Sociodemographic Variation in Children's Health Behaviors During the COVID-19 Pandemic.

Background: Societal changes during the COVID-19 pandemic may affect children's health behaviors and exacerbate disparities. This study aimed to describe children's health behaviors during the COVID-19 pandemic, how they vary by sociodemographic characteristics, and the extent to which parent coping strategies mitigate the impact of pandemic-related financial strain on these behaviors. Methods: This study used pooled data from 50 cohorts in the Environmental influences on Child Health Outcomes Program. Children or parent proxies reported sociodemographic characteristics, health behaviors, and parent coping strategies. Results: Of 3315 children aged 3-17 years, 49% were female and 57% were non-Hispanic white. Children of parents who reported food access as a source of stress were 35% less likely to engage in a higher level of physical activity. Children of parents who changed their work schedule to care for their children had 82 fewer min/day of screen time and 13 more min/day of sleep compared with children of parents who maintained their schedule. Parents changing their work schedule were also associated with a 31% lower odds of the child consuming sugar-sweetened beverages. Conclusions: Parents experiencing pandemic-related financial strain may need additional support to promote healthy behaviors. Understanding how changes in parent work schedules support shorter screen time and longer sleep duration can inform future interventions.

Analysis of Early-Life Growth and Age at Pubertal Onset in US Children.

Importance: Earlier pubertal onset may be associated with an increased risk of chronic diseases. However, the extent to which growth in the first 5 years of life-an important developmental life stage that lays the foundation for later health outcomes-is associated with pubertal onset remains understudied. Objective: To assess whether changes in weight, length or height, and body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) during the first 5 years of life are associated with earlier pubertal onset. Design, Setting, and Participants: This cohort study used data from 36 cohorts participating in the Environmental Influences on Child Health Outcomes program from January 1, 1986, to December 31, 2015. Participant inclusion required at least 1 anthropometric measure in the first 5 years of life and at least 1 measure of pubertal onset. Data were analyzed from January 1 to June 30, 2021. Exposures: Standardized velocities of weight, length or height, and BMI gain in early infancy (0-0.5 years), late infancy (0.5-2 years), and early childhood (2-5 years). Main Outcomes and Measures: Markers of pubertal onset for boys and girls, including age at peak height velocity (APHV), time to puberty score greater than 1, time to Tanner pubic hair stage greater than 1, and time to menarche. Multivariable regression models were used to estimate mean differences in APHV by growth periods. Results: Of 7495 children included in the study, 3772 (50.3%) were girls, 4505 (60.1%) were White individuals, and 6307 (84.1%) were born during or after the year 2000. Girls had a younger APHV (10.8 vs 12.9 years) than boys. In boys, faster weight gain (per 1-SD increase) in early infancy (ß, -0.08 years; 95% CI, -0.10 to -0.06), late infancy (ß, -0.10 years; 95% CI, -0.12 to -0.08), and early childhood (ß, -0.07 years; 95% CI, -0.08 to -0.05) was associated with younger APHV after adjusting for the child's birth year, race, and Hispanic ethnicity as well as maternal age at delivery; educational level during pregnancy; annual household income during pregnancy; prenatal cigarette smoking; whether the mother was nulliparous; whether the mother had gestational diabetes, hypertension, or preeclampsia; mode of delivery; prepregnancy BMI; gestational weight gain; and gestational age at delivery. Similar associations were observed for length or height and BMI gains during the same age periods. In girls, faster gains (per 1-SD increase) in weight (ß, -0.03 years; 95% CI, -0.05 to -0.01) and height (ß, -0.02 years; 95% CI, -0.04 to 0.00) in early childhood were associated with younger APHV. Faster BMI gain in late infancy was associated with earlier time to menarche, whereas faster BMI gain in early childhood was associated with earlier time to Tanner pubic hair stage greater than 1. Conclusions and Relevance: This cohort study found that faster gains in weight, length or height, or BMI in early life were associated with earlier pubertal onset. The results suggest that children who experience faster early growth should be monitored closely for earlier onset of puberty and referred as appropriate for supportive services.

Pediatric Research and Health Care for Transgender and Gender Diverse Adolescents and Young Adults: Improving (Biopsychosocial) Health Outcomes.

Adolescent and young adult (AYA) transgender health care and research have expanded rapidly in the United States and abroad, but the effects of gender-affirming social, hormonal, or surgical care on overall health remain unclear. Gender diverse identities, also termed nonbinary, have often been neglected in favor of (male/female) binary identities, even in the context of transgender health care and research. No high quality studies have assessed how gender-affirming medical care impact health inequities in transgender and gender diverse (TG/GD) adults, much less in AYAs, despite the fact that that TG/GD adults have higher than average morbidity and mortality across a host of health concerns, from human immunodeficiency virus infection to thromboembolism, and that reported depression with suicidal ideation is >10 times higher in TG/GD adults than in the general population. TG/GD youth have related but different needs from TG/GD adults. TG/GD AYA are embedded in family and schools, where stigma may be difficult to escape; mental health during adolescence has areas of increased risk as well as resilience; and the effects of early hormonal and surgical interventions on long-term health are insufficiently studied. Because of this, an inclusive and proactive approach to addressing the needs of TG/GD AYA by pediatric clinicians, researchers, and educators is particularly crucial. This article focuses on what is known and unknown about clinical practice, research, and education related to TG/GD health. We highlight the role of gender affirmation by clinicians as they care and advocate for TG/GD AYAs; the potential challenges of hormonal treatment for peripubertal youth; and short- and long-term effects on physical and reproductive health of medical or surgical interventions. We also discuss how social context influences knowledge gaps and the health-relevant risks faced by TG/GD AYA. The challenges are formidable, but opportunities await: high priority research questions to explore, educational gaps to be filled, and advocacy that needs the voices of pediatricians to promote policies to facilitate positive health outcomes for TG/GD AYA.

Association of Prepregnancy BMI, Gestational Weight Gain, and Child Birth Weight with Metabolic Dysfunction in Children and Adolescents with Obesity.

OBJECTIVES: Previous studies have reported that maternal prepregnancy body mass index (BMI), gestational weight gain (GWG), and child birth weight are positively associated with metabolic dysfunction (a broader term than metabolic syndrome) in children and adolescents. Physical activity habits may play a role in reducing these risk factors. The objectives of this study were to investigate the association of prepregnancy BMI, GWG, child birth weight, physical activity, and sedentary time with metabolic dysfunction in a cohort of children and adolescents with obesity. METHODS: Participants (N = 117; 53% Hispanic) were children and adolescents, aged 8 to 17 years, with obesity. Fasting serum glucose, insulin, and a complete lipid profile were obtained. Body weight, height, waist circumference, and blood pressure were measured. A self-reported survey assessed prepregnancy BMI, GWG, child birth weight, physical activity, and sedentary time. The χ2 test and the Mantel-Haenzel test statistic were used to examine the differences in proportions for the outcome of metabolic dysfunction. RESULTS: In this sample, 76.9% of children and adolescents had metabolic dysfunction. Prepregnancy BMI and GWG were not associated with metabolic dysfunction. Child birth weight and sedentary behavior were positively correlated (P = 0.033 and P = 0.015, respectively) with a diagnosis of metabolic dysfunction. Physical activity levels were not associated with metabolic dysfunction. Hispanic and non-Hispanic youth were similar for all risk factors. CONCLUSIONS: Contrary to previous studies, prepregnancy BMI and GWG were not correlated with metabolic dysfunction. These findings support the need for lifestyle interventions, particularly in reducing sedentary behaviors, in obese children and adolescents.

Cold-Activated Brown Adipose Tissue is Associated with Less Cardiometabolic Dysfunction in Young Adults with Obesity.

OBJECTIVE: This study aimed to test the hypothesis that young adults with obesity and cold-activated brown adipose tissue (BAT) are less likely to have metabolic dysfunction (dyslipidemia, insulin resistance, and hypertension) than those without cold-activated BAT. Previous studies have noted a potentially protective effect of BAT and higher adiponectin/leptin ratios, but they have acknowledged that the clinical implications of these findings remain uncertain. METHODS: Twenty-one females and twenty-three males with obesity (BMI ≥ 30 kg/m2 ) underwent a 2-hour cooling protocol before 18 F-fluorodeoxyglucose (18 F-FDG)-positron emission tomography/x-ray computed tomography scan to determine the prevalence, volume, and 18 F-FDG uptake of cold-activated BAT. RESULTS: Cold-activated BAT was identified in 43% of participants (11 female, 8 male); females had greater 18 F-FDG uptake. Those with cold-activated BAT had a lesser degree of metabolic dysfunction. Cold-activated BAT volume correlated with triglycerides (inversely) and adiponectin (concordantly). Body-mass-adjusted cold-activated BAT activity correlated with high-density lipoprotein cholesterol (concordantly). Males with cold-activated BAT had lower leptin and higher adiponectin/leptin ratio. CONCLUSIONS: A high prevalence of cold-activated BAT was found in the study participants. BAT could be important in decreasing metabolic dysfunction among young adults with obesity, making it a potential target for treating metabolically unhealthy obesity.

Understanding childhood obesity in the US: the NIH environmental influences on child health outcomes (ECHO) program.

BACKGROUND: Few resources exist for prospective, longitudinal analysis of the relationships between early life environment and later obesity in large diverse samples of children in the United States (US). In 2016, the National Institutes of Health launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate influences of environmental exposures on child health and development. We describe demographics and overweight and obesity prevalence in ECHO, and ECHO's potential as a resource for understanding how early life environmental factors affect obesity risk. METHODS: In this cross-sectional study of 70 extant US and Puerto Rico cohorts, 2003-2017, we examined age, race/ethnicity, and sex in children with body mass index (BMI) data, including 28,507 full-term post-birth to <2 years and 38,332 aged 2-18 years. Main outcomes included high BMI for age <2 years, and at 2-18 years overweight (BMI 85th to <95th percentile), obesity (BMI ≥ 95th percentile), and severe obesity (BMI ≥ 120% of 95th percentile). RESULTS: The study population had diverse race/ethnicity and maternal demographics. Each outcome was more common with increasing age and varied with race/ethnicity. High BMI prevalence (95% CI) was 4.7% (3.5, 6.0) <1 year, and 10.6% (7.4, 13.7) for 1 to <2 years; overweight prevalence increased from 13.9% (12.4, 15.9) at 2-3 years to 19.9% (11.7, 28.2) at 12 to <18 years. ECHO has the statistical power to detect relative risks for 'high' BMI ranging from 1.2 to 2.2 for a wide range of exposure prevalences (1-50%) within each age group. CONCLUSIONS: ECHO is a powerful resource for understanding influences of chemical, biological, social, natural, and built environments on onset and trajectories of obesity in US children. The large sample size of ECHO cohorts adopting a standardized protocol for new data collection of varied exposures along with longitudinal assessments will allow refined analyses to identify drivers of childhood obesity.

Universal Lipid Screening in 9- to 11-Year-Olds Before and After 2011 Guidelines.

OBJECTIVE: To determine whether the 2011 guidelines for universal routine screening for dyslipidemia in children aged 9 to 11 years, published by the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents and National Heart, Lung, and Blood Institute, are being followed by pediatric primary-care providers. METHODS: Retrospective data were obtained for 63,951 well-child visits (WCV) in children aged 9 to 11 years from 2 health care systems and 1 insurance program from 2009 to 2015. The proportion of WCV that had a lipid panel or total cholesterol test performed within 1 year of the visit was compared for 2009-2011 versus 2013-2015. Associations between demographic variables and lipid screening were evaluated with logistic regression. The frequency of tested children who had abnormal lipid results was evaluated. RESULTS: Only 3.5% of 9- to 11-year WCV had lipid tests performed in association with the visit before and after the guidelines. Of those tested, 43% had an abnormal lipid result. CONCLUSIONS: Utah clinicians rarely follow guidelines for universal lipid screening of children aged 9 to 11. This represents a missed opportunity to identify children at risk for early-onset cardiovascular disease.

A picture of Indian adolescent mental health: an analysis from three urban secondary schools.

Purpose Mental health disorders are a pressing issue among adolescents around the world, including in India. A better understanding of the factors related to poor mental health will allow for more effective and targeted interventions for Indian adolescents. Methods The Indian Adolescent Health Questionnaire (IAHQ), a validated questionnaire designed specifically for use in schools, was administered to approximately 1500 secondary students in three private urban Indian schools in 2012. The Strengths and Difficulties Questionnaire (SDQ) module assessed mental health. Linear regression was used to predict SDQ scores. The biopsychosocial framework was used as an organizing framework to understand how each explanatory variable in the final model might impact the SDQ score. Results One thousand four hundred and eight students returned IAHQ surveys (93.9% response rate); 1102 students completed questions for inclusion in the regression model (78.3% inclusion rate). Statistically significant (p < 0.05) independent variables associated with SDQ scores were gender, level of overall health, negative peer pressure, insults from peers, kindness of peers, feeling safe at home, at school, or with friends, and grades. Discussion Schools have a role to play in improving adolescent mental health. Many of the significant variables in our study can be addressed in the school environment through school-wide, long-term programs utilizing teachers and lay counselors. The IAHQ and SDQ can be used by schools to identify factors that contribute to poor mental health among students and then develop targeted programs to support improved mental health.

Breast-feeding, Leptin:Adiponectin Ratio, and Metabolic Dysfunction in Adolescents with Obesity.

OBJECTIVES: Increased adiposity increases leptin and decreases adiponectin concentrations, resulting in an increased leptin:adiponectin ratio (LAR). In adults, components of the metabolic syndrome and other cardiometabolic risk factors, what we classify here as "metabolic dysfunction," are associated with both a high LAR and a history of being breast-fed. The relation among breast-feeding, LAR, and degree of metabolic dysfunction in obese youth is unknown. The purpose of our pilot study was to explore this relation and estimate the effect size of the relations to determine the sample size needed to power future prospective studies. METHODS: We obtained fasting levels of leptin, adiponectin, lipids, insulin, and glucose from obese youth (aged 8-17 years). Weight, height, waist circumference, blood pressure, and breast-feeding history also were assessed. RESULTS: Of 96 participants, 78 were breast-fed as infants, 54% of whom were breast-fed for >6 months. Wide variation was observed in LARs among children who were and were not breast-fed (>100% coefficient of variation). Overall, prevalence of metabolic dysfunction in the cohort was 94% and was not proven to be associated with higher LAR. CONCLUSIONS: In this cohort of obese youth, we found a high prevalence of breast-feeding, metabolic dysfunction, and wide variation in the LARs. Based on the effect size estimated, future studies would need to enroll >1500 patients or identify, stratify, and selectively enroll obese patients without metabolic dysfunction to accurately determine whether breast-feeding in infancy influences LARs or metabolic dysfunction among obese youth.

Dyslipidemia Screening of 9- to 11-Year-Olds at Well-Child Visits by Utah Pediatricians.

In 2011, an expert National Institutes of Health panel published the "Integrated Guidelines for CV Health and Risk Reduction in Children and Adolescents," which recommended screening all children aged 9 to 11 years for dyslipidemia. It is unknown if this guideline is being followed. We surveyed members of the Utah chapter of the American Academy of Pediatrics to determine whether they performed universal lipid screening at well-child visits (WCV) on their patients at 9,10, or 11 years and how comfortable they were with evaluating and/or managing children with dyslipidemia. Of the 118 respondents who practiced primary care, only 18 (15%) screened all children at WCV; 86 (73%) tested "some," most commonly children who were obese or had a positive family history. 18% were unfamiliar with the guidelines; 28% were familiar with the guidelines but felt they were "inappropriate;" 98 (84%) of the respondents said they were "very or somewhat comfortable" evaluating children with dyslipidemia.

Optimizing enrollment in pediatric obese patients: reflections on recruitment characteristics.

Clinical research involving children and adolescents with obesity is challenging due to recruitment, transportation barriers, parents/guardians working multiple jobs and the need to coordinate the schedule of the participant and the parent/guardian. We describe recruitment efforts and successes for a longitudinal observational study of adolescents with obesity.

Changes in Fasting Lipids during Puberty.

OBJECTIVE: To describe longitudinal changes in plasma lipid levels and pubertal stage in youths from age 8-18 years, in Project HeartBeat! STUDY DESIGN: Fasting blood samples and pubertal stage, using physical assessment of secondary sex characteristics, were obtained every 4 months for up to 4 years in a mixed longitudinal study of 633 children (49.1% female, 20.1% black), initially aged 8, 11, and 14 years. Total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, triglycerides (TG), and nonhigh density lipoprotein-cholesterol measurements were obtained. Data were collected from 1991-1995. RESULTS: Pubertal stage correlations with age varied among all race-sex groups (range, r = 0.61-0.70), and a given pubertal stage could represent a range of 5 years or more of chronological age. Throughout puberty, levels of total cholesterol, low density lipoprotein-cholesterol, and nonhigh density lipoprotein-cholesterol decreased, TG in males increased, and high density lipoprotein-cholesterol and TG in females showed no changes. Within a given pubertal stage, plasma lipid levels tended to differ by race, sex, or both. CONCLUSIONS: Lipid levels change markedly by pubertal stage, and patterns differ by sex and race. Chronological age ranges widely within a given pubertal stage and is an insensitive indicator of pubertal stage and the related changes in lipid levels. Pubertal development should be considered when determining screening criteria to identify youths with adverse blood lipid levels.

Special population considerations and regulatory affairs for clinical research.

Special populations, including women (non-pregnant and pregnant), pediatrics, and the elderly, require additional consideration with regard to clinical research. There are very specific regulatory laws, which protect these special populations, that need to be understood and adhered to in order to perform clinical research. This review provides a broad overview of some of the physiological differences in special populations and discusses how these differences may affect study design and regulatory considerations. These various special populations, with respect to regulatory affairs, are clearly defined within the Code of Federal Regulations. The definition of "special population" exists to provide enhanced awareness of their vulnerabilities, thereby allowing the creation of regulatory guidance aimed to decrease injury or outright harm. Currently, progress is being made to be more inclusive of special populations in clinical trials. This reflects changing attitudes towards drug information, with it being more representative of those patients that will ultimately be prescribed or exposed to the therapy. However, all research undertaken in these populations should be performed in a manner that ensures all protections of each participant are upheld.

Comanagement of Pediatric Depression and Obesity: A Clear Need for Evidence.

PURPOSE: The purpose of this article is to provide a review of the existing literature for the comanagement of depression and obesity in the pediatric population. METHODS: A review of the current literature was conducted using EBSCOhost and EMBASE to identify evidence and recommendations for the comanagement of depression and obesity among children and adolescents (aged 2-18 years). Additional search criteria included peer-reviewed, English language-only full-text articles published before August 2015. FINDINGS: Multiple factors contribute to and influence the interplay of obesity and depression in the pediatric population. These 2 chronic conditions are affected by multiple factors, including the roles of the family, school, health care practitioners, and access to health care. In addition, there are no formal recommendations for the treatment of depression in the setting of obesity for pediatric or adult populations, and there is only medication approved by the Food and Drug Administration (orlistat) for the treatment of obesity in the adolescent population. Bariatric surgery may play a role in some adolescents, but larger and long-term clinical studies with the use of therapeutic agents in conjunction with lifestyle modification need to be conducted to support this. IMPLICATIONS: The interrelatedness of these 2 separate diseases is not well understood; the presence of 1 of the diseases clearly contributes to the manifestation of the other and likely to the ability to treat the other disease. Current focus is on modifying behavior to decrease weight. Weight loss is associated with improvement in depressive symptoms but may not be adequate to treat depression.

Physicians and Physician Trainees Rarely Identify or Address Overweight/Obesity in Hospitalized Children.

OBJECTIVES: To determine how frequently physicians identify and address overweight/obesity in hospitalized children and to compare physician documentation across training level (medical student, intern, resident, attending). STUDY DESIGN: We conducted a retrospective chart review. Using an administrative database, Centers for Disease Control and Prevention body mass index calculator, and random sampling technique, we identified a study population of 300 children aged 2-18 years with overweight/obesity hospitalized on the general medical service of a tertiary care pediatric hospital. We reviewed admission, progress, and discharge notes to determine how frequently physicians and physician trainees identified (documented in history, physical exam, or assessment) and addressed (documented in hospital or discharge plan) overweight/obesity. RESULTS: Physicians and physician trainees identified overweight/obesity in 8.3% (n = 25) and addressed it in 4% (n = 12) of 300 hospitalized children with overweight/obesity. Interns were most likely to document overweight/obesity in history (8.3% of the 266 patients they followed). Attendings were most likely to document overweight/obesity in physical examination (8.3%), assessment (4%), and plan (4%) of the 300 patients they followed. Medical students were least likely to document overweight/obesity including it in the assessment (0.4%) and plan (0.4%) of the 244 hospitalized children with overweight/obesity they followed. CONCLUSIONS: Physicians and physician trainees rarely identify or address overweight/obesity in hospitalized children. This represents a missed opportunity for both patient care and physician trainee education.

Development and validation of the Indian Adolescent Health Questionnaire.

The period of adolescence is a critical time of development. There is an urgent need to better assess adolescent health worldwide, particularly in India, a country with the world's largest adolescent population. Validated screening tools are needed to evaluate health-related risks and behaviors in this growing demographic. We developed, validated and administered a school-based health assessment, the Indian Adolescent Health Questionnaire, which can be used as a comprehensive health-screening tool among Indian adolescents in secondary school.

Validity and reliability of perinatal biomarkers of adiposity after storage as dried blood spots on paper.

OBJECTIVE: To validate use of chip-based immunoaffinity capillary electrophoresis on dried blood spot samples (DBSS) to measure obesity-related hormones. METHODS: Chip-based immunoaffinity capillary electrophoresis was used to measure adiponectin, leptin and insulin in capillary serum and DBSS in pregnant women and infant heelstick at birth and six weeks. Concordance of measurements was determined with Pearson's correlation and Bland-Altman plots. RESULTS: We report high concordance between results obtained from serum and DBSS. CONCLUSIONS: Ease of sample collection and storage makes DBSS an optimal method for use in studies involving neonates and young children, as well as studies conducted in areas where freezer storage is not available.

Expected changes in clinical measures of adiposity during puberty.

BACKGROUND: Clinicians use several measures to estimate adiposity. Body mass index (BMI), although not a measure of adiposity, is commonly used to define weight status. Percent body fat (%BF) measures total body fatness, which is composed of central and peripheral fat, estimated by waist circumference (WC) and skinfold thickness, respectively. Abnormal increases in fat during puberty may reflect an increased risk of developing cardiovascular disease. Therefore, it is important to establish the normal patterns of change in clinically relevant measures of adiposity. PURPOSE: To describe the normal patterns of change in clinical measures of adiposity during puberty. DESIGN/METHODS: Multilevel modeling and linear regression analyses of 642 children in Project HeartBeat!, aged 8-18 years (non-black and black), who had assessments of BMI, %BF, WC, sums of 2- and 6-skinfolds, and pubertal stage (PS) triennially between 1991 and 1995. RESULTS: In males, the normal pattern from PS1 to PS5 is for %BF to decrease, skinfold thickness to remain stable, and WC to increase. However, after adjusting for height, WC does not change. In females, %BF remains stable from PS1 to PS5, whereas skinfold thickness increases. As in males waist-height ratio does not change, indicating that central adiposity does not normally increase during puberty. Although BMI increases in both genders and races from PS1 to PS5, mean values at PS5 were well below 25 kg/m(2). CONCLUSIONS: During puberty, increase in %BF is abnormal in females and even more so in males. Likewise, increase in waist-height ratio is also abnormal and may suggest an increased risk for adiposity-associated morbidity.

Nutrient intake, physical activity, and CVD risk factors in children: Project HeartBeat!

BACKGROUND: Associations among dietary intake, physical activity, and cardiovascular disease (CVD) risk factors are inconsistent among male and female youth, possibly from lack of adjustment for pubertal status. The purpose of this report is to describe the associations of CVD risk factors among youth, adjusted for sexual maturation. METHODS: Data analyzed in 2007 from a sumsample of 556 children aged 8, 11, and 14 years in Project HeartBeat!, 1991-1993, provide cross-sectional patterns of CVD risk factors by age and gender, adjusting for sexual maturation, within dietary fat and physical activity categories. RESULTS: Girls consuming moderate- to high-fat diets were significantly less physically active than those consuming low-fat diets. Boys and girls consuming high-fat diets had higher saturated fat and cholesterol intakes than children in low-fat categories. Boys had no significant differences in physical activity, blood pressure, waist circumference, or plasma cholesterol levels across fat categories. Girls' plasma cholesterol levels showed no significant differences across fat categories. Dietary intake did not differ across moderate-to-vigorous physical activity (MVPA) categories within gender. There were no differences in BMI by fat or MVPA categories for either gender. Girls' waist circumference differed significantly by fat category, and systolic blood pressure differed significantly across fat and MVPA categories. Boys' fifth-phase diastolic blood pressure was significantly different across MVPA categories. CONCLUSIONS: Girls consuming atherogenic diets were significantly less physically active than those with low fat intakes, whereas boys consuming high-fat diets did not show differences in physical activity measures. With the prevalence of overweight rising among youth, the impact of atherogenic diets and sedentary lifestyles on CVD risk factors is of concern to public health professionals.

Trajectories of fat mass index, fat free-mass index, and waist circumference in children: Project HeartBeat!

BACKGROUND: Body composition and fat distribution change dramatically during adolescence. Data based on longitudinal studies to describe these changes are limited. The aim of this study was to describe age-related changes in fat free-mass index (FFMI) and fat mass index (FMI), which are components of BMI, and waist circumference (WC) in participants of Project HeartBeat!, a longitudinal study of children. METHODS: Anthropometric measurements and body composition data were obtained in a mixed longitudinal study of 678 children (49.1% female, 20.1% black), initially aged 8, 11, and 14 years, every 4 months for 4 years (1991-1995). Trajectories of change from ages 8 to 18 years were measured for FFMI, FMI, and WC. Because of the small number of observations for black participants, trajectories for this group were limited to ages 8.5-15 years. RESULTS: Body mass index, FFMI, and WC increased steadily with age for all race-gender cohorts. However, in nonblack girls, FFMI remained constant after about age 16 years. For black boys and girls, FFMI was similar at age 8.5 years but increased more steeply for black boys by age 15 years. In girls, FMI showed an upward trend until shortly after age 14 years, when it remained constant. In boys, FMI increased between age 8 years and age 10 years, and then decreased. CONCLUSIONS: The extent to which each component of BMI contributes to the changes in BMI depends on the gender, race, and age of the individual. Healthcare providers need to be aware that children who show upward deviation of BMI or BMI percentiles may have increases in their lean body mass rather than in adiposity.