Childhood Obesity - Science topic

There are two primary hormones involved in hunger signals: ghrelin and leptin. When you haven't eaten for some time, the stomach (and other parts of the digestive tract, to a lesser degree) produces ghrelin, which increases appetite, gastric motility, and gastric acid secretion.

However, some other factors like Poverty, Conflict, Gender Inequality, Seasonal Changes, Natural Disasters and Lack of Access to Safe Water are also affecting.

Kindly see the following RG links and PDF attachments.

Before you decide on how many and which fatty acids you include in your analysis; you must have  hypothesis based on the role of specific fatty acids on the determinants of cardiovascular health related outcomes.  Even if you chose saturated fats , not all are the same in modifying  LDL-chol,  HDL-chol  and Triglyceride levels .  

You need to focus your research after you have reviewed both the epidemiological evidence as well as the clinical studies on the topics. There are short term , long term and life course studies on this topic.    You can start by looking at the FAO/WHO report on Dietary Fats and Fatty Acids  in human nutrition  

You can find MET charts of different activities in textbooks such as McArdle's "Exercise Physiology" or in the 2011 Compendium of Physical Activities paper: https://www.ncbi.nlm.nih.gov/pubmed/21681120

You can compare the bicycling equivalent of walking in miles by comparing the total power (in Watt) of biking with the work produced by walking. However, keep in mind that the produced work depends on body mass, while the energy expenditure also depends on individual characteristics such exercise economy, oxygen consumption, etc.

Dear Xenophon,

It was very useful.

Thank you very much.

It refers to an epidemiologic study. You can choose the groups of individuals (cohorts)  from more than 2 centers (multiple centers) on the bases of factors that you want to investigate. Then, you follow up the cohorts over a period of time (prospective) to find out  the incidence rates of the outcomes.  As Emmadi points out observational study means there is no intervention, you just observe the outcomes.

Hello everybody,

I was thinking of conducting a study that investigates both pyscho-social well-being and biosphysiological markers that correlate with the well-being of students. There is some effort on the correlation between childhood obesity, life style and the prevalence of early adulthood diabetes. Additionally, other markers could be important, such as BMI, leptin, and even vitamin serum levels (such as B12 and D).  This is a rich area of investigation. But we can determine our priorities first and then decide on the variables which can be included in the study.

Hi Chris, 

For children and adolescents, weight status is commonly defined using BMI classifications, however, these are interpreted according to sex-specific percentiles based on a reference population  such as Cole et al. 1995. In the UK, children and adolescents between the 85th and 94th percentile are classified as overweight, whereas children and adolescents beyond the 95th percentile are classified as being obese. I am not sure of the cutoff points in Sweeden, but I have given an example of how you could write your findings below.

"According to age and sex-specific BMI centiles (Cole et al., 1995) the majority of the SUBJECTS were classified as having a healthy body mass (71.4%), 14.3% were classified as overweight and 14.3% as obese."

Hope this helps. 

Best,

For adult measurement follow Judwin Ndzo's instruction - put in simple English - find the lowest part of the rib and highest part of the hip bone, mark the mid point, using a measure tape measure around keeping the tape fitting around the waist or measure the narrowest part of the waist. (> 102 cm for man and > 88 cm for woman are considered high risk for cardio vascular diseases and diabetes type II). For children you need to measure BMI (sex and age specific) 

Very interesting story of an inventor who has diligently photo-documented his meals as an attempt to understand the correlation between diet, optimal health and creativity. I think Instagram is a good idea, especially if the photos extend to the mundane, and the routine. Perhaps along a similar philosophy as the quantified self movement.

Delhiganesh, 

I did find evidence that supports exercise lowering butyrylcholinesterase, but the main article is in Spanish. Here is the link and abstract:

ABSTRACT

OBJECTIVE: To evaluate the effect of 12 weeks of physical exercise (PE) on cardiovascular risk factors and BChE activity in obese adolescents.

SUBJECTS AND METHODS: The sample consisted of 24 obese adolescents and 51 normal weight controls. The following variables were measured in the initial stage and after 12 weeks: weight, height, BMI, waist circumference (WC), fat percentage (% F), maximal oxygen uptake (VO2max), systolic (SBP) and diastolic (DBP) blood pressure, glucose (GLY) and insulin (INS) at baseline and after 120 min, triacylglycerol (TG), total cholesterol (TC), LDL cholesterol, HDL cholesterol, and BChE activity (kU/l).

RESULTS: After the intervention, there was significant reduction in BMI, WC, %F, TG, GLI 120, INS 120 min, and BChE activity.

CONCLUSION: The reduction in BChE activity, observed after physical exercise, was accompanied by the reduction of the variables associated with cardiovascular risk and obesity, indicating that BChE can be used as a secondary marker for the risk associated with early onset obesity.

Pesticides are stored in fat cells and butyrlcholinesterase is generally higher in obese as compared to non-obese children.

Hi Bill

 If childhood obesity is not related to any other disease, it is better to use  diet and exercise therapy. Shaping behavior step by step, is an another method. childhood obesity rather to prevent than to cure.On the other hand if obesity is related to some other disease then it might be cure by special drugs. 

For tracking individual dietary patterns, FFQ's are more appropriate. 24 hour recalls are more appropriate if you are trying to gauge a specific demographic's eating patterns.

Dear Nicholas

I monitor the weight and weight related behaviours of children age 5-16 yrs in NSW (Australia's most populous state).

This is the link to the last survey report (am currently doing 2015 survey) where you can find the survey instruments and methods. Note weight-related behavious are very difficult to measure so one typically uses indicators of these behaviours.

This is FYI - you need to ascertain what are risk factors for urban Zambia children - questions about diet need to be culturally relevant eg seek potential questionnaires from Zambia.

Main thing to keep in mind is if doing an intervention - that BMI and other measures of adiposity are distal outcomes... ie change in diet and activity precedes change.  If just doing a cross-sectional survey then you can only check associations (not causal pathways)

Finally - children under 12 are poor reports so often need to consider asking parents to proxy report for thier child (and note the issues with proxy reporting), and finally - care regarding the lenght of your survey - if long too much burden on the respondant and response rate and data quality go down.

hope this is of some help - good luck!

Dear Malou,

I agree that the Marshmallow Test is not suitable for a home visit. Having done many home assessments myself, there are so many things that can distract the experiment conditions... I would personally advise against it. Keeping a child in a room for 15 minutes without distractors is virtually impossible at home. The kid could just get bored and grab a toy. 

For the waiting time, you would typically use 15 minutes for your age group. The original task used 15 minutes with 3.5 to almost 6 years old.

Best regards,

Thank you very much for the explanation, Sevket, now it all makes sense.

This is a major research focus of my colleague, Alexandra Corning (at University of Notre Dame). Check out her work!

Dear Esther Myers,

Thanks for your help, I will send a email.

Regards.

This may be true; however, normal weight children who do not eat fruits and vegetables are probably an exception. The larger public health issue is obesity and its long-term effects from childhood through adulthood.

N.est il pas mieux de proposer des mets selon les besoins energetiques moyennes des ecoliers en tenant compte de leur metabolisme basal affecte d un coefficient de 1,5 (physical activity level )

Yes, I have published these three papers:

"OVERWEIGHT IN PRESCHOOL CHILDREN: ANALYSIS OF A POSSIBLE INTERVENTION". Journal of Human Growth and Development (ISSN: 2175-3598) 2012; 22(1):11-16; 

"Preschool children and excess weight: the impact of a low complexity intervention in public day care centers". Journal of Human Growth and Development (ISSN:2175-3598) 2013, 23(3): 290-295;

and

"A 10-MONTH ANTHROPOMETRIC AND BIOIMPEDANCE EVALUATION OF A NUTRITIONAL EDUCATION PROGRAM FOR 7 - TO 14-YEAR-OLD STUDENTS". Journal of Human Growth and Development (ISSN: 2175-3598) 2012; 22(3): 283-290;

In Austria we did a cross sectional study, which was published thios yaer. We calculated thresholds according to cut-off-values in adults according to WHO. These method has been used before by the IOTF (Internatinal Obesity Taskforce) by Cole 2001. You find the publication attached. If you need some more information please contact me.

Our research team, led by University at Albany public health researcher Janine Jurkowski and Harvard researcher, Kirsten Davison, pioneered a complex strategy and achieved promising results.  Essentially, we started with the assumption that the bulk of the USA research was narrowly child-centered; and when schools were involved, student-centered.   Granting the merits of this research, it ignored or gave short shrift to child, family and community social ecologies.  It also proceeded with "professional knows best assumptions."   

This kind of selectivity-as-limitations informed our design for vulnerable preschool children and their family systems.  In a nutshell, our National Institutes of Health funded research combined family-centered practices with community-based, participatory research.   Family-centered practices proceed with the ideas that parents particularly have expertise; and also that this expertise needs to be tapped in intervention design and development.  Informed by this basic idea, representative parents served on our community advisory board (for CBPR), and we also prepared and supported them as co-researchers.    We have promising outcomes to show for this bold experiment, and we also contributed to relevant theory with an enhanced version of the family ecological model for health behavior analysis and change.    Several publications provide most of the relevant details.  A final one in development now depicts theories of change. 

I need to say I've been worked as a health Educator for health professionals at Brazilian Health System. I'm not a clinical worker, but I believe the extent would be the same as the children health conditions as well as the family support.

I couldn't agree more with Sivan. One of the most important aspects in assessing "behaviors" is to reflect the knowledge about the (sub)factor structure among the variables/items. Even if you know that some variables are more "related" among each other than with others, just taking averages of "apples and oranges" may not be the best strategy to reflect your knowledge. You may want to consider methods that allow you to reflect that "more" is "better" for each of the variables, but do not require you to pretend that you know how much more in one variable is equivalent to how much more in another variable.

Poetically, "a rose by any other name or label would smell the same." When I was growing up there were a few kids that were overweight. None in my public school were obese. I cannot recall one classmate or for that matter anyone I heard of or saw that was autistic. Why, temporally speaking, would that be? Kids then were more active. We walked to school or rode our bikes. (Like the Dutch where it is uncommon to see obesity). Our food tasted like food; it was healthier; fruit and vegetables were not picked before they were ripe and had nutrient value. Tomatoes tasted like tomatoes. Fish was not farm fed, nor beef grain fed. (In many parts of the world where food has not become "lifeless", obesity is uncommon." Perhaps, just a thought, obesity and overweight are the body's response to not getting the nutritional value that is needed i.e., a compensatory mechanism like up-regulation of receptors in the setting of a deficiency (soluble transferring receptor ↑ in the setting of iron deficiency".

Now add in the propensity to feed many families with the high carb composition of fast foods. Toss in television and the contribution of sitting on one's duff and stuffing our mouths while watching high anxiety episodes of serial killers, etc. Think about the brain-washing of our society's media where everything is oriented towards buy this, eat that, drive this i.e., it's all about getting, taking in, possessing. We now live in a world where TV shows about diners, drive-ins, cooking high caloric meals flourish. We even have TV shows that highlight obese characters. News programs interview one obese person after another. America, the land of the free and the home of the brave has become the land of entitlements, what's in it for me, and a meal of burgers, fries, and soft drink for only $5.

So what do you think? Labeling obesity as a disease will change anything? Perhaps when healthcare premiums are dramatically less with ideal weight, BMI or waist circumference that will change. Perhaps when are city planners make every third street a bicycle only or a shared bicycle-pedestrian street that will change. Perhaps when we move water from areas that flood every year and create a new great lakes system in the SouthWest and grow organic crops, and mandate grass-fed beef that will change; and when citizens demand less brutality and violence-oriented TV (note second-hand stress now in the news) that will change.

The chances of the above happening are next to nothing. Sadly, our American society and elsewhere are "emulating" the decadence that characterized the fall of the Roman empire. But who knows, the story is not over until the "fat lady sings."

Intense strength training and plyometrics are ususlly posponded at the end of growth age. However researchers found that there is no particular aversion against the use of strength training in children provided that they have medical clearance, trained by a qualified professional and gradual overload. Several benifits of strength training were also documented s/a improved motor skill and body composition, increased bone health etc. So it seems that strength training may be safe and benificial in children

McDonagh et al. JAMA Pediatr online doi:10.1001/jamapediatrics.2013.4200

Nice RCT

This may turn out to be an excellent case Chandra.

The reason why I say so- is because I encountered a similar case 3 years ago, and the memory of it is still refreshing because it required a lot of 'head scratching' to figure out what was wrong- but ultimately I was able to find out (in that case) the problem - a lucky shot- but it earned me the 'Dr. House' title from my colleagues. :-)

Before I narrate that case- let me ask you a few other questions- 1) Was the increase in appetite significant? 2) How many years since she rapidly gained weight? (as evidenced from her growth chart) , 3) Any documented hypotension/shock at any time?, 4) Any unexplained 3rd space fluid collections?, 4) Sleep rhythm?, 5) Any significant infection prior to the start of these changes requiring hospitalizations? 6) Any history of trauma?

7) What all imaging studies of what all body parts were done? 8) Investigations on blood/ urine? 9)What about the weight /history in family members? 10) Developmental history? 11) Was ABG/ sugar monitoring done?

OK- now coming to the case

I had a patient - an 8 year old girl who was referred as a case of septic shock. She was obese, and her parents had tols us that till the age of 6 she was growing normally, then had an episode of fever(lasting 6 days), and since then she had been eating voraciously and gained weight rapidly. He parents were of medium build.

The child was hypoxic and in shock on admission, and required venous cut-down. She was ventilated in view of severe respiratory distress, which was caused by massive pleural effusions bilaterally. She was intubated and ventilated with a reatively high PIP/PEEP, and the following bedside USG thorax confirmed the findings. Cardiac echo showed diastolic dysfunction. ABG showed respiratory acidosis. Renal functions, and blood workup was normal. Dengue serology was negative, septic screen was negative, serum proteins were borderline.

We initially thought of the effusions and the progressive weight gain/polyphagia as two separate entities, but by day two had to consider the possibility that they could be related.

By evening of day 2, child's condition improved, as we could lower her ventilator settings. On day 3 morning, she self-extubated, and was surprisingly stable. She was interacting with her parents as well A repeat USG thorax showed almost 80% reduction in her pleural effusion- which perplexed me to no end. We did an MRI brain- which was normal.

By this time we were considering almost everything- right from Diabetes to Kleine Levin, Bardet- Biedl, an amygdaloid dysfunction etc. Hypothyroidism was ruled out. USG KUB was normal. So was Serum cortisol.

On day 4 noon- child again had a rapid decompensation, and had to be ventilated again, although this time, a CxR did not show any effusion. We gave her IV fluid boluses and then hemodynamics stabilized, by day 5 she again self extubated- but continued to be stable thereafter.

At this point I suggested a thoracic MRI - especially of the thorax because the rapid disappearance of the effusions was still most puzzling. I added a 'malignancy- ? lymphoma' also into my probable diagnosis sheet.

we shifted the patient via ambulance to a super specialty centre, and got the MRI done- and lo!- there was a mediastinal lymphoma. A screening of other areas was normal.

She was subsequently operated after 2 months, and is now on chemo. Her weight has started dropping (probably multifactorial causation).

So In short- keep an open mind, and the more puzzling a patient- work even more towards the diagnosis.Wish you success!

The issue is a complex one, and as I will suggest below, we cannot casually assume that the perceived relationship between fast food consumption and overweight/obesity is primarily due to fast food consumption in and of itself, and recent data in fact suggests that it is not; only when we appreciate this, can we tackle the underlying etiology of overweight/obesity, and implement effective and properly targeted public health interventions for reducing the causal forces in play.

To understand this, it is important to recognized that until late (Jan, 2014) in the study of the health effects of fast food consumption, a core unanswered question has been whether associations of fast food consumption with total diet and overweight/obesity are actually attributable specifically to foods consumed from fast food restaurants or to poor dietary choices at other times. This recognizes a confounder in virtually all studies in this domain, namely that fast food consumption might not be directly associated with increased energy intake and weight gain, but rather might be a surrogate marker for other unhealthy behaviors associated with these outcomes [1]. Otherwise if studies do not control for confounding by food choices outside the fast food restaurant, then associations between fast food consumption on the one hand and overweight/obesity might be overestimated [2].

But finally, the recent (Jan, 2014) UNC study [3] compared the independent associations of fast food consumption for overweight/obesity or dietary outcomes, with dietary pattern for the remainder of intake (the "diet remainder"), to determine whether obesity and the poor dietary outcomes linked with fast food consumption are more strongly associated with the actual fast food or the remainder of diet. The UNC study set out to answer this question for the first time, using nationally representative sample, finding that both low and high fast food consumers ate less healthfully outside the fast food restaurant and were 1.5 (low fast food consumers) and 2.2 (fast food consumers) times as likely to consume a Western dietary pattern for the remainder of diet, compared with nonconsumers. This shows that it is the remainder of the diet, but not fast food in and of itself, that was associated with overweight/obesity; indeed, the diet outside the fast food restaurant had a stronger relation with poor dietary outcomes than did fast food consumption itself.

These breakthrough findings are confirmative with previous studies that used within-person analysis [2;4,5,6] that found that high fast food consumption was associated with poor dietary outcomes, even after adjustment for Western diet for the remainder of intake. Of the two associations: (1) between fast food and poor diet, and (2) between consuming a Western diet outside the fast food restaurant and poor dietary outcomes, the second association (2) was significantly stronger than the first.

These lines of evidence converge to clearly suggest:

(1) that fast food consumers in general exhibit less healthy dietary patterns outside the fast food restaurant; and

(2) that a Western dietary pattern for the remainder of intake is more strongly associated with overweight/obesity than fast food consumption itself.

REFERENCES

1. Rosenheck R. Fast food consumption and increased caloric intake: a systematic review of a trajectory towards weight gain and obesity risk. Obes Rev 2008;9:535–47.

2. Mancino L, Todd J, Guthrie J, Lin B-H. How food away from home affects childrenaposs diet quality. Washington, DC: US Department of Agriculture, Economic Research Service, 2010. (Economic Research Report Number 104.).

3. Poti JM, Duffey KJ, Popkin BM. The association of fast food consumption with poor dietary outcomes and obesity among children: is it the fast food or the remainder of the diet? Am J Clin Nutr 2014; 99(1):162-71.

4. Powell LM, Nguyen BT. Fast-food and full-service restaurant consumption among children and adolescents: effect on energy, beverage, and nutrient intake. Arch Pediatr Adolesc Med 2012;167:14–20.

5. Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 2004;113:112–8.

6. Paeratakul S, Ferdinand DP, Champagne CM, Ryan DH, Bray GA. Fast-food consumption among US adults and children: dietary and nutrient intake profile. J Am Diet Assoc 2003;103:1332–8.

The issue is a complex one, and as I will suggest below, we cannot casually assume that the perceived relationship between fast food consumption and overweight/obesity is primarily due to fast food consumption in and of itself, and recent data in fact suggests that it is not; only when we appreciate this, can we tackle the underlying etiology of overweight/obesity, and implement effective and properly targeted public health interventions for reducing the causal forces in play.

To understand this, it is important to recognized that until late (Jan, 2014) in the study of the health effects of fast food consumption, a core unanswered question has been whether associations of fast food consumption with total diet and overweight/obesity are actually attributable specifically to foods consumed from fast food restaurants or to poor dietary choices at other times. This recognizes a confounder in virtually all studies in this domain, namely that fast food consumption might not be directly associated with increased energy intake and weight gain, but rather might be a surrogate marker for other unhealthy behaviors associated with these outcomes [1]. Otherwise if studies do not control for confounding by food choices outside the fast food restaurant, then associations between fast food consumption on the one hand and overweight/obesity might be overestimated [2].

But finally, the recent (Jan, 2014) UNC study [3] compared the independent associations of fast food consumption for overweight/obesity or dietary outcomes, with dietary pattern for the remainder of intake (the "diet remainder"), to determine whether obesity and the poor dietary outcomes linked with fast food consumption are more strongly associated with the actual fast food or the remainder of diet. The UNC study set out to answer this question for the first time, using nationally representative sample, finding that both low and high fast food consumers ate less healthfully outside the fast food restaurant and were 1.5 (low fast food consumers) and 2.2 (fast food consumers) times as likely to consume a Western dietary pattern for the remainder of diet, compared with nonconsumers. This shows that it is the remainder of the diet, but not fast food in and of itself, that was associated with overweight/obesity; indeed, the diet outside the fast food restaurant had a stronger relation with poor dietary outcomes than did fast food consumption itself.

These breakthrough findings are confirmative with previous studies that used within-person analysis [2;4,5,6] that found that high fast food consumption was associated with poor dietary outcomes, even after adjustment for Western diet for the remainder of intake. Of the two associations: (1) between fast food and poor diet, and (2) between consuming a Western diet outside the fast food restaurant and poor dietary outcomes, the second association (2) was significantly stronger than the first.

These lines of evidence converge to clearly suggest:

(1) that fast food consumers in general exhibit less healthy dietary patterns outside the fast food restaurant; and

(2) that a Western dietary pattern for the remainder of intake is more strongly associated with overweight/obesity than fast food consumption itself.

REFERENCES

1. Rosenheck R. Fast food consumption and increased caloric intake: a systematic review of a trajectory towards weight gain and obesity risk. Obes Rev 2008;9:535–47.

2. Mancino L, Todd J, Guthrie J, Lin B-H. How food away from home affects childrenaposs diet quality. Washington, DC: US Department of Agriculture, Economic Research Service, 2010. (Economic Research Report Number 104.).

3. Poti JM, Duffey KJ, Popkin BM. The association of fast food consumption with poor dietary outcomes and obesity among children: is it the fast food or the remainder of the diet? Am J Clin Nutr 2014; 99(1):162-71.

4. Powell LM, Nguyen BT. Fast-food and full-service restaurant consumption among children and adolescents: effect on energy, beverage, and nutrient intake. Arch Pediatr Adolesc Med 2012;167:14–20.

5. Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 2004;113:112–8.

6. Paeratakul S, Ferdinand DP, Champagne CM, Ryan DH, Bray GA. Fast-food consumption among US adults and children: dietary and nutrient intake profile. J Am Diet Assoc 2003;103:1332–8.

Hey Edward, what in the gamut of "childhood obesity" are you looking at? The variables would differ based on your primary end point - like is it prevalence, or prevention/intervention or looking at cause and effect of parent lifestyle patterns or behaviour or child behaviour on their present weight status or predicting future disease conditions..so it depends on many things. And very importantly what is the age group you plan to study?

Theese colleagues of mine are a good candidates

Martha Guevara <marthaguevara8@yahoo.com.mx>

Aurora Serralde <aurozabeth@yahoo.com.mx>

Some really great insights. Thank you.

Nowzia I completely agree that a holistic approach is to be championed with regards to childhood obesity. Medical intervention is not the way forwards, that I am certain of.

John, yes of course, this is no standalone solution. In fact, studies generally show that, where childhood food and nutrition education is concerned, a multi-disciplinary approach is likely to be most effective. Nutritionists, child psychologists, teachers and in some instances social workers could all provide a service to children who have eating problems.

This ties in with your point, Joann. Again, I completely agree that underlying mental health issues must be resolved to see significant change in the long term.

To branch out further, it might also be that parents/carers need help with food and nutrition education. Often bad food relationships and issues with diet are passed down from those who supply the child with food.

What about using these diaries to collect data on behavioural patterns in obese children? How then might we analyse them in order to get the best possible results?

Cole's criteria are adequate if you wish to have a rough idea of the epidemiological situation in your country in comparison with international criteria. They are not adequate at all for clinical purpose. I suggest you to use WHO criteria which are free online on the WHO website and deal with breastfed babies with good SES.

Best regards

ML Frelut

I made my son (age 12 at the time) read nutrition journal articles, but we're a house full of geeks. On the rare occasions that we out, my kids ask the server for the restaurant's nutrition data!

We have used the DQI derived by Kim et al 2003 (Kim, S., Haines, P.S., Siega-Riz, A.M., & Popkin, B.M. (2003). The diet quality index-international (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by china and the united states. Journal of Nutrition, 133, 3476-3484) in our work (Children's Lifestyle and School Performance Study II, www.nsclass.ca). This is a composite measure of diet quality ranging from 0 to 100. DQI values encompass dietary variety (i.e., overall variety and variety within protein sources, to assess whether intake comes from diverse sources both across and within food groups), adequacy (i.e. the intake of dietary elements that must be supplied sufficiently to guarantee a healthy diet), moderation (i.e. intake of food and nutrients that are related to chronic diseases and that may need restriction), and balance (i.e. the overall balance of diet in terms of proportionality in energy sources and fatty acid composition).

J Nephrol. 2012 Oct 24:0. doi: 10.5301/jn.5000235. [Epub ahead of print]

Anthropometric measures can better predict high blood pressure in adolescents.

Papalia T, Greco R, Lofaro D, Mollica A, Roberti R, Bonofiglio R.

Source

Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza - Italy.

Abstract

Background: Among children, obesity and overweight may be predictors of cardiovascular (CV) risk. The purpose of this study was to examine whether body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR) were related to blood pressure (BP) among healthy southern Italian students enrolled in 3 different secondary schools. Methods: Weight, height, BP and WC were measured; BMI and WHtR were calculated for 872 Italian students. Based on percentiles of BMI, the subjects were classified as underweight, normal weight, overweight or obese. Systolic BP or diastolic BP >95th percentile were considered as high BP values (according to the 2004 guidelines of the US National Heart, Lung, and Blood Institute). Central obesity was defined as WC >75th percentile or WHtR =0.5. Results: Of the students, 8.7% were obese, 29% with WC >75th percentile and 29.5% with WHtR >0.5, while 4.6% showed high BP. Logistic regression showed a strong correlation between BMI and high BP (odds ratio [OR] = 1.030, p<0.0001), between WC and high BP (OR = 1.029, p<0.0001). Also WHtR (OR = 3.403, p<0.0001) was shown to be a predictor of high BP. In the male group, all of the variables considered showed a good capability to predict high BP, while in the females, only BMI (OR = 1.019, p<0.05) and WHtR (OR = 2.685, p<0.05) were associated with high BP. Conclusions: In this study, we found a different correlation between BMI, WC and BP in the 2 subgroups: males and females. Only WHtR showed a significant ability to predict high BP in both groups. WHtR might represent an easily measurable anthropometric index and a better predictor of CV risk in adolescents

Tonia,

We just finished a five year nih/ninr grant children and parents partnering together to manage their weight. We served 718 children and parents in rural north carolina and am just getting ready to submit the main effects article. The intervention was based on a nutrition and exercise education and coping skills training intervention I developed. Let me know if you would like to talk further.

Diane