Triponderal mass index is as strong as body mass index in the determination of obesity and adiposity.

OBJECTIVE: In determining obesity and body adiposity, triponderal mass index (TMI) is as strong an anthropometric measurement as body mass index (BMI). The aim of this study was to develop TMI reference values for Turkish children and adolescents and compare TMI with BMI according to body adiposity and obesity indices. METHODS: Data from the DAMTCA-II (Determination of Anthropometric Measurements of Turkish Children and Adolescents II) study were used in this cross-sectional study. Data from 4330 children (1931 boys, 2399 girls) ages 6 to 17 y were evaluated, and the TMI percentile values were produced. The predictive power of TMI and BMI for obesity and overweight were done for waist circumference, waist/height ratio, body fat percentage, and upper arm fat area, which are different parameters used to determine body adiposity. RESULTS: The 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, and 97th TMI percentiles and mean values were calculated for all children's age and sex. TMI cutoff values were calculated by receiver operating characteristic analysis regarding waist/height ratio 0.5, waist circumference ≥90 percentile, arm fat area ≥85 percentile, and body fat percentage ≥85. TMI and BMI area under the curve values were similar for each of these four measurements. TMI was as robust an index as BMI in demonstrating obesity and adiposity for all age groups in boys and girls. It was concluded that the values >90th percentile (median 15.8 kg/m3) in girls aged ≤10 y, 95th percentile (median 16.2 kg/m3) in girls aged >10 y, >85th percentile (median 14.9 kg/m3) in boys aged ≤12 y and 75th percentile (median value 14.5 kg/m3) in boys aged >12 y are critical values for TMI when evaluating adiposity and obesity. CONCLUSIONS: We considered that TMI is as effective as BMI in terms of waist/height ratio, waist circumference, arm fat area, and body fat percentage in determining overweight and obesity in children. The ages at which TMI showed distinct variation were determined for both sexes.

Four-site skinfolds thickness percentiles of schoolchildren and adolescents in Turkey.

OBJECTIVE: The primary purpose of the current study was to establish Turkish smoothed centile charts and Lambda, Mu, Sigma (LMS) tables for four-site skinfold thickness based on a population-based sample, and secondary purpose was to elaborate a reference for the percentage of body fat. DESIGN: A cross-sectional and descriptive study was conducted between January and May 2017. Triceps, biceps and subscapular, suprailiac skinfold thicknesses were measured using Holtain skinfold caliper. Age- and gender-specific percentile values were determined with the LMS method, and body fat percentage was calculated using the Westrate and Deurenberg equation. SETTING: Afyonkarahisar province in Turkey. PARTICIPANTS: The current study was conducted on 4565, 6-18-year-old students. RESULTS: The triceps, biceps and subscapular skinfolds of the girls were higher than the boys. From the age of seven, the sum of four skinfold thicknesses of the girls was more than those of the boys. This difference became more evident after the age of 12. Although fat percentages of girls showed a fluctuating change, it decreased with the age in boys. Westrate and Deurenberg equation fat percentages of girls until adolescence were lower than boys, but increased after 12 years of age and exceeded that of boys. CONCLUSIONS: The current study has provided sex- and age-specific reference values for skinfold thickness and has shown that obesity in girls is higher than in boys in schoolchildren in Afyonkarahisar. The current study has also shown that skinfold thickness measurements are a valuable tool for screening obesity in children.

Wrist Circumference and Frame Size Percentiles in 6-17-Year-Old Turkish Children and Adolescents in Kayseri.

OBJECTIVE: The aim of the current study was to provide wrist circumference (WrC) and body frame size (height/WrC) percentile values in Turkish children and adolescents aged 6-17 years. METHODS: In this cross-sectional study, the data of "Determination of Anthropometric Measures of Turkish Children and Adolescents" (DAMTCA II) study in Kayseri/Turkey were used. A total of 4330 observations were recorded (1931 boys, 2399 girls). The WrC and frame size reference values were produced with generalized additive models for location, scale and shape. RESULTS: The WrC percentiles (3rd-97th) were calculated. The frame size (height/WrC) was estimated as small, medium, and large (<15th, 15-85th, and ≥85th percentiles, respectively). For both genders, WrC linearly increased with age (13.0-16.8 cm for boys and 12.5-15.5 cm for girls). In boys and girls, the mean ± standard deviation of WrC is 13.00±0.89 cm and 12.48±0.93 cm (6 years) and increases to 16.83±1.16 and 15.58±0.86 cm (17 years), respectively. The WrC values in all age groups were higher in boys compared with girls. The increment in frame size from 6 to 17 years were 1.25 cm in boys and 0.85 cm in girls. CONCLUSION: WrC is a simple, easy-to-detect anthropometric index which is not subject to measurement errors. Additionally, WrC can be used both to decide about frame size and to determine metabolic risks related to obesity. We consider that this easy-to-get anthropometric index can be used both in screening procedures and clinical assessment procedure for obesity-related metabolic consequences.

Comparison of Updated Weight and Height Percentiles with Previous References in 6-17-Year-Old Children in Kayseri, Turkey.

OBJECTIVE: To compare updated weight and height percentiles of 6-17-year-old children from all socio-economic levels in Kayseri with previous local references and other national/international data. METHODS: The second study "Determination of Anthropometric Measurements of Turkish Children and Adolescents study (DAMTCA II)" was conducted in Kayseri, between October 2007 and April 2008. Weight and height measurements from 4321 (1926 boys, 2395 girls) school children aged between 6 to 17 years were included in this cross-sectional study. Using these data, weight and height percentile curves were produced with generalized additive models for location, scale and shape (GAMLSS) and compared with the most recent references. RESULTS: Smoothed percentile curves including the 3rd, 5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, 95th, and 97th percentiles were obtained for boys and girls. These results were compared with DAMTCA I study and with two national (Istanbul and Ankara) and international data from Asia and from Europe. CONCLUSION: This study provides updated weight and height references for Turkish school children aged between 6 and 17 years residing in Kayseri.

Relationship between Neck Circumference and Non-Alcoholic Fatty Liver Disease in Childhood Obesity.

OBJECTIVE: The aim of this study was to establish the association between anthropometric parameters and non-alcoholic fatty liver disease (NAFLD) and to determine the most reliable measurement as a parameter in predicting NAFLD. METHODS: Two-hundred fifty-three obese children of ages 10 to 18 years were enrolled in this study. Anthropometric data and metabolic parameters such as fasting blood glucose, insulin and lipid levels, were measured. Liver function tests were assessed. NAFLD was determined by ultrasound. RESULTS: Most metabolic parameters and anthropometric indices were significantly higher in children with NAFLD. A univariate logistic regression analysis was performed, taking NAFLD status as the dependent variable and anthropometric parameters as the independent variables. NAFLD was affected significantly by the anthropometric values. The multiple logistic regression analysis showed that neck circumference (NC) was the only parameter which determined the risk in both genders. Each 1 cm increase in the NC increased the risk of NAFLD 1.544-fold (p<0.001, 95% confidence interval (CI): 1.357-2.214) in the boys and 1.733-fold (p=0.001, 95% CI: 1.185-2.012) in the girls. Receiver operating characteristic analysis was performed to compare the reliability of anthropometric measurements. NC was observed to be a better indicator. CONCLUSION: Measurement of the NC was shown to be associated with NAFLD in children. We suggest the use of NC as a novel, simple, practical, and reliable anthropometric index in predicting children at risk for NAFLD.

Determining abdominal obesity cut-offs and relevant risk factors for anthropometric indices in Turkish children and adolescents.

AIM: To determine the ≥90th percentile values of waist circumference (WC) to calculate anthropometric measures, indices and relevant risk factors in 5358 Turkish children and adolescents. METHODS: This cross-sectional study was conducted in Kayseri, Turkey, from February to April 2005. Cut-offs for body weight, height, mid-upper arm circumference (MUAC), triceps skinfold thickness, body mass index (BMI), and fat percentages were calculated for ≥90th percentile of WC. RESULTS: According to the results of binary multiple logistic regression analysis (the backward stepwise procedure), sleep duration (boys), maternal education (boys), elevator use (boys), and appetite (boys and girls) were revealed as significant predictors of abdominal obesity, adjusted for age. Appetite was the strongest variable to be associated with abdominal obesity for both genders. CONCLUSIONS: According to receiver operating characteristic analysis, for all age groups within both genders, the best predictors to explain abdominal obesity were BMI and MUAC, respectively.

Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents.

BACKGROUND: This aim of this study was to update information on body mass index (BMI) references and prevalence of overweight and obesity in Turkey, and to compare our data with previous local and international data. METHODS: This cross-sectional study was carried out in Turkish school-age children living in Kayseri, Turkey in 2008. BMI references were calculated and the prevalence of overweight and obesity was determined. Growth curves were produced and compared with concomitant (4 years ago) local and international data. RESULTS: A total of 4241 children (2339 girls and 1902 boys) aged 6-18 years were included. The 5th and 50th percentiles of boys in the current study were approximately 0.8-1.2 units lower than those reported previously. The 95th percentile in our study was higher than those found in previous studies. The prevalence of obesity and overweight was found to be higher in the current study when compared with a previous study (3.9%-4.5% and 15.4%-18.0%, respectively). In the current study, obesity was found to be increased in boys (4.8%-5.4%) but decreased in girls (4.8%-3.5%) when compared with a previous study. We found that our BMI references were significantly higher until 15-16 years of age for the 85th and 95th percentiles compared with World Health Organization standards. CONCLUSIONS: This study provides information on updated BMI references and the prevalence of overweight and obesity. The prevalence of overweight and obesity should be screened in short periods. In the evaluation of overweight and obesity, international standards and local references should be evaluated together.

Waist circumference percentiles among Turkish children under the age of 6 years.

Waist circumference, a proxy measure of abdominal obesity, is associated with cardio-metabolic risk factors in childhood and adolescence. Although there are numerous studies about waist circumference percentiles in children, only a few studies cover preschool children. The aim of this study was to develop age- and gender-specific waist circumference smoothed reference curves in Turkish preschool children to determine abdominal obesity prevalence and to compare them with reference curves obtained from different countries. The design of the study was cross-sectional. A total of 2,947 children (1,471 boys and 1,476 girls) aged 0-6 years were included in the study. The subjects were divided according to their gender. Waist circumference was measured by using a standardized procedure. The age- and gender-specific waist circumference reference curves were constructed and smoothed with LMS method. The reference values of waist circumference, including 3rd, 10th 25th, 50th, 75th, 90th, and 97th percentiles, and standard deviations were given for preschool children. Waist circumference values increased with age, and there were differences between genders. The prevalence of abdominal obesity was calculated as 10.1 % for boys and 10.7 % for girls. Having compared our data with two other countries' data, we found that our waist circumference data were significantly lower. This is the first cross-sectional study for age- and gender-specific references of 0- to 6-year-old Turkish children. The gender- and age-specific waist circumference percentiles can be used to determine the risk of central obesity.

Weight for length/height percentiles in infants and young children in Kayseri/Turkey.

OBJECTIVE: To produce weight for length/height (WLH) percentiles to be used for the screening of growth and assessment of failure to thrive in infancy and early childhood. METHODS: The data (2009-2010) of the Anthropometry of Turkish Children aged 0-6 years (ATCA-06) study were used. A cross-sectional study was designed to calculate the WLH references. Reference weight values for each 5-cm LH intervals were determined using the LMS Chart Maker Pro version 2.3 software program (The Institute of Child Health, London). RESULTS: A total of 3123 children (1573 female, 1550 male) aged 0-6 years were included in the calculation of the 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, and 97th WLH percentiles. The difference between the 3rd and the 97th percentiles for males was 2.02 cm to 12.64 cm in the 50-54.99 cm and 125-130 cm LH ranges. In the girls, the differences between the 3rd-97th percentiles ranged from 2.02 cm to 12.64 cm in the 50-54.99 cm and 125-130 cm LH groups. The maximum difference between the 3rd and 97th percentiles was about half the variation of mean WLH throughout the first six years of life. The most rapid change in WLH was observed in the 0-2-year period. Turkish references for WLH were not different from the World Health Organization standards. CONCLUSIONS: This is the first study in Turkey presenting WLH references in 0-6 year old children. We suggest that the use of WLH in the first two years of life may be more useful than age-adjusted references in assessment of nutritional status and diagnosis of failure to thrive.

Neck circumference as a novel parameter to determine metabolic risk factors in obese children.

BACKGROUND: To establish the association between neck circumference and cardiometabolic risk factors and to determine the utility of the neck circumference as a parameter in predicting children at cardiometabolic risk. MATERIALS AND METHODS: Five - hundred and eighty-one children (461: overweight/obese, 120: normal body mass index) aged between 5 and 18 years were enrolled. Neck circumference, waist circumference, blood pressure and fasting plasma glucose, insulin, total cholesterol, triglyceride and high-density lipoprotein (HDL) cholesterol were recorded, and the homeostasis model assessment for insulin resistance score was calculated. RESULTS: Neck circumference was negatively correlated with HDL cholesterol and positively correlated with all other parameters, with the exception of fasting plasma glucose in pubertal boys and girls and total cholesterol in pubertal girls. Linear regression analysis by designating neck circumference as a dependent variable revealed that insulin and TG levels in prepubertal boys and blood pressure and TG levels in pubertal boys were positively correlated with neck circumference. We found that diastolic blood pressure and insulin were positively correlated, while HDL levels were negatively correlated with neck circumference in prepubertal girls. Systolic blood pressure and insulin were positively correlated with neck circumference in pubertal girls. The cut-off value for neck circumference, as an indicator for metabolic syndrome (MS), was calculated as 36 cm in boys and 35 cm in girls. CONCLUSIONS: Neck circumference measurement was shown to be associated with cardiometabolic risk factors in children. We suggest the use of neck circumference as a novel, simple, practical and reliable anthropometric index in predicting children at risk for cardiometabolic diseases.

Weight, height and BMI references in Elazig: an east Anatolian city.

The aim of this study was to produce the growth references for Elazig children aged 6-11 years. Data were collected in eight primary schools of Elazig in 2007. Age- and gender-specific height, weight and body mass index (BMI) references were produced with LMS (Lambda-Mu-Sigma) method and compared with reported values in an Anatolian and a metropolitan city. A total of 3342 (1634 females, 1708 males) children aged 6-11 years from among 4258 students were included in the study. Age- and gender-specific height, weight and BMI references were produced. The 3rd-97th percentiles were detected to be higher than the range of percentiles between 6-11-year-old children. We consider that this first local reference for Elazig will provide a useful tool for health planning and monitoring of growth and development.

Normal standards of eye projection in Turkish children 6 to 17 years of age.

BACKGROUND: There are a few international and Turkish reports on children's eye projection references. METHODS: This is a cross-sectional study. Data were obtained from the second study of the Determination of Anthropometric Measurements of Turkish Children and Adolescents study group (DAMTCA II).The study population was 4,533 primary and secondary school students aged 6 to 18 years (2,512 girls, 2,021 boys). A Hertel exophthalmometer was used; age- and gender-specific means and standard deviations and percentiles were calculated for eye projection. RESULTS: The 3rd, 5th, 10th, 25th, 50th, 75th, 80th, 85th, 90th, 95th, and 97th percentiles of right and left eye projection, and the mean and standard deviation for each age and gender were calculated. In 6-year-old children, the smoothed eye projection of the 3rd-97th percentiles for the right and left eye in boys were detected as 11.2 mm-17.0 mm for right eye and 11.1 mm-17.0 mm for left eye. In 17-year-old male adolescents, the 3rd-97th percentiles were detected as 11.9 mm-19.5 mm for the right eye and 11.8 mm-19.2 mm for the left eye. The 3rd-97th percentiles in 6-year-old girls were detected as 11.1 mm-17.1 mm for the right eye and 10.9 mm-17.1 mm for the left eye. In 17-year-old girls, the 3rd-97th percentiles were detected as 11.7 mm-19.4 mm for the right eye and 11.8-19.2 mm for the left eye. CONCLUSIONS: Age- and gender-specific references for exophthalmos provide important information both for the clinical decision-making process, and screening in the diagnosis of abnormal or pathological conditions which result in exophthalmos.

Exophthalmometric references of 7-18 year-old children in Kayseri, Turkey.

AIM: To produce age and gender specific exophthalmos references for Turkish children aged 7-18 years old. STUDY DESIGN: This was a preliminary cross-sectional study. Data were obtained from the second study of the Determination of Anthropometric Measurements of Turkish Children and Adolescents (DAMTCA II). A Hertel exophthalmometer was used and age and gender specific standard deviations (SD) and percentiles were calculated. RESULTS: The 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th 97th percentiles of right and left eye protrusion, and the mean and SD for each age and gender were calculated. In comparison of eyes and genders: Protrusion in the right eye was 14.81 (1.68), and 14.65 (1.67) in the left eye for boys. Protrusion in the right eye was 14.95 (1.68) and 14.75 (1.67) in the left eye of girls. In both genders the difference in protrusion of the two eyes was statistically significant (p <0.001). Exophthalmometric measurements were compared for pubertal periods by one-way analysis of variance and a significant difference was found in exophthalmos between pubertal periods for both eyes and gender (p <0.001). CONCLUSIONS: Age and gender specific references for exophthalmia provide information for both clinical decision process and screening in describing abnormal or pathological conditions resulting in exophthalmos.

Waist circumference and mid-upper arm circumference in evaluation of obesity in children aged between 6 and 17 years.

OBJECTIVE: The purpose of this study was to determine the cut-off values for waist circumference (WC) and mid-upper arm circumference (MUAC) and to assess their use in screening for obesity in children. METHODS: Anthropometric measurements of a total of 2621 boys and 2737 girls aged 6-17 years were analyzed. WC and MUAC values were compared with ROC analysis using body mass index (BMI) cut-off values of the International Obesity Task Force (IOTF) and using WC≥ 90th percentile.for MUAC. RESULTS: In both genders, except for boys and girls in the 6-year age group and post-pubertal boys, the differences between area under curve (AUC) values for WC and MUAC were not significant, indicating that both indices performed equally well in predicting obesity. Sensitivity was suboptimal through age groups 6-9 years in the boys and sensitivity was suboptimal at 6, 7,14 and 17 years both in boys and girls. CONCLUSIONS: We conclude that MUAC can be a useful parameter in screening obesity and body fat distribution in children and, can be applied in epidemiological studies and in clinical practice.

Neck circumference: an additional tool of screening overweight and obesity in childhood.

UNLABELLED: Obesity, particularly in the upper part of body, is a major health problem. Central obesity is related to cardiovascular disease and metabolic disorders. There are various techniques for assessing upper body fat content for the overweight and obese subjects other than waist circumference (WC). We tried to find out if neck circumference (NC) alone can be used to assess overweight and obesity. Four hundred twelve overweight and obese patients (208 girls and 204 boys) and 555 healthy children (284 girls and 271 boys) aged 6-18 years were recruited for this present study. There were significant and positive correlations between BMI-WC, BMI-NC, and WC-NC (p < 0.001). NC cutoffs for overweight and obesity were determined for each age and pubertal period. NC cutoffs of boys were increased from 28.0 to 38.0. This range was 27.0-34.5 for girls in the same range. We also calculated NC cutoffs for prepubertal and pubertal periods (respectively, 29.0 and 32.5 for boys and 28.0-31.0 for girls). CONCLUSION: NC is a reliable and easy to use tool to determine overweight and obesity in children, and NC is not as good as WC in determining overweight and obesity, both providing similar information.

Is plasma homocysteine level associated with metabolic syndrome components in adolescents?

BACKGROUND: This study investigated whether serum homocysteine (Hcy) level is associated with metabolic syndrome components, including high waist circumference (WC), hypertriglyceridemia, low high-density lipoprotein-cholesterol (HDL-C), elevated systolic blood pressure (SBP), and insulin resistance (IR) in adolescents living in Central Anatolia, Turkey. METHODS: The data of The Prevalence of Metabolic Syndrome Among Adolescents Study, a cross-sectional study carried out in two of the central and ten outlying districts of Kayseri was used. Components of metabolic syndrome were modified from the Adult Treatment Panel III (ATP III). A multivariate regression model was developed to examine the relationships between the homocysteine (Hcy) level and metabolic syndrome components. Hyperhomocysteinemia (HH) was defined as level of Hcy > or = 15 micromol/L. RESULTS: Mean plasma Hcy level of adolescents with metabolic syndrome was found to be 11.8 +/- 5.0 micromol/L. Although the Hcy level of females (11.4 +/- 5.5 micromol/L) was lower than that of males (12.0 +/- 4.7 micromol/L), the difference was not statistically significant (P > 0.05). In all, 40.5% of adolescents had Hcy levels between 10 and 15 micromol/L (mild HH) and 17.7% of adolescents had Hcy levels of > or = 15 micromol/L. The Hcy level was negative and weakly correlated with insulin resistance in females (r = -0.319, P = 0.058) and negative strongly correlated with SBP in males (r = - 0.385, P = 0.011). There were no associations between Hcy level and other components of metabolic syndrome. CONCLUSIONS: An elevated plasma Hcy level is not considered to be related to components of metabolic syndrome. But HH may be an independent risk factor, especially for diabetic adolescents or those who have cardiovascular events as in adults.

Cross-sectional reference values for mid-upper arm circumference, triceps skinfold thickness and arm fat area of Turkish children and adolescents.

The aim of the study was to establish cross-sectional reference values for the mid-upper arm circumference (MUAC), triceps skinfold thickness (TSF) and arm fat area (AFA) of Turkish children and adolescents. In total 5,553 students aged between 6 and 17 years were selected by a multistage sampling method from schools representing city centre, rural and urban areas of Kayseri, Central Anatolia. The MUAC and TSF were measured, and the arm muscle area, arm area, AFA and fat percentage (%) were calculated. The LMS method was employed to calculate the MUAC, TSF and AFA curve parameters. The MUAC, TSF, AFA and fat percentage in each age group were significantly higher in girls than in boys. In boys, the TSF 50th percentile ranged from 7.6 mm at 17 years to 9.0 mm at 11 years; whereas in girls this ranged from 9.4 mm at 6 years to 14.6 mm at 17 years. The MUAC 50th percentile ranged from 17.0 to 23.6 cm in boys, and from 15.6 cm to 20.9 cm in girls. The AFA 50th percentile measurements ranged from 4.5 cm at 6 years to 5.8 cm at 12-14 years in boys; and ranged from 7.2 cm at 6 years to 14.8 cm at 17 years in girls. The percentile distribution was more disperse towards higher TSF and AFA values in boys than in girls.

Turkish general practitioners and complementary/alternative medicine.

BACKGROUND: Complementary and alternative medicine (CAM) is in the spotlight of society. However, what is the position of physicians at this point? OBJECTIVES: To determine general practitioners' (GP) knowledge, attitudes, and approaches to CAM. METHODS: All GPs (n=521) practicing in Bursa Province, Turkey were surveyed by a questionnaire. RESULTS: Responses from 49% of GPs were analyzed. Altogether, most of our physicians (96.5%) had not received any education about CAM, wanted to learn more (74.4%), and their knowledge levels were low (60.8%). About half of them (51%) believed in the efficiency of CAM, whereas 38.0% did not. GPs desire more information about herbal medicine and acupuncture. Only 29% of GPs were using some type of CAM for themselves. CONCLUSIONS: GPs are aware of the subject's importance and want to learn more about CAM and improve their knowledge. It would be reasonable to provide training possibilities for GPs, primarily for the CAM types highly used by the population and most requested by the physicians.