Article

Which Amount of BMI-SDS Reduction Is Necessary to Improve Cardiovascular Risk Factors in Overweight Children?

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Abstract

Context: Knowing the changes of cardiovascular risk factors (CRF) in relation to weight loss would be helpful to advise overweight children and their parents and to decide whether drugs should be prescribed in addition to lifestyle intervention. Objective: To determine the BMI-SDS reduction to improve CRFs in overweight children. Design: Prospective observation study. Setting: Specialized outpatient obesity clinic. Patients: 1388 overweight children (mean BMI 27.9±0.1, mean age 11.4±0.1years, 43.8% male, 45.5% prepubertal). Intervention: 1-year lifestyle intervention. Main outcome measures: We studied changes of blood pressure (BP), fasting HDL-, LDL-cholesterol, triglycerides, glucose, and insulin resistance index HOMA. Change of weight status was determined by delta BMI-SDS based on the recommended percentiles of the International Task Force of Obesity. Results: BMI-SDS change was associated with a significant improvement of all CRFs except fasting glucose and LDL-cholesterol after adjusting for multiple confounders such as baseline CRF, age, gender, BMI, pubertal stage and its changes. BMI-SDS reduction ≥0.25-0.5 was related to a decrease of systolic BP (-3.2±1.4mmHg), diastolic BP (-2.2±1.1mmHg), triglycerides (-6.9±5.8mg/dl), HOMA (-0.5±0.3), and triglyceride/HDL-cholesterol (-0.3±0.2), while HDL-cholesterol increased (+1.3±1.2mg/dl). A reduction of >0.5 BMI-SDS led to more pronounced improvement (systolic BP -6.0±1.3mmHg, diastolic BP -5.1±1.3mmHg, triglycerides -16.4±7.1mg/dl, HDL-cholesterol +1.6±1.5mg/dl, HOMA -0.9±0.3). Per 0.1 BMI-SDS reduction systolic BP (-1.0mmHg), diastolic BP (-0.8mmHg), triglycerides (-2.3mg/dl), HOMA (-0.2), and triglyceride/HDL-cholesterol (-0.5), decreased significantly, while HDL-cholesterol (0.2mg/dl) increased significantly in linear regression analyses accounted for multiple confounders. Conclusions: A BMI-SDS reduction ≥0.25 improved significantly hypertension, hypertriglyceridemia and low HDL-cholesterol, while a BMI-SDS >0.5 doubled the effect.

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... Some benefits of this lifestyle intervention were maintained at 12 months of follow-up. It is suggested that a decrease in cardiometabolic risk is achieved when the reduction in BMI-SDS is greater or equal to 0.2 [29]. In this regard, Reinehr et al. (2016) indicate that the decrease in BMI-SDS is linked to a reduction in both SBP and DBP [29]. ...
... It is suggested that a decrease in cardiometabolic risk is achieved when the reduction in BMI-SDS is greater or equal to 0.2 [29]. In this regard, Reinehr et al. (2016) indicate that the decrease in BMI-SDS is linked to a reduction in both SBP and DBP [29]. However, in our study, neither systolic nor diastolic blood pressure decreased after 12 months of follow-up. ...
... It is suggested that a decrease in cardiometabolic risk is achieved when the reduction in BMI-SDS is greater or equal to 0.2 [29]. In this regard, Reinehr et al. (2016) indicate that the decrease in BMI-SDS is linked to a reduction in both SBP and DBP [29]. However, in our study, neither systolic nor diastolic blood pressure decreased after 12 months of follow-up. ...
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Elevated circulating plasma levels of both lipopolysaccharide-binding protein (LBP) and chemerin are reported in patients with obesity, but few studies are available on lifestyle intervention programs. We investigated the association of both LBP and chemerin plasma levels with metabolic syndrome (MetS) outcomes in a lifestyle intervention in children and adolescents with abdominal obesity Methods: Twenty-nine patients enrolled in a randomized controlled trial were selected. The lifestyle intervention with a 2-month intensive phase and a subsequent 10-month follow-up consisted of a moderate calorie-restricted diet, recommendations to increase physical activity levels, and nutritional education. Results: Weight loss was accompanied by a significant reduction in MetS prevalence (−43%; p = 0.009). Chemerin (p = 0.029) and LBP (p = 0.033) plasma levels were significantly reduced at 2 months and 12 months, respectively. At the end of intervention, MetS components were associated with both LBP (p = 0.017) and chemerin (p < 0.001) plasma levels. Conclusions: We describe for the first time a reduction in both LBP and chemerin plasma levels and its association with MetS risk factors after a lifestyle intervention program in children and adolescents with abdominal obesity. Therefore, LBP and chemerin plasma levels could be used as biomarkers for the progression of cardiovascular risk in pediatric populations.
... Childhood obesity is a multisystem disease with negative consequences and various comorbidities, thereby contributing to premature death in adulthood [60]. Physical exercise represents a non-pharmacological intervention crucial to mitigate the problems of overweight and obesity, as well as related comorbidities starting from childhood [61]; several studies demonstrated the importance of the reduction of the BMI z-score, WC, and WHtR in children with OB to prevent and/or reduce the cardiovascular risk and to obtain better health outcomes [62][63][64][65][66][67][68][69]. ...
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COVID-19 restrictions have dramatically reduced the active lifestyle and physical activity (PA) levels in the whole population, a situation that can contribute to weight gain and to develop obesity. To improve physical fitness (PF) in children with obesity during COVID-19 restrictions, sport specialists started to deliver physical training through tele-exercise. For these reasons, the aim of this study was to evaluate the effects of a 12-week online supervised training program in children with obesity on different PF components and PA levels. We enrolled a total of 40 Caucasian children (9 F/31 M; aged 11 ± 1.9 years) with obesity. The data collection consisted of a series of anthropometric measures, the PAQ-C questionnaire, and PF tests, valid and reliable tools to assess PF in children. We used a Wilcoxon’s t-test and a Student’s t-test, as appropriate, to assess the differences before and after the training protocol. A total of 37 patients completed the training protocol and were considered in the analysis. Our results show an improvement in all the PF tests, a reduction in the BMI z-score, the waist circumference, and in the waist-to-height ratio, and an increased PA level. In conclusion, the results of our study show that an online supervised training program is effective to promote PA, improving PF and reducing the BMI z-score in children with obesity.
... The interventions should be provided with culturally and developmentally appropriate comprehensive lifestyle programs that integrate diabetes management with the ultimate goal of 7-10% reduction in body weight in those that have completed linear growth [15]. Weight loss of the magnitude of 0.5 kg/m 2 decrease in body mass index (BMI) [19] or a 0.25 to 0.5 decrease in BMI Z-score has been in children has been associated with improvements in insulin sensitivity [20]. ...
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The prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents is on the rise, and the increase in prevalence of this disorder parallels the modern epidemic of childhood obesity worldwide. T2DM affects primarily post-pubertal adolescents from ethnic/racial minorities and those from socioeconomically disadvantaged backgrounds. Youth with T2DM often have additional cardiovascular risk factors at diagnosis. T2DM in youth is more progressive in comparison to adult onset T2DM and shows lower rates of response to pharmacotherapy and more rapid development of diabetes-related complications. Lifestyle modifications and metformin are recommended as the first-line treatment for youth with T2DM in the absence of significant hyperglycemia. Assessment of pancreatic autoimmunity is recommended in all youth who appear to have T2DM. Pharmacotherapeutic options for youth with T2DM are limited at this time. Liraglutide, a GLP-1 agonist, was recently approved for T2DM in adolescents 10 years of age and older. Several clinical trials are currently underway with youth with T2DM with medications that are approved for T2DM in adults. Bariatric surgery is associated with excellent rates of remission of T2DM in adolescents with severe obesity and should be considered in selected adolescents.
... Participants were divided in four subgroups on the basis of their change in BMI SDS: BMI SDS increased, BMI SDS decreased by > 0 to < 0.25, BMI SDS decreased by ≥ 0.25 to < 0.5 and BMI SDS decreased by ≥ 0.5. These groups were chosen on the basis of previous studies where a minimum reduction in BMI SDS of at least 0.25 was required to improve body composition and cardio metabolic health [15,16]. ...
Article
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Objective This study evaluated the effect of an after-school group-based medium-intensity multicomponent behavioural intervention programme for children aged 8–12 years classified as overweight, obese or at risk for overweight on body mass index standard deviation score (BMI SDS). In accordance with standardized protocols body weight and height were measured in 195 participants (88 boys, 107 girls) at baseline and at the end of the programme. A total of 166 children derived from a school-based monitoring system served as control group. Multivariate regression analyses examined the effect of the intervention and the independent factors associated with better outcomes in the intervention group. Results Analysis of covariance showed a significant intervention effect on BMI SDS in favour of the intervention group (b-coefficient − 0.13 ± 0.03; p < 0.01) compared with the control group. Change in BMI SDS between baseline and follow-up in the intervention group was associated with baseline age (b-coefficient 0.03 ± 0.02; p = 0.04) but was independent from gender, ethnicity, baseline BMI SDS, time between baseline and follow-up, school year and attendance rate.
... Interventions in childhood are critical, as children with obesity experience a range of physical and psychosocial health issues and are at a high risk of developing chronic disease in adulthood [2]. Diet, physical activity, and other behavioral interventions can be effective in terms of change in adiposity, and significant clinically relevant metabolic benefits have been demonstrated with a 0.25 reduction in BMI z-score [3], although meaningful reductions in cardiometabolic markers are observed with reductions of 0.15 [4,5]. Recent Cochrane meta-analyses of behavior change interventions reported 12-month reductions in BMI z-score of −0.06 units among children aged 6 to 11 years [6] and −0.13 units (95% CI −0.21 to −0.05) in adolescents aged 12 to 17 years [7]. ...
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Background: Multicomponent family interventions underline current best practice in childhood obesity treatment. Mobile health (mHealth) adjuncts that address eating and physical activity behaviors have shown promise in clinical studies. Objective: This study aimed to describe process methods for applying an mHealth intervention to reduce the rate of eating and monitor physical activity among children with obesity.
... Participants were divided in four subgroups on the basis of their change in BMI SDS: BMI SDS increased, BMI SDS decreased by > 0 to < 0.25, BMI SDS decreased by ≥ 0.25 to < 0.5 and BMI SDS decreased by ≥ 0.5. These groups were chosen on the basis of previous studies where a minimum reduction in BMI SDS of at least 0.25 was required to improve body composition and cardio metabolic health (14,15). ...
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Objective This study evaluated the effect of an after-school group-based medium-intensity multicomponent behavioural intervention programme for children aged 8-12 years with overweight or obesity on body mass index standard deviation score (BMI SDS). In accordance with standardized protocols body weight and height were measured in 195 participants (88 boys, 107 girls) at baseline and at the end of the programme. A total of 166 children derived from a school-based monitoring system served as control group. Multivariate regression analyses examined the effect of the intervention and the independent factors associated with better outcomes in the intervention group. Results Analysis of covariance showed a significant intervention effect on BMI SDS in favour of the intervention group (b-coefficient -0.13 ± 0.03; p< 0.01) compared with the control group. Change in BMI SDS between baseline and follow-up in the intervention group was associated with baseline age (b-coefficient 0.03 ± 0.02; p= 0.04) but was independent from gender, ethnicity, baseline BMI SDS, time between baseline and follow-up, school year and attendance rate.
... Lower NEDF consumption implies a significant improvement in diets, as NEDF are rich in added sugar, saturated fat, and sodium, which have been associated with obesity in children (33-35, 39, 40). Body weight loss in children has been linked with improvement in blood pressure, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, or insulin resistance even if the BMI z-score reduction is small (41); thus, small but sustained weight loss or prevention of unhealthy weight gain could help reverse the burden of disease that derives from obesity in children. ...
Article
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Background: Consumption of foods high in energy, sugar, fat, and salt contributes to the increase in body mass index and the prevalence of overweight and obesity in children. Mexico implemented an 8% tax to non-essential energy-dense foods (NEDF) in 2014 as part of a national strategy to reduce obesity. Objective: We modeled the potential effect of the NEDF tax on body mass index and overweight and obesity in Mexican children (6–17 years). Materials and Methods: We used the Dynamic Childhood Growth and Obesity Model calibrated to Mexican children to simulate the potential 1-year effect of the NEDF tax on body weight. Inputs for the model included NEDF consumption, weight, and height, obtained from the 2012 Mexican National Health and Nutrition Survey. To project the potential impact of the tax, we ran a first simulation without intervention and another reducing the caloric intake from NEDF in the proportion observed in the Mexican population after the tax (−5.1%). The tax effect was defined as the absolute difference in body mass index and prevalence of overweight and obesity between both models. Results: The tax on NEDF should lead to a mean reduction of 4.1 g or 17.4 kcal/day of NEDF at the population level. One year after the tax, mean body weight and body mass index should decrease 0.40 kg and 0.19 kg/m ² ; this translates into −1.7 and −0.4% points in overweight and obesity, respectively. Conclusions: The use of fiscal instruments to discourage the consumption of NEDF could help to reduce the prevalence of overweight and obesity in children.
... These findings agree with previous studies [35,[42][43][44][45], reporting after 5-12 months of nutritional only or lifestyle interventions in overweight/obese children a mean decrease of BMI z-score ranging from about 5% [43,44] to 20% [43]. Interestingly, it should be noted that the effectiveness of an intervention on the cardio-vascular risk has been recognized when the BMI z score reduction is at least 0.5 [46,47]. ...
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Background The Atherogenic Index of Plasma is a predictive biomarker of atherosclerosis in adults but there is a lack of studies in paediatric population aimed at evaluating the longitudinal changes of the AIP and of the cardiometabolic blood profile related to nutritional interventions. The aim of this study was to compare the effect of individual- versus collective-based nutritional-lifestyle intervention on the Atherogenic Index of Plasma in schoolchildren with obesity. Methods One-hundred sixty-four children aged 6–12 years with Body Mass Index z-score > 2 referred to the Paediatric Obesity Clinic, San Paolo Hospital, Milan, Italy, were consecutively enrolled and randomized to undergo to either an individual- (n = 82) or a collective- (n = 82) based intervention promoting a balanced normo-caloric diet and physical activity. In addition, the individual intervention included a tailored personalized nutritional advice and education based on the revised Coventry, Aberdeen, and London-Refined taxonomy. Both at baseline and after 12 months of intervention, dietary habits and anthropometric measures were assessed, a fasting blood sample were taken for biochemistry analysis. Results The participation rate at 12 months was 93.3% (n = 153 patients), 76 children in the individual-intervention and 77 children in the collective intervention. At univariate analysis, mean longitudinal change in Atherogenic Index of Plasma was greater in the individual than collective intervention (− 0.12 vs. − 0.05), as well as change in triglyceride-glucose index (− 0.22 vs. − 0.08) and Body Mass Index z-score (− 0.59 vs. − 0.37). At multiple analysis, only change in Body Mass Index z-score remained independently associated with intervention (odds ratio 3.37). Conclusion In children with obesity, an individual-based nutritional and lifestyle intervention, including techniques from the CALO-RE taxonomy, could have an additional beneficial effect over a collective-based intervention, although the actual size of the effect remains to be clarified. Trial Registration Clinical Trials NCT03728621
... BMIz among children receiving both enhanced standard of care arm and individualized telehealth coaching (text messages 2x/week and telephone/video sessions every other month) [25] and greater than similar family-based weight management interventions according to a recent Cochrane review of interventions that lasted 6 months or longer [26]. However, the total contact hours did not meet the US Preventive Services Task Force recommendations of at least 26 hours to align with prior efficacious interventions [2], and the BMIz reduction did not meet previously suggested threshold of -0.25 for cardiometabolic improvement [27]. Importantly, in the pilot study, only 4 of the 10 children had obesity and an additional 4 were overweight, and it is not known if these children had cardiometabolic dysregulation. ...
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BACKGROUND: Family-based behavioral therapy is an efficacious approach to deliver weight management counseling to children and their parents. However, most families do not have access to in-person, evidence-based treatment. We previously developed and tested DRIVE (Developing Relationships that Include Values of Eating and Exercise), a home-based parent training program to maintain body weight among children at risk for obesity, with the intent to eventually disseminate it nationally alongside SafeCare, a parent support program that focuses on parent-child interactions. Currently the DRIVE program has only been tested independently of SafeCare. This study created the "mHealth DRIVE" program by further adapting DRIVE to incorporate digital and mobile health tools, including remotely delivered sessions, a wireless scale that enabled a child-tailored weight graph, and a pedometer. Telehealth delivery via mHealth platforms and other digital tools can improve program cost-effectiveness, deliver long-term care, and directly support both families and care providers. OBJECTIVE: The objective of this study was to examine preliminary acceptability and effectiveness of the mHealth DRIVE program among children and parents who received it and among SafeCare providers who potentially could deliver it. METHODS: Study 1 was a 13-week pilot study of a remotely delivered mHealth family-based weight management program. Satisfaction surveys were administered, and height and weight were measured pre- and post-study. Study 2 was a feasibility/acceptability survey administered to SafeCare providers. RESULTS: Parental and child satisfaction (mean of 4.9/6.0 and 3.8/5.0, respectively) were high, and children's (N=10) BMI z-scores significantly decreased (mean -0.14, SD 0.17; P=.025). Over 90% of SafeCare providers (N=74) indicated that SafeCare families would benefit from learning how to eat healthily and be more active, and 80% of providers reported that they and the families would benefit from digital tools to support child weight management. CONCLUSIONS: Pediatric mHealth weight management interventions show promise for effectiveness and acceptability by families and providers.
... Furthermore, although the children and adolescents with follow-up data achieved a significant decrease of their degree of overweight, this decrease was only marginal and likely not relevant for the CVRFs since the decrease of BMI-SDS was <0.2 on average. It has been shown that a decrease of >0.25 BMI-SDS is necessary to improve CVRFs in children and adolescents [26]. This emphasizes the limitations of short-term inpatient or long-term outpatient standard-of-care conservative obesity management. ...
Article
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Objective Obesity is associated with many cardiovascular risk factors (CVRF) in childhood. There is an ongoing discussion whether there is a linear relationship between degree of overweight and deterioration of CVRFs justifying body mass index (BMI) cut-offs for treatment decisions. Methods We studied the impact of BMI-SDS on blood pressure, lipids, and glucose metabolism in 76,660 children (aged 5–25 years) subdivided in five groups: overweight (BMI-SDS 1.3 to <1.8), obesity class I (BMI-SDS 1.8 to <2.3), class II (BMI-SDS 2.3–2.8), class III (BMI-SDS > 2.8–3.3), and class IV (BMI-SDS > 3.3). Analyses were stratified by age and sex. Results We found a relationship between BMI-SDS and blood pressure, triglycerides, HDL cholesterol, liver enzymes, and the triglycerides–HDL-cholesterol ratio at any age and sex. Many of these associations lost significance when comparing children with obesity classes III and IV: In females < 14 years and males < 12 years triglycerides and glucose parameters did not differ significantly between classes IV and III obesity. Prevalence of dyslipidemia was significantly higher in class IV compared to class III obesity only in females ≥ 14 years and males ≥ 12 years but not in younger children. In girls < 14 years and in boys of any age, the prevalences of type 2 diabetes mellitus did not differ between classes III and IV obesity. Conclusions Since a BMI above the highest BMI cut-off was not associated consistently with dyslipidemia and disturbed glucose metabolism in every age group both in boys and girls, measurements of CVRFs instead of BMI cut-off seem preferable to guide different treatment approaches in obesity such as medications or bariatric surgery.
... The amount of overweight reduction to achieve improvements has not been established yet. A prospective observational study conducted on 1,388 overweight children, with a mean age of 11.4 ± 0.1 years, showed that a BMI-SDS reduction of 0.25 or greater significantly improved hypertension, hypertriglyceridaemia, and low HDL cholesterol, whereas a BMI-SDS of >0.5 doubled the effect [18]. The Endocrine Society Clinical Practice Guidelines recommend a minimum of 20 min of moderate-to-vigorous physical activity (PA) daily, with a goal of 60 min and a maximum of 1-2 h per day of non-academic screen time in order to discourage sedentary behaviours [16]. ...
Article
Although metabolic syndrome (MetS) in children and adolescents is a frequently discussed topic in the literature, uniform guidelines on its definition and treatment are still lacking. Insulin resistance, central obesity, dyslipidaemia, and hypertension are commonly considered the main components of MetS. The first recommended approach to all these pathological conditions in children and adolescents is lifestyle intervention (diet and physical exercise); however, in some selected cases, a pharmacological or surgical treatment might prove useful for the prevention of metabolic and cardiovascular complications. The aim of this review is to present the more recent evidence about the treatment of the major components of MetS in children and adolescents, focussing on the current recommendations concerning lifestyle changes, available drugs, and bariatric surgery.
... Previous authors have demonstrated that reductions of 0.25-0.50 SD in z BMI are associated with decreased levels of triglycerides, HOMA-IR and TGA/HDL-C ratio as well as an increase in HDL-C [48]. In this pilot study, 0.30 SD drop in z BMI was achieved in 16 weeks of combined physical activity and nutritional counselling and was already related to improvements in biochemical parameters. ...
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Aerobics or strength exercise plus diet interventions have been shown to counteract childhood obesity. However, little is known with regard to periodized multicomponent exercise interventions combined with nutritional counselling, which might be less demanding but more enjoyable and respectful of children and adolescents' nature. In order to analyze the impact of such a multimodal approach, 18 obese children (10.8 ± 1.6 years; 63% females; z Body Mass Index 3 ± 0.4) trained for 60 min, twice weekly and were measured for body composition, biochemical parameters and physical function. We found that 16 weeks of multimodal intervention (14 of training), based on fun-type skill-learning physical activities and physical conditioning with challenging circuits and games, together with nutritional counselling, led to an attendance > 80%, with significant overall health improvement. Body composition was enhanced (p < 0.01 for z BMI, mid-upper-arm-circumference, waist-to-height ratio, tricipital and subscapular skinfolds, body-fat % by Slaughter equation and Dual energy X-ray absorptiometry body fat% and trunk fat%), as well as metabolic profile (LDL cholesterol, gamma-glutamyl transferase , alanine aminotransferase ; p < 0.05), homeostatic model assessment of insulin resistance (HOMA-IR; p < 0.05) and inflammatory response (C-Reactive Protein; p < 0.05). Physical fitness was also improved (p < 0.01) through better cardiovascular test scores and fundamental movement patterns (Functional Movement Screen-7, FMS-4). Tailoring multimodal supervised strategies ensured attendance, active participation and enjoyment, compensating for the lack of strict caloric restrictions and the low volume and training frequency compared to the exercise prescription guidelines for obesity. Nutritional counselling reinforced exercise benefits and turned the intervention into a powerful educational strategy. Teamwork and professionals' specificity may also be key factors.
... Childhood obesity is a risk factor for negative health consequences [59]. Understanding the diminution of treatment effectiveness in these children is clinically relevant because even modest reductions of BMI z-scores by 0.125 or more can result in significant improvements of several parameters of the metabolic syndrome [60]. Evaluation of and adaptations to FBT that specifically address satiety responsiveness might help some children and families better implement behavior change and be more successful in treatment. ...
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Family-based behavioral treatment (FBT) is the recommended treatment for children with common obesity. However, there is a large variability in short- and long-term treatment response, and mechanisms for unsuccessful treatment outcomes are not fully understood. In this study, we tested if brain response to visual food cues among children with obesity before treatment predicted weight or behavioral outcomes during a 6-month behavioral weight management program and/or long-term relative weight maintenance over a 1-year follow-up period. Thirty-seven children with obesity (age 9–11 years, 62% male) who entered active FBT (attended two or more sessions) and had outcome data. Brain activation was assessed at pretreatment by functional magnetic resonance imaging across an a priori set of appetite-processing brain regions that included the ventral and dorsal striatum, mOFC, amygdala, substantia nigra/ventral tegmental area, and insula in response to viewing food images before and after a standardized meal. Children with more robust reductions in brain activation to high-calorie food cue images following a meal had greater declines in BMI z-score during FBT (r = 0.42; 95% CI: 0.09, 0.66; P = 0.02) and greater improvements in Healthy Eating Index scores (r = −0.41; 95% CI: −0.67, −0.06; P = 0.02). In whole-brain analyses, greater activation in the ventromedial prefrontal cortex, specifically by high-calorie food cues, was predictive of better treatment outcomes (whole-brain cluster corrected P = 0.02). There were no significant predictors of relative weight maintenance, and initial behavioral or hormonal measures did not predict FBT outcomes. Children’s brain responses to a meal prior to obesity treatment were related to treatment-based weight outcomes, suggesting that neurophysiologic factors and appetitive drive, more so than initial hormone status or behavioral characteristics, limit intervention success.
... In addition to validation with fat change, change in BMI metrics should be validated against metabolic effect, such as change in lipids or glucose. Studies have found that BMIz decreases of 0.15 to 0.5 result in improvement in metabolic health in children with obesity (23)(24)(25). No reports have explored any variation in this relationship across the range of obesity, although the inconsistent relation between obesity severity and BMIz makes such variation likely. ...
Article
Objective This study aimed to examine the relation between change in different BMI metrics and change in adiposity over a 12‐month weight management intervention. Methods Baseline and 12‐month weights and heights from 399 children aged 2 to 12 years with BMI ≥ 85th percentile were used to calculate BMI, %BMIp95, %BMIp50, BMI z‐score (BMIz ), and modified BMI z‐score (BMImz ). Changes (Δ) in these measures were compared with changes in body fat percent (Δfat%) from bioelectrical impedance assessment. Correlation and regression models predicting associations between ΔBMI metrics and Δfat% were examined. Results A total of 89% of the cohort was Hispanic, and 34% had class 2 or 3 obesity. In models predicting Δfat% adjusting for age, sex, and weight category, R ² for ΔBMI, ΔBMIz , BMImz , Δ%BMIp95, and Δ%BMIp50 were 0.53, 0.38, 0.45, 0.53, and 0.54, respectively (all P < 0.001). Only the ΔBMIz model had an interaction with weight status. Among the models with the highest R ², age group and sex interacted with the Δ%BMIp95 model but not ΔBMI or ΔBMIp50 models. Conclusions Longitudinal analyses demonstrate the utility of several BMI metrics other than z‐score in capturing adiposity change consistently across a range of obesity severity. Characteristics of studied groups and interpretability could influence metric choice.
... Det er per i dag ingen konsensus for hvor stor endring i BMI-standardavviksskår som anses som klinisk signifikant (20). Flere studier har imidlertid sett forbedringer i kardiovaskulaer risiko ved reduksjon av BMI-standardavviksskår på minst 0,25, selv om dette ikke nødvendigvis betyr at man oppnår en BMI under grenseverdien for fedme (iso-BMI 30) (21,22). I flere studier er det også funnet økt kardiovaskulaer risiko ved økende fedme (23), noe som underbygger at stabilisering av vekten i seg selv kan regnes som et tilfredsstillende behandlingsmål. ...
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Background: Lifestyle interventions for children and adolescents with severe obesity show moderate short-term effects on weight reduction internationally. We evaluated treatment results at two Norwegian specialist outpatient clinics. Material and method: We performed a retrospective analysis of data from children and adolescents between 3 and 18 years of age collected in 2012-2016. Children and adolescents with severe obesity who attended their one-year follow-up were included. We included in the analyses the following body weight measures: percentage overweight as defined by the International Obesity Task Force cut-off (% IOTF-25); BMI standard deviation score; waist circumference standard deviation score; and body fat percentage at the start of treatment and at one-year follow-up. Results: Of 568 children and adolescents who started treatment, 416 (73 %) attended the one-year check-up. A total of 271 (65 %) patients achieved a reduction in %IOTF-25, while 228 patients (55 %) reduced their BMI standard deviation score. There was a statistically significant mean reduction of all four registered body weight measurements. Altogether 54 of 325 children (17 %) changed category from severe obesity to obesity, 8 (2 %) went from severe obesity to overweight, and 8 of 91 children (9 %) changed category from obesity to overweight or normal weight. The proportion of participants with a reduction of more than 5 % in %IOTF-25 was 43 % (177/416), and a reduction in BMI standard deviation score of more than 0.25 was observed in 23 % (95/416) of participants. Girls responded on average more poorly to the intervention than boys. There was no clinically significant difference in results between the treatment centres. Interpretation: After one year of treatment of children and adolescents with severe obesity in two specialist healthcare centres, we found a moderate mean reduction in weight, waist circumference and body fat percentage, but with large interindividual variation.
... Importantly, a variety of different factors determine sugar consumption and obesity; there is no magic bullet but rather many small levers that need to be pushed. Given that 94% of teenagers in Europe consume more sugar than recommended (Mesana et al., 2018) and that the number of children with obesity is 10 times higher than 40 years ago (Abarca-Gómez et al., 2017), every lever needs to be taken into account: Even small changes can improve population health (e.g., Reinehr et al., 2016). ...
Article
Background Increased soft drink consumption has been proposed as both predictor and result of mental health problems. Although possible mechanisms for both directions have been suggested, understanding of the association is limited. Most previous research has been crosssectional and could not assess directionality. Method This study investigated the directionality of the association between soft drink consumption and mental health using longitudinal panel data of N = 5,882 children and adolescents from the nationally representative German KiGGS baseline study (2003–2006) and KiGGS Wave 1 (2009–2012). Soft drink consumption and mental health problems were assessed by standardized questionnaire (baseline) and telephone interview (Wave 1). Four cross-lagged panel models were specified and compared regarding their fit indices. Specific paths were tested for significance. Results Positive cross-sectional associations between soft drink consumption and mental health problems were found at both measurement points (ps < .01), even after controlling for third variables (including age, gender, and socioeconomic status). Only the lagged effect of mental health problems on soft drink consumption reached statistical significance (β = .031, p = .020), but not vice versa. The corresponding model also showed the best model fit overall. Conclusions Mental health problems predicted soft drink consumption over an average of six years, but not vice versa. These findings suggest that consuming soft drinks might be a dysfunctional strategy for coping with mental health problems for children and adolescents and highlight the importance of considering mental health problems in the prevention of soft drink overconsumption and obesity.
... For the short-term assessment, the costs associated with a BMI-SDS reduction of 0.25 were estimated because prior research reported that a BMI-SDS reduction of !0.25 units yielded significant benefits to body composition and cardiovascular health. 48,49 Using the information on intervention costs (1799V per person, full costs) and the average change in the BMI-SDS (À0.19), we determined a hypothetical price of 2367V for a 0.25 reduction (0.25 divided by 0.19, resulting in approximately 132%, multiplied with the cost of 1799V), assuming a linear relation between cost and BMI-SDS reduction. ...
Article
Abstract: Objectives: Facing an epidemic of childhood obesity and budget constraints, public health administrations are showing an urgent interest in interventions that are both health- and cost-effective. Thus, this study intends to analyze the return on investment of these existing programs. Study design: All analyses are based on a comprehensive data set from 249 obese and overweight children who participated in the Children's Health InterventionaL Trial (CHILT), an 11-month outpatient multidisciplinary family-based program. Methods: Cost-effectiveness was assessed by comparing estimated savings associated with a reduction in weight and improvement of obesity-related health parameters with intervention costs. Projected future savings in healthcare expenditures were modeled on existing research, using estimates of healthcare costs associated with juvenile obesity and remission thresholds of obesity-related disease. Results: On average, participants achieved a 0.19 unit reduction in BMI- SDS, lowered their blood pressure (systolic -1.76 mmHg, diastolic -2.82 mmHg) and improved their HDL- and LDL-cholesterol values (HDL +1.31 mg/dL, LDL -4.82 mg/dL). The intervention costs were 1799€ per participant and the benefits of avoided future healthcare costs varied by individual. On an aggregated level, future savings amounted to between 1859€ and 1926€ per person, translating into a return on investment of 3.3% to 7.0%. Conclusions: This study shows that a multicomponent obesity intervention, such as the CHILT program, not only results in weight loss and improves important health parameters but is also cost-effective.
... However, some evidence suggests that BMI z-score reductions greater than 0•25 and 0•5 might represent clinically important thresholds. 104 Several high-quality clinical practice guidelines are in use internationally. [96][97][98][99][100][101][102] Treatment type and intensity depends upon obesity severity, the age and developmental stage of the child, needs and preferences of the patient and family, clinical competency and training of the clinician(s), and the health-care system in which treatment is offered. ...
Article
Background: There is limited evidence regarding the experiences, challenges, and needs of adolescents living with obesity (ALwO), their caregivers, and healthcare professionals (HCPs). Objectives: The cross-sectional, survey-based global ACTION Teens study aimed to identify perceptions, attitudes, behaviours, and barriers to effective obesity care among ALwO, caregivers of ALwO, and HCPs. Methods: ALwO (aged 12 to <18 years; N = 5275), caregivers (N = 5389), and HCPs treating ALwO (N = 2323) from 10 countries completed an online survey (August-December 2021). Results: Most ALwO perceived their weight as above normal (76% vs. 66% of caregivers), were worried about its impact on their health (85% vs. 80% of caregivers), and recently made a weight loss attempt (58%). While 45% of caregivers believed ALwO would slim down with age, only 24% of HCPs agreed. Most commonly reported weight loss motivators for ALwO were wanting to be more fit/in better shape according to ALwO (40%) and caregivers (32%), and improved confidence/social life according to HCPs (69%). ALwO weight loss barriers included lack of hunger control (most commonly reported by ALwO/caregivers), lack of motivation, unhealthy eating habits (most commonly agreed by HCPs), and lack of exercise. Conclusions: Misalignment between ALwO, caregivers, and HCPs-including caregivers' underestimation of the impact of obesity on ALwO and HCPs' misperception of key motivators/barriers for weight loss-suggests a need for improved communication and education.
... The 0.23 higher BMI z-score observed in this study is higher than the effect estimates of other early life risk factors associated with childhood overweight, such as caesarean delivery and childcare [44,45]. A reduction of 0.25 BMI z-score has been associated with clinically relevant reductions in cardiovascular risk factors in overweight children, indicating the potential public health relevance of the reported association between frequent infections and BMI z-score [46,47]. The percentage of children with at least six parent-reported infections in the first 3 years of life was approximately 20%. ...
Article
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The incidence of childhood overweight and obesity is rising. It is hypothesized that infections in early childhood are associated with being overweight. This study investigated the association between the number of symptomatic infections or antibiotic prescriptions in the first 3 years of life and body mass index (BMI) in adolescence. The current study is part of the Prevention and Incidence of Asthma and Mite Allergy population-based birth cohort study. Weight and height were measured by trained research staff at ages 12 and 16 years. The 3015 active participants at age 18 years were asked for informed consent for general practitioner (GP) data collection and 1519 gave written informed consent. Studied exposures include (1) GP-diagnosed infections, (2) antibiotic prescriptions, and (3) parent-reported infections in the first 3 years of life. Generalized estimating equation analysis was used to determine the association between each of these exposures and BMI z-score. Exposure data and BMI measurement in adolescence were available for 622 participants. The frequencies of GP-diagnosed infections and antibiotic prescriptions were not associated with BMI z-score in adolescence with estimates being 0.14 (95% CI −0.09–0.37) and 0.10 (95% CI −0.14–0.34) for the highest exposure categories, respectively. Having ≥6 parent-reported infections up to age 3 years was associated with a 0.23 (95% CI 0.01–0.44) higher BMI z-score compared to <2 parent-reported infections. For all infectious disease measures an increase in BMI z-score for the highest childhood exposure to infectious disease was observed, although only statistically significant for parent-reported infections. These results do not show an evident link with infection severity, but suggest a possible cumulative effect of repeated symptomatic infections on overweight development.
... Replaced meals are not recommended, since efficacy and safety have not been tested in children and adolescents; hypocaloric diets with low glycemic load, although having an effect on satiety, have not superior effect compared with other dietary approaches in the medium term [77]. The diet effect on these children is evaluated using the BMI-SDS (Standard Deviation Score); a reduction >0.5 in a growing child correlates with better body composition and decreased CHD risk [78]; waist circumference and skinfold thicknesses can be also used to measure fat percentage, but they do not offer other benefits with regard to BMI [79]. Several studies have shown that the discontinuation of weight management programs can discourage families, hinder the action of clinicians and result in inefficient use of clinical resources. ...
Article
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Coronary Heart Disease (CHD) is a major mortality and morbidity cause in adulthood worldwide. The atherosclerotic process starts even before birth, progresses through childhood and, if not stopped, eventually leads to CHD. Therefore, it is important to start prevention from the earliest stages of life. CHD prevention can be performed at different interventional stages: primordial prevention is aimed at preventing risk factors, primary prevention is aimed at early identification and treatment of risk factors, secondary prevention is aimed at reducing the risk of further events in those patients who have already experienced a CHD event. In this context, CHD risk stratification is of utmost importance, in order to tailor the preventive and therapeutic approach. Nutritional intervention is the milestone treatment in pediatric patients at increased CHD risk. According to the Developmental Origin of Health and Disease theory, the origins of lifestyle-related disease is formed in the so called “first thousand days” from conception, when an insult, either positive or negative, can cause life-lasting consequences. Nutrition is a positive epigenetic factor: an adequate nutritional intervention in a developmental critical period can change the outcome from childhood into adulthood.
... There was also a trend toward higher BMI among Hispanic and Black youth compared with non-Hispanic White youth and females compared with males, but these trends were not uniform across regions. Regional differences in average BMI z scores, although modest, are likely clinically meaningful (25,26), especially the lower average BMI z score in the West. ...
Article
Objective The aim of this study was to describe the association of individual-level characteristics (sex, race/ethnicity, birth weight, maternal education) with child BMI within each US Census region and variation in child BMI by region. Methods This study used pooled data from 25 prospective cohort studies. Region of residence (Northeast, Midwest, South, West) was based on residential zip codes. Age- and sex-specific BMI z scores were the outcome. Results The final sample included 14,313 children with 85,428 BMI measurements, 49% female and 51% non-Hispanic White. Males had a lower average BMI z score compared with females in the Midwest (β = −0.12, 95% CI: −0.19 to −0.05) and West (β = −0.12, 95% CI: −0.20 to −0.04). Compared with non-Hispanic White children, BMI z score was generally higher among children who were Hispanic and Black but not across all regions. Compared with the Northeast, average BMI z score was significantly higher in the Midwest (β = 0.09, 95% CI: 0.05-0.14) and lower in the South (β = −0.12, 95% CI: −0.16 to −0.08) and West (β = −0.14, 95% CI: −0.19 to −0.09) after adjustment for age, sex, race/ethnicity, and birth weight. Conclusions Region of residence was associated with child BMI z scores, even after adjustment for sociodemographic characteristics. Understanding regional influences can inform targeted efforts to mitigate BMI-related disparities among children.
... Two examples are presented, showing either 3.0 kg of weight increase or 1.0 kg of weight loss after 6 months of treatment in a 10.5 year-old boy with a linear growth of + 3 cm. In both cases a reduction of BMI Z-score above 0.25 was hypothesized, an amount that has been deemed to be effective in reducing cardiovascular risk factors in obese children [24]. Reduction of 0.7 or 2.4 BF% was estimated according to the height-weight formula against to a reduction of BMI Z-score of 0.26 or 0.54, respectively. ...
Article
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Background The assessment of body composition is central in diagnosis and treatment of paediatric obesity, but a criterion method is not feasible in clinical practice. Even the use of bioelectrical impedance analysis (BIA) is limited in children. Body mass index (BMI) Z-score is frequently used as a proxy index of body composition, but it does not discriminate between fat mass and fat-free mass. We aimed to assess the extent to which fat mass and percentage of body fat estimated by a height-weight equation agreed with a BIA equation in youths with obesity from South Italy. Furthermore, we investigated the correlation between BMI Z-score and fat mass or percentage of body mass estimated by these two models. Methods One-hundred-seventy-four youths with obesity (52.3% males, mean age 10.8 ± 1.9) were enrolled in this cross-sectional study. Fat mass and percentage of body fat were calculated according to a height-weight based prediction model and to a BIA prediction model. Results According to Bland–Altman statistics, mean differences were relatively small for both fat mass (+ 0.65 kg) and percentage of body fat (+ 1.27%) with an overestimation at lower mean values; the majority of values fell within the limits of agreement. BMI Z-score was significantly associated with both fat mass and percentage of body fat, regardless of the method, but the strength of correlation was higher when the height-weight equation was considered ( r = 0.82; p < 0.001). Conclusions This formula may serve as surrogate for body fat estimation when instrumental tools are not available. Dealing with changes of body fat instead of BMI Z-score may help children and parents to focus on diet for health.
... However, some evidence suggests that BMI z-score reductions greater than 0•25 and 0•5 might represent clinically important thresholds. 104 Several high-quality clinical practice guidelines are in use internationally. [96][97][98][99][100][101][102] Treatment type and intensity depends upon obesity severity, the age and developmental stage of the child, needs and preferences of the patient and family, clinical competency and training of the clinician(s), and the healthcare system in which treatment is offered. ...
Article
This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice.
... Interventions in childhood are critical, as children with obesity experience a range of physical and psychosocial health issues and are at a high risk of developing chronic disease in adulthood [2]. Diet, physical activity, and other behavioral interventions can be effective in terms of change in adiposity, and significant clinically relevant metabolic benefits have been demonstrated with a 0.25 reduction in BMI z-score [3], although meaningful reductions in cardiometabolic markers are observed with reductions of 0.15 [4,5]. Recent Cochrane meta-analyses of behavior change interventions reported 12-month reductions in BMI z-score of −0.06 units among children aged 6 to 11 years [6] and −0.13 units (95% CI −0.21 to −0.05) in adolescents aged 12 to 17 years [7]. ...
Article
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Mobile health (mHealth) platforms have become increasingly popular for delivering health interventions in recent years and particularly in light of the COVID-19 pandemic. Childhood obesity treatment is an area where mHealth interventions may be useful due to the multidisciplinary nature of interventions and the need for long-term care. Many mHealth apps targeting youth exist but the evidence base underpinning the methods for assessing technical usability, user engagement and user satisfaction of such apps with target end-users or among clinical populations is unclear, including for those aimed at paediatric overweight and obesity management. This review aims to examine the current literature and provide an overview of the scientific methods employed to test usability and engagement with mHealth apps in children and adolescents with obesity. A narrative literature review was undertaken following a systematic search. Four academic databases were searched. Inclusion criteria were studies describing the usability of mHealth interventions for childhood obesity treatment. Following the application of inclusion and exclusion criteria, fifty-nine articles were included for full-text review, and seven studies met the criteria for usability and engagement in a clinical paediatric population with obesity. Six apps were tested for usability and one for engagement in childhood obesity treatment. Sample sizes ranged from 6-1120 participants. The included studies reported several heterogenous measurement instruments, data collection approaches, and outcomes. Recommendations for future research include the standardization and validation of instruments to measure usability and engagement within mHealth studies in this population.
... Adjusted analyses in our completers group showed a significant reduction in BMI-SDS of -0¢32. This largely exceeded the widely used cut-off value of -0¢25 BMI-SDS for effective and clinically relevant interventions [28][29][30]. It is also more beneficial than the average results of outpatient childhood obesity programs as documented by recent Cochrane systematic reviews reporting BMI-SDS reductions ranging from -0¢03 to -0¢20 [11,12. ...
Article
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Background In most childhood obesity interventions, disadvantaged groups are underrepresented, and results are modest and not maintained. A long-term collaborative community-based approach is necessary to reach out to children from multi-ethnic backgrounds and achieve sustainable behavior change, resulting in sustained Body Mass Index-Standard Deviation Score (BMI-SDS) reductions. The objective is to determine the effects of GO! on BMI-SDS and Health-Related Quality of Life (HRQoL) for children and adolescents having overweight or obesity. Methods A prospective, longitudinal cohort study was used to collect two-year follow-up data from November 2014 to July 2019. Children and adolescents (4-19 years old) from the low socioeconomic status and multi-ethnic district of Malburgen in the Dutch city of Arnhem were included. 178 children having overweight or obesity were recruited, with 155 children measured at baseline and after two years as a minimum, while 23 were lost to follow up. Participants attending the program for over six months were defined as completers (n=107) and participants attending the program for less than six months were defined as non-completers (n=48). The child health coach (CHC) acts as a central care provider in the collaborative community with healthcare providers from both medical and social fields. This coach coordinates, monitors and coaches healthy lifestyles, while increasing self-management for both children and parents. This is done in a customized and neighborhood-oriented manner and provided by all the stakeholders involved in GO!. The main outcomes are the change in BMI-SDS scores and HRQoL scores reported by participants. Findings After 24 months, completers showed a decrease in BMI-SDS of -0·32 [95% CI: -0·42, -0·21], compared with -0·14 [95% CI: -0·29, 0·01] for non-completers (adjusted for gender and ethnicity; P=0.036). While 25% suffered from overweight and 75% from obesity at the start, following the intervention 5% showed normal weight, with 33% overweight and 62% with obesity. HRQoL reported by participants improved over time, showing no differences between completers and non-completers, gender and ethnicity after two years. Interpretation Our results suggest that the GO! program might be effective in reaching out and reducing BMI-SDS for participants in a low socioeconomic status and multi-ethnic district over a two-year period. We noticed also trends to beneficial shifts in obesity grades. HRQoL improved regardless of the participation rate, gender and ethnic background. In light of the study limitations, further studies are needed to corroborate our observations. Funding Dullerts-foundation, Nicolai Broederschap foundation, Burger en Nieuwe weeshuis foundation, Rijnkind foundation, Arnhems Achterstandswijken foundation, Menzis-foundation, the municipalities of Arnhem, Rheden, Overbetuwe and Lingewaard, the Association of Dutch municipalities, and Province of Gelderland.
... Die Ergebnisse des multivariaten Mehrebenen-Modells fasst Tabelle Zur Einordnung: Eine zBMI-Reduktion um .25 ist trotz der kleinen Zahl eine bedeutsame Veränderung, die nachweislich mit positiven gesundheitlichen Folgen einhergeht (Reinehr et al., 2016). Wie sich eine zBMI-Abnahme in dieser Größenordnung innerhalb eines Jahres in Kilogramm ausdrückt, veranschaulichen Mühlig et al. (2014) anhand von zwei Beispielen: Bei einem stark adipösen, 15-jährigen Mädchen (102 kg, 170 cm, 1 cm Längenwachstum nach einem Jahr) bedeutet sie eine Gewichtsreduktion um 4.8 kg, bei einem 8-jährigen adipösen Jungen (40 kg, 130 cm, 6 cm Längenwachstum nach einem Jahr) hingegen eine Gewichtszunahme um 3.5 kg, d.h. ...
Article
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Zusammenfassung Verschiedentlich wurde aufgezeigt, dass sich Kinder und Jugendliche im Ernährungs-und Bewegungsverhalten gegenseitig beeinflussen, z. B. bei der Konsumhäufigkeit von Fastfood. Eine Erklärung dafür ist, dass das unter Gleichaltrigen übliche und beliebte Verhalten die persönlichen Vorlieben verstärkt oder neue Ge-wohnheiten entstehen lässt. Es ist wenig darüber bekannt, ob sich dieser Zusammenhang auch im gruppen-therapeutischen Kontext zeigt. In der vorliegenden Studie wurde bei Kindern und Jugendlichen mit Adipositas untersucht, ob sich das durchschnittliche Ernährungs-und Bewegungsverhalten der Therapiegruppe auf den Behandlungsverlauf der einzelnen Gruppenmitglieder auswirkt. Die Untersuchungsgruppe bildeten 570 Kinder und Jugendliche aus 54 Behandlungsgruppen, die zwischen 2009 und 2013 in ambulanten, multidisziplinären Gruppentherapieprogrammen in der Schweiz behandelt wurden. Die Ergebnisse der multivariaten Mehrebenen-Regressionsmodelle weisen auf signifikante Gruppenunterschiede hin: In einer Gruppe mit Kindern und Jugendlichen behandelt zu werden, die im Schnitt die Verhaltensempfehlungen zu Ernährung und Bewegung stark umsetzen, wirkte sich positiv auf die durchschnittliche (alters-und ge-schlechtsstandardisierte) BMI-Reduktion der einzelnen Gruppenmitglieder aus. Individuelle und familiäre Voraussetzungen wurden dabei kontrolliert. Es wird vermutet, dass das gesundheitsförderliche Verhalten der anderen Gruppenmitglieder die Veränderungsmotivation und das Selbstwirksamkeitsgefühl des Einzelnen stärkt und dies die Zielerreichung der Behandlung begünstigt. Das Ernährungs-und Bewegungs-verhalten von Gleichaltrigen war bislang zwar als ursächlicher Faktor für Adipositas bei Kindern und Jugendlichen bekannt, gemäß den vorliegenden Ergebnissen ist es aber auch ein bedeutsamer Interventionsfaktor. Für die Interventionspraxis wäre es vielversprechend, Ansätze zu entwickeln, die solche positiven Gruppenprozesse gezielt(er) fördern. Abstract Previous findings suggest that children and adolescents influence each other in terms of eating habits and physical activity, e.g. in the frequency of consumption of fast food. One explanation for this is that common and popular behavior among peers reinforces personal preferences or promotes new habits. Little is known about whether this also applies to the group treatment context. The present study among children and adolescents with obesity addresses the question of whether the average eating behaviour and physical activity of the therapy group effects the course of treatment of the individual group members. The study group consisted of 570 children and adolescents from 54 treatment groups who were treated in an outpatient, multidisciplinary group therapy program in Switzerland between 2009 and 2013. The results of the multi-variate multi-level regression models show significant group differences: Being treated in a group with children and adolescents who, on average, implement the recommendations on healthy eating and physical activity well, had a positive effect on the average BMI reduction (standardized for sex and age) of the individual group members, when simultaneously controlling for individual influencing factors. It is assumed that the health-promoting behavior of the other group members strengthens the motivation for change and the individual's sense of self-efficacy and that this promotes the achievement of the treatment's goals. Although eating habits and physical activity of peers have been discussed as etiological factor for childhood obesity, the present results indicate that they are also a significant intervention factor. For the intervention practice, it would be promising to develop approaches that promote such positive group processes (more) specifically.
... The amount of weight loss needed to improve elements of the metabolic syndrome in obese children and adolescents, such as hypertension, elevated triglycerides and low HDL-cholesterol concentrations, is 0.25-0.50 BMI SD score [67]. This BMI SDs change translates to a BMI reduction of 1.0 -2.0 kg/m2 in a 13 year old adolescent, and is associated with an improvement of all abnormal cardiovascular risk factors, except fasting blood glucose. ...
Article
Background: Severe obesity among adolescent shows a worrisome trend in regard of its increasing prevalence and poses a great challenge for treatment. Conservative measures have modest effects on weight loss, usually fail in achieving a sustainable weight loss and resolution of comorbidities. This has led to greater utilization of bariatric surgery (BS) that offers a fast reduction in body mass index (BMI) with little perioperative complications. Despite the increasing utilization of BS, data is still insufficient, regarding their long-term outcome in adolescents. We review short and long-term effects of bariatric surgery and their implications on bone health and nutritional deficiencies in adolescents. In addition, we discuss possible pharmaceutical alternatives. Summary: BS results in a substantial weight loss of roughly 37% in the first-year post-operation and is superior to conservative measures in resolution of metabolic comorbidities. BS significantly improves health-related quality of life. Longer follow up, shows weight regain in 50% of patients. Furthermore, reduced bone mass and nutritional deficiencies were reported in up to 90% of patients. Most recently, alternative to BS became more relevant with approval of GLP-1 analogues use in adolescents. GLP-1 analogues are potent enough to induce moderate clinically meaningful weight loss and improvement of metabolic component. Key Messages: We conclude that obese adolescents without major obesity related complications may benefit from pharmacological interventions with lifestyle modification. We advise considering BS as treatment approach in adolescents with severe obesity and major obesity related complications with proper pre-operative preparation and post operative follow up in excellence centers.
... Obesity treatment outcome was measured by subtracting BMI SDS at the first visit from BMI SDS at the last visit prior to the index date. As a BMI SDS reduction of 0.25 or greater has previously been shown to improve cardiovascular risk factors in children with obesity, 24 we used this cut-off value to evaluate whether a BMI SDS reduction of 0.25 or greater also reduces the risk for NAFLD. ...
Article
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Not all children with obesity carry a similar risk of non-alcoholic fatty liver disease (NAFLD). We investigated the effect of obesity severity, metabolic risk parameters, and obesity treatment outcome on later risk of NAFLD in paediatric obesity. We conducted a nested case–control study of children and adolescents enrolled in the Swedish Childhood Obesity Treatment Register (BORIS) (2001–2016). NAFLD was ascertained from the National Patient Register. Five controls per case were matched by sex and age at index date and at the obesity treatment initiation. Seventy-six pairs (n cases = 76, n controls = 241) were included in the analysis (29% females, mean age at obesity treatment initiation was 10.8 ± 3.07 years). Mean age of NAFLD diagnosis was 14.2 ± 3.07 years. The risk for NAFLD increased with severe obesity (odds ratio [OR]: 3.15, 95% confidence interval [CI]: 1.69–5.89), impaired fasting glucose (OR: 5.29, 95% CI: 1.40–20.06), high triglycerides (OR: 2.33, 95% CI: 1.22–4.43) and weight gain (OR: 4.67, 95% CI: 1.51–14.49 per body mass index standard deviation score [BMI SDS] unit). Relative weight loss of at least 0.25 BMI SDS units reduced NAFLD risk independently of other risk factors (OR: 0.09, 95% CI: 0.01–0.56). Severe obesity, impaired fasting glucose and high triglycerides are risk factors for future NAFLD in paediatric obesity. Successful obesity treatment almost eliminates the risk for NAFLD independently of obesity severity, IFG and high triglycerides.
... In healthy children with O&MS, attainment of BMI below overweight threshold is usually targeted [39]. A BMI reduction of −0.25 SDS has been reported to result in significantly improved BP, triglycerides, and HDL levels [72]. Still, individualized energy intake according to age, CKD stage, dialysis, and comorbidities in order to achieve normal growth should be provided according to PRNT recommendations for energy requirements in children with CKD2-5D [17]. ...
Article
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Obesity and metabolic syndrome (O&MS) due to the worldwide obesity epidemic affects children at all stages of chronic kidney disease (CKD) including dialysis and after kidney transplantation. The presence of O&MS in the pediatric CKD population may augment the already increased cardiovascular risk and contribute to the loss of kidney function. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists who develop clinical practice recommendations (CPRs) for the nutritional management of children with kidney diseases. We present CPRs for the assessment and management of O&MS in children with CKD stages 2–5, on dialysis and after kidney transplantation. We address the risk factors and diagnostic criteria for O&MS and discuss their management focusing on non-pharmacological treatment management, including diet, physical activity, and behavior modification in the context of age and CKD stage. The statements have been graded using the American Academy of Pediatrics grading matrix. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. Research recommendations are provided. The CPRs will be periodically audited and updated by the PRNT.
Article
Zusammenfassung Adipositas und assoziierte kardiovaskuläre Risikofaktoren, wie arterielle Hypertonie, Dyslipidämie, Hyperinsulinämie und gestörte Glukosetoleranz, entstehen häufig bereits in der Kindheit und legen somit den Grundstein für Herz-Kreislauf-Erkrankungen im Erwachsenenalter. Gleichwohl lassen sich Folgeschäden wie endotheliale Dysfunktion, Arteriosklerose und kardiales Remodeling bereits in dieser frühen Lebensphase nachweisen. Die Risikofaktoren zeigen eine hohe Stabilität bis in das Erwachsenenalter hinein und führen in ihrer langfristigen Akkumulation zur Ausprägung kardiovaskulärer Ereignisse. Auch wenn eine Gewichtsreduktion nur in seltenen Fällen gelingt, sollte eine konsequente Therapie der Adipositas und ihrer Komorbiditäten frühzeitig versucht werden, da eine Remission während der Kindheit das Risiko für kardiovaskuläre Folgen im Erwachsenenalter auf ein Niveau senkt, welches vergleichbar mit dem der schlanken Normalbevölkerung ist.
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To compare the effectiveness of family‐based behavioural social facilitation treatment (FBSFT) versus treatment as usual (TAU) in children with severe obesity. Parallel‐design, nonblinded, randomized controlled trial conducted at a Norwegian obesity outpatient clinic. Children aged 6–18 years referred to the clinic between 2014 and 2018 were invited to participate. Participants were randomly allocated using sequentially numbered, opaqued, sealed envelopes. FBSFT (n = 59) entailed 17 sessions of structured cognitive behavioural treatment, TAU (n = 55) entailed standard lifestyle counselling sessions every third month for 1 year. Primary outcomes included changes in body mass index standard deviation score (BMI SDS) and percentage above the International Obesity Task Force cut‐off for overweight (%IOTF‐25). Secondary outcomes included changes in sleep, physical activity, and eating behaviour. From pre‐ to posttreatment there was a statistically significant difference in change in both BMI SDS (0.19 units, 95% confidence interval [CI]: 0.10–0.28, p < .001) and %IOTF‐25 (5.48%, 95%CI: 2.74–8.22, p < .001) between FBSFT and TAU groups. FBSFT participants achieved significant reductions in mean BMI SDS (0.16 units, (95%CI: −0.22 to −0.10, p < .001) and %IOTF‐25 (6.53%, 95% CI: −8.45 to −4.60, p < .001), whereas in TAU nonsignificant changes were observed in BMI SDS (0.03 units, 95% CI: −0.03 to 0.09, p = .30) and %IOTF‐25 (−1.04%, 95% CI: −2.99 to −0.90, p = .29). More FBSFT participants (31.5%) had clinically meaningful BMI SDS reductions of ≥0.25 from pre‐ to posttreatment than in TAU (13.0%, p = .021). Regarding secondary outcomes, only changes in sleep timing differed significantly between groups. FBSFT improved weight‐related outcomes compared to TAU.
Article
Introducción: en las últimas décadas la obesidad pediátrica ha adquirido niveles epidémicos a nivel mundial. Objetivo: identificar evidencias científicas respecto de la obesidad pediátrica y su relación con la aparición precoz del síndrome cardiometabólico. Método: la investigación fue realizada mediante una revisión sistemática, entre enero y febrero de 2020, de las bases bibliografías MEDLINE, LILACS y ScIELO, utilizando los descriptores: “Child*”, “Teen*”, “Adolescent”, “Pediatric Obesity”, “Metabolic syndrome”, “Cardiovascular diseases”, “Arterial hypertension”, “Insulin resistance”, “dyslipidemias”, “Glycosylated hemoglobin A”, “HbA1”. Resultados: de los 2.604 artículos localizados, 32 fueron incluidos en el análisis. La población de estudio fue de 56.761 niños y adolescentes entre 2 y 18 años. Más de la mitad de los estudios se realizaron en el continente americano y fueron principalmente de tipo transversal. En varias de estas investigaciones, los participantes o datos formaban parte de proyectos o encuestas de salud. La medición de los componentes del síndrome metabólico fue realizada, esencialmente, según la definición de la Organización Mundial de la Salud e International Diabetes Federation. Las variables más alteradas en niños y adolescentes con sobrepeso y obesidad fueron los parámetros antropométricos, bioquímicos y hemodinámicos. Conclusión: los estudios muestran la consolidación de la obesidad como factor de riesgo adquirido para la aparición de enfermedades metabólicas, pero lo más trascendental es la sólida evidencia encontrada de estudios de intervención, sobre la reversibilidad de las alteraciones patológicas como producto de una práctica de estilos de vida saludables.
Article
Adolescent obesity continues to be a serious concern around the world, placing young people at risk for chronic conditions and early death. Research has shown that social relationships are important in making health behavior changes, such as following health-care recommendations for eating and physical activity. Specifically, the trust of health-care providers has been shown to be important in making health behavior change. Evidence suggests that obese young adults are less trusting of health-care providers than their healthy weight peers, but it is not known if this also applies to obese adolescents. The purpose of this secondary analysis study was to determine relationships between the trust of health-care providers and body mass index percentile in adolescents. Participants were 224 adolescents aged 14–19 years attending a public high school in the Midwestern United States. The Wake Forest Physician Trust scale measured the trust of health-care providers. Height and weight were collected at a school screening; body mass index percentile categories were determined according to age- and sex-adjusted body mass index percentiles. One-way analysis of variance and post hoc Tukey tests showed trust scores varied significantly between body mass index percentile categories of girls. Results suggest it may be necessary for health-care providers to make additional efforts to build trust with obese adolescent girls than with other groups of adolescents.
Article
Objective To determine whether 12‐month BMI SDS reductions persisted at 24 months in a multi‐disciplinary assessment and intervention program for children and adolescents with obesity, and whether secondary outcomes improved. Methods This was a community‐based 12‐month RCT in Aotearoa/New Zealand. Eligible participants were aged 5 to 16 years with BMI ≥98th centile or BMI >91st centile with weight‐related comorbidities. The low‐intensity control received comprehensive home‐based baseline assessments and advice, and 6‐monthly follow‐up. The high‐intensity intervention received the same assessments and advice, but also weekly multidisciplinary sessions. Primary outcome was BMI SDS at 12 months. Secondary outcomes included cardiovascular and metabolic markers. Results 121 participants (60% of participants at baseline) were assessed at 24 months. BMI SDS reduction at 12 months was lost at 24 months in the modified intention‐to‐treat analysis [Control −0.03 (95%CI −0.14, 0.09) and Intervention −0.02 (−0.12, 0.08); P = .93]. However, sweet drink intake was reduced, water intake increased, and there were improvements in cardiovascular fitness in the high‐intensity intervention. ≥70% attendance in the high‐intensity intervention resulted in a persistent BMI SDS reduction of −0.22 after 24 months (95%CI −0.38, −0.06). Conclusions This trial was negative in terms of primary outcome at 24 months. However, high engagement led to sustained treatment effect, and there were multiple improvements in health measures.
Article
Background: In the UK, more than one in five children are overweight on starting school. An elevated body mass index (BMI) in childhood increases the likelihood of developing many health and social issues. The Lifestyles, Eating and Activity for Families (LEAF) programme is a weight management service for clinically obese children under the age of 7 years and their families. This study evaluates the effectiveness of the LEAF programme by measuring BMI z-score change, the reduction in calorific beverage consumption and user satisfaction. Methods: Data were collected over 6 years from 2012 and children who met the local weight management pathway criteria were recruited. Contact time was typically 20 h over 12 months and included home and clinic-based assessment by the multidisciplinary team and community-based intervention through six group sessions. This study compared baseline and post-intervention BMI z-scores (zBMI) for 65 children, as well as daily total calorific intakes from beverages for 41 children, and, in addition, 20 parents completed user satisfaction questionnaires. Results: There was a highly significant reduction in both mean zBMI (0.5; p < 0.001) and mean total calories from beverages (199; p < 0.001) across the intervention period. There was no significant correlation between zBMI and beverage calorific trends. Families who completed user satisfaction questionnaires reported that they had changed their dietary habits and 90% would recommend the programme to others. Conclusions: This initial evaluation indicates that the LEAF programme was effective in reducing the zBMI of a group of clinically obese young children. Keywords obesity epidemic, young children, intervention, multidisciplinary.
Article
Background: Using meta-regression, this article aims at establishing the minimum change in BMI-standard deviation score (SDS) needed to improve lipid profiles and blood pressure in children and adolescents with obesity, to aid future trials and guidelines. Methods: Studies with participants involved in lifestyle interventions, aged 4-19 years, with a diagnosis of obesity according to defined BMI thresholds, were considered for inclusion in a large systematic review. Interventions had to report pre- and post-intervention (or mean change in) BMI-SDS, plus either systolic blood pressure (SBP), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and/or triglycerides (TGs). Random-effects meta-regression quantified the relationship between mean change in BMI-SDS and mean change in cardiovascular outcomes. Results: Seventy-one papers reported various cardiovascular measurements and mean change in BMI-SDS. Fifty-four, 59, 46, and 54 studies were analyzed, reporting a change in SBP, HDL, LDL, and TG, respectively. Reduction in mean BMI-SDS was significantly related to improvements in SBP, LDL, TG, and HDL (p < 0.05); BMI-SDS reductions of 1, 1.2, and 0.7 ensured a mean reduction of SBP, LDL, and TG, respectively, although an equivalent value for HDL improvement was indeterminate. Conclusion: Reductions in mean BMI-SDS of >1, >1.2, or >0.7 are likely to reduce SBP, LDL, and TG, respectively. Further studies are needed to clarify the optimal duration, intensity, and setting for interventions. Consistency is required regarding derived BMI values to facilitate future systematic reviews and meta-analyses.
Article
Objective This study aimed to determine 5-year outcomes from a 12-month, family-based, multidisciplinary lifestyle intervention program for children. Methods This study was the 5-year follow-up of a randomized clinical trial comparing a low-intensity control group (home-based assessments) with a high-intensity intervention group (assessments plus weekly sessions) in New Zealand. Participants were aged 5 to 16 years with BMI ≥ 98th centile or > 91st centile with weight-related comorbidities. The primary outcome was BMI standard deviation score (BMISDS). Secondary outcomes included various health markers. Results Of the 199 children included in the study at baseline (47% who identified as Māori, 53% who identified as female, 28% in the most deprived quintile, mean age = 10.7 years, mean BMISDS = 3.12), 86 completed a 5-year assessment (43%). BMISDS reduction at 12 months was not retained (control = 0.00 [95% CI: −0.22 to 0.21] and intervention = 0.17 [95% CI: −0.01 to 0.34]; p = 0.221) but was greater in participants aged <10 years versus >10 years at baseline (−0.15 [95% CI: −0.33 to 0.03] vs. 0.21 [95% CI: 0.03 to 0.40]; p = 0.008). BMISDS trajectory favored participants with high attendance (p = 0.013). There were persistent improvements in water intake and health-related quality of life in both groups as well as reduced sweet drink intake in the intervention group. Conclusions This intervention, with high engagement from those most affected by obesity, did not achieve long-term efficacy of the primary outcome. Attendance and age remain important considerations for future interventions to achieve long-term BMISDS reduction.
Article
Our study examined the association between hedonic hunger and body mass and whether caloric intake mediated the association between these constructs in adolescents. One hundred adolescents with overweight or obesity completed measures of hedonic food reward, dietary intake, and height and weight. Exaggerated hedonic food responses were associated with higher body mass. For 16% of participants who had high hedonic hunger, and high body mass, caloric intake mediated the association between hedonic hunger and zBMI. These results suggest that hedonic hunger may override the homeostatic need for energy and may be associated with increased caloric intake, potentiating weight gain.
Article
Background: A relation between thyroid-stimulating hormone (TSH), insulin resistance - both of which are related to obesity - and thyroid volume has been suggested. Therefore, we analyzed thyroid volume and structure in relation to thyroid function parameters, weight status, and insulin resistance. Methods: This is a cross-sectional study in which weight status (BMI-SDS), thyroid function parameters (TSH, free tri-iodothyronine [fT3], and free thyroxine [fT4]), insulin resistance index (HOMA-IR), and thyroid volume (ultrasound) were determined in 617 overweight children (aged 10.4 ± 2.2 years, 50% male, BMI-SDS 2.5 ± 0.6) and in 27 normal-weight children of a similar age and gender. Furthermore, changes in thyroid volume and structure, and thyroid function parameters were analyzed in 83 obese children (51% male, mean age 10.3 ± 2.2) at baseline and at the end of a 1-year lifestyle intervention. Results: Overweight children had a significant greater thyroid volume (4.2 ± 1.8 vs. 4.1 ± 0.5 mL) and higher TSH (3.1 ± 1.5 vs. 2.4 ± 1.1 mU/L) and fT3 (4.4 ± 0.7 vs. 4.1 ± 0.5 pg/mL) concentrations compared to normal-weight children. In multiple linear regression analyses adjusted to multiple confounders, thyroid volume was significantly related to BMI-SDS (b coefficient 0.44 ± 0.10, r2 = 0.41) but not to any thyroid function parameter or HOMA-IR. Changes in BMI-SDS were significantly associated with changes in thyroid volume (r = 0.22). The changes in thyroid volume were not correlated to changes of any thyroid function parameter or HOMA-IR. Conclusions: Thyroid volume is positively correlated to weight status in childhood obesity and the change is reversible after weight loss independently of thyroid function parameters and insulin resistance. Further studies are needed to understand why thyroid volume is increased reversibly in overweight children.
Article
Aims We examined whether a woman’s birthweight, childhood height, body mass index (BMI), and BMI changes from childhood to pregnancy were associated with risks of gestational diabetes mellitus (GDM). Methods We studied 13,031 women from the Copenhagen School Health Records Register born 1959–1996 with birthweight and measured anthropometric information at ages 7 and/or 13. The diagnosis of GDM (n = 255) was obtained from a national health register. Risk ratios (RR) were estimated using log-linear binomial regression. Results Own birthweight and childhood height were inversely associated with GDM. Girls with overweight at age 7 had a higher risk of GDM than girls with normal-weight (RR: 1.79, 95% CI: 1.31, 2.47). Compared to women with normal-weight in childhood and adulthood, risks of GDM were higher in women who developed overweight from age 7 to pregnancy (RR: 4.62; 3.48, 6.14) or had overweight at both times (RR: 4.71; 3.24, 6.85). In women whose BMI normalized from age 7 to pregnancy the RR for GDM was 1.08 (0.47, 2.46). Conclusions Lower birthweight, shorter childhood height, and higher childhood BMI are associated with increased risks of GDM. Efforts to help girls maintain a normal BMI before pregnancy may be warranted to minimize risks of GDM.
Article
Objectives Obesity is the most prevalent risk factor for cardiovascular disease (CVD) in children. We developed a 2-year lifestyle intervention for youth at risk of CVD. We assessed changes in body mass index z-scores (zBMI) and key cardiometabolic risk factors, physical fitness, and capacity among those who completed the program. Methods The CIRCUIT program is a multidisciplinary lifestyle intervention for children aged 4 to 18 years at risk of CVD, based on a personalized plan to improve cardiometabolic outcomes by increasing physical activity and reducing sedentary behaviours. Both at baseline and 2-year follow-up, we measured zBMI, blood pressure z-scores (zBP), adiposity (%body and %trunk fat), fasting blood glucose and lipid profile, aerobic (VO2max) and anaerobic (5×5 m shuttle run test) fitness, and physical capacity indicators. Differences between baseline and follow-up were examined using paired t-tests (for age-sex standardized outcomes) and multivariable mixed effect models, adjusted for age and sex (for other outcomes). Results Among the 106 participants (53 males) who completed the 2-year program, mean age at baseline was 10.9 years (SD=3.2). After 2 years, zBMI and diastolic zBP decreased by 0.30SD (95% CI: −0.44; −0.16) and 0.43SD (95% CI: −0.65; −0.23), respectively. Participants improved %body and %trunk fat, lipid profile, aerobic and anaerobic fitness levels, and physical capacity (p<0.02). No changes in systolic zBP nor in fasting plasma glucose were observed. Conclusion Our findings showed improved zBMI, cardiometabolic outcomes, physical fitness, and capacity among children at risk of CVD, suggesting that CIRCUIT is a promising intervention.
Article
The majority of children living in foster care in the United States have a history of maltreatment and/or disrupted caregiving. Maltreatment in early childhood adversely affects development at many levels, including neurobiology and behavior. One neurobiological measure associated with maltreatment is alpha electroencephalogram (EEG) asymmetry. Prior research has found greater right frontal asymmetry among children with a history of maltreatment. However, little research has been extended developmentally downward to examine alpha asymmetry and its behavioral correlates among toddlers in foster care; this was the purpose of the present study. Differences in EEG asymmetry were examined between a sample of foster toddlers (mean age = 3.21 years, n = 38) and a community comparison, low-income sample without a history of foster care (mean age = 3.04 years, n = 16). The toddlers in the foster care group exhibited greater right alpha asymmetry, primarily driven by differences in parietal asymmetry. Neither frontal nor parietal asymmetry were clearly related to internalizing or externalizing behaviors, measured concurrently or at previous time points. These findings reveal differences in alpha EEG asymmetry among toddlers in foster care, and highlight the need to better understand associations between neurobiological and behavioral functioning following early adversity.
Article
The U.S. Preventive Services Task Force (USPSTF) has set forth recommendations for clinicians to screen youth (6‐18 years) for obesity. Those identified should be referred to comprehensive weight management programs consisting of at least 26 contact hours and focus on multiple targets of behaviour (ie, diet, physical activity, behaviour change). However, these recommendations are primarily based upon outcomes from randomized controlled trials and the feasibility of meeting these guidelines for adolescents in a clinical setting is unknown. The present study employed a multi‐informant qualitative approach with adolescents, parents, and physicians, to identify and understand multiple perspectives on the feasibility and acceptability of implementing the USPSTF guidelines. In‐depth interviews with seven adolescents, seven parents, and four physicians were analysed. Generally, participants viewed the guidelines positively but identified changes that may be necessary to increase the feasibility of adolescents engaging in programs that meet these guidelines. Participants also noted the importance of flexibility within programs, indicating that it would be difficult for many adolescents to participate in a program that was not tailored to their needs and resources. Future research should focus on adapting clinical weight management programs to meet both USPSTF guidelines and the needs of adolescents and their families.
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This study aimed to use primary care electronic health records to evaluate the prevalence of overweight and obesity in 2-15-year-old children in England and compare trends over the last two decades. Cohort study of primary care electronic health records. 375 general practices in England that contribute to the UK Clinical Practice Research Datalink. Individual participants were sampled if they were aged between 2 and 15 years during the period 1994-2013 and had one or more records of body mass index (BMI). Prevalence of overweight (including obesity) was defined as a BMI equal to or greater than the 85th centile of the 1990 UK reference population. Data were analysed for 370 544 children with 507 483 BMI records. From 1994 to 2003, the odds of overweight and obesity increased by 8.1% per year (95% CI 7.2% to 8.9%) compared with 0.4% (-0.2% to 1.1%) from 2004 to 2013. Trends were similar for boys and girls, but differed by age groups, with prevalence stabilising in 2004 to 2013 in the younger (2-10 year) but not older (11-15 year) age group, where rates continued to increase. Primary care electronic health records in England may provide a valuable resource for monitoring obesity trends. More than a third of UK children are overweight or obese, but the prevalence of overweight and obesity may have stabilised between 2004 and 2013. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Background: Health-related quality of life (HRQoL) was found to improve in participants of weight management interventions. However, information on moderately overweight youth as well as on maintaining HRQoL improvements following treatment is sparse. We studied the HRQoL of 74 overweight, but not obese participants (32.4% male, mean age = 11.61 ± 1.70 SD) of a comprehensive and effective six-month outpatient training at four time-points up to 12 months after end of treatment. Methods: HRQoL was measured by self-report and proxy-report versions of the generic German KINDL-R, including six sub domains, and an obesity-specific additional module. Changes in original and z-standardized scores were analyzed by (2×4) doubly multivariate analysis of variance. This was done separately for self- and proxy-reported HRQoL, taking into account further socio-demographic background variables and social desirability. Additionally, correlations between changes in HRQoL scores and changes in zBMI were examined. Results: There were significant multivariate time effects for self-reported and proxy-reported HRQoL and a significant time-gender interaction in self-reports revealed (p < .05). Improvements in weight-specific HRQoL were evident during treatment (partial η² = 0.14-0.19). Generic HRQoL further increased after end of treatment. The largest effects were found on the dimension self-esteem (partial η² = 0.08-0.09 for proxy- and self-reported z-scores, respectively). Correlations with changes in weight were gender-specific, and weight reduction was only associated with HRQoL improvements in girls. Conclusions: Positive effects of outpatient training on generic and weight-specific HRQoL of moderately overweight (not obese) children and adolescents could be demonstrated. Improvements in HRQoL were not consistently bound to weight reduction. While changes in weight-specific HRQoL were more immediate, generic HRQoL further increased after treatment ended. An extended follow-up may therefore be needed to scrutinize HRQoL improvements due to weight management. Trial registration: clinicaltrials.gov NCT00422916.
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Background and objectives: The effects of lifestyle interventions on cardio-metabolic outcomes in overweight children have not been reviewed systematically. The objective of the study was to examine the impact of lifestyle interventions incorporating a dietary component on both weight change and cardio-metabolic risks in overweight/obese children. Methods: English-language articles from 1975 to 2010, available from 7 databases, were used as data sources. Two independent reviewers assessed articles against the following eligibility criteria: randomized controlled trial, participants overweight/obese and ≤18 years, comparing lifestyle interventions to no treatment/wait-list control, usual care, or written education materials. Study quality was critically appraised by 2 reviewers using established criteria; Review Manager 5.1 was used for meta-analyses. Results: Of 38 eligible studies, 33 had complete data for meta-analysis on weight change; 15 reported serum lipids, fasting insulin, or blood pressure. Lifestyle interventions produced significant weight loss compared with no-treatment control conditions: BMI (-1.25kg/m(2), 95% confidence interval [CI] -2.18 to -0.32) and BMI z score (-0.10, 95% CI -0.18 to -0.02). Studies comparing lifestyle interventions to usual care also resulted in significant immediate (-1.30kg/m(2), 95% CI -1.58 to -1.03) and posttreatment effects (-0.92 kg/m(2), 95% CI -1.31 to -0.54) on BMI up to 1 year from baseline. Lifestyle interventions led to significant improvements in low-density lipoprotein cholesterol (-0.30 mmol/L, 95% CI -0.45 to -0.15), triglycerides (-0.15 mmol/L, 95% CI -0.24 to -0.07), fasting insulin (-55.1 pmol/L, 95% CI -71.2 to -39.1) and blood pressure up to 1 year from baseline. No differences were found for high-density lipoprotein cholesterol. Conclusions: Lifestyle interventions can lead to improvements in weight and cardio-metabolic outcomes. Further research is needed to determine the optimal length, intensity, and long-term effectiveness of lifestyle interventions.
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The prevalence of childhood obesity increased in the 1980s and 1990s but there were no significant changes in prevalence between 1999-2000 and 2007-2008 in the United States. To present the most recent estimates of obesity prevalence in US children and adolescents for 2009-2010 and to investigate trends in obesity prevalence and body mass index (BMI) among children and adolescents between 1999-2000 and 2009-2010. Cross-sectional analyses of a representative sample (N = 4111) of the US child and adolescent population (birth through 19 years of age) with measured heights and weights from the National Health and Nutrition Examination Survey 2009-2010. Prevalence of high weight-for-recumbent length (≥95th percentile on the growth charts) among infants and toddlers from birth to 2 years of age and obesity (BMI ≥95th percentile of the BMI-for-age growth charts) among children and adolescents aged 2 through 19 years. Analyses of trends in obesity by sex and race/ethnicity, and analyses of trends in BMI within sex-specific age groups for 6 survey periods (1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, and 2009-2010) over 12 years. In 2009-2010, 9.7% (95% CI, 7.6%-12.3%) of infants and toddlers had a high weight-for-recumbent length and 16.9% (95% CI, 15.4%-18.4%) of children and adolescents from 2 through 19 years of age were obese. There was no difference in obesity prevalence among males (P = .62) or females (P = .65) between 2007-2008 and 2009-2010. However, trend analyses over a 12-year period indicated a significant increase in obesity prevalence between 1999-2000 and 2009-2010 in males aged 2 through 19 years (odds ratio, 1.05; 95% CI, 1.01-1.10) but not in females (odds ratio, 1.02; 95% CI, 0.98-1.07) per 2-year survey cycle. There was a significant increase in BMI among adolescent males aged 12 through 19 years (P = .04) but not among any other age group or among females. In 2009-2010, the prevalence of obesity in children and adolescents was 16.9%; this was not changed compared with 2007-2008.
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Emerging data indicate that insulin resistance is common among children and adolescents and is related to cardiometabolic risk, therefore requiring consideration early in life. However, there is still confusion on how to define insulin resistance, how to measure it, what its risk factors are, and whether there are effective strategies to prevent and treat it. A consensus conference was organized in order to clarify these points. The consensus was internationally supported by all the major scientific societies in pediatric endocrinology and 37 participants. An independent and systematic search of the literature was conducted to identify key articles relating to insulin resistance in children. The conference was divided into five themes and working groups: background and definition; methods of measurement and screening; risk factors and consequences; prevention; and treatment. Each group selected key issues, searched the literature, and developed a draft document. During a 3-d meeting, these papers were debated and finalized by each group before presenting them to the full forum for further discussion and agreement. Given the current childhood obesity epidemic, insulin resistance in children is an important issue confronting health care professionals. There are no clear criteria to define insulin resistance in children, and surrogate markers such as fasting insulin are poor measures of insulin sensitivity. Based on current screening criteria and methodology, there is no justification for screening children for insulin resistance. Lifestyle interventions including diet and exercise can improve insulin sensitivity, whereas drugs should be implemented only in selected cases.
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We examined treatment-seeking overweight and obese youths to better understand the gender, age, and treatment modality differences in generic and disease-specific health-related quality of life (HRQOL). This multicenter study included 1,916 patients (mean = 12.6 years; 57% females; mean zBMI = 2.4) who started treatment for overweight and obesity in 48 treatment facilities between July 2005 and October 2006. The facilities offered either inpatient treatment or outpatient programs. Prior to treatment, all participants completed the generic KIDSCREEN-27 HRQOL-questionnaire, the self-perception subscale of the generic KIDSCREEN-52 and the disease-specific obesity module of the KINDLR.The patients' HRQOL was compared to the KIDSCREEN reference sample from the general population by one-way analyses of variance, adjusting for age, gender, and socioeconomic status. Independent t-tests were conducted to compare disease-specific HRQOL scores between patients by gender and age group. Significant mean differences in HRQOL between inpatients and outpatients were explored by one-way analyses of variance, adjusting for age, gender, and zBMI. Effect sizes 'd' were calculated employing the estimated marginal means and the pooled standard deviation (m(treatment) - m(norm)/SD(pooled)). The patients' HRQOL scores were impaired relative to German norms, with effect sizes up to d = 1.12. The pattern of impairment was similar in boys and girls as well as in children and adolescents. In each of the analyses, at least three of six KIDSCREEN subscales were affected. Regardless of gender and age group, the highest impairments were found in self-perception and physical well-being. Because of the strong decrease in HRQOL in the general population during adolescence, compared to age-specific norms, adolescents were less impaired than were children. However, overweight and obese adolescents (especially females) reported the lowest absolute HRQOL scores. HRQOL varied with the intensity of treatment. Inpatients had significantly lower scores than did outpatients, even after adjusting for age, gender and zBMI. The results suggest the presence of differences in HRQOL with regard to gender, age, and treatment modality in treatment-seeking overweight and obese youths. Research and clinical practice must consider the particular impairments of inpatients as well as the impairments of (especially female) adolescents.
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To study the impact of body mass index (BMI) SD score (SDS) improvement through lifestyle modification on metabolic risk and body composition over 12 months. Prospective cohort study. Hospital outpatient weight management clinic in the UK. 88 adolescents (40 males, 86% Caucasian) of median age 12.4 years (range 9.1-17.4) and mean (SD) BMI SDS 3.23 (0.49). BMI at baseline and 12 months was adjusted for age and gender providing BMI SDS using British 1990 growth reference data. Body composition was measured by bioimpedance. A standard oral glucose tolerance test (OGTT) examined glucose metabolism. Fasting lipid profiles, high sensitivity C-reactive protein (HsCRP) and blood pressure (BP) were measured. Reducing BMI SDS by >or=0.5 achieved significant improvements in important measures of body composition with mean waist circumference SDS reducing by 0.74 units and body fat SDS by 0.60 units, while also leading to significant reductions in key metabolic risk factors (triglycerides (-30%), low-density lipoprotein-cholesterol (-15%), HsCRP (-45%)). A lesser reduction of >or=0.25 improved insulin sensitivity, total cholesterol/high-density lipoprotein ratio and BP. The greater the BMI SDS reduction, the better the improvement seen in insulin sensitivity. The most insulinsensitive individuals at baseline were most likely to achieve BMI SDS changes of >or=0.5 regardless of baseline BMI SDS. Improvement in body composition and cardiometabolic risk can be seen with BMI SDS reductions of >or=0.25 in obese adolescents, while greater benefits accrue from losing at least 0.5 BMI SDS. The most insulin-sensitive individuals seem best able to effect these changes.
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Objective: Our objective was to formulate practice guidelines for the treatment and prevention of pediatric obesity. Conclusions: We recommend defining overweight as body mass index (BMI) in at least the 85th percentile but < the 95th percentile and obesity as BMI in at least the 95th percentile against routine endocrine studies unless the height velocity is attenuated or inappropriate for the family background or stage of puberty; referring patients to a geneticist if there is evidence of a genetic syndrome; evaluating for obesity-associated comorbidities in children with BMI in at least the 85th percentile; and prescribing and supporting intensive lifestyle (dietary, physical activity, and behavioral) modification as the prerequisite for any treatment. We suggest that pharmacotherapy (in combination with lifestyle modification) be considered in: 1) obese children only after failure of a formal program of intensive lifestyle modification; and 2) overweight children only if severe comorbidities persist despite intensive lifestyle modification, particularly in children with a strong family history of type 2 diabetes or premature cardiovascular disease. Pharmacotherapy should be provided only by clinicians who are experienced in the use of antiobesity agents and aware of the potential for adverse reactions. We suggest bariatric surgery for adolescents with BMI above 50 kg/m(2), or BMI above 40 kg/m(2) with severe comorbidities in whom lifestyle modifications and/or pharmacotherapy have failed. Candidates for surgery and their families must be psychologically stable and capable of adhering to lifestyle modifications. Access to experienced surgeons and sophisticated multidisciplinary teams who assess the benefits and risks of surgery is obligatory. We emphasize the prevention of obesity by recommending breast-feeding of infants for at least 6 months and advocating that schools provide for 60 min of moderate to vigorous daily exercise in all grades. We suggest that clinicians educate children and parents through anticipatory guidance about healthy dietary and activity habits, and we advocate for restricting the availability of unhealthy food choices in schools, policies to ban advertising unhealthy food choices to children, and community redesign to maximize opportunities for safe walking and bike riding to school, athletic activities, and neighborhood shopping.
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Rare mutations of the low-density lipoprotein receptor gene (LDLR) cause familial hypercholesterolemia, which increases the risk for coronary artery disease (CAD). Less is known about the implications of common genetic variation in the LDLR gene regarding the variability of cholesterol levels and risk of CAD. Imputed genotype data at the LDLR locus on 1 644 individuals of a population-based sample were explored for association with LDL-C level. Replication of association with LDL-C level was sought for the most significant single nucleotide polymorphism (SNP) within the LDLR gene in three European samples comprising 6 642 adults and 533 children. Association of this SNP with CAD was examined in six case-control studies involving more than 15 000 individuals. Each copy of the minor T allele of SNP rs2228671 within LDLR (frequency 11%) was related to a decrease of LDL-C levels by 0.19 mmol/L (95% confidence interval (CI) [0.13-0.24] mmol/L, p = 1.5x10(-10)). This association with LDL-C was uniformly found in children, men, and women of all samples studied. In parallel, the T allele of rs2228671 was associated with a significantly lower risk of CAD (Odds Ratio per copy of the T allele: 0.82, 95% CI [0.76-0.89], p = 2.1x10(-7)). Adjustment for LDL-C levels by logistic regression or Mendelian Randomisation models abolished the significant association between rs2228671 with CAD completely, indicating a functional link between the genetic variant at the LDLR gene locus, change in LDL-C and risk of CAD. A common variant at the LDLR gene locus affects LDL-C levels and, thereby, the risk for CAD.
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Although overweight and obesity in childhood are related to dyslipidemia, hyperinsulinemia, and hypertension, most studies have examined levels of these risk factors individually or have used internal cutpoints (eg, quintiles) to classify overweight and risk factors. We used cutpoints derived from several national studies to examine the relation of overweight (Quetelet index, >95th percentile) to adverse risk factor levels and risk factor clustering. The sample consisted of 9167 5- to 17-year-olds examined in seven cross-sectional studies conducted by the Bogalusa Heart Study between 1973 and 1994. About 11% of examined schoolchildren were considered overweight. Although adverse lipid, insulin, and blood pressure levels did not vary substantially with the Quetelet index at levels <85th percentile, risk factor prevalences increased greatly at higher levels of the Quetelet index. Overweight schoolchildren were 2.4 times as likely as children with a Quetelet index <85th percentile to have an elevated level of total cholesterol. Odds ratios for other associations were 2.4 (diastolic blood pressure), 3.0 (low-density lipoprotein cholesterol), 3.4 (high-density lipoprotein cholesterol), 4.5 (systolic blood pressure), 7.1 (triglycerides), and 12.6 (fasting insulin). Several of these associations differed between whites and blacks, and by age. Of the 813 overweight schoolchildren, 475 (58%) were found to have at least one risk factor. Furthermore, the use of overweight as a screening tool could identify 50% of schoolchildren who had two or more risk factors. Because overweight is associated with various risk factors even among young children, it is possible that the successful prevention and treatment of obesity in childhood could reduce the adult incidence of cardiovascular disease.
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To develop an internationally acceptable definition of child overweight and obesity, specifying the measurement, the reference population, and the age and sex specific cut off points. International survey of six large nationally representative cross sectional growth studies. Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States. 97 876 males and 94 851 females from birth to 25 years of age. Body mass index (weight/height(2)). For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut off points of 25 and 30 kg/m(2) for adult overweight and obesity. The resulting curves were averaged to provide age and sex specific cut off points from 2-18 years. The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.
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The prevalence of the metabolic syndrome is highest among Hispanic adults. However, studies exploring the metabolic syndrome in overweight Hispanic youth are lacking. Subjects were 126 overweight children (8-13 yr of age) with a family history for type 2 diabetes. The metabolic syndrome was defined as having at least three of the following: abdominal obesity, low high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, hypertension, and/or impaired glucose tolerance. Insulin sensitivity was determined by the frequently sampled iv glucose tolerance test and minimal modeling. The prevalence of abdominal obesity, low HDL cholesterol, hypertriglyceridemia, systolic and diastolic hypertension, and impaired glucose tolerance was 62, 67, 26, 22, 4, and 27%, respectively. The presence of zero, one, two, or three or more features of the metabolic syndrome was 9, 22, 38, and 30%, respectively. After controlling for body composition, insulin sensitivity was positively related to HDL cholesterol (P < 0.01) and negatively related to triglycerides (P < 0.001) and systolic (P < 0.01) and diastolic blood pressure (P < 0.05). Insulin sensitivity significantly decreased (P < 0.001) as the number of features of the metabolic syndrome increased. In conclusion, overweight Hispanic youth with a family history for type 2 diabetes are at increased risk for cardiovascular disease and type 2 diabetes, and this appears to be due to decreased insulin sensitivity. Improving insulin resistance may be crucial for the prevention of chronic disease in this at-risk population.
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Background Low socio-economic status (SES) is a significant risk factor for childhood overweight and obesity (COWOB) in high-income countries. Parents to young children buffer and accentuate social and cultural influences, and are central to the development of this disease. An understanding of the parent-related mechanisms that underlie the SES-COWOB relationship is needed to improve the efficacy of prevention and intervention efforts. ObjectiveA systematic review of relevant literature was conducted to investigate the mechanisms by which levels of SES (low, middle and high) are associated to COWOB, by exploring mediation and interaction effects. Method Six electronic databases were searched yielding 5155 initial records, once duplicates were removed. Studies were included if they investigated COWOB, SES, parent-related factors and the multivariate relationship between these factors. Thirty studies were included. Factors found to be mediating the SES-COWOB relationship or interacting with SES to influence COWOB were categorized according to an ecological systems framework, at child, parent, household and social system level factors. ResultsHigh parent body mass index, ethnicity, child-care attendance, high TV time (mother and child), breastfeeding (early weaning), food intake behaviours and birthweight potentially mediate the relationship between SES and COWOB. Different risk factors for COWOB in different SES groups were found. For low SES families, parental obesity and maternal depressive symptoms were strong risk factors for COWOB, whereas long maternal working hours and a permissive parenting style were risk factors for higher SES families. None of the studies investigated parental psychological attributes such as attitudes, beliefs, self-esteem and so on as potential mechanisms/risk factors. Conclusions Families from different SES groups have different risk and protective factors for COWOB. Prevention and intervention efforts may have improved efficacy if they are tailored to address specific risk factors within SES.
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Impaired glucose effectiveness (GE) plays a role in the deterioration of glucose metabolism. Our aim was to validate a surrogate of GE derived from an oral glucose tolerance test (OGTT), and to assess the impact of degrees of obesity and of glucose tolerance on it. The OGTT-derived surrogate of GE (oGE) was validated in obese adolescents who underwent an OGTT and an intravenous glucose tolerance test (IVGTT). We then evaluated anthropometric determinants of the oGE and its impact on the dynamics of glucose tolerance in a cohort of children with varying degrees of obesity. The correlation of oGE and IVGTT-derived GE in 98 obese adolescents was r = 0.35 (P < 0.001) as a whole, and r = 0.51 (P < 0.001) in subjects with normal glucose tolerance. In a cohort of 1,418 children, the adjusted GE was associated with increasing obesity (P < 0.001 for each category of obesity). Quartiles of oGE and the oral disposition index were associated with 2-h glucose levels (P < 0.001 for both). Among 421 nondiabetic obese subjects (276 subjects with normal glucose tolerance/145 subjects with impaired glucose tolerance who repeated their OGTT after a mean time of 28 ± 16 months), oGE changes were tightly associated with weight (r = 0.85, P < 0.001) and waist circumference changes (r = 0.67, P < 0.001). Baseline oGE and changes in oGE over time emerged as significant predictors of the change in 2-h glucose levels (standardized Β = -0.76 and Β = -0.98 respectively, P < 0.001 for both). The oGE is associated with the degree of and changes in weight and waist circumference, and is an independent predictor of glucose tolerance dynamics. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
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Context: The concept of metabolic healthy obese (MHO) status has been proposed also for children. However, it is unclear whether this is a stable status in childhood. Objective: The aim was to analyze the changes of MHO status over time. Design and setting: This is 1-year longitudinal analysis of our obesity cohort. Participants: All obese children of our outpatient obesity clinic with 1-year follow-up were included. Interventions: Standard care intervention was used. Main outcome measures: We examined body mass index (BMI), waist circumference, pubertal stage, blood pressure, fasting lipids, glucose, and insulin resistance index homeostasis model assessment (HOMA). MHO status was defined by absence of cardiovascular risk factors. Results: A total of 2017 obese children (mean age, 11.6 ± 2.8 y; 45% male; BMI, 28.5 ± 5.3 kg/m(2); BMI-z score, 2.4 ±0.5) were enrolled onto the study, and 49.3% of the children were MHO at baseline. After 1 year, the majority of the MHO remained MHO (68.0%). MHO children were significantly younger, more frequently prepubertal, and less overweight compared with metabolic unhealthy obese (MUO) children (all P < .05). In the longitudinal analyses, entering into puberty (OR, 1.9; 95% confidence interval, 1.3-2.8]; P = .004) doubled the risk for switching from MHO to MUO, whereas changing from mid to late puberty nearly tripled the likelihood for switching from MUO to MHO (OR 3.1 [2.1-4.5], P < .001) in multiple logistic regression analyses adjusted for age, sex, and changes of body mass index standard deviation score (BMI-SDS). Conclusions: MHO is a stable status in childhood obesity as long as pubertal status remains stable. Due to the strong association between puberty and MUO status, the concept of MHO is questionable, at least in pubertal children.
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Background: For a successful nutrition counseling of children and adolescents, knowledge of dietary habits is mandatory. This report describes food group intake and gives details of the customary food selection of healthy German children and adolescents. Main foods which are consumed in large amounts were identified as those on which health promotion should be concentrated. Methods: 3-day weighed dietary records of 344 children (age range 4–6 years) and 92 adolescents (age range 13–14 years) concerning the period 1990–1997 of the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study) were evaluated. Results: The number of different foods recorded during the 3-day observation period ranged from 21 to 70 and was independent of age or sex. In contrast to dietary guidelines, the consumption of animal foods and ’fats/oils’ exceeded the consumption of plant foods with the exception of adolescent girls. Food selection was very similar in age and sex groups. Conclusion: Our study shows that under preventive aspects the current food selection could be improved without disturbing the prevailing dietary habits and food preferences.
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The international (International Obesity Task Force; IOTF) body mass index (BMI) cut-offs are widely used to assess the prevalence of child overweight, obesity and thinness. Based on data from six countries fitted by the LMS method, they link BMI values at 18 years (16, 17, 18.5, 25 and 30 kg m(-2)) to child centiles, which are averaged across the countries. Unlike other BMI references, e.g. the World Health Organization (WHO) standard, these cut-offs cannot be expressed as centiles (e.g. 85th). To address this, we averaged the previously unpublished L, M and S curves for the six countries, and used them to derive new cut-offs defined in terms of the centiles at 18 years corresponding to each BMI value. These new cut-offs were compared with the originals, and with the WHO standard and reference, by measuring their prevalence rates based on US and Chinese data. The new cut-offs were virtually identical to the originals, giving prevalence rates differing by < 0.2% on average. The discrepancies were smaller for overweight and obesity than for thinness. The international and WHO prevalences were systematically different before/after age 5. Defining the international cut-offs in terms of the underlying LMS curves has several benefits. New cut-offs are easy to derive (e.g. BMI 35 for morbid obesity), and they can be expressed as BMI centiles (e.g. boys obesity = 98.9th centile), allowing them to be compared with other BMI references. For WHO, median BMI is relatively low in early life and high at older ages, probably due to its method of construction.
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The aim of the present study was to investigate the aggregation of cardiovascular risk factors (hyperinsulinaemia, impaired glucose tolerance, dyslipidaemia, and hypertension) in 180 (77 female, 103 male) obese and 239 control children. Blood glucose, serum insulin and lipid levels were determined from blood samples taken after an overnight fast. Oral glucose tolerance tests were performed and blood glucose concentrations were monitored. The body mass index, body fat (on the basis of skinfold measurements), lean body mass and waist/hip ratio were calculated and blood pressure was measured five times in all subjects. It was shown that only 14.4% of obese children were free from any risk factors, in contrast to 79.1% of the control children. Four risk factors (metabolic cardiovascular syndrome) were found in 8.9% of the obese children (8.7% in males and 9.l % in females) while none could be detected in controls. Considerable differences were also detected in the prevalence of one, two or three risk factors between control and obese children. Patients with the metabolic cardiovascular syndrome could not be characterized by any of the investigated anthropometric characteristics, but the duration of obesity was significantly longer in these children. Conclusion Potential risk factors for cardiovascular diseases already tend to cluster in childhood and they are strongly associated with obesity. Our observations suggest that the development of the metabolic cardiovascular syndrome has its origin in childhood.
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Objective To develop an internationally acceptable definition of child overweight and obesity, specifying the measurement, the reference population, and the age and sex specific cut off points. Design International survey of six large nationally representative cross sectional growth studies. Setting Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States. Subjects 97 876 males and 94 851 females from birth to 25 years of age. Main outcome measure Body mass index (weight/height 2 ). Results For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut off points of 25 and 30 kg/m 2 for adult overweight and obesity. The resulting curves were averaged to provide age and sex specific cut off points from 2›18 years. Conclusions The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.
Article
Lifestyle interventions address primarily obese children, while interventions tailored to overweight but not obese children are scarce. The effectiveness of the lifestyle intervention "Obeldicks light" based on physical activity training, nutrition education, and behavior counseling for overweight children and their parents has been demonstrated by a randomized controlled trial. Here, we present the 12 months follow-up analysis of these children after end of intervention. Degree of overweight (BMI and SDS-BMI), waist circumference, skinfold thickness, bioimpedance analyses (BIA), and blood pressure were determined in 76 overweight (BMI>90(th)≤97(th) percentile) children (mean age 11.8 ± 1.8years, 67% females, mean BMI 24.3 ± 1.9 kg/m(2)) participating in the evaluation study of "Obeldicks light" at onset of intervention (T0), end of 6 months intervention (T1), 6 months after end of intervention (T2) and 12 months after end of intervention (T3). Comparisons were performed on an intention-to-treat approach. The drop-out rate was 4% in the intervention period and additional 3% during follow-up. The children reduced significantly (p < 0.001) their SDS-BMI in the intervention period between T0 and T1 (-0.27 ± 0.23; p < 0.001). This SDS-BMI reduction remained stable at T2 (T0-T2:-0.26 ± 0.31; p < 0.001) and T3 (T0-T3:-0.26 ± 0.39; p < 0.001). SDS-BMI reductions were independent from age and gender. Body fat measured by skinfold thickness and BIA, waist circumference, and blood pressure decreased significantly in the intervention period and remained stable in the follow-up period as well. The lifestyle intervention "Obeldicks light" was effective in reducing degree of overweight, fat mass, waist circumference, and blood pressure both at end of intervention and in a 12 months follow-up period.
Article
A 2008 report from the American Academy of Pediatrics recommended both population and individual approaches (including pharmacologic interventions) for adolescents who had low-density lipoprotein (LDL) cholesterol levels above various cutoff points (130, 160, and 190 mg/dL). However, the tracking and variability of these very high levels have not been investigated. A total of 6827 subjects underwent multiple LDL cholesterol determinations in childhood and adulthood in the Bogalusa Heart Study. The total number of determinations was 26748, and the median interval between examinations was 3 years. Correlations between initial and subsequent LDL cholesterol levels ranged from r approximately 0.8 for measurements made within the same year to r approximately 0.5 for periods of > or = 20 years. Most children who had very high LDL cholesterol levels, however, had substantially lower levels at the next examination. LDL cholesterol levels between 160 and 189 mg/dL (n = 201) decreased, on average, by 21 mg/dL at the next examination, whereas levels of > or = 190 mg/dL (n = 44) decreased by 34 mg/dL. In contrast, the mean increase for LDL cholesterol levels of <70 mg/dL was 13 mg/dL. These changes were equal to those expected on the basis of regression to the mean. There can be large changes in extreme levels of LDL cholesterol because of regression to the mean, and practitioners should be aware that very high levels may decrease substantially in the absence of any intervention.
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Worldwide prevalence of childhood obesity has increased greatly during the past three decades. The increasing occurrence in children of disorders such as type 2 diabetes is believed to be a consequence of this obesity epidemic. Much progress has been made in understanding of the genetics and physiology of appetite control and from these advances, elucidation of the causes of some rare obesity syndromes. However, these rare disorders have so far taught us few lessons about prevention or reversal of obesity in most children. Calorie intake and activity recommendations need reassessment and improved quantification at a population level because of sedentary lifestyles of children nowadays. For individual treatment, currently recommended calorie prescriptions might be too conservative in view of evolving insight into the so-called energy gap. Although quality of research into both prevention and treatment has improved, high-quality multicentre trials with long-term follow-up are needed. Meanwhile, prevention and treatment approaches to increase energy expenditure and decrease intake should continue. Recent data suggest that the spiralling increase in childhood obesity prevalence might be abating; increased efforts should be made on all fronts to continue this potentially exciting trend.
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The effect of childhood risk factors for cardiovascular disease on adult mortality is poorly understood. In a cohort of 4857 American Indian children without diabetes (mean age, 11.3 years; 12,659 examinations) who were born between 1945 and 1984, we assessed whether body-mass index (BMI), glucose tolerance, and blood pressure and cholesterol levels predicted premature death. Risk factors were standardized according to sex and age. Proportional-hazards models were used to assess whether each risk factor was associated with time to death occurring before 55 years of age. Models were adjusted for baseline age, sex, birth cohort, and Pima or Tohono O'odham Indian heritage. There were 166 deaths from endogenous causes (3.4% of the cohort) during a median follow-up period of 23.9 years. Rates of death from endogenous causes among children in the highest quartile of BMI were more than double those among children in the lowest BMI quartile (incidence-rate ratio, 2.30; 95% confidence interval [CI], 1.46 to 3.62). Rates of death from endogenous causes among children in the highest quartile of glucose intolerance were 73% higher than those among children in the lowest quartile (incidence-rate ratio, 1.73; 95% CI, 1.09 to 2.74). No significant associations were seen between rates of death from endogenous or external causes and childhood cholesterol levels or systolic or diastolic blood-pressure levels on a continuous scale, although childhood hypertension was significantly associated with premature death from endogenous causes (incidence-rate ratio, 1.57; 95% CI, 1.10 to 2.24). Obesity, glucose intolerance, and hypertension in childhood were strongly associated with increased rates of premature death from endogenous causes in this population. In contrast, childhood hypercholesterolemia was not a major predictor of premature death from endogenous causes.
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Cross-sectional studies showed worsening of cardiovascular risk factors with increasing severity of childhood obesity. The aim of this study was to investigate the impact of obesity dynamics on cardiovascular risk factors and on the stability of the diagnosis of metabolic syndrome (MS) in obese youth. A longitudinal assessment of components of the MS using two definitions was performed in 186 obese adolescents (106 females/80 males, age 13.1 +/- 2.5 yr). Components of the MS were assessed at baseline and after 19 +/- 7 months. We stratified the cohort into three categories based on the 25th and 75th percentile of body mass index (BMI) z-score change: category 1 reduced BMI z-score by 0.09 or more, category 2 had a BMI z-score change of between -0.09 and 0.12, and category 3 increased BMI z-score by >0.12. Subjects who reduced their BMI z-score significantly decreased their fasting and 2-h glucose levels and triglyceride levels and increased their high density lipoprotein cholesterol in comparison to subjects who increased their BMI z-score. BMI z-score changes negatively correlated with changes in insulin sensitivity (r = -0.36, p < 0.001). Among those with no MS at baseline (n = 119), 10 (8%), most of whom significantly increased their BMI z-score, developed MS. Of 67 who had MS at baseline, 33 (50%), most of whom decreased their BMI z-score, lost the diagnosis. Obesity dynamics, tightly linked to changes in insulin sensitivity, have an impact on each individual component of the MS and on the stability of the diagnosis of MS in obese youth.
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Weight loss is the appropriate approach to reduce the obesity-related health risk. However, the effect of lifestyle interventions on the metabolic syndrome prevalence has been rarely studied in obese children. We analyzed changes of weight status, 2h glucose levels from oral glucose tolerance tests (oGTT), fasting glucose, lipids, blood pressure, and the prevalence of metabolic syndrome in relation to a 1-year outpatient lifestyle intervention in 288 obese children (45% male; mean age 12.5 years, mean SDS-BMI 2.48). These data were compared to 186 obese children without intervention with similar distributions of age, gender, and weight status. Lifestyle intervention led to a significant decrease of SDS-BMI (mean -0.22; 95%CI -0.18 to -0.26), while SDS-BMI increased significantly in children without intervention (mean +0.15; 95%CI +0.13 to +0.18). Children with lifestyle intervention had a significant decrease of metabolic syndrome prevalence (from 19% to 9%; definition according to IDF) and an improvement of waist circumference, blood pressure, and 2h glucose values in the oGTT in contrast to obese children without intervention. The degree of weight loss was significantly associated with the amount of improvement of the components of the metabolic syndrome. Particularly, the children with a SDS-BMI reduction >0.5 showed an improvement of all components of the metabolic syndrome. Lifestyle intervention led to weight loss and an improvement of the metabolic syndrome and its components. Degree of weight loss was associated with the improvement of the prevalence of metabolic syndrome and its components.
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The severity of the long term consequences of the current childhood obesity epidemic on coronary heart disease is unknown. Therefore we investigated the association between body mass index (BMI) at ages 7-13 years and heart disease in adulthood among 276,835 Danish schoolchildren. We found that higher BMI during this period of childhood is associated with an increased risk of any, non-fatal and fatal heart disease in adulthood. Worldwide, as children are becoming heavier, our findings suggest that greater numbers of children are at risk of having coronary heart disease in adulthood.
Article
It is now common practice to express child growth status in the form of SD scores. The LMS method provides a way of obtaining normalized growth centile standards which simplifies this assessment, and which deals quite generally with skewness which may be present in the distribution of the measurement (eg height, weight, circumferences or skinfolds). It assumes that the data can be normalized by using a power transformation, which stretches one tail of the distribution and shrinks the other, removing the skewness. The optimal power to obtain normality is calculated for each of a series of age groups and the trend summarized by a smooth (L) curve. Trends in the mean (M) and coefficient of variation (S) are similarly smoothed. The resulting L, M and S curves contain the information to draw any centile curve, and to convert measurements (even extreme values) into exact SD scores. A table giving approximate standard errors for the smoothed centiles is provided. The method, which is illustrated with US girls' weight data, should prove useful both for the construction and application of growth standards.
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The steady-state basal plasma glucose and insulin concentrations are determined by their interaction in a feedback loop. A computer-solved model has been used to predict the homeostatic concentrations which arise from varying degrees beta-cell deficiency and insulin resistance. Comparison of a patient's fasting values with the model's predictions allows a quantitative assessment of the contributions of insulin resistance and deficient beta-cell function to the fasting hyperglycaemia (homeostasis model assessment, HOMA). The accuracy and precision of the estimate have been determined by comparison with independent measures of insulin resistance and beta-cell function using hyperglycaemic and euglycaemic clamps and an intravenous glucose tolerance test. The estimate of insulin resistance obtained by homeostasis model assessment correlated with estimates obtained by use of the euglycaemic clamp (Rs = 0.88, p less than 0.0001), the fasting insulin concentration (Rs = 0.81, p less than 0.0001), and the hyperglycaemic clamp, (Rs = 0.69, p less than 0.01). There was no correlation with any aspect of insulin-receptor binding. The estimate of deficient beta-cell function obtained by homeostasis model assessment correlated with that derived using the hyperglycaemic clamp (Rs = 0.61, p less than 0.01) and with the estimate from the intravenous glucose tolerance test (Rs = 0.64, p less than 0.05). The low precision of the estimates from the model (coefficients of variation: 31% for insulin resistance and 32% for beta-cell deficit) limits its use, but the correlation of the model's estimates with patient data accords with the hypothesis that basal glucose and insulin interactions are largely determined by a simple feed back loop.
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For a successful nutrition counseling of children and adolescents, knowledge of dietary habits is mandatory. This report describes food group intake and gives details of the customary food selection of healthy German children and adolescents. Main foods which are consumed in large amounts were identified as those on which health promotion should be concentrated. 3-day weighed dietary records of 344 children (age range 4-6 years) and 92 adolescents (age range 13-14 years) concerning the period 1990-1997 of the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study) were evaluated. The number of different foods recorded during the 3-day observation period ranged from 21 to 70 and was independent of age or sex. In contrast to dietary guidelines, the consumption of animal foods and 'fats/oils' exceeded the consumption of plant foods with the exception of adolescent girls. Food selection was very similar in age and sex groups. Our study shows that under preventive aspects the current food selection could be improved without disturbing the prevailing dietary habits and food preferences.
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A multicenter, randomized, double-blind, placebo-controlled study was conducted to evaluate LDL cholesterol-lowering efficacy, overal