Pre-PAQ), and responses were collected from the parents. The participants’ waist circumferences (in cm), waist-to-hip ratios, and body mass index (in kg/m², and in a z-score calculated relative to the normative value for age and sex) were used as indicators of body composition. All children were of the same age and tested over a one-month period of the same year as a part of the regular examination undertaken before attending elementary school. With only 6% of the children having a low KIDMED score, adherence to the MD was high. MD adherence was higher in girls (Chi-square = 15.31, p < 0.01) and children who live on the coast of the Adriatic Sea (Chi-square = 18.51, p < 0.01). A mixed effects logistic regression (with kindergarten as random factor) identified sedentary activity to be negatively associated with MD adherence (OR per point: 0.65, 95% CI: 0.44–0.91). High adherence to the MD in the studied sample may be attributed to regulated feeding in kindergarten. Considering that most Croatian elementary schools do not provide food to their students, MD adherence should be investigated later in life and also in other parts of the country where the MD is culturally less prevalent.

Adiposity, inflammation and fat-soluble vitamins in adolescents

OBJECTIVE

Evaluate the association between inflammatory process, adiposity, and vitamins A, D, and E in adolescents, according to gender.

METHODS

Cross-sectional study with adolescents aged 12-19 years old of both genders attending public schools in Recife. A questionnaire was used to collect data on socioeconomic level, lifestyle, and food intake of adolescents. Then, an anthropometric evaluation and a blood sampling were performed to analyze serum concentrations of α-1-acid glycoprotein, retinol, β-carotene, α-tocopherol, and 25-hydroxy-vitamin D.

RESULTS

The levels of α-1-acid glycoprotein were higher for abdominal obesity in both genders. Male adolescents with insufficient serum α-tocopherol levels had low levels of α-1-acid glycoprotein (p=0.03) and an increased risk of 25-hydroxy-vitamin D and β-carotene deficiency in relation to total and abdominal fat; female adolescents had an increased risk of insufficient β-carotene with abdominal obesity (PR: 1.33; 95% CI: 1.2-1.5).

CONCLUSION

Abdominal adiposity implies a higher risk of inflammation and causes different changes to the levels of fat-soluble vitamins according to gender.

Favorable impact of long-term exercise on disease symptoms in pediatric patients with inflammatory bowel disease

Background

Evidence is growing that both short- and long-term physical exercise have the potential to positively impact on the physiological system related to inflammatory indices, though, such patterns are unknown for pediatric patients with Inflammatory Bowel Disease (IBD). The aim of the present intervention study was to investigate the influence of a single bout and chronic moderate-intensity exercise on IBD-related inflammatory indices and exercise capacity among pediatric individuals with IBD and healthy controls.

Method

Twenty-one pediatric patients with IBD, split into a “remission-group” (IBD-RE; n = 14) and an “active disease group” (IBD-AD; n = 7), were compared to 23 age matched healthy controls (HC). All participants completed a single bout of exercise at baseline and an 8-week exercise intervention. Before and after the single bout of exercise IBD-related inflammatory indices (erythrocyte sedimentation rate (ESR), albumin, C-reactive protein (CRP), cortisol, hemoglobin, hematocrit, thrombocytes and leukocytes) were assessed.

Results

At baseline, after a single bout of exercise, inflammation (albumin, hemoglobin, erythrocytes, hematocrit and leukocytes) increased in all three groups IBD-AD, IBD-RE and HC. CRP and thrombocytes were only elevated in IBD-AD and IBD-RE, compared to HC. After a longer-term exercise intervention, ESR, CRP and thrombocytes significantly decreased in all groups. The longer-term exercise intervention did not decrease acute immunopathologic responses after a single bout of exercise, compared to baseline.

Conclusion

Whereas a single bout of exercise increases albumin, erythrocytes and leukocytes, longer-term moderate-intensity exercise reduced inflammatory markers in pediatric patients with IBD. Children and teenagers with IBD should be encouraged to engage in regular moderate-intensity exercise activities, as such activities may contribute to inflammation suppression and improved disease management.

Development of a Computational Model to Predict Excess Body Fat in Adolescents through Low Cost Variables

BACKGROUND

Excess body fat has been growing alarmingly among adolescents, especially in low income and middle income countries where access to health services is scarce. Currently, the main method for assessing overweight in adolescents is the body mass index, but its use is criticized for its low sensitivity and high specificity, which may lead to a late diagnosis of comorbidities associated with excess body fat, such as cardiovascular diseases. Thus, the aim of this study was to develop a computational model using linear regression to predict obesity in adolescents and compare it with commonly used anthropometric methods. To improve the performance of our model, we estimated the percentage of fat and then classified the nutritional status of these adolescents.

METHODS

The model was developed using easily measurable socio-demographic and clinical variables from a database of 772 adolescents of both genders, aged 10-19 years. The predictive performance was evaluated by the following metrics: accuracy, sensitivity, specificity, and area under ROC curve. The performance of the method was compared to the anthropometric parameters: body mass index and waist-to-height ratio.

RESULTS

Our model showed a high correlation (R = 0.80) with the body fat percentage value obtained through bioimpedance. In addition, regarding discrimination, our model obtained better results compared to BMI and WHtR: AUROC = 0.80, 0.64, and 0.55, respectively. It also presented a high sensitivity of 92% and low false negative rate (6%), while BMI and WHtR showed low sensitivity (27% and 9.9%) and a high false negative rate (65% and 53%), respectively.

CONCLUSIONS

The computational model of this study obtained a better performance in the evaluation of excess body fat in adolescents, compared to the usual anthropometric indicators presenting itself as a low cost alternative for screening obesity in adolescents living in Brazilian regions where financial resources are scarce.

Pregnancy or cord 25-hydroxyvitamin D is not associated with measures of body fat or adiposity in children from three months to three years of age. An Odense Child Cohort study

BACKGROUND & AIMS

The susceptibility to overweight in adults born during winter season may suggest foetal programming of prenatal vitamin D levels on adiposity. We investigated whether cord or pregnancy serum 25-hydroxyvitamin D (s-25OHD) was associated with infant and child body fat measures in a Danish population-based prospective cohort.

METHODS

In the Odense Child Cohort, 1905 singletons had cord s-25OHD and data on waist circumference (WC), weight, body mass index (BMI), and sum of skin folds (SSF) at median 3.7 months, 18.9 months and three years' age. Early and late pregnancy samples of s-25OHD (mean gestational age 12 and 29 weeks) were chosen as secondary exposures. Multiple linear and logistic regression as well as linear mixed models was applied testing the relation between cord and pregnancy s-25OHD and body fat outcomes and their Z-scores by use of updated national reference populations. Models were adjusted for maternal educational level, maternal ethnicity, pre-gestational BMI and season of birth, a priori stratified by sex.

RESULTS

The median [IQR] cord s-25OHD was 45.5 [31.1; 60.9] nmol/L. Cord s-25OHD <50 nmol/L was found in 57.5%; values < 25 nmol/L in 16.3%. The mean Z-scores of body fat measures at all ages were in the range of -0.32 to +0.42. No consistent associations were found between s-25OHD in cord, early pregnancy or late pregnancy and WC, weight, BMI, SSF, or their Z-scores at ages 3.7 months, 18.9 months, or 3 years. Neither did a computed composite outcome (WC, SSF, BMI, or weight >90th vs. ≤90 percentile) associate with cord or pregnancy s-25OHD.

CONCLUSION

Cord or pregnancy s-25OHD was not associated with measures of body fat or adiposity in children up to three years of age. Our data suggested no programming effect of maternal s-25OHD on offspring obesity in a relatively lean and healthy population of mothers.

Perfil nutricional e percepção da imagem corporal em adolescentes de escolas públicas e privadas de município mineiro

Introdução: A caracterização do perfil nutricional da população de adolescentes, assim como o diagnóstico de sobrepeso e obesidade, é de suma importância para auxiliar a elaboração de medidas de controle e reversão do quadro, possibilitando melhora na qualidade de vida e a prevenção das doenças crônicas não transmissíveis (DCNTs). Objetivo: Traçar o perfil nutricional e fatores associados (gênero, tipo de escola, idade e percepção da imagem corporal) em adolescentes de município de Minas Gerais. Material e Métodos: Estudo transversal, desenvolvido com estudantes de ambos os gêneros do ensino fundamental 2, com idade entre dez a dezesseis anos, matriculados em escolas públicas e privadas. Foram coletados dados antropométricos de 576 indivíduos, incluindo peso, altura e circunferência da cintura, padronizados de acordo com as orientações do Ministério da Saúde. Também foram coletados dados referentes ao hábito alimentar e a percepção da imagem corporal dos indivíduos, através de questionários semi-estruturados e auto preenchidos. Resultados: Dos adolescentes estudados, 58,7% pertenciam à rede pública de ensino, 64,9% do gênero feminino e a mediana de idade foi de 13 anos. Em relação ao estado nutricional, 1,5% da amostra encontrava-se com a estatura inadequada para a idade, 30,93% apresentavam excesso de gordura abdominal e 34,4% excesso de peso. Em relação a imagem corporal, observou-se que os indivíduos obesos e com sobrepeso apresentaram maior insatisfação com sua imagem corporal, quando comparados ao grupo dos indivíduos eutróficos. Em relação aos hábitos alimentares, 37,1% dos adolescentes relataram nunca realizar o café da manhã, mas em relação as outras refeições (almoço e janta) a maioria relatou consumir sempre. Em relação aos alimentos ultraprocessados, 41,2% dos adolescentes relataram consumir guloseimas diariamente e 33,2%, refrigerantes ou suco em pó. Conclusão: São necessárias medidas que promovam a alimentação saudável, visando a prevenção da obesidade, sobrepeso e das doenças crônicas não transmissíveis em adolescentes.

Association of measures of central fat accumulation indices with body fat distribution and metabolic, hormonal, and inflammatory parameters in women with polycystic ovary syndrome

OBJECTIVE

To investigate the associations among visceral adiposity index (VAI), lipid accumulation product (LAP), body fat percentage (%), and android/gynoid ratio (A/G ratio) in women with polycystic ovary syndrome (PCOS) and verify if the parameters representative of visceral obesity correlate with and exhibit the same frequency as body composition variables; anthropometric indices; and metabolic, hormonal, and inflammatory parameters.

SUBJECTS AND METHODS

This was a cross-sectional study that included 94 women with PCOS. Hormonal, metabolic, and inflammatory parameters were analyzed in all women. Free androgen index (FAI) and homeostasis model assessment (HOMA-IR), as well as LAP, VAI, and anthropometric indices, were calculated. The regions of interest (ROIs) in body composition and body composition indices were evaluated using a dual X-ray absorptiometry (DXA). Overall, 32 variables were selected as markers of body fat distribution.

RESULTS

Among the 32 markers evaluated, 29 correlated with LAP, whereas 25 correlated with VAI, 19 with body fat (%), and 30 with A/G ratio. Additionally, some markers correlated with the four adiposity indices evaluated: ROIs, except for total mass and leg fat (%); body composition (body mass index, waist circumference, and hip circumference) indices; fasting insulin; and C-reactive protein.

CONCLUSION

LAP and VAI may be sensitive measures for screening and preventing metabolic syndrome and insulin resistance in PCOS, with LAP being more sensitive than VAI, and the A/G ratio may be more sensitive than body fat percentage.

Menstrual characteristics and its association with socio-demographic factors and nutritional status: a study among the urban slum adolescent girls of West Bengal, India

Menstrual health is one of the major areas of concern in reproductive health, and affects a large number of women throughout their reproductive life from adolescence. Menstruation is a biological phenomenon imbued with social-cultural, nutritional and personal significance. The present study aims to focus on the menstrual characteristics and its association with socio-demographic factors and nutritional status among the urban slum adolescent girls of North 24 Parganas district, West Bengal. This community-based study was conducted among a group of 90 Bengali speaking Hindu adolescent girls aged between 16 to 18 years. A pre-tested structured schedule was used to collect detailed information about the socio-economic conditions and menstrual characteristics. All anthropometric measurements were taken using the standard procedures. Results of the study revealed that underweight girls attained menarche comparatively in later age (12.67±1.23) than that of healthy and overweight girls. Mean length of the menstrual cycle, mean duration of menstrual bleeding and mean number of days of peak discharge were maximum among the girls whose BMI was below 5th percentile, i.e. underweight. Majority of the underweight (75%) and healthy (50%) girls experienced heavy discharge during their menstrual days. Disorders like premenstrual syndrome (PMS) (78.8%) and dysmenorrhea (85.5%) were the major prevalent menstrual problems among these girls and occurrence of the symptoms of these disorders significantly varied based on their BMI. A highly significant difference (p<0.01) was found among underweight, healthy and overweight girls in terms of duration of menstrual bleeding, mean number of days of peak discharge and occurrences of PMS. Result of linear regression and step wise logistic regression (backward elimination) shows that various socio-economic and anthropometric variables are the influential predictors of menstrual characteristics like duration of menstrual discharge, cycle length, days of peak discharge as well as menstrual problems like cycle irregularity and heavy flow (p<0.05). Therefore, the present study unwraps a podium to focus on the menstrual health issues of the adolescent girls and enforce health education as well as instigates nutritional intervention programme to fortify the existing menstrual health status.

Obesity and Bone Health Revisited: A Mendelian Randomization Study for Koreans

Epidemiologic studies have replicated positive associations between obesity and bone health, but their mechanisms are still debatable. We aimed to scrutinize an association between bone health and obesity using genetic instrumental variables (IVs) with the distinction of general versus abdominal obesity. We selected independent IVs of body mass index (BMI) and BMI-adjusted waist circumference (aWC, a proxy of a central fat distribution) by combining novel genomewide searches from the Korean Genome Epidemiology Study (KoGES) consortium and existing reports. We evaluated the associations of obesity indices with bone health measures for weight-bearing and non-weight-bearing bones, applying standard Mendelian randomization analyses. The IVs for BMI and aWC selected from KoGES cohort studies (n = 14,389) explained its own trait only, negating the mutual correlation at the phenotypic level. Two-stage least squares analyses using an independent cohort study (n = 2507, mean age = 44.4 years, men = 44.3%) showed that BMI but not aWC was positively associated with bone mineral density (BMD for weight-bearing bones: 0.063 ± 0.016 g/cm² per one standard deviation increase in BMI), implying the fat distribution might be neutral. The association was weaker for non-weight-bearing bones (BMI on BMD: 0.034 ± 0.011 g/cm² ), and for postmenopausal women the association was absent. Obesity increased both bone area and bone mineral content (BMC) to a lesser degree, but the increase in BMC was not evident for menopausal women. When we stratified the weight into lean body mass and fat mass, the increase in BMD was more evident for lean body mass, and fat mass showed a beneficial role only for men and premenopausal women. Our findings suggest that bone health might gain little from obesity, if any, through its added weight, and other means to prevent bone loss would be essential for postmenopausal women. © 2019 American Society for Bone and Mineral Research.

Waist circumference as high blood pressure predictor in school age children

Childhood hypertension is becoming more common with the increasing numbers of child obesity, which has encouraged new studies to identify a good anthropometric marker for high blood pressure levels. The objective this study was to identify the best anthropometric predictor of risk of hypertension in children between 8-10 years of age. The Children were evaluated for socioeconomic status and their blood pressure (BP), weight, height, waist circumference (WC) and percentage of body fat (PBF) were measured. The study included 445 children, of which 50.1% were females. The prevalence of obesity defined by body mass index (BMI) was 14.6%. Increased BP was found in 3.4% and 2.2% of the children, considering the pre-hypertension and hypertension classifications respectively. The arithmetic mean of BP value correlated significantly with BMI, WC and PBF. After height control, the correlations that were maintained significant were between WC and systolic blood pressure (SBP) and between WC and diastolic blood pressure (DBP). The variable with the highest predictive power of the occurrence of hypertension was WC. The results indicate that, in this population of children between 8 and 10 years old, WC is a measurement of higher value in predicting increased BP.

The role of emotional eating in the links between racial discrimination and physical and mental health

The environmental affordances (EA) model posits that maladaptive self-regulatory strategies (e.g., emotional eating) directly and indirectly heighten African Americans' risk for downstream medical morbidities while also potentially mitigating the psychological impact of stressors. We empirically tested the full EA model. In doing so, we investigated the associations among racial discrimination, depressive symptomatology, and physical health proxies as well as the intervening role of emotional eating in these associations among 150 African Americans aged 18-27. The increased frequency of experiencing racial discrimination was significantly associated with poorer self-reported health, greater depressive symptomatology, and more emotional eating. There was no significant association between emotional eating and physical health and emotional eating did not mediate the relation between racial discrimination and physical health. Finally, racial discrimination was associated with depressive symptomatology, but only among African Americans with mean or high levels of emotional eating.

Exposure to Gestational Diabetes Is a Stronger Predictor of Dysmetabolic Traits in Children Than Size at Birth

CONTEXT AND OBJECTIVE

Being born small or large for gestational age and intrauterine exposure to gestational diabetes (GDM) increase the risk of type 2 diabetes in the offspring. However, the potential combined deleterious effects of size at birth and GDM exposure remains unknown. We examined the independent effect of size at birth and the influence of GDM exposure in utero on cardiometabolic traits, body composition, and puberty status in children.

DESIGN, PARTICIPANTS, AND METHODS

The present study was a longitudinal birth cohort study. We used clinical data from 490 offspring of mothers with GDM and 527 control offspring aged 9 to 16 years, born singleton at term from the Danish National Birth Cohort with available birthweight data.

RESULTS

We found no evidence of a U-shaped association between size at birth (expressed as birthweight, sex, and gestational age adjusted z-score) and cardiometabolic traits. Body size in childhood and adolescence reflected the size at birth but was not reflected in any metabolic outcome. No synergistic adverse effect of being born small or large for gestational age and exposure to GDM was shown. However, GDM was associated with an adverse metabolic profile and earlier onset of female puberty in childhood and adolescence independently of size at birth.

CONCLUSION

In childhood and adolescence, we found GDM was a stronger predictor of dysmetabolic traits than size at birth. The combination of being born small or large and exposed to GDM does not exacerbate the metabolic profile in the offspring.

Metabolic trajectories across early adolescence: differences by sex, weight, pubertal status and race/ethnicity

Background: Biomarkers of cardiovascular and metabolic risk track from adolescence into adulthood, therefore characterising the direction and magnitude of these changes is an important first step to identifying health trajectories that presage future disease risk.Aim: To characterise changes in metabolic biomarkers across early adolescence in a multi-ethnic cohort.Subjects and methods: Among 891 participants in Project Viva we estimated changes in insulin resistance (HOMA-IR), adipokines, lipids, and SBP between ages 6-10 years and 11-16 years. Next, we used multivariable linear regression to examine associations of sex, baseline overweight/obesity, baseline pubertal status and race/ethnicity with change in the biomarkers during follow-up.Results: Boys exhibited a larger decrement in adiponectin (-0.66 [95% CI = -1.14, -0.18)] ng/mL) and a greater increase in SBP (3.20 [2.10, 4.30] mmHg) than girls. Overweight/obese participants experienced larger increases in HOMA-IR, leptin, and triglycerides; and a steeper decrement in HDL. Pubertal youth showed larger decrements in total and LDL cholesterol than their pre-pubertal counterparts. In comparison to White participants, Black youth experienced a larger magnitude of increase in HOMA-IR, and Hispanic youth exhibited larger decrements in adiponectin and HDL.Conclusions: Change in metabolic biomarkers across early adolescence differed by sex, weight status, pubertal status and race/ethnicity. Some of the metabolic changes may reflect normal physiological changes of puberty, while others may presage future disease risk. Future studies are warranted to link metabolic changes during adolescence to long-term health.

Antenatal Synthetic Glucocorticoid Exposure at Human Therapeutic Equivalent Doses Predisposes Middle-Age Male Offspring Baboons to an Obese Phenotype That Emerges With Aging

INTRODUCTION

Women threatening premature delivery receive synthetic glucocorticoids (sGC) to accelerate fetal lung maturation, reducing neonatal mortality and morbidity. Few investigations have explored potential long-term offspring side effects. We previously reported increased pericardial fat and liver lipids in 10-year-old (human equivalent 40 years) male baboons exposed to 3 antenatal sGC courses. We hypothesized middle-aged sGC male offspring show obesity-related morphometric changes.

METHODS

Pregnant baboons received courses of 2 betamethasone injections (175 μg·kg-1·d-1 intramuscular) at 0.6, 0.64, and 0.68 gestation. At 10 to 12.5 years, we measured morphometrics and serum lipids in 5 sGC-exposed males and 10 age-matched controls. We determined whether morphometric parameters predicted amount of pericardial fat or lipids. Life-course serum lipids were measured in 25 males (7-23 years) providing normal regression formulas to compare sGC baboons' lipid biological and chronological age.

RESULTS

Birth weights were similar. When studied, sGC-exposed males showed a steeper weight increase from 8 to 12 years and had increased waist and hip circumferences, neck and triceps skinfolds, and total and low-density lipoprotein cholesterol. Triceps skinfold correlated with apical and midventricular pericardial fat thickness, hip and waist circumferences with insulin.

CONCLUSIONS

Triceps skinfold and waist and hip circumferences are useful biomarkers for identifying individuals at risk for obesity and metabolic dysregulation following fetal sGC exposure. Prenatal sGC exposure predisposes male offspring to internal adiposity, greater body size, and increased serum lipids. Results provide further evidence for developmental programming by fetal sGC exposure and call attention to potential emergence of adverse life-course effects.

Comparison of various anthropometric indices in predicting abdominal obesity in Chinese children: a cross-sectional study

Background

Former evidence regarding reference values of abdominal fat percentage (AFP) and optimal anthropometric indicators in predicting abdominal obesity measured by dual-energy X-ray absorptiometry (DXA) scan in Chinese children were scarce.

Methods

A total of 452 Chinese children aged 6–9 years were included in this cross-sectional study. Abdominal fat and lean mass were measured by a DXA scan, and AFP were calculated. Anthropometric indicators including body mass index (BMI), chest circumference (CC), waist circumference (WC) and hip circumference (HC) were measured, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) was also calculated.

Results

By defining abdominal obesity as those with an AFP ≥ 85th percentile, the cutoffs values are 24.80, 30.29, 31.58, 31.86% in boys, and 25.02, 30.32, 31.66, 31.79% in girls, for children aged 6, 7, 8, and 9 years old, respectively. All anthropometric indicators were independently and positively associated with AFP (P all < 0.01). In girls, BMI was found to be the optimal predictors of childhood abdominal obesity. The values of area under curves (AUCs) were significantly higher (P all < 0.05) than other anthropometric indicators, except for WHtR (AUCs value: 0.886). However, in boys, WHtR instead of BMI, provided the largest AUCs value (0.922) in predicting abdominal obesity, followed by BMI ((AUCs value: 0.913).

Conclusion

This study provides reference values of AFP measured by DXA in Chinese children aged 6–9 years. BMI and WHtR tend to be the optimal anthropometric indicators in predicting abdominal obesity in Chinese girls and boys, respectively.

Physical fitness of children and adolescents with moderate to severe intellectual disabilities

Background: Low levels of physical fitness are associated with low physical and mental health. The aims of this study were to assess the health-related physical fitness of children with intellectual disability (ID), and study the association of physical activity and motor development with physical fitness.Methods: One hundred and twenty-eight children with moderate to severe ID (83 boys; age 2-18 years) visiting specialised day programme centres engaged in field-based physical fitness tests (body composition, muscular strength, muscular endurance, and cardiorespiratory fitness). Scores were compared to reference values, and with linear regression analysis the association between the fitness outcomes and physical activity and motor development was studied.Results: High rates of overweight (23-25%) and obesity (10-15%) were found. A majority of the participants (71-91%) scored below reference values for muscular strength, endurance, and cardiorespiratory fitness tests. Physical activity and motor development were positively associated with scores on several fitness test (β = 0.27-0.44; p < 0.05).Conclusions: Children with moderate to severe ID visiting specialised day programme centres have strikingly low physical fitness levels. Policies and interventions to increase the physical fitness for this specific group of children are urgently needed, in which increasing physical activity and motor skills are expected to be effective components.Implications for rehabilitationStrikingly low levels of physical fitness were seen in children and adolescents with moderate to severe intellectual disabilities.This vulnerable group is in need of appropriate interventions to increase their physical fitness levels.Increasing the physical activity is a potential component in these interventions.Improving motor development will most likely lead to improved physical fitness as well.

CARDIOMETABOLIC RISK FACTORS ASSOCIATED WITH ACTIVE COMMUTING TO SCHOOL

OBJECTIVE

To verify if there is an association between cardiometabolic risk factors and active daily commuting to school among children and adolescents.

METHODS

A total of 1,743 schoolchildren aged 7 to 17 years old were evaluated in the city of Santa Cruz do Sul (RS). The way of commuting to school was investigated with a questionnaire, and the cardiometabolic risk factors analyzed were body mass index (BMI), waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, blood glucose, triglycerides, total cholesterol (TC) and fractions, LDL and HDL.

RESULTS

The prevalence of active commuting among schoolchildren was 48.0% (95%CI 45.7-50.4), and it was associated, in the crude analysis, with blood glucose and LDL cholesterol levels. Passive schoolchildren had a 1.1 higher prevalence ratio of high glucose and LDL cholesterol levels. However, when sociodemographic variables were included in the model, these associations were not maintained.

CONCLUSIONS

The prevalence of active commuting in the sample studied is low and it was shown to have a crude association with glucose and LDL cholesterol levels in students. However, sociodemographic factors seem to influence these associations.

Psychosocial stress and C-reactive protein from mid-adolescence to young adulthood

OBJECTIVE

Cardiovascular disease (CVD) is one of the most prevalent chronic conditions and leading causes of death. Although CVD clinically manifests in adulthood, underlying processes of CVD begin in the earlier decades of life. Inflammation has been shown to play a key role, but relatively little is understood about how inflammation changes over time among young individuals. Additionally, how psychosocial factors like stress may influence changes in inflammation earlier in the lifespan is not entirely clear. Thus, the current three-wave longitudinal study examined the developmental trajectory of CRP, a marker of systemic inflammation, over a 4-year period from mid-adolescence into young adulthood. Between- and within-person differences in stress in relation to changes in CRP were also examined.

METHOD

A sample of 350 individuals was recruited during mid-adolescence and participated in 1 to 3 assessments, 2 years apart. At each assessment, participants provided dried blood spots for the assessment of CRP and reported on recent major life events, perceived stress, and daily interpersonal stress.

RESULTS

Multilevel modeling indicated that CRP increased with age, and within-person increases in perceived stress, but not life events or daily stress, were associated with higher CRP. Between-person differences in average levels of stress from mid-adolescence into young adulthood were not associated with changes in CRP.

CONCLUSION

These findings suggest that the link between stress and systemic inflammation between mid-adolescence and young adulthood may be most affected by contemporaneous experiences of perceived stress. There was little evidence to suggest that CRP trajectories varied by between-person differences in overall average levels of perceived stress, life events, and daily stress. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

[Association between excess weight and serum lipid alterations in adolescents]

The study estimated the prevalence of serum lipid alterations among adolescents and investigated its association with excess weight and abdominal obesity. It involved a cross-sectional study with 525 adolescents from Piracicaba (São Paulo state). Anthropometric (body mass index, waist circumference and waist-height ratio) and biochemical information were obtained (total cholesterol and fractions, triglycerides). The relationship between the anthropometric indicators and alterations in lipid profile was tested by logistic regression. The prevalence of dyslipidemia was in the order of 81%. An association was verified between high WHeR and serum lipid alterations in total cholesterol (OR = 2.00; CI 95% = 1.09-3.64) and triglycerides (OR = 4.48; CI 95% = 2.03-9.89) after adjustment for age and sex. No significant associations of alterations in lipid profile were found with excess weight and CC. The high prevalence of dyslipidemia and its association with abdominal obesity indicates that preventive measures should begin in childhood in order to reduce the occurrence of cardiovascular diseases.

High blood pressure screening in children and adolescents from Amargosa, Bahia: usefulness of anthropometric indices of obesity

OBJECTIVE

To determine the predictive power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), and their respective cut-off points for high blood pressure (BP) screening in Brazilian children and adolescents.

METHOD

Cross-sectional study conducted with 1,139 students aged 6 to 17years. Body weight, height, WC, and BP were measured. High BP was classified as systolic or diastolic ≥ 95th percentile. Receiver Operating Characteristic (ROC) curves were constructed, and the area under the curve, sensitivity, and specificity were calculated.

RESULTS

The prevalence of high BP was 27.0%. Anthropometric indices showed a significant association with high BP (accuracy ranging from 0.62 - 0.81), except for WHtR among male adolescents.Sensitivity was low, regardless of the anthropometric index, gender, and age group.

CONCLUSION

BMI, WC, and WHtR were associated with high BP, but the cut-off points tested showed low sensitivity. Determining specific cut-off points for each population can enable the use of anthropometric indices in high BP screening.

Exercise training in women with cardiovascular disease: Differential response and barriers - review and perspective

BACKGROUND

Exercise-based cardiac rehabilitation has a class 1A recommendation in coronary artery disease and heart failure based on its beneficial effects on mortality, morbidity and quality of life. However, the inter-individual response to exercise training is highly variable and influenced by both training and patient characteristics. Notably, men and women display a different training response, even when accounting for age, height and lean muscle mass. Most studies investigating exercise effects on various physiological outcomes focus on male patients. Because women are understudied, the scientific evidence for tailored exercise prescription in women is still limited.

METHODS

This narrative review summarises: (a) the underlying physiological determinants of the response to exercise training in women with cardiovascular disease, in which women rely more on fat than on carbohydrate oxidation during exercise, have lower aerobic capacities and smaller increases in cardiac function during exercise; (b) the benefits and barriers of exercise in women, in whom improving cardiometabolic risk and quality of life is weighed against socioeconomic and psychological needs; and (c) the relevance of different clinical endpoints in exercise trials such as maximum oxygen uptake, morbidity, mortality, training characteristics, quality of life and metabolic or vascular endpoints.

RESULTS

Finally, we provide a perspective on how to improve referral, enrolment and adherence to exercise training in women, with structured approaches to inform the referring physician as well as the patient, and offering more flexible, gender-tailored or tele/smartphone-based programmes while addressing the socioeconomic and psychological needs of the patients. This may ultimately improve the admission, adherence and outcome of exercise-based cardiac rehabilitation in women.

Cutoff points for continuous metabolic risk score in adolescents from southern Brazil

OBJECTIVE

There is no consensus on the best diagnostic criteria for metabolic syndrome (MetS) in the child and adolescent population. Thus, the present study aimed to establish cutoff points for a continuous metabolic risk score (cMetS) in adolescents from southern Brazil.

METHODS

This was a cross-sectional study conducted between 2014 and 2015. The sample consisted of 1739 schoolchildren (985 girls), aged 10-17 years. cMetS was calculated by sum of the Z-score of the following parameters: waist circumference, systolic blood pressure, glucose, high-density lipoprotein cholesterol, triglycerides, and cardiorespiratory fitness. Three diagnostic criteria of MetS were used to create cut points for cMetS.

RESULTS

The best cutoff point for cMetS was set at 3.40 for boys (sensitivity: 100.0%, specificity: 92.9%, AUC: 0.978) and 3.61 for girls (sensitivity: 100, 0%, specificity: 93.1%, AUC: 0.991). For these cutoff points, metabolic risk was found in 8.9% of adolescents (9.4% for boys and 8.5% for girls). A linear relationship was found between the mean values of cMetS and the number of components of MetS (mean cMetS -1.09 for no component present and 6.66 for 3 or more components).

CONCLUSIONS

The use of cMetS is valid for adolescents and can detect a greater proportion of students with metabolic risk, compared to the current criteria for diagnosis of MetS.

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

BACKGROUND

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

AIM

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

SUBJECTS AND METHODS

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

RESULTS

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

CONCLUSION

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

The role of the genetic variants IRX3 rs3751723 and FTO rs9939609 in the obesity phenotypes of children and adolescents

OBJECTIVE

We investigated the association of IRX3 SNP rs3751723 with anthropometric characteristics related to adiposity and potential relationships with FTO SNP rs9939609 in a population of Brazilian children and adolescents.

METHODS

A total of 871 children and adolescents between 7 and 17 years of age were recruited. Adiposity measurements and biochemical parameters were assessed. The variants were genotyped by real-time PCR. Analysis of multiple linear regression, multiple logistic regression, and generalised multifactor dimensionality reduction (GMDR) adjusted for sex, age and ethnicity were applied to test the polymorphisms association with obesity-related phenotypes and the interaction between them.

RESULTS

The analyses showed that IRX3 was associated with obesity and fat percentage (BF%). An association of FTO rs9939609 with body mass index (BMI) Z-Score and with waist circumference (WC) was detected. The odds ratios (OR) showed that IRX3 rs3751723 was associated with risk of obesity in additive model (p=0.017), recessive model (p=0.016) and with high BF% in all models. FTO rs9939609 was associated with risk of obesity in additive model (p=0.031), recessive (p=0.033) and with altered WC in all models. GMDR-based predictive models for the risk of obesity, altered WC and high BF% adjusted by age, ethnicity and sex suggested no interaction of the two loci.

CONCLUSIONS

The genetic variants rs3751723 and rs9939609 have an influence on the characteristics of adiposity; however, the effects of IRX3 and FTO investigated polymorphisms are independent in relation to adiposity parameters.

Low Diagnostic Accuracy of Body Mass Index-Based and Waist Circumference-Based References of Childhood Overweight and Obesity in Identifying Overfat among Chinese Children and Adolescents

This study aimed to investigate the diagnostic accuracy of body mass index- (BMI-) based and waist circumference- (WC-) based references for childhood overweight and obesity in screening overfat individuals among 2134 Chinese children and adolescents. In this study, overfat status was defined as over 25% body fat for boys and over 30% for girls. Childhood obesity or overweight was defined by four BMI-based references and two WC-based references. All BMI-based references for obesity showed low sensitivity (SE) (0.128–0.473) but high specificity (SP) (0.971–0.998) in detecting overfat individuals in the current population. SE values increased from 0.493 to 0.881 when BMI- and WC-based references for overweight were used to detect overfat individuals. All references for overweight showed high SP rates (0.816–0.966). To improve diagnostic accuracy for childhood obesity, further studies may define a cut-off value for childhood obesity specific for a local population and ethnicity by using health-related overfat data.

Obesity and Cardiometabolic Risk Factors in Children and Young Adults With Non-classical 21-Hydroxylase Deficiency

Introduction: Classical congenital adrenal hyperplasia is associated with an increased risk of obesity and cardiometabolic disease. The aim of the study was to determine if this is also true for non-classical congenital adrenal hyperplasia (NCCAH). Methods: A retrospective, cross-sectional, single-center study design was used. Data were collected on 114 patients (92 female) with NCCAH diagnosed during childhood/adolescence at a tertiary medical center. Patients were classified by treatment status at the last clinic visit. Outcome measures were assessed at diagnosis and the last clinic visit: weight status, body composition, blood pressure, lipid profile, and glucose metabolism. The prevalence of overweight/obesity was compared to the parental prevalence, and for patients aged 11-20 years, to the Israeli National Survey. Results: Mean age was 7.9 ± 4.2 years at diagnosis and 17.1 ± 6.9 years at the last follow-up. At the last clinic visit, 76 patients were under treatment with glucocorticoids, 27 were off-treatment (previously treated), and 11 had never been treated. The rate of obesity (11.4%) was similar to the parental rates, and the rate of overweight was significantly lower. In patients 11-20 years old, rates of obesity or obesity + overweight were similar to the general Israeli population (11.4 vs. 15.1%, P = 0.24 and 34.2 vs. 41.6% P = 0.18, respectively). No significant difference was found between glucocorticoid-treated and off-treatment patients in any of the metabolic or anthropometric parameters evaluated, except for a lower mean fat mass (% of body weight) in off-treatment patients (23.0 ± 7.7% vs. 27.8 ± 6.8%, P = 0.06). Systolic hypertension was found in 12.2% of NCCAH patients either treated or untreated. Conclusion: NCCAH diagnosed in childhood, whether treated or untreated, does not pose an increased risk of overweight, obesity, or metabolic derangements in adolescence and early adulthood.