Comparison between type A and type B early adiposity rebound in predicting overweight and obesity in children: a longitudinal study.

Early adiposity rebound (EAR) predicts paediatric overweight/obesity, but current approaches do not consider both the starting point of EAR and the BMI trajectory. We compared the clinical characteristics at birth, age 3-5 and 6-8 years of children, according to the EAR and to its type (type A/type B-EAR). We assessed the children's odds of being classified as overweight/obese at age 6-8 years, according to the type of EAR as defined at age 3-5 years. As part of this two-wave observational study, 1055 children were recruited and examined at age 3-5 years. Antenatal and postnatal information was collected through interviews with parents, and weight and height from the health records. Type A and type B-EAR were defined in wave 1 according to the BMI nadir and the variation of BMI z-score between the starting point of the adiposity rebound and the last point on the curve. At 6-8 years (wave 2), 867 children were followed up; 426 (40·4 %) children demonstrated EAR. Among them, 172 had type A-EAR, higher rates of parental obesity (P < 0·05) and greater birth weight compared with other children (P < 0·001). Odds for overweight/obesity at 6-8 years, when adjusting for antenatal and postnatal factors, was 21·35 (95 % CI 10·94, 41·66) in type A-EAR children and not significant in type B-EAR children (OR 1·76; 95 % CI 0·84, 3·68) compared with children without EAR. Classification of EAR into two subtypes provides physicians with a reliable approach to identify children at risk for overweight/obesity before the age of 5 years.

Short-term and long-term positive outcomes of the multidisciplinary care implemented by the French health networks for the prevention and care of paediatric overweight and obesity.

BACKGROUND: The nine French regional health networks for the prevention and care of paediatric obesity offer a 2-year program of multidisciplinary primary care (medical, dietetical, psychological, adapted physical activity) based on multicomponent lifestyle interventions. OBJECTIVES: To assess the short-term and long-term impact of care management. METHODS: The impact of the multidisciplinary care was assessed by changes in the body mass index (BMI) Z score during the period of the care, and at least 2 years after the end. Anthropometric data were collected at baseline and at the end of the care either through a digital medical file or through direct phone contacts with the referring. Long-term outcomes were assessed through studies relative to post follow-up evaluation. RESULTS: At the end of the period of the care in a network, 72.9% of 6947 children had decreased their BMI Z score from 3.6 ± 1.0 DS at baseline to 3.3 ± 1.1 DS at the end. The four studies relative to long-term evaluation showed a pursuit of the decrease of BMI Z score during the 5.1 years after the beginning of the care. CONCLUSIONS: The care provided by regional French networks for prevention and care of paediatric obesity induce a reduction of BMI that continues afterwards.

Cardiometabolic risk is associated with the severity of sleep-disordered breathing in children with obesity.

BACKGROUND: The alarming progression of pediatric obesity is associated with the development of sleep-disordered breathing (SDB), and both exhibit similar adverse cardiometabolic health outcomes. Physical activity level (PAL) may counteract sleep and metabolic disturbances. The present study investigates i) the association between the metabolic syndrome in childhood obesity and SDB, ii) the impact of SDB severity on cardiometabolic risk scores and PAL in children with obesity. METHODS: Maturation status (Tanner stages), anthropometric (height, weight, body mass index, waist circumference, body adiposity index) and cardiometabolic characteristics (systolic and diastolic blood pressure, lipid and glycemic profiles) were assessed in 83 obese children (mean±SD, age: 10.7±2.7years). PAL and SDB were investigated with a step test and interviews, and an overnight sleep monitor, respectively. The presence or absence of metabolic syndrome (MS) was established and continuous cardiometabolic risk scores were calculated (MetScoreBMI and MetScoreWC). RESULTS: Obese children with (61.4%) and without (38.6%) MS present similar SDB. SDB severity is associated with increased insulin concentrations, MetScoreBMI and MetScoreWC (p<0.05) in obese children. There is no association between SDB and PAL. CONCLUSIONS: In a context where no consensus exists for SDB diagnosis in children, our results suggest the influence of SDB severity on cardiometabolic risk factors. Further studies are needed to explore the association between PAL and both metabolic and sleep alterations in obese children.

Validation of a new scale to measure perceived exertion in obese adolescents: the Childhood Obesity Perceived Exertion (Cope-10) Scale.

BACKGROUND: The aim of this study was to validate a measurement scale for perceived exertion, named the Childhood Obesity Perceived Exertion Scale (COPE-10), by evaluating concurrent validity, reliability and sensitivity in obese adolescents. METHODS: Thirty obese adolescents (BMI 36.2±0.8 kg.m-2), aged 14.2±0.3 years, performed two incremental exercise tests (maximal followed by submaximal) before and after a multidisciplinary obesity management program. To standardize workload, physiological variables [heart rate (HR), ventilation (E) and gas exchange (O2)] and perceived exertion (RPE) were modelized (fHR, fVE, fVO2, fRPE). At a rank of 6 on the COPE-10 Scale (RPE6) and at fixed second ventilatory threshold (VT2), we determined respectively the associated power (WPRPE6, WPVT2) and HR (HRRPE6, HRVT2). RESULTS: During maximal exercise, we observed significant correlations between fRPE and each of fHR (r=0.88 ; r=0.91), fVE (r=0.93 ; r=0.94) and fVO2 (r=0.87 ; r=0.89) before and after management respectively, indicating the concurrent validity of the COPE-10 Scale to estimate exercise intensity in obese adolescents. During submaximal exercise, we observed intraclass correlation coefficients of 0.77 before and 0.86 after management, showing reliability. After management, WPVT2 and WPRPE6 increased significantly (+23W and +21W ; P<0.001), and there was a significant correlation between HRVT2 and HRRPE6 (r=0.90), illustrating the scale's sensitivity to change. CONCLUSIONS: The COPE-10 Scale is a valid tool to measure perceived exertion in obese adolescents. This inexpensive and non-invasive instrument could be widely used in rehabilitation programs for obese youths.

Evaluation of cardiorespiratory fitness using three field tests in obese adolescents: validity, sensitivity and prediction of peak VO2.

OBJECTIVES: Evaluation of cardiorespiratory fitness in obese adolescents is necessary to develop personalised retraining programmes. We aimed to measure cardiorespiratory fitness using 3 field tests, and to evaluate their validity and sensitivity compared to values obtained by laboratory tests. DESIGN: Longitudinal interventional study in obese adolescents admitted to a rehabilitation centre for a 9-month programme of obesity management. METHODS: A 12-min walk/run test, an adapted 20 m shuttle walk-run test (starting speed 4 km h(-1), increments of 0.5 km h(-1)min(-1)) and a 4-level submaximal cycle ergometer test were performed to estimate respectively distance covered in 12 min, maximum speed and maximal aerobic power. RESULTS: Thirty adolescents aged 14.2 ± 1.6 years were included. After 9 months intervention, we observed a significant reduction in body mass index, and an increase in peak VO2 and field test results. We observed significant correlations between pre- and post-intervention values of peak VO2 and distance covered in 12 min (r=0.70 pre; r=0.82 post), maximum speed (r=0.80 pre; r=0.83 post) and maximal aerobic power (r=0.71 pre; r=0.84 post). Multiple linear regression made it possible to estimate peak VO2 based on results from the 3 field tests using prediction equations specific to a population of obese adolescents. CONCLUSIONS: These field tests, including the adapted 20 m shuttle walk-run test, adequately assess cardiorespiratory fitness in obese adolescents, and are sensitive to changes over time. Predictive equations including BMI are useful in clinical practice to predict peak VO2 in these patients.