A practical model for identification of children at risk of excess energy intake in the developing world.

OBJECTIVE: We describe diet quality by demographic factors and weight status among Barbadian children and examine associations with excess energy intake (EI). A screening tool for the identification of children at risk of excess EI was developed. DESIGN: In a cross-sectional survey, the Diet Quality Index-International (DQI-I) was used to assess dietary intakes from repeat 24h recalls among 362 children aged 9-10 years. Participants were selected by probability proportional to size. A model to identify excess energy intake from easily measured components of the DQI-I was developed. SETTING: Barbados.ParticipantsPrimary-school children in Barbados. RESULTS: Over one-third of children were overweight/obese, and mean EI for boys (8644 (se 174·5) kJ/d (2066 (se 41·7) kcal/d)) and girls (8912 (se 169·9) kJ/d (2130 (se 40·6) kcal/d)) exceeded the RDA. Children consuming a variety of food groups, more vegetables and fruits, and lower percentage energy contribution from empty-calorie foods showed reduced likelihood of excess EI. Intake of more than 2400 mg Na/d and higher macronutrient and fatty acid ratios were positively related to the consumption of excess energy. A model using five DQI-I components (overall food group variety, variety for protein source, vegetables, fruits and empty calorie intake) had high sensitivity for identification of children at risk of excess EI. CONCLUSIONS: Children's diet quality, despite low intakes of fruit and vegetables, was within acceptable ranges as assessed by the DQI-I and RDA; however, portion size was large and EI high. A practical model for identification of children at risk of excess EI has been developed.

Drastic increases in overweight and obesity from 1981 to 2010 and related risk factors: results from the Barbados Children's Health and Nutrition Study.

OBJECTIVE: To examine overweight and obesity (OWOB), changes in prevalence and potential risk factors in Barbadian children. DESIGN: A cross-section of students were weighed and measured. The WHO BMI-for-age growth references (BAZ), the International Obesity Task Force cut-offs and the US Centers for Disease Control and Prevention growth percentiles were used to determine OWOB prevalence. Harvard weight-for-height-for-age growth standards were used to estimate differences in OWOB prevalence from 1981 to 2010. Samples of parents and students were interviewed to describe correlates of OWOB. SETTING: Barbados. SUBJECTS: Public-school students (n 580) in class 3. RESULTS: Based on WHO BAZ, the overall prevalence of OWOB was 34·8 % (95 % CI 30·9, 38·7 %). A trend of higher OWOB prevalence was seen for girls across cut-offs, with significant sex differences noted using the International Obesity Task Force cut-offs. According to Harvard growth standards, OWOB has increased dramatically, from 8·52 % to 32·5 %. Children were more likely to be OWOB when annual household income was below BBD 9000 (OR=2·69; 95 % CI 1·21, 5·99). Eating dinner with the family every night was associated with a lower prevalence of OWOB (OR=0·56; 95 % CI 0·36, 0·87). CONCLUSIONS: The sharp increase of OWOB rates in Barbados warrants attention. Sex disparities in OWOB prevalence may emerge at a young age. Promoting family meals may be a feasible option for OWOB prevention. Understanding familial and sociodemographic factors influencing OWOB will be useful in planning successful intervention or prevention programmes in Barbados.

Cystic neutrophilic granulomatous mastitis: A case report and review of the literature.

The present study describes a case of cystic neutrophilic granulomatous mastitis. The clinical and radiological findings of the patient were consistent with idiopathic granulomatous mastitis. Cystic neutrophilic granulomatous mastitis is a rare subtype of mastitis with a distinct histological pattern that is associated with the Corynebacterium species. The diagnosis and treatment of cystic neutrophilic granulomatous mastitis remains a significant challenge due to the scarcity of available data. The present study describes a classic case of cystic neutrophilic granulomatous mastitis that includes clinical, radiological and histopathological findings. To the best of our knowledge, this is the first case documenting radiological findings before and after treatment. This report encourages the consideration of this entity in the differential diagnoses of mastitis.

Electronic based reported anthropometry-A useful tool for interim monitoring of obesity prevalence in developing states.

BACKGROUND: Wide participation in electronic surveys and reliable reporting of anthropometry can serve to reduce costs associated with monitoring of obesity among adolescents where resources are limited. We conducted a single school pilot study among Caribbean adolescents to assess use of electronic surveys and whether face to face encouragement could promote enrollment. In addition, we assessed students' ability to reliably report simple anthropometry. METHODS: Students were provided with access to an electronic survey on anthropometry and food preferences regarding school-based food offerings. Responses to survey questions were presented as percentages. A sample of students also had their heights and weights measured after reporting these measures from memory. Intra-class correlation coefficients were used to assess reliability among measurers and Bland-Altman plots, consistency between student reported and recorded anthropometric measures and Support Vector Machine to assess robustness of anthropometry prediction models. RESULTS: Response rate to the electronic survey was low (9%). Students were able to interpret questions; open-ended options were inappropriately used 13% of the time. Post survey qualitative responses indicated displeasure with use of school-associated e-mail addresses. Concerns with confidentiality were expressed as well as preference for completion of surveys during school time. Students reliably reported anthropometry most measures fell within the 95% CI of Bland-Altman plots. SVM classified with a prediction accuracy of 95%. Estimates of overweight from recorded and reported measures were similar. CONCLUSIONS: Adolescents are able to report simple anthropometry, and this can be used to help with monitoring of growth and overweight. Although they are capable of competently completing electronic surveys, school-based email is an ineffective contact tool. In-person school-based contact and administration of surveys are preferred. Adolescents can reliably report simple anthropometry that can be utilized for estimation of overweight/obesity prevalence. This method can be widely applied.

Guidelines for preoperative investigations for elective surgery at Queen Elizabeth Hospital: effects on practices, outcomes, and costs.

STUDY OBJECTIVE: We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices. DESIGN: A prospective study. SETTING: Queen Elizabeth Hospital, Barbados. PATIENTS: Participants comprised all patients undergoing general, epidural, spinal, and regional anesthesia, with the exception of emergency cases or instances where an anesthesiologist was not required. INTERVENTION: Introduction of formal guidelines for preoperative investigations. MEASUREMENTS: The patterns of preoperative testing were assessed by audit, and this assessment was repeated postintervention. PI guidelines developed were presented to all surgical departments. MAIN RESULTS: For younger patients (<60 years), the mean number of tests decreased from 3.42±1.8 in the preguideline group to 2.89±1.98 in the postguideline group (P=.042). The total number of chest x-rays decreased by 14.8% (P=.012) and full blood counts by 7.6% (P=.036). The implementation of PI guidelines led to overall savings of US $7589 per 1000 patients, which is equivalent to (US $40,745.50 per annum). The most notable savings were due to decreased number of chest x-rays. PIs were performed routinely even in the absence of clinical indications. CONCLUSION: Our findings indicate that introduction of guidelines has reduced the level of preanesthetic investigations to some extent; nevertheless, further change is desirable. In addition, costs to the institution were decreased with no compromise to patient safety.

Associations of blood pressure with body composition among Afro-Caribbean children in Barbados.

UNLABELLED: Despite complex presentation of adult hypertension and a concomitant obesity epidemic, little is known about overweight in relation to blood pressure among Caribbean children. We examined blood pressure in relation to body size in a cross-sectional study of 573 Barbadian children aged 9-10 years (2010-2011). The United States normative blood pressure percentiles were used to identify children with high (≥95th percentile) or high normal blood pressure (90th-95th percentile). The World Health Organization body mass index cut-off points were used to assess weight status. MAJOR FINDINGS: Thirty percent of children were overweight/obese. Percentage fat mass differed between girls (20.4%) and boys (17.72%) (p<0.05). Mean systolic blood pressure among girls was 106.11 (95% CI 105.05, 107.17) mmHg and 105.23 (104.09, 106.38) for boys. The percentages with high or high-normal mean systolic blood pressure were 14.38% (10.47, 18.29) for girls and 8.08% (4.74, 11.41) for boys. Height and body mass index were independent correlates of systolic and diastolic blood pressure. Mean systolic blood pressure was related to lean mass but not fat mass, while diastolic blood pressure was associated with fat mass index and overweight. PRINCIPAL CONCLUSION: One third of 9-10 year old children in Barbados were overweight/obese and 12% had elevated mean systolic blood pressure. BP was related to body size. These findings signal potential adverse trends in weight gain and BP trends for children growing up in the context of a country that has recently undergone rapid economic transition.

Early childhood nutritional status in CARICOM countries: an overview with respect to five nutrition related millennium development goals.

Previous reviews of nutritional status in children under 5 years describe the Caribbean grouped with Latin America. This paper focuses specifically on the Caribbean and the goals and targets of the Millennium Declaration that have bearing on childhood development. The results indicate that CARICOM countries have made progress in terms of child health as assessed by gross health indicators. Yet, the millennium generation experiences coexistence of undernutrition and overweight in early childhood. The associations of GNI with markers such as poverty indices are somewhat inconsistent with traditional findings and highlight a need to reassess the causes of infant mortality and low birth weight. However, a lack of systematic local data has hampered progress on an individual country basis. Interventions that deal more pointedly with country specific needs are required including those targeting obesity if the MDGs are to be attained by all member states.

Diet, physical activity, weight status, and culture in a sample of children from the developing world.

Objective. Barbados, a small developing state at the end of the nutrition transition, faces an obesity epidemic. Although there is hope of stemming the epidemic in childhood, no descriptions of children's dietary and physical activity (PA) patterns are available for planning purposes. We describe the food and activity preferences and adult encouragement of active and sedentary behaviors for children 9-11 years in relation to weight status and the cultural context. Design. We used data from a pilot study preceding a large-scale ongoing study on the local drivers of the obesity epidemic among preadolescent children. PA, sedentary activity, and dietary intakes were assessed from recalls. Weight and height were measured. Setting. Barbados. Subjects. Sixty-two (62), 9-11-year-old school children. Results. Sugar-sweetened beverages provided 21% of energy consumed. Energy intake significantly explained BMI. Parents selected significantly more of children's sedentary activities and encouraged mostly homework and chores (59%). Children's self-selected school-based activity was significantly related to BMI. Conclusions. Childhood obesity prevention recommendations and research should focus on culture-specific practices that promote acquired taste for excess sugar and parent-child interactions regarding PA. Child influenced by school-based activity intervention may an important area for preventive intervention research.

The barbados emergency ambulance service: high frequency of nontransported calls.

Objectives. There are no published studies on the Barbados Emergency Ambulance Service and no assessment of the calls that end in nontransported individuals. We describe reasons for the nontransport of potential clients. Methods. We used the Emergency Medical Dispatch (Medical Priority Dispatch System) instrument, augmented with five local call types, to collect information on types of calls. The calls were categorised under 7 headings. Correlations between call types and response time were calculated. Results. Most calls were from the category medical (54%). Nineteen (19%) percent of calls were in the non-transported category. Calls from call type Cancelled accounted for most of these and this was related to response time, while Refused service was inversely related (P = 0.01). Conclusions. The Barbados Ambulance Service is mostly used by people with a known illness and for trauma cases. One-fifth of calls fall into a category where the ambulance is not used often due to cancellation which is related to response time. Other factors such as the use of alternative transport are also important. Further study to identify factors that contribute to the non-transported category of calls is necessary if improvements in service quality are to be made.

Misperceptions, inactivity and maternal factors may drive obesity among Barbadian adolescents.

OBJECTIVES: To describe (1) the prevalence of overweight and obesity and their association with physical activity; (2) the effect of different cut-off points for body mass index (BMI) on weight status categorisation; and (3) associations of weight status with perceptions of body size, health and diet quality. DESIGN: A cross-sectional study. SETTING: Secondary schools in Barbados. SUBJECTS: A cohort of 400 schoolchildren, 11-16 years old, selected to study physical education practices. RESULTS: Prevalence of overweight (15% boys; 17% girls) and obesity (7% boys; 12% girls) was high. Maternal obesity, as defined by the International Obesity Task Force (IOTF) BMI cut-off points, predicted weight status such that reporting an obese mother increased the odds of being overweight by 5.25 (95% confidence interval: 2.44, 11.31). Physical activity was inversely associated with weight status; however levels were low. Recreational physical activity was not associated with weight status in either category. Overweight subjects tended to misclassify themselves as normal weight and those who misclassified perceived themselves to be of similar health status to normal-weight subjects. The National Center for Health Statistics and IOTF BMI cut-off points produced different estimates of overweight and obesity. CONCLUSIONS: Our findings suggest that inadequate physical activity and ignorance related to food and appropriate body size are promoting high levels of adiposity with a strong contribution from maternal obesity, which may be explained by perinatal and other intergenerational effects acting on both sexes. Prevalence studies and local proxy tools for adiposity assessment are needed.

The effects of birth weight and postnatal linear growth retardation on body mass index, fatness and fat distribution in mid and late childhood.

OBJECTIVE: To determine the effects of birth weight and early childhood stunting on body mass index (BMI), body fat and fat distribution at ages 7 and 11 years, and the change from 7 to 11 years. DESIGN: Prospective cohort study SETTING: Kingston, Jamaica. SUBJECTS: One hundred and sixteen stunted children (height-for-age below two standard deviations (<-2SD) of the National Center for Health Statistics (NCHS) references) and 190 non-stunted children (height-for-age > -1SD), identified at age 9-24 months. The stunted group was divided into a previously stunted group (height-for-age at 11 years >or= -1SD) and a chronically stunted group (height-for-age < -1SD). RESULTS: Birth weight was positively related to the children's BMI but not to measures of body fat. Birth weight was negatively associated with the subscapular/triceps skinfold (SSF/TSF) ratio at age 11 years, and to the change between 7 and 11 years. Controlling for birth weight, the chronically stunted group remained significantly smaller than the non-stunted children at both ages and increased less from 7 to 11 years in all measures except the SSF/TSF ratio, which was significantly greater at age 7 years. The previously stunted group had significantly lower BMI and percentage body fat at age 7 years than the non-stunted group. Change from 7 to 11 years was not significantly different from that of the non-stunted group except for a smaller increase in TSF. At age 11 years they had significantly lower TSF and percentage body fat. CONCLUSIONS: Children stunted in early childhood had less fat and lower BMI than non-stunted children but had a more central fat distribution that was partially explained by their lower birth weights. The association between birth weight and central fat distribution developed between 7 and 11 years.