Increasing prevalence of overweight among US low-income preschool children: the Centers for Disease Control and Prevention pediatric nutrition surveillance, 1983 to 1995

Using Explainable Artificial Intelligence to Discover Interactions in an Ecological Model for Obesity

Ecological theories suggest that environmental, social, and individual factors interact to cause obesity. Yet, many analytic techniques, such as multilevel modeling, require manual specification of interacting factors, making them inept in their ability to search for interactions. This paper shows evidence that an explainable artificial intelligence approach, commonly employed in genomics research, can address this problem. The method entails using random intersection trees to decode interactions learned by random forest models. Here, this approach is used to extract interactions between features of a multi-level environment from random forest models of waist-to-height ratios using 11,112 participants from the Adolescent Brain Cognitive Development study. This study shows that methods used to discover interactions between genes can also discover interacting features of the environment that impact obesity. This new approach to modeling ecosystems may help shine a spotlight on combinations of environmental features that are important to obesity, as well as other health outcomes.

Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016

BACKGROUND

Food insecurity is associated with poorer nutrient intakes from food sources and lower dietary supplement use. However, its association with total usual nutrient intakes, inclusive of dietary supplements, and biomarkers of nutritional status among US children remains unknown.

OBJECTIVE

The objective was to assess total usual nutrient intakes, Healthy Eating Index-2015 (HEI-2015) scores, and nutritional biomarkers by food security status, sex, and age among US children.

METHODS

Cross-sectional data from 9147 children aged 1-18 y from the 2011-2016 NHANES were analyzed. Usual energy and total nutrient intakes and HEI-2015 scores were estimated using the National Cancer Institute method from 24-h dietary recalls.

RESULTS

Overall diet quality was poor, and intakes of sodium, added sugars, and saturated fat were higher than recommended limits, regardless of food security status. Food-insecure girls and boys were at higher risk of inadequate intakes for vitamin D and magnesium, and girls also had higher risk for inadequate calcium intakes compared with their food-secure counterparts, when total intakes were examined. Choline intakes of food-insecure children were less likely to meet the adequate intake than those of their food-secure peers. No differences by food security status were noted for folate, vitamin C, iron, zinc, potassium, and sodium intakes. Food-insecure adolescent girls aged 14-18 y were at higher risk of micronutrient inadequacies than any other subgroup, with 92.8% (SE: 3.6%) at risk of inadequate intakes for vitamin D. No differences in biomarkers for vitamin D, folate, iron, and zinc were observed by food security status. The prevalence of iron deficiency was 12.7% in food-secure and 12.0% in food-insecure adolescent girls.

CONCLUSIONS

Food insecurity was associated with compromised intake of some micronutrients, especially among adolescent girls. These results highlight a need for targeted interventions to improve children's overall diet quality, including the reduction of specific nutrient inadequacies, especially among food-insecure children. This study was registered at clinicaltrials.gov as NCT03400436.

Are there birth cohort effects in disparities in child obesity by maternal education?

BACKGROUND

Children belonging to the same birth cohort (i.e., born in the same year) experience shared exposure to a common obesity-related milieu during the critical early years of development-e.g., secular beliefs and feeding practices, adverse chemical exposures, food access and nutrition assistance policies-that set the stage for a shared trajectory of obesity as they mature. Fundamental cause theory suggests that inequitable distribution of recent efforts to stem the rise in child obesity may exacerbate cohort-based disparities over time.

METHODS

Data were from electronic health records spanning 2007-2016 linked to birth records for children ages 2-19 years. We used hierarchical age-period-cohort models to investigate cohort effects on disparities in obesity related to maternal education. We hypothesized that maternal education-based disparities in prevalence of obesity would be larger among more recent birth cohorts.

RESULTS

Sex-stratified models adjusted for race/ethnicity showed substantial obesity disparities by maternal education that were evident even at young ages: prevalence among children with maternal education < high school compared to maternal college degree was approximately three times as high among girls and twice as high among boys. For maternal education < high school, disparities compared to maternal college degree were higher in more recent birth cohorts. Among girls, this disparity cohort effect was evident at younger ages (at age 4, the disparity increased by 4 [0.1-8] percentage points per 5 birth years), while among boys it was larger at older ages (at age 16, the disparity increased by 7 [1-14] percentage points per 5 birth years).

CONCLUSIONS

There may be widening maternal education-based disparities in child obesity by birth cohort at some ages.

Risk Factors for Obesity and Overfat among Primary School Children in Mashonaland West Province, Zimbabwe

Associated childhood obesity risk factors are not well established in developing countries such as Zimbabwe and this information is essential for tailored intervention development. This study aimed to identify prominent risk factors for overweight/obese and overfat/obese among primary school children of Mashonaland West Province in Zimbabwe. A school-based cross-sectional study was conducted using multi-stage random cluster sampling approach (30 × 30). Bivariate and multivariable logistic regression was employed and identified the risk factors for overweight/obese and overfat/obese. A total of 974 participants were enrolled in the study. Prominent significant risk factors of overweight/obese after multivariable adjustment were higher socio-economic households; parental diabetes status; and living in Makonde, Zvimba, Sanyati or Mhondoro-Ngezi district as opposed to Hurungwe district. Risk factors for overfat/obese that remained statically significant were children in urban areas (aOR = 3.19, 95% CI: 2.18-4.66, p = 0.000), being one child in a household, and parents who have diabetes mellitus. Living in Makonde, Sanyati, and Zvimba district remained associated with overfat/obese compared to Hurungwe district. This study has identified prominent proximal determinants of overweight/obese and overfat/obese among primary school children in Zimbabwe, to better assist policy guidance. Aggressive education on good nutrition activities should be tailored and targeted to most affected urban areas within high-risk districts.

Longitudinal changes in BMI z-scores among 45 414 2-4-year olds with severe obesity

BACKGROUND

BMI z-scores (BMIz) based on the Centers for Disease Control and Prevention (CDC) growth charts among children do not accurately characterise BMI levels among children with very high BMIs. These limitations may be particularly relevant in longitudinal and intervention studies, as the large changes in the L (normality) and S (dispersion) parameters with age can influence BMIz.

AIM

To compare longitudinal changes in BMIz with BMI expressed as a percentage of the 95th percentile (%BMIp95) and a modified z-score calculated as log(BMI/M)/S.

SUBJECTS AND METHODS

A total of 45 414 2-4-year-olds with severe obesity (%BMIp95 ≥ 120).

RESULTS

Changes in very high BMIz levels differed from the other metrics. Among severely obese 2-year-old girls, for example, the mean BMIz decreased by 0.6 SD between examinations, but there were only small changes in BMIp95 and modified BMIz. Some 2-year-old girls had BMIz decreases of >1 SD, even though they had large increases in BMI, %BMIp95 and modified BMIz.

CONCLUSIONS

Among children with severe obesity, BMIz changes may be due to differences in the transformations used to estimate levels of BMIz rather than to changes in body size. The BMIs of these children could be expressed relative to the 95th percentile or as modified z-scores.

The Limitations of Transforming Very High Body Mass Indexes into z-Scores among 8.7 Million 2- to 4-Year-Old Children

OBJECTIVE

To examine the associations among several body mass index (BMI) metrics (z-scores, percent of the 95th percentile (%BMIp95) and BMI minus 95th percentile (ΔBMIp95) as calculated in the growth charts from the Centers for Disease Control and Prevention (CDC). It is known that the widely used BMI z-scores (BMIz) and percentiles calculated from the growth charts can differ substantially from those that directly observed in the data for BMIs above the 97th percentile (z = 1.88).

STUDY DESIGN

Cross-sectional analyses of 8.7 million 2- to 4-year-old children who were examined from 2008 through 2011 in the CDC's Pediatric Nutrition Surveillance System.

RESULTS

Because of the transformation used to calculate z-scores, the theoretical maximum BMIz varied by >3-fold across ages. This results in the conversion of very high BMIs into a narrow range of z-scores that varied by sex and age. Among children with severe obesity, levels of BMIz were only moderately correlated (r ~ 0.5) with %BMIp95 and ΔBMIp95. Among these children with severe obesity, BMIz levels could differ by more than 1 SD among children who had very similar levels of BMI, %BMIp95 and ΔBMIp95 due to differences in age or sex.

CONCLUSIONS

The effective upper limit of BMIz values calculated from the CDC growth charts, which varies by sex and age, strongly influences the calculation of z-scores for children with severe obesity. Expressing these very high BMIs relative to the CDC 95th percentile, either as a difference or percentage, would be preferable to using BMI-for-age, particularly when assessing the effectiveness of interventions.

The Role of O-GlcNAcylation in Perivascular Adipose Tissue Dysfunction of Offspring of High-Fat Diet-Fed Rats

Perivascular adipose tissue (PVAT), which reduces vascular contractility, is dysfunctional in the male offspring of rats fed a high-fat diet (HFD), partially due to a reduced NO bioavailability. O-GlcNAcylation of eNOS decreases its activity, thus we investigated the role of O-GlcNAcylation in the prenatal programming of PVAT dysfunction. Female Sprague-Dawley rats were fed either a control (10% fat) or an obesogenic HFD (45% fat) diet for 12 weeks prior to mating, and throughout pregnancy and lactation. Offspring were weaned onto the control diet and were killed at 12 and 24 weeks of age. Mesenteric arteries from the 12-week-old offspring of HFD dams (HFDO) contracted less to U46619; these effects were mimicked by glucosamine in control arteries. PVAT from 12- and 24-week-old controls, but not from HFDO, exerted an anticontractile effect. Glucosamine attenuated the anticontractile effect of PVAT in the vessels from controls but not from HFDO. AMP-activated protein kinase (AMPK) activation (with A769662) partially restored an anticontractile effect in glucosamine-treated controls and HFDO PVAT. Glucosamine decreased AMPK activity and expression in HFDO PVAT, although phosphorylated eNOS expression was only reduced in that from males. The loss of anticontractile effect of HFDO PVAT is likely to result from increased O-GlcNAcylation, which decreased AMPK activity and, in males, decreased NO bioavailability.

Prevalence and Determinants of Overweight and Obesity in Children and Adolescents from Migrant and Seasonal Farmworker Families in the United States-A Systematic Review and Qualitative Assessment

Overweight and obesity (OW/OB) is a pressing health concern among migrant and seasonal farmworker (MSFW) families in the US. The limited number of previously reported research on MSFW families suggests that their unique sociodemographic characteristics and lifestyle predispose them to poor health outcomes including OW/OB. We aimed to synthesize and assess available data on the prevalence and modifiable health determinants of OW/OB in MSFW children and adolescents. Literature search, study selection, data extraction and synthesis, and qualitative assessment of selected studies were performed independently by two authors. Ten cross-sectional studies met the inclusion criteria: articles or dissertations investigating prevalence and association between health determinants and OW/OB in MSFW children and adolescents (<20 years) in the US. The prevalence of OW, OB, and OW/OB ranged from 10%–33%, 15%–37%, and 31%–73%, respectively. Children’s education, household food insecurity, parents’ weight status, parents’ distorted perception of their children’s weight status, and parents’ participation in the federal nutrition assistance program were significantly associated with the children’s and adolescents’ risk of OW/OB. Promotion of culturally relevant public health programs and implementation of a systematic health surveillance plan for MSFWs and their children should be emphasized to combat OW/OB among MSFW children and adolescents.

The prevalence and validity of high, biologically implausible values of weight, height, and BMI among 8.8 million children

OBJECTIVE

This study assessed the prevalence and consistency of high values of weight, height, and BMI considered to be biologically implausible (BIV) using cut points proposed by WHO among 8.8 million low-income children (13.7 million observations).

METHODS

Cross-sectional and longitudinal analyses were performed among 2- to 4-year-olds who were examined from 2008 through 2011.

RESULTS

Overall, 2.7% of the body size measurements were classified as BIVs; 95% of these BIVs were very high. Among the subset of children (3.6 million) examined more than once, most of those who initially had a high weight or BMI BIV also had a high BIV at the second examination; odds ratios were >250. Based on several alternative classifications of BIVs, the current cut points likely underestimate the prevalence of obesity by about 1%.

CONCLUSIONS

Many of the extremely high values of body size currently flagged as BIVs are unlikely to be errors. Increasing the z-score cut points or using a percentage of the maximum values in the National Health and Nutrition Examination Survey, could improve the balance between removing probable errors and retaining those that are likely correct.

Diet inequality prevails among consumers interested and knowledgeable in nutrition

Background

Previous studies have demonstrated a correlation between diet cost and adherence to nutritional recommendations among consumers in general. This has adverse effects on diet and health inequality. It could be hypothesized that consumers knowledgeable in nutrition escape this correlation.

Objective

Investigate whether the previously observed relationship between diet cost and nutritional quality prevails among consumers with an above-average interest in and knowledge of nutrition.

Design

Full open diet registrations of 330 students taking a basic university-level course in nutrition over a total of 780 days.

Results

The consumers with the highest daily average diet cost differ from the lowest cost quartile: The diets had higher micronutrient density, more fruits and vegetables, and lower energy density. The highest cost daily diet quartile had a significantly higher energy adjusted intake of the micronutrients that were on average consumed below the recommendation (vitamin D, folate, and iron for women). On the other hand, alcohol intake was significantly higher among the high diet cost group. The highest diet cost respondents consumed more fish, meat, coffee, and spreads, whereas the lowest diet cost respondents had a higher consumption of cereals, bread, jam, sausage, and milk.

Conclusions

Dietary differences prevail even in the above-average interested and knowledgeable group. The respondents did not use their higher level of knowledge to break this commonly observed relationship. This suggests that an increased minimum level of knowledge in nutrition may not by itself eliminate dietary inequality.

Comparing Methods for Identifying Biologically Implausible Values in Height, Weight, and Body Mass Index Among Youth

As more epidemiologic data on childhood obesity become available, researchers are faced with decisions regarding how to determine biologically implausible values (BIVs) in height, weight, and body mass index. The purpose of the current study was 1) to track how often large, epidemiologic studies address BIVs, 2) to review BIV identification methods, and 3) to apply those methods to a large data set of youth to determine the effects on obesity and BIV prevalence estimates. Studies with large samples of anthropometric data (n > 1,000) were reviewed to track whether and how BIVs were defined. Identified methods were then applied to a longitudinal sample of 13,662 students (65% African American, 52% male) in 55 urban, low-income schools that enroll students from kindergarten through eighth grade (ages 5-13 years) in Philadelphia, Pennsylvania, during 2011-2012. Using measured weight and height at baseline and 1-year follow-up, we compared descriptive statistics, weight status prevalence, and BIV prevalence estimates. Eleven different BIV methods were identified. When these methods were applied to a large data set, severe obesity and BIV prevalence ranged from 7.2% to 8.6% and from 0.04% to 1.68%, respectively. Approximately 41% of large epidemiologic studies did not address BIV identification, and existing identification methods varied considerably. Increased standardization of the identification and treatment of BIVs may aid in the comparability of study results and accurate monitoring of obesity trends.

Low demanding parental feeding style is associated with low consumption of whole grains among children of recent immigrants

We explored the influence of immigrant mothers feeding style on their children's fruit, vegetable and whole grain intake and how this relationship differed by mother's time in the U.S. Baseline data were collected on mother-child (3-12 yrs) dyads enrolled in Live Well (n = 313), a community-based, participatory, randomized controlled lifestyle intervention (2008-2013). Socio-demographics, years of residence in the U.S., behavioral data, and responses to the Caregiver's Feeding Styles Questionnaire (CFSQ) were obtained from the mother. Measured heights and weights were obtained for both mother and child. Child dietary intake was assessed using the Block Food Screener. Separate multiple linear regression models were run, adjusting for child and mother covariates. Interactions between feeding styles and years in the U.S. (<5 and ≥ 5 years), ethnicity, and child age were tested. Sixty-nine percent of mothers were overweight or obese, 46% of the children were overweight or obese. For mothers in the U.S. for<5 years, having a low demanding/high responsive style was associated with lower child intake of whole grains in adjusted models vs. a high demanding/high responsive style (p < 0.05). This was not seen for mothers in the U.S. for≥5 years. Thus, the influence of feeding style on dietary intake may change with length of time in the U.S. These hypotheses-generating findings call for future research to understand how broader socio-cultural factors influence the feeding dynamic among immigrants.

Has it become increasingly expensive to follow a nutritious diet? Insights from a new price index for nutritious diets in Sweden 1980-2012

Background

Health-related illnesses such as obesity and diabetes continue to increase, particularly in groups of low socioeconomic status. The increasing cost of nutritious food has been suggested as an explanation.

Objective

To construct a price index describing the cost of a diet adhering to nutritional recommendations for a rational and knowledgeable consumer and, furthermore, to investigate which nutrients have become more expensive to obtain over time.

Methods

Linear programming and goal programming were used to calculate two optimal and nutritious diets for each year in the interval under different assumptions. The first model describes the rational choice of a cost-minimizing consumer; the second, the choice of a consumer trying to deviate as little as possible from average consumption. Shadow price analysis was used to investigate how nutrients contribute to the diet cost.

Results

The cost of a diet adhering to nutritional recommendations has not increased more than general food prices in Sweden between 1980 and 2012. However, following nutrient recommendations increases the diet cost even for a rational consumer, particularly for vitamin D, iron, and selenium. The cost of adhering to the vitamin D recommendation has increased faster than the general food prices.

Conclusions

Not adhering to recommendations (especially those for vitamin D) offers an opportunity for consumers to lower the diet cost. However, the cost of nutritious diets has not increased more than the cost of food in general between 1980 and 2012 in Sweden.

Maternal depression, stress and feeding styles: towards a framework for theory and research in child obesity

Against the background of rising rates of obesity in children and adults in the USA, and modest effect sizes for obesity interventions, the aim of the present narrative review paper is to extend the UNICEF care model to focus on childhood obesity and its associated risks with an emphasis on the emotional climate of the parent-child relationship within the family. Specifically, we extended the UNICEF model by applying the systems approach to childhood obesity and by combining previously unintegrated sets of literature across multiple disciplines including developmental psychology, clinical psychology and nutrition. Specifically, we modified the extended care model by explicitly integrating new linkages (i.e. parental feeding styles, stress, depression and mother's own eating behaviour) that have been found to be associated with the development of children's eating behaviours and risk of childhood obesity. These new linkages are based on studies that were not incorporated into the original UNICEF model, but suggest important implications for childhood obesity. In all, this narrative review offers important advancements to the scientific understanding of familial influences on children's eating behaviours and childhood obesity.

Changes in body mass index associated with head start participation

OBJECTIVES

The goal of this study was to determine if Head Start participation is associated with healthy changes in BMI.

METHODS

The sample included children participating in Head Start between 2005 and 2013 and children from 2 comparison groups drawn from a Michigan primary care health system: 5405 receiving Medicaid and 19,320 not receiving Medicaid. Change in BMI z score from the beginning to the end of each of 2 academic years and the intervening summer was compared between groups by using piecewise linear mixed models adjusted for age, gender, and race/ethnicity.

RESULTS

The total sample included 43,748 children providing 83,239 anthropometric measures. The Head Start sample was 64.9% white, 10.8% black, and 14.4% Hispanic; 16.8% of the children were obese and 16.6% were overweight at the initial observation. Children who entered Head Start as obese exhibited a greater decline in the BMI z score during the first academic year versus the comparison groups (β = -0.70 [SE: 0.05] vs -0.07 [0.08] in the Medicaid group [P < .001] and -0.15 [SE: 0.05] in the Not Medicaid group [P < .001]); patterns were similar for overweight children. Head Start participants were less obese, less overweight, and less underweight at follow-up than children in the comparison groups.

CONCLUSIONS

Preschool-aged children with an unhealthy weight status who participated in Head Start had a significantly healthier BMI by kindergarten entry age than comparison children in a primary care health system (both those receiving and those not receiving Medicaid).

Growth comparison in children with and without food allergies in 2 different demographic populations

OBJECTIVE

To examine the effects of food avoidance on the growth of children with food allergies.

STUDY DESIGN

A retrospective chart review was performed for children with and without food allergies followed at 2 New York City general pediatric practices. Charts were selected based on codes from the International Classification of Diseases, 9th Revision, for well child visit, food allergy, anaphylaxis, and/or epinephrine autoinjector prescriptions. Heights and weights were obtained to calculate body mass index, height, and weight z-scores.

RESULTS

Of the 9938 children seen, 439 (4.4%) were avoiding one or more foods. Of those with commercial insurance, children with food allergies were significantly shorter (mean height z-score = 0.06; P = .01) and weighed less (mean weight z-score -0.1; P = .006) than children without food allergies (mean height z-score = 0.42; mean weight z-score = 0.07). In contrast, children with food allergies and state insurance were not smaller in height or weight compared with children without food allergies. Among white subjects, there was a significant effect of food allergies on height and weight (ANOVA for height P = .012, for weight P = .0036) that was not observed for Hispanic/Latino, black, or Asian subjects. Children with allergies to milk weighed significantly less than children without milk allergies (P = .0006).

CONCLUSIONS

Children with food allergies and commercial insurance have significant impairment in growth compared with those without food allergies. Additionally, children avoiding all forms of milk are shorter and weigh less than matched counterparts. Therefore, height and weight measurements should be assessed routinely in children with food allergies because there is risk for growth impairment in this population.

Trends in obesity prevalence and disparities among low-income children in Oklahoma, 2005-2010

BACKGROUND

National WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children) data indicate a decrease in obesity prevalence among most low-income preschool-aged children. Though racial/ethnic disparities exist, studies examining obesity trends among various racial/ethnic groups are lacking. The aims of this study were to identify racial/ethnic disparities in obesity among low-income preschool children in Oklahoma and describe trends in obesity prevalence among four major racial/ethnic groups.

METHODS

Subjects included 218,486 children 2-4 years of age who participated in WIC in Oklahoma from 2005 to 2010. Logistic regression was performed to identify disparities and trends in obesity among American Indian, Hispanic, White, and African American children.

RESULTS

Racial/ethnic disparities in obesity were evident, with prevalence highest in Hispanics and lowest in African Americans. Obesity increased among girls for all racial/ethnic groups from 2005 to 2010 (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01, 1.03). Among boys, obesity increased in African Americans (OR, 1.04; 95% CI, 1.01, 1.07), but remained stable in other racial/ethnic groups.

CONCLUSIONS

In Oklahoma, in contrast to recent national studies, obesity is increasing among certain groups of low-income preschool children. These findings suggest geographic diversity in obesity and that state-specific obesity surveillance is important to help target interventions to those at highest risk.

Prevalence of Obesity: A Public Health Problem Poorly Understood

This review article discusses the Dietary Guidelines for Americans (DGA) in support of a total diet approach to achieving diet and health goals, especially as they relate to the obesity epidemic. However, some scientists and organizations have identified one food, food group, or nutrient as the cause of the obesity epidemic and recommend that simply reducing that food/food group/nutrient will solve the problem. This is simplistic and unlikely to be effective in long term management of the obesity problem. This article also acknowledges discrepancies in the literature and the lack of consensus opinions from systematic reviews. Failure to consider the evidence as a whole can lead to inaccurate reports which may, in turn, adversely influence clinical practice, public policy, and future research. This article also considers where the line should be drawn between individual choice and responsibility and public regulation. Using sugar sweetened beverages as an example, the article considers the lack of a consistent association between added sugars and weight in the literature and calls for policy recommendations that are based on science and emphasizes the need for evidence-based policies rather than policy-based evidence.

Prevalence and determinants of obesity among primary school children in Dar es Salaam, Tanzania

BACKGROUND

Childhood obesity has increased dramatically and has become a public health concern worldwide. Childhood obesity is likely to persist through adulthood and may lead to early onset of NCDs. However, there is paucity of data on obesity among primary school children in Tanzania. This study assessed the prevalence and determinants of obesity among primary school children in Dar es Salaam.

METHODS

A cross sectional study was conducted among school age children in randomly selected schools in Dar es Salaam. Anthropometric and blood pressure measurements were taken using standard procedures. Body Mass Index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m2). Child obesity was defined as BMI at or above 95th percentile for age and sex. Socio-demographic characteristics of children were determined using a structured questionnaire. Logistic regression was used to determine association between independent variables with obesity among primary school children in Dar es Salaam.

RESULTS

A total of 446 children were included in the analysis. The mean age of the participants was 11.1±2.0 years and 53.1% were girls. The mean BMI, SBP and DBP were 16.6±4.0 kg/m2, 103.9±10.3mmHg and 65.6±8.2mmHg respectively. The overall prevalence of child obesity was 5.2% and was higher among girls (6.3%) compared to boys (3.8%). Obese children had significantly higher mean values for age (p=0.042), systolic and diastolic blood pressures (all p<0.001). Most obese children were from households with fewer children (p=0.019) and residing in urban areas (p=0.002). Controlling for other variables, age above 10 years (AOR=3.3, 95% CI=1.5-7.2), female sex (AOR=2.6, 95% CI=1.4-4.9), urban residence (AOR=2.5, 95% CI=1.2-5.3) and having money to spend at school (AOR=2.6, 95% CI=1.4-4.8) were significantly associated with child obesity.

CONCLUSIONS

The prevalence of childhood obesity in this population was found to be low. However, children from urban schools and girls were proportionately more obese compared to their counterparts. Primary preventive measures for childhood obesity should start early in childhood and address socioeconomic factors of parents contributing to childhood obesity.

Hispanic and black US children's paths to high adolescent obesity prevalence

OBJECTIVE

The study aims to identify the ages contributing most to the development of higher obesity prevalence in the 8th grade (approximately age 14) among Hispanic and black children than among non-Hispanic white children in the United States.

METHODS

Using the nationally representative Early Childhood Longitudinal Study (ECLS-K), a sample of 17,420 children in kindergarten in 1999, followed in 1st, 3rd, 5th and 8th grades through 2007, was analysed. First, 'normal', 'overweight' and 'obese' weight-status categories in each grade were assigned from US Centers for Disease Control body mass index percentiles. Second, probabilities of being in each of the three weight-status categories in kindergarten and of transitioning between categories after kindergarten were estimated by logistic regression. These probabilities were then used as parameters of a weight-status trajectory simulation model from which a decomposition analysis was performed.

RESULTS

Obesity prevalence in the 8th grade was equally high among Hispanic (25.0%, 95% confidence interval [CI]: 22.3, 27.8%) and black children (25.1%; 95% CI: 20.9, 29.6%) compared to white children (17.4%; 95% CI: 15.9, 19.0%). As much as 73% of the Hispanic-white 8th grade obesity disparity was generated by 3rd grade and 44% by kindergarten. In contrast, only 15% of the black-white obesity 8th grade disparity was generated by kindergarten, whereas 75% was generated between the 3rd and 8th grades and 53% between the 5th and 8th grades.

CONCLUSIONS

Although adolescent obesity is equally prevalent among Hispanic and black children, obesity emerges and is sustained earlier in Hispanic children. Diagnosis and prevention strategies should be designed accordingly.

Socioeconomic status and the health of youth: a multilevel, multidomain approach to conceptualizing pathways

Previous research has clearly established associations between low socioeconomic status (SES) and poor youth physical health outcomes. This article provides an overview of the main pathways through which low SES environments come to influence youth health. We focus on 2 prevalent chronic health problems in youth today, asthma and obesity. We review and propose a model that encompasses (a) multiple levels of influence, including the neighborhood, family and person level; (b) both social and physical domains in the environment; and finally (c) dynamic relationships between these factors. A synthesis of existing research and our proposed model draw attention to the notion of adverse physical and social exposures in youth's neighborhood environments altering family characteristics and youth psychosocial and behavioral profiles, thereby increasing youth's risk for health problems. We also note the importance of acknowledging reciprocal influences across levels and domains (e.g., between family and child) that create self-perpetuating patterns of influence that further accentuate the impact of these factors on youth health. Finally, we document that factors across levels can interact (e.g., environmental pollution levels with child stress) to create unique, synergistic effects on youth health. Our model stresses the importance of evaluating influences on youth's physical health not in isolation but in the context of the broader social and physical environments in which youth live. Understanding the complex relationships between the factors that link low SES to youth's long-term health trajectories is necessary for the creation and implementation of successful interventions and policies to ultimately reduce health disparities.

Decreasing prevalence of obesity among young children in Massachusetts from 2004 to 2008

OBJECTIVE

To examine whether the obesity prevalence is increasing, level, or decreasing among young US children (aged <6 years) in the past decade; and to compare regional data to those of 2 national databases.

METHODS

We analyzed data from 108 762 well-child visits (36 827 children) at a multisite pediatric practice in eastern Massachusetts during 1999-2008. By using the Centers for Disease Control and Prevention 2000 gender-specific growth charts, we defined obesity as weight-for-length ≥95th percentile for children aged <24 months and BMI ≥95th percentile for children aged 24 to <72 months. By using multivariable logistic regression, we estimated gender-specific obesity trends in 2 separate periods, 1999-2003 and 2004-2008, adjusting for age group, race/ethnicity, health insurance, and practice site.

RESULTS

From 1999 to 2003, the obesity prevalence was fairly stable among both boys and girls. From 2004 to 2008, the obesity prevalence substantially decreased among both boys and girls. The decline in obesity prevalence during 2004-2008 was more pronounced among children insured by non-Medicaid health plans than among those insured by Medicaid.

CONCLUSIONS

Among children aged <6 years at this multisite pediatric practice, obesity prevalence decreased during 2004-2008, which is in line with national data showing no increase in prevalence during this time period. The smaller decrease among Medicaid-insured children may portend widening of socioeconomic disparities in childhood obesity.

Family income and childhood obesity in eight European cities: the mediating roles of neighborhood characteristics and physical activity

Utilizing data from the Large Analysis and Review of European Housing and Health Status (LARES) research program conducted by the WHO in eight European cities (Forli, Vilnius, Ferreira do Alentejo, Bonn, Geneva, Angers, Bratislava, Budapest), we examined whether the well-documented inverse correlation between family income and children's BMI might be explained, in part, by access to open green space and ensuing physical activity. We found that household income was inversely related to BMI among 1184 children, ages 6-18 years of age. Utilizing structural equation modeling with statistical controls for age and gender, we found evidence for two indirect paths between household income and BMI. One indirect relationship operates successively through open green space and physical activity. The second path operates through physical activity alone. The child's height and weight as well as level of physical activity were reported by their mother. Open green space was assessed by trained observers' ratings of the area surrounding the child's home. Limitations of the study and implications for better understanding of the ecological context of obesity are discussed.

Promoting health at the community level: thinking globally, acting locally

Prevention of childhood obesity is a societal priority. Despite our knowledge about the scope of the problem and the determinants that lead to it, we have yet to produce meaningful declines in obesity rates. Recent attention has been given to interventions that employ multiple strategies across multiple settings involving whole communities given their promising results. The next era of science calls for interdisciplinary teams who will envision a whole system approach to advance the community-based obesity prevention model. This perspective describes some of the more recent discussions of community-based methodologies such as the ANGELO (Analysis Grid for Environments Linked to Obesity) framework, best-practice principles, and a whole system intervention approach to obesity prevention. The proposed required elements to advance community-based research to address childhood obesity are: A systems perspective and approach, training of future leaders in community research methodology and social change, applying transdisciplinary strategies, funding to conduct rigorous trials to determine efficacy and effectiveness, enhanced design and analysis approaches, new and improved tools and methodologies to collect quantitative and qualitative data, enhanced community engagement models and sustainability frameworks, advancement of a bold public policy agenda, economic modeling, and acknowledgment of the approach as viable. To reverse childhood obesity, we need to embrace and integrate complex strategies at multiple levels within communities across the globe.

Lifecourse approach to racial/ethnic disparities in childhood obesity

Eliminating racial/ethnic disparities in health and health care is a national priority, and obesity is a prime target. During the last 30 y in the United States, the prevalence of obesity among children has dramatically increased, sparing no age group. Obesity in childhood is associated with adverse cardio-metabolic outcomes such as hypertension, hyperlipidemia, and type II diabetes and with other long-term adverse outcomes, including both physical and psychosocial consequences. By the preschool years, racial/ethnic disparities in obesity prevalence are already present, suggesting that disparities in childhood obesity prevalence have their origins in the earliest stages of life. Several risk factors during pregnancy are associated with increased risk of offspring obesity, including excessive maternal gestational weight gain, gestational diabetes, smoking during pregnancy, antenatal depression, and biological stress. During infancy and early childhood, rapid infant weight gain, infant feeding practices, sleep duration, child's diet, physical activity, and sedentary practices are associated with the development of obesity. Studies have found substantial racial/ethnic differences in many of these early life risk factors for childhood obesity. It is possible that racial/ethnic differences in early life risk factors for obesity might contribute to the high prevalence of obesity among minority preschool-age children and beyond. Understanding these differences may help inform the design of clinical and public health interventions and policies to reduce the prevalence of childhood obesity and eliminate disparities among racial/ethnic minority children.

Federal food policy and childhood obesity: a solution or part of the problem?

Amid growing concern about childhood obesity, the United States spends billions of dollars on food assistance: providing meals and subsidizing food purchases. We examine the relationship between food assistance and body mass index (BMI) for young, low-income children, who are a primary target population for federal food programs and for efforts to prevent childhood obesity. Our findings indicate that food assistance may unintentionally contribute to the childhood obesity problem in cities with high food prices. We also find that subsidized meals at school or day care are beneficial for children's weight status, and we argue that expanding access to subsidized meals may be the most effective tool to use in combating obesity in poor children.

Does maternal feeding restriction lead to childhood obesity in a prospective cohort study?

BACKGROUND

Some studies show that greater parental control over children's eating habits predicts later obesity, but it is unclear whether parents are reacting to infants who are already overweight.

OBJECTIVE

To examine the longitudinal association between maternal feeding restriction at age 1 and body mass index (BMI) at age 3 and the extent to which the association is explained by weight for length (WFL) at age 1.

METHODS

We studied 837 mother-infant pairs from a prospective cohort study. The main exposure was maternal feeding restriction at age 1, defined as agreeing or strongly agreeing with the following question: "I have to be careful not to feed my child too much." We ran multivariable linear regression models before and after adjusting for WFL at age 1. All models were adjusted for parental and child sociodemographic characteristics.

RESULTS

100 (12.0%) mothers reported feeding restriction at age 1. Mean (SD) WFL z-score at age 1 was 0.32 (1.01), and BMI z-score at age 3 was 0.43 (1.01). Maternal feeding restriction at age 1 was associated with higher BMI z-score at age 3 before (β 0.26 (95% CI 0.05 to 0.48)) but not after (β 0.00 (95% CI -0.17 to 0.18)) adjusting for WFL z-score at age 1. Each unit of WFL z-score at age 1 was associated with an increment of 0.57 BMI z-score units at age 3 (95% CI 0.51 to 0.62).

CONCLUSIONS

We found that maternal feeding restriction was associated with children having a higher BMI at age 3 before, but not after, adjusting for WFL at age 1. One potential reason may be that parents restrict the food intake of infants who are already overweight.

Latina mothers' beliefs and practices related to weight status, feeding, and the development of child overweight

OBJECTIVE

To examine maternal beliefs and practices related to weight status, child feeding, and child overweight in the Latino culture that may contribute to the rising rates of overweight among preschool Latino children in the United States.

DESIGN AND SAMPLE

This 2-phase qualitative study relies on data obtained in 6 focus groups with a total of 31 primarily Spanish-speaking, low-income mothers, followed by 20 individual, in-depth interviews with women participating in a health promotion educational program.

MEASURES

Child-feeding beliefs, practices, and weight status perceptions were elicited.

RESULTS

The findings indicated that most respondents reported personal struggles with weight gain, particularly during and after pregnancy, and were concerned that their children would become obese. Although subjects understood the health and social consequences related to overweight, many discussed the pressures of familial and cultural influences endorsing a "chubby child."

CONCLUSIONS

Education and interventions that incorporate "culturally mediated" pathways to address mothers' feeding practices are essential for the prevention and control of childhood overweight among low-income Latinos. Nurses should be aware of the social and cultural influences on Latina mothers' beliefs and practices related to weight status and feeding practices and address these in their education approaches to prevent childhood overweight and obesity with this population group.

Otitis media and associations with overweight status in toddlers

INTRODUCTION

Otitis media (OM) is a significant disease that affects nearly all children early in life. Recently, childhood overweight has become an epidemic. Past research has demonstrated that a history of OM is related to food preferences and overweight through proposed physiological mechanisms. The purpose of this study was to explore the relationship between recurrent OM (ROM)/tympanostomy tube treatment and overweight status.

METHODS

Data were analyzed from a prospective cohort of mothers and children recruited from 1991-1996 from a local health maintenance organization. ROM and tympanostomy tube status were obtained through a combination of physical exam and medical record abstraction. ROM and tympanostomy tube status were analyzed as categorical variables with weight-for-length (WFL) data from well child checks. Chi-square and logistic regression for univariate and multivariate analyses were performed.

RESULTS

11.4% of children had a WFL measure at two years of age ≥ 95 th percentile. Those children with a history of tympanostomy tube treatment had a significantly increased risk of having a WFL ≥ 95 th percentile after controlling for birth weight, maternal prenatal smoking, maternal education, and family income (OR 3.32, 95% CI 1.43-7.72). The alternative hypothesis that children with larger WFL at two month of age would have a greater number of OM episodes by two years of age was not significant.

CONCLUSION

The findings of this study are consistent with the hypothesis and prior research that OM treated with tympanostomy tubes is associated with overweight status.

Risk profiles for overweight/obesity among preschoolers

BACKGROUND

The epidemic of overweight/obesity among U.S. children has led to an alarming increase in health-related consequences, including early-onset diabetes and cardiovascular disease. Recent research has identified the independent contribution of several maternal and child factors to the development of childhood overweight/obesity. Few studies, however, have examined risk profiles of childhood obesity.

AIM

This study used classification and regression tree (CART) analysis to examine the combined effect of maternal and child factors in generating risk profiles for overweight/obesity among preschoolers.

STUDY DESIGN

Data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) study were used. The sample was comprised of preschool children. CART and logistic regression models were built and compared.

RESULTS

Children who were overweight/obese at two years of age had an increased risk of being overweight/obese at four years of age. Children born to overweight/obese mothers were more likely to be overweight/obese by age four, even if their BMI at two years of age was normal. Children with high birth weight (> or = 4000 g.) were also more likely to be overweight/obese at age four years if they were born to mothers with a normal pregravid BMI, but were of a lower socioeconomic status. Among preschoolers whose mothers were black or white and who had a high pregravid BMI, breastfeeding duration and parity played an important role in determining their risk of being overweight/obese.

CONCLUSIONS

Classification tree analysis confirms and extends current knowledge of preschool overweight/obesity by providing preliminary risk profiles that are structured within the context of prenatal and postnatal maternal and child characteristics.

The "childhood obesity epidemic": health crisis or social construction?

There has been a meteoric rise over the past two decades in the medical research and media coverage of the so-called global childhood obesity epidemic. Recently, in response to this phenomenon, there has been a spate of books and articles in the fields of critical sociology and cultural studies that have argued that this "epidemic" is socially constructed, what Natalie Boero (2007) dubs a "postmodern epidemic." As an anthropologist who has studied child nutrition and obesity in relation to poverty and the school environment, I am concerned about both the lack of reflexivity among medical researchers as well as critical scholars' treatment of the problem as entirely socially constructed. In this article I present both sides of this debate and then discuss how wee can attempt to navigate a middle course that recognizes this health issue but also offers alternative approaches to those set by the biomedical agenda.

Parent involvement is associated with early success in obesity treatment

OBJECTIVE

The study examined the influence of parent involvement and family factors on body mass index (BMI) change in a pediatric obesity treatment program.

METHODS

A total of 104 children and their caregivers were examined during a 12-week obesity intervention. Participants (mean age = 11.42 years; SD = 2.83) and their caregivers completed measures of family environment and depression prior to enrollment. Children's BMI and parental involvement were rated weekly during the intervention. Logistic regressions were conducted to examine the role of sociodemographic factors, family characteristics, and parent involvement on weight.

RESULTS

Children with the lowest parent involvement were less likely to lose any weight or have clinically significant (>or=2 kg) weight loss. Demographics and family factors did not predict BMI change. Parent involvement related to ethnicity, absences and physical activity.

CONCLUSIONS

Parental involvement may be helpful in identifying who is likely to do well in a weight loss program.

Early weaning and other potential risk factors for overweight among preschool children

OBJECTIVE

To investigate whether early weaning constitutes a risk factor for overweight at preschool age and to identify other factors that affect this association.

METHODS

This was a case-control study of 366 children aged 2 to 6 years (176 boys and 190 girls) from three cities. The case group comprised overweight children, as defined by body mass index (BMI) for age greater than or equal to the 85(th) percentile. The main exposure analyzed was early weaning (exclusive or predominant breastfeeding for less than four months).

RESULTS

Early weaning was a significant risk factor for overweight in univariate analysis (OR = 1.69; 95% CI: 1.10-2.60; p = 0.02), but not in multivariate analysis (OR = 1.42; 95% CI: 0.86-2.34; p = 0.17). Maternal overweight, birth weight > or = 3,500 g and sedentarism were the main risk factors for overweight in multivariate analysis.

DISCUSSION

In our study, the protective effect of breastfeeding against overweight was only shown in univariate analysis; it did not persist after controlling for other variables. It is possible that breastfeeding has only a small protective role against overweight in comparison with other variables of greater importance.

CONCLUSION

Our results suggest that the potential protective effect of breastfeeding against overweight among preschool children is weaker than genetic and other environmental factors.

Individual, family, and community environmental correlates of obesity in Latino elementary school children

BACKGROUND

The prevalence of overweight children has reached epidemic proportions, and affects Latinos youth more than other subgroups in the United States. Given the prevalence of obesity and its economic consequences, community health initiatives have shifted toward primary prevention at younger ages.

METHODS

Data representing all levels of the ecological systems theory were collected using diverse methods. Participants were children enrolled in K-2nd grade and their parents.

RESULTS

Overweight children were less active compared to normal weight children. The parents of overweight children provided less instrumental support to engage in activity and set fewer limits on their child's activities. Similarly, parents of overweight children were less likely to control, but more likely to set limits on their child's diet compared to parents of normal weight children. Parents who rated their health more positively and were less acculturated were more likely to have children who were overweight. School and community level variables were not significantly correlated with children's weight. Adjusting for the aforementioned variables, parents' weight status was positively associated with children's weight.

CONCLUSIONS

Social and structural environments in which Hispanic children are reared may play an important role in determining their risk for obesity and related behaviors. Parents' weight was among the strongest correlate of child weight; however, the extent to which this influence functions primarily through biological or social/structural influences is not entirely clear. The role of school and community factors on child's health practices and body mass index needs to be further examined.

Research opportunities with curanderos to address childhood overweight in Latino families

Curanderos are consulted as an adjunct or alternative to biomedical health care in the greater southwest, although the extent of their involvement in obesity prevention and treatment is poorly understood. Seven curanderos participated in audiotaped interviews about their work with families and beliefs about childhood feeding and overweight. Themes reflected curanderos' beliefs about their practice and childhood obesity. Curanderos approach their work as a calling, emphasizing elements from nature in etiology and cure. From the curandero's standpoint, essential elements of obesity management must acknowledge the socially marginalized experiences of Latinos. We encountered working with curanderos as problematic, and this likely reflected our differing personal characteristics and a tension between our healing professions. Curanderos could serve as collaborators in childhood obesity interventions if we craft health messages and delivery modes that resonate with Latino families and address ethical and communication issues on the research team.

Obesity in the transition to adulthood: predictions across race/ethnicity, immigrant generation, and sex

OBJECTIVE

To trace how racial/ethnic and immigrant disparities in body mass index (BMI) change over time as adolescents (age, 11-19 years) transition to young adulthood (age, 20-28 years).

DESIGN

We used growth curve modeling to estimate the pattern of change in BMI from adolescence through the transition to adulthood.

SETTING

All participants in the study were residents of the United States enrolled in junior high school or high school during the 1994-1995 school year.

PARTICIPANTS

More than 20 000 adolescents from nationally representative data interviewed at wave I (1994-1995) and followed up in wave II (1996) and III (2001-2002) of the National Longitudinal Study of Adolescent Health when the sample was in early adulthood.

MAIN EXPOSURES

Race/ethnicity, immigrant generation, and sex.

OUTCOME MEASURE

Body mass index.

RESULTS

Findings indicate significant differences in both the level and change in BMI across age by sex, race/ethnicity, and immigrant generation. Females, second- and third-generation immigrants, and Hispanic and black individuals experience more rapidly increasing BMIs from adolescence into young adulthood. Increases in BMI are relatively lower for males, first-generation immigrants, and white and Asian individuals.

CONCLUSION

Disparities in BMI and prevalence of overweight and obesity widen with age as adolescents leave home and begin independent lives as young adults in their 20s.

Infant temperament contributes to early infant growth: A prospective cohort of African American infants

Background

Prospective studies linking infant temperament, or behavioral style, to infant body composition are lacking. In this longitudinal study (3 to 18 months), we seek to examine the associations between two dimensions of infant temperament (distress to limitations and activity level) and two anthropometric indicators (weight-for-length z-scores (WLZ) and skin fold (SF) measures) in a population at high risk of overweight.

Methods

Data are from the Infant Care and Risk of Obesity Project, a longitudinal study of North Carolina low income African American mother-infant dyads (n = 206). Two temperament dimensions were assessed using the Infant Behavior Questionnaire-Revised. A high distress to limitations score denotes an infant whose mother perceives that s/he often cries or fusses, and a high activity level score one who moves his/her limbs and squirms frequently. Cross-sectional analyses were conducted using ordinary least squares regression. Fixed effects longitudinal models were used to estimate anthropometric outcomes as a function of time varying infant temperament.

Results

In longitudinal models, increased activity levels were associated with later decreased fatness and WLZ. In contrast, high levels of distress to limitations were associated with later increased fatness at all time points and later increased WLZ at 12 months.

Conclusion

Infant temperament dimensions contribute to our understanding of the role of behavior in the development of the risk of overweight in the formative months of life. Identification of modifiable risk factors early in life may help target strategies for establishing healthy lifestyles prior to the onset of overweight.

Development and validation of the Infant Feeding Style Questionnaire

This study describes and validates the Infant Feeding Style Questionnaire (IFSQ), a self-report instrument designed to measure feeding beliefs and behaviors among mothers of infants and young children. Categorical confirmatory factor analysis was used to estimate latent factors for five feeding styles, laissez-faire, restrictive, pressuring, responsive and indulgent, and to validate that items hypothesized a priori as measures of each style yielded well-fitting models. Models were tested and iteratively modified to determine the best fitting model for each of 13 feeding style sub-constructs, using a sample of 154 low-income African-American mothers of infants aged 3-20 months in North Carolina. With minor changes, models were confirmed in an independent sample of 150 African-American first-time mothers, yielding a final instrument with 39 questions on maternal beliefs, 24 questions on behaviors and an additional 20 behavioral items pertaining to solid feeding for infants over 6 months of age. Internal reliability measures for the sub-constructs ranged from 0.75 to 0.95. Several sub-constructs, responsive to satiety cues, pressuring with cereal, indulgent pampering and indulgent soothing, were inversely related to infant weight-for-length z-score, providing initial support for the validity of this instrument for assessing maternal feeding beliefs and behaviors that may influence infant weight outcomes.

Formulary coverage for lipid-lowering drugs recommended for children

OBJECTIVE/METHODS

A cross-sectional assessment to describe availability, coverage, and pediatric labeling status of lipid-lowering drugs offered by 1 private and 1 public insurance plan formularies.

RESULTS

Both insurance plans had equal medication availability of bile acid sequestrants (7), statins (10), and cholesterol-absorption blockers (CAB; 1). The private plan had 3 bile acid sequestrants and 3 statins listed as preferred drugs; the CAB was not preferred. In contrast, the public plan had 5 bile acid sequestrants, 7 statins, and the CAB as preferred drugs. For medications with pediatric labeling, the private plan covered 50% as preferred drugs whereas the public plan covered 70% as preferred drugs.

CONCLUSIONS

If new recommendations of the American Academy of Pediatrics for treatment of dyslipidemia in children were implemented today, children with the public plan would have equal choice but better coverage of lipid-lowering drugs as preferred drugs, including those with FDA approval, compared with children with the private plan.

Maternal behavior and infant weight gain in the first year

OBJECTIVE

To examine the relative contributions of maternal characteristics and behaviors in predicting infant weight gain over the first year of postpartum life.

DESIGN

Longitudinal study of maternal feeding style throughout infancy.

SETTING

A Special Supplemental Nutrition Program for Women, Infants, and Children center.

PARTICIPANTS

Ninety-six low-income, minority mother-infant dyads.

MAIN OUTCOME MEASURES

Infant weight gain at 3, 6, and 12 months.

ANALYSIS

Multiple linear and backward regressions.

RESULTS

None of the mother-infant perinatal measures predicted infant weight gain from birth to 3 months, nor did measures from birth to 3 months predict weight gain from 3 to 6 months. However, the number of feedings and lessened maternal sensitivity to infant cues predicted weight gain from 6 to 12 months.

CONCLUSIONS AND IMPLICATIONS

These results suggest that feeding plays an important role in promoting rapid weight gain in infants, since the maternal reports of feeding frequency, as well as their lessened sensitivity to the infants' cues, indicate that the infants in this study may have been regularly overfed. Nutrition educators who work with low-income populations should provide guidance to mothers in feeding their infants by helping them to recognize hunger signals and respond to satiety cues.

Obesity in Turkish children and adolescents: prevalence and non-nutritional correlates in an urban sample

OBJECTIVES

The aim of the present study was to identify the prevalence and non-nutritional correlates of childhood obesity in primary school children and adolescents living in a representative sample of an urban area in western Anatolia.

METHODS

The study was designed as a cross-sectional, population-based study. A representative sample of primary school children in Aydin was randomly selected according to age, gender and socio-economic status. Body mass index (BMI) was calculated after weight and height measurement. Centres for Disease Control 2000 growth charts for children and adolescents were used to identify BMI percentiles. Weight and height percentiles were obtained from charts of growth curves for Turkish children.

RESULTS

The age range of children was 6-16 years. A total of 924 children and 424 adolescents were screened for obesity. Overweight and obesity prevalence in primary school children living in Aydin was 12.2% and 3.7%, respectively. High socio-economic status was found to be associated with childhood obesity. There was no association between obesity and gender, adolescence, educational status of parents and occupation of father.

CONCLUSION

In the present study, we focused on some of the non-nutritional correlates of obesity in a representative population of an urban area in a developing country. Obesity prevalence rate in Turkish children living in Aydin was higher in children from a higher socio-economic group in contrast to reports from many developed countries.

Opportunities for the primary prevention of obesity during infancy

Many parents, grandparents, and clinicians have associated a baby’s ability to eat and gain weight as a sign of good health, and clinicians typically only call significant attention to infant growth if a baby is failing to thrive or showing severe excesses in growth. Recent evidence, however, has suggested that pediatric healthcare providers should pay closer attention to growth patterns during infancy. Both higher weight and upward crossing of major percentile lines on the weight-for-age growth chart during infancy have long term health consequences, and are associated with overweight and obesity later in life. Clinicians should utilize the numerous available opportunities to discuss healthy growth and growth charts during health maintenance visits in the first two years after birth. Further, providers should instruct parents on strategies to promote healthy behaviors that can have long lasting obesity preventive effects.

Differences in food supplies of U.S. households with and without overweight individuals

Household food supplies of families with at least one child 12 years or younger (n=100) were inventoried in order to describe its nutrient content and compare food supplies of families with and without overweight individuals (i.e., healthy vs. overweight mothers; healthy vs. overweight fathers; healthy vs. overweight child[ren]). Nutrient adequacy ratios (NAR) for carbohydrate, dietary fiber, calcium, iron, total fat, and saturated fat were approximately one indicating amounts available per 2000 calories approximately equaled the Daily Value. NARs for protein, sugar, vitamin A, vitamin C, and sodium exceeded one and cholesterol NAR was less than one. Households were similar in number of household members, days until they planned to grocery shop again, and total days of meals and snacks to be served from household food supplies until the next grocery shopping trip. Frozen vegetables contributed significantly greater amounts of calories, carbohydrates, fat, and protein and meat supplied significantly more fat and protein in households with overweight fathers than in households with healthy weight fathers. In households with an overweight child, grains supplied significantly more protein and carbohydrate than in comparison households. Encouraging healthful changes to the home food supply may result in improvements in dietary intake and overall weight status.