Alan R Sinaiko

University of Minnesota Duluth, Duluth, Minnesota, United States

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Publications (124)592.77 Total impact

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    ABSTRACT: Background Visceral adipose tissue (VAT) generally demonstrates a stronger relationship with cardiometabolic risk factors than total body fat or subcutaneous adipose tissue.Objectives The purpose of this study was to compare VAT estimated in children by total volume dual-energy X-ray absorptiometry (DXA) with a gold standard measurement, single slice (L4–L5) computed tomography (CT).MethodsA total of 329 (152 females, 177 males) children ages 6–18 years (mean age 12.3 ± 3.6) and with average body mass index percentile of 54.9% (3–99%) had their VAT estimated by both CT and DXA. Linear association between methods was measured using Pearson's correlation. Multiple linear regressions compared the associations between cardiometabolic risk factors and both CT-VAT and DXA-VAT, respectively.ResultsIn children, DXA-VAT was correlated significantly with CT-VAT, with a stronger relationship in overweight and obese children. Multiple regression analysis showed that both estimates of VAT were significantly associated with lipids and insulin sensitivity, measured by euglycaemic-hyperinsulinaemic clamp. Additionally, DXA-VAT was associated with diastolic blood pressure, homeostasis model of insulin resistance and fasting insulin, but CT-VAT was not.Conclusion In children, total volume DXA-VAT and single slice CT-VAT are significantly correlated and each demonstrates similar associations with cardiometabolic risk factors. This suggests that DXA is a useful and valid method for estimation of VAT in children.
    Pediatric Obesity 08/2014; · 2.28 Impact Factor
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    ABSTRACT: Evaluate the association of abdominal visceral and subcutaneous fat, independent of total body fat, with cardiometabolic risk factors and insulin resistance among youth. Visceral and subcutaneous fat, percent total body fat, insulin resistance (adjusted for lean body mass: Mlbm), blood pressure, glucose, insulin, and lipids were obtained in 472 youth ages 6-18 years. Linear regression, adjusted for age, sex, race, Tanner stage, and percent total body fat, was used to evaluate associations of visceral and subcutaneous fat with cardiometabolic risk factors. Visceral fat was associated inversely with Mlbm (p=0.003) and positively with fasting insulin (p=0.002) and triglycerides (p=0.002). Visceral fat levels above the mean were associated inversely with HDL cholesterol (p=0.002), and positively systolic blood pressure (p<0.0001) and non-HDL cholesterol (p<0.0001). Subcutaneous fat was associated inversely with Mlbm (p=0.003) and HDL cholesterol (p<0.05), and positively with fasting glucose (p<0.05), fasting insulin (p=0.0003), systolic blood pressure (p=0.005), and triglycerides (p=0.003). Subcutaneous fat levels above the mean were associated with non-HDL cholesterol (p=0.0002). These findings suggest that there may be a threshold level of visceral and subcutaneous fat (regardless of total body fat), that when exceeded in childhood, is more likely to be associated with many cardiometabolic risk factors. Triglycerides and insulin resistance appear to be associated with these fat depots at even lower thresholds of abdominal adiposity.
    Clinical obesity. 04/2014; 4(2):101-107.
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    ABSTRACT: Newer approaches for classifying gradations of pediatric obesity by level of body mass index (BMI) percentage above the 95th percentile have recently been recommended in the management and tracking of obese children. Examining the prevalence and persistence of severe obesity using such methods along with the associations with other cardiovascular risk factors such as hypertension is important for characterizing the clinical significance of severe obesity classification methods. This retrospective study was conducted in an integrated healthcare delivery system to characterize obesity and obesity severity in children and adolescents by level of body mass index (BMI) percentage above the 95th BMI percentile, to examine tracking of obesity status over 2-3 years, and to examine associations with blood pressure. Moderate obesity was defined by BMI 100-119 % of the 95th percentile and severe obesity by BMI >=120 % x 95th percentile. Hypertension was defined by 3 consecutive blood pressures >=95th percentile (for age, sex and height) on separate days and was examined in association with obesity severity. Among 117,618 children aged 6-17 years with measured blood pressure and BMI at a well-child visit during 2007-2010, the prevalence of obesity was 17.9 % overall and was highest among Hispanics (28.9 %) and blacks (20.5 %) for boys, and blacks (23.2 %) and Hispanics (21.5 %) for girls. Severe obesity prevalence was 5.6 % overall and was highest in 12-17 year old Hispanic boys (10.6 %) and black girls (9.5 %). Subsequent BMI obtained 2-3 years later also demonstrated strong tracking of severe obesity. Stratification of BMI by percentage above the 95th BMI percentile was associated with a graded increase in the risk of hypertension, with severe obesity contributing to a 2.8-fold greater odds of hypertension compared to moderate obesity. Severe obesity was found in 5.6 % of this community-based pediatric population, varied by gender and race/ethnicity (highest among Hispanics and blacks) and showed strong evidence for persistence over several years. Increasing gradation of obesity was associated with higher risk for hypertension, with a nearly three-fold increased risk when comparing severe to moderate obesity, underscoring the heightened health risk associated with severe obesity in children and adolescents.
    International Journal of Pediatric Endocrinology 03/2014; 2014(1):3.
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    ABSTRACT: Background: Childhood cancer survivors (CCS) are more insulin resistant (IR) and have higher levels of several cardiovascular (CV) risk factors even while still children. This study examines specific treatment exposures associated with CV risk factors and IR. Methods: CCS age 9-18 years at study entry and in remission >5 years from diagnosis (n=319) and 208 sibling controls were recruited into this cross-sectional study that included physiologic assessment of IR (hyperinsulinemic euglycemic clamp) and assessment of CV risk factors.. Regression and recursive tree modeling were used to ascertain treatment combinations associated with IR and CV risk. Results: Mean current age of CCS was 14.5yr, 54% were male (siblings 13.6yr, 54% male). Diagnoses included leukemia (35%), brain tumors (36%), solid tumors (33%) or lymphoma (6%). Among CCS, analysis of individual chemotherapy agents failed to find associations with CV risk factors or IR. Compared to siblings, IR was significantly higher in CCS who received platinum plus cranial radiation (CRT, 92% brain tumors) and in those who received steroids but no platinum (majority leukemia). IR did not differ between CCS who received surgery alone vs. siblings. Within survivor comparisons failed to elucidate treatment combinations that increased IR compared to those who received surgery only. Conclusions: Exposure to platinum, CRT or steroids is associated with IR and CV risk factors and should be taken into consideration in the development of screening recommendations for CV risk. Impact: Earlier identification of CCS who may benefit from targeted prevention efforts may reduce their future risk of CV disease.
    Cancer Epidemiology Biomarkers &amp Prevention 09/2013; · 4.56 Impact Factor
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    ABSTRACT: Few studies have examined the relations of adiposity and lifestyle factors in young offspring with their parents as children (parentschild) or at their current age (parentsadult). Therefore, we compared measures of adiposity and lifestyle in parentschild and parentsadult with their offspring. Two generations (one parent and his/her offspring) participated in this study: 234 parents from a previously established cohort and 382 offspring. Parentsadult and offspring underwent measurements for height, weight, waist circumference, % body fat, visceral fat, and lifestyle habits. Participants were classified as normal weight, overweight, obese based on age-specific BMI criteria. Mixed model linear regression analysis evaluated the associations of adiposity and lifestyle factors of parentschild and parentsadult with that of their offspring, adjusting for age, sex, race, and family membership. The prevalence of obesity was greater among offspring mean age 12.3 years compared to their parentschild mean age 12.6 years (18.4% vs 10.1%, p<0.001) even though hours of television (TV) watching were similar between the two generations as children (p=0.80). Sixty percent of parents (as children and adults) and offspring reported more than 2 hours of TV/day. Offspring of parents who were overweight and obese as children had greater BMI (all p<0.001) than offspring of parents who were normal weight as children. For both parentadult and offspring, adiposity was greater with greater total screen time. Identifying high-risk families is important for early intervention of overweight, especially in children.
    BMC Pediatrics 09/2013; 13(1):133. · 1.98 Impact Factor
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    ABSTRACT: Background/Aims The aim of the study was to ascertain frequency of glucose screening in children and adolescents, in predefined age, gender, BMI, and race strata. Methods Study subjects included 68,322 individuals age 3-17 years at cohort entry and followed for a median of 37 months. Subjects had at least one office visit at HealthPartners Medical Group (HPMG). Subjects had their laboratory data examined for date and results of any fasting or random glucose, glycated hemoglobin (A1c), or oral glucose tolerance tests done in an outpatient setting. We report descriptive statistics on rate of glucose testing and rate of tests indicating pre-diabetes by age, gender, BMI, race/ethnicity group, and calendar year. Results Overall rate of glucose screening was 10.7% (7278/68322). Rates increased in recent years compared to earlier years, were similar in males and females, and were greater in older subjects, those with obesity, and those of minority race or Hispanic ethnicity. The test rate was 4.4% (1145/26245) per year in 2007 compared to 19.7% (1687/8563) in 2010. Glucose screening was most often done with fasting or random glucose, but 7.7% (560/7278) of tests were glycated hemoglobin (A1c). About 13.9% (1013/7278) of tests showed results indicating pre-diabetes. Of the 1013 with a test result indicating pre-diabetes, 79.1% (801/1013) were age 12 and older, 60% (608/1013) were of minority race or Hispanic ethnicity, and 30.9% (313/1013) were obese. Diabetes diagnosis (250.xx) was present in 2.2% (161/7278) of the subjects with one or more glucose/A1c tests. Conclusions Rates of glucose testing are highest in demographic subgroups with the highest risk, and have increased markedly in recent years. As the rate of screening increases further, it is likely that the proportion that screen positive for pre-diabetes or diabetes will decline. A substantial number of adolescents have recently been identified as having pre-diabetes, and further work is needed to characterize care subsequently provided to these subjects, and to characterize other CV risk factors.
    Clinical Medicine &amp Research 09/2013; 11(3):145.
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    ABSTRACT: Background/Aims The National High Blood Pressure Education Program (NHBPEP) guidelines define hypertension (HT) in children and adolescents as blood pressure (BP) measures above the 95th percentile on three consecutive clinic visits. In contrast, the Expert Panel of Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (Expert Panel) clinical practice guidelines define HT as the average of three consecutive BP measures above the 95th percentile. Here we quantify the impact of these two different case definitions of HT on occurrence of HT in a defined population of children and adolescents. Methods Study subjects were a cohort of 117,329 pediatric primary care patients, drawn from three large, geographically dispersed health systems. Subjects were 3-17 years old at entry between January 1, 2007 and December 31, 2010. Subjects having an elevated initial BP were not excluded, nor were subjects having BP diagnosis codes at baseline or follow-up. We estimated the period prevalence rate of HT using NHBPEP and Expert Panel definitions, applying a rolling window to the longitudinal BP measurements to consider each successive block of three BP measures. Analyses were performed separately for children (3-11 years) and adolescents (12-17 years). Data were analyzed by Poisson regression to estimate annual rates of HT. Results Subjects were followed for an average of 2.1 years. HT defined by elevated BP ≥95th percentile on 3 consecutive clinic visits occurred at a rate of 0.25%/year in children, and 0.42%/year in adolescents. HT defined as the average BP ≥95th percentile from 3 successive clinic visits occurred at higher rates; 0.49%/year in children (P ≤0.00005) and 0.75%/year in adolescents (P ≤0.00005). For subjects with HT defined by elevated BP ≥95th percentile on 3 consecutive clinic visits, the average time between elevated measurements was 19 weeks (s.d. 25 weeks). Conclusions HT rates in children and adolescents were twice as high when using an average of 3 consecutive measures (Expert Panel method) as when using 3 consecutive hypertensive levels (NHBPEP definition). The impact of these differences in HT rates on downstream risk of persistent HT and CV events later in life requires further investigation.
    Clinical Medicine &amp Research 09/2013; 11(3):137.
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    ABSTRACT: Background/Aims The aim of the study was to examine the prevalence of obesity and extreme obesity in school-aged children using three classifications based on body mass index (BMI): BMI percentile, percentage above the 95th percentile and Z score, and the association of BMI stratification with elevated blood pressure. Methods This was a retrospective study of 117,618 children aged 6-17 years receiving well-child care in Kaiser Permanente Northern California between July 2007 and December 2010. Blood pressure, BMI and other data were extracted from electronic records. Results The prevalence of BMI >95th percentile ranged from 14.5% (4,395 of 30,235) in whites and 14.3% (2,287 of 16,033) in Asians to 22.3% (1,809 of 8,124) in blacks and 25.8% (5,734 of 22,187) in Hispanics. For boys, the highest prevalence was in Hispanics (29.2%, 3,346 of 11,452), followed by blacks (21.0%, 879 of 4,193); for girls, the highest prevalence was in blacks (23.7%, 930 of 3,931) and then Hispanics (22.2%, 2,388 of 10,735). For extreme obesity, a threshold of BMI ≥120% of the 95th BMI percentile identified the largest proportion of children (5.6%, 6,532 of 117,618) compared to BMI ≥99th percentile (3.8%, 4,488 of 117,618) and BMI Z score ≥3.0 (0.1%, 83 of 117,618). Stratification of BMI by percentage above the 95th percentile demonstrated a graded relationship between obesity severity and risk of elevated blood pressure. Conclusions The prevalence of obesity and extreme obesity in children varied by age, gender and race/ethnicity, with the highest prevalence among Hispanics followed by black children. Compared to BMI thresholds based on the 99th BMI percentile or BMI Z score of 3, classification by BMI ≥120% of the 95th BMI percentile identified a greater percentage of severely obese children in whom additional health risk-stratification was achieved by further categorizing based on percentage above the 95th BMI percentile. This classification approach may be useful for obesity management in clinical practice, public health surveillance, and research.
    Clinical Medicine &amp Research 09/2013; 11(3):138.
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    ABSTRACT: Background/Aims Early childhood adiposity may have significant later health effects, highlighting the importance of early recognition in young children. This study examines the prevalence and recognition of obesity and severe obesity in preschool-aged children. Methods The electronic medical record was used to examine body mass index (BMI), height, sex, and race/ ethnicity in 42,559 children aged 3-5 years 2007-2010 within Kaiser Permanente Northern California. Normal BMI (BMI <85th percentile); overweight (BMI 85th-94th percentile); obesity (BMI ≥95th percentile); and extreme obesity (BMI ≥99th percentile or BMI ≥1.2×95th BMI percentile) were classified using the 2000 Center for Disease Control and Prevention growth charts. Provider recognition of elevated BMI was examined for obese children aged 5 years. Results Among 42,559 children, 12.4% (2,698 of 21,720) of boys and 10.0% (2,077 of 20,839) of girls had BMI ≥95th percentile. The prevalence was highest among Hispanics (18.2%, 982 of 5,397 boys and 15.2%, 760 of 4,988 girls), followed by blacks (12.4%, 161 of 1,138 boys and 12.7%, 154 of 1,216 girls). A positive trend existed between BMI category and median height percentile, with obesity rates highest in the highest height quintile. The proportion with BMI ≥99th percentile was 3.9% (1,670 of 42,559), nearly two-fold higher for boys (66.8%, 1,116 of 1,670) versus girls (33.2%, 554 of 1,670), and identified a larger proportion of children compared to BMI ≥1.2× 95th BMI percentile (1.6%, P <0.001). Among those aged 5 years, 77.9% of obese children (1082 of 1389) had provider diagnosis of obesity or elevated BMI, increasing to 84.5% (424 of 502) among the subset with severe obesity. Conclusions Obesity and severe obesity are evident as early as age 3-5 years, with race/ ethnic trends similar to older children. This study underscores the need for continued recognition and contextualization of early childhood obesity in order to develop effective strategies for early weight management.
    Clinical Medicine &amp Research 09/2013; 11(3):139.
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    ABSTRACT: Background/Aims Overweight and obesity among US children and adolescents is an important public health problem. Conditions associated with obesity, such as type 2 diabetes, hypertension, and hypercholesterolemia, are becoming more common in children. This study examined the relationship between changes in BMI percentile and incident prehypertension and hypertension in a cohort of children and adolescents. Methods Study subjects were 23,578 patients, ages 3-17, with three or more outpatient primary care visits between 2007 and 2010 at HealthPartners Medical Group, Kaiser Permanente Colorado, or Kaiser Permanente Northern California. Data were extracted from electronic health records (EHR). Change in BMI was defined as: increase, decrease, stayed obese, stayed overweight, and stayed healthy weight using established BMI percentile cut-points. Incident prehypertension and hypertension were defined using blood pressures and diagnosis codes from the EHR. We used time-dependent Cox proportional hazards models to estimate the hazard of change in BMI percentile with incident prehypertension and hypertension. Results Over a median 2.6 years follow-up, there were 7,232 cases of incident prehypertension, 148 diagnoses of incident hypertension, and 107 additional cases of incident hypertension based on blood pressure data from the EHR. Seventy-one prehypertensives went on to develop hypertension. Those who stayed obese, stayed overweight, and increased BMI had increased hazard of incident prehypertension (1.96, 1.39, and 1.49, respectively) and increased hazard of incident hypertension (3.61, 1.21, and 1.83, respectively) compared with those who stayed healthy weight. Conclusions Persistently high BMI or increasing BMI over time was associated with pronounced increase in risk of both incident prehypertension and hypertension. Future research should examine factors associated with the development and recognition of hypertension.
    Clinical Medicine &amp Research 09/2013; 11(3):139.
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    ABSTRACT: Little is known about the relation of pubertal development on endothelial function and arterial elasticity in children and adolescents; therefore, we compared brachial artery flow-mediated dilation and carotid artery elasticity across Tanner (pubertal) stages in children and adolescents. Blood pressure, fasting lipids, glucose and insulin, body fat, insulin sensitivity adjusted for lean body mass, brachial flow-mediated dilation (percent dilation and area under the curve), endothelium-independent dilation (peak dilation and area under the curve), and carotid artery elasticity were evaluated across pubertal stages (Tanner I vs Tanner II-IV vs Tanner V) in 344 children and adolescents (184 males, 160 females; ages 6 to 21 years). One hundred twenty-four subjects (mean age 8.23 ± 0.15 years; 52 females) were Tanner stage I; 105 subjects (mean age 13.19 ± 0.17 years; 47 females) were Tanner stages II-IV; and 115 subjects (mean age 17.19 ± 0.16 years; 61 females) were Tanner stage V. There were no significant differences for any of the measures of vascular structure and function across pubertal stages. Results of the current study indicate that smooth-muscle and endothelial function, as well as carotid artery elasticity, do not differ throughout pubertal development and that accounting for pubertal stage when reporting vascular data in children and adolescents may be unnecessary.
    The Journal of pediatrics 08/2013; · 4.02 Impact Factor
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    ABSTRACT: Adiponectin is strongly inversely associated with insulin resistance and type 2 diabetes but its causal role remains controversial. We used a Mendelian randomisation approach to test the hypothesis that adiponectin causally influences insulin resistance and type 2 diabetes. We used genetic variants at the ADIPOQ gene as instruments to calculate a regression slope between adiponectin levels and metabolic traits (up to 31,000 individuals) and a combination of instrumental variables and summary statistics based genetic risk scores to test the associations with gold standard measures of insulin sensitivity (2,969 individuals) and type 2 diabetes (15,960 cases and 64,731 controls). In conventional regression analyses a 1 SD decrease in adiponectin levels was correlated with a 0.31 SD (95%CIs: 0.26-0.35) increase in fasting insulin, a 0.34 SD (0.30-0.38) decrease in insulin sensitivity and a type 2 diabetes odds ratio of 1.75 (95%CIs: 1.47-2.13). The instrumental variable analysis revealed no evidence of a causal association between genetically lower circulating adiponectin and higher fasting insulin (0.02 SD, 95%CI: -0.07, 0.11, N=29,771), nominal evidence of a causal relationship with lower insulin sensitivity (-0.20 SD; 95%CIs: -0.38, -0.02; N=1,860) and no evidence of a relationship with type 2 diabetes (odds ratio 0.94; 95%CIs: 0.75, 1.19; N= 2,777 cases and 13,011 controls). Using the ADIPOQ summary statistics genetic risk scores we found no evidence of an association between adiponectin lowering alleles and insulin sensitivity (effect per weighted adiponectin lowering allele: -0.03 SD, 95%CIs: -0.07, 0.01; N=2,969) or type 2 diabetes (odds ratio per weighted adiponectin lowering allele: 0.99; 95%CIs: 0.95, 1.04; 15,960 cases vs. 64,731 controls). These results do not provide any consistent evidence that interventions aimed at increasing adiponectin levels will improve insulin sensitivity or risk of type 2 diabetes.
    Diabetes 07/2013; · 7.90 Impact Factor
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    ABSTRACT: BACKGROUND AND OBJECTIVE:Screening for hypertension in children occurs during routine care. When blood pressure (BP) is elevated in the hypertensive range, a repeat measurement within 1 to 2 weeks is recommended. The objective was to assess patterns of care after an incident elevated BP, including timing of repeat BP measurement and likelihood of persistently elevated BP.METHODS:This retrospective study was conducted in 3 health care organizations. All children aged 3 through 17 years with an incident elevated BP at an outpatient visit during 2007 through 2010 were identified. Within this group, we assessed the proportion who had a repeat BP measured within 1 month of their incident elevated BP and the proportion who subsequently met the definition of hypertension. Multivariate analyses were used to identify factors associated with follow-up BP within 1 month of initial elevated BP.RESULTS:Among 72 625 children and adolescents in the population, 6108 (8.4%) had an incident elevated BP during the study period. Among 6108 with an incident elevated BP, 20.9% had a repeat BP measured within 1 month. In multivariate analyses, having a follow-up BP within 1 month was not significantly more likely among individuals with obesity or stage 2 systolic elevation. Among 6108 individuals with an incident elevated BP, 84 (1.4%) had a second and third consecutive elevated BP within 12 months.CONCLUSIONS:Whereas >8% of children and adolescents had an incident elevated BP, the great majority of BPs were not repeated within 1 month. However, relatively few individuals subsequently met the definition of hypertension.
    PEDIATRICS 07/2013; · 4.47 Impact Factor
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    ABSTRACT: WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: The prevalence of obesity in the United States has increased dramatically over the past three decades. There is a growing spectrum of severe obesity among children and adolescents. Obesity trends and race/ethnic differences may be evident at a young age. WHAT THIS STUDY ADDS: Among children aged 3-5 years, the prevalence of obesity and severe obesity was higher in boys than in girls, and highest among children of Hispanic ethnicity. Within this young age group, higher body mass index (BMI) was associated with greater height percentile. Among obese children aged 5 years, provider recognition of obesity or elevated BMI was high, approaching 80% of children. BACKGROUND: Early childhood adiposity may have significant later health effects. This study examines the prevalence and recognition of obesity and severe obesity among preschool-aged children. METHODS: The electronic medical record was used to examine body mass index (BMI), height, sex and race/ethnicity in 42 559 children aged 3-5 years between 2007 and 2010. Normal or underweight (BMI < 85th percentile); overweight (BMI 85th-94th percentile); obesity (BMI ≥ 95th percentile); and severe obesity (BMI ≥ 1.2 × 95th percentile) were classified using the 2000 Centers for Disease Control and Prevention growth charts. Provider recognition of elevated BMI was examined for obese children aged 5 years. RESULTS: Among 42 559 children, 12.4% of boys and 10.0% of girls had BMI ≥ 95th percentile. The prevalence was highest among Hispanics (18.2% boys, 15.2% girls), followed by blacks (12.4% boys, 12.7% girls). A positive trend existed between increasing BMI category and median height percentile, with obesity rates highest in the highest height quintile. The prevalence of severe obesity was 1.6% overall and somewhat higher for boys compared with girls (1.9 vs. 1.4%, P < 0.01). By race/ethnicity, the highest prevalence of severe obesity was seen in Hispanic boys (3.3%). Among those aged 5 years, 77.9% of obese children had provider diagnosis of obesity or elevated BMI, increasing to 89.0% for the subset with severe obesity. CONCLUSIONS: Obesity and severe obesity are evident as early as age 3-5 years, with race/ethnic trends similar to older children. This study underscores the need for continued recognition and contextualization of early childhood obesity in order to develop effective strategies for early weight management.
    Pediatric Obesity 05/2013; · 2.28 Impact Factor
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    ABSTRACT: The objective of this study was to describe longitudinal relations of serum total free fatty acids (FFA) to insulin resistance (IR) and cardiovascular (CV) risk factors from adolescence into adulthood. The cohort included participants in a longitudinal study of obesity and IR with complete data, including anthropometric measures, FFA, IR measured by euglycemic clamp, blood pressure, fasting serum lipids and insulin at mean-ages 15 and 22 (N=207) and their parents (N=272). FFA and IR were not significantly related at mean-age 15 but were significantly related at mean-age 22. FFA did not relate to BMI at either age. FFA at age 15 estimated IR at age 22. In parents (mean-age 51) FFA was significantly correlated with BMI, percent body fat, systolic blood pressure, LDL, and IR. Associations with all risk factors except IR in parents were attenuated by adjustment for BMI. Most age 22 correlations with parents were higher than corresponding age 15 correlations. This study finds that FFA is associated with IR starting in young adulthood. The relation between FFA and CV risk factors does not become significant until later adulthood. The results support a significant impact of early metabolic dysfunction on later CV risk.
    Diabetes 05/2013; · 7.90 Impact Factor
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    ABSTRACT: OBJECTIVE:To examine the prevalence of prehypertension and hypertension among children receiving well-child care in community-based practices.METHODS:Children aged 3 to 17 years with measurements of height, weight, and blood pressure (BP) obtained at an initial (index) well-child visit between July 2007 and December 2009 were included in this retrospective cohort study across 3 large, integrated health care delivery systems. Index BP classification was based on the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents: normal BP, <90th percentile; prehypertension, 90th to 94th percentile; hypertension, 3 BP measurements ≥95th percentile (index and 2 subsequent consecutive visits).RESULTS:The cohort included 199 513 children (24.3% aged 3-5 years, 34.5% aged 6-11 years, and 41.2% aged 12-17 years) with substantial racial/ethnic diversity (35.9% white, 7.8% black, 17.6% Hispanic, 11.7% Asian/Pacific Islander, and 27.0% other/unknown race). At the index visit, 81.9% of participants were normotensive, 12.7% had prehypertension, and 5.4% had a BP in the hypertension range (≥95th percentile). Of the 10 848 children with an index hypertensive BP level, 3.8% of those with a follow-up BP measurement had confirmed hypertension (estimated 0.3% prevalence). Increasing age and BMI were significantly associated with prehypertension and confirmed hypertension (P < .001 for trend). Among racial/ethnic groups, blacks and Asians had the highest prevalence of hypertension.CONCLUSIONS:The prevalence of hypertension in this community-based study is lower than previously reported from school-based studies. With the size and diversity of this cohort, these results suggest the prevalence of hypertension in children may actually be lower than previously reported.
    PEDIATRICS 01/2013; · 4.47 Impact Factor
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    ABSTRACT: Background Childhood cancer survivors (CCS) are at risk for growth hormone (GH) deficiency. CCS are also at increased risk for early mortality from cardiovascular (CV) disease, but the association between GH levels and CV risk remains poorly understood. The goal of this study was to examine the cross‐sectional association between stimulated GH levels and CV risk factors in CCS younger than 18 years. ProcedureA total of 276 CCS (147 males, 14.4 ± 2.6 years) ≥5 years after cancer diagnosis, and 208 sibling controls (112 males, 13.6 ± 2.4 years) participated in this cross‐sectional study, which included anthropometry, body composition, and metabolic studies. Blunted response (BR) was defined as peak GH level lbm) was measured by euglycemic hyperinsulinemic clamp. Statistical analyses used linear and logistic regression accounting for sibling clustering, adjusted for age, sex, Tanner stage, and adiposity. ResultsThirty‐four (12%) CCS showed BR to GH stimulation. BR CCS were shorter and had a lower IGF‐1 than controls; only 6 of 34 received cranial radiation therapy. CCS with normal stimulated GH response were similar to controls for CV risk factors. Conversely, BR CCS had greater adiposity, higher lipids, and lower Mlbm than controls. Differences in lipids and Mlbm between BR CCS and controls remained significant after adjustment for BMI or visceral fat. ConclusionsBR to GH stimulation is prevalent in CCS youth and is associated with an unfavorable CV risk factor profile. Further studies are needed to establish the mechanisms of these associations. Pediatr Blood Cancer 2013; 60: 467–473. © 2012 Wiley Periodicals, Inc.
    Pediatric Blood & Cancer 01/2013; 60(3). · 2.35 Impact Factor
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    ABSTRACT: Goals for cardiovascular (CV) disease prevention were set by the American Heart Association in 2010 for the concept of CV health. Ideal CV health is defined by 7 CV health metrics: blood pressure, glucose, cholesterol, body mass index, and physical activity on recommended levels; nonsmoking; and a healthy diet. We studied the prevalence of ideal CV health and its associations with ultrasonographically measured carotid intima-media thickness (cIMT) cross-sectionally in 5 international populations. Prevalence of ideal CV health was assessed among 5785 young adults (age, 36.6±3.2 years) comprising 335 participants from the Minneapolis Childhood Cohort Studies (Minnesota), 723 from the Princeton Follow-up Study, 981 from the Bogalusa Heart Study (BHS), 1898 from the Cardiovascular Risk in Young Finns Study (YFS), and 1848 from the Childhood Determinants of Adult Health Study (CDAH). Only 1% of the participants had all 7 ideal CV health metrics. The number of ideal CV health metrics associated inversely with cIMT in the 4 cohorts in which cIMT was available: for each additional ideal CV health metric, cIMT was 12.7 μm thinner in Minnesota (P=0.0002), 9.1 μm thinner in BHS (P=0.05), 10.4 μm thinner in YFS (P<0.0001), and 3.4 μm thinner in CDAH (P=0.03). The number of ideal CV health metrics was inversely associated with cIMT in the cohorts in which cIMT was available, indicating that ideal CV health metrics are associated with vascular health at the population level. Ideal CV health was rare in this large international sample of young adults, emphasizing the need for effective strategies for health promotion.
    Journal of the American Heart Association. 01/2013; 2(3):e000244.
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    ABSTRACT: Background/Aims Identification of persistently elevated blood pressure (BP) in children can be challenging because BP measurements are subject to biological fluctuation and measurement error. The National High Blood Pressure Education Program 4th Working Group (NHBPEP) Guidelines define hypertension (HT) as BP that is =95th percentile for sex, age and height on 3 consecutive clinic measurements on different days. However, HT is a chronic condition, and it is not clear whether a definition incorporating multiple measures over a longer period of time would alter the prevalence compared to the present definition of HT. Methods Subjects included all children and adolescents, 3 to 17 years old, who received care at a Midwestern medical group and had three or more BP percentile measures taken between 1 January 2007 and 31 December 2010. All data were collected from an electronic medical record. We compared the prevalence of HT based on BP = 95th percentile on 3 consecutive visits with the prevalence based on the average of multiple BP percentile measurements over the previous 2 or previous 4 years. Results Among the 22,173 children and adolescents in this cohort, HT prevalence differed according to the length of the measurement period and the classification method used. The NHBPEP definition of HT found 1.2% of children were hypertensive using 2 years of BP measurements, and 2.1% of children using 4 years of measurements. Averaging all measurements, 1.3% of children were classified as hypertensive using 2 years of BP measurements and 0.5% using 4 years of measurements. Discussion The 2 methods found similar prevalence of HT over 2 years of observation, but over 4 years, the averaging method resulted in 4 times fewer children with HT. We speculate that the current NHBPEP approach may over-diagnose HT and that longer periods of observation may provide a more valid estimate of BP status.
    Clinical Medicine &amp Research 08/2012; 10(3):154-5.
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    ABSTRACT: Background/Aims To ascertain the prevalence and joint prevalence of elevated BMI and elevated BP in children and adolescents receiving clinical care, using electronic medical record (EMR) data. Methods We studied BP and BMI percentiles (%) of 79,838 U.S. subjects age 3 to 17 years with three or more eligible BP percentile measures from 1/1/2007 to 12/31/2009. We extracted data on age, diastolic and systolic BP, height, and weight from electronic medical records (EMR) and calculated BMI percentiles and BP percentiles using standard methods. Here we report by age group the proportions of subjects with normal BMI and normal BP percentile, elevated BMI >=85th percentile or >=95th percentile, or hypertension (HT) defined as elevated BP >= 95th percentile on 3 or more occasions, or Pre-Hypertension (Pre-HT) defined as BP >= 90th percentile at least once but not meeting definition for HT. Results Data Supplied as a Table, Not Accepted By Abstract Software. Discussion The proportion of children and adolescents with both normal BP and normal BMI was 46.7% and decreased with age, while the proportion with both elevated BP and BMI rose from 7.8% to 20.0% with increasing age. Clinical and public policy initiatives to reduce the very high frequency of these risk factors in U.S. children and adolescents should be carefully considered.
    Clinical Medicine &amp Research 08/2012; 10(3):188-9.

Publication Stats

3k Citations
592.77 Total Impact Points

Institutions

  • 1998–2014
    • University of Minnesota Duluth
      • Medical School
      Duluth, Minnesota, United States
  • 2013
    • Fred Hutchinson Cancer Research Center
      • Division of Clinical Research
      Seattle, WA, United States
  • 2011–2013
    • Children's Hospitals and Clinics of Minnesota
      Minneapolis, Minnesota, United States
  • 2012
    • Northwestern University
      • Department of Preventive Medicine
      Evanston, IL, United States
  • 1998–2012
    • University of Minnesota Twin Cities
      • • Department of Pediatrics
      • • Department of Kinesiology
      • • Division of Epidemiology and Community Health
      • • School of Public Health
      Minneapolis, MN, United States
  • 2005–2010
    • University of Wisconsin, Madison
      • Department of Ophthalmology and Visual Sciences
      Madison, MS, United States
  • 2009
    • University of Rochester
      • Department of Pediatrics
      Rochester, NY, United States
  • 2003
    • McGill University
      • Department of Pediatrics
      Montréal, Quebec, Canada
    • University of New Mexico
      • Department of Pediatrics
      Albuquerque, NM, United States
  • 2001
    • University of Cincinnati
      Cincinnati, Ohio, United States