[Obese children and adolescents. Waist-hip ratio and cardiovascular risk]. / Adipöse Kinder und Jugendliche. Taillen-Hüft-Ratio und kardiovaskuläres Risiko.

In obese adults body fat distribution is more closely associated with cardiovascular risk factors and cardiovascular disease, type II diabetes and gout than the degree of obesity; the android, abdominal body fat pattern carrying more risk than the gynoid, femoral form. For characterizing the different types of fat distribution the ratio of waist to hip girth (WHR) is commonly used. The question was whether these facts can already be demonstrated in obese children. In the studied group of 69 obese children, aged between 3-16 years (mean = 10.8 years) with a mean of 47% overweight no correlations between percentage overweight and waist hip ratio could be found. Better correlations of serum triglycerides, total- and LDL-cholesterol, the atherogenic index LDL/HDL-cholesterol, fasting insulin level, oral glucose tolerance and blood pressure were obtained with percentage overweight than with waist-hip-ratio. HDL-cholesterol was the only parameter showing better and significant correlation with waist-hip-ratio than with percentage overweight. These results are in contrast to the situation in adults but are comparable with other studies in normal weighed and obese children, where correlations of waist hip ratio with body fat and risk factors were low in childhood, becoming higher in adolescence. Only after onset of puberty does waist hip ratio seem to be an indicator for body fat distribution and for possibly associated additional risk factors as in adults. For estimation of the cardiovascular risk in obese children, determination of WHR need not to be recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

[Significance of gender of obese children and body weight of parents and siblings for the results of the treatment of obesity in childhood]. / Die Bedeutung des Geschlechts adipöser Kinder sowie des Körpergewichts von Eltern und Geschwistern für das Ergebnis einer Adipositastherapie im Kindesalter.

We studied the influence of family size, family history of obesity, and the obese children's sex on the short and medium term outcome of an obesity therapy in children aged 10.7 +/- 3 years with mean percentage overweight of 41.4 +/- 16.9%. Family parameters such as obesity on other family members, single child families, and sex of the obese children did not influence the decision to stop or to complete therapy. Boys were more successful in weight reduction than girls both after 3-6 months and after 3-5 years; the difference being not significant, however. Children without family history initially were significantly less overweight than those with familial obesity, and they exhibited the best short and medium term results. Children of obese families initially were the fattest ones. They reduced their weight more than average, but they tended to regain weight during the following 3-5 years, reaching the highest levels of overweight after that time. Children without family history of obesity did not regain weight, however. Thus even after good short term results obese children of obese parents should be regarded at risk for relapse and should be checked for years after therapy to prevent weight regain.

[Short- and intermediate-term results of treatment of children with obesity]. / Kurz- und mittelfristige Ergebnisse der Behandlung von Kindern mit Adipositas.

We report on the short- and medium-term outcome of obesity therapy in 160 obese children and youths aged 10.7 +/- 3 years, who had been admitted to our department between 1982 and 1984. Mean initial percentage overweight of all children was 41.4 +/- 16.8%. 59 of the children stopped therapy after 1-2 visits, and 101 children (group 1) continued the therapeutic regimen until the end. Our treatment consists of individual consultations with the aim of behaviour modification, and reduction or modification of caloric intake. Within 3-6 months mean weight reduction was 15.3% in the children of group 1. After 3-5 years the medium-term outcome of 48 of these children (group 2) was controlled by phone. Their initial weight reduction had been 17.2%, and after 3-5 years their percentage overweight was still 10.6% below their initial values. During therapy 68% of the children had successfully reduced their overweight below the margin of 20%, and after 3-5 years still 42% of the children remained in this range. Our short term results are similar to those of other studies on obese children, but there are no other comparable publications for medium term outcome. According to our results children should be checked for years after successful obesity therapy in order to prevent relapses.

[Growth, maturation and environment]. / Wachstum, Reifung und Umwelt.

Using as example the secular trend, relations between growth, maturation and environment are discussed. This phenomenon is characterized by an increase of the average height and an acceleration of growth velocity and maturation. The increase is acquired mainly in the early childhood. The secular trend has been modified by local and socio-economic differences in the frequency of malnutrition and morbidity. It is now minimal in countries with high standards of health and hygiene. It can appear or can be accelerated in all developing countries with progress in child-health, especially in early childhood. A negative trend can be expected in every country, where child-health deteriorates for a long time.

[Criteria for the assessment of data and measures in obesity in children]. / Kriterien zur Beurteilung von Daten und Massnahmen bei Adipositas im Kindesalter.

DEFINITION: Obese children have more than 20% overweight in relation to height. DIAGNOSTIC PROCEDURES: Estimation of serum concentrations of triglycerides, total-, HDL- and LDL-cholesterol, and of blood pressure; oral glucose tolerance testing in patients with more than 40% overweight. INDICATION FOR THERAPY: More than 20% overweight in relation to height. EVALUATION OF THERAPEUTIC RESULTS: Main goal: less than 20% overweight; if not possible, stabilisation of overweight between 20 and 30%; if not possible in cases of severe obesity (more than 60% overweight): Either reduction of overweight more than 40% (in patients with 80% overweight or more) or reduction of overweight more than 20 and less than 40% (in patients with 60-70% overweight) and stabilisation of overweight within these ranges respectively. Therapeutic results should be reported in relation to the end of therapy as short term results: at most 2 years, as medium term results: at least 3 years, and as long term results: after growth stop.

[Breast feeding as "alternative" nutrition? An orientation aid in the field spanning ideology and current status]. / Stillen als "alternative" Ernährung? Eine Orientierungshilfe im Spannungsfeld zwischen Ideologie und Sachverhalten.

Recommending breast feeding supports a trend "back to nature". However, there are believers in the unbiased goodness of nature, who claim effects of mothers milk, e.g. protection from the evils of civilization, that are not confirmed by current scientific knowledge. As nature is not uniquely good (it feeds the donkey and the lion), and as biology is not perfect, breast feeding does not guarantee an uneventful infancy and childhood. There is even a pathology of breast feeding that the pediatrician should be familiar with.- The proven benefits, claimed effects, and some risks of breast feeding are reviewed on the basis of research results, and conclusions are drawn to make breast feeding as uneventful an experience as possible. Potential fields of research are being identified.

[Representative studies of the vitamin D status of 2-year-old children in Frankfurt am Main]. / Repräsentative Untersuchungen zur Vitamin-D-Versorgung zweijähriger Kleinkinder in Frankfurt/M.

In a representative sample population of 421 two-year-old Frankfurt children studied for vitamin-D nutritional status, only one case of subclinical rickets was discovered. 93.3% of the children have been a regular vitamin-D supplements during the first 12 month of life, but only 32.7% of them continued to receive the supplement beyond the age of one year. Risk groups were not identified, neither with regard to ethnic groups, nor smaller vitamin-D doses, or any other aspect.

[Obesity in childhood]. / Adipositas im Kindesalter.

It is impossible to make general statements on obesity, and apply them to all adipose patients. These statements can be more or less valid for various populations of obese subjects depending on the definition of obesity chosen. Obesity in infancy should not be disregarded, although it has not been proven that obese infants become obese adults, whereas obese adolescents tend to remain obese. Obesity is genetically determined yet exogenous factors are more or less necessary for its development. The significance of risk factors changes during childhood, depends on the gender, and varies with different populations. The hypothesis that obese patients have a diminished thermogenesis should be considered although it is not clear whether this applies to all obese patients. Research on disregulation of appetite could result in further clarification of the pathogenic mechanism causing obesity. Treatment of obesity is necessary in patients with 120% or more overweight related to height, preferably before age of 7 years to take advantage of further growth as a regulating factor.