Childhood overweight, obesity, and the metabolic syndrome in developing countries

Genetic variance in nitric oxide synthase and endothelin genes among children with and without endothelial dysfunction

Background

The presence of endothelial dysfunction (ED) constitutes an early risk factor for cardiovascular disease (CVD) in children. Nitric oxide (NO) and endothelin (EDN) are generated in endothelial cells and are critical regulators of vascular function, with ED resulting from an imbalance between these two molecules. We hypothesized that genetic variants in NO synthase and EDN isoforms and its receptors (EDNRA and EDNRB) may account for a proportion of the risk for ED in developing children.

Methods

Consecutive children (ages 5–10 years) were prospectively recruited from the community. Time to peak post-occlusive reperfusion (Tmax) was considered as the indicator of either normal endothelial function (NEF; Tmax < 45 sec) or ED (Tmax ≥ 45 sec). Lipid profiles, high sensitivity C-reactive protein (hsCRP), fasting glucose and insulin were assayed using ELISA. Genomic DNA from peripheral blood was extracted and genotyped for NOS1 (209 SNPs), NOS2 (122 SNPs), NOS3 (50 SNPs), EDN1 (43 SNPs), EDN2 (48 SNPs), EDN3 (14 SNPs), EDNRA (27 SNPs), and EDNRB (23 SNPs) using a custom SNPs array. Linkage disequilibrium was analyzed using Haploview version 4.2 software.

Results

The relative frequencies of SNPs were evaluated in 122 children, 84 with NEF and 38 with ED. The frequencies of NOS1 (11 SNPs), and EDN1 (2 SNPs) were differentially distributed between NEF vs. ED, and no significant differences emerged for all other genes. Significant SNPs for NOS1 and EDN1 SNPs were further validated with RT-PCR.

Conclusions

Genetic variants in the NOS1 and EDN1 genes appear to account for important components of the variance in endothelial function, particularly when concurrent risk factors such as obesity exist. Thus, analysis of genotype-phenotype interactions in children at risk for ED will be critical for more accurate formulation of categorical CVD risk estimates.

Risks of metabolic syndrome in students of the faculty of health sciences

BACKGROUND

Metabolic syndrome is highly prevalent in the adult population worldwide. Education may play an important role in preventing metabolic syndrome in young adults, especially those who are attending university. Such adults are at a critical point in their lives and make their own lifestyle choices that can affect their future health.

AIMS

The aims of this study were to determine the metabolic syndrome risk levels of students from the Faculty of Health Sciences.

STUDY DESIGN

Survey design study.

METHODS

In a questionnaire developed by the researchers to collect data in accordance with the relevant literature, the scale of the risk of metabolic syndrome was assessed. A stepwise logistic regression analysis was performed to determine the risks.

RESULTS

Important risk factors for metabolic syndrome were found to be gender, weight gain, "stress eating" excessive amounts of food, sleeping for more than 8 hours a day, feeling tired after sleep, belonging to a divided family, and eating whilst working on the computer.

CONCLUSION

The students from the Faculty of Health Sciences, particularly because they are trained in the health sector, are expected to have more information about the risk factors of metabolic syndrome, and take necessary precautions to prevent it.

Effects of ACE inhibitors on insulin resistance and lipid profile in children with metabolic syndrome

OBJECTIVE

The aim of this study was to evaluate the effects of using ACE inhibitors on insulin resistance, glucose metabolism, body fat composition, and lipid profile in children over 10 years of age with obesity-associated metabolic syndrome (MS).

METHODS

A total of 53 children with MS, who had been followed for at least one year were included in the study. The sample was divided into two groups: Group 1-30 obese children (13 female, 17 male) who were not using an ACE inhibitor and Group 2-23 obese children (13 female, 10 male) who were using an ACE inhibitor. Anthropometric and laboratory data obtained at baseline and at the 3rd, 6th, and 12th months of follow-up were compared in the two groups.

RESULTS

Comparison of the data in the two groups at 3rd, 6th, and 12th months revealed no statistically significant differences in terms of weight standard deviation score (SDS), body mass index SDS, weight for height percentile, body fat percentage, and very low-density lipoprotein (VLDL)values. However, there were statistically significant differences in mean glucose and insulin levels, homeostasis model assessment for insulin resistance, LDL and high-density lipoprotein values, and highly significant differences in mean triglyceride values.

CONCLUSIONS

The positive effects of ACE inhibitor drugs, particularly on hypertriglyceridemia and insulin resistance, might bring them forth as first-line drugs in the treatment of obese and hypertensive children. Randomized, controlled, double-blind, and long-term studies are needed for a definitive conclusion.

Prevalence and Associated Factors of Overweight and Obesity Among High School Adolescents in Urban Communities of Hawassa, Southern Ethiopia

Over the past few decades, the prevalence of overweight and obesity has significantly increased among adolescents of developed countries and becoming an emerging problem in countries undergoing socioeconomic transition. The adverse health outcomes resulting from overweight and obesity include short-term psychosocial problems and long-term non-psychological problems such as high blood pressure and type-2 diabetes. The objective of this study was to assess the prevalence and associated factors of overweight and obesity among high school adolescent in urban communities of Hawassa city. A cross-sectional study was conducted from February 20 to March 9/ 2012 among 559 secondary school students aged 10 to 19 years old in Hawassa city. A self-administered questionnaire was used to collect demographic, socio-economic, dietary and physical activity data. All anthropometric measurements of weight, height and TSFT were performed by using calibrated equipments and standardized techniques. The data was analyzed using SPSS for windows version 16 and WHO Anthro-Plus programs. Statistical tests for significance were performed at 5% level of significance. The results showed that the prevalence of overweight in the study participants was 12.9% and the prevalence of obesity was 2.7% based on age and sex specific BMI classification while based on TSFT, the prevalence of overweight and obesity was 11.0% and 3.8% respectively. Statistically significant agreement was observed between the tools (k= 0.841; p <0.001). The present study also found that there were a statistically significant association between sex, total physical activity, socio economic index, consumption frequency of meat, fruit, fast food and time spent watching TV/using computer with overweight and obesity prevalence (p<0.05). The present study revealed that more than one tenth of adolescents were overweight, making it a hidden problem of Hawassa city. The causes of overweight and obesity among adolescents aged 10-19 years in the study area may be many and complex but it might stem basically from the life style of adolescents. This information is useful for the planning of health and nutrition programs as well as intervention strategies to combat adolescent overweight and obesity.

Association of children's obesity with the quality of parental-child attachment and psychological variables

AIM

This study aimed to investigate the association of children's obesity with parental attachment and psychological variables as impulsivity, self-control and efficiency of eating control.

METHODS

This cross-sectional study was conducted among 202 obese students aged 9-13 years selected by multistage cluster sampling from different areas of Isfahan, Iran. Three questionnaires were considered to be answered by the students and one for their parents. The students completed the following questionnaires: (i) Inventory of Parent and Peer Attachment-Revised version for Children (IPPA-R); (ii) Impulsivity Scale (IS); (iii) Efficiency of Eating Control; and (iv) Self-control Rating Scale (SCRS).

RESULTS

The quality of children's attachment had direct effects on self-efficacy of eating management and on obesity by mediating of self-efficacy of eating. Moreover, attachment had direct effect on self-control and impulsivity, and in turn through these psychological variables, it had indirect effects on self-efficacy of eating management.

CONCLUSION

The findings of this study underscore the importance of parent-child attachment quality. It can be suggested that childhood obesity can be prevented and managed with creating a secure attachment bond between children and parents and increasing perceived self-efficacy eating management in children.

Clustering of cardiac risk factors associated with the metabolic syndrome and associations with psychosocial distress in a young Asian Indian population

The metabolic syndrome is a precursor for coronary heart disease. However, its pathophysiology is not clear, its phenotypic expression may vary by region; also, the phenotypic manifestation may be exacerbated by psychosocial distress and family history. The purpose of the current study was to assess the factor structure of the metabolic syndrome in young urban Asian Indians. Asian Indian youth (N = 112) were evaluated for body mass index (BMI), waist-hip ratio, blood pressure (systolic: SBP; diastolic: DBP), blood sugar, triglycerides, cholesterol, insulin, psychosocial distress and family health history. Factor analyses were computed on components of the metabolic syndrome. Three factors were identified for the entire sample: hemodynamic-obesity (SBP, DBP, waist-hip ratio), Lipid (cholesterol, triglyceride), and insulin-obesity (blood sugar, BMI, insulin). Similar to previous research with this population, three distinct factors with no overlap were identified. Factors did not correlate with psychosocial distress or family history. Lack of correlation with family history and psychosocial distress may be a function of the young age and demographics of the sample.

Association of blood cadmium level with cardiometabolic risk factors and liver enzymes in a nationally representative sample of adolescents: the CASPIAN-III study

Introduction. This study aimed to determine the association of blood cadmium level with cardiometabolic risk factors and liver enzymes in adolescents. Methods. This case control study comprised 320 Iranian adolescents, 160 with metabolic syndrome and an equal number of controls. They were selected from participants of a nationwide survey entitled the CASPIAN-III study. Cadmium was measured by atomic absorption method. Results. The mean age of the case and control groups was not significantly different (15.3 ± 2.6 versus 14.63 ± 2.5 years, resp., P > 0.05). The mean cadmium level was near double-fold higher than the standards of the World Health Organization, without significant difference between the MetS and control groups (10.09 ± 2.21, 9.97 ± 2.38 μg/L, resp., P > 0.05). Cadmium level had positive but nonsignificant correlations with diastolic blood pressure, serum triglycerides, fasting blood glucose, LDL-C, and liver enzymes. Conclusion. Cadmium level had positive but nonsignificant association with some cardiometabolic risk factors and liver enzymes. The associations did not reach statistical significant level, and this may be because of the high levels of cadmium in both groups studied or because of the young age group of participants. Controlling environmental pollutants shall be a priority for the prevention of chronic diseases.

Melatonin ameliorates low-grade inflammation and oxidative stress in young Zucker diabetic fatty rats

The aim of this study was to investigate the effects of melatonin on low-grade inflammation and oxidative stress in young male Zucker diabetic fatty (ZDF) rats, an experimental model of metabolic syndrome and type 2 diabetes mellitus (T2DM). ZDF rats (n = 30) and lean littermates (ZL) (n = 30) were used. At 6 wk of age, both lean and fatty animals were subdivided into three groups, each composed of 10 rats: naive (N), vehicle treated (V), and melatonin treated (M) (10 mg/kg/day) for 6 wk. Vehicle and melatonin were added to the drinking water. Pro-inflammatory state was evaluated by plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP). Also, oxidative stress was assessed by plasma lipid peroxidation (LPO), both basal and after Fe(2+)/H2O2 inducement. ZDF rats exhibited higher levels of IL-6 (112.4 ± 1.5 pg/mL), TNF-α (11.0 ± 0.1 pg/mL) and CRP (828 ± 16.0 µg/mL) compared with lean rats (IL-6, 89.9 ± 1.0, P < 0.01; TNF-α, 9.7 ± 0.4, P < 0.01; CRP, 508 ± 21.5, P < 0.001). Melatonin lowered IL-6 (10%, P < 0.05), TNF-α (10%, P < 0.05), and CRP (21%, P < 0.01). Basal and Fe(2+)/H2O2-induced LPO, expressed as malondialdehyde equivalents (µmol/L), were higher in ZDF rats (basal, 3.2 ± 0.1 versus 2.5 ± 0.1 in ZL, P < 0.01; Fe(2+)/H2O2-induced, 8.7 ± 0.2 versus 5.5 ± 0.3 in ZL; P < 0.001). Melatonin improved basal LPO (15%, P < 0.05) in ZDF rats, and Fe(2+)/H2O2- induced LPO in both ZL (15.2%, P < 0.01) and ZDF rats (39%, P < 0.001). These results demonstrated that oral melatonin administration ameliorates the pro-inflammatory state and oxidative stress, which underlie the development of insulin resistance and their consequences, metabolic syndrome, diabetes, and cardiovascular disease.

First report on body image and weight control in a nationally representative sample of a pediatric population in the Middle East and North Africa: the CASPIAN-III study

INTRODUCTION

This study explores the associations of weight perceptions with actual body mass index (BMI) and attempts to lose weight in a nationally representative sample of a pediatric population.

MATERIAL AND METHODS

Data were collected from school students of 27 provinces in Iran, as part of "the national survey of school student high risk behaviors". We used t-test for continuous data and chi square test for categorical data. The correlation between categorical variables was assessed by Cramer's phi test. A multiple nominal logistic regression model was fitted to data to assess the association between perceived body weight and gender by adjusting for potential confounding variables.

RESULTS

The study participants consisted of 5570 (2784 girls, 70% urban) students with mean age of 14.7 ±2.4 years. Overall, 17.3% of students were underweight, and 17.7% were overweight or obese. Nearly 25% and 50% of participants reported themselves as appropriate weight and very obese, respectively. In both genders, the strength of association between perceived weight and actual BMI was quite high (Cramer's phi coefficient = 0.5, p < 0.0001), and that of perceived body weight with trying to lose weight was moderate (Cramer's phi coefficient = 0.2, p < 0.0001). Overweight students were more likely than their obese peers to try to lose weight. After adjusting for possible confounders, the chance of perceiving oneself as very obese compared to perceiving oneself as very thin was 1.56-fold higher in girls than in boys, i.e. OR (95% CI): 1.56 (1.27-1.91).

CONCLUSIONS

This study revealed a considerably frequent "mismatch" between actual weight status and body shape dissatisfaction, which supports the necessity of increasing public awareness in this regard.

Vascular transcriptional alterations produced by juvenile obesity in Ossabaw swine

We adopted a transcriptome-wide microarray analysis approach to determine the extent to which vascular gene expression is altered as a result of juvenile obesity and identify obesity-responsive mRNAs. We examined transcriptional profiles in the left anterior descending coronary artery (LAD), perivascular fat adjacent to the LAD, and descending thoracic aorta between obese (n = 5) and lean (n = 6) juvenile Ossabaw pigs (age = 22 wk). Obesity was experimentally induced by feeding the animals a high-fat/high-fructose corn syrup/high-cholesterol diet for 16 wk. We found that expression of 189 vascular cell genes in the LAD and expression of 165 genes in the thoracic aorta were altered with juvenile obesity (false discovery rate ≤ 10%) with an overlap of only 28 genes between both arteries. Notably, a number of genes found to be markedly upregulated in the LAD of obese pigs are implicated in atherosclerosis, including ACP5, LYZ, CXCL14, APOE, PLA2G7, LGALS3, SPP1, ITGB2, CYBB, and P2RY12. Furthermore, pathway analysis revealed the induction of proinflammatory and pro-oxidant pathways with obesity primarily in the LAD. Gene expression in the LAD perivascular fat was minimally altered with juvenile obesity. Together, we provide new evidence that obesity produces artery-specific changes in pretranslational regulation with a clear upregulation of proatherogenic genes in the LAD. Our data may offer potential viable drug targets and mechanistic insights regarding the molecular precursors involved in the origins of overnutrition and obesity-associated vascular disease. In particular, our results suggest that the oxidized LDL/LOX-1/NF-κB signaling axis may be involved in the early initiation of a juvenile obesity-induced proatherogenic coronary artery phenotype.

Probiotics as a novel treatment for non-alcoholic Fatty liver disease; a systematic review on the current evidences

CONTEXT

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease, with 5-10% of liver having extra fat. Increase in its prevalence in all age groups is linked with obesity and Type II diabetes. The treatment of NAFLD remains controversial. A growing body of evidence suggests a relation between overgrowth of gut microbiota with NAFLD and non-alcoholic steatohepatitis (NASH). The objective of this review is to provide an overview on experimental and clinical studies assessing all positive and negative effects of probiotics.

EVIDENCE ACQUISITION

We made a critical appraisal on various types of documents published from 1999 to March 2012 in journals, electronic books, seminars, and symposium contexts including Medline, PubMed, and Cochrane Central Register of Controlled Trials databases. We used the key words: "non-alcoholic fatty liver disease, probiotics, non-alcoholic steatohepatitis, liver disease, and fatty liver".

RESULTS

Probiotics, as biological factors, control the gut microbiota and result in its progression. It is in this sense that they are suggestive of a new and a natural way of promoting liver function. Correspondingly, limited evidence suggests that probiotics could be considered as a new way of treatment for NAFLD.

CONCLUSIONS

Various experimental studies and clinical trials revealed promising effects of probiotics in improving NAFLD; however given the limited experience in this field, generalization of probiotics as treatment of NAFLD needs substantiation through more trials with a larger sample sizes and with longer-term follow up.

Assessing dementia in resource-poor regions

The numbers and proportions of elderly are increasing rapidly in developing countries, where prevalence of dementia is often high. Providing cost-effective services for dementia sufferers and their caregivers in these resource-poor regions poses numerous challenges; developing resources for diagnosis must be the first step. Capacity building for diagnosis involves training and education of healthcare providers, as well as the general public, development of infrastructure, and resolution of economic and ethical issues. Recent progress in some low-to-middle-income countries (LMICs) provides evidence that partnerships between wealthy and resource-poor countries, and between developing countries, can improve diagnostic capabilities. Without the involvement of the mental health community of developed countries in such capacity-building programs, dementia in the developing world is a disaster waiting to happen.

Increasing Fruit and Vegetable Consumption among Schoolchildren: Efforts in Middle-Income Countries

Background

To reverse the trend of rising child obesity rates in many middle-income countries, recommendations include increasing fruit and vegetable consumption. Schools can positively impact children's eating behavior, and multicomponent interventions that include the curriculum, school food environments, and parental involvement are most effective.

Objective

To find out how fruits and vegetables feature in the dietary guidelines provided to schools, what specific schemes are available for providing these foods, the extent to which nutrition education is included in the curriculum, and how vegetables and fruits are procured in primary schools.

Methods

In 2008, a survey questionnaire previously validated and revised was sent electronically to national program managers and focal points for school feeding programs in 58 middle-income countries. The rationale was to obtain information relevant to the entire country from these key informants. The survey response rate was 46%. The information provided by 22 respondents in 18 countries was included in the current study. On average, respondents answered 88% of the questions analyzed in this paper. Of the respondents, 73% worked for the national authority responsible for school food programs, with 45% at the program coordinator or director level.

Results

Few countries have any special fruit and vegetable schemes; implementation constraints include cost and lack of storage facilities. Although 11 of 18 countries have both nutrient-based guidelines and school food guidelines for meals, fruits and vegetables are often not adequately specified.

Conclusions

In some countries, nutrition education, special activities, school gardens, and parental participation are used to promote fruits and vegetables. Specific schemes are needed in some, together with school food guidelines that include fruits and vegetables.

Metabolic Syndrome and Cardiovascular Risk Factors in a National Sample of Adolescent Population in the Middle East and North Africa: The CASPIAN III Study

Objective. The present study was designed to investigate the prevalence of different combinations of the metabolic syndrome (MetS) risk factors among a nationally representative sample of adolescents in the Middle East and North Africa (MENA). Methods. The study sample, obtained as part of the third study of the school-based surveillance system entitled CASPIAN III, was representative of the Iranian adolescent population aged from 10 to 18 years. The prevalence of different components of MetS was studied and their discriminative value was assessed by receiver operating characteristic (ROC) curve analysis. Results. The study participants consisted of 5738 students (2875 girls) with mean age of 14.7 ± 2.4 years) living in 23 provinces in Iran; 17.4% of participants were underweight and 17.7% were overweight or obese. Based on the criteria of the International Diabetes Federation for the adolescent age group, 24.2% of participants had one risk factor, 8.0% had two, 2.1% had three, and 0.3% had all the four components of MetS. Low HDL-C was the most common component (43.2% among the overweight/obese versus 34.9% of the normal-weight participants), whereas high blood pressure was the least common component. The prevalence of MetS was 15.4% in the overweight/obese participants, the corresponding figure was 1.8% for the normal-weight students, and 2.5% in the whole population studied. Overweight/obese subjects had a 9.68 increased odds of (95% CI: 6.65-14.09) the MetS compared to their normal-weight counterparts. For all the three risk factors, AUC ranged between 0.84 and 0.88, 0.83 and 0.87, and 0.86 and 0.89 in waist circumference, abdominal obesity, and BMI for boys and between 0.78 and 0.97, 0.67 and 0.93, and 0.82 and 0.96 for girls, respectively. Conclusion. The findings from this study provide alarming evidence-based data on the considerable prevalence of obesity, MetS, and CVD risk factors in the adolescent age group. These results are confirmatory evidence for the necessity of primordial/primary prevention of noncommunicable disease should be considered as a health priority in communities facing a double burden of nutritional disorders.

Exploring the paradox: double burden of malnutrition in rural South Africa

BACKGROUND

This article is a review of the PhD thesis by Elizabeth Kimani-Murage that explores the double burden of malnutrition in rural South Africa. This is in the context of a worryingly rapid increase in obesity and obesity-related diseases in low- and middle-income countries (LMICs) including South Africa, and in the wake of on-going nutrition transition and lifestyle changes in these countries.

OBJECTIVE

To understand the profiles of malnutrition among children and adolescents in a poor, high HIV prevalent, transitional society in a middle-income country.

METHODS

A cross-sectional growth survey was conducted in 2007 targeting 4,000 children and adolescents aged 1-20 years. In addition, HIV testing was carried out on children aged 1-5 years and Tanner pubertal assessment among adolescents aged 9-20 years.

RESULTS

The study shows stunting at an early age and adolescent obesity, particularly among girls, that co-exists in the same socio-geographic population. The study also shows that HIV is an independent modifiable risk factor for poor nutritional outcomes in children and makes a significant contribution to nutritional outcomes at the individual level. Significant predictors of undernutrition at an early age, documented at individual, household, and community levels, include child's HIV status, age and birth weight, maternal age, age of household head, and area of residence. Significant predictors of overweight/obesity and risk for metabolic disease during adolescence, documented at individual and household levels include child's age, sex, and pubertal development, household-level food security, socio-economic status, and household head's highest education level.

CONCLUSIONS

The combination of early stunting and adolescent obesity raises critical concerns in the wake of the rising public health importance of metabolic diseases in LMICs. This is because, both paediatric obesity and adult short stature are risk factors for metabolic syndrome and metabolic diseases in adulthood. Clearly, policies and interventions to address malnutrition in this and other transitional societies need to be double-pronged and gender-sensitive.

Eating behaviors and overweight among adolescents: a population-based survey in Japan

OBJECTIVES

The aim of the present study was to investigate the relationship between eating behaviors and overweight among population-based adolescents in Japan.

METHODS

Study subjects comprised adolescents in the seventh grade (age range, 12-13 years) from Ina, a town in Saitama Prefecture, Japan, between 1999 and 2008. The height and weight of the subjects were measured, and information concerning eating behaviors (eating speed and eating until full) was obtained using a self-administered questionnaire.

RESULTS

Among boys (n = 1586), fast eating speed significantly increased the odds ratio (OR) for overweight when compared with medium eating speed, regardless of eating until full or not; moreover, a more marked increase in the OR was observed among boys eating until full (OR: 2.78, 95% confidence interval: 1.76-4.38) than among those not eating until full (2.43, 1.41-4.20). Among girls (n = 1542), fast eating speed led to a significant increase in the OR in those eating until full; however, no significant increases were observed in the OR in those eating quickly and not until full.

CONCLUSIONS

Among adolescents, fast eating speed was associated with overweight; furthermore, the combination of both fast eating speed and eating until full may have a significant effect on overweight.

A proposed cutoff point of waist-to-height ratio for metabolic risk in African township adolescents

OBJECTIVE

A waist:height ratio (WHtR) higher than 0.5 has been proposed as a cutoff point for abdominal obesity in both sexes and at all ages. It is unknown if this cutoff point is appropriate for previously undernourished adolescents. We assessed the cutoff value of the WHtR associated with an increased metabolic risk in 178 black South African 14- to 18-y-old adolescents (69 boys, 109 girls).

METHODS

We measured weight, height, waist circumference, fasting plasma glucose and insulin levels, serum high-sensitivity C-reactive protein, and blood pressure and calculated the WHtR and homeostasis model assessment of insulin resistance (HOMA-IR). Using receiver operating characteristics curve analyses, we assessed the WHtR with the highest sensitivity and specificity to discriminate adolescents with increased fasting plasma glucose, HOMA-IR, serum high-sensitivity C-reactive protein, and blood pressure from those with "normal" values.

RESULTS

The WHtR cutoff points derived from the receiver operating characteristics curves ranged from 0.40 to 0.41, with best diagnostic value at 0.41. A WHtR of 0.40 had 80% sensitivity and 38.5% specificity to classify adolescents with fasting blood glucose level higher than 5.6 mmol/L (area under the curve [AUC] 0.57). A WHtR of 0.41 had 64% sensitivity and 58.5% specificity for a HOMA-IR higher than 3.4 (AUC 0.66), 55% sensitivity and 55.6% specificity for a high-sensitivity C-reactive protein level higher than 1 mg/L (AUC 0.57), and 64% sensitivity and 50.2% specificity for a blood pressure higher than the age-, sex-, and height-specific 90th percentiles (AUC 0.56). Adolescents with a WHtR higher than 0.41 had an odds ratio of 2.46 (95% confidence interval 0.96-6.30) for having a HOMA-IR higher than 3.4.

CONCLUSION

The WHtR cutoff to indicate metabolic risk for black South African adolescents is 0.41, which is lower than the proposed international cutoff of 0.5. The WHtR can be used for screening adolescents with components of the metabolic syndrome in intervention programs.

Prevalences of overweight and obesity and their association with physical activity pattern among Iranian adolescents aged 12-17 years

OBJECTIVE

The objective of the present study was to investigate the prevalences of overweight and obesity and their association with physical activity pattern among adolescents in northern Iran.

DESIGN

A cross-sectional study.

SETTING

Babol, northern Iran.

SUBJECTS

A representative sample of 1200 adolescents aged 12-17 years was recruited. All selected adolescents were interviewed, their leisure-time and sport physical activities were collected by a standard Baecke questionnaire and their height and weight were measured by standard methods. The diagnosis of overweight and obesity was determined by comparing BMI values with the BMI index for age and sex percentiles set by the US Centers for Disease Control and Prevention in 2000.

RESULTS

The prevalences of overweight and obesity were 15.1 % and 8.3 %, respectively. The proportion of obesity was significantly higher in boys than in girls (10.2 % v. 6.5 %, P = 0.028). Overall, the levels of high, moderate and low leisure-time physical activity were 2.9 %, 79.4 % and 17.7 %, respectively. The corresponding levels of high, moderate and low sport physical activity were 17.4 %, 75.2 % and 7.4 %. The levels of leisure-time and sport physical activities were significantly higher among the boys than the girls (P < 0.001). There was also a significant association of studying in private schools and playing computer games with overweight/obesity (P < 0.001). Moderate leisure-time physical activity was unexpectedly associated with a greater risk of overweight/obesity compared with the low level (P = 0.002).

CONCLUSIONS

The findings indicate a high prevalence of overweight/obesity in these Iranian adolescents, particularly the boys. The influence of physical activity and diet on overweight/obesity requires further prospective studies.

First National Report on Aminotransaminases' Percentiles in Children of the Middle East and North Africa (MENA): the CASPIAN-III Study

BACKGROUND

By the current global obesogenic environment, non-alcoholic fatty liver disease is becoming an important health problem in the pediatric age group.

OBJECTIVES

This study aimed to determine the first age-and gender-specific percentiles and upper limit normal limit (ULN) of alanine aminotransaminase (ALT) and aspartate aminotransaminase (AST) among a nationally-representative sample of children and adolescents in the Middle East and North Africa (MENA). The second objective was to determine the linear association of obesity indexes and age with serum ALT and AST levels.

PATIENTS AND METHODS

This nationwide study was conducted among a representative sample of 4078 students aged 10-18 years, who were selected by multistage random cluster sampling from 27 provinces of Iran. ALT and AST were measured on fresh sera. Body mass index (BMI) was calculated as an index of generalized obesity, and waist- to- height ratio (WHtR) as an index of abdominal obesity. The age- and gender-specific percentiles of ALT and AST were constructed, and the 95th percentile of each enzyme was considered as the ULN. Gender-specific linear regression analysis was employed to examine the association of BMI or WHtR with the levels of ALT and AST.

RESULTS

Data of ALT and AST were available for 4078 (2038 girls) and 4150 (2061 girls),respectively. Participants had a mean (SD) age of 14.71 (2.41).The ULN of ALT for boys, girls,and the total individuals were 36.00; 38.00; and, 37.00 U/L, respectively. In both genders, ALT and AST had linear association with age. The association with BMI was significant for ALT in both genders and for AST only in boys, the association of ALT with WHtR was significant in both genders; the corresponding figures were not significant for AST.

CONCLUSIONS

The findings of the current study confirmed the current ULN value of 40 U/L commonly used for the pediatric age group. The linear association of indexes for generalized and abdominal obesity with ALT underscores the importance of timely prevention and control of childhood obesity.

Child patterns of growth delay and cognitive development in a Bolivian mining city

OBJECTIVES

This study aims to (1) follow up and characterize infant growth patterns during the first year of life in Bolivia, and (2) determine whether there exists an association between weight gain and cognitive development in children living near contaminated mining industries.

METHODS

Data on 175 children participating to the ToxBol (Toxicity in Bolivia) birth cohort were analyzed. Rapid-growth during the first 6 months was defined as a change in weight z-score > 0.67 while slow-growth was defined as a weight z-score change of < -0.67. Neurodevelopment was evaluated using the Bayley Scales of Infant Development at 10.5-12.5 months of age. Mixed models were used to examine the association between cognitive development and weight gain.

RESULTS

Rapid growers weighed less at birth (P < 0.01). However, they revealed a higher body mass index at 12 months of age (0.70 ± 0.73, P < 0.01). After adjustment for confounding, rapid growth was not associated with cognitive development (coef = 0.49, 95% confidence interval = -4.10, 5.08).

CONCLUSIONS

In this Bolivian cohort, children born smaller were more likely to grow/develop faster and attain greater weight and length. Their cognitive development was not affected by their growth patterns.

Effect of substituting saturated with monounsaturated fatty acids on serum visfatin levels and insulin resistance in overweight women: a randomized cross-over clinical trial

OBJECTIVE

This study aimed to determine the effects of a monounsaturated fatty acids (MUFA)-rich diet on serum visfatin, interleukin-6 and insulin levels among overweight women.

DESIGN

In this randomized cross-over clinical trial, 17 premenopausal overweight women were included. Participants were randomly assigned to consume either a hypocaloric, saturated fatty acids (SFA)-rich diet (16% SFA and 8% MUFA) or a hypocaloric, MUFA-rich diet (16% MUFA and 8% SFA) for 12 weeks crossing over after a 2-week washout period. Percentages of energy from other macronutrients were similar between the two diets. Biochemical and anthropometric assessments were done at the first and at the end of each period. Statistical analyses were done using paired t-test. In all statistical analysis, p < 0.05 was considered as significant.

RESULTS

The participant's mean body mass index was 27.6 kg/m². Mean percentages of MUFA intake were 13% during MUFA-rich diet and 7% during SFA-rich diet. The corresponding values for SFA intake were 8.5% and 14%, respectively. We failed to find any significant differences between two intervention diets in terms of their effect on the serum levels of IL-6, visfatin and insulin. However, serum visfatin and IL-6 levels increased during the SFA-rich diet (0.4 ± 0.4 ng/ml and 0.19 ± 0.3 pg/ml, respectively) and decreased during the MUFA-rich diet (-0.7 ± 0.5 ng/ml and -0.17 ± 0.3 pg/ml, respectively). In spite of a slight reduction in both periods, changes in serum insulin levels did not reach significant levels comparing the two periods.

CONCLUSIONS

Our findings did not support any significant effect of a MUFA-rich intake on serum IL-6 and insulin levels as compared with a SFA-rich diet; however, it has the potential to favourably affect serum visfatin levels.

Asthma in late adolescents of Western Mexico: prevalence and associated factors

INTRODUCTION

Given the number of changes that occur during late adolescence, it is possible that the behavior of asthma may also be different. The aim of our paper is to determine the prevalence of asthma in a population of late adolescents and its possible association with obesity, tobacco smoke exposure and family history of allergic disease.

METHODS AND SUBJECTS

In a cross-sectional, population-based analytical study design, we selected a stratified random sample of subjects aged 15 to 18. By modeling risk through logistic regression, we assessed the relationship between asthma and the following covariables: gender, obesity, excess weight, family history of allergic disease and tobacco smoke exposure.

RESULTS

1,600 subjects were included, and the following prevalences were identified: asthma 7.8%, obesity 9.6%, active smoking in the father 2 9.8%, active smoking in the mother 18.6% and active smoking habit in the study subjects 15.1%. In the final model, a significant association was found between asthma and the following variables: 1) asthma in the mother (adjusted OR [aOR]=2.95, 95% CI, 1.55 to 5.6); 2) history of allergic rhinitis (aOR=4.66, 95% CI, 2.63 to 8.25); and 3) male sex (aOR=1.48, 95% CI, 1.02 to 2.15). No association was seen with obesity or tobacco smoking of the parents.

CONCLUSION

Our results suggest that maternal history of asthma, personal history of allergic rhinitis and male sex are related with asthma late adolescence, while smoking and being overweight are not.

Feeding and growth of normal birth weight infants during the first year of life in Shanghai

AIM

This study aimed to explore the relationship between infant feeding practices and growth outcomes in the first 12 months of life.

DESIGN

Investigators completed 262 questionnaires, which included infant feeding patterns, feeding environment, feeding beliefs/attitudes and caregivers' feeding behaviors through on-site face-to-face interviews with the main caregivers of infants at 12 months of age. The infant's weight and length at ages 6 and 12 months were measured.

SETTING

The study was conducted in urban Shanghai, China.

SUBJECTS

This study included 262 healthy normal birth weight full-term singleton 6-month-old infants and their main caregivers.

RESULTS

Among 262 infants, 86 (32.82%) infants were overweight [BMI-for-age z scores (BAZ)>+1] at 12 months. Compared with normal weight infants, the overweight infants had higher birth weights (P=0.009). Furthermore, the overweight infants gained significantly more weight (P<0.001) in the first year of life. In normal weight infants, caregivers worried more about infants being "underweight" and "eating less" (P<0.001) whereas caregivers with overweight infants worried more about infants being "overweight" (P<0.001). Consequently, the total score of caregivers' over-feeding behaviors was significantly higher in normal weight infants (P=0.029). However, in overweight infants, the scores of "fed quickly within 10 min" (r=0.223, P=0.039) and "feeding was the best way to stop the infant's fussiness" (r=0.285, P=0.008) were positively correlated with BAZ.

CONCLUSIONS

Overweight in early life is associated with carelessness about excessive appetite and some particular infant feeding behaviors of caregivers in Shanghai.

Prevalence of overweight and obesity in preschool children (2-5 year-olds) in Birjand, Iran

BACKGROUND

Childhood overweight and obesity have increased progressively in developing countries and nowadays they are considered as a global epidemic.The aim of the present study was to determine prevalence of overweight and obesity in 2-5 year-old children in kindergartens of Birjand in 2008.

FINDINGS

This cross- sectional and descriptive- analytical study was conducted on 500 children, who were 2-5 years-old, in kindergartens of Birjand selected through census. It was found that prevalence of overweight was 10.6% (11.7% in females and 9.6% in males) and obesity 7.6% (6.3% in females and 9.6% in males). Prevalence of overweight and obesity were statistically significant regarding birth weight, mother's occupation and father's level of education.

CONCLUSION

Prevalence of overweight and obesity in pre-schoolchildren is more than that of 7-18 year-old group in Birjand, but it is less than the result of similar studies in Tehran and most studies in other countries. Further studies are recommended to identify risk factors in obese children. Periodic studies are necessary to compare the changes in prevalence of obesity in children in future.

Nutritional status and risk factors of overweight and obesity for children aged 9-15 years in Chengdu, Southwest China

Background

Obesity is widespread in the world including developing countries. However malnutrition in poor areas is still a serious problem. Few investigations, especially in a large sample, have been performed in Western area of China. This study aimed to evaluate the nutritional status of school children aged 9–15 years in large Southwest city of China, and identify the differential impact of aberrant birth categories and family history of obesity related disease on childhood overweight and obesity development.

Methods

A multistage random cluster sampling was performed to evaluate the prevalence of thinness, overweight and obesity, which were defined by the new age-, sex-, specific BMI reference developed by World Health Organization (WHO) (2007). And then a frequency matched case–control study was performed to identify the risk factors of overweight and obesity.

Results

7,194 children (3,494 boys, 3,700 girls) were recruited, and 1,282 (17.8%) had excess bodyweight (14.5% overweight, 3.3% obesity). The combined prevalence gradually decreased with age, and were more prevalent among boys than girls (P <0.05). Meanwhile 6.3% were found thinness and there were little differences in genders (P >0.05). Preterm large for gestational age (OR = 2.746), maternal history of obesity related disease (OR = 1.713), paternal history of obesity related disease (OR = 1.583), preterm appropriate for gestational age (OR = 1.564), full term small for gestational age (OR = 1.454) and full term large for gestational age (OR = 1.418) were recognized as significant risk factors in the multivariate regression analysis (P <0.05).

Conclusions

While overweight and obesity was dramatically spreading, malnutrition still remained a serious problem. This unmatched nutritional status should be emphasized in backward cities of China. Children born of both preterm and LGA, whose parents particularly mothers had a history of obesity related disease, should be emphatically intervened as early as possible.

Metabolic risk factors, leisure time physical activity, and nutrition in german children and adolescents

Purpose. We assessed the five components of the metabolic syndrome (MetS) as defined by the International Diabetes Federation (IDF) in 6040 (3158 males) youths aged 6–16 years who participated in the Präventions-Erziehungs-Programm (PEP Family Heart Study) in Nuernberg between 2000 and 2007. The purpose of this cross-sectional study was to examine associations with lifestyle habits. Results and Discussion. The prevalence of MetS was low in children (1.6%) and adolescents (2.3%). High waist circumference (WC) and low HDL-C were slightly higher in females (9.5% and 7.5%, resp.) than in males (8.8% and 5.7%, resp.). Low leisure time physical activity (LTPA) was significantly associated with low HDL-C (odds ratio [OR] 2.4; 95% CI 1.2–5.0) and inversely associated with hypertension (r = −0.146), hypertriglyceridemia (r = −0.141), and central adiposity (r = −0.258). The risk for low HDL-C (≤1.3 mmol/L) was 1.7-fold (CI 1.0–2.6) higher in youth with high (≥33%) saturated fat consumption. A low polyunsaturated/saturated fat ratio (P/S ratio) was significantly associated with fasting hyperglycemia (OR 1.4; 95% CI 1.0–1.2).

Trends of Components of the Metabolic Syndrome in German First Graders Throughout 10 Years: The PEP Family Heart Study

Although childhood overweight and obesity are increasing worldwide, some countries report trends for stabilization. However, the trend for the potentially atherogenic components of the metabolic syndrome (MetS) in children and adolescents is not well understood. Therefore, the purpose of this study was to analyze the trend of the five components of over 10 years in 2228 first graders aged 6 years. Waist circumference (WC) remained mainly unchanged between 1994 and 2003 whereas the other four components continuously decreased. In boys and girls mean values of triglycerides (-25.9% and -28.6%, resp.), HDL cholesterol (-19.8% and -23.4%, resp.), fasting glucose (-7.3% and -9%, resp.), systolic (-3.8% and -4.1%, resp.), and diastolic (-10.2% and -9.7%, resp.) blood pressure significantly decreased. Whereas the prevalence of abdominal adiposity was stable at baseline and after 10 years (-1% in boys and +2% in girls), the prevalence of hypertension, hypertriglyceridemia, low HDL-C, and glucose was very low without any trend.

Effect of women's nutrition before and during early pregnancy on maternal and infant outcomes: a systematic review

Current understanding of biologic processes indicates that women's nutritional status before and during early pregnancy may play an important role in determining early developmental processes and ensuring successful pregnancy outcomes. We conducted a systematic review of the evidence for the impact of maternal nutrition before and during early pregnancy (<12 weeks gestation) on maternal, neonatal and child health outcomes and included 45 articles (nine intervention trials and 32 observational studies) that were identified through PubMed and EMBASE database searches and examining review articles. Intervention trials and observational studies show that periconceptional (<12 weeks gestation) folic acid supplementation significantly reduced the risk of neural tube defects. Observational studies suggest that preconceptional and periconceptional intake of vitamin and mineral supplements is associated with a reduced risk of delivering offspring who are low birthweight and/or small-for-gestational age (SGA) and preterm deliveries (PTD). Some studies report that indicators of maternal prepregnancy size, low stature, underweight and overweight are associated with increased risks of PTD and SGA. The available data indicate the importance of women's nutrition prior to and during the first trimester of pregnancy, but there is a need for well-designed prospective studies and controlled trials in developing country settings that examine relationships with low birthweight, SGA, PTD, stillbirth and maternal and neonatal mortality. The knowledge gaps that need to be addressed include the evaluation of periconceptional interventions such as food supplements, multivitamin-mineral supplements and/or specific micronutrients (iron, zinc, iodine, vitamin B-6 and B-12) as well as the relationship between measures of prepregnancy body size and composition and maternal, neonatal and child health outcomes.

Comparisons between inverted body mass index and body mass index as proxies for body fatness and risk factors for metabolic risk and cardiorespiratory fitness in Portuguese adolescents

OBJECTIVES

To compare inverted body mass index (iBMI, cm(2) /kg) and body mass index (BMI, kg/m(2) ) as predictors of body fatness, metabolic risk, and cardiovascular fitness in adolescents.

METHODS

A cross-sectional school-based study was conducted on 445 Portuguese adolescents (252 girls and 193 boys) aged 10-17 years. Height and body mass were assessed to determine iBMI and BMI, percent body fatness was determined from skinfold measures (tricep, subscapular) using the Slaughter et al. (1988: Hum Biol 60: 709-723) regression equation and cardiorespiratory fitness (CRF) was assessed using the 20-m shuttle run test. Capillary blood sampling was used to determine: Total cholesterol, triglycerides, high, and low density lipoprotein. These were combined with measures of systolic blood pressure and waist circumference as z-scores. Metabolic risk (MRS) was constructed by summing the z-scores.

RESULTS

iBMI and BMI were both significantly related to percent body fatness, CRF and MRS (all P = 0.005 or better). BMI was not normally distributed (P = 0.0001), whereas iBMI was (P > 0.05). Regression analysis identified that iBMI and BMI, both alongside for age, were significant predictors of percent body fatness, CRF and MRS (all P = 0.005 or better). Compared with BMI, iBMI was a similar predictor of CRF, MRS and body fatness.

CONCLUSIONS

iBMI offers a biologically sound alternative to BMI to assess the effect of weight status on MRS and CRF in adolescents and allows appropriate use of parametrical statistical techniques without changing the conclusions drawn from such data.

Distribution and association of hs-CRP with cardiovascular risk variables of metabolic syndrome in adolescent learners

OBJECTIVE

Metabolic syndrome (MetS) and its associated cardiovascular risk are on the increase in children. High-sensitivity C-reactive protein (hs-CRP) has emerged as a useful marker for inflammation associated with atherosclerosis and cardiovascular disease. Our aim was to determine the distribution of hs-CRP in an effort to identify the MetS variable that is critical in modulating plasma CRP levels in a population of South African adolescents.

DESIGN

A cross-sectional analytical study design was used for this investigation, where the dependent and independent variables were measured simultaneously.

METHODS

Anthropometric variables, blood pressure, fasting blood glucose and lipids were performed on 324 consenting learners aged 15-18 years from three different ethnic groups (Black, White and Coloured). The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) for ages 15-18 year olds was used to define MetS.

RESULTS

The prevalence of MetS and obesity was 3.7% and 7.1%, respectively. The hs-CRP levels were significantly higher in subjects with a waist-circumference greater than the 90th percentile (p < 0.01) and in obese learners with MetS, but was lower in adolescents with normal weight and MetS. Median hs-CRP levels increased with an increasing number of metabolic abnormalities and exceeded 3 mg/L in 19% of adolescents. Gender and ethnic differences were observed.

CONCLUSION

Our findings suggest that obesity and waist circumference appear to be major mediators of hs-CRP levels in South African adolescents.

Obesity is associated with insulin resistance and components of the metabolic syndrome in Lebanese adolescents

Background

Prevalence of metabolic syndrome (MS) in obese adolescents has been reported to range between 18–42%, depending on country of origin, thus suggesting an ethnic-based association between obesity and MS.

Aim

This study aims to investigate the magnitude of the association between obesity, insulin resistance and components of MS among adolescents in Lebanon.

Subjects and methods

The sample included 263 adolescents at 4^th and 5^th Tanner stages of puberty (104 obese; 78 overweight; 81 normal weight). Anthropometric, biochemical and blood pressure measurements were performed. Body fat was assessed using dual-energy X-ray absorptiometry.

Results

According to International Diabetes Federation criteria, MS was identified in 21.2% of obese, 3.8% of overweight and 1.2% of normal weight subjects. The most common metabolic abnormalities among subjects having MS were elevated waist circumference (96.2%), low HDL (96.2%) and hypertriglyceridemia (73.1%). Insulin resistance was identified in all subjects having MS. Regression analyses showed that percentage body fat, waist circumference and BMI were similar in their ability to predict the MS in this age group.

Conclusions

MS was identified in a substantial proportion of Lebanese obese adolescents, thus highlighting the importance of early screening for obesity-associated metabolic abnormalities and of developing successful multi-component interventions addressing adolescent obesity.

Long working hours and metabolic syndrome among Japanese men: a cross-sectional study

Background

The link between long working hours and health has been extensively studied for decades. Despite global concern regarding metabolic syndrome, however, no studies to date have solely evaluated the relationship between long working hours and that syndrome. We therefore examined the association between long working hours and metabolic syndrome in a cross-sectional study.

Methods

Between May and October 2009, we collected data from annual health checkups and questionnaires from employees at a manufacturing company in Shizuoka, Japan. Questionnaires were returned by 1,601 workers (response rate: 96.2%; 1,314 men, 287 women). After exclusions, including women because of a lack of overtime work, the analysis was performed for 933 men. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for metabolic syndrome. Further, we conducted a stratified analysis by age-group (<40 years vs. ≥40 years).

Results

Metabolic syndrome was identified in 110 workers (11.8%). We observed a positive association between working hours and metabolic syndrome after adjusting for age, occupation, shift work, smoking status, frequency of alcohol consumption, and cohabiting status. Compared with subjects who worked 7–8 h/day, multivariate ORs for metabolic syndrome were 1.66 (95% CI, 0.91–3.01), 1.48 (95% CI, 0.75–2.90), and 2.32 (95% CI, 1.04–5.16) for those working 8–9 h/day, 9–10 h/day, and >10 h/day, respectively. Similar patterns were obtained when we excluded shift workers from the analysis. In age-stratified analysis, the corresponding ORs among workers aged ≥40 years were 2.02 (95% CI, 1.04–3.90), 1.21 (95% CI, 0.53–2.77), and 3.14 (95% CI, 1.24–7.95). In contrast, no clear association was found among workers aged <40 years.

Conclusions

The present study suggests that 10 h/day may be a trigger level of working hours for increased risk of metabolic syndrome among Japanese male workers.

Prevention of death and disability from injuries to children and adolescents

One million children and adolescents die each year from injuries and many-fold more suffer long-term disability. While there have been substantial reductions in injury mortality over the last 50 years, further decreases in morbidity and mortality will require consideration of additional factors. This article discusses five different components to further reduce the injury burden: consideration of the epidemiologic transition occurring in both high-income as well as low- and middle-income countries; expanding the concept of injury prevention to that of injury control, with substantial emphasis on acute care and rehabilitation of the injured child; inclusion of adolescents in paediatric injury control; improving the quality of research conducted; and changing the way priorities are determined in the injury field.

Economic impact of childhood obesity on health systems: a systematic review

The primary purpose of this study is to analyse the costs related to childhood obesity (CO) with reference to different models of healthcare systems. A systematic review of the economic impact of CO on healthcare systems was conducted by searching the main electronic scientific databases. Cost-of-illness (COI) analyses of children aged under 18 years who had been diagnosed as overweight or obese published up to July 2010 were considered. Short- and long-term consequences of CO were taken into account. In order to appraise the quality of the included studies, the British Medical Journal referees' checklist was used. About 3,844 COI analyses were initially found and 10 were finally considered in the current review: two studies referred to Beveridge and eight referred to Voluntary health insurance models. No studies have been conducted within a Bismarck model. Six studies considered in-patient costs, four studies estimated outpatient and primary care costs and seven studies considered pharmaceutical costs. The average quality of the included analyses was medium. The analysis confirmed the significance of CO related costs and the heterogeneity among available studies, which made it impossible to compare the different healthcare models.

Is there an association between socioeconomic status and body mass index among adolescents in Mauritius?

There are no documented studies on socioeconomic status (SES) and body mass index (BMI) among Mauritian adolescents. This study aimed to determine the relationships between SES and BMI among adolescents with focus on diet quality and physical activity (PA) as mediating factors. Mauritian school adolescents (n = 200; 96 males, 104 females) were recruited using multistage sampling. Participants completed a self-reported questionnaire. Height and weight were measured and used to calculate BMI (categorised into underweight, healthy-weight, overweight, obese). Chi-square test, Pearson correlation, and Independent samples t-test were used for statistical analysis. A negative association was found between SES and BMI (χ(2) = 8.15%, P < 0.05). Diet quality, time spent in PA at school (P = 0.000), but not total PA (P = 0.562), were significantly associated with high SES. Poor diet quality and less time spent in PA at school could explain BMI discrepancies between SES groups.

Eating behavior and childhood overweight among population-based elementary schoolchildren in Japan

This study investigated the relationship between eating behavior and childhood overweight among population-based elementary schoolchildren in Japan. Data was collected from fourth graders (9 or 10 years of age) from Ina Town, Saitama Prefecture, Japan from 1999 to 2009. Information about subjects' sex, age, and lifestyle, including eating behaviors (eating until full and chewing thoroughly), was obtained using a self-administered questionnaire, and height and weight were measured directly. Overweight was determined according to the definition established by the International Obesity Task Force. Data from 4027 subjects (2079 boys and 1948 girls) were analyzed. Chewing thoroughly was associated with a significantly decreased odds ratio (OR) for being overweight, whereas eating until full significantly increased the OR for being overweight (OR: 1.50, 95% confidence interval: 1.16-1.94) among boys. However, eating until full was not associated with a significantly increased OR for being overweight among the group that reported chewing thoroughly, whereas it was associated with a significantly increased OR for being overweight (2.02, 1.38-2.94) among boys who did not chew thoroughly. In conclusion, eating until full or not chewing thoroughly was associated with being overweight among elementary schoolchildren. Results of this study suggest that chewing thoroughly may be an avenue to explore childhood overweight prevention efforts.

Mother-Daughter Correlation of Central Obesity and Other Noncommunicable Disease Risk Factors

This study aimed to investigate the mother-daughter correlation for central obesity and other noncommunicable disease risk factors. The authors used metabolic and anthropometric data from the Tehran Lipid and Glucose Study, enrolling 1041 mother-daughter pairs for the current study. Three age strata were defined: 3 to 9 years for childhood (146 mother-daughter pairs), 10 to 17 years for adolescence (395 mother-daughter pairs), and 18 to 25 years for early adulthood (500 mother-daughter pairs). Familial associations for central obesity and other noncommunicable disease risk factors were assessed. The prevalence of central obesity was 44.7% in mothers and 11.2% in daughters (6.2% in the 3-9, 19.2% in the 10-17, and 6.4% in the 18-25 years groups). Mothers with central obesity were more likely than nonobese mothers to have daughters with central obesity (10.5% and 1.7%, respectively; P = .0001). Central obesity indices among daughters were positively correlated with those of their mothers in all 3 age strata. Correlations for other noncommunicable disease risk factors were analyzed before and after adjusting the risk factor levels for mothers’ and daughters’ waist circumferences (WCs) within each group to determine whether risk factor correlations were, in part, a result of the central obesity correlations. After the non-communicable disease risk factor levels of participants were adjusted for their WCs, the mother-daughter correlations remained significant. The consistent association of central obesity between mothers and daughters may indicate the key role that could be played by the mother in the primary prevention of central obesity, particularly in high-risk families.

Can a trial of motivational lifestyle counseling be effective for controlling childhood obesity and the associated cardiometabolic risk factors?

OBJECTIVES

This study was conducted to assess the effectiveness of a simple office-based program for encouraging healthy lifestyle on controlling childhood obesity and associated cardiometabolic risk factors.

METHODS

This non-randomized 24-week lifestyle modification trial was conducted among 457 obese children and adolescents, aged 2-18 years, who had at least one cardiometabolic risk factor in addition to obesity. This trial included three components of exercise, diet education and behavior modification, with all recommendations provided by a pediatrician, two general physicians and a nurse. Instead of strict inhibitory recommendations, healthier lifestyle was encouraged.

RESULTS

Overall 448 (98.04%) of enrolled children completed the trial with a mean age of 9.6 ± 2.9 years. After the trial, the mean of anthropometric measures and cardiometabolic risk factors decreased significantly, the mean high-density lipoprotein cholesterol (HDL-C) increased significantly, and the prevalence of the metabolic syndrome decreased from 20.8% to 1.8%. Triglycerides, LDL-C, diastolic blood pressure and WC had the highest decrease in all age groups, with the most prominent changes in the 14-18-year age group. By each -1SD decline in BMI and WC, risk factors had significant improvement.

CONCLUSION

Motivational office-based counseling can be effective in treatment of childhood obesity and its associated cardio-metabolic risk factors. Such approach can be implemented in the primary health care system; and can be of special concern in low- and middle-income countries with limited human and financial resources. We suggest that expanding the roles of non-physician clinicians such as nurse practitioners can help to increase the amount of time available for such services.

Obesity trends and determinants in Indonesia

Obesity is becoming a serious issue in many developing countries, with negative implications for economic growth and human wellbeing. While previous micro level studies on obesity have mostly used cross-section data, we analyze trends and determinants with panel data from Indonesia. Over the past 20 years, obesity has increased remarkably in Indonesia across all population groups, including rural and low income strata. The problem is particularly severe among women. Panel regressions confirm that changing food consumption patterns, coupled with decreasing physical activity, directly contribute to this trend. From a policy perspective, nutrition awareness and education campaigns, combined with programs to support leisure time exercise especially for women, seem to be most promising to contain the obesity pandemic.

Parental determinants of overweight and obesity in Iranian adolescents: a national study

OBJECTIVE

Overweight among adolescents is not only an important public health problem but also a problem affecting economic growth in developing countries. The aim of this study was to investigate the parental determinants of overweight and obesity in Iranian adolescents at national level.

METHODS

This cross sectional study was conducted within the framework of the Comprehensive Study on Household Food Consumption Patterns and Nutritional Status of IR Iran during 2001-2003. In adolescents, anthropometric indices were defined based on the CDC 2000 cut-off points for age and gender-specific body mass index (BMI). Parental characteristics were collected by questionnaire. Among the 7158 participating households, data on 7908 adolescents aged 11-19 years (3750 girls and 4158 boys) was analyzed.

FINDINGS

The prevalence of overweight (85-94th percentile) in boys and girls was 6.2%, and 8.7%, respectively. The prevalence of obesity (≥95th percentile) among boys and girls was similar (3.3%). Parents' weight status, father's job and parents' education showed significant association with weight status in adolescents. Logistic regression analysis showed that parental overweight and obesity, parental education and father's job were the main parental determinants of overweight and obesity in Iranian adolescents.

CONCLUSION

Parental overweight and obesity, parental education and father's job seem to be the major parental determinants of overweight in Iranian adolescents. Future prevention programs must take these risk factors into account.

Melatonin improves glucose homeostasis in young Zucker diabetic fatty rats

The aim of this study was to investigate the effects of melatonin on glucose homeostasis in young male Zucker diabetic fatty (ZDF) rats, an experimental model of metabolic syndrome and type 2 diabetes mellitus (T2DM). ZDF rats (n=30) and lean littermates (ZL) (n=30) were used. At 6wk of age, both lean and fatty animals were subdivided into three groups, each composed of ten rats: naive (N), vehicle treated (V), and melatonin treated (M) (10mg/kg/day) for 6wk. Vehicle and melatonin were added to the drinking water. ZDF rats developed DM (fasting hyperglycemia, 460±39.8mg/dL; HbA(1) c 8.3±0.5%) with both insulin resistance (HOMA-IR 9.28±0.9 versus 1.2±0.1 in ZL) and decreased β-cell function (HOMA1-%B) by 75%, compared with ZL rats. Melatonin reduced fasting hyperglycemia by 18.6% (P<0.05) and HbA(1) c by 11% (P<0.05) in ZDF rats. Also, melatonin lowered insulinemia by 15.9% (P<0.05) and HOMA-IR by 31% (P<0.01) and increased HOMA1-%B by 14.4% (P<0.05). In addition, melatonin decreased hyperleptinemia by 34% (P<0.001) and raised hypoadiponectinemia by 40% (P<0.001) in ZDF rats. Moreover, melatonin reduced serum free fatty acid levels by 13.5% (P<0.05). These data demonstrate that oral melatonin administration ameliorates glucose homeostasis in young ZDF rats by improving both insulin action and β-cell function. These observations have implications on melatonin's possible use as a new pharmacologic therapy for improving glucose homeostasis and of obesity-related T2DM, in young subjects.

Prevalence and risk factors associated with nutrition-related noncommunicable diseases in the Eastern Mediterranean region

This paper reviews the current situation concerning nutrition-related noncommunicable diseases (N-NCDs) and the risk factors associated with these diseases in the Eastern Mediterranean region (EMR). A systematic literature review of studies and reports published between January 1, 1990 and September 15, 2011 was conducted using the PubMed and Google Scholar databases. Cardiovascular disease, type 2 diabetes, metabolic syndrome, obesity, cancer, and osteoporosis have become the main causes of morbidity and mortality, especially with progressive aging of the population. The estimated mortality rate due to cardiovascular disease and diabetes ranged from 179.8 to 765.2 per 100,000 population, with the highest rates in poor countries. The prevalence of metabolic syndrome was very high, ranging from 19% to 45%. The prevalence of overweight and obesity (body mass index ≥25 kg/m(2)) has reached an alarming level in most countries of the region, ranging from 25% to 82%, with a higher prevalence among women. The estimated mortality rate for cancer ranged from 61.9 to 151 per 100,000 population. Osteoporosis has become a critical problem, particularly among women. Several risk factors may be contributing to the high prevalence of N-NCDs in EMR, including nutrition transition, low intake of fruit and vegetables, demographic transition, urbanization, physical inactivity, hypertension, tobacco smoking, stunting of growth of preschool children, and lack of nutrition and health awareness. Intervention programs to prevent and control N-NCDs are urgently needed, with special focus on promotion of healthy eating and physical activity.