Policy dialogue report: achieving healthy weights among children and adolescents in the Caribbean: “Moving from research to policy to action”

On 30, April 2014, CARPHA hosted a Policy Dialogue in Oranjestad, Aruba on the topic; Achieving Healthy Weights among Children and Adolescents in the Caribbean: “Moving from Research to Policy to Action. Chief Medical Officers from CARPHA Member States were the main audience for this Dialogue which sought to present synthesized research evidence about effective interventions for prevention of obesity; to consider the views and experience of stakeholders; and to foster discussion of actionable steps that could be taken in the Caribbean region.

Safeguarding our future development: plan of action for promoting healthy weights in the Caribbean: prevention and control of childhood obesity: 2014-2019

The Caribbean is in the midst of a childhood obesity epidemic. At least 1 in every 5 of our children are carrying unhealthy weights and are at risk of developing non-communicable diseases later in life. This Plan provides a comprehensive public health response to our problem. It seeks to tackle the underlying variables that produce the obesogenic environments that are fuelling the epidemic but it also supports more direct measures to effect change at the individual and community level as well as to provide clinical, family and psychosocial support for the child who is already affected by overweight/obesity. No response is however complete without giving due consideration to the capacity of the people, systems and institutions that will be called upon to deliver. Our Plan for Action therefore also includes measures to augment capacity in critical area and to effectively monitor progress and measure results.

Genetic and environmental influences on skeletal muscle phenotypes as a function of age and sex in large, multigenerational families of African heritage

The aim of this study was to estimate the heritability of and environmental contributions to skeletal muscle phenotypes (appendicular lean mass and calf muscle cross-sectional area) in subjects of African descent and to determine whether heritability estimates are impacted by sex or age. Body composition was measured by dual-energy X-ray absorptiometry and computed tomography in 444 men and women aged 18 yr and older (mean: 43 yr) from eight large, multigenerational Afro-Caribbean families (family size range: 21-112). Using quantitative genetic methods, we estimated heritability and the association of anthropometric, lifestyle, and medical variables with skeletal muscle phenotypes. In the overall group, we estimated the heritability of lean mass and calf muscle cross-sectional area (h(2) = 0.18-0.23, P < 0.01) and contribution of environmental factors to these phenotypes (r(2) = 0.27-0.55, P < 0.05). In our age-specific analysis, the heritability of leg lean mass was lower in older vs. younger individuals (h(2) = 0.05 vs. 0.23, respectively, P = 0.1). Sex was a significant covariate in our models (P < 0.001), although sex-specific differences in heritability varied depending on the lean mass phenotype analyzed. High genetic correlations (rho(G) = 0.69-0.81; P < 0.01) between different lean mass measures suggest these traits share a large proportion of genetic components. Our results demonstrate the heritability of skeletal muscle traits in individuals of African heritage and that heritability may differ as a function of sex and age. As the loss of skeletal muscle mass is related to metabolic abnormalities, disability, and mortality in older individuals, further research is warranted to identify specific genetic loci that contribute to these traits in general and in a sex- and age-specific manner.

Effects of fasting therapy in obese dogs on body weight, and hematological, blood coagulation and serum biochemical values

Body weight, hematological parameters, blood coagulation profiles and serum biochemistry values were investigated in obese beagles during the fasting and refeeding period. There were no severe clinical changes (alopecia, hepatopathy, respiratory abnormalities and cardiac sufficiency) in the obese dogs throughout this study. During refeeding the obese dogs showed two phases of weight reduction - initial rapid weight loss and subsequent slow weight loss. After refeeding, they rapidly regained their initial body weight. Except for transient decreases in some erythrocytic parameters, fasting therapy had no apparent effects on hematological and blood coagulation values. Serum biochemical examinations revealed significant changes in fasting period. In carbohydrate metabolism, blood glucose concentrations gradually decreased and insulin levels declined to normal range. Total ketone body levels rose mainly due to increases in 3-hydroxybutyrate concentrations. In lipid metabolism, triglyceride, total cholesterol and phospholipids decreased and fatty acid values. The enzyme activities varied within the normal limits. These serum biochemical parameters recovered to the initial levels immediately after the beginning of refeeding. These clinical and clinicopathological results reveal that obese dogs tolerate fasting very well without developing severe ketosis. Our data suggested that obese dogs could use very efficiently ketone bodies and free fatty acids for energy requirements during fasting. In conclusion, fasting therapy does not cause any adverse effects (anemia, severe ketosis and behavioural abnormailities) in obese dogs.

Effects of fasting therapy in obese dogs on body weight, and hematological, blood coagulation and serum biochemical values

Body weight, hematological parameters, blood coagulation profiles and serum biochemistry values were investigated in obese beagles during the fasting and refeeding period. There were no severe clinical changes (alopecia, hepatopathy, respiratory abnormalities and cardiac sufficiency) in the obese dogs throughout this study. During refeeding the obese dogs showed two phases of weight reduction - initial rapid weight loss and subsequent slow weight loss. After refeeding, they rapidly regained their initial body weight. Except for transient decreases in some erythrocytic parameters, fasting therapy had no apparent effects on hematological and blood coagulation values. Serum biochemical examinations revealed significant changes in fasting period. In carbohydrate metabolism, blood glucose concentrations gradually decreased and insulin levels declined to normal range. Total ketone body levels rose mainly due to increases in 3-hydroxybutyrate concentrations. In lipid metabolism, triglyceride, total cholesterol and phospholipids decreased and fatty acid values. The enzyme activities varied within the normal limits. These serum biochemical parameters recovered to the initial levels immediately after the beginning of refeeding. These clinical and clinicopathological results reveal that obese dogs tolerate fasting very well without developing severe ketosis. Our data suggested that obese dogs could use very efficiently ketone bodies and free fatty acids for energy requirements during fasting. In conclusion, fasting therapy does not cause any adverse effects (anemia, severe ketosis and behavioural abnormailities) in obese dogs.

Sickle Cell Disease and age at menarche in Jamaican girls: observations from a cohort study

AIMS: (1) To investigate the distribution of age at menarche in a representative sample of 99 patients with homozygous sickle cell disease (ss), 69 with sickle cell haemoglobin C (sc) disease, and 100 controls with a normal haemoglobin (AA) genotype followed in a cohort study from birth. (2) To explore the determinants of the age menarche. METHODS: Children ascertained in a new-born screening programme were followed prospectively from birth to age 18-26.5 years with regular assessments of height, weight, puberal stage, and haematological indices at the Sickle Cell Clinic of the University Hospital of the West Indies. RESULTS: All subjects have now reached menarche and the mean age in normal controls (13.0 years) was significantly earlier than in SC disease (13.5 years) or SS disease (15.4 years). Greater weight and earlier age at menarche was the only association significant across all genotypes although additional contributions occured from fetal haemoglobin and red cell count in SS disease. Alpha thalassaemia, which ameliorates many of the effects of SS disease, had no discernible effect on menarche. CONCLUSIONS: Mean age at menarche is delayed by 0.5 years in SC disease and by 2.4 years in SS disease. Weight appears to be the principle determinant of age at menarche. (AU)

First trimester maternal weight influences foeto-placental growth [abstract]

OBJECTIVE: To examine the effect of maternal weight on foetoplacental growth. METHODS: Seven hundred and twelve women attending their first antenatal clinic visit at the University Hospital of the West Indies, Kingston, Jamaica, were invited to join a perspective study. Maternal anthropometry and blood pressure were performed. Abdominal ultrasound was performed at 14, 17, 20, 25, 30, and 35 weeks of gestation to determine placental and foetal growth. Placental volume was measured at the first 3 visits and foetal biparietal diameter, femoral lenght, and head and abdominal circumfrence were measured at all 6 visits. Two groups of women were created based on their first trimester weight (<55kg and o55kg) for comparison. A ratio of placental volume to foetal abdominal circumference was created and the rate of growth examined between 14 to 17 and 17 to 20 weeks' gestation. RESULTS: Women with lower maternal weight in the first trimester had significantly smaller placental volumes at 17 and 20 weeks' gestation (p<0.03 and P<0.0001, respectivley). Lighter women had foetuses with a smaller head circumference and femoral length noted at 35 weeks gestation (p<0.01 and p<0.03, respectively). A significant relation with with foetal abdominal circumferences was seen as early as 25 weeks' gestation. The rate of foeto-placental growth when first examined at 14 weeks was similar between the two groups of women. However, in the lighter women, relative growth of placenta between 14 to 17 and 17 to 20 weeks' gestation was less than in the heavier women, suggesting poorer relative placental growth in lighter mothers. CONCLUSION: Maternal weight is an important contributor to foeto-placental growth. Lighter women are more likely to have poorer placental growth and hence smaller foetuses. (AU)

Effect of aqueos neem leaf extract on blood pressure in conscious Wistar rats (a preliminary report)[abstract]

OBJECTIVE: This work investigates the effects of aqeous neem leaf extract on blood pressure (systolic, diastolic, and mean arterial pressure), heart rate and body weight in conscious Wistar rats. METHODS: The rats were divided into three groups of six. The first group received a daily intra-oesophageal bolus of 0.5 ml water. The 2nd and 3rd were given 20 mg/kg and 40 mg/kg body weight, respectively, of aqeous neem leef extract. Blood pressures and heart rate were measured using the LE 5002 Stroage Pressure meter (Letica Scientific Instruments). Body weight was also measured weekly for eight weeks. Statistical analysis was carried out using SPSS. RESULTS: Blood pressure, heart rate and body rate were not statistically different between the three groups on day 1. By week 8, the diastolic and mean arterial pressures wre significantly lower (p<0.0001) in the two neem-treated groups than in the controls. There was also no significant difference in weight between the groups. CONCLUSION: The results show that administration of o 20 mg/kg-body weight of aqeuous neem leaf extract reduces diastoloc and mena arterial blood pressures in conscious rats (AU)

A sonographic study of kidney dimensions in a sample of healthy Jamaicans

A sonographic study of 49 randomly selected healthy Jamaicans was conducted to establish a guide for renal dimensions in the population. The mean length of the right kidney was 9.7 ñ 0.7 cm and the left 10 ñ 0.7 cm. The left kidney was longer than the right in the overall group and in males. There was no difference in width between right or left kidneys in the groups as a whole or within either gender. There was a significant association between the weight of males and the width of their kidneys; however, this association was not seen in females. The lone association between weight of the participants and renal length occurred in females and only with respect to the left kidney. Lengths and widths of kidneys were not associated with height in either gender. Renal surface area (RSA) was similar between the genders and also between right and left kidneys. Similarly, there was no significant association between renal length and body surface area (BSA) overall or within the genders. Renal index (RI) which is more reliable at assessing renal parenchymal mass than renal length alone was 20.92 and 22.86 for the right and left kidneys, respectively in males. Similarly, RI for the right and left kidneys in females was 23.76 and 25.54, respectively.(AU)

Tracing Jamaican community childhood cohorts: influences of growth from 0 to 5 years on height, weight and blood pressure of adults aged 35+ years

OBJECTIVE: To investigate the early postnatal growth-chronic disease hypothesis, we decided to trace two total community cohorts of Jamaican children (Studies A & B). DESIGN AND METHODS: Prenatal and postnatal under-nutrition were widespread in the Caribbean in the early-mid 20th century. Current rates of some chronic diseases (high blood pressure (BP), diabetes) may reflect recent lifestyle and body mass index (BMI) changes, superimposed on these early constraints on childhood growth. Study A comprised children born between 1962 and 1963 and their recalled birth weight, weight at 1 month and height from 3 months were noted and other details were measured 1-3 monthly for 5 years, with re-measures at age 10-11 years (n=177). In study B (n=417), similar parameters were noted for all children <5 years, until 5 years of age. If traced, we took lifestyle enquiries, standardised measures of current height, weight, BP and fasting blood glucose. RESULTS: In Study A, 130 children (73 percent) were traced: 35 had migrated overseas (26 with whereabouts known), 3 died, 5 were ill/pregnant, leaving 87 available and known locally. Of 65 invited, 61 (28 men, 33 women) were seen. Of 205 initially sampled in Study B, 24 had migrated, 5 died, and 2 were ill so that 174 (85 percent) were still known locally but not yet followed. Study A: Univariate correlations between growth in height from 3 months to 5 years and current systolic BP (SBP) of adults aged 35+ years were inverse, at -0.21. Adjusted for current BMI, these changed to -0.25; further adjusting for initial 3-month height reduced the co-relation to -0.17 (p<0.02). Earlier height increments (to 2, 3 or 4 years) were more weakly inversely related to adult SBP, as was growth in weight, univariate -0.10, and after adjusting for current BMI and weight, -0.15 (p<0.05). Adjusted correlations with diastolic BP were prominent (-0.37) from 3 months to 4 years but not up to 5 years. Height and weight had tracked markedly from 0 to 5 years, those who grew the least having higher adult BP. CONCLUSION: Tracing adult cohorts from these earlier childhood studies in modern Jamaica is practical, worthwhile sample sizes can be achieved (>70 percent) and from this previously relatively undernourished community, those who grew least from 0 to 5 years had higher BP, even after accounting for initial size.(Au)

Height and weight reference curves for homozygous sickle cell disease

Objective: To derive height and weight growth reference curves for children with homozygous sickle cell disease. STUDY DESIGN: Subjects (n = 315) were participants in a population based, longitudinal cohort study of sickle cell disease in Kingston, Jamaica. Regular measurements of height and weight were made from enrolment into the study at birth up to 22 years of age. RESULTS: Sex specific growth reference curve for height for age and weight foir age covering the age range 0-18 years are presented. CONCLUSIONS: These growth reference curves are suitable for identifying coincidental growth problems in children with homozygous sickle cell disease.(AU)

Maternal pre-pregnancy weight and placental weight determine birth weight in normal Jamaican infants

Birth weight is related to neonatal health and long-term risk of chronic disease. Since animal studies have shown that birth outcome is related to placental function, the present project was designed to explore the relationship between birth weight and placental growth and composition with factors during pregnancy among normal term pregnancies in 51 primiparous and 40 multiparous women delivering at the University Hospital of the West Indies. Both groups were followed by 15 weeks of gestation to term. The primiparous group was generally younger than the multiparous (mean age 22ñ4 versus 31ñ5 yr). They were significantly lighter (55ñ8 versus 61ñ9kg) with a lower body mass index (21ñ3 versus 23ñ4kg/m2) during early pregnancy, but gained more weight during pregnancy, 11kg compared with 8 kg, respectively. The duration of pregnancy was similar for both groups. Although the size of the placenta was not significantly different between the two groups, the mean weight of the multiparous placentae was more than that of the primiparous placentae. Also, for all mothers both placental weight and initial maternal weight related directly to birth weight. Placental non collagen protein (NCP), sodium and potassium contents were significantly higher for multiparous women and were related to birth weight. The primiparous group had babies who were significantly lighter, 3.03 kg compared with 3.36 kg, for the multiparous and this could be attributed to differences in placental function and maternal weight. When account was taken of the difference in maternal weight at the start of the pregnancy and the difference in placenta weight, parity no longer explained any of the differences in birth weight. It is concluded that maternal body weight at the time of becoming pregnant and the early development of the placenta determine the efficiency with which nutrients might be delivered to the foetus and hence foetal growth. The difference in birth weight between primiparous and multiparous women can be explained by the differences in maternal weight at the time of becoming pregnant.(AU)

The nutritional status of rural Jamaican school children

Three thousand, eight hundred and eighty-two (3,882) children in grades 2-5, attending 16 rural primary and all-age schools in central Jamaica were weighed and their weight-for-age standard deviation scores calculated using the World Health Organization/National Cancer for Health Statistics (WHO/NCHS) refernces. Heights were also measured in a random sample of the grade 5 children (n=793) and height-for-age and body mass index (BMI - kg/m2) calculated. Sixty-nine percent of the total sample were of normal weight-for-age, 2 percent were moderately undernourished (weight-for-age > -3 Z-score, <-2 Z-score), and a further 24 percent mildly undernourished (weight-for-age >-2 Z-score, <-1 Z-score). Few children were overweight. The frequency distribution of weight-for-age was similar in girls and boys. In the subsample of children in whom heights were measured, 25.8 percent were <-1 Z-score height-for-age, and of these 4.9 percent were <-2 Z-score. Compared with a survey conducted in a similar rural area in the 1960s, the children's mean weights for age group categories were 1.1 to 3.7 kg heavier. Children who were older than appropriate for their grade were more likely to be undernourished (Odds ratio 3.94, 95 percent CI 3.21,4.83), which suggests that undernourished children may be more likely to repeat a grade or start school later (AU)

Vitamin A and zinc supplementation of preschool children

OBJECTIVE: To determine whether supplementation of vitamin A and/or zinc (Zn) improved serum levels of these nutrients and/or height and weight gains in preschool children, 22 to 66 months, living in Belize, Central America. METHODS: Subjects received either Zn, vitamin A, Zn and vitamin A or a placebo (70 mg Zn and/or 3030 RE vitamin A, once per week) for 6 months in a 2x2 factorial design. Forty-three children, from a population of 104 prescreened, completed the study; they were selected, prior to treatment, for low/marginal serum concentrations of these micronutrients. RESULTS: Serum Zn levels were greater (16 percent, p < 0.001) for those who received Zn. In contrast, after vitamin A treatment, there were no differences in serum vitamin A among groups. Although increases in height (+4.4 cm, p<0.001) and weight (+0.79 kg, p<0.001), compared with baseline values, were numerically greatest for children who received both supplements, only the vitamin A supplementation effect was significant, resulting in increased height (+1.4 cm, p<0.002) and greater weight gain (+0.15 kg, p<0.03) compared to those receiving no vitamin A. Vitamin A supplementation alone significantly increased (p<0.001) hemoglobin concentration. CONCLUSION: The results suggest that the preschool children in this study, prescreened for low/marginal serum concentrations from a larger population prior to treatment, were enduring inadequate vitamin A and, to a lesser degree, Zn nutriture. Height and weight gain were significantly increased in the subjects who received a single weekly supplement 3030 RE of vitamin A.(Au)

Blood pressure in Jamaican children: relationship to body size and composition

Blood pressure levels in adults and children are related to body size and composition, but some of these relationships are unclear and they have been incompletely described in the Jamaican population. In a cross-sectional survey of 2,332 school children (6-16 years old; 1,046 boys, 1,286 girls), we measured systolic and diastolic blood pressure and pulse rate, and explored their relationship to weight, height, and waist, hip and mid-upper arm circumferences. The effect of these and other derived measures of body composition on blood pressure was explored in univariate and multivariate analysis. Blood pressure increased with age in both boys and girls, although the increase was greater for systolic than for diastolic blood pressure. The increase of systolic blood pressure among boys continued after age 11 years, but that for girls levelled off. Height and weight were the major predictors of blood pressure, but were highly correlated with each other and with all measures of body composition. Age, height and height-sex interaction explained 11.4 percent of systolic blood pressure variation, and the largest incremental contribution to this model was provided by the addition of body mass index or hip circumference, each explaining an additional 2.6 percent of the variance. Lean body mass made a larger contribution to blood pressure than percent fatness. Blood pressure in Jamaican children rises with age and this rise may be steeper in boys than girls. Blood pressure variation is significantly related to several measures of body composition including measures of fatness and fat free masses.(AU)

Biochemical markers of growth in the male and female adolescents - abstract

The biochemical markers of growth, insulin-like growth factor-1 (IGF-1) and the carboxyterminal propeptide of the type 1 procollagen (PICP) have been related to anthropometric indicators of growth. We have demonstrated a relationship among plasma levels of IGF-1 and height (ht) for age and weight (wt) for age Z-scores in children 2-10 years. PICP has been associated with height (kit) velocity. We therefore looked at plasma levels of these indicators in adolscents expected to attain maximum growth velocity during the year: boys ( n=20) 13-14 years old (mean age, 13.7 years) and girls ( n=18) 11-12 years old (mean age, 11.6 years). Ht, wt, mid-upper arm circumference (MUAC), triceps and subscapular skinfold thickness were measured at baseline, then every 3 months for a year. At each visit, a venous blood sample was taken for plasma determinations of IGF - 1 and PICP by radioimmunoassay (RIA). The girls were slightly above and the boys were slightly below the NCHS references for their age with the exception of the triceps skinfold. The observed mean ht and wt velocities among the boys were 5.5 cm/year and 5.3 kg/year and the girls, 5.3 cm/year and 4.9 kg/year. The mean plasma level of IGF -1 in the adolescents were double those in the 2 - 10 year old age group with the girls (41.02 nmol/ml 95 percent CI22.0, 60.0) higher than the boys (35.39 nmol/ml 95 percent CI15.4,55.39). The difference was statistically significant. The mean plasma levels of PICP were similar for boys, (399.63 ng/ml 95 percent CI59.83, 739.43) and for the girls (398.76 ng/ml 95 percent CI 114.36, 683.16). These values were slightly higher than those in the 2-10 year-old age group. These values of IGF-1 and PIUCP are comparable to those of other populations. Mean percent body fat (PBF) increased linearly during the year in the girls, was related to the their body mass index (BMI) and was significantly higher than that in the boys. There was no association between PBF and BMI in the boys. Unlike the 2-10 year-old age group, there were no consistent relationships demonstrated among the anthropometric and the biochemical markers of growth in adolscents. This may reflect the mixed levels of maturity and the influence of the pubertal hormones in this group of adolescents. (AU)

Relationship between blood pressure and body mass index in lean populations

Associations between body mass index (BMI) and blood pressure (BP) have been consistently observed, but remain poorly understood. One unresolved question is whether there is a linear relationship across the entire BMI range. We investigated this question among 11235 adult men and women from seven low-BMI populations in Africa and the Caribbean. We used kernel smoothing and multivariate linear and spline regression modeling to examine gender differences in the relationship and to test for a threshold. Age-adjusted slopes of BP on BMI were uniformly higher in men than women, with pooled slopes ratios of 2.00 and 2.20 for systolic and diastolic BPs, respectively. Men displayed no evidence of age modification or nonlinearity in the relationship, and the age-adjusted slope of systolic BP on BMI was 0.90 (95 percent confidence interval [CI], 0.76 to 1.04). Women demonstrated both age modification and nonlinearity. For both younger (<45 years) and older (45+ years) women, the optimal change point for a single threshold model was found to be 21kg/m. Slopes of systolic BP on BMI above this threshold were positive and significant: 0.68 (95 percent CI, 0.54 to 0.81) and 0.53 (95 percent CI, 0.29 to 0.76) for younger and older women, respectively. Slopes below the threshold were essentially zero for both groups of women, and difference between the slopes above and below the threshold was significant for younger women (P=.018). In summary, we observed a threshold at 21kg/m in the relationship between BMI and BP for women but not for men. This contributes to the effort to identify the mechanism that underlie this relationship and how they differ by gender.(AU)