Dynamic and static tests of balance and postural sway in boys: effects of previous wrist bone fractures and high adiposity

The associations of body composition, fitness, and physical activity with balance in children: The Arkansas Active Kids study

BACKGROUND

Balance plays an important role in children's motor development. However, the factors that are associated with balance in children are not yet fully understood.

RESEARCH QUESTION

We aimed to investigate the association of body composition, physical fitness, and daily physical activity on balance in children.

METHODS

The sample was composed of 219 children (53 % females), aged 9.0 (IQR = 2.2) years with a body mass index (BMI)-percentile of 74.9 (IQR = 48.7). Balance was evaluated through a force platform in the upright bipedal stance under different sensory conditions. Anthropometry, body composition (dual-energy x-ray absorptiometry), knee maximal strength (isokinetic dynamometer), aerobic capacity (indirect calorimetry), and daily physical activity (accelerometry and questionnaires) were also assessed.

RESULTS

Higher levels of body mass, waist circumference, and fat mass were associated with worse balance, whereas greater knee extension strength and peak oxygen uptake were linked to enhanced balance. Among those, fat mass percentage and waist circumference were the most important factors associated with balance performance. Moreover, it was observed that the associations between the identified anthropometric and body composition measures with balance could be counteracted by physical fitness and physical activity levels.

SIGNIFICANCE

Our findings revealed that anthropometric measures, body composition, and physical fitness levels are associated with children's balance. Furthermore, physical fitness and physical activity may be especially relevant, as they could help mitigate the detrimental effect of excess fat mass on postural control.

Body balance on Horus® computerized posturography and body measurements in healthy children

PURPOSE

To verify possible associations between body balance and growth curves, weight, height and body mass index in healthy children.

METHODS

Quantitative cross-sectional study. Two hundred and sixteen children aged between 4 and 6 years and 11 months participated. An interview was carried out with the parents/guardians and the children underwent visual screening, auditory assessment (pure tone audiometry screening method, otoacoustic emissions and immittance testing), verification of weight and height measurements and Horus® computerized posturography. Anthro and AnthroPlus software were used to classify the growth curves by age, sex, height, weight and body mass index. Responses were analyzed using the non-parametric Kruskal-Walli and post hoc Dunn-Bonferroni statistical tests for pairwise comparisons between ages, with p<0.05.

RESULTS

The measurement of weight by length showed a correlation with different examination conditions at 4 years-old, mainly for the average speed data. The same data, under different examination conditions, showed a correlation with the body mass index at 4 and 5 years of age, between children classified with weight outside the expected standard and those underweight. Children considered underweight had greater instability in body balance. Height and weight showed correlation for different examination conditions in the three age groups.

CONCLUSION

There was an association between responses in posturography and individual body measurements (weight, height and body mass index. Therefore, it is suggested that these measurements be analyzed and considered in the evaluation with computerized posturography in children aged 4 to 6 years.

Associations of abdominal obesity with different types of bone fractures in adults: A systematic review and dose-response meta-analysis of prospective cohort studies

Findings on the association between abdominal obesity and hip fracture were summarized in a meta-analysis in 2017; however, no study has examined the dose-response association between abdominal fat indices and hip fracture. Also, we found no meta-analysis investigating other types of bone fractures including any vertebral fractures in relation to abdominal obesity. Therefore, the present systematic review and dose-response meta-analysis of prospective cohort studies were conducted to examine the association between abdominal obesity and different types of bone fractures. A comprehensive literature search was done by searching PubMed, Scopus, Web of Science, and Google Scholar until October 2021. In total, 23 articles from prospective cohort studies with a total sample size of 3,456,631 participants were included. During the follow-up periods ranging between 4 and 26 years, 137,989 cases of bone fracture were recorded. After comparing the highest and lowest categories of abdominal fat indices, the summary relative risks (RRs) of any, hip, and vertebral fractures were 0.99 (95% CI: 0.81-1.20), 1.09 (95% CI: 0.82-1.43), and 1.18 (95% CI: 1.05-1.33), respectively, indicating a significant positive association between abdominal obesity and risk of vertebral fracture. In the non-linear dose-response analysis, abdominal obesity based on the waist-to-hip ratio (WHR) was positively associated with an increased risk of hip fracture from 0.7 to 1.1 units of WHR. In the linear analysis, a 10 cm increase in waist circumference (WC) was associated with a 3% higher risk of vertebral fracture. We found no other dose-response association for other types of bone fractures. In conclusion, abdominal obesity may be associated with a higher risk of hip and vertebral fractures.

Insufficient Bone Mineralization to Sustain Mechanical Load of Weight in Obese Boys: A Cross-Sectional Study

CONTEXT

The increase in bone mineral content (BMC) and density (BMD) measured by dual-energy x-ray absorptiometry (DXA) in obese children may not sustain the mechanical load associated with weight, and the factors influencing bone mineralization are not well known.

OBJECTIVE

We described bone mineralization in boys with overweight/obesity and leanness in relation to body composition.

METHODS

Cross-sectional study in the Pediatric Endocrinology Unit of Angers University Hospital with 249 overweight/obese boys aged 8-18 who underwent DXA and insulin, testosterone, and IGF-1 measurements. Bone mineralization was compared with data from 301 lean boys of similar age and height from NHANES 2011-2015, using the same DXA model. Path analyses were performed to evaluate factors associated with total body less head (TBLH) BMC.

RESULTS

The mean age- and height-adjusted difference in TBLH BMC between obese and lean boys was 241 ± 20 g/cm2. Each 1 kg/m2 increase in BMI was associated with +39 ± 6 g of TBLH BMC in lean subjects vs + 25 ± 3 g in obese subjects (P < .05). Each 1 kg/m2 increase in lean BMI (LBMI) was associated with +78 ± 5 g of TBLH BMC in lean and obese boys, and each 1 kg/m2 increase in fat mass index (FMI) was associated with a decrease of 9 ± 3 g of TBLH BMC. The TBLH BMC was directly positively influenced by LBMI and indirectly and positively influenced by IGF-1, testosterone, and insulin (mediated through height and LBMI). FMI indirectly influenced TBLH BMC, both positively through LBMI and negatively through its negative impact on IGF-1 and testosterone.

CONCLUSION

The increase in bone mineralization in obese children does not adapt to the increase in body mass.

Obese adolescents have higher risk for severe lower extremity fractures after falling

INTRODUCTION

Reports vary on the impact of obesity on the incidence of lower extremity fractures after a fall. We hypothesized that obese adolescents (OA) presenting after a fall have a higher risk of any and severe lower extremity fractures compared to non-OAs.

METHODS

A national database was queried for adolescents (12-17 years old) after a fall. Primary outcome included lower extremity fracture. Adolescents with a body mass index (BMI) ≥ 30 (OA) were compared to adolescents with a BMI < 30 (non-OA).

RESULTS

From 20,264 falls, 2523 (12.5%) included OAs. Compared to non-OAs, the rate of any lower extremity fracture was higher for OAs (51.5% vs. 30.7%, p < 0.001). This remained true for lower extremity fractures at all locations (all p < 0.05). After adjusting for sex and age, associated risk for any lower extremity fracture (OR 2.41, CI 2.22-2.63, p < 0.001) and severe lower extremity fracture (OR 1.31, CI 1.15-1.49, p < 0.001) was higher for OAs. This remained true in subset analyses of ground level falls (GLF) and falls from height (FFH) (all p < 0.05).

CONCLUSIONS

Obesity significantly impacts adolescents' risk of all types of lower extremity fractures after FFH or GLF. Hence, providers should have heightened awareness for possible lower extremity fractures in OAs.

LEVEL OF EVIDENCE

IV.

Is There an Association between BMI, Height, and Gender and Long-Bone Fractures during Childhood and Adolescence? A Large Cross-Sectional Population Study of 911,206 Subjects

INTRODUCTION

Traumatic long-bone fractures (TLFs) among children and adolescents are relatively common, with morbidity and economic consequences. Obesity has become a significant global concern. Studies have found an association between TLFs and BMI in the past but not in a large cross-sectional population study. Our study objective was to measure the incidence of TLFs in the 17-year-old general population and evaluate its association with BMI, body height, and gender.

METHODS

Data from a medical database containing all 17-year-old candidates' records before recruitment into mandatory military service were retrieved as BMI, height, gender, and history of TLFs. Logistic regression models assessed the association between BMI and height to TLFs.

RESULTS

The records of 911,206 subjects (515,339 males) were reviewed. In total, 9.65% had a history of TLFs (12.25% and 6.25% for males/females, respectively). Higher BMI was associated with TLF, with a linear trend in the odds ratio (OR) for having TLFs. The strongest association was found between obese females and TLFs (OR = 1.364, p < 0.0001). Height was an independent factor positively associated with TLFs. The OR for a TLF in the highest height quintile was 1.238 (p < 0.001) for males and 1.411 (p < 0.001) for females compared to the lowest quintile. Although TLFs were more common in males, the OR for TLFs was more prominent in females.

CONCLUSIONS

There is an association between BMI, body height, and TLFs in healthy adolescents. TLFs are more common in males, but the strongest association between overweight and obesity is evident in females.

Balance Assessment Using a Smartwatch Inertial Measurement Unit with Principal Component Analysis for Anatomical Calibration

Balance assessment, or posturography, tracks and prevents health complications for a variety of groups with balance impairment, including the elderly population and patients with traumatic brain injury. Wearables can revolutionize state-of-the-art posturography methods, which have recently shifted focus to clinical validation of strictly positioned inertial measurement units (IMUs) as replacements for force-plate systems. Yet, modern anatomical calibration (i.e., sensor-to-segment alignment) methods have not been utilized in inertial-based posturography studies. Functional calibration methods can replace the need for strict placement of inertial measurement units, which may be tedious or confusing for certain users. In this study, balance-related metrics from a smartwatch IMU were tested against a strictly placed IMU after using a functional calibration method. The smartwatch and strictly placed IMUs were strongly correlated in clinically relevant posturography scores (r = 0.861-0.970, p < 0.001). Additionally, the smartwatch was able to detect significant variance (p < 0.001) between pose-type scores from the mediolateral (ML) acceleration data and anterior-posterior (AP) rotation data. With this calibration method, a large problem with inertial-based posturography has been addressed, and wearable, "at-home" balance-assessment technology is within possibility.

Descriptive Epidemiology of Isolated Distal Radius Fractures in Children: Results From a Prospective Multicenter Registry

INTRODUCTION

More than 1 in 4 pediatric fractures involves the distal radius. Most prior epidemiologic studies are limited to retrospective, single center investigations, and often include adults. This study aims to describe the contemporary epidemiology of pediatric distal radius fractures using prospectively collected data from a multicenter Pediatric Distal Radius Fracture Registry.

METHODS

Patients aged 4 to 18 years diagnosed with a distal radius fracture from June 2018 through December 2019 at 4 tertiary care pediatric centers were screened and enrolled in this prospective longitudinal cohort study. Patients were excluded if they presented with bilateral distal radius fractures, polytrauma, or re-fracture. Demographic information, mechanism of injury, fracture characteristics, associated injuries, and procedural information were recorded. All radiographs were reviewed and measured. Descriptive statistics and bivariate analyses were performed.

RESULTS

A total of 1951 patients were included. The mean age was 9.9±3.3 years, and 61.3% of patients were male ( P <0.001). Most injuries occurred during a high-energy fall (33.5%) or sports participation (28.4%). The greatest proportion of fractures occurred during the spring months (38.5%). Torus fractures (44.0%) were more common than bicortical (31.3%) or physeal (21.0%) fractures. Of the physeal fractures, 84.3% were Salter-Harris type II. Associated ulnar fractures were observed in 51.2% of patients. The mean age at injury was higher for patients with physeal fractures (11.6±2.9 y) than patients with torus or bicortical fractures (9.4±3.1 and 9.6±3.1 y, respectively; P <0.001). Thirty-six percent of distal radius fractures underwent closed reduction and 3.3% underwent surgical fixation. Patients treated with closed reduction were more likely to be male (68.7% vs. 57.2%; P <0.001), obese (25.3% vs. 17.2%; P <0.001), and have bicortical fractures (62.2% vs. 14.5%; P <0.001).

CONCLUSIONS

Distal radius fractures in children have a male preponderance and are most likely to occur in the spring months and during high-energy falls and sports. Physeal fractures tend to occur in older children while torus and bicortical fractures tend to occur in younger children.

LEVEL OF EVIDENCE

Level I-prognostic.

Evaluation of center of mass estimation for obese using statically equivalent serial chain

The complex structure of the human body makes its center of mass (CoM) estimation very challenging. The typically used estimation methods usually suffer from large estimation errors when applied to bodies with structural differences. Thus, a reliable estimation method is of utmost importance. In this paper, we present a detailed evaluation of a subject-specific CoM estimation technique named Statically Equivalent Serial Chain (SESC) by investigating its estimation ability over two different groups of subjects (Fit and Obese) in comparison to the segmental analysis method. For this study, we used an IMU-based motion capture system and a force platform to record the joint angles and corresponding center of pressure (CoP) values of twenty-five participants while performing a series of static postures. The root-mean-square errors (RMSE) of SESC's estimation for both groups showed close and lower mean values, whereas the segmental analysis method showed significantly larger RMSE values in comparison to SESC (p < 0.05). In addition, we used the Bland-Altman analysis to evaluate the agreement between the two techniques and the ground truth CoP, which showed the accuracy, precision, and reliability of SESC over both groups. In contrast, the segmental analysis method did not present neither accurate nor precise estimations, as our analysis revealed considerable fixed and proportional biases.

Differences in the manifestation of balance according to BMI levels for women students of the Faculty of Physical Education and Sports

Abstract Background: Static and dynamic balance are factors of major importance in the manifestation of human motor skills at a higher level. Purpose: The determination of vari-ations in the performance of balance tests for young women students at the Faculty of Physical Education and Sports (48 cases in the 1st year of bachelor's degree), divided and analyzed 3 BMI levels (underweight / 7 cases, normal weight / 34 cases and overweight / 7 cases) and comparing these results with other similar research. Material and method: The testing of the group was scheduled at the Research Center for Human Performance, be-longing to the Faculty of Physical Education and Sports in Galați, in the month of April of the 2018-2019 academic year. For the assessment of balance, 7 tests were used, of which 4 associated with dynamic postural stability (Walk and turn field sobriety test/errors, Func-tional reach test/cm, Fukuda test/degrees of rotation, Bass test/ points) and 3 measuring static stability (Flamingo test/falls, One leg standing with eyes closed/sec, Stork test/sec). Nonparametric tests (Mann-Whitney U) were applied to compare differences between batches. Results: The average values of underweight and normal-weight women are better than those of overweight women for the entire set of assessment tests. The underweight group has the best results for the Standing balance test, Functional reach test, Flamingo test, Walk and turn field sobriety test, Fukuda test, and the normal weight women for Stork test, respectively Bass test. We found a lack of significant thresholds when comparing the results between the 3 groups (P> 0.05) for Stork test, Standing balance test and Functional reach test, so the working hypothesis formulated is only partially confirmed. The only significant difference between underweight and normal weight (P <0.05) is found in the Flamingo test, with better values for underweight. Significant difference thresholds for Flamingo test and Fukuda test are recorded between the underweight and overweight groups (Z values have associated thresholds P<0.05). The most significant differences are found between the normal weight and overweight groups (P <0.05), respectively for the Bass test, Fukuda test and Walk and turn field sobriety test. Conclusion: Constant physical activity (as a feature of the analyzed group) reduces the chances of significant differences in all balance tests between BMI levels. Keywords: female students; university specialization; static and dynamic postural control; physical activity

Forearm Fractures in Overweight-Obese Children and Adolescents: A Matter of Bone Density, Bone Geometry or Body Composition?

Forearm fractures in children and adolescents are associated with increased body mass index (BMI). This bone site is non-weight-bearing and therefore is appropriate to explore the effect of BMI on bone mineral density (BMD) and bone geometry, avoiding the confounding effect of increased weight-associated mechanical loading. The aim of this review was to summarize available evidence on bone indices and body composition assessed by peripheral quantitative computed tomography (pQCT) or dual X-ray absorptiometry (DXA) at the forearm level in overweight (Ow) or obese (Ob) subjects. We conducted a review of the literature according to the PICOS model. A total of 46 studies were identified following the literature search. A final number of 12 studies were included in this review. pQCT studies evidenced that Ow and Ob children typically have normal or increased volumetric BMD (vBMD), total bone area and cortical area, with normal or reduced cortical thickness at the forearm. Outcomes from DXA evaluations are less conclusive. In almost all the studies fat mass and lean mass area at the forearm are increased. A higher fat-to-lean mass ratio has been observed in few studies. Bone strength was reported as normal or increased compared to normal weight peers. In Ow or Ob children-adolescents, vBMD, bone size and bone strength are not reduced compared to normal weight peers. The local higher fat-to-lean mass ratio may give a mismatch between bone strength and the load experienced by the distal forearm during a fall, resulting in increased risk of forearm fractures.

Screening for balance in children and adults in a community science education setting: Normative data, influence of age, sex, and body mass index, and feasibility

BACKGROUND

Screening standing and walking balance is useful for people suspected of having vestibular disorders, a variety of neurologic and musculoskeletal disorders, and for screening astronauts returning after exposure to microgravity. Visitors to a community science education center children and adults, aged 4 to 85, were tested on tandem walking with eyes closed and the modified Romberg test on compliant foam. They were then asked about their experience participating in research, many people for the first time.

METHODS

Subjects performed 10 steps of tandem walking with eyes closed, and three trials of the modified Romberg, or Clinical Test of Sensory Integration and Balance, with eyes closed, standing on compliant memory foam, with a) head still, b) head shaking in yaw, and c) head nodding in pitch. Afterward, staff queried subjects about the experience of participating in science.

RESULTS

Age-related changes across the life span occurred in both sets of tests. Therefore, look-up tables by age are provided. Body mass index significantly affected tandem walking. Some sex differences were found. The tests were easy to administer in a community setting. Most participants enjoyed the experience and reported that they learned about the process of scientific research.

DISCUSSION

These data support and extend the evidence for age-related changes in balance performance across the lifespan and for an influence of body mass index on some balance skills. Clinicians and sports educators should be cognizant of these differences when they use these tests for screening. The community science education environment provided a useful laboratory in which to collect valid and reliable data, while simultaneously educating participants about the process of science.

The Association of Gender and Body Mass Index on the Values of Static and Dynamic Balance of University Students (A Cross-Sectional Design Study)

The balance of the body conditions the quality and efficiency of the movements in daily and sports activities, its impairment generating problems in the manifestation of motor skills for all age groups. The aim of this study is to analyze how the gender and BMI values of university students influence the results of the static and dynamic balance tests applied. The investigated group consists of 195 undergraduate students, from various specializations of the Dunărea de Jos University in Galați (99 males and 96 females, ages = 20.16 ± 1.98, BMI = 24.15 ± 5.68). The independent variables gender and BMI levels (underweight, normal weight and overweight/obese) were defined. The participants were evaluated in May 2019 using a series of 7 tests: one leg standing test with eyes closed, stork test, flamingo test, Bass test, functional reach test, walk and turn field sobriety test and Fukuda test. The results provided using multivariate analysis (MANOVA) indicate balanced performance for the gender variable, but with significantly better values for women in the one leg standing test, flamingo test and functional reach test (F values are associated with thresholds p < 0.05). Men obtain slightly better, but statistically insignificant (p > 0.05), performances on the stork test, Bass test and Fukuda test. The BMI step comparison confirms the difficulties of the overweight group in assessing balance, with the lowest scores in maintaining static positions and the most errors in dynamic balance tests, with significant differences from normal and underweight in most tests (p < 0.05). An interesting aspect is the slightly superior performance of the underweight compared to the normal weight group, for the one leg standing test, flamingo test and walk and turn field sobriety test. The analysis of Spearman correlation coefficients indicates a number of significant associations between elevated BMI values and decreased performance on balance tests.

Saturation Effect of Body Mass Index on Bone Mineral Density in Adolescents of Different Ages: A Population-Based Study

BACKGROUND

Adolescence is a critical period for bone development, and peak bone mass may be reached in late adolescence. Boosting bone accumulation at this time can help preserve adult bone health and avoid osteoporosis later in life. Body mass index (BMI) has been found to have a favorable impact on bone mineral density (BMD) in previous research. However, excessive obesity is harmful to health and may lead to various systemic diseases. Therefore, finding an appropriate BMI to maintain a balance between obesity and BMD is critical for adolescents.

METHODS

The datasets from the National Health and Nutrition Examination Survey (NHANES) 2011-2020 were used in a cross-sectional investigation. Multivariate linear regression models were used to examine the linear connection between BMI and BMD. Fitted smoothing curves and threshold effect analysis were used to describe the nonlinear relationship. Subgroup analyses were then conducted based on gender and age.

RESULTS

This population-based study included a total of 6,143 adolescents aged 8-19 years. In a multivariate linear regression analysis, a good association between BMI and total BMD was shown [0.014 (0.013, 0.014)]. This positive association was maintained in all subgroup analyses grouped by sex and age. Furthermore, the association between BMI and BMD was nonlinear with a saturation point present, as evidenced by smoothed curve fitting. According to the threshold effect study, with an age group of two years, adolescents of different ages had different BMI saturation values with respect to BMD.

CONCLUSIONS

Our study showed a significant positive and saturated association between BMI and BMD in adolescents aged 8-19 years. Maintaining BMI at saturation values may reduce other adverse effects while achieving optimal BMD.

Obesity and Bone: A Complex Relationship

There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.

Multisensory postural control in adults: Variation in visual, haptic, and proprioceptive inputs

Maintaining balance is fundamentally a multisensory process, with visual, haptic, and proprioceptive information all playing an important role in postural control. The current project examined the interaction between such sensory inputs, manipulating visual (presence versus absence), haptic (presence versus absence of contact with a stable or unstable finger support surface), and proprioceptive (varying stance widths, including shoulder width stance, Chaplin [heels together, feet splayed at approximately 60°] stance, feet together stance, and tandem stance) information. Analyses of mean velocity of the Centre of Pressure (CoP) revealed significant interactions between these factors, with stability gains observed as a function of increasing sensory information (e.g., visual, haptic, visual + haptic), although the nature of these gains was modulated by the proprioceptive information and the reliability of the haptic support surface (i.e., unstable versus stable finger supports). Subsequent analyses on individual difference parameters (e.g., height, leg length, weight, and areas of base of support) revealed that these variables were significantly related to postural measures across experimental conditions. These findings are discussed relative to their implications for multisensory postural control, and with respect to inverted pendulum models of balance. (185 words).

Sensory, voluntary, and motor postural control in children and adolescents with mucopolysaccharidosis

OBJECTIVES

This study aimed to investigate automatic and voluntary motor control performances, which have an important function in maintaining balance, in children and adolescents with mucopolysaccharidosis (MPS).

METHODS

The records of 70 patients were retrospectively analyzed. The results of Computerized Dynamic Posturography (CDP) performed according to the age and development of the individuals were examined. The results of 10 children and adolescents with MPS (mean age: 9.43 ranging from 6 to 14; four males and six females) who completed the sensory analysis, Weight-Bearing Squat Test, and Adaptation Test were retrieved from the database of the CDP. Nine healthy children and adolescents with typical development (mean age: 9.63 ranging from 6 to 14; four males and five females) were included as the control group.

RESULTS

In the sensory analysis test, there was a statistically significant difference between the two groups in the visual ratio parameter. In the adaptation test, there was a statistically significant difference between the two groups in the toes up and toes down trials. There was no statistically significant difference between the groups in the Weight-Bearing Squat test at 0° knee extension and various knee flexions.

CONCLUSIONS

Children and adolescents with MPS should be directed to the appropriate exercise and therapy programs to develop postural and balance control, which have a significant effect on their quality of life and the ability to independently perform daily activities of living. In addition to routine hearing assessments for patients with MPS, other objective tests used in the differential diagnosis of balance and vestibular system should also be implemented.

Changes in the Sensory Weighting Strategies in Balance Control Throughout Maturation in Children

BACKGROUND

 The central nervous system integrates information from different sensory inputs (vestibular, visual, and somatosensory) to maintain balance. However, strategies for weighing sensory information change as maturation occurs.

PURPOSE

 The purpose of this study was to: (1) evaluate postural control development in a large sample of healthy children aged 5 to 17 years old, (2) analyze changes in sensory weighting strategies as maturation occurs, and (3) determine the extent to which anthropometric characteristics (height, weight, body mass index [BMI]) influence postural control.

SAMPLE SIZE

 This study recruited 120 healthy children, equally distributed in gender and number, into four age groups (5-8 years, 9-11 years, 12-14 years, and 15-17 years) and compared them to a control group of 20 healthy adults (aged 20-25 years).

RESEARCH DESIGN

 The sensory organization test (SOT) was used to assess overall balance and the use of specific sensory inputs to maintain postural control. All children underwent the six SOT conditions: (1) eyes open, surround and platform stable, (2) eyes closed, surround and platform stable, (3) eyes open, sway-referenced surround, platform stable, (4) eyes open, sway-referenced platform, (5) eyes closed, sway-referenced platform, and (6) eyes open, sway-referenced surround and platform.

DATA ANALYSIS

 Condition-specific equilibrium scores (ES), composite equilibrium scores (CES), and sensory analysis ratios were analyzed to determine whether the performance was related to age, gender, or specific anthropometric characteristics (height, weight, and BMI).

RESULTS

 Data showed a significant age-associated improvement in ES for all 6 conditions (p < 0.05) and in CES (p = 0.001). For both genders, (1) somatosensory function was adult-like by age 5 to 8 years, (2) visual function peaked around age 12 years, and (3) vestibular function reached maturity by age 15 to 17 years (p < 0.05). A moderate positive correlation (r(140) = 0.684, p = 0.01; two-tailed) between height and CES was found and a weak positive correlation (r(140) = 0.198, p = 0.01) between height and somatosensory ratio was noted. Lower vestibular ratio scores were observed in children who had a higher BMI (p = 0.001).

CONCLUSION

 The efficient use of individual sensory system input to maintain balance does not occur at the same age. Age and gender affect the changes in sensory weighting strategies, while height and BMI influence postural control in children. These factors need to be accounted for in child assessment.

Balance Tests in Pre-Adolescent Children: Retest Reliability, Construct Validity, and Relative Ability

Balance is an essential prerequisite for the normal physical development of a child. It consists of the ability to maintain the body’s centre of mass over its base of support, which is enabled by automatic postural adjustments, and maintain posture and stability in various conditions and activities. The present study aimed to determine the measurement characteristics (reliability and concurrent validity) and the relative ability of balance tests and different motor tests in healthy 11-year-olds. We also evaluated the impact of vision on balance ability. Our results showed high interrater reliability (from 0.810 to 0.910) and confirmed the construct validity of the included balance tests. Girls performed significantly better than boys in laboratory tandem stance in following balance components: total sway path with eyes open (BSEO) (t = 2.68, p = 0.01, effect size (ES) = 0.81), total body sway with eyes closed of centre of pressure (CoP) displacement in the a-p direction (BSEC) (t = 1.86, p = 0.07, ES = 0.57), mean velocity of CoP displacements (VEO) (t = 2.67, p = 0.01, ES = 0.83), mean amplitude of CoP displacements in the a-p direction (AapEO) (t = 3.38. p = 0.00, ES = 1.01) and in mean amplitude of CoP displacements in the m-l direction (AmlEO) (t = 3.68, p = 0.00, ES = 1.19). With eyes closed, girls performed significantly better (t = 2.28, p = 0.03, ES = 0.70) than boys did in the mean amplitude of COP displacements in the a-p direction (AapEO) and significantly better (t = 2.37, p = 0.03, ES = 0.71) in the mean amplitude of COP displacements in the m-l direction (AmlEC). Insignificant correlations between different balance tests, except for a correlation between the flamingo test and one-leg stance on a low beam (r = 0.558, p < 0.01), show that each test assesses different aspects of balance ability; therefore, balance cannot be assessed with a single test.

Preschool Obesity Is Associated With an Increased Risk of Childhood Fracture: A Longitudinal Cohort Study of 466,997 Children and Up to 11 Years of Follow-up in Catalonia, Spain

This study aimed to determine if having an overweight or obese range body mass index (BMI) at time of beginning school is associated with increased fracture incidence in childhood. A dynamic cohort was created from children presenting for routine preschool primary care screening, collected in the Information System for Research in Primary Care (SIDIAP) platform in Catalonia, Spain. Data were collected from 296 primary care centers representing 74% of the regional pediatric population. A total of 466,997 children (48.6% female) with a validated weight and height measurement within routine health care screening at age 4 years (±6 months) between 2006 and 2013 were included, and followed up to the age of 15, migration out of region, death, or until December 31, 2016. BMI was calculated at age 4 years and classified using WHO growth tables, and fractures were identified using previously validated ICD10 codes in electronic primary care records, divided by anatomical location. Actuarial lifetables were used to calculate cumulative incidence. Cox regression was used to investigate the association of BMI category and fracture risk with adjustment for socioeconomic status, age, sex, and nationality. Median follow-up was 4.90 years (interquartile range [IQR] 2.50 to 7.61). Cumulative incidence of any fracture during childhood was 9.20% (95% confidence interval [CI] 3.79% to 14.61%) for underweight, 10.06% (9.82% to 10.29%) for normal weight, 11.28% (10.22% to 12.35%) for overweight children, and 13.05% (10.69% to 15.41%) for children with obesity. Compared with children of normal range weight, having an overweight and obese range BMI was associated with an excess risk of lower limb fracture (adjusted hazard ratio [HR] = 1.42 [1.26 to 1.59]; 1.74 [1.46 to 2.06], respectively) and upper limb fracture (adjusted HR = 1.10 [1.03 to 1.17]; 1.19 [1.07 to 1.31]). Overall, preschool children with an overweight or obese range BMI had increased incidence of upper and lower limb fractures in childhood compared with contemporaries of normal weight. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

Obese Children Have Different Forearm Fracture Characteristics Compared With Normal-weight Children

BACKGROUND

Current estimates suggest that one third of children and adolescents are overweight and 1 in 5 are obese. Obese children are at increased risk of sustaining more complex fractures, failing nonoperative treatment, and experiencing more complications during treatment. The purpose of this study was to compare forearm fracture characteristics, treatment, and complications in grouped overweight and obese [OW+OB; body mass index-for-age percentile (BMI%) ≥85] pediatric patients compared with normal-weight (NW; BMI%≤84) patients.

METHODS

This was a retrospective comparative study of patients aged 2 to 17 years old who presented with a forearm fracture resulting from low-energy trauma between January 2010 and September 2017. Patients with incomplete height and weight data; an underlying condition that predisposes to fractures or altered fracture healing; and torus, greenstick, pathologic, and high-energy fractures were excluded. Demographics, fracture characteristics, treatment, and complications were recorded. Descriptive and inferential analyses were conducted.

RESULTS

A total of 565 patients (403 NW, 162 OW+OB) met the inclusion criteria. NW children sustained open fractures nearly twice as frequently as the OW+OB children but this was not statistically significant (9.7% vs. 4.9%; P=0.065). Subanalysis showed that NW children were 4.1 times more likely to sustain an open fracture compared with obese (BMI%≥95) children (9.7% vs. 2.4%; P=0.029). A significant relationship was found between BMI% and location of the fracture, the bones involved, and fracture type. The OW+OB children sustained more distal forearm fractures than midshaft and proximal forearm fractures. Isolated radial shaft fractures were more common in the OW+OB group, whereas isolated ulnar shaft fractures were more common in the NW group. There was no difference in associated neurovascular injury, initial nonoperative versus operative management, failure of nonoperative treatment, and treatment complications.

CONCLUSIONS

OW+OB children have different forearm fracture characteristics compared with their NW peers. The thick soft tissue envelope in obese children may be protective against an open forearm fracture. In contrast to previous studies, obesity was not associated with failure of nonoperative treatment or a higher rate of complications.

LEVEL OF EVIDENCE

Level III-prognostic.

A comparison of diet versus diet + exercise programs for health improvement in middle-aged overweight women

BACKGROUND

Obesity is an independent risk factor for many diseases. Many studies have investigated the benefits of losing weight as well as the best methods for weight loss. This research evaluated the impact of various weight loss programs on health enhancement among overweight women aged 40-60 years.

METHODS

This was a retrospective observational study that analyzed data from 145 overweight women in weight loss programs. Each woman joined one of four programs: 8 weeks of exercise plus diet (exe + nutr), 8 weeks of diet only (nutrition), 8 weeks of exercise only, or a control group. Women completed a psychological questionnaire and also underwent anthropometric tests, blood pressure checks, a predicted maximal oxygen consumption (VO2 max) test on an ergometer bicycle, a one-leg balance test, straight leg test, and a sit and reach test, both before and after the program. Participants also provided a blood sample.

RESULTS

All of the measured variables improved in the exe + nutr and nutrition programs when compared with the control group; the exe + nutr group improved the most: body mass index, -1.3 kg/m2; body fat, -2.9%; lean body mass, +1.1; VO2 max, +4.8; body image, +1.02; and p < 0.01.

CONCLUSION

The hypothesis-generating findings showed that weight loss programs improved anthropometric, biochemical, physiological, physical, and psychological variables in women aged 40-60 years. The program that included diet restriction with exercise, guidance, and regular counseling showed the best results.

Understanding the impact of age, gender, height and body mass index on children's balance

AIM

This research aimed to understand the influence of age, gender, height and body mass index (BMI) on balance ability in children aged 4-12 years. The secondary aim was to develop normative values for three balance tests on the Balance Master system.

METHODS

Children were recruited in 2017 through community advertising. Balance testing occurred at three recreational centres in Frankston, Victoria, Australia. Data were collected by the Rhythmic Weight Shift, modified Clinical Test of Sensory Integration and Limits of Stability balance tests of the Balance Master equipment. Multiple regression analysis determined associations between variables including age, gender, height and BMI.

RESULTS

There were 91 children recruited and consented. Children were aged between 4 and 12 years old. Balance ability was shown to improve with age (P < .05), with girls demonstrating more mature balance strategies at earlier ages. Decreased BMI was associated with greater balance ability and postural control (P < .05).

CONCLUSION

The normative values established may be used to support clinical paediatric assessment with this equipment. Findings of this study suggest that increased BMI may be associated with poorer balance ability in children. However, further research studies are needed to explore this assertion.

The role of PPARγ in childhood obesity-induced fractures

Globally, obesity is on the rise with ~ 30% of the world’s population now obese, and childhood obesity is following similar trends. Childhood obesity has been associated with numerous chronic conditions, including musculoskeletal disorders. This review highlights the effects of childhood adiposity on bone density by way of analyzing clinical studies and further describing two severe skeletal conditions, slipped capital femoral epiphysis and Blount’s disease. The latter half of this review discusses bone remodeling and cell types that mediate bone growth and strength, including key growth factors and transcription factors that help orchestrate this complex pathology. In particular, the transcriptional factor peroxisome proliferator-activated receptor gamma (PPARγ) is examined as it is a master regulator of adipocyte differentiation in mesenchymal stem cells (MSCs) that can also influence osteoblast populations. Obese individuals are known to have higher levels of PPARγ expression which contributes to their increased adipocyte numbers and decreased bone density. Modulating PPAR*gamma* signaling can have significant effects on adipogenesis, thereby directing MSCs down the osteoblastogenesis pathway and in turn increasing bone mineral density. Lastly, we explore the potential of PPARγ as a druggable target to decrease adiposity, increase bone density, and be a treatment for children with obesity-induced bone fractures.

Age-related Assessment of Postural Control Development: A Cross-sectional Study in Children and Adolescents

The aim of this study was to outline an age-dependent range of posturography measures obtained from healthy children. One hundred and fifty healthy 4-18-year-old children underwent video Head Impulse Test and static posturography testing. Surface, length and power spectra values were compared between each group of pupils and 32 healthy adults. As well as a significant (p < 0.025) increase in surface and length, when compared to healthy adults, increased values within the low/middle frequency domain and within the high frequency domain were also observed in 4-13 and 4-7-year-old children, respectively. In conclusion, although the nature of postural control development remains largely undetermined, this study represents a first attempt to outline an age-dependent normal range of the relative contribution of inputs in typically developing children.

Relationships between adiposity and postural control in girls during balance tasks of varying difficulty

OBJECTIVE

This study aimed to examine associations between postural control and body composition in 8-10-year-old girls.

METHODS

An observational cross-sectional study was conducted in 47 girls who were healthy-weight/overweight/obese [body mass index (BMI) percentile]. Girls participated in six postural control conditions of varying difficulty (standing with malleoli touching, tandem stance leading with dominant and non-dominant foot, repeated with eyes open and closed). Postural control outcomes included Centre of Pressure (COP) sway area, COP principal and minor axis length and COP maximum velocity. Data were analysed using linear mixed modelling.

RESULTS

BMI percentile was positively associated with COP sway area (p=0.034) and principal axis (p=0.030) during tandem stance non-dominant foot leading with eyes closed and COP principal axis during tandem stance dominant foot leading with eyes open (p=0.045). BMI percentile significantly interacted with postural control conditions of varying difficulty to predict postural control outcomes (p≤0.035), notable for tandem stance positions [all four COP sway outcomes in tandem stance non-dominant foot leading eyes closed; tandem stance dominant foot leading with eyes open and closed (two COP sway outcomes each)].

CONCLUSIONS

Girls with greater adiposity may have impairments in postural control, but only during more challenging postural control conditions. In contrast, BMI has little role to play in girls' postural control in easier postural control conditions (standing with feet together). These findings may suggest potential functional or safety considerations when girls with overweight/obesity are performing demanding postural control tasks (such as during sport or physical activity).

The Role of Obesity in Pediatric Orthopedics

Pediatric obesity has become a worldwide epidemic and leads to notable effects on the developing skeleton that can have lifelong implications. Obesity in the pediatric population alters bone metabolism, increasing the risk for fracture. It can alter the presentation of common pediatric orthopaedic conditions such as scoliosis. Obesity also leads to changes in the patterns and severity of pediatric fractures as well as alters conservative fracture treatment due to increased displacement risk. Obese pediatric trauma patients place a high burden on the nationwide hospital system in a variety of ways including the increased risk of perioperative complications. Obesity is modifiable, and addressing the issue can improve the orthopaedic and overall health of children.

Postural Changes After Abdominoplasty in Morbid Obese Patients

BACKGROUND

In the multidisciplinary treatment of obesity, the role of a plastic surgeon is to remove the excess of skin after weight loss to obtain cosmetic, functional, and psychological benefits. Obesity modifies body geometry, increases the mass of different segments, and imposes functional limitations in life activities that may predispose the obese to injury. The authors evaluated the postural conditions of obese patients, before and 12 months after surgery.

METHODS

The study included 15 obese patients of both genders affected by class II obesity. Postural function was evaluated preoperatively and 12 months postoperatively. Patients underwent conventional abdominoplasty surgical procedure. In all patients, plantar pressure distribution and balance (stabilometric test) were evaluated before and 3 months after surgery.

RESULTS

The static pedobarographic revealed a significant reduction in forefoot peak pressure; total plantar force; rearfoot plantar force percentage; midfoot plantar force percentage; and forefoot, midfoot, and rearfoot plantar contact areas percentage 3 months after surgery; the dynamic's one showed a reduction in the first metatarsal peak pressure and plantar contact. The stabilometric values showed a reduction in the range of center of foot pressure (CP) displacement along y axis, the average displacement of the CP speed from the mean (RMS y velocity), and CP mean peak in the condition of vision.

CONCLUSIONS

Our study demonstrates the beneficial effect of dermolipectomies and the consequential weight loss on postural stability of obese men. Such findings may support the hypothesis that dermolipectomy may improve postural stability with and without vision. The data demonstrate that the benefits are related to the magnitude of the resected tissue.

An epidemiological evaluation of fractures and its determinants among Lebanese schoolchildren: a cross-sectional study

The purpose of this study is to establish the prevalence and determinants of fractures among 974 Lebanese schoolchildren aged 8-18. Fractures might be less common in the Lebanese pediatric population compared to western populations. Male gender and high SES are independent risk factors for fractures, while 25(OH)D and BMI have no impact.

PURPOSE

To establish the prevalence of fractures among Lebanese schoolchildren and its relationship with age, gender, BMI, 25 hydroxyvitamin D (25(OH)D) levels, and socioeconomic status (SES).

METHODS

In this cross-sectional study, 974 Lebanese schoolchildren aged 8-18 years old, mean age 13.37 ± 2.92 (508 boys and 466 girls), were recruited from 10 schools with different SES. For each participant, a questionnaire was used to collect data regarding history of fractures. Serum 25(OH)D was also measured.

RESULTS

The prevalence of Lebanese children sustaining ≥ 1 fracture was 16.9% and was higher in boys compared to girls (22.2% vs 11.1%, p < 0.0001). A 71.3% of fractures were localized in the upper limbs and 20% of participants had at least one displaced fracture. Children who sustained a fracture had a non-significant higher BMI compared to those without (p = 0.096). The percentage of children with fractures was higher in children from high SES compared to those from middle and low SES (respectively 23.3% vs. 16.3% and 13.8%, p < 0.0001). Fractures occurred at a younger age in girls compared to boys, but this difference was non-significant (p = 0.13). 25(OH)D levels were significantly higher in children with fractures compared to those without (p = 0.017). Finally, female gender was protective against upper limb fractures (p = 0.009). In a logistic regression analysis, male gender and high SES were independently associated with fractures, while BMI and 25(OH)D were not.

CONCLUSION

Our study demonstrates that the prevalence of fractures in the Lebanese pediatric population might be lower than western populations. It also confirms that male gender and high SES are independent risk factors for fractures, while 25(OH)D and BMI were not independently associated with fracture risk.

Gait Pattern, Impact to the Skeleton and Postural Balance in Overweight and Obese Children: A Review

The article reviews the biomechanical factors that may cause overweight/obese children to reduce their level of physical activity, while increasing their risk of overuse injuries and exercise-related pain. Recommendations would be to screen those children for any gait or postural impairments before they join any exercise program, and to provide them with specific gait treatments and/or physical exercise programs, in order to decrease their risk for future musculoskeletal injuries and pain.

Obesity in Pediatric Trauma

Obese children with high-energy injuries present with more severe injuries, more extremity injuries, and higher Injury Severity Scores. They are at increased risk for complications, prolonged ventilation, and ICU stay and have increased mortality. Obesity is associated with altered bone mass accrual and higher fracture rates. Obese patients have a higher risk of loss of reduction of forearm fractures, more severe supracondylar fractures, and a higher likelihood of lateral condyle fractures. Obese patients are more likely to have complications with femur fractures and have higher rates of foot and ankle fracture.

Fat and bone in children - where are we now?

The risk of fracture secondary to low-impact trauma is greater in obese children, suggesting obese children are at risk of skeletal fragility. However, despite this finding, there is a lack of agreement about the impact of excessive adiposity on skeletal development. The combination of poor diet, sedentary lifestyle, greater force generated on impact through falls, and greater propensity to falls may in part explain the increased risk of fracture in obese children. To date, evidence suggests that in early childhood years, obesity confers a structural advantage to the developing skeleton. However, in time, this relationship attenuates and then reverses, such that there is a critical period during skeletal development when obesity has a detrimental effect on skeletal structure and strength. Fat mass may be important to the developing cortical and trabecular bone compartments, provided that gains in fat mass are not excessive. However, when fat accumulation reaches excessive levels, unfavorable metabolic changes may impede skeletal development. Evidence from studies examining bone microstructure suggests skeletal adaption to excessive load fails, and bone strength is relatively diminished in relation to body size in obese children. Mechanisms that may explain these changes include changes in the hormonal environment, particularly in relation to alterations in adipokines and fat distribution. Given the concomitant rise in the prevalence of childhood obesity and fractures, as well as adult osteoporosis, further work is required to understand the relationship between obesity and skeletal development.

Effect of body mass index and fat mass on balance force platform measurements during a one-legged stance in older adults

The purpose of this study was to evaluate the impact of body mass index (BMI) and fat mass on balance force platform measurements in older adults. The sample consisted of 257 participants who were stratified into four groups by BMI: low weight, normal weight, pre-obesity and obesity. For fat mass variables, older individuals were classified into low and high-fat mass. All groups investigated performed three trials of one-legged stance balance on a force platform. Center of pressure (COP) domain parameters were computed from the mean across trials. Analysis of variance results revealed no significant interactions for groups and sexes for all COP parameters. Comparable balance results were found for BMI and fat groups for all COP parameters. A statistical effect (P < 0.05) was only reported for sex differences for COP parameters, regardless of BMI and fat mass variables. Overall, women presented better balance than men. In conclusion, BMI and fat mass do not seem to influence the balance of older adults during a one-leg stance task.

Relationship between body composition and postural control in prepubertal overweight/obese children: A cross-sectional study

BACKGROUND

Excess body weight during childhood causes reduced motor functionality and problems in postural control, a negative influence which has been reported in the literature. Nevertheless, no information regarding the effect of body composition on the postural control of overweight and obese children is available. The objective of this study was therefore to establish these relationships.

METHODS

A cross-sectional design was used to establish relationships between body composition and postural control variables obtained in bipedal eyes-open and eyes-closed conditions in twenty-two children. Centre of pressure signals were analysed in the temporal and frequency domains. Pearson correlations were applied to establish relationships between variables. Principal component analysis was applied to the body composition variables to avoid potential multicollinearity in the regression models. These principal components were used to perform a multiple linear regression analysis, from which regression models were obtained to predict postural control.

FINDINGS

Height and leg mass were the body composition variables that showed the highest correlation with postural control. Multiple regression models were also obtained and several of these models showed a higher correlation coefficient in predicting postural control than simple correlations. These models revealed that leg and trunk mass were good predictors of postural control. More equations were found in the eyes-open than eyes-closed condition.

INTERPRETATION

Body weight and height are negatively correlated with postural control. However, leg and trunk mass are better postural control predictors than arm or body mass. Finally, body composition variables are more useful in predicting postural control when the eyes are open.

Effects of a Randomized Weight Loss Intervention Trial in Obese Adolescents on Tibia and Radius Bone Geometry and Volumetric Density

Obese adolescents have increased fracture risk, but effects of alterations in adiposity on bone accrual and strength in obese adolescents are not understood. We evaluated 12-month changes in trabecular and cortical volumetric bone mineral density (vBMD) and cortical geometry in obese adolescents undergoing a randomized weight management program, and investigated the effect of body composition changes on bone outcomes. Peripheral quantitative computed tomography (pQCT) of the radius and tibia, and whole-body dual-energy X-ray absorptiometry (DXA) scans were obtained at baseline, 6 months, and 12 months in 91 obese adolescents randomized to standard care versus behavioral intervention for weight loss. Longitudinal models assessed effects of body composition changes on bone outcomes, adjusted for age, bone length, and African-American ancestry, and stratified by sex. Secondary analyses included adjustment for physical activity, maturation, vitamin D, and inflammatory biomarkers. Baseline body mass index (BMI) was similar between intervention groups. Twelve-month change in BMI in the standard care group was 1.0 kg/m² versus -0.4 kg/m² in the behavioral intervention group (p < 0.01). Intervention groups were similar in bone outcomes, so they were combined for subsequent analyses. For the tibia, BMI change was not associated with change in vBMD or structure. Greater baseline lean body mass index (LBMI) associated with higher cortical vBMD in males, trabecular vBMD in females, and polar section modulus (pZ) and periosteal circumference (Peri-C) in both sexes. In females, change in LBMI positively associated with gains in pZ and Peri-C. Baseline visceral adipose tissue (VFAT) was inversely associated with pZ in males and cortical vBMD in females. Change in VFAT did not affect bone outcomes. For the radius, BMI and LBMI changes positively associated with pZ in males. Thus, in obese adolescents, weight loss intervention with modest changes in BMI was not detrimental to radius or tibia bone strength, and changes in lean, but not adiposity, measures were beneficial to bone development. © 2017 American Society for Bone and Mineral Research.

Relationship between overweight/obesity in the first year of age and traumatic dental injuries in early childhood: Findings from a birth cohort study

BACKGROUND/AIM

The impact of traumatic dental injuries (TDI) in the primary dentition on oral health-related quality of life indicates the need for the planning of prevention strategies. The aim of this study was to assess whether anthropometric characteristics in early life are associated with TDI by preschool age.

MATERIALS AND METHODS

A birth cohort was recruited from the public healthcare system in the city of Porto Alegre, Brazil. Socio-demographic variables, type of birth, head circumference, weight, and length were collected at birth (WHO standards). Head circumference, body mass index for age, and height for age were collected at 12 months. TDI (Andreasen criteria) at three years of age (n = 458) were recorded by two examiners who had undergone training and calibration exercises. Multivariable analysis was carried out with Poisson regression with robust variance.

RESULTS

A total of 31.0% of the children (142/458) exhibited TDI at three years of age. In the final model, the risk of TDI was 47% higher among children with a smaller head circumference upon birth and nearly 60% higher among those who were overweight/obese at 12 months of age (RR: 1.58; 95% CI: 1.15-2.17). The risk of TDI was also significantly higher among boys (RR 1.50; 95% CI: 1.13-2.00), but the outcome was not significantly associated with socioeconomic variables or other anthropometric variables.

CONCLUSION

Overweight/obesity in early life is a risk factor for TDI in preschool children.

Balance, Proprioception, and Gross Motor Development of Chinese Children Aged 3 to 6 Years

The authors' aim was to find the features of balance, proprioception, and gross motor development of Chinese children 3-6 years old and their correlations, provide theoretical support for promoting children's motor development, and enrich the world theoretical system of motor development. This study used a Tekscan foot pressure measurement instrument (Tekscan, Inc., Boston, MA), walking on a balance beam, Xsens 3-dimensional positional measuring system (Xsens Technologies, Enschede, the Netherlands), and Test of Gross Motor Development-2 to assess static balance, dynamic balance, knee proprioception, and levels of gross motor development (GMD) of 3- to 6-year-old children (n = 60) in Beijing. The results are as follows: children had significant age differences in static balance, dynamic balance, proprioception, and levels of GMD; children had significant gender differences in static balance, proprioception, and levels of GMD; children's static balance, dynamic balance, and proprioception had a very significant positive correlation with GMD (p < .01), but no significant correlation with body mass index.

Abdominal Obesity and Risk of Hip Fracture: A Systematic Review and Meta-Analysis of Prospective Studies

Data on the association between general obesity and hip fracture were summarized in a 2013 meta-analysis; however, to our knowledge, no study has examined the association between abdominal obesity and the risk of hip fracture. The present systematic review and meta-analysis of prospective studies was undertaken to summarize the association between abdominal obesity and the risk of hip fracture. We searched online databases for relevant publications up to February 2017, using relevant keywords. In total, 14 studies were included in the systematic review and 9 studies, with a total sample size of 295,674 individuals (129,964 men and 165,703 women), were included in the meta-analysis. Participants were apparently healthy and aged ≥40 y. We found that abdominal obesity (defined by various waist-hip ratios) was positively associated with the risk of hip fracture (combined RR: 1.24, 95% CI: 1.05, 1.46, P = 0.01). Combining 8 effect sizes from 6 studies, we noted a marginally significant positive association between abdominal obesity (defined by various waist circumferences) and the risk of hip fracture (combined RR: 1.36; 95% CI: 0.97, 1.89, P = 0.07). This association became significant in a fixed-effects model (combined effect size: 1.40, 95% CI: 1.25, 1.58, P < 0.001). Based on 5 effect sizes, we found that a 0.1-U increase in the waist-hip ratio was associated with a 16% increase in the risk of hip fracture (combined RR: 1.16, 95% CI: 1.04, 1.29, P = 0.007), whereas a 10-cm increase in waist circumference was not significantly associated with a higher risk of hip fracture (combined RR: 1.13, 95% CI: 0.94, 1.36, P = 0.19). This association became significant, however, when we applied a fixed-effects model (combined effect size: 1.21, 95% CI: 1.15, 1.27, P < 0.001). We found that abdominal obesity was associated with a higher risk of hip fracture in 295,674 individuals. Further studies are needed to test whether there are associations between abdominal obesity and fractures at other bone sites.

The Impact of Fat and Obesity on Bone Microarchitecture and Strength in Children

A complex interplay of genetic, environmental, hormonal, and behavioral factors affect skeletal development, several of which are associated with childhood fractures. Given the rise in obesity worldwide, it is of particular concern that excess fat accumulation during childhood appears to be a risk factor for fractures. Plausible explanations for this higher fracture risk include a greater propensity for falls, greater force generation upon fall impact, unhealthy lifestyle habits, and excessive adipose tissue that may have direct or indirect detrimental effects on skeletal development. To date, there remains little resolution or agreement about the impact of obesity and adiposity on skeletal development as well as the mechanisms underpinning these changes. Limitations of imaging modalities, short duration of follow-up in longitudinal studies, and differences among cohorts examined may all contribute to conflicting results. Nonetheless, a linear relationship between increasing adiposity and skeletal development seems unlikely. Fat mass may confer advantages to the developing cortical and trabecular bone compartments, provided that gains in fat mass are not excessive. However, when fat mass accumulation reaches excessive levels, unfavorable metabolic changes may impede skeletal development. Mechanisms underpinning these changes may relate to changes in the hormonal milieu, with adipokines potentially playing a central role, but again findings have been confounding. Changes in the relationship between fat and bone also appear to be age and sex dependent. Clearly, more work is needed to better understand the controversial impact of fat and obesity on skeletal development and fracture risk during childhood.

Influence of body mass index on movement efficiency among firefighter recruits

BACKGROUND

Previous research has demonstrated links between musculoskeletal injury risk and measures of obesity and movement efficiency among the firefighter population. However, the influence of obesity on movement efficiency among firefighter recruits remains uninvestigated.

OBJECTIVE

To investigate the influence of obesity on movement efficiency measures among firefighter recruits.

METHODS

Measures of obesity were collected among 73 male firefighter recruits. Participants were grouped into standard body mass index (BMI) categories (normal, overweight, obese). Differences in Total Functional Movement Screen (FMS) scores and Y-Balance Test (YBT) composite scores were examined between BMI categories. In addition, the relationships between measures of obesity and movement efficiency were also examined.

RESULTS

No significant differences in movement efficiency measures were identified between BMI categories (p > 0.05). However, significant bivariate correlations were identified between BMI (kg/m2) and Total FMS score (r = -0.235, p = 0.045), as well as between fat-free mass (FFM) and Total FMS score (r = -0.231, p = 0.049), when examined among all participants.

CONCLUSIONS

BMI may influence measures of movement efficiency among firefighter recruits to a lesser extent than among other previously examined populations. Future research should examine the influence of other unexamined physiological variables on movement efficiency.

Sex-specific association between obesity and self-reported falls and injuries among community-dwelling Canadians aged 65 years and older

This study investigated the relationship between body mass index (BMI) and falls among community-dwelling elderly. Results indicate that obesity is associated with increased falls and there appears to be a sex-specific difference with obese men at higher risk of falling. Obesity is identified as a risk factor for falls in men.

INTRODUCTION

The prevalence of falls, fall-related injuries, and obesity has increased over the last decade. The objectives of this study were to investigate sex-specific association and dose-response relationship between BMI and falls (and related injuries) among community-dwelling elderly.

METHODS

Our study sample consisted of 15,860 adults aged 65 years or older (6399 men and 9461 women) from the 2008-2009 Canadian Community Health Survey-Healthy Aging (CCHS-HA). Falls, fall-related injuries, and BMI measures were self-reported. For both sex, dose-response curves presenting the relationship between BMI, falls, and fall-related injuries were first examined. Thereafter, multivariate logistic regression analyses were also performed to investigate these relationships after adjustment for potentially confounding variables.

RESULTS

Of women, 21.7 % reported a fall and 16.9 % of men. The dose-response relationship between BMI and prevalence of falls showed that underweight and obese individuals reported falling more than normal and overweight individuals; this being more apparent in men than women. Finally, the dose relationship between BMI and prevalence of fall-related injuries showed that only obese men seem more likely to have sustained a fall-related injury. Results from the multivariate analysis showed that obesity in men was significantly associated with higher odds of falling odds ratio (OR) 1.33 (1.04-1.70) and was not significantly associated with higher odds of fall-related injuries OR 1.10 (0.66-1.84) over a 12-month period compared to normal weight men. For women, obesity was not significantly associated with higher fall prevalence OR 0.99 (0.79-1.25) and fall-related injuries OR 0.71 (0.51-1.00).

CONCLUSION

Obesity is associated with self-reported falls, and there appears to be a sex-specific difference in elderly persons.

Effects of overweight and obesity on motor and mental development in infants and toddlers

BACKGROUND

A consequence of childhood obesity may be poor developmental outcomes.

OBJECTIVES

This study aimed to examine the relationship between weight and developmental delays in young children.

METHODS

We conducted a secondary analysis of the Early Childhood Longitudinal Study Birth Cohort data. Logistic regression models quantified the association between different weight statuses (normal weight <85th, overweight ≥90th, obese ≥95th percentile for weight) and delays in motor and mental development.

RESULTS

Children classified as overweight in both waves had higher percentages of delays in wave 2 (motor [7.5 vs. 6.2-6.4%], mental [8.6 vs. 5.9-6.7%]), as well as wave 1 and/or wave 2 (motor [14.8 vs. 10.9-13.0%], mental [11.9 vs. 9.0-10.1%]), compared with other children. This association was also found in children who were obese at both time points in wave 2 (motor delay [8.9 vs. 4.9-7.3%], mental delay [10.3 vs. 6.0-7.2%]), as well as wave 1 and/or wave 2 (motor delay [14.5 vs. 10.9-12.9%], mental delay [14.1 vs. 9.4-10.1%]). In the adjusted models, children classified as always obese were more likely to have a mental delay in wave 2 (adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI]: 1.21-2.95) as well as wave 1 and/or wave 2 (aOR 1.56, 95% CI: 1.08-2.26). These children were also more likely to have motor delay (aOR 1.47, 95% CI: 1.02-2.13) in wave 1 and/or wave 2.

CONCLUSION

Overweight children are more likely than their normal-weight peers to have motor and mental developmental delays. Preventing obesity during infancy may facilitate reducing developmental delays in young children.

Effects of high heeled shoes wearing experience and heel height on human standing balance and functional mobility

This study aimed to examine the effects of high heeled shoes (HHS) wearing experience and heel height on human standing balance and functional mobility. Thirty young and healthy females (ten experienced and twenty inexperienced HHS wearers) participated in a series of balance tests when they wore shoes of four different heel heights: 1 cm (flat), 4 cm (low), 7 cm (medium) and 10 cm (high). Experimental results show that regardless of the wearing experience, the heel elevation induces more effort from lower limb muscles (particularly calf muscles) and results in worse functional mobility starting at 7 cm heel height. While the heel height increased to 10 cm, the standing balance also becomes worse. Experienced HHS wearers do not show significantly better overall performance on standing balance and functional mobility than inexperienced controls, even though they have better directional control (76.8% vs. 74.4%) and larger maximum excursion (93.3% vs. 89.7%). To maintain standing balance, experienced wearers exert less effort on tibialis anterior, vastus lateralis and erector spinae muscles at the cost of more intensive effort from gastrocnemius medialis muscle.

PRACTITIONER SUMMARY

Many women wear high heeled shoes (HHS) to increase female attractiveness. This study shows that HHS induce more muscular effort and worse human standing balance and functional mobility, especially when heel height reaches 10 cm. HHS wearing experience only provides certain advantages to wearers on limits of stability in terms of larger maximum excursion and better directional control.

Ball games and nutrition counseling improve postural control in overweight children

Background

Motor skills are impaired in overweight children whose levels of physical activity are low and these children are more likely to sustain lower extremity injuries.

The purpose of this study was to analyze prospectively in overweight children the influence of ball games and nutrition counseling on postural control.

Methods

In all, 46 overweight children (age: 6–12 years, BMI: female: 25.2 ± 3.6 kg/m², male: 26.2 ± 2.8 kg/m² (mean value ± standard deviation) were examined prospectively in four randomized groups (ball games, nutrition counseling, ball games and nutrition counseling, and group without intervention) for six months. A one-legged standing test was performed.

Results

The children demonstrated improved postural control after six months of intervention: mean difference M1-M2 ± standard deviation: 5 ± 6 error points (p < 0.001, T = 4.906), whereas the control group without intervention did not show any significant improvement: 2 ± 8 error points (p = 0.357, T = 0.972).

Conclusions

Ball games and nutrition counseling have a positive influence on postural control and therefore could help prevent injury.

Trial registration

ClinicalTrials.gov Identifier: NCT01825174.

Registered April 2, 2013

The Association Between Weight Status and Pediatric Forearm Fractures Resulting From Ground-Level Falls

OBJECTIVE

The purpose of our study was to evaluate the hypothesis that pediatric forearm fractures resulting from ground-level falls are associated with increased weight status (weight for age/sex percentile ≥ 95th) in comparison with those resulting from major trauma.

METHODS

This is a retrospective case-control study nested within a case series of 929 children, ages 0 to 17 years, with self-identified residence in Washington, DC, who were treated for isolated forearm fractures in an urban, academic pediatric emergency department between 2003 and 2006. Multivariable logistic regression was performed to test for the association of weight status with mechanism of injury while controlling for sex, age, race/ethnicity, bone fractured, and season.

RESULTS

Of 929 forearm fractures, there were 226 (24.3%) with ground-level falls and 54 (5.8%) with major trauma. Compared with children with forearm fractures resulting from major trauma, ground-level fall cases were significantly older (10.4 [3.4] vs 7.4 [4.2] years, P < 0.05), had greater adjusted odds of having a weight for age/sex of 95th percentile or higher (odds ratio, 2.7; 95% confidence interval, 1.2-6.5), and had significantly more radius-only fractures (odds ratio, 2.3; 95% confidence interval, 1.2-4.7). These groups did not differ in sex, race/ethnicity, or injury season.

CONCLUSIONS

Ground-level falls are a common mechanism of pediatric forearm fracture and are significantly associated with increased weight status and radius-only fractures. These results suggest the need for further investigation into obesity and bone health in pediatric patients with forearm fractures caused by ground-level falls.

Relation between the Sensory and Anthropometric Variables in the Quiet Standing Postural Control: Is the Inverted Pendulum Important for the Static Balance Control?

The aim of this study was to evaluate the relation between the sensory and anthropometric variables in the quiet standing. Methods. One hundred individuals (50 men, 50 women; 20–40 years old) participated in this study. For all participants, the body composition (fat tissue, lean mass, bone mineral content, and bone mineral density) and body mass, height, trunk-head length, lower limb length, and upper limb length were measured. The center of pressure was measured during the quiet standing posture, the eyes opened and closed with a force platform. Correlation and regression analysis were run to analyze the relation among body composition, anthropometric data, and postural sway. Results. The correlation analysis showed low relation between postural sway and anthropometric variables. The multiple linear regression analyses showed that the height explained 12% of the mediolateral displacement and 11% of the center of pressure area. The length of the trunk head explained 6% of displacement in the anteroposterior postural sway. During eyes closed condition, the support basis and height explained 18% of mediolateral postural sway. Conclusion. The postural control depends on body composition and dimension. This relation is mediated by the sensory information. The height was the anthropometric variable that most influenced the postural sway.

Differences in childhood adiposity influence upper limb fracture site

INTRODUCTION

Although it has been suggested that overweight and obese children have an increased risk of fracture, recent studies in post-menopausal women have shown that the relationship between obesity and fracture risk varies by fracture site. We therefore assessed whether adiposity and overweight/obesity prevalence differed by upper limb fracture site in children.

METHODS

Height, weight, BMI, triceps and subscapular skinfold thickness (SFT) were measured in children aged 3-18 years with an acute upper limb fracture. Data was compared across three fracture sites (hand, forearm and upper arm/shoulder [UA]), and to published reference data.

RESULTS

401 children (67.1% male, median age 11.71 years, range 3.54-17.27 years) participated. 34.2%, 50.6% and 15.2% had fractures of the hand, forearm and UA, respectively. Children with forearm fractures had higher weight, BMI, subscapular SFT and fat percentage z-scores than those with UA fractures (p<0.05 for all). SFT and fat percentage z-scores were also higher in children with forearm fractures compared to hand fractures, but children with hand and UA fractures did not differ. Overweight and obesity prevalence was higher in children with forearm fractures (37.6%) than those with UA fractures (19.0%, p=0.009). This prevalence was also higher than the published United Kingdom population prevalence (27.9%, p=0.003), whereas that of children with either UA (p=0.13) or hand fractures (29.1%, p=0.76) did not differ. These differences in anthropometry and overweight/obesity prevalence by fracture site were evident in boys, but not present in girls.

CONCLUSION

Measurements of adiposity and the prevalence of overweight/obesity differ by fracture site in children, and in particular boys, with upper limb fractures.

Altered characteristics of balance control in obese older adults

BACKGROUND

Obesity is one of the most significant epidemiological trends of the last decades. Recently it was found that obese individuals show postural instability. Balance control mechanisms in obese older adults were less studied. Therefore we aimed to investigate the effect of obesity on balance control mechanisms in older adults.

METHODS

Parameters from Stabilogram-Diffusion Analysis (SDA) and measures from summary statistics of foot centre-of-pressure (COP) displacements along the anterior-posterior (AP) and mediolateral (ML) directions in eyes open and eyes closed conditions were used to characterize postural control in 22 obese (30-<35kg/m(2)), 26 overweight (25-<30kg/m(2)), and 18 normal weight subjects (18.5-<25kg/m(2)).

RESULTS

Obese group subjects demonstrated significantly greater transition displacement, transition time interval, and short-term scaling exponent in the ML-direction compared with the normal weight group (eyes open and closed). In the AP-direction the obese group showed greater transition displacement (eyes open) and short-term scaling exponent (eyes open and closed). Average AP-COP and ML-COP ranges of COP sway were higher in the obese group compared with the normal weight group (eyes open and closed).

CONCLUSIONS

This work indicates an altered postural control process in obese older adults. A greater sway displacement before closed-loop feedback mechanisms are called into play was seen in the ML direction that may lead to a higher risk of instability and fall events.

Changing trends in the management of children's fractures

The management of children's fractures has evolved as a result of better health education, changes in lifestyle, improved implant technology and the changing expectations of society. This review focuses on the changes seen in paediatric fractures, including epidemiology, the increasing problems of obesity, the mechanisms of injury, non-accidental injuries and litigation. We also examine the changes in the management of fractures at three specific sites: the supracondylar humerus, femoral shaft and forearm. There has been an increasing trend towards surgical stabilisation of these fractures. The reasons for this are multifactorial, including societal expectations of a perfect result and reduced hospital stay. Reduced hospital stay is beneficial to the social, educational and psychological needs of the child and beneficial to society as a whole, due to reduced costs.