Publications (117) View all
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Article: Moderate agreement between body mass index and measures of waist circumference in the identification of overweight among 5-year-old children; the 'Be active, eat right' study.
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ABSTRACT: BACKGROUND: Body mass index (BMI) is a common indirect method to assess weight status among children. There is evidence that BMI data alone can underestimate overweight-related health risk and that waist circumference (WC) should also be measured. In this study we investigated the agreement between BMI and WC and BMI and the waist-height ratio (WHtR) when used to identify overweight among children. METHODS: This cross-sectional population-based study uses baseline data from 5-year-olds (n = 7703) collected by healthcare professionals for the 'Be active, eat right' study. RESULTS: According to age-specific and sex-specific cut-off points for BMI (IOTF, 2000) and WC (Fredriks et al., 2005), the prevalence of overweight (obesity included) was 7.0% and 7.1% among boys, and 11.6% and 10.1% among girls, respectively. For the WHtR the 90th percentile was used as the cut-off point. Among boys, observed proportion of agreement between BMI and WC classification was 0.95, Cohen's kappa 0.58 (95% CI; 0.53-0.63), and proportions of positive and negative agreement were 0.61 and 0.97, respectively. Observed proportion of agreement between BMI and WHtR classification was 0.92, Cohen's kappa 0.46 (95% CI; 0.41-0.51), and proportions of positive and negative agreement were 0.51 and 0.95. Children identified as overweight according to WC were relatively tall, and children classified as overweight according to the WHtR only were relatively short (comparable results for girls). CONCLUSIONS: There is moderate agreement between BMI and measures of WC on the presence of overweight among 5-year-olds. If BMI data and cut-offs continue to be used, then part of the group of children identified as overweight according to WC and the WHtR will be omitted. Follow-up of the children classified as overweight according to BMI only, WC only, and WHtR only, will give indications whether WC should be measured in addition to BMI or whether WC should only be measured in certain subgroups (e.g. relatively tall or short children) to identify and monitor overweight in children. This may improve early identification and prevention of overweight and overweight-related health problems in children.BMC Pediatrics 04/2013; 13(1):63. · 1.88 Impact Factor -
Article: Breastfeeding and food pattern in overweight children in the Caribbean.
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ABSTRACT: As in most countries around the globe, overweight and obesity are a major threat to public health on the Caribbean island of Aruba. Increasing evidence confirms that breastfeeding protects against overweight and obesity. However, little is known about the mechanism underlying the association between breastfeeding and obesity. One possibility is that breastfed infants are better able to control their meal size and intervals than formula-fed infants. This might lead to a healthier diet in later life and protect against overweight and obesity. To determine the relationship between breastfeeding, food pattern and being overweight in the Caribbean. In a cross-sectional school-based study in 2004-2005, weight and height were measured by two research assistants in 1776 children aged 6-11 years on Aruba, an island in the Caribbean. BMI was defined according to guidelines by the International Obesity Task Force. Parents completed a questionnaire pertaining to breastfeeding and dietary food pattern. 1451/1776 (81·7%) children were breastfed; 851/1766 (47·9%) children were breastfed for <4 months, 227/1776 (12·8%) for 4-6 months and 373/1776 (21·0%) for ≥6 months. Children who were breastfed for ≥4 months had lower odds (OR 0·32, 95%CI 0·25-0·40) of being overweight including obesity than those who either were not breastfed or who were breastfed for <4 months. Children who were breastfed for ≥4 months were more likely to have a structured food pattern of six eating moments a day (OR 7·43, 95% CI 5·87-9·39, P<0·001) and to have breakfast every day (OR 2·86, 95% CI 2·17-3·78, P<0·001) than those who were not or who were breastfed for <4 months. Breastfeeding for ≥4 months is associated with a structured food pattern (six eating moments a day including a daily breakfast) and carries a strikingly lower risk of overweight in children. Promoting prolonged breastfeeding together with a focus on a subsequent structured food pattern could be a cheap method of preventing overweight.Paediatrics and international child health. 01/2013; 33(1):18-22. -
Article: Trends in Menarcheal Age between 1955 and 2009 in the Netherlands.
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ABSTRACT: To assess and compare the secular trend in age at menarche in Dutch girls (1955-2009) and girls from Turkish and Moroccan descent living in the Netherlands (1997-2009). Data on growth and maturation were collected in 20,867 children of Dutch, Turkish and Moroccan descent in 2009 by trained health care professionals. Girls, 9 years and older, of Dutch (n = 2138), Turkish (n = 282), and Moroccan (n = 295) descent were asked whether they had experienced their first period. We compared median menarcheal age in 2009 with data from the previous Dutch Nationwide Growth Studies in 1955, 1965, 1980 and 1997. Age specific body mass index (BMI) z-scores were calculated to assess differences in BMI between pre- and postmenarcheal girls in different age groups. Median age at menarche in Dutch girls, decreased significantly from 13.66 years in 1955 to 13.15 years in 1997 and 13.05 years in 2009. Compared to Dutch girls there is a larger decrease in median age of menarche in girls of Turkish and Moroccan descent between 1997 and 2009. In Turkish girls age at menarche decreased from 12.80 to 12.50 years and in Moroccan girls from 12.90 to 12.60 years. Thirty-three percent of Turkish girls younger than 12 years start menstruating in primary school. BMI-SDS is significantly higher in postmenarcheal girls than in premenarcheal girls irrespective of age. There is a continuing secular trend in earlier age at menarche in Dutch girls. An even faster decrease in age at menarche is observed in girls of Turkish and Moroccan descent in the Netherlands.PLoS ONE 01/2013; 8(4):e60056. · 4.09 Impact Factor -
Article: The world's tallest nation has stopped growing taller: the height of Dutch children 1955-2009.
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ABSTRACT: Background:Records show that mean height in The Netherlands has increased since 1858. This study looks at whether this trend in the world's tallest nation is continuing, and we consider the influence of the geographical region, and of child and parental education, on changes in height.Methods:We compared the height of young Dutch people aged 0-21 years as determined on the basis of the growth study of 2009 with the height data from growth studies conducted in 1955, 1965, 1980, and 1997.Results:The analysis sample included 5,811 boys and 6,194 girls. Height by age was the same as in 1997. Mean final height was 183.8 cm (SD=7.1 cm) in boys and 170.7 cm (SD=6.3 cm) in girls. The educational levels of both children and their parents are positively correlated with mean height. Since 1997, differences between geographical regions have decreased but not vanished, with the northern population being the tallest.Conclusion:The world's tallest population has stopped growing taller after a period of 150 years. The cause is unclear. The Dutch may have reached the optimal height distribution. Alternatively, growth-promoting environmental factors may have stabilised in the last decade, preventing the population from attaining its full growth potential.Pediatric Research (2012); doi:10.1038/pr.2012.189.Pediatric Research 12/2012; · 2.70 Impact Factor -
Article: High cardiovascular risk in severely obese young children and adolescents.
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ABSTRACT: To assess the prevalence of cardiovascular risk factors in severely obese children and adolescents. A nationwide prospective surveillance study was carried out from July 2005 to July 2007 where paediatricians were asked to report all new cases of severe obesity in 2-18-year-old children to the Dutch Paediatric Surveillance Unit. Severe obesity is defined by gender and age-dependent cut-off points for body mass index based on Dutch National Growth Studies corresponding to the adult cut-off point of 35 kg/m(2). Paediatricians were asked to complete a questionnaire for every severely obese child regarding socio-demographic characteristics and cardiovascular risk factors (blood pressure, fasting blood glucose and lipids). In 2005, 2006 and 2007, 94%, 87% and 87%, respectively, of paediatricians in the Netherlands responded to the monthly request from the Dutch Paediatric Surveillance Unit and 500 children with newly diagnosed severe obesity were reported. 72.6% (n=363) of paediatricians responded to a subsequent questionnaire. Cardiovascular risk factor data were available in 255/307 (83%) children who were correctly classified as severely obese. 67% had at least one cardiovascular risk factor (56% hypertension, 14% high blood glucose, 0.7% type 2 diabetes and up to 54% low HDL-cholesterol). Remarkably, 62% of severely obese children aged ≤12 years already had one or more cardiovascular risk factors. A high number (2/3) of severely obese children have cardiovascular risk factors. Internationally accepted criteria for defining severe obesity and guidelines for early detection and treatment of severe obesity and comorbidity are urgently needed.Archives of Disease in Childhood 07/2012; 97(9):818-21. · 2.88 Impact Factor
