Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991

Inequalities in adiposity trends between 1979 and 1999 in Guatemalan children

BACKGROUND

Guatemala suffered from civil war and high levels of inequality and childhood stunting in the second half of the 20th century, but little is known about inequalities in secular trends in adiposity.

OBJECTIVES

To investigate differences in childhood body mass index (BMI) and skinfold thickness trajectories from 1979 to 1999 between three groups of children: High socioeconomic position (SEP) Ladino, Low SEP Ladino, and Low SEP Indigenous Maya.

METHODS

The sample comprised 19 346 children aged 7-17 years with 54 638 observations. The outcomes were height, BMI, triceps skinfold thickness (TST), and subscapular skinfold thickness (SST) Z-scores according to the Centers for Disease Control and Prevention (CDC) references. Sex-specific multilevel models were used to estimate and compare mean trajectories from 1979 to 1999 between the three groups.

RESULTS

Mean Z-scores were always highest for High SEP Ladino children and lowest for Low SEP Maya children. Despite their very short stature, the Low SEP groups had SST trajectories that were above the 50th centile. The BMI trajectories were relatively flat and within one major centile band of the CDC median, with differences between the three groups that were small (0.2-0.3 Z-scores) and did not attenuate over time. Conversely, the TST Z-score trajectories demonstrated larger positive secular trends (e.g., from -1.25 in 1979 to -0.06 in 1999 for Low SEP Maya boys), with differences between the three groups that were large (0.5-1.2 Z-scores) and did attenuate over time (in boys). Secular trends and between-group difference in the SST Z-score trajectories were less pronounced, but again we found stronger evidence in boys that the estimated inequalities attenuated over time.

CONCLUSIONS

Secular trends and inequalities in skinfolds differ from those for BMI in Guatemalan children. Differences between groups in skinfolds attenuated over time, at least in boys, but whether this is good news is questionable given the very short stature yet relatively large subscapular skinfolds of the Low SEP groups.

Anthropometry-Based Prediction Equation of Body Composition in a Population Aged 12-88 Years

BACKGROUND

Direct anthropometric measurements to assess body composition have limited precision and/or specificity.

OBJECTIVES

The study aimed to develop a prediction equation based on anthropometric measurements for estimating total body water (TBW) in a healthy population.

METHODS

TBW was assessed using the deuterium dilution method in 398 Moroccan participants (235 women and 163 men) aged 11.6-88 y, then compared to the estimations made by previously published anthropometric equations. By sex, participants were randomly assigned into development (n = 199) and validation subgroups (n = 199). A new anthropometric equation was developed in the development subgroup from data obtained on body volume (BV), weight, and sex, where the BV was calculated from participants' height. Then the equation was validated in the validation subgroup using the Bland and Altman procedure, bias, and pure error. External validation was performed using a sample from Tunisia (n = 220, 51.8% female, 18-65 y).

RESULTS

Bias in predicting TBW showed unacceptable value for all previously published equations as it was significantly overestimated. The following new equation using anthropometric measurements [TBW (kg) = -5.249 + 107.502 BV (L) + 0.289 weight (kg) + 2.015 sex (male: 1, female: 0); (R² = 0.91, RMSE = 1.885 kg)] was developed, and its internal validation was confirmed. The generated bias and pure error values were 0.047 kg (95% CI: -0.235, 0.330) and 2.02 kg (95% CI: 1.73, 2.31), respectively. The external validation of the new TBW prediction equation on a Tunisian sample showed a bias and pure error values of 0.07 kg (95% CI: -0.289, 0.429) and 2.36 kg, respectively.

CONCLUSIONS

The results indicate that the new anthropometric-based prediction equation provides a good estimation of TBW and other body composition compartments. It could be recommended as an alternative method to assess body composition for epidemiological and clinical studies.

Maternal age at menarche and reproductive health in young adult men: a cohort study

STUDY QUESTION

Is maternal age at menarche associated with reproductive health in sons measured by semen quality, testes volume and reproductive hormone levels?

SUMMARY ANSWER

Later maternal age at menarche was associated with impaired semen characteristics, lower testes volume and altered levels of reproductive hormones, while earlier maternal age at menarche was not strongly associated with reproductive outcomes in sons.

WHAT IS KNOWN ALREADY

Both earlier and later maternal age at menarche may be associated with altered male reproductive health outcomes. This is the first study to investigate the potential association between maternal age at menarche and semen quality, testes volume and reproductive hormone levels in sons.

STUDY DESIGN, SIZE, DURATION

In this population-based cohort study, we used data from the Fetal Programming of Semen Quality Cohort nested within the Danish National Birth Cohort. In total, 5697 sons born in 1998-2000 were invited to participate in the cohort in 2017-2019.

PARTICIPANTS/MATERIALS, SETTING, METHODS

In total, 1043 (18% of the invited) young men with information on maternal age at menarche provided a semen and blood sample, measured their testes volume, and filled in a questionnaire on health behavior and pubertal development. Maternal age at menarche was reported by the mothers during pregnancy and examined categorically (as earlier, at the same time or later than their peers), continuously and modeled as splines. We estimated relative percentage differences in the reproductive outcomes using negative binomial regression models. Further, we did a mediation analysis to investigate the potential mediating role of timing of the sons' pubertal development.

MAIN RESULTS AND THE ROLE OF CHANCE

Sons whose mothers had age at menarche later than peers had 15% lower (95% CI: -27%; 0%) sperm concentration, 14% lower (95% CI: -28%; 1%) total sperm count, 7% higher (95% CI: 0%; 14%) proportion of nonprogressive or immotile spermatozoa, 6% lower (95% CI: -11%; 0%) testes volume, 6% lower (95% CI: -12%; 1%) luteinizing hormone, 6% lower (95% CI: -12%; 1%) sex hormone-binding globulin and 5% lower (95% CI: -9%; 0%) testosterone levels compared with sons whose mothers had age at menarche at the same time as peers. Our study did not suggest that earlier maternal age at menarche was strongly associated with semen quality, testes volume or reproductive hormones in sons. However, the spline analyses indicated a potential inverted U-shaped association for sperm concentration and testes volume, and levels of sex hormone-binding globulin and testosterone. We found no strong evidence of mediation by timing of the sons' own pubertal development.

LIMITATIONS, REASONS FOR CAUTION

There was a rather low participation rate in the Fetal Programming of Semen Quality Cohort and we tried to counter it by applying selection weights. Maternal age at menarche was recalled during pregnancy, which may introduce misclassification, most likely nondifferential. Inaccuracy of the sons' recalled pubertal development years after the event may result in underestimation of the possible mediating role of pubertal timing.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings may represent a degree of shared heritability of reproductive health or be a result of an underlying epigenetic profile or unknown shared environmental, cultural or dietary exposure, causing both altered age at menarche and impaired reproductive health outcomes in sons. However, the exact mechanism for the investigated association remains unknown.

STUDY FUNDING/COMPETING INTEREST(S)

This article is part of the ReproUnion collaborative study, cofinanced by the European Union, Intereg V ÖKS (20200407). The FEPOS project was further funded by the Lundbeck Foundation (R170-2014-855), the Capital Region of Denmark, Medical doctor Sofus Carl Emil Friis and spouse Olga Doris Friis's Grant, Axel Muusfeldt's Foundation (2016-491), A.P. Møller Foundation (16-37), the Health Foundation and Dagmar Marshall's Fond. Additionally, this study received funding from Aarhus University. There are no competing interests.

TRIAL REGISTRATION NUMBER

N/A.

A visualized and scientometric analysis of research trends of weight loss in overweight/obese children and adolescents (1958-2021)

Background

Weight loss is an appropriate approach to reduce the health risks associated with overweight/obese children and adolescents, and the optimal method of weight loss requires further research. This study systematically explores scientific co-operation, disciplinary interaction, hotspots and trends in the field of weight loss in overweight/obese children and adolescents (WLOCA), and provides references for further research.

Methods

Citespace 5.8.R1 (64-bit) was adopted to conduct a comprehensive visualization analysis of the literature on WLOCA from Web of Science Core Collection, including publication, institution, country/region, author, journal, keywords and reference.

Results

2,513 papers were found in the Web of Science Core Collection, and the annual number of papers published has increased significantly since 2003. Cincinnati Children's Hospital is the institution with the largest number of publications, while Washington University plays a pivotal role in the collaboration network. In terms of nations, USA has made greater contributions than the rest in terms of the number of publications and global co-operation research. The most influential authors in this field are Thomas H. Inge, Thomas Reinehr, Todd M. Jenkins, Epstein LH, Ogden CL, etc. The most active journals are "Obesity," "International Journal of Obesity," "Obesity Surgery," "Pediatrics," etc. which are characterized by interdisciplinary interactions. Research hot topics mainly include "assessment of obesity and pathophysiological mechanism," "comprehensive intervention," and "bariatric surgery," and there's a gradual shift from "lifestyle intervention" and "pathophysiological mechanism" to "clinical surgical application." In addition, disciplinary integration and comprehensive research, targeted intervention and treatment, and prospective research are the future research trends.

Conclusion

The overall trend in WLOCA study is positive. The main contribution of this study is to reveal the overall picture of the research in this field with visual maps and detailed data by combining quantitative with qualitative approaches, which can provide valuable references for relevant researchers to quickly understand the status of studies on WLOCA, to seek co-operation, and grasp research hotspots and frontier trends.

Behavioral and emotional adaptations of obese and underweight students in response to the COVID-19 pandemic

Previous studies have investigated the effects of COVID-19 on the general population of college students. However, research evaluating the complex behavioral and psychological impact of the pandemic on both obese and underweight students is currently limited. We used data from a survey conducted from March to April 2020 across 2534 students enrolled in seven US universities. We examined whether the associations between taking various behaviors and being obese and underweight students are unidimensional, or varies based on various negative emotions, and their sociodemographic characteristics. Also, we checked whether emotions of obese and underweight groups are impaired, which consequently might impact taking various cautionary behaviors. The results highlight complex relationships between being obese and underweight students and other considered variables. For instance, despite the associated risk, it was found that obese students are associated with less fear, guilt and irritability due to the pandemic. However, those associations vary based on factors such as level of educations. In addition, while obese students are less likely to avoid a large group of people, the impact changes based on gender. Lack of precautions and emotions is despite the increased risk of hospitalization and death associated with obese and underweight groups. Finally, it was found that there are negative and stable associations between higher social class, income, and the lower likelihood of being obese or underweight. Significant differences and similarities were also found across factors to obese and underweight students.

Anti-obesity weight loss medications: Short-term and long-term use

As obesity prevalence increases, more and more drugs that assist with weight loss have been developed. Numerous weight loss drugs had been approved, but many have also been withdrawn based on their lack of efficacy as well as safety concerns. Initial approaches in developing weight loss drugs was by increasing physiological energy expenditure and suppressing the appetite. Subsequently, as more physiological mechanisms for weight gain has been unearthed, drugs targeting newly discovered receptors and/or enzymes have been introduced with improved safety profiles and fewer psychological adverse events. Additionally, drugs targeting hunger or satiety signaling have been actively studied, and have shown increased adoption by physicians. Studies have also evaluated drugs that target metabolic tissues-such as adipose tissue or muscle-to promote weight loss, however to-date nothing has carried on into clinical practice. Starting with a brief history of early obesity treatments, this review evaluates current weight loss pharmaceutical options based on their duration of therapy status.

Maternal obesity, pregnancy weight gain, and birth weight and risk of colorectal cancer

OBJECTIVE

Colorectal cancer (CRC) is a leading cause of cancer-related death worldwide. Obesity is a well-established risk factor for CRC, and fetal or developmental origins of obesity may underlie its effect on cancer in adulthood. We examined associations of maternal obesity, pregnancy weight gain, and birth weight and CRC in adult offspring.

DESIGN

The Child Health and Development Studies is a prospective cohort of women receiving prenatal care between 1959 and 1966 in Oakland, California (N=18 751 live births among 14 507 mothers). Clinical information was abstracted from mothers' medical records 6 months prior to pregnancy through delivery. Diagnoses of CRC in adult (age ≥18 years) offspring were ascertained through 2019 by linkage with the California Cancer Registry. We used Cox proportional hazards models to estimate adjusted HR (aHR); we examined effect measure modification using single-referent models to estimate the relative excess risk due to interaction (RERI).

RESULTS

68 offspring were diagnosed with CRC over 738 048 person-years of follow-up, and half (48.5%) were diagnosed younger than age 50 years. Maternal obesity (≥30 kg/m²) increased the risk of CRC in offspring (aHR 2.51, 95% CI 1.05 to 6.02). Total weight gain modified the association of rate of early weight gain (RERI -4.37, 95% CI -9.49 to 0.76), suggesting discordant growth from early to late pregnancy increases risk. There was an elevated association with birth weight (≥4000 g: aHR 1.95, 95% CI 0.8 to 4.38).

CONCLUSION

Our results suggest that in utero events are important risk factors for CRC and may contribute to increasing incidence rates in younger adults.

Is it possible to model the impact of calorie-reduction interventions on childhood obesity at a population level and across the range of deprivation: Evidence from the Avon Longitudinal Study of Parents and Children (ALSPAC)

Background

Simulated interventions using observational data have the potential to inform policy and public health interventions where randomised controlled trials are not feasible. National childhood obesity policy is one such area. Overweight and obesity are primarily caused by energy-rich and low-nutrient diets that contribute to a positive net energy imbalance. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated whether causal modelling techniques could be applied to simulate the potential impact of policy-relevant calorie-reduction interventions on population prevalence and inequalities in obesity in childhood.

Methods

Predicted probabilities of obesity at age 11 (UK90 cut offs) were estimated from logistic marginal structural models (MSM) accounting for observed calorie consumption at age 7 and confounding, overall and by maternal occupational social class. A series of population intervention scenarios were modelled to simulate daily calorie-reduction interventions that differed in effectiveness, targeting mechanism and programme uptake level.

Results

The estimated effect of maternal social class on obesity after accounting for confounding and observed calorie intake was provided by the controlled direct effect (CDE), in which, 18.3% of children were living with obesity at age 11 years,. A universal simulation to lower median intake to the estimated average requirement (EAR) (a 6.1% reduction in daily calories) with 75% uptake reduced overall obesity prevalence by 0.6%; there was little impact on inequalities. A targeted intervention to limit consumption to the EAR for children with above average intake reduced population obesity prevalence at 11 years by 1.5% but inequalities remained broadly unchanged. A targeted intervention for children of low-income families reduced prevalence by 0.7% and was found to slightly reduce inequalities.

Conclusions

MSMs allow estimation of effects of simulated calorie-reduction interventions on childhood obesity prevalence and inequalities, although estimates are limited by the accuracy of reported calorie intake. Further work is needed to understand causal pathways and opportunities for intervention. Nevertheless, simulated intervention techniques have promise for informing national policy where experimental data are not available.

Severe Obesity in Children and Adolescents: Metabolic Effects, Assessment, and Treatment

Childhood obesity has been increasing steadily in recent decades, and severe childhood obesity has emerged as a major public health problem both nationally and internationally. A current concern is that lockdown due to the coronavirus disease 2019 (COVID-19) pandemic could exacerbate the spread of childhood obesity and increase the gap in obesity risk. Recent research results indicate the aggravation of obesity after school closures. The consequences of severe childhood obesity are more devastating than those of mild to moderate obesity. Children with severe obesity are at greater risk than others for hypertension, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, atherosclerosis, and adult obesity. Accurately assessing and diagnosing a child with severe obesity is the key to implementing successful therapy. A detailed and accurate patient history and physical examination are important to discriminate monogenic obesity and metabolic syndrome diagnoses from severe obesity without an underlying cause. Psychosocial factors, including eating behaviors, should be assessed to facilitate better weight management outcomes. Treatment options for severe pediatric obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. However, lifestyle modification should be the priority. Although progress has been made, safe and effective treatment for severe pediatric obesity is still challenging. More efforts and innovations are needed to find a solution for the huge medical and emotional burden that these children and their families carry. Public health organizations also need to make efforts to encourage and normalize healthy eating habits and exercise to prevent severe obesity in childhood.

Modeling the impact of calorie-reduction interventions on population prevalence and inequalities in childhood obesity in the Southampton Women's Survey

BACKGROUND

In the United Kingdom, rates of childhood obesity are high and inequalities in obesity have widened in recent years. Children with obesity face heightened risks of living with obesity as adults and suffering from associated morbidities. Addressing population prevalence and inequalities in childhood obesity is a key priority for public health policymakers in the United Kingdom and elsewhere. Where randomized controlled trials are not possible, potential policy actions can be simulated using causal modeling techniques.

OBJECTIVES

Using data from the Southampton Women's Survey (SWS), a cohort with high quality dietary and lifestyle data, the potential impact of policy-relevant calorie-reduction interventions on population prevalence and inequalities of childhood obesity was investigated.

METHODS

Predicted probabilities of obesity (using UK90 cut-offs) at age 6-7 years were estimated from logistic marginal structural models adjusting for observed calorie consumption at age 3 years (using food diaries) and confounding. A series of policy-relevant intervention scenarios were modeled to simulate reductions in energy intake (differing in effectiveness, the targeting mechanisms, and level of uptake).

RESULTS

At age 6-7 years, 8.3% of children were living with obesity, after accounting for observed energy intake and confounding. A universal intervention to lower median energy intake to the estimated average requirement (a 13% decrease), with an uptake of 75%, reduced obesity prevalence by 1% but relative and absolute inequalities remained broadly unchanged.

CONCLUSIONS

Simulated interventions substantially reduced population prevalence of obesity, which may be useful in informing policymakers.

Why is colorectal cancer increasing in younger age groups in the United States?

Introduction: While colorectal cancer (CRC) incidence and mortality have decreased for older adults, the rates are increasing in adults younger than 50 years of age in the United States as well as globally. In response to strong epidemiologic evidence as well as sophisticated models, the American Cancer Society (ACS) has recommended screening adults for CRC starting at age 45. Understanding the factors associated with the rise of incidence in adults younger than age 50 may help to identify those adults who may be at greatest risk.Areas covered: In this review, we provide an overview of the recent literature and discuss possible explanations for the increase in CRC in young adults including obesity and other recognized CRC risk factors, delay in diagnosis of symptomatic patients (<50 years of age), and review perspectives on the current and future status of the field.Expert opinion: Currently there are little data regarding risk factors for CRC in average risk young adults who are asymptomatic. With potential endorsement of screening at 45 years of age by US Preventive Services Task Force, more data regarding clinical and molecular risk factors associated with CRC in young adults will be available.

Longitudinal trajectories of adiposity-related measures from age 2-5 years in a population of low-income Hispanic children

BACKGROUND

We estimated longitudinal trajectories of body mass index (BMI) z-score and percentile, weight for height (WFH) z-score and percentile, and percentage of the 95th BMI percentile (BMIp95) among low-income Hispanic children ages 2-5 years to provide normative data for this population and compare the behavior of different measures.

METHODS

Longitudinal height and weight measurements obtained from 18,072 Hispanic children aged 2-5 years enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children in Los Angeles County were analyzed. Trajectories of adiposity-related measures were estimated using mixed models, stratified by sex and BMI percentile at age 2 years.

RESULTS

For children in the 5th-85th BMI percentile at age 2 years, all adiposity-related measures rose during ages 2-3.5 years; during ages 3.5-5 years, BMI-based measures increased, BMIp95 decreased, and WFH-based measures were stable. For children exceeding the 85th BMI percentile at age 2 years, measures generally trended downward during ages 2-5 years, except for BMIp95, which had variable trends.

CONCLUSIONS

Adiposity measures changed at different rates as children grew during ages 2-3.5 years compared to ages 3.5-5 years, and different measures displayed different trends. Studies should consider examining multiple measures and focusing on change relative to a comparison group.

IMPACT

To address the childhood obesity epidemic, information on normative trajectories of adiposity-related measures in at-risk populations of young children is needed. Longitudinal analysis of data collected from low-income Hispanic children during ages 2-5 years revealed different patterns for different adiposity measures and for ages 2-3.5 years versus 3.5-5 years. Child obesity studies should consider examining multiple adiposity measures and focus on change relative to a comparison group to avoid misinterpreting longitudinal patterns.

Urban-rural differences in perception of trees described by parents bringing up children in Warsaw and Jedlińsk, Poland

Parents’ attitudes to trees and nature are reflected not only in their children’s outdoor activity, but also in the way they perceive, learn and value the environment. One hundred and eleven respondents, divided into two groups by place of residence, assessed statements in a survey questionnaire. Two groups of questions aimed at evaluating tree benefits and disservices as perceived by urban and rural parents, and identifying their preferences concerning outdoor activity of their children. Tree benefits and disadvantages were grouped into five categories (social, economic, environmental, health and aesthetic). Both urban and rural parents presented similar attitudes to trees as well as to their children’s play environments. Among 37 statements concerning tree benefits, only five revealed statistically significant differences. The most important difference appeared in the way urban and rural parents perceived the aspects of danger. Trees were not perceived as posing any risk on playgrounds for city residents, who—unlike villagers—opposed to the removal of trees from playgrounds.

Epidemiology and Mechanisms of the Increasing Incidence of Colon and Rectal Cancers in Young Adults

In contrast to the decreasing incidence of colorectal cancer (CRC) in older populations, the incidence has nearly doubled in younger adults since the early 1990s. Approximately 1 in 10 new diagnoses of CRC are now made in individuals 50 years or younger. Patients' risk of CRC has been calculated largely by age and family history, yet 3 of 4 patients with early-onset CRC have no family history of the disease. Rapidly increasing incidence rates in younger people could result from generational differences in diet, environmental exposures, and lifestyle factors. We review epidemiologic trends in CRC, data on genetic and nongenetic risk factors, and new approaches for determining CRC risk. These may identify individuals likely to benefit from early screening and specialized surveillance.

Obesity in Childhood and Adolescence, Genetic Factors

Obesity and excess weight are a pandemic phenomenon in the modern world. Childhood and adolescent obesity often ends up in obesity in adults. The costs of obesity and its consequences are staggering for any society, crippling for countries in development. Childhood obesity is also widespread in Macedonia. Metabolic syndrome, dyslipidemia and carbohydrate intolerance are found in significant numbers. Parents and grandparents are often obese. Some of the children are either dysmorphic, or slightly retarded. We have already described patients with Prader-Willi syndrome, Bardet-Biedl syndrome or WAGR syndrome. A genetic screening for mutations in monogenic obesity in children with early, rapid-onset or severe obesity, severe hyperphagia, hypogonadism, intestinal dysfunction, hypopigmentation of hair and skin, postprandial hypoglycaemia, diabetes insipidus, abnormal leptin level and coexistence of lean and obese siblings in the family discovers many genetic forms of obesity. There are about 30 monogenic forms of obesity. In addition, obesity is different in ethnic groups, and the types of monogenic obesity differ. In brief, an increasing number of genes and genetic mechanisms in children continue to be discovered. This sheds new light on the molecular mechanisms of obesity and potentially gives a target for new forms of treatment.

Body mass index across the life course: emergence of race-by-sex disparities in early childhood

PURPOSE

The purpose of this study was to assess when in the life-course race-by-sex disparities in body mass index (BMI) emerge.

METHODS

Child Health and Development Studies participants, from whom height and weight data were collected at ages 5, 9-11, and 15-17 years, were followed up at the age of 50 years for anthropometric outcomes. Follow-up was completed for 605 subjects, 460 of whom were assessed for height and weight at the age of 50 years, had at least one available childhood BMI measure, and self-identified as either non-Hispanic black or non-Hispanic white. Linear regression analyses were conducted to determine whether interactions existed between race (black vs. white) and sex for predicting BMI at ages 5, 9-11, 15-17, and 50 years.

RESULTS

At age 5 years, BMI was independent of sex for both blacks and whites, but by the age of 9-11 years, BMI was sex-dependent in blacks, with higher BMI observed among black females. This sex dependence for BMI among blacks persisted at ages 15-17 years and age 50 years. The race-by-sex interaction was significant at ages 9-11, 15-17, and 50 years (P for interaction = 0.001, 0.002, and 0.01, respectively).

CONCLUSIONS

Race-by-sex disparities in body size were observed by the age of 9-11 years and persisted until the age of 50 years.

The Protective Effect of Exclusive Breastfeeding on Overweight/Obesity in Children with High Birth Weight

BACKGROUND

A positive association between birth weight (BW) and body mass index (BMI) has been shown among children in many populations. The aim of this study was to investigate BMI trajectory according to BW status and the protective effect of breastfeeding on the prevalence of overweight/obesity in children 6 years of age.

METHODS

A retrospective cohort study was conducted between January 1, 2008 and December 31, 2016 utilizing data from the National Health Information Database of Korea. The 38,049 subjects were followed until the end of 2016, providing that subjects were completely eligible for all health check-ups from birth to 6 years of age. At each check-up period, multiple logistic regressions were used to investigate the association between BW status (low birth weight [LBW], normal birth weight [NBW], high birth weight [HBW]) and growth development.

RESULTS

HBW infants were highly likely to be overweight/obese compared to NBW infants (odds ratio [OR], 1.70-2.35) and LBW infants were highly likely to be underweight (OR, 1.69-2.20) through 6 years of age. The risk of overweight/obesity decreased significantly if HBW infants were breast-fed for 6 months (OR, 0.54-0.76).

CONCLUSION

HBW status is associated with overweight/obesity during early childhood. Exclusive breastfeeding is a significant protective factor against overweight/obesity in children with HBW.

Raising an Active and Healthy Generation: A Comprehensive Public Health Initiative

Physical activity (PA) provides important health benefits to youth, but most U.S. children and adolescents fail to meet federal PA guidelines. The purpose of this article is to present a plan for a large-scale public health initiative aimed at producing population-level increases in PA among U.S. youth.

Community Healthcare and Technology to Enhance Communication in Pediatric Obesity Care

Childhood obesity continues to be a critical healthcare issue and a paradigm of a pervasive chronic disease affecting even our youngest children. When considered within the context of the socioecological model, the factors that influence weight status, including the social determinants of health, limit the impact of multidisciplinary care that occurs solely within the medical setting. Coordinated care that incorporates communication between the healthcare and community sectors is necessary to more effectively prevent and treat obesity. In this article, the Expert Exchange authors, with input from providers convened at an international pediatric meeting, provide recommendations to address this critical issue. These recommendations draw upon examples from the management of other chronic conditions that might be applied to the treatment of obesity, such as the use of care plans and health assessment forms to allow weight management specialists and community personnel (e.g., school counselors) to communicate about treatment recommendations and responses. To facilitate communication across the healthcare and community sectors, practical considerations regarding the development and/or evaluation of communication tools are presented. In addition, the use of technology to enhance healthcare-community communication is explored as a means to decrease the barriers to collaboration and to create a web of connection between the community and healthcare providers that promote wellness and a healthy weight status.

Physical Growth, Body Scale, and Perceptual-Motor Development

In this chapter we consider from the theoretical framework of the ecological approach to perception and action, the relations between physical growth and body scale in the context of children's perceptual-motor development. Body scale and the timescale of its change through growth are shown to relate to the emergence and dissolution of the fundamental skills in infancy, the perception of what an environment affords functionally for action, together with the emergent pattern of movement coordination. A central issue in typical and atypical motor development is the mapping of the timescale of adaptive change in the acquisition of perceptual-motor skill to the accompanying timescale of change in physical growth.

Complications Associated with Underweight Primary Immunodeficiency Patients: Prevalence and Associations Within the USIDNET Registry

PURPOSE

The point prevalence of underweight status and obesity in primary immunodeficiency disease (PID) is unknown, despite the described associations between PID and weight loss and failure to thrive. The goal of this study is to estimate the prevalence of underweight status and obesity in PID patients and to investigate the associations between abnormal body weight and complications of PID.

METHODS

Using the US Immunodeficiency Network (USIDNET), we performed a retrospective analysis of 653 pediatric (age 2 to 20 years) and 514 adult (age > 20) patient records with information on patient body mass index (BMI). Prevalence of underweight and obese status in PID patients was compared to data from the National Health and Nutrition Examination Survey (NHANES).

RESULTS

After separating BMI data by year of entry to the database, we demonstrated that both adult and pediatric patients with PID had significantly higher prevalence of underweight patients in multiple years of analysis. Further examination of underweight patients by PID diagnosis revealed that underweight status in adults with CVID was associated with granulomatous disease as well as earlier age of CVID diagnosis. In the pediatric CVID cohort, underweight status was significantly associated with lymphopenia. Examination of obesity in pediatric and adult PID patients compared to NHANES database revealed only a single year when obesity in PID patients was significantly less prevalent. In other 2-year time intervals from 2005 to 2014, the prevalence of obesity was unchanged in children and adults.

CONCLUSIONS

These results quantify the prevalence of underweight status in PID in a North American population and demonstrate that whether as a result of weight loss or poor weight gain, underweight status is more prevalent in the PID population than in the general US population. The prevalence of obesity in PID patients was similar to that seen in the general population. This highlights the need for continued education on the association of low weight and PID.

CLINICAL TRIAL REGISTRATION

NCT01953016.

Obesogenic Behavior and Weight-Based Stigma in Popular Children's Movies, 2012 to 2015

BACKGROUND

Obesity-promoting content and weight-stigmatizing messages are common in child-directed television programming and advertisements, and 1 study found similar trends in G- and PG-rated movies from 2006 to 2010. Our objective was to examine the prevalence of such content in more recent popular children's movies.

METHODS

Raters examined 31 top-grossing G- and PG-rated movies released from 2012 to 2015. For each 10-minute segment (N = 302) and for movies as units, raters documented the presence of eating-, activity-, and weight-related content observed on-screen. To assess interrater reliability, 10 movies (32%) were coded by more than 1 rater.

RESULTS

The result of Cohen's κ test of agreement among 3 raters was 0.65 for binary responses (good agreement). All 31 movies included obesity-promoting content; most common were unhealthy foods (87% of movies, 42% of segments), exaggerated portion sizes (71%, 29%), screen use (68%, 38%), and sugar-sweetened beverages (61%, 24%). Weight-based stigma, such as a verbal insult about body size or weight, was observed in 84% of movies and 30% of segments.

CONCLUSIONS

Children's movies include much obesogenic and weight-stigmatizing content. These messages are not shown in isolated incidences; rather, they often appear on-screen multiple times throughout the entire movie. Future research should explore these trends over time, and their effects.

Analysis of Factors Affecting the Body Mass Index in a National Sample of Iranian Children and Adolescents: Bootstrapping Regression

Background

This study aims to evaluate the effect of some factors, including birth weight, sex, age, waist circumference, family history of obesity, as well as some lifestyle factors as frequency of breakfast days and physical activity, on the body mass index among a nationally representative sample of Iranian children and adolescents by using bootstrapping regression.

Materials and Methods

This study was conducted as the third survey of a school-based surveillance system (CASPIAN-III study). Total participants were 5570 school students, aged 10-18 years, selected by multistage random cluster sampling from urban and rural areas of 27 provinces of Iran. Multiple linear regressions was used to evaluate the effect of various factors on obesity, but in our data the assumptions of this model violated, and possible solutions were not appropriate, therefore the bootstrapping regression based on the observations and errors resampling approaches was used as an alternative.

Results

The tests of significance showed that the effects of sex, age, waist circumference, family history obesity and frequency of breakfast days were clearly significant (P < 0.001). The effect of vigorous level of physical activity was significant in comparison to mild physical activity (P = 0.01). In comparison to low birth weight, medium and high birth weight had significant effect on obesity.

Conclusions

Bootstrap method is preferable in linear regression because of some theoretical properties like having any distributional assumptions on the residuals and hence allows for inference even if the errors do not follow normal distribution or constant error variance.

The Association between Socioeconomic Status and Obesity in Korean Children: An Analysis of the Fifth Korea National Health and Nutrition Examination Survey (2010-2012)

PURPOSE

Obesity is one of the most common health problems among children and its prevalence has increased in recent decades. Socioeconomic status (SES) is a well-known risk factor for childhood obesity although the associations were different across countries. Previous studies in other countries have reported a positive association between childhood obesity and SES in developing countries, and inverse correlation has been reported in developed countries. For this reason, we wanted to investigate the relationship between SES and obesity in Korean children.

METHODS

Data were acquired 3,095 boys and girls who participated in the fifth Korea National Health and Nutrition Examination Survey, which was conducted from 2010 to 2012. Body mass index was calculated from measured anthropometric data using the 2007 Korean National Growth Charts.

RESULTS

Upon univariate analysis, we did not find any statistically significant differences in the parental employment status, monthly family income between children with and without obesity. Multiple logistic regression analysis showed childhood obesity was positively associated with maternal overweight (OR, 1.889; 95% CI, 1.079-3.309), maternal obesity (OR, 3.409; 95% CI, 2.228-5.215) and paternal obesity (OR, 2.135; 95% CI, 1.257-3.627).

CONCLUSION

The present study showed that socioeconomic status might not an important risk factor for obesity in Korean children. These results warrant further studies to clarify the association between SES and obesity in Korean children.

Monitoring obesity prevalence in the United States through bookmarking activities in online food portals

Studying the impact of food consumption on people's health is a serious matter for its implications on public policy, but it has traditionally been a slow process since it requires information gathered through expensive collection processes such as surveys, census and systematic reviews of research articles. We argue that this process could be supported and hastened using data collected via online social networks. In this work we investigate the relationships between the online traces left behind by users of a large US online food community and the prevalence of obesity in 47 states and 311 counties in the US. Using data associated with the recipes bookmarked over an 9-year period by 144,839 users of the Allrecipes.com food website residing throughout the US, several hierarchical regression models are created to (i) shed light on these relations and (ii) establish their magnitude. The results of our analysis provide strong evidence that bookmarking activities on recipes in online food communities can provide a signal allowing food and health related issues, such as obesity to be better understood and monitored. We discover that higher fat and sugar content in bookmarked recipes is associated with higher rates of obesity. The dataset is complicated, but strong temporal and geographical trends are identifiable. We show the importance of accounting for these trends in the modeling process.

Serum Pentraxin 3 Fragment as a Noninvasive Marker of Nonalcoholic Fatty Liver Disease in Obese Children and Adolescents

BACKGROUND/AIMS

It was suggested that serum pentraxin 3 (PTX3) levels could differentiate obese children with nonalcoholic steatohepatitis (NASH) from those with simple steatosis. Thus, we aimed to evaluate the clinical utility of serum PTX3 fragment levels in the diagnosis of NASH and the assessment of its severity in obese children with suspected nonalcoholic fatty liver disease (NAFLD).

METHODS

Fifty obese children were compared to 25 matched controls. All were subjected to history taking, anthropometric measurements, and abdominal ultrasonography, as well as laboratory assessments of liver functions, fasting lipid profile, fasting blood glucose, fasting insulin, homeostasis model assessment (HOMA) index, fasting glucose/insulin ratio, and serum PTX3.

RESULTS

PTX3 was higher in obese cases than controls (p = 0.0001). Eighty percent of the cases had NAFLD with progressive increases in PTX3 levels as the severity of fatty liver increased (p = 0.0001). Moreover, PTX3 was higher in cases with elevated liver enzymes (3.205 ± 0.77 U/l) than those with normal liver enzymes (2.77 + 0.69 U/l, p < 0.0001). A cutoff value of 3.03 U/l differentiated fatty liver from NASH with a sensitivity of 89% and a specificity of 86%.

CONCLUSION

Noninvasive monitoring of serum PTX3 fragment levels in obese patients with suspected NAFLD may be used as a reliable tool for differentiating NASH from simple fatty liver.

Overweight adult cats have significantly lower voluntary physical activity than adult lean cats

Objectives

The objectives of the current pilot study were to evaluate whether body condition score (BCS) and body weight are significantly related to physical activity counts, and to evaluate potential interaction between BCS and voluntary physical activity measured over a 14 day period.

Methods

Ten (five lean, five overweight), neutered, adult American Shorthair cats were selected for this study (median age 4 ± 0.5 years). Cats with a BCS of ⩽3.0 were considered lean, whereas cats with a BCS >3.0 were considered overweight, using a 5-point scale. Cats were housed in a free-living environment with indoor/outdoor access and were individually fed once daily a commercially available dry extruded diet and allowed 1 h to eat. Voluntary physical activity was measured consecutively for 14 days using the Actical Activity Monitors that were worn parallel to the ribs and attached via a harness.

Results

Lean cats had a greater mean total daily voluntary physical activity ( P = 0.0059), and a greater voluntary physical activity during light ( P = 0.0023) and dark ( P = 0.0446) periods, with overweight cats having 60% of the physical activity of lean cats. Lean cats were more active before feeding and during animal care procedures. These data suggest that lean cats have a greater anticipatory physical activity prior to feeding and are more eager to have social interaction with humans than overweight cats. A significant interaction was observed between day of physical activity measurement and BCS for total daily voluntary physical activity ( P = 0.0133) and activity during the light period ( P = 0.0016) where lean cats were consistently more active than overweight cats. In general, cats were more active during weekdays vs weekends.

Conclusions and relevance

The results of this study suggest that overweight cats are less active than lean cats and that voluntary physical activity level appears to be influenced by social interaction with humans.

Is infant body mass index associated with adulthood body composition trajectories? An exploratory analysis

BACKGROUND

Infant body mass index (BMI) is increasingly used as a marker of obesity risk based on its association with young-adulthood BMI.

OBJECTIVES

The aim of this study is to test the association of infant BMI with young-adulthood fat mass and fat-free mass, and how this association changes during advancing adulthood.

METHODS

Body mass index Z-score at age 9 months was measured in 350 White, non-Hispanic Fels Longitudinal Study participants. This exposure was entered into multilevel models to test its association with trajectories describing 2665 BMI observations and 1388 observations of fat mass index (FMI, kg m^-2 ) and fat-free mass index (FFMI, kg m^-2 ) between ages 20 and 60 years.

RESULTS

Partitioning young-adulthood BMI into its fat and fat-free components, infant BMI Z-score was associated with FFMI (β = 0.745; 95% confidence interval = 0.367 to 1.124) but not FMI (0.528; -0.055 to 1.110) at age 20 years. Greater infant BMI Z-score was associated with slower age-related increases in all outcomes, such that (looking at 10-year intervals) only FFMI at age 30 years was related to infant BMI Z-score (0.338; 0.119, 0.557).

CONCLUSIONS

Focus on infant BMI reduction for adulthood obesity prevention warrants caution as high infant BMI values are associated with greater lean mass, which is protective against ageing changes.

Physical Activity and Changes in Adiposity in the Transition from Elementary to Middle School

OBJECTIVES

This study examined the longitudinal associations of objectively measured physical activity, sedentary behavior, and diet quality with two measures of adiposity and a measure of weight status.

METHODS

A total of 658 children from 21 elementary schools (45.1% boys; 40% white, 33% black, 9% Hispanic, and 18% other race/ethnicity) were assessed at least twice in fifth, sixth, and/or seventh grade. Fat mass index (FMI), percent body fat (PBF), and BMI were calculated from body weight, standing and seated heights, and bioelectrical impedance (BIA) measured each year.

RESULTS

At follow-up, both FMI and PBF decreased among boys and increased among girls, while BMI increased in both boys and girls. After controlling for race/ethnicity, parent education, and maturity offset at baseline, growth curve analyses showed that moderate-to-vigorous physical activity (MVPA) was significantly and negatively associated with FMI, PBF, and BMI for both boys and girls. After forming tertiles of fifth grade MVPA, least-square means for FMI, PBF, and BMI were examined by grade and gender. For both boys and girls, higher MVPA was associated with lower FMI, PBF, and BMI at all three grade levels. The relationships between sedentary behavior and diet quality and FMI, PBF, and BMI were not consistent for boys or girls.

CONCLUSIONS

As boys and girls transitioned from elementary to middle school, children who participated in higher levels of MVPA maintained more favorable levels of two indicators of adiposity and a measure of weight status. These findings support the need for interventions to help children meet current public health guidelines for physical activity.

Pediatric Weight Management Program Outcomes in a Largely Minority, Low Socioeconomic Status Population

This article describes the outcomes of a pediatric weight management program for a population primarily composed of minority ethnic groups and those from a lower socioeconomic status group. As these groups are disproportionally affected by pediatric obesity and overweight complicated by higher rates of attrition and poorer response to intervention, it is important that adequate and effective treatment exists for patients in these groups. Further research is needed to analyze the outcomes and attrition in these high-risk populations.

The International Growth Standard for Children and Adolescents Project: Environmental Influences on Preadolescent and Adolescent Growth in Weight and Height

This review has two aims. The first is to identify important environmental influences on the growth of children aged 1 to 9 years and of adolescents, defined as those aged 10 to 19 years. The second is to identify possible environmentally based criteria for the selection of individuals and populations for data collection in the development of an international growth reference for these age ranges. There are many common environmental influences on the growth of children between the ages of 1 and 19 years; the examination and description of these forms the main body of this review. Subsequently, environmental factors influencing adolescent growth only are considered. In both cases, possible selection criteria are put forward. The most important inclusion criteria for both preadolescence and adolescence are good nutrition, lack of infection, and socioeconomic status that does not constrain growth. Additionally, low birthweight, catch-up growth, breastfeeding, and early adiposity rebound have impacts on growth and/or body composition into puberty. Exclusion of children born at low birth and/or experiencing catch-up growth could be most realistically operationalized if populations in which secular trends in growth were either completed or minimal were selected. Although an effect of hypoxia on child and adolescent growth, independent of nutrition, is small at most, many high-altitude populations have high prevalances of low birthweight and should be excluded on this basis. Since all populations are exposed to pollutants, contaminants, and toxicants in varying degrees, they cannot be realistically excluded from the sample frame. However, it may be desirable to exclude populations that are habitually exposed to extremely high levels of environmental pollution, including air pollution, and those living in close proximity to toxic waste. It is impossible to exclude populations and individuals on the basis of their exposure to aflatoxin contamination of food. However, exclusion on the basis of low socioeconomic status or poverty may well act as a proxy for this. There are a small number of populations that show extreme patterns of growth in body size and proportion in preadolescence and adolescence, and these should be excluded from the sample frame.

Plasma Lipid Levels in 10- to 13-year-old Costa Rican Elementary Schoolchildren

An adverse lipid profile is a major risk factor for atherosclerosis. This study evaluated the lipid profiles of 683 schoolchildren aged 10 to 13 years. The prevalence of both high LDL and high total cholesterol levels was significantly (p < . 001) higher in private schoolchildren than in public schoolchildren. There were no significant differences in the prevalence of high triglyceride levels among the schoolchildren. Mean total cholesterol and LDL cholesterol levels were significantly higher in children whose parents had completed over 11 years of schooling. Private schoolchildren were more sedentary and tended to have a more atherogenic diet. Our data suggest that prevention programmes in primary schools are required to decrease the prevalence of cardiovascular risk factors, including abnormal lipid profiles.

Measurement of physical activity in obese persons: how and why? A review

[Purpose] Overweight and obesity are major risk factors for poor health, especially in children. Reduced physical activity, prompted by a sedentary lifestyle, is a major contributor. Hence, it is important to assess physical activity using standardized methods in public health to identify the risks associated with obesity. There have been no recent reports comparing such modalities for use by clinicians and researchers. In this article, some of these methods for use in the assessment of physical activity are reviewed, and their advantages and disadvantages are described. [Subjects and Methods] Electronic databases including PubMed, Medline, and Google Scholar were searched for literature, using key words Obesity, Physical activity, and Physical Behavior Monitoring. [Results] With advances in technology, various novel methods have been developed to assess physical behavior, but conventional methods are still relevant and easy to administer. [Conclusion] There are various measurement options available. Researchers may choose devices providing more accurate measurements, while clinicians may prefer portability and affordability for patients.

Self-worth and psychological adjustment of obese children: An analysis through the Draw-A-Person

AIM

To investigate psychopathological correlates of child obesity via the Draw-A-Person test (DAP).

METHODS

The participants were 50 children with a mean age of 9.74 years. Body mass index (BMI) was used as a measure of body fat. Children were divided into normal (n = 17), overweight (n = 14) and obese (n = 19). Two qualitative methods of scoring the DAP based on an integrative approach were used to assess self-concept (ESW) and overall level of children's adjustment (EAC). A procedure for judging interpretative skills of clinicians was implemented before they evaluated children's drawings.

RESULTS

As predicted by our hypothesis, BMI was negatively correlated with ESW, r (50) = -0.29, P < 0.05, but not with EAC, r (50) = - 0.08, P = ns. To evaluate the effect of gender, Pearson correlations were re-computed regrouping the sample accordingly: BMI and EAC reached a significant negative correlation in female subjects, r (24) = -0.36, P < 0.05, and a positive correlation in male subjects, r (26) = 0.37, P = < 0.05; negative correlation between BMI and ESW became stronger in females, r (24) = -0.51, P < 0.01 but not in males, whose correlation disappeared resulting not-significant, r (26) = -0.06, P = ns. No effect of age was found. Results indicate that obesity has a negative correlation exclusively on overall adjustment and self-concept in female children.

CONCLUSION

It was concluded that there is a negative bias toward females that reveals how the stigma of obesity is widespread in Western society.

The asthma-anxiety connection

BACKGROUND

The literature reports a significant association between various mental disorders and asthma, in particular depression and/or anxiety, with some more robust data regarding anxiety disorders. However, the nature of this association remains largely unclear.

OBJECTIVES

(1) To test the hypothesis of a specific association of anxiety and depressive disorder (according to the DSM-IV) with asthma and (2) to test the bidirectional hypothesis of causality between asthma and psychiatric disorders.

METHODS

Ninety-six adults were compared with 96 control subjects matched according to main socio-demographic variables (i.e., gender, age, marital status, cohabiting/non-cohabiting, and BMI). Subjects with asthma were divided according to GINA and ACT classifications. All subjects underwent Structured Clinical Interviews for DSM-IV Axis I (SCID-I) diagnosis.

RESULTS

Significant association between asthma and lifetime anxiety disorders emerged (OR 3.03; p = 0.003); no significant association with other psychiatric diagnosis emerged. Moreover, lifetime and current anxiety were associated with asthma severity levels (p < 0.01 and p = 0.001 based on age). Asthma preceded anxiety in 48% of cases; in 52% of cases, anxiety preceded asthma, without significant group differences. The risk of asthma, particularly of severe, uncontrolled forms (p < 0.01), resulted higher in lifetime anxiety disorder patients (p = 0.003 and p = 0.001 based on age at onset). Current anxiety increased the risk of asthma, and that of an uncontrolled form (p < 0.05). Asthma increased the risk of lifetime anxiety disorders (p = 0.002 and p = 0.018 using ages). Intermittent asthma increased the risk of lifetime and current anxiety disorders (p < 0.01).

CONCLUSIONS

Anxiety disorders, in particular Lifetime Anxiety Disorders, represent the only psychiatric disorder significantly associated with asthma, with a possible bidirectional, anxiety-asthma relationship, each of which can be caused or result from the other.

Childhood obesity and the role of physical activity

Similar to adult obesity, childhood obesity has recently become a serious threat to public health. Children face the same environmental and lifestyle challenges that have made high energy dense food and drink increasingly available and opportunities for energy expenditure through transport and active play less likely. Governments are becoming concerned but research has been under funded, is relatively scarce in the UK and has provided little sound evidence on which to base interventions.

Physical activity seems to be declining and there is some evidence that time spent in sedentary pursuits such as TV watching is increasing and that this may be related to obesity. However, not all children are inactive and it may be more fruitful to independently examine different elements of activity such as play, walking and cycling as transport, organised sports, and active jobs so that children’s profiles of activity can be mapped on an individual and group level.

Recent research using accelerometry is providing insight into those elements which produce significant energy expenditure in a child’s daily routine. The school and the structure to the school day appear particularly important. It is also likely that attention will need to be paid to parenting - the anxieties that parents demonstrate when making decisions about the freedom of their child to be active. Furthermore, without neighbourhoods that are safe and attractive for activity it is unlikely that levels will be increased. For physical activity to contribute to reversing the trend in childhood obesity, a multi-factorial and multi-agency solution will be required that involves schools, the home, the neighbourhood and considered local planning and provision.

Awareness, knowledge, and perception of heart disease among adolescents

BACKGROUND

Perceptions of cardiovascular risk among adolescents have not been studied recently. The rise in unattended risk factors and the obesity pandemic have created calculable cardiovascular disease risk in the adolescent population.

DESIGN

We sought to assess the awareness, level of knowledge, and perception of cardiovascular disease in an adolescent population.

METHODS

We administered a survey designed to collect data on demographics, beliefs regarding risk factor importance, perceived future risk and other knowledge-based assessment questions about cardiovascular disease.

RESULTS

Students, n=873, (45.4% male, mean age 15.6 years) in grades 9-12, from four Michigan high schools completed the survey unassisted. Accidents were rated as the greatest perceived lifetime health risk (39.1%). A minority (16.6%) of respondents selected cardiovascular disease as the greatest lifetime risk placing it behind accidents and cancer. When asked to identify the greatest cause of death for each sex, 42.3% of respondents correctly recognized cardiovascular disease for men and 14.0% correctly recognized cardiovascular disease for women in the United States, P<0.0001. Forty percent of respondents incorrectly chose a substance abuse/use behavior, other than cigarettes, as the most important cardiovascular disease risk behavior.

CONCLUSIONS

Our findings suggest that adolescents lack knowledge regarding the risk of cardiovascular disease and do not perceive themselves at risk for cardiovascular disease. These data will be useful in designing future preventive strategies and interventions aimed at this target population.

Review: Obesity and cardiometabolic syndrome in children

The cardiometabolic syndrome is highly prevalent among overweight youth. The risk of developing the cardiometabolic syndrome is likely triggered or exacerbated by concurrent obesity, unhealthy lifestyle/eating habits, and hormonal changes (puberty). Current screening recommendations include measurement of blood pressure, fasting insulin and glucose, and total cholesterol. However, limiting assessments to these measures underestimates cardiometabolic risk in overweight youth, particularly minorities. Early identification of cardiometabolic risk in its incipient stages may justify early and more aggressive intervention to prevent progression and complications. This review provides rationale for additional assessments to determine cardiometabolic risk in overweight youth and recommends treatment options.

Adolescents and Eating Disorders:

Little is known about the incidence and prevalence of eating disorders among adolescents of color who are poor or identify themselves as gay or lesbian. Among American women, eating disturbances are equally as common among Native, Asian, or Hispanic Americans as they are among Caucasians. African Americans were at higher risk of developing eating disorders than were Hispanic and Asian Americans. Media and gender-role body stereotype and body dissatisfaction are strongly linked and have been shown to be the strongest predictors of disordered eating. As these youth adopt Western values about beauty, they may be at increased risk for developing eating disorders.

Exercise Locus of Control, Behavior, and Intention Among Mexican American Youth

Mexican American youth have higher physical inactivity rates than their Black or non-Hispanic White counterparts. The purpose of this study was to examine the relationships among exercise locus of control, age, present exercise level, weight status, and gender with intention to exercise in a sample of Mexican American youth. The study sample consisted of 216 boys and 185 girls ranging in age from 10 to 15 years, and data were collected through a self-report survey instrument and height and weight measures to calculate body mass index. Structural equation modeling was employed to test for variable associations. Results suggested that for boys and girls, current exercise involvement had the greatest influence on intent to be physically active, and age had a mediating effect because of the increased importance of the powerful others’ exercise locus of control belief as one grew older.

Factors affecting Nutritional Status of Malaysian Primary School Children

This paper investigates the nutritional status of a randomly selected cohort of school children and the factors affecting it. This random survey was conducted in the state of Selangor, involving 1,405 primary students (aged 9-10 years from 54 national primary schools). Physical examination was carried out on all the students. Information on the students was also obtained from the parents. Blood samples were taken by using the finger pricking technique. Body mass index (BMI) was used as a measure of physical growth.

The students were mainly from urban areas (82.9%). The mean age was 9.71 years and a higher proportion was females (51%). Malays constituted 83.6%, Indians 11.6% and Chinese 4.2% of the study population. The mean weight and height were 32.30 kg and 135.18cm respectively. The mean BMI was 17.42 kg/m2, with 1.2% of the students underweight, 76.3% normal BMI, 16.3% overweight and 6.3% were obese. Nutritional status was significantly related to blood pressure, history of breast feeding, eating fast food, taking canned/bottled drinks, income and educational level of parents. Significant differences in nutritional status between sexes and locations (rural/ urban) were also found. The prevalence of overweight and obese children was of concern. There is thus an urgent need for the School Health Program to periodically monitor the school children's eating habits and physical growth. Appropriate counselling on nutritional intake and physical activities should be given not only to schoolchildren but also to their teachers and parents or caregivers. Asia Pac J Public Health 2005; 17(2): 71-80.

Adoption and Institutionalization of the Child and Adolescent Trial for Cardiovascular Health (CATCH) in El Paso, Texas

One goal of national health-promotion research is to disseminate and institutionalize experimentally tested programs in local communities. In 1997, the national Child and Adolescent Trial for Cardiovascular Health (CATCH) was chosen by the Paso del Norte Health Foundation as their first community-wide preventive health initiative for the El Paso, Texas/Juárez, México border region. With help from researchers at the University of Texas at Houston, evaluators from the University of Texas at El Paso, and the Region 19 Educational Services Center, CATCH was implemented in 18 Title I pilot schools. Known as the Coordinated Approach to Child Health 5 years later, the El Paso CATCH program has been embraced by the border community and reaches 108 elementary schools from New Mexico to West Central Texas. There are also plans to implement CATCH in Juárez. This article describes the institutionalization of CATCH in a predominately Hispanic, low income border region.

Opportunities for Student Physical Activity in Elementary Schools: A Cross-Sectional Survey of Frequency and Correlates

The objectives of this study were to describe opportunities for student physical activity (PA) in elementary schools and to identify factors in the school environment associated with higher PA opportunity. Self-report questionnaires were completed by school principals and physical education teachers in 277 schools (88% response) in metropolitan Montreal. Correlates of opportunity were identified using ordinal logistic regression. There was substantial variation in PA opportunities between schools. Higher opportunity was associated with role modeling of PA by school principals, their interest in increasing PA through links to the municipality, adequate financial and human resources, access to school sports facilities, adequate space for storing student sports equipment, and suburban location. There is both the need and the potential for intervention to increase PAopportunities in elementary schools. Addressing barriers related to resources and access to sports facilities may help reduce disparities between schools in opportunities for students to engage in PA.

Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988-1994 Through 2013-2014

IMPORTANCE

Previous analyses of obesity trends among children and adolescents showed an increase between 1988-1994 and 1999-2000, but no change between 2003-2004 and 2011-2012, except for a significant decline among children aged 2 to 5 years.

OBJECTIVES

To provide estimates of obesity and extreme obesity prevalence for children and adolescents for 2011-2014 and investigate trends by age between 1988-1994 and 2013-2014.

DESIGN, SETTING, AND PARTICIPANTS

Children and adolescents aged 2 to 19 years with measured weight and height in the 1988-1994 through 2013-2014 National Health and Nutrition Examination Surveys.

EXPOSURES

Survey period.

MAIN OUTCOMES AND MEASURES

Obesity was defined as a body mass index (BMI) at or above the sex-specific 95th percentile on the US Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts. Extreme obesity was defined as a BMI at or above 120% of the sex-specific 95th percentile on the CDC BMI-for-age growth charts. Detailed estimates are presented for 2011-2014. The analyses of linear and quadratic trends in prevalence were conducted using 9 survey periods. Trend analyses between 2005-2006 and 2013-2014 also were conducted.

RESULTS

Measurements from 40,780 children and adolescents (mean age, 11.0 years; 48.8% female) between 1988-1994 and 2013-2014 were analyzed. Among children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% (95% CI, 15.5%-18.6%) and extreme obesity was 5.8% (95% CI, 4.9%-6.8%). Among children aged 2 to 5 years, obesity increased from 7.2% (95% CI, 5.8%-8.8%) in 1988-1994 to 13.9% (95% CI, 10.7%-17.7%) (P < .001) in 2003-2004 and then decreased to 9.4% (95% CI, 6.8%-12.6%) (P = .03) in 2013-2014. Among children aged 6 to 11 years, obesity increased from 11.3% (95% CI, 9.4%-13.4%) in 1988-1994 to 19.6% (95% CI, 17.1%-22.4%) (P < .001) in 2007-2008, and then did not change (2013-2014: 17.4% [95% CI, 13.8%-21.4%]; P = .44). Obesity increased among adolescents aged 12 to 19 years between 1988-1994 (10.5% [95% CI, 8.8%-12.5%]) and 2013-2014 (20.6% [95% CI, 16.2%-25.6%]; P < .001) as did extreme obesity among children aged 6 to 11 years (3.6% [95% CI, 2.5%-5.0%] in 1988-1994 to 4.3% [95% CI, 3.0%-6.1%] in 2013-2014; P = .02) and adolescents aged 12 to 19 years (2.6% [95% CI, 1.7%-3.9%] in 1988-1994 to 9.1% [95% CI, 7.0%-11.5%] in 2013-2014; P < .001). No significant trends were observed between 2005-2006 and 2013-2014 (P value range, .09-.87).

CONCLUSIONS AND RELEVANCE

In this nationally representative study of US children and adolescents aged 2 to 19 years, the prevalence of obesity in 2011-2014 was 17.0% and extreme obesity was 5.8%. Between 1988-1994 and 2013-2014, the prevalence of obesity increased until 2003-2004 and then decreased in children aged 2 to 5 years, increased until 2007-2008 and then leveled off in children aged 6 to 11 years, and increased among adolescents aged 12 to 19 years.