Association of dairy intake with weight change in adolescents undergoing obesity treatment.

BACKGROUND: The role of dairy products in obesity treatment for adolescents is unclear. The study purpose was to assess the association between dairy intake and changes in BMI z-score (zBMI) during adolescent obesity treatment. METHODS: Observational study nested within a randomized control trial. Linear mixed-effects regression models were adjusted for important non-lifestyle factors then further adjusted for dietary and physical activity variables. In total, 91 adolescents were studied. RESULTS: Each serving of total dairy (ß = -0.0054, P < 0.01), unflavored milk (ß = -0.012, P < 0.01), reduced fat (ß = -0.0078, P < 0.05), and low fat/fat-free products (ß = -0.0149, P < 0.01) was associated with a decrease in zBMI over 12 months. These associations were no longer significant after adjustment for other dietary and physical activity factors. Sugar-sweetened beverage intake was inversely associated with intake of total dairy (ß = -0.186, P = 0.001), unflavored milk (ß = -0.115, P = 0.003) and low fat/fat-free dairy (ß = -0.125, P = 0.001). CONCLUSIONS: Intakes of total dairy, unflavored milk, reduced fat dairy and low fat/fat-free dairy products are associated with improved obesity treatment outcomes among adolescents. This could be due to co-occurring healthy lifestyle behaviors or to replacement of other food and beverages associated with obesity, such as sugar-sweetened beverages, by dairy products.

Body composition estimation using skinfolds in children with and without health conditions affecting growth and body composition.

BACKGROUND: Body composition prediction equations using skinfolds are useful alternatives to advanced techniques, but their utility across diverse paediatric populations is unknown. AIM: To evaluate published and new prediction equations across diverse samples of children with health conditions affecting growth and body composition. SUBJECTS AND METHODS: Anthropometric and dual-energy X-ray absorptiometry (DXA) body composition measures were obtained in children with Down syndrome (n = 59), Crohn disease (n = 128), steroid-sensitive nephrotic syndrome (n = 67) and a healthy reference group (n = 835). Published body composition equations were evaluated. New equations were developed for ages 3-21 years using the healthy reference sample and validated in other groups and national survey data. RESULTS: Fat mass (FM), fat-free mass (FFM) and percentage body fat (%BF) from published equations were highly correlated with DXA-derived measures (r = 0.71-0.98), but with poor agreement (mean difference = 2.4 kg, -1.9 kg and 6.3% for FM, FFM and %BF). New equations produced similar correlations (r = 0.85-1.0) with improved agreement for the reference group (0.2 kg, 0.4 kg and 0.0% for FM, FFM and %BF, respectively) and in sub-groups. CONCLUSIONS: New body composition prediction equations show excellent agreement with DXA and improve body composition estimation in healthy children and those with selected conditions affecting growth.

Body weight status and cardiovascular risk factors in adults by frequency of candy consumption.

BACKGROUND: Limited information is available regarding the impact of candy consumption on health. The purpose of this study was to investigate associations between typical frequency of candy consumption and body weight status and select cardiovascular risk factors among adults in the United States. METHODS: Using data collected in the 2003-2006 National Health and Nutrition Examination Surveys (NHANES), adults were categorized as infrequent (≤ 3 eating occasions [EO]/month), moderate (> 3 EO/month and ≤ 3.5 EO/week), or frequent (> 3.5 EO/week) candy consumers based on the combined frequency of chocolate and other candy consumption over the previous 12 months. Weight and adiposity status were analyzed using logistic regression models, and blood pressure, lipids, and insulin sensitivity were analyzed using linear regression models. Models were adjusted for age, sex and race/ethnicity, and also for additional covariates with potential associations with the outcomes. Appropriate statistical weights were used to yield results generalizable to the US population. RESULTS: Frequency of candy consumption was not associated with the risk of obesity, overweight/obesity, elevated waist circumference, elevated skinfold thickness, blood pressure, low density lipoprotein (LDL) or high density lipoprotein (HDL) cholesterol, triglycerides, or insulin resistance. Increased frequency of candy consumption was associated with higher energy intakes and higher energy adjusted intakes of carbohydrates, total sugars and added sugars, total fat, saturated fatty acids and monounsaturated fatty acids (p < 0.05), and lower adjusted intakes of protein and cholesterol (p < 0.001). CONCLUSIONS: Increased frequency of candy consumption among adults in the United States was not associated with objective measures of adiposity or select cardiovascular risk factors, despite associated dietary differences. Given the cross-sectional study design, however, it cannot be concluded that candy consumption does not cause obesity or untoward levels of cardiovascular risk markers. The lack of an association between frequency of candy consumption and cardiovascular risk factors could be due to reduced intake of candy among the overweight due to dieting or a health professional's recommendations. Additionally, it is important to note that the analysis was based on frequency of candy consumption and not amount of candy consumed. Longitudinal studies are needed to confirm the lack of associations between frequency of candy consumption and cardiovascular risk factors.

Prediabetic obese adolescents have a more atherogenic lipoprotein profile compared with normoglycemic obese peers.

OBJECTIVE: To compare lipoprotein profiles of prediabetic to normoglycemic obese adolescents. STUDY DESIGN: Cross-sectional study of 95 obese, pubertal adolescents (12-17 years), who underwent oral glucose tolerance test, lipid panel, and lipoprotein subclass particle analysis (nuclear magnetic resonance spectroscopy). Univariate and linear regression analyses compared prediabetic and normoglycemic groups. RESULTS: Of 95 obese adolescents enrolled in the study, 22.1% (n = 21) had prediabetes. They were similar to normoglycemic adolescents (n = 74) in age, race, body mass index, standard lipids, total low-density lipoprotein particles (LDL-P), and total high-density lipoprotein particles (HDL-P). However, prediabetics had higher concentrations of small LDL-P (714.0 ± 288.0 vs 537.7 ± 266.5 nmol/L, P = .01) and smaller LDL-P size (20.73 ± 0.41 vs 21.18 ± 0.65 nm, P = .003), than normoglycemic youth. Prediabetics had higher small HDL-P (18.5 ± 3.8 vs 16.6 ± 3.9 umol/L, P = .046), lower large HDL-P (4.49 ± 2.0 vs 6.32 ± 2.6 umol/L, P = .004), and smaller HDL-P size (8.73 ± 0.31 vs 9.01 ± 0.39 nm, P = .003). After adjusting for demographics, Tanner stage, and body mass index using multiple linear regression, all differences remained significant except for small HDL-P. After additional adjustment for Homeostasis Model Assessment-Insulin Resistance Index, only LDL-P size difference remained significant. CONCLUSION: Obese prediabetic adolescents have a significantly more atherogenic lipoprotein profile compared with obese normoglycemic peers. Prediabetic adolescents may benefit from more aggressive interventions to decrease future cardiovascular risk.

Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis.

To assess the predictive ability of infant weight gain on subsequent obesity we performed a meta-analysis of individual-level data on 47,661 participants from 10 cohort studies from the UK, France, Finland, Sweden, the US and Seychelles. For each individual, weight SD scores at birth and age 1 year were calculated using the same external reference (British 1990). Childhood obesity was defined by International Obesity Task Force criteria. Each +1 unit increase in weight SD scores between 0 and 1 year conferred a twofold higher risk of childhood obesity (odds ratio = 1.97 [95% confidence interval (CI) 1.83, 2.12]), and a 23% higher risk of adult obesity (odds ratio = 1.23 [1.16, 1.30]), adjusted for sex, age and birthweight. There was little heterogeneity between studies. A risk score for childhood obesity comprising weight gain 0-1 year, mother's body mass index, birthweight and sex was generated in a random 50% selection of individuals from general population cohorts with available information (n = 8236); this score showed moderate predictive ability in the remaining 50% sample (area under receiving operating curve = 77% [95% CI 74, 80%]). A separate risk score for childhood overweight showed similar predictive ability (area under receiving operating curve = 76% [73, 79%]). In conclusion, infant weight gain showed a consistent positive association with subsequent obesity. A risk score combining birthweight and infant weight gain (or simply infant weight), together with mother's body mass index and sex may allow early stratification of infants at risk of childhood obesity.

Child-feeding practices among Chinese-American and non-Hispanic white caregivers.

This study compared child-feeding and related practices with child weight status between Chinese-American and non-Hispanic white caregivers who attended three community health centers. Study participants were caregivers of 50 Chinese-American and 108 non-Hispanic white children aged 2-12 years who completed a short version of the child feeding questionnaire in English or Chinese. The feeding behaviors assessed were concern, pressure, restriction, and monitoring. Child body mass index (BMI) z-scores were calculated from child weight and height measured in clinic by clinicians trained in anthropometrics. The sample was stratified into 2-5 and 6-12 years age groups to account for developmental differences. Internal consistency (Cronbach's alpha) was moderate to high and similar by ethnicity for all four behaviors for Chinese-Americans and non-Hispanic whites. In models adjusted for confounding variables, Chinese-American caregivers had higher mean scores than non-Hispanic white caregivers for concern and restriction in all age groups and monitoring in 2-5 year-olds. No feeding practices were associated with child BMI in Chinese-Americans; concern and restriction were associated with child BMI in non-Hispanic whites in 2-5 year-olds. These results suggest that differences in child-feeding practices exist between Chinese-American and non-Hispanic white caregivers.

Adolescent obesity prevention in Botswana: beliefs and recommendations of school personnel.

The study's objectives were to gain school personnel's (1) perceptions on diet, physical activity, body size, and obesity, (2) description of school food and physical activity practices, and (3) recommendations for programs to prevent adolescent obesity. The study took place in six junior secondary schools of varying socioeconomic status in Gaborone, Botswana. Using a qualitative descriptive design, semistructured interviews were conducted with key school personnel. Directed content analysis was used to summarize the findings. School personnel believed that obesity was an important problem. They felt that school food was unhealthy and that physical activity was provided insufficiently. Participants shared enthusiasm for a school-based health-promoting intervention that must be fun and include active engagement and education on healthy lifestyles for all students. Participants supported on-site food shop inventory changes and physical activity programs. Potential barriers listed were schools' financial resources, interest of students, and time limitations of all involved.

Socio-economic status and urbanization are linked to snacks and obesity in adolescents in Botswana.

OBJECTIVE: To describe patterns of food consumption associated with overweight/obesity (OW/OB) and their links to socio-economic status (SES) and urbanization. DESIGN: A nationwide cross-sectional survey. SETTING: Secondary schools in cities, towns and villages in Botswana, Africa. SUBJECTS: A total of 746 adolescent schoolchildren. RESULTS: OW/OB is associated with greater SES, city residence and a snack-food diet pattern. Students belonging to higher SES compared with those from a lower SES background reported significantly (P < 0·01) more daily servings of snack foods (1·55 v. 0·76) and fewer servings of traditional diet foods (0·99 v. 1·68) and also reported that they ate meals outside the home more often (90% v. 72%). Students in cities ate significantly (P < 0·01) more servings of snacks (1·69 v. 1·05 v. 0·51) and fewer servings of traditional foods (0·67 v. 1·52 v. 1·61) compared with those in urban and rural villages. The odds of OW/OB were increased 1·16-fold with a snack-food diet, a result that was diminished when controlled for SES. CONCLUSIONS: These data suggest that nutritional transition occurs at different rates across urbanization and SES levels in Botswana. In cities, increasing the availability of fruit while reducing access to or portion sizes of snack items is important. Emphasis on continued intake of traditional foods may also be helpful as rural areas undergo economic and infrastructural development.

Early growth patterns and long-term obesity risk.

PURPOSE OF REVIEW: This review is an update on recent findings regarding early growth patterns and later obesity. These data are important because the potential programming of obesity in early life provides hope for new prevention strategies targeting early growth for long-term benefits. RECENT FINDINGS: Recent findings regarding the association of childhood or adulthood obesity with fetal growth, gestational weight gain, maternal diabetes, or infancy weight gain are reviewed. Some related outcomes and potential mechanisms are also described. Most studies remain observational and confirm previous findings, but some intervention studies have begun to appear in the recent literature and support some, but not other, observed associations. SUMMARY: Past and recent findings confirm the association of early growth patterns with obesity. However, causality must be demonstrated and safety must be established before translating these findings into public health recommendations.

A descriptive study of complications of gastrostomy tubes in children.

OBJECTIVES: The purpose of this study was to determine the number and types of complications experienced by children with gastrostomy tubes. METHODS: This is a prospective study of children with gastrostomy tube complications. Enrollment occurred on the first 24 months of the study. Data were collected for 4 years, beginning at the enrollment of the first participant. Demographic data and information on infections, granulation tissue formation, and major complications were recorded. RESULTS: Infections occurred in 37% of patients, with most experiencing a single infection that occurred within the first 15 days after tube placement. Granulation tissue developed in 68% of patients, with 17% experiencing recurrent granulation tissue despite treatment. There was no difference in infection rates or granulation tissue formation between subgroups based on gender, ethnicity, or parents' education level. Major complications occurred in 4% of the patients. CONCLUSION: Complications of infection and granulation tissue occur frequently and likely are a cause of stress and increased burden of care for these children and families. Improved strategies for care are needed.

Increasing prevalence of overweight among Seychelles children, 1998-2002.

To examine the prevalence and trends in excess weight among children in the Seychelles. Serial surveys of weight and height were conducted each year between 1998-2002 in all students attending four school grades (crèche, 4th, 7th and 10th years of compulsory school). Overweight and obesity were defined using age-specific body mass index (BMI) criteria of the International Obesity Task Force. Two questions explored physical activity at leisure time and daily walking time. From an eligible total of 32 077 observations between 1998-2002, data were available in 22 694 (71%), which corresponded to 17 627 separate children. Median age in the four grades was respectively 5.5, 9.2, 12.6, and 15.8 years. The overall prevalence of excess weight ('overweight' and 'obese' categories combined) was 10.5% in boys and 16.4% in girls. From 1998 to 2002, the prevalence of excess weight increased from 8.4% to 11.8% in boys and from 11.9% to 18.4% in girls. The increase of excess weight over calendar years was particularly marked among the younger children. Only a quarter of children reported walking at least 30minutes per day. Leisure physical activity was inversely associated with excess body weight. The prevalence of excess body weight was high among school children of Seychelles and increased substantially over a five-year period. This calls for prompt and energetic policies and programs to promote physical activity and healthy nutrition among children.

Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: a scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the expert panel on population and prevention science).

Obesity is a major influence on the development and course of cardiovascular diseases and affects physical and social functioning and quality of life. The importance of effective interventions to reduce obesity and related health risks has increased in recent decades because the number of adults and children who are obese has reached epidemic proportions. To prevent the development of overweight and obesity throughout the life course, population-based strategies that improve social and physical environmental contexts for healthful eating and physical activity are essential. Population-based approaches to obesity prevention are complementary to clinical preventive strategies and also to treatment programs for those who are already obese. This American Heart Association scientific statement aims: 1) to raise awareness of the importance of undertaking population-based initiatives specifically geared to the prevention of excess weight gain in adults and children; 2) to describe considerations for undertaking obesity prevention overall and in key risk subgroups; 3) to differentiate environmental and policy approaches to obesity prevention from those used in clinical prevention and obesity treatment; 4) to identify potential targets of environmental and policy change using an ecological model that includes multiple layers of influences on eating and physical activity across multiple societal sectors; and 5) to highlight the spectrum of potentially relevant interventions and the nature of evidence needed to inform population-based approaches. The evidence-based experience for population-wide approaches to obesity prevention is highlighted.

Increased prevalence of abnormal glucose tolerance among obese siblings of children with type 2 diabetes.

OBJECTIVE: To test the hypothesis that overweight siblings of children with type 2 diabetes mellitus (T2DM) have a higher prevalence of abnormal glucose tolerance (AGT) compared with other overweight children. STUDY DESIGN: This was a cross-sectional study of overweight (body mass index [BMI] >or= 95(th) percentile) subjects, age 8 to 17 years, with at least 1 sibling age >or= 12 years. The primary outcome was AGT, as assessed by the oral glucose tolerance test (2-hour glucose >or= 140 mg/dL). The secondary outcome was insulin resistance by homeostasis model assessment (HOMA). RESULTS: The sibling (n=20) and control (n=42) groups were similar in terms of age, sex, racial distribution (largely African American), pubertal status, and BMI. The prevalence of AGT in the sibling group was 40.0% (n=8), compared with 14.3% (n=6) in controls (P= .048, Fisher exact test; unadjusted odds ratio=4.0; 95% confidence interval=1.2 to 13.5). Univariate analysis did not identify confounders for either outcome. There were no significant differences in HOMA or hemoglobin A1c between the 2 groups. CONCLUSIONS: Overweight siblings of children with T2DM had 4 times greater odds of having AGT compared with other overweight children. This group may represent a particularly high-risk population to target for screening and pediatric T2DM prevention.

Ethnic and sex differences in the association between metabolic syndrome and suspected nonalcoholic fatty liver disease in a nationally representative sample of US adolescents.

OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized among overweight adolescents. Metabolic syndrome often coexists with NAFLD in adults. This study aimed to determine whether, in US adolescents, metabolic syndrome increases the odds of alanine aminotransferase (ALT)>40 U/L, a surrogate for NAFLD. MATERIALS AND METHODS: A cross-sectional study of the association between metabolic syndrome and ALT>40 U/L was undertaken in a sample of 12- to 19-year-olds from the National Health and Nutrition Examination Survey, 1999 to 2002, representative of the US adolescent population. Subjects were excluded for incomplete data, pregnancy, steroid or hepatotoxic drug use, cholestasis or viral hepatitis, and alcohol intake. The metabolic syndrome was defined by adult criteria adapted for pediatric body size and blood pressure. The association of metabolic syndrome with ALT>40 U/L, effect modifiers, and confounders were analyzed using National Health and Nutrition Examination Survey sampling weights. RESULTS: Of 4902 adolescents, the 1323 included were similar to the excluded ones, except for the important variable sex (55% vs 49% male, P=0.03, respectively). The metabolic syndrome was associated with ALT>40 U/L (odds ratio [OR] 16.7, confidence interval [CI] 6.2-45.1, P<0.001) with significant interaction by sex: OR 20.4 (CI 6.2-66.7, P<0.001) for males versus 3.1 (CI 0.4-25.1, P=0.3) for females. Further stratification of males suggested interaction by ethnicity: OR 5.0 (CI 1.3-19.0, P=0.02) for Hispanics versus 34.3 (CI 7.61-55.4, P<0.001) for non-Hispanics. Among Hispanic males, adjustment for body mass index z score explained the association (OR 0.6; CI 0.1-2.9, P=0.5), whereas among non-Hispanic males, the association remained after adjustment for BMIz (OR 11.1; CI 3.2-38.0, P<0.001). CONCLUSIONS: Metabolic syndrome is strongly associated with ALT>40 U/L in US male adolescents. Body mass index z score explained this association among Hispanics, but not among non-Hispanic males. Significant sex and ethnic differences exist in the association of pediatric metabolic syndrome with elevated ALT.

The relationship between birth weight and feeding maturation in preterm infants.

AIM: To report changes in ingestive behaviour from 35 to 40 weeks post-conceptual age and examine the association between birth weight and feeding maturation in preterm infants. METHODS: One hundred and four preterm infants born 24 to 34 weeks gestational age were studied. Feeding maturation was assessed as the change from 35 to 40 weeks post-conceptual age in the number of sucks over 5 min, sucking bursts, sucks per burst, time between bursts and maximum pressure during a suck (Pmax). The association between birth weight and each sucking behaviour was examined after adjusting for potential confounders. RESULTS: Significant changes in feeding maturation occurred between 35 and 40 weeks. Birth weight was positively associated with change in Pmax and change in number of sucks per burst for extremely premature infants born 24 to <29 weeks gestational age but not for very premature infants born >/=29 to 34 weeks. The association between birth weight and change in Pmax for extremely premature infants remained significant after adjustment (adjusted beta = 0.128 mmHg increase in change in maximum sucking pressure per every 1 g of birth weight, 95% CI = 0.017, 0.239, p = 0.03). CONCLUSION: Birth weight is positively associated with maturation in maximum sucking pressure among infants born extremely premature.

Leptin levels among prepubertal children with Down syndrome compared with their siblings.

OBJECTIVES: To compare levels of leptin and other obesity-related hormones in prepubertal children with Down syndrome (DS), a population at high obesity risk, and those in unaffected siblings to better understand the pathophysiology of obesity in children with DS. STUDY DESIGN: This was a cross-sectional study of 35 children with DS and 33 control siblings, ages 4 to 10 years, with a fasting blood sample and anthropometric measurements to estimate body composition. Generalized estimating equations were used to account for the lack of independence between siblings. RESULTS: In addition to having higher body mass index and percent body fat, children with DS had higher leptin levels than unaffected siblings, even after adjustment for age, sex, race, and ethnicity (difference, 5.8 ng/mL; 95% CI, 2.4-9.3; P = .001) and further adjustment for percent body fat (difference, 2.7 ng/mL; 95% CI, 0.08-5.40, P = .04). Leptin and percent body fat were positively associated in both groups (P < .0001), but with a significantly greater positive association in the DS group, suggesting a significant effect modification (P < .0001). CONCLUSIONS: This group of children with DS had increased leptin levels for percent body fat than their unaffected siblings. This difference may contribute to the increased risk for obesity in children with DS.

Risk for active tuberculosis in inflammatory bowel disease patients.

BACKGROUND & AIMS: The primary aim of this study was to determine the incidence of active tuberculosis in an inflammatory bowel disease population compared with the general population before the availability of infliximab. METHODS: We performed a retrospective cohort study with the General Practice Research Database from January 1988-October 1997. Ulcerative colitis and Crohn's disease subjects with a minimum of 1 year of follow-up were matched to randomly selected subjects from the remaining population on year of birth (+/-5 years), sex, and primary care practice at ratio of 1:4. Active tuberculosis was determined by tuberculosis diagnostic codes. The incidence of active tuberculosis in the inflammatory bowel disease population and the relative risk for active tuberculosis in inflammatory bowel disease population compared with the general population were calculated. Multivariate logistic regression analysis was performed to adjust for confounders. RESULTS: There were 16,213 inflammatory bowel disease subjects and 66,512 control subjects. The annual incidence of active tuberculosis was 20/100,000 in inflammatory bowel disease subjects compared with 9/100,000 in control subjects, yielding an unadjusted relative risk for active tuberculosis of 2.36 (95% confidence interval, 1.17-4.74). Adjusting for confounders, corticosteroid use and smoking, the odds ratio of inflammatory bowel disease for active tuberculosis was 1.88 (95% confidence interval, 0.68-5.20). CONCLUSIONS: During the pre-infliximab era, inflammatory bowel disease subjects appeared to be at higher risk for active tuberculosis than the general population, with immunosuppressant medications likely the main reason for this increased risk.