Overweight, fat patterning, and cardiovascular disease risk factors in black and white girls: The National Heart, Lung, and Blood Institute Growth and Health Study

Birth History and Cardiovascular Disease Risk Among Youth With Significant Obesity

Children born prematurely have greater lifetime risk for hypertension. We aimed to determine (1) the association between prematurity and cardiovascular disease (CVD) risk factors among 90 children with obesity and elevated blood pressure and (2) if dietary sodium intake modified these associations. Multivariable regression analysis explored for associations between prematurity (<37 weeks gestation; early gestational age) and low birth weight (<2.5 kg) with hypertension, left ventricular mass index (LVMI), and left ventricular hypertrophy (LVH). Effect modification by dietary sodium intake was also explored. Patients were predominately male (60%), black (78%), adolescents (13.3 years), and with substantial obesity (body mass index: 36.5 kg/m2). Early gestational age/low birth weight was not an independent predictor for hypertension, LVMI, or LVH. There was no effect modification by sodium load. Our results suggest the increased CVD risk conferred by prematurity is less significant at certain cardiometabolic profiles. Promoting heart-healthy lifestyles to prevent pediatric obesity remains of utmost importance to foster cardiovascular health.

Highly processed food intake and immediate and future emotions in everyday life

Increased consumption of highly processed foods may result in lower diet quality, and low diet quality is associated with elevated risk of cardiovascular disease, type 2 diabetes, and cancer. One mechanism driving highly processed food intake is the expectation that eating these foods will improve emotional experiences, particularly in individuals with elevated "highly processed food addiction" symptoms. However, experimental findings about the emotional experiences following highly processed food intake are mixed. Furthermore, prior studies have generally failed to capture the potentially prolonged emotional effects of eating highly processed foods and not tested for individual differences. The present study was a preregistered archival data analysis of an ambulatory electronic diary study that captured real-life emotions following highly processed food intake. Multilevel modeling was used to predict the effects of highly processed food intake on subsequent positive and negative emotions immediately, 1 h, and 3 h after consumption. Intake of sweet high-fat foods, fast foods, and non-alcoholic sugary drinks was associated with greater positive emotions immediately after eating, and sweet high-fat food intake remained associated with greater positive emotions 1 h later. Sweet high-fat food and non-alcoholic sugary drink intake were associated with fewer negative emotions 1 h after consumption, and the negative association between non-alcoholic sugary drink intake and negative emotions was stronger for those with elevated highly processed food addiction symptoms. Overall, results suggest that highly processed food intake results in small alterations in positive and negative emotions immediately and up to 1 h after intake; however, these do not persist through 3 h after intake. The ability of highly processed foods to briefly alter emotions may be key to their reinforcing nature.

Causative Mechanisms of Childhood and Adolescent Obesity Leading to Adult Cardiometabolic Disease: A Literature Review

The past few decades have shown a worrisome increase in the prevalence of obesity and its related illnesses. This increasing burden has a noteworthy impact on overall worldwide mortality and morbidity, with significant economic implications as well. The same trend is apparent regarding pediatric obesity. This is a particularly concerning aspect when considering the well-established link between cardiovascular disease and obesity, and the fact that childhood obesity frequently leads to adult obesity. Moreover, most obese adults have a history of excess weight starting in childhood. In addition, given the cumulative character of both time and severity of exposure to obesity as a risk factor for associated diseases, the repercussions of obesity prevalence and related morbidity could be exponential in time. The purpose of this review is to outline key aspects regarding the current knowledge on childhood and adolescent obesity as a cardiometabolic risk factor, as well as the most common etiological pathways involved in the development of weight excess and associated cardiovascular and metabolic diseases.

Early-Pregnancy Dydrogesterone Supplementation Mimicking Luteal-Phase Support in ART Patients Did Not Provoke Major Reproductive Disorders in Pregnant Mice and Their Progeny

Progestogens are frequently administered during early pregnancy to patients undergoing assisted reproductive techniques (ART) to overcome progesterone deficits following ART procedures. Orally administered dydrogesterone (DG) shows equal efficacy to other progestogens with a higher level of patient compliance. However, potential harmful effects of DG on critical pregnancy processes and on the health of the progeny are not yet completely ruled out. We treated pregnant mice with DG in the mode, duration, and doses comparable to ART patients. Subsequently, we studied DG effects on embryo implantation, placental and fetal growth, fetal-maternal circulation, fetal survival, and the uterine immune status. After birth of in utero DG-exposed progeny, we assessed their sex ratios, weight gain, and reproductive performance. Early-pregnancy DG administration did not interfere with placental and fetal development, fetal-maternal circulation, or fetal survival, and provoked only minor changes in the uterine immune compartment. DG-exposed offspring grew normally, were fertile, and showed no reproductive abnormalities with the exception of an altered spermiogram in male progeny. Notably, DG shifted the sex ratio in favor of female progeny. Even though our data may be reassuring for the use of DG in ART patients, the detrimental effects on spermatogenesis in mice warrants further investigations and may be a reason for caution for routine DG supplementation in early pregnancy.

The Relationship between Body Mass Index and Physical Fitness among Chinese University Students: Results of a Longitudinal Study

Over the past few decades, a gradual increase in sedentary lifestyles along with the increased consumption of a modern, hypercaloric diet has resulted in a substantial increase in the number of those classified as overweight or obese in China. The prevalence of overweight and obesity has become a key public health issue. However, it is important to be cautious when interpreting the literature as the majority of studies apply cross-sectional data to assess and subjectively compare the relationship between physical fitness and being overweight and obese. In the present study, longitudinal data were collected from 3066 students (enrolled in 2014) at a university in China at the beginning of each academic year throughout their four-year university program. The aim of this study was to analyze the various associations between BMI, explosive power, flexibility, and cardiorespiratory endurance, and a random-intercept panel model (RIPM) was separately employed on male and female participants to identify between- and within-person variations. In this way, the associations for between-person physical fitness and normal/overweight/obese weight ranges, and for within-person physical fitness and normal/overweight/obese weight ranges could be observed. The results of this study revealed that every physical fitness test chosen for evaluation (such as the standing long jump for explosive power or the distance run for cardiorespiratory endurance) was negatively related to the BMI results, irrespective of sex, with the notable exception of the flexibility results. In addition, this study showed that both males and females exhibited positively correlated results in both between-person BMI and flexibility as well as within-person BMI and flexibility. Furthermore, the relationships between and within persons of cardiorespiratory endurance, explosive power, and flexibility all showed positive correlations across both sexes. The dynamics between physical fitness and BMI identified in this study could prove useful to practitioners and researchers investigating such relationships in the future.

Do the Same Central Anthropometric Variables that Best Predict Blood Pressure in European Americans also Best Predict Blood Pressure in African Americans?

Objective

The purpose of this study was to determine if central anthropometric variables that best estimate blood pressure risks in European Americans also best estimate blood pressure risks in African Americans.

Design

The participants were 357 normotensive African and European American volunteers with a mean age of 32.6 ± 12.4 years. Participants were evaluated for central adiposity with dual energy X-ray absorptiometry, abdomen and thigh skinfolds, waist and hip circumferences, waist/hip ratio, waist/height ratio, body mass index, and systolic and diastolic blood pressures. Descriptive statistics, partial correlations, ANOVA and stepwise regressions were used to analyze the data.

Results

Central adiposity anthropometric indices made different contributions to blood pressure in African and European American men and women. When weight was held constant, waist circumference shared stronger partial relationships with blood pressure in African Americans (r = .30 to .47) than in European Americans (r = .11 to .32). Waist circumference in combination with other indices was a predictor of systolic and diastolic blood pressures in European American men (P<.05) but only a predictor for diastolic blood pressure in African American men and women (P<.01). Hip circumference was the only predictor for systolic blood pressure (P<.01) in African American men and women.

Conclusions

Further research on the relative contributions of central anthropometric indices to blood pressure in African and European Americans is warranted. A better understanding of this relationship may help reduce hypertensive morbidity and mortality disparities between African and European Americans.

Childhood obesity and the associated rise in cardiometabolic complications

Childhood obesity is one of the most serious global public-health challenges of the twenty-first century. Over the past four decades, the number of children and adolescents with obesity has risen more than tenfold. Worldwide, an increasing number of youth are facing greater exposure to obesity throughout their lives, and this increase will contribute to the early development of type 2 diabetes, fatty liver and cardiovascular complications. Herein, we provide a brief overview of trends in the global shifts in, and environmental and genetic determinants of, childhood obesity. We then discuss recent progress in the elucidation of the central role of insulin resistance, the key element linking obesity and cardiovascular-risk-factor clustering, and the potential mechanisms through which ectopic lipid accumulation leads to insulin resistance and its associated cardiometabolic complications in obese adolescents. In the absence of effective prevention and intervention programs, childhood obesity will have severe public-health consequences for decades to come.

The Effect of Bisphenol A on Puberty: A Critical Review of the Medical Literature

Many scientific studies have revealed a trend towards an earlier onset of puberty and have disclosed an increasing number of children that display precocious puberty. As an explanation, some authors have considered the global socio-economic improvement across different populations, and other authors have considered the action of endocrine disrupting chemicals (EDCs). Among these, bisphenol A (BPA), an aromatic compound largely used worldwide as a precursor of some plastics and chemical additives, is well known for its molecular oestrogen-like and obesogenic actions. We reviewed the medical literature of the previous 20 years that examined associations between BPA exposure and the age of puberty in humans, considering only those referring to clinical or epidemiological data. Of 19 studies, only 7 showed a correlation between BPA and puberty. In particular, the possible disruptive role of BPA on puberty may be seen in those with central precocious puberty or isolated premature breast development aged 2 months to 4 years old, even if the mechanism is undefined. Some studies also found a close relationship between urinary BPA, body weight, and early puberty, which can be explained by the obesogenic effect of BPA itself. The currently available data do not allow establishment of a clear role for BPA in pubertal development because of the conflicting results among all clinical and epidemiological studies examined. Further research is needed to fully understand the potential role of exposure to EDCs and their adverse endocrine health outcomes.

Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association

Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.

Prevalence and Costs of Five Chronic Conditions in Children

The objective is to examine the prevalence and health-care costs associated with asthma, epilepsy, hypertension, food allergies, and diabetes in children aged 0-18 years. Prevalence was calculated using 2005-2012 Medical Expenditure Panel Survey (MEPS) data, a population-based, nationally representative sample. Using MEPS, two-part models estimated the cost of each condition for all children while controlling for sociodemographic categories. Prevalence rates varied by race and ethnicity across conditions. Females had higher prevalence of all chronic conditions, except epilepsy. An additional US$1,377.60-US$9,059.49 annually were spent on medical expenses for children aged 0-18 years, with asthma, diabetes, or epilepsy compared to children without these conditions. This is the first study to examine the costs and prevalence of chronic health conditions in children and adolescents using a single data set. Understanding the odds of having a condition by sociodemographic categories highlights disparities that can potentially inform school nurses on the best allocation of resources to serve students.

Ultrasound measurement of pediatric visceral fat thickness: correlations with metabolic and liver profiles

PURPOSE

Abdominal obesity is a fundamental factor underlying the development of metabolic syndrome. Because of radiation exposure and cost, computed tomography or dual-energy X-ray absorptiometry to evaluate abdominal adiposity are not appropriate in children. Authors evaluated whether ultrasound results could be an indicator of insulin resistance and nonalcoholic fatty liver disease (NAFLD).

METHODS

We enrolled 73 subjects (aged 6-16 years) who were evaluated abdominal adiposity by ultrasound. Subcutaneous fat thickness was defined as the measurement from the skin-fat interface to the linea alba, and visceral fat thickness (VFT) was defined as the thickness from the linea alba to the aorta. Anthropometric and biochemical metabolic parameters were also collected and compared. The subjects who met 2 criteria, radiologic confirmed fatty liver and alanine aminotransferase >40, were diagnosed with NAFLD.

RESULTS

There was a strong positive correlation between VFT and obesity. VFT was highly correlated with the homeostasis model assessment for insulin resistance score (r=0.403, P<0.001). The area under the curve for VFT as a predictor of NAFLD was 0.875 (95% confidence interval [CI], 0.787-0.964). VFT of 34.3 mm was found to be the discriminating cutoff for NAFLD (sensitivity, 84.6%; specificity, 71.2%, respectively).

CONCLUSION

Ultrasound could be useful in measuring VFT and assessing abdominal adiposity in children. Moreover, increased VFT might be an appropriate prognostic factor for insulin resistance and NAFLD.

Childhood obesity: prevention is better than cure

Obesity and its associated comorbidities have emerged as a major health problem garnering interests from both public health agencies and mainstream media consumers. With increasing awareness on its impact on health, finances, and community at large, it has come to the forefront for scientific research and development of health plans. The need for better strategies and novel interventions to manage obesity is now being recognized by the entire health care system. Obesity and overweight is now the fifth leading global risk factor for mortality. Strategic investment is thus urgently needed to implement population-based childhood obesity prevention programmes which are effective and also culturally appropriate. Population-based prevention is crucial to stem this rising tide of childhood obesity which is fast reaching epidemic proportions. Obesity has its onset very early in life; therefore, children constitute a major group of this disease. It is thus imperative to lay utmost importance on prevention of obesity in children and herald its progress, if present already. Furthermore, treatment is still in preliminary stage, so early prevention holds better than treatment at later stages. This article is an attempt to lay emphasis on childhood obesity as a problem that needs to be recognized early and measures for its prevention.

Non-high-density lipoprotein cholesterol: distribution and prevalence of high serum levels in children and adolescents: United States National Health and Nutrition Examination Surveys, 2005-2010

OBJECTIVES

To estimate age-related changes for serum concentration of non-high-density lipoprotein cholesterol (HDL-C), describe non-HDL-C distribution, and examine the prevalence of high non-HDL-C levels in children and adolescents by demographic characteristics and weight status.

STUDY DESIGN

Data from 7058 participants ages 6-19 years in the 2005-2010 National Health and Nutrition Examination Surveys were analyzed. A high level of non-HDL-C was defined as a non-HDL-C value ≥ 145 mg/dL.

RESULTS

Locally weighted scatterplot smoothing-smoothed curves showed that non-HDL-C levels increased from 101 mg/dL at age 6 to 111 mg/dL at age 10, decreased to 101 mg/dL at age 14, and then increased to 122 mg/dL at age 19 in non-Hispanic white males. Non-HDL-C levels generally were greater in female than male subjects, lower in non-Hispanic black subjects, and similar in male and slightly lower in female Mexican American subjects, compared with non-Hispanic white subjects. The overall mean was 108 (SE 0.5), and the percentiles were 67 (5th), 74 (10th), 87 (25th), 104 (50th), 123 (75th), 145 (90th), and 158 (95th) mg/dL. Mean and percentiles were greater among age groups 9-11 and 17-19 years than others and greater among non-Hispanic white than non-Hispanic black subjects. The prevalence of high non-HDL-C was 11.8% (95% CI 9.9%-14.0%) and 15.0% (95% CI 12.9%-17.3%) for the age groups 9-11 and 17-19, respectively. It varied significantly by race/ethnicity and overweight/obesity status.

CONCLUSION

Non-HDL-C levels vary by age, sex, race/ethnicity, and weight classification status. Evaluation of non-HDL-C in youth should account for its normal physiologic patterns and variations in demographic characteristics and weight classification.

Risk factors for overweight/obesity in preschool children: an ecological approach

BACKGROUND

Identification of risk factors is critical to preventing the childhood obesity epidemic. Risk factors that contribute to obesity are multifactorial. However, limited research has focused on identifying obesity risk factors using an ecological approach.

METHODS

Baseline self-report survey data from the STRONG Kids program were used. The sample consisted of 329 parent-child dyads recruited from childcare programs in east-central Illinois. Child height and weight were measured and converted to age- and sex-specific z-scores using standard growth charts. An ecological model provided the theoretical framework for the selection of 22 previously reported childhood obesity risk factors. Multiple logistic regression analyses were used to identify risk factors.

RESULTS

Of 22 potential risk factors, three were found to be significantly associated with child overweight/obesity. These included child nighttime sleep duration (χ(2)=8.56; p=0.003), parent BMI (χ(2)=5.62; p=0.01), and parental restrictive feeding for weight control (χ(2)=4.77; p=0.02). Children who slept for 8 hours and less were 2.2 times more likely to be overweight/obese [95% confidence interval (CI): 1.3-3.7), whereas children with an overweight/obese parent were 1.9 times more likely to be overweight/obese (95% CI: 1.12-3.2). Finally, children whose parents used restrictive feeding practices were 1.75 times more likely to be overweight/obese (95% CI: 1.06-2.9).

CONCLUSIONS

Using an ecological approach, we conclude that childhood obesity prevention efforts may benefit from targeting the key risk factors of child sleep duration, parent BMI, and parental restrictive feeding practices as focus areas for obesity prevention.

Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association

Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks.

Gender differences in physiologic markers and health behaviors associated with childhood obesity

BACKGROUND

Previous studies have demonstrated gender-related differences in body composition, physical activity, and diet. This observational study assesses gender variance in independent predictors for obesity to determine targeted areas for intervention.

METHODS

Data from 1714 sixth-grade students enrolled in Project Healthy Schools were compared by using health behaviors and physiologic markers (lipids, random glucose, blood pressure, and resting and recovery heart rates). Students were stratified by gender and obesity (BMI ≥95th percentile by age and gender). Physiologic markers and behaviors were compared by using χ(2) analysis. Univariate associations with P < .10 were included in a stepwise logistic regression model to determine independent predictors for obesity by gender.

RESULTS

Nonobese students (both boys and girls) showed significantly healthier physiologic parameters compared with their obese counterparts. Two behaviors independently correlated with obesity in both boys and girls: regularly eating school lunches (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.01-1.64; OR 1.27, 95% CI 1.00-1.62, respectively) and watching ≥2 hours of television per day (OR 1.19, 95% CI 1.07-1.32; OR 1.19, 95% CI 1.06-1.34, respectively). Vigorous physical activity and involvement in school sports teams appeared to be protective against obesity in boys (OR 0.90, 95% CI 0.82-0.98; OR 0.77, 95% CI 0.64-0.94, respectively), whereas milk consumption appeared protective in girls (OR 0.81, 95% CI 0.67-0.98).

CONCLUSIONS

Among middle-school children, we observed gender-related differences in factors associated with obesity. Additional research is warranted to determine the beneficial impact of improving school lunches and decreasing screen time, while improving our understanding of gender-related differences in milk consumption and physical activities in relation to BMI.

Academy of Nutrition and Dietetics benchmarks for nutrition in child care 2011: are child-care providers across contexts meeting recommendations?

The Academy of Nutrition and Dietetics (Academy) recommends feeding practices for child-care providers to establish nutrition habits in early childhood to prevent obesity. With >12 million US children in child care, little is known about child-care providers' feeding practices. The purpose of this study was to examine child-care providers' feeding practices to assess whether providers met the Academy's benchmarks and whether attainment of benchmarks varied across child-care contexts (Head Start, Child and Adult Care Food Program [CACFP], and non-CACFP). Cross-sectional data was collected in 2011 and 2012 from 118 child-care providers who completed self-administered surveys regarding their feeding practices for 2- to 5-year-old children. χ(2) tests and analysis of variance were used to determine variation across contexts. Head Start providers sat more frequently with children during meals (P=0.01), ate the same foods as children (P=0.001), and served meals family style (P<0.0001) more often compared with CACFP and non-CACFP providers. Head Start providers (P=0.002), parents (P=0.001), and children (P=0.01) received more nutrition-education opportunities compared with CACFP and non-CACFP. Head Start providers encouraged more balance and variety of foods (P<0.05), offered healthier foods (P<0.05), modeled healthy eating (P<0.001), and taught children about nutrition (P<0.001) compared with CACFP and non-CACFP providers. Providers across all three contexts used significantly more non-internal than internal mealtime verbal comments (P<0.0001). Head Start providers had greater compliance with the Academy's benchmarks compared with CACFP and non-CACFP providers. Possible reasons for this compliance might be attributed to Head Start nutrition performance standards and increased nutrition-training opportunities for Head Start staff. Head Start programs can serve as a model in implementing the Academy's benchmarks.

Adiposity markers and cardiovascular risk in urban Colombian adolescents: heterogeneity in association patterns

OBJECTIVE

The aim of this study was to evaluate the relationship of tricipital (TS), abdominal (AS), subscapular (SS), and suprailiac (SIS) skinfolds, Body Mass Index (BMI), and Waist Circumference (WC) with 1) variables related to cardiovascular risk (CVR) and 2) the clustering of cardiovascular risk factors (CVRF) - referenced pediatric cut-off points - in a multivariate analysis.

MATERIALS/METHODS

The sample was 1672 adolescents. Glucose, lipid profile, blood pressure and anthropometric variables were measured.

RESULTS

Adjusting for age, gender, and caloric intake, the highest quartile (Q4) of adiposity markers was associated to Q4 of biochemical and blood pressure variables. However, the association was not found for WC, SS and TS with glucose, and for diastolic blood pressure (DBP) with TS, SS, and SIS. Triglycerides Q4 was related to Q4 of SS, AS, and SIS after further adjustments, as well as HDL cholesterol (HDL-C) Q1 with Q4 of SS and AS. Glucose Q4 was associated to BMI, AS (Not adjusting for BMI and SIS), and SIS Q4 (Not adjusting for BMI and TS). LDL-Cholesterol (LDL-C) Q4 was associated to TS and SS Q4. The associations of LDL-C Q4 and HDL-C Q1 with WC Q4 were not significant after further adjustments. All the adiposity markers, except WC and TS, were associated to CVRF clustering in all the adjustments.

CONCLUSIONS

In the adolescents, subcutaneous fat from the trunk (SS, AS, SIS) was better and independently associated to CVR variables and with CVRF clustering than visceral fat (WC). Further research is required to explain the specificity in the described associations.

Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore

Introduction: This study examines the prevalence of overweight and obesity in 6- to 72-month-old Chinese preschoolers in Singapore using 3 references. Materials and Methods: This was a population-based cross-sectional study of 3009 Chinese preschoolers aged 6 to 72 months from southwestern and western parts of Singapore. Overweight and obesity were defi ned by using the Center for Disease Control (CDC) (85th and 95th percentile, respectively), the International Obesity Task Force (IOTF) and the local National Health Group Polyclinics (NHGP), Singapore (90th and 97th percentile, respectively) references. Results: The prevalence of overweight and obesity in 24 to 72 months old Chinese children were 8.1% and 7.1% (the CDC reference), 7.6% and 3.9% (the IOTF reference) and 7.5% and 5.3% (the local reference [NHGP]) respectively. For preschoolers aged 6 to 72 months, the prevalence of overweight and obesity was 7.0% and 5.3%, respectively, using the local reference. An increasing trend in the prevalence of obesity with increasing age was seen in both genders, using the CDC and IOTF references (P ≤0.001 and 0.001, respectively). The boys were more likely to be obese than the girls using the CDC reference (OR = 1.42, 95% CI, 1.02 to 1.97, P = 0.03). Conclusion: Our study showed a lower prevalence of overweight and obesity among Chinese preschoolers in Singapore when compared to other countries like the United States, Italy, Chile using the CDC and/or IOTF references. The CDC reference overestimated whereas the IOTF reference underestimated the prevalence of overweight and obesity for our population when compared to using the local NHGP reference. Key words: CDC, Cross-sectional, IOTF, Population-based

Comparison of Visceral Adipose Tissue Mass in Adult African Americans and Whites**

OBJECTIVE

Previous studies have reported racial differences in the amount of visceral adipose tissue (VAT), a risk factor for metabolic diseases. These results are equivocal and have not controlled for hormonal influences on VAT mass. This study was designed to measure the extent to which race is associated with VAT, controlling for total adipose tissue (TAT) mass and testosterone.

RESEARCH METHODS AND PROCEDURES

Using a cross-sectional study design, we measured TAT mass using DXA, VAT and subcutaneous adipose tissue mass using magnetic resonance imaging, and sex hormones using radioimmunoassay in 224 African-American and white men and women.

RESULTS

White men had increased VAT mass, even when controlling for TAT and age, compared with African-American men. White women also had a higher VAT mass compared with African-American women, but only when controlling for TAT and age. When multiple linear regression was used to evaluate the racial differences in VAT mass in a subset of subjects (n=80), controlling for sex hormones, it was found that white men, but not women, had increased VAT mass compared with their African-American counterparts.

DISCUSSION

Based on the results of this study, we conclude that, when controlling for TAT, sex hormone levels, and age, white men, but not women, have more VAT mass than African-American men and women. Additional studies are needed to explore possible environmental and genetic influences on fat distribution relative to race and sex.

Nutritional quality of foods and beverages on child-care centre menus in Mexico

OBJECTIVE

The purpose of the present study was to assess the nutritional quality of foods and beverages listed on menus serving children in government-sponsored child-care centres throughout Mexico.

DESIGN

For this cross-sectional menu assessment, we compared (i) food groups and portion sizes of foods and beverages on the menus with MyPlate recommendations and (ii) macronutrients, sugar and fibre with Daily Reference Intake standards.

SETTING

Menus reflected foods and beverages served to children attending one of 142 government-sponsored child-care centres throughout Mexico.

SUBJECTS

There were fifty-four distinct menus for children aged 4–6 months, 7–9 months, 10–12 months, 13–23 months, 24–47 months and 48–72 months.

RESULTS

Menus included a variety of foods meeting minimum MyPlate recommendations for each food category except whole grains for children aged 48–72 months. Menus listed excessive amounts of high-energy beverages, including full-fat milk, fruit juice and sugar-sweetened beverages for children of all ages. The mean daily energy content of menu items yielded an average of 2?76 MJ for infants, 4.77 MJ for children aged 13–23 months, 5.36 MJ for children aged 24–47 months and 5.87 MJ for children aged 48–72 months. Foods and beverages on menus provided sufficient grams of carbohydrate and fat, but excessive protein.

CONCLUSIONS

Menus provided a variety of foods but excessive energy. Whole grains were limited, and high-energy beverages were prevalent. Both may be appropriate targets for nutrition intervention. Future studies should move beyond menus and assess what children actually consume in child care.

The economic burden placed on healthcare systems by childhood obesity

The obesity epidemic has transformed children's healthcare, such that diabetes, hypertension and the metabolic syndrome are phrases more commonly used by child health providers than ever before. This article reviews the economic consequences of this epidemic for healthcare delivery systems, both in the short term when obesity has been associated with increased utilization, and in the long term where increased likelihood of adult obesity and cardiovascular disease is well documented. Large investments through research and prevention are needed and are likely to provide strong returns in cost savings, and would optimally emerge through a cooperative effort between private and government payers alike.

An economic perspective on childhood obesity: recent findings on cost of illness and cost effectiveness of interventions

OBJECTIVE

This review aims to put an economic perspective on childhood and adolescent obesity by providing an overview on the latest literature on obesity-related costs and the cost effectiveness of interventions to prevent or manage the problem.

METHODS

The review is based on a comprehensive PubMed/Medline search performed in October 2011.

RESULTS

Findings on the economic burden of childhood obesity are inconclusive. Considering the different cost components and age groups, most but not all studies found excess health care costs for obese compared with normal-weight peers. The main limitations relate to short study periods and the strong focus on health care costs, neglecting other components of the economic burden of childhood obesity. The results of the economic evaluations of childhood and adolescent obesity programs support the expectation that preventive and management interventions with acceptable cost effectiveness do exist. Some interventions may even be cost saving. However, owing to the differences in various methodologic aspects, it is difficult to compare preventive and treatment approaches in their cost effectiveness or to determine the most cost-effective timing of preventive interventions during infancy and adolescence.

CONCLUSION

To design effective public policies against the obesity epidemic, a better understanding and a more precise assessment of the health care costs and the broader economic burden are necessary but, critically, depend on the collection of additional longitudinal data. The economic evaluation of childhood obesity interventions poses various methodologic challenges, which should be addressed in future research to fully use the potential of economic evaluation as an aid to decision making.

Childhood obesity and cardiovascular disease

Childhood obesity has reached epidemic proportions. Many of these children have risk factors for later disease, including cardiovascular disease. For optimal cardiovascular health, health care professionals must be able to identify children and youth at risk and provide appropriate support as needed. The present article reviews the current medical literature on obesity and cardiovascular disease risk factors in the paediatric population, the long-term cardiovascular consequences of childhood obesity and the importance of early life. Recommendations promoting optimal cardiovascular health in all children and youth are discussed.

Effects of early prepubertal exposure to bisphenol A on the onset of puberty, ovarian weights, and estrous cycle in female mice

OBJECTIVE

Bisphenol A (BPA) is a chemical used extensively to manufacture plastics and epoxy resin liners for food and beverage cans. BPA, with properties similar to estrogen, has endocrine-disrupting effects. In the present study, we examined the effects of early prepubertal BPA exposure on the onset of puberty and reproductive parameters such as estrous cycle and reproductive organ weights in female mice.

METHODS

Female mice were injected subcutaneously at postnatal day (PND) 8 with BPA (0.1, 1, 10, 100 mg/kg) in sesame oil or with sesame oil alone. Body weight was measured from PND 10 to 70. Vaginal opening and estrous cycle were monitored from PND 20 to 29. Animals were sacrificed at PND 25, 30, and 70, and the ovary and uterus weights were measured.

RESULTS

Early prepubertal exposure to BPA (10 and 100 mg/kg) significantly decreased body weight from PND 18 to 30. BPA treated mice at testing dose levels showed early opening of the vagina compared to the control group. The number of estrous cycle and days of estrus were significantly decreased in high dose (100 mg/kg) BPA treated mice. The ovary weight at PND 25 and 30 was significantly decreased in all BPA treatment groups.

CONCLUSION

Early prepubertal exposure to BPA accelerated the onset of puberty but decreased reproductive parameters in female mice.

Associations of BMI and its fat-free and fat components with blood lipids in children: Project HeartBeat!

AIM: This study aimed to distinguish between the roles of the two components of BMI, the fat mass (FM) index and the fat-free mass (FFM) index, in BMI's association with blood lipids in children and adolescents. METHODS: A total of 678 children (49.1% female, 79.9% non-black), initially aged 8, 11 and 14 years, were followed at 4-month intervals for up to 4 years (1991-1995). Total cholesterol (TC), LDL-C, HDL-C and triglycerides were determined in fasting blood samples. FFM index and FM index were calculated as FFM (kg)/height (m)(2) and FM (kg)/height (m)(2), respectively. Using a multilevel linear model, repeated measurements of blood lipids were regressed on concurrent measures of BMI or its components, adjusting for age, sex and race and, in a subsample, also for physical activity, energy intake and sexual maturity. RESULTS: Estimated regression coefficients for the relations of TC with BMI, FFM index and FM index were 1.539, -0.606 (p > 0.05) and 3.649, respectively. When FFM index and FM index were entered into the TC model simultaneously, regression coefficients were -0.855 and 3.743, respectively. An increase in BMI was related to an increase in TC; however, an equivalent increase in FM index was related to a greater increase in TC and, when FFM index was tested alone or with FM index, an increase in FFM index was related to a decrease in TC. Similar results were observed for LDL-C. FFM index and FM index were both inversely related to HDL-C and directly to triglycerides. Compared with FFM index, the equivalent increase in FM index showed a greater decrease in HDL-C. CONCLUSION: Greater BMI was related to adverse levels of blood lipids in children and adolescents, which was mainly attributable to BMI's fat component. It is important to identify weight management strategies to halt the childhood obesity epidemic and subsequently prevent heart disease in adulthood.

[Classic and emergent cardiovascular risk factors in schoolchildren in Asturias]

INTRODUCTION

Classic cardiovascular risk factors are present in infancy. C-reactive protein, leptin and adiponectin are the most important inflammatory cardiovascular risk markers.

PATIENTS AND METHODS

A descriptive, cross-sectional study, including children aged 6-12 years old from two local primary schools in the city of Avilés. Body measurements were made to determine the prevalence of obesity and overweight. Systolic and diastolic blood pressure was measured and the presence of metabolic syndrome was determined. Family income, dietary, and life-style habits were collected using the questionnaires GRAFFAR, KIDMED and Self-report instruments for measuring physical activity, respectively. Blood analysis included lipid profile, insulin resistance profile, liver profile, C-reactive protein, leptin and adiponectin.

RESULTS

A total of 459 schoolchildren were included of whom 31% were overweight and 10.9% were obese. Obese children were heavier with higher levels of body mass index, waist circumference, blood pressure, C- reactive protein, leptin, and lower levels of HDL-cholesterol and apolipoprotein A than non-obese children. No differences were found in physical and sedentary activities, but obese children had a worse quality diet than non-obese children.

CONCLUSIONS

Prevalence of obesity and overweight is reaching worrying levels in school age children. Obesity is associated with other classic and inflammatory cardiovascular risk factors. Obese children have a worse quality diet, although they do not do any less physical activities or any more sedentary than non-obese children.

The relative importance of predictors of body mass index change, overweight and obesity in adolescent girls

OBJECTIVE

To determine the relative importance of familial, dietary, behavioral, psychological and social risk factors for predicting body mass index (BMI) change, and onset of overweight and obesity among adolescent girls.

METHODS

Data from the NHLBI Growth and Health Study (n = 2 150), a longitudinal cohort of girls, were used to identify the most important predictors of change in BMI percentile between the ages of 9 and 19 years, and second, risk for becoming overweight and obese. Forty-one baseline predictors were assessed using a tree-based regression method (Random forest) to rank the relative importance of risk factors.

RESULTS

The five factors that best predicted change in BMI percentile (p < 0.05) were related to family socio-economic position (income and parent education) and drive to restrict eating and weight (body dissatisfaction, drive for thinness and unhappiness with physical appearance). The factors that were statistically significant (p < 0.05) predictors of both onset of overweight and obesity were income, ineffectiveness and race.

CONCLUSIONS

Family socio-economic position and emotion regulation appeared as the top predictors of both BMI change and onset of overweight and obesity. Our results build upon prior findings that policies to prevent the onset of obesity during adolescence be targeted towards girls from lower socio-economic position households. Our findings also suggest several novel psychological factors including ineffectiveness as predictors of obesity during adolescence. These predictive findings offer a direction for future inquiry into adolescent obesity etiology using causal methods.

Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment

Overweight and obesity in youth is a worldwide public health problem. Overweight and obesity in childhood and adolescents have a substantial effect upon many systems, resulting in clinical conditions such as metabolic syndrome, early atherosclerosis, dyslipidemia, hypertension and type 2 diabetes (T2D). Obesity and the type of body fat distribution are still the core aspects of insulin resistance and seem to be the physiopathologic links common to metabolic syndrome, cardiovascular disease and T2D. The earlier the appearance of the clustering of risk factors and the higher the time of exposure, the greater will be the chance of developing coronary disease with a more severe endpoint. The age when the event may occur seems to be related to the presence and aggregation of risk factors throughout life.The treatment in this age-group is non pharmacological and aims at promoting changes in lifestyle. However, pharmacological treatments are indicated in special situations.The major goals in dietary treatments are not only limited to weight loss, but also to an improvement in the quality of life. Modification of risk factors associated to comorbidities, personal satisfaction of the child or adolescent and trying to establish healthy life habits from an early age are also important. There is a continuous debate on the best possible exercise to do, for children or adolescents, in order to lose weight. The prescription of physical activity to children and adolescents requires extensive integrated work among multidisciplinary teams, patients and their families, in order to reach therapeutic success.The most important conclusion drawn from this symposium was that if the growing prevalence of overweight and obesity continues at this pace, the result will be a population of children and adolescents with metabolic syndrome. This would lead to high mortality rates in young adults, changing the current increasing trend of worldwide longevity. Government actions and a better understanding of the causes of this problem must be implemented worldwide, by aiming at the prevention of obesity in children and adolescents.

Eating behaviors of children in the context of their family environment

Both a family history of obesity and early childhood obesity have been identified as strong predictors of adult obesity risk. The finding that parental obesity, maternal obesity in particular, increases a child's risk for developing obesity suggests that either shared genes, or environment, or likely a combination of both may promote overeating and excessive weight gain in children. Parents not only create food environments for children's early experiences with food and eating, but they also influence their children's eating by modeling their own eating behaviors, taste preferences, and food choices. Thus, it is important to identify intermediary behavioral eating traits which promote overeating and obesity in children and to determine the extent to which associations between eating traits and excessive weight gain in children may be influenced by genetic factors, environmental factors, or both. Behavioral genetic methods can be used to help partition genetic and environmental sources of variability in behavioral traits. The focus of this paper is to review and discuss findings from both short-term experimental and prospective cohort studies on eating behaviors of children at various stages in their lives. Select child eating traits and parent-child resemblances in eating will be further examined in the context of children's home environment and their familial predisposition to obesity. The paper represents an invited review by a symposium, award winner or keynote speaker at the Society for the Study of Ingestive Behavior [SSIB] Annual Meeting in Portland, July 2009.

Preteen insulin levels interact with caloric intake to predict increases in obesity at ages 18 to 19 years: a 10-year prospective study of black and white girls

We evaluated the associations of teenage insulin and adolescent diet with 10-year weight gain in an analysis sample of black and white girls matched for pubertal stage, body mass index (BMI) (or fat mass), and insulin at ages 9 to 10 years. We hypothesized that preteen insulin and insulin resistance would interact with dietary factors to positively predict increases in BMI. Furthermore, we hypothesized that increased insulin and insulin resistance, interacting with higher caloric intake during adolescence, would lead to greater increments in BMI in black girls than in white girls. Prospective 10-year follow-up was performed on 215 pairs of black and white schoolgirls matched at baseline by BMI (or fat mass), insulin, and pubertal stage, with repeated measures of body habitus, insulin, and dietary intake. When matched for BMI, black girls had higher fat-free mass and white girls had higher fat mass at ages 9 to 10 years. Black-white differences in caloric intake were not significant at ages 9 to 10 years, but black girls consumed more calories at age 19 years. Black girls consumed a greater percentage of calories from fat throughout. At age 19 years, black girls had higher BMI, fat mass index, and insulin. When matched at ages 9 to 10 years for fat mass, black girls were heavier, had higher BMI, and had greater fat-free mass. By ages 18 to 19 years, black girls continued to have higher BMI, but had accrued higher fat mass and a higher percentage of body fat. By stepwise multiple regression, 10-year increases in BMI were predicted by ages 9 to 10 years BMI, 10-year change in insulin, and a 3-way interaction between ages 9 to 10 years insulin, adolescent caloric intake, and race (higher in black girls) (all Ps < .0001). Insulin at ages 9 to 10 years interacts with caloric intake to increase BMI by age 19 years. There appear to be intrinsic black-white metabolic differences that lead to greater gains in fat during adolescence in black girls. Evaluating BMI and insulin at ages 9 to 10 years could identify girls (particularly black) who would optimally benefit from dietary and exercise interventions to avoid obesity.

Racial differences in the association between body fat distribution and lipid profiles among reproductive-age women

AIM

The aim of this study was to examine the racial and ethnic differences in the relationship between body fat distribution variables and serum lipid profiles.

METHODS

Secondary data analyses were conducted on 708 healthy women (204 blacks, 247 whites and 257 Hispanics), aged 16-33 years, seen in an outpatients clinic for contraception. Pearson correlation and multivariable linear regression techniques were used to identify racial/ethnic differences in the relationship between lipid profiles and body fat after adjusting for lean mass as well as demographic and lifestyle variables.

RESULTS

All body fat distribution variables were significantly associated with total cholesterol (TC) (r=0.14 to 0.26), triglycerides (TG) (r=0.13 to 0.46), HDL cholesterol (r=-0.13 to -0.34), cholesterol-to-HDL ratio (r=0.20 to 0.50) and atherogenic index of plasma (AIP) (r=0.16 to 0.49). Significant racial/ethnic differences were observed in many associations. After adjusting for lean mass, and other demographic and lifestyle factors, the study showed that black women demonstrated significantly weaker associations than their white and Hispanic counterparts using multivariable linear regression procedures.

CONCLUSION

The relationship between lipid profiles and body fat distribution variables varies by race/ethnicity in reproductive-age women. A better understanding of these racial/ethnic differences has important implications for clinical and public-health efforts in targeting the prevention of cardiovascular disease (CVD).

Adiposity is inversely related to insulin sensitivity in relatively lean Chinese adolescents: a population-based twin study

BACKGROUND

Adolescence is a critical period for rising adiposity and falling insulin sensitivity (IS), but the independent relation between adiposity and IS remains understudied.

OBJECTIVE

The objective was to examine which adiposity measures are most strongly associated with IS in nondiabetic adolescents, whether sex-difference exists, and to what degree genetic or environmental factors affect the adiposity-IS relation.

DESIGN

The study included 1613 rural Chinese adolescents (888 males) aged 13-20 y from a population-based twin cohort. We used graphic plots and linear mixed models to examine the relation of anthropometric and dual-energy X-ray absorptiometry-based measures of adiposity with IS [QUantitative Insulin-sensitivity ChecK Index (QUICKI), fasting serum insulin (FSI), homeostasis model assessment of insulin resistance (HOMA-IR)] and structural equation models to estimate genetic/environmental influences on these associations.

RESULTS

In graphic analyses, participants in the highest quintile (quintile 5) of waist circumference (WC) and percentage body fat (%BF) had the lowest QUICKI and the highest FSI and HOMA-IR values for all age-sex groups. In regression models adjusted for age, Tanner stage, zygosity, and physical activity, all adiposity measures showed inverse associations with IS in both sexes, but WC explained the largest fraction of variance in IS measures (10-14%). Of the phenotypic correlations between adiposity measures and IS (-0.28 to -0.38), 74-85% were attributed to shared genetic factors and 15-26% to common unique environmental factors in both sexes.

CONCLUSIONS

In these relatively lean Chinese adolescents, WC and %BF (quintile 5) are the adiposity measures most consistently and strongly associated with decreased IS in both sexes. To a large degree, shared genetic factors contribute to this association.

Antenatal and postpartum depressive symptoms are differentially associated with early childhood weight and adiposity

Antenatal depression is associated with small-for-gestational age, but few studies have examined associations with weight during childhood. Similarly, few studies address whether antenatal and postpartum depression differentially affect child weight. Among 838 mother-child dyads in Project Viva, a prospective cohort study, we examined relationships of antenatal and postpartum depression with child weight and adiposity. We assessed maternal depression at mid-pregnancy and 6 months postpartum with the Edinburgh Postnatal Depression Scale (score > or =13 indicating probable depression). We assessed child outcomes at age 3 years: body mass index (BMI) z-score, weight-for-height z-score, sum of subscapular (SS) and triceps (TR) skinfold thickness (SS + TR) for overall adiposity, and SS : TR ratio for central adiposity. Sixty-nine (8.2%) women experienced antenatal depression and 59 (7.0%) postpartum depression. Mean (SD) outcomes at age 3 were: BMI z-score, 0.45 (1.01); SS + TR, 16.72 (4.03) mm; SS : TR, 0.64 (0.15). In multivariable models, antenatal depression was associated with lower child BMI z-score (-0.24 [95% confidence interval: -0.49, 0.00]), but higher SS : TR (0.05 [0.01, 0.09]). There was no evidence of a dose-response relationship between antenatal depression and these outcomes. Postpartum depression was associated with higher SS + TR (1.14 [0.11, 2.18]). In conclusion, whereas antenatal depression was associated with smaller size and central adiposity at age 3 years, postpartum depression was associated with higher overall adiposity.

Health-related physical fitness and weight status in Hong Kong adolescents

Background

This study was designed to investigate the relation between health-related physical fitness and weight status in Hong Kong adolescents.

Methods

3,204 students aged 12-18 years participated in the Hong Kong Student Obesity Surveillance (HKSOS) project in 2006-2007. Anthropometric measures (height, weight) and health-related fitness (push-up, sit-up, sit-and-reach, 9-minute run) were assessed. Body mass index (BMI) was computed to classify participants into normal weight, underweight (Grade I, II/III), overweight, and obese groups. The associations of health-related physical fitness with BMI and weight status were examined by partial correlation coefficients and analysis of covariance, respectively.

Results

More boys than girls were overweight or obese (18.0% vs 8.7%), but more girls than boys were underweight (22.3% vs 16.7%). Boys performed significantly (P < 0.001) better in sit-up (38.8 vs 31.6 times/min) and 9-minute run (1632.1 vs 1353.2 m), but poorer in sit-and-reach (27.4 vs 32.2 cm) than girls. All four physical fitness tests were significantly positively correlated with each other in both sexes, and BMI was only weakly correlated with sit up and sit-and-reach tests in boys. Decreasing performance (P for trend < 0.05) was observed from normal weight to overweight and obese for push-up, sit-up, and 9-minute run in both sexes. From normal weight to Grade I and Grade II/III underweight, decreasing performance (P for trend < 0.05) for sit-up and sit-and-reach in both sexes and for push-up in boys was observed.

Conclusions

The relations between BMI and health-related physical fitness in adolescents were non-linear. Overweight/obese and underweight adolescents had poorer performance in push-up and sit-up tests than normal weight adolescents. Different aspects of health-related physical fitness may serve as immediate indicators of potential health risks for underweight and overweight adolescents.

Increasing physical activity among African-American women and girls

The benefits of physical activity on diseases and risk factors are well known. Despite the known benefits, many segments of the population, particularly African-American women and girls, do not obtain adequate levels of physical activity. Strategies are needed to identify successful and sustainable interventions to increase physical activity among this population. We reviewed literature published between 2007 and 2009 that focused on increasing physical activity or fitness among this population. We identified 37 studies, 11 of which focused on increasing physical activity. This article summarizes the findings from those 11 studies and provides recommendations for improving strategies to increase physical activity in African-American women and girls.

Prevention of overweight and obesity in children under the age of 6 years

Although obesity was rarely observed among children 30 years ago, it is now evident among Canadian children of all ages. Currently, 15.2% of 2- to 5-year-old children are overweight, whereas 6.3% are obese. Limited data suggest that poor dietary and physical activity patterns are increasing obesity risk among these young children. Body weight and lifestyle behaviours are known to track from childhood to adulthood, thereby increasing the risk for obesity and other chronic diseases later in life. Intrauterine life, infancy, and the preschool years may all include critical periods that program the long-term regulation of energy balance, and therefore obesity-prevention strategies should be initiated in utero and continue throughout childhood and adolescence. Although single-strategy obesity-prevention initiatives have had limited success, programs that target multiple behaviours may help reduce body weight and body fat among young children. Parental involvement is key to the success of obesity-prevention programs at a young age, as parents have primary control over their children's food and activity environments. Accordingly, parental obesity is the best predictor of childhood obesity. Parents should be encouraged to teach and role model healthy lifestyle behaviours for their young children. Health professionals can also be involved in obesity prevention, as they are ideally placed to identify young children at risk for obesity. By calculating and plotting the body mass index for all children, and initiating obesity-prevention strategies in utero, health professionals can help curb the rise in overweight and obesity among young children.

Early child care and adiposity at ages 1 and 3 years

BACKGROUND

The majority of infants in the United States are in nonparental child care, yet little is known about the effect of child care on development of obesity.

OBJECTIVE

To examine the relationship between child care attendance from birth to 6 months and adiposity at 1 and 3 years of age.

METHODS

We studied 1138 children from a prospective cohort of pregnant women and their offspring. The main exposure was time in child care from birth to 6 months of age, overall and by type of care: (1) child care center; (2) someone else's home; and (3) child's own home by nonparent. The main outcomes were weight-for-length (WFL) z score at 1 year and BMI z score at 3 years of age.

RESULTS

A total of 649 (57%) infants attended child care; 17% were cared for in a center, 27% in someone else's home, and 21% in their own home by a nonparent. After adjustment for confounders, overall time in child care was associated with an increased WFL z score at 1 year and BMI z score at 3 years of age but not skinfold thicknesses. Center and own home care were not associated with the outcomes, but care in someone else's home was associated with an increase in both the 1- and 3-year outcomes.

CONCLUSION

Child care in the first 6 months of life, especially in someone else's home, was associated with an increased WFL z score at 1 year and BMI z score at 3 years of age.

Physical Activity at Child Care Settings: Review and Research Recommendations

Child care settings, such as nursery schools and preschools, provide important opportunities to increase physical activity in children aged 2 to 5 years. Because of the large numbers of children enrolled, physical activity interventions at child care facilities have the potential to reach many children at an age when behaviors are influenced more easily. To learn more about this possibility, the authors conducted a systematic review of the published literature for intervention studies conducted at organized child care settings that focused on increasing children’s physical activity levels. Although 8 databases were searched from their inception, only 9 studies were found that met inclusion criteria, all of which were published since 2003. Of these, 7 studies implemented some type of organized educational program or specific curricula, whereas 2 studies implemented environmental changes. Intervention length across studies varied from 2 days to 12 months. Five studies demonstrated a positive change in physical activity; however, the limited number of studies included and the range of research quality made it difficult to draw clear conclusions. A number of potential targets for increasing physical activity at child care settings were identified, including active opportunities, sedentary opportunities, physical environment, staff training and behavior, center policies, and outreach. All these areas seem to merit further investigation, and specific research questions for each are discussed.

Effects of childhood obesity on hospital care and costs, 1999-2005

Childhood obesity is increasingly recognized as an epidemic, but the economic consequences have not been well quantified. We evaluated trends in obesity-associated hospitalizations, charges, and costs using 1999-2005 data from a nationally representative sample of admissions to U.S. hospitals. We detected a near-doubling in hospitalizations with a diagnosis of obesity between 1999 and 2005 and an increase in costs from $125.9 million to 237.6 million (in 2005 dollars) between 2001 and 2005. Medicaid appears to bear a large burden of hospitalizations for conditions that occur along with obesity, while private payers pay a greater portion of hospitalization costs to treat obesity itself.

Blood lipids in children: age-related patterns and association with body-fat indices: Project HeartBeat!

BACKGROUND

Longitudinal data on the normal development of blood lipids and its relationships with body fatness in children and adolescents are limited. Objectives of the current analysis were to estimate trajectories related to age for four blood lipid components and to examine the impact of change in body fatness on blood lipid levels, comparing estimated effects among adiposity indices, in children and adolescents.

METHODS

Three cohorts, with a total of 678 children (49.1% female, 79.9% nonblack) initially aged 8, 11, and 14 years, were followed at 4-month intervals (1991-1995). Total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride levels were determined in blood samples taken following fasting. Body fatness was measured by five adiposity indices-BMI; percent body fat (PBF); abdominal circumference; and the sums of six and of two skinfold thicknesses. Trajectories of change in blood lipid levels from ages 8 to 18 years were estimated by gender and race. The impact of change in body fatness on lipid levels was evaluated for each index, adjusting for gender, race, and age.

RESULTS

All lipid components varied significantly with age. Total cholesterol decreased by approximately 19 mg/dL from ages 9 to 16 years in girls and more steeply from ages 10 to 17 years in boys. LDL-C decreased monotonically, more steeply in boys than in girls. It was higher among nonblacks than among blacks. HDL-C increased monotonically in girls, mainly from ages 14 to 18 years, but fluctuated sharply among boys. Levels of HDL-C were higher among blacks than among nonblacks. The levels of triglycerides increased from ages 8 to 12 years among girls and, almost linearly, from ages 8 to 18 years among boys. The levels of triglycerides were higher among nonblacks than among blacks. Increase in body fatness was significantly associated with increases in total cholesterol, LDL-C, and triglyceride levels. Significant interactions between the adiposity indices (except for BMI) and gender indicated smaller impacts of change in body fatness on total cholesterol and LDL-C in girls than in boys. The estimated impact on triglycerides was weaker among blacks than among nonblacks, except for PBF. Change in body fatness was negatively associated with HDL-C. The results remained essentially unchanged after adjustments for energy intake, physical activity, and sexual maturation.

CONCLUSIONS

Patterns of change with age in blood lipid components vary significantly among gender and racial groups. Increase in body fatness among children is consistently associated with adverse change in blood lipids. Evaluation of blood lipid level should take into account variation by age, gender, and race. Intervention through body-fat control should help prevent adverse lipid levels in children and adolescents.

[Hypertension in obese children and adolescents]

Obesity, especially upper body fat distribution, has become an increasingly important medical problem in children and adolescents. Outcomes related to childhood obesity include, as in adult population, hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, obstructive sleep apnea, orthopedic and socio-psychological problems. Obese children are at approximately 3-fold higher risk for hypertension from non-obese ones. Obesity-hypertension appears to be characterized by a preponderance of isolated systolic hypertension, increased heart rate and blood pressure variability, increased levels of plasma catecholamine and aldosterone, and salt-sensitivity. Lifestyle changes of weight loss, healthier diet and regular physical exercise are effective in obesity-hypertension control, though pharmacological treatment is frequently necessary. Screening for dyslipidemia and impaired glucose tolerance should be performed in paediatric patients with obese hypertension on regular basis, at least once annually or semiannually to discover metabolic syndrome and to prevent its increased cardiovascular risk. Of course, prevention of obesity is the primary goal.

Environmental exposures and puberty in inner-city girls

BACKGROUND

Hormonally active environmental exposures are suspected to alter onset of puberty in girls, but research on this question has been very limited.

OBJECTIVE

We investigated pubertal status in relation to hormonally active environmental exposures among a multiethnic group of 192 healthy 9-year-old girls residing in New York City.

METHODS

Information was collected on breast and pubic hair stages, weight and height. Phytoestrogen intake was estimated from a food-frequency questionnaire. Three phytoestrogens and bis-phenolA (BPA) were measured in urine. In a subset, 1,1'-dichloro-2,2'-bis(4-chlorophenyl)ethylene (DDE), polychlorinated biphenyls (PCBs) were measured in blood plasma and lead (Pb) in blood. Associations of exposures with pubertal stages (present=stage 2+ vs absent=stage 1) were examined using t-tests and Poisson multivariate regression to derive prevalence ratios (PR, 95%-confidence limits [CI]).

RESULTS

Breast development was present in 53% of girls. DDE, Pb, and dietary intakes of phytoestrogens were not significantly associated with breast stage. Urinary phytoestrogen biomarker concentrations were lower among girls with breast development compared with no development. In multivariate models, main effects were strongest for two urinary isoflavones, daidzein (PR 0.89 [0.83-0.96] per ln microg/g creatinine) and genistein (0.94 [0.88-1.01]). Body mass index (BMI) is a hormonally relevant, strong risk factor for breast development. Therefore, BMI-modification of exposure effects was examined, and associations became stronger. Delayed breast development was observed among girls with below-median BMI and third tertile (high exposure) of urinary daidzein (PR 0.46 [0.26-0.78]); a similar effect was seen with genistein, comparing to girls >or= median BMI and lowest two tertiles (combined) of these isoflavones. With urinary enterolactone a phytoestrogen effect was seen only among girls with high BMI, where breast development was delayed among those with high urinary enterolactone (PR 0.55 [0.32-0.96] for the upper tertile vs lower two combined). There was no main effect of PCBs on breast stage, but girls with below-median BMI and >or= median PCB levels had reduced risk for breast development (any vs none) compared with other BMI-PCB groups. No biomarkers were associated with hair development, which was present in 31% of girls.

CONCLUSIONS

Phytoestrogens and PCBs are environmental exposures that may delay breast development, especially in conjunction with BMI, which governs the endogenous hormonal milieu. Further research to confirm these findings may improve our understanding of the role of early life development in breast cancer risk and other chronic diseases related to obesity.