Evaluation and refinement of the PRESTARt tool for identifying 12-14 year olds at high lifetime risk of developing type 2 diabetes compared to a clinicians assessment of risk: a cross-sectional study.

BACKGROUND: Traditionally Type 2 Diabetes Mellitus (T2DM) was associated with older age, but is now being increasingly diagnosed in younger populations due to the increasing prevalence of obesity and inactivity. We aimed to evaluate whether a tool developed for community use to identify adolescents at high lifetime risk of developing T2DM agreed with a risk assessment conducted by a clinician using data collected from five European countries. We also assessed whether the tool could be simplified. METHODS: To evaluate the tool we collected data from 636 adolescents aged 12-14 years from five European countries. Each participant's data were then assessed by two clinicians independently, who judged each participant to be at either low or high risk of developing T2DM in their lifetime. This was used as the gold standard to which the tool was evaluated and refined. RESULTS: The refined tool categorised adolescents at high risk if they were overweight/obese and had at least one other risk factor (High waist circumference, family history of diabetes, parental obesity, not breast fed, high sugar intake, high screen time, low physical activity and low fruit and vegetable intake). Of those found to be at high risk by the clinicians, 93% were also deemed high risk by the tool. The specificity shows that 67% of those deemed at low risk by the clinicians were also found to be a low risk by the tool. CONCLUSIONS: We have evaluated a tool for identifying adolescents with risk factors associated with the development of T2DM in the future. Future work to externally validate the tool using prospective data including T2DM incidence is required.

Prevention of childhood obesity: recruiting strategies via local paediatricians and study protocol for a telephone-based counselling programme.

AIM: Prevention research has to elucidate how families with overweight children can be convinced to participate in obesity intervention trials. Here we describe the detailed recruitment process for a telephone-based obesity prevention programme for families with overweight children and present participation rates, the study design and a socio-demographic description of participating families. METHODS: Overweight (BMI > 90th percentile) children and adolescents 4-17 years of age were screened via the German paediatrician network CrescNet. The prevention programme (multiple computer aided telephone counselling interviews) was suggested to eligible families via local paediatricians. Participating families were compared anthropometrically and socio-demographically to the entire screening population and to micro-census data, a representative national survey. RESULTS: The screening process assessed 4005 candidates for eligibility. Paediatricians reported having suggested programme participation to 3387 candidates (referred to as 100%). 427 candidates (12.6%) returned a written consent for programme participation. 303 candidates (9.0%) started the intervention. The study population (n = 303) included more obese (45.6% vs. 33.2%; p < 0.001) and fewer overweight participants (40.4% vs. 55.2%; p < 0.001) than the entire screening population. Compared to the micro-census, families with adolescents (8.2% vs. 16.9%; p < 0.001) and single parents (16.0% vs. 23.3%; p < 0.005) were underrepresented in the study population, whereas families living in rural areas were overrepresented (58.7% vs. 50.2%; p < 0.005). CONCLUSIONS: Although 84.6% of the paediatricians forwarded the suggestion for programme participation to eligible families, participation rates for this low-threshold; telephone-based obesity intervention remained very low. "Hard-to-engage groups" for effective obesity prevention seem to include single parents, as well as parents of adolescents.

Physical activity in 3-6 year old children measured by SenseWear Pro®: direct accelerometry in the course of the week and relation to weight status, media consumption, and socioeconomic factors.

BACKGROUND: Data on objectively measured physical activity (PA) in preschoolers are controversial. Direct accelerometry was performed in children aged 3-6 years, and differences in PA patterns over the course of the week were evaluated. Data were analyzed with gender, BMI, lifestyle, and socioeconomic parameters as covariates. METHODS: PA was measured in 119 children by the SensewearPro® accelerometer and analyzed in the 92 (40 girls) that wore it for at least 4 days including one day of the weekend. Median measuring time in this group was 7 consecutive days (median/mean daily measuring time: 23.5 h/d and 21.8 h/d, respectively), corresponding to 834,000 analyzed minutes. PA questionnaires were completed by 103 parents and 87 preschool teachers to collect anthropometric, lifestyle, and socioeconomic data. RESULTS: Median daily PA (MET>3) was 4.3 hours (mean: 4.4 hours). Boys spent an estimated 52 min/week more being very active (MET>6) than girls (95% CI [6, 96] min/week, p = 0.02). PA was lower during the weekend (3.7 h/d) compared to weekdays (4.5 h/d), p = 3 × 10(-6)), where a 95% CI for the difference is [0.5, 1.0] h/d. PA levels did not differ between overweight/obese children (median 4.7 h/d) and normal-weight peers (median 4.2 h/d). Daily media consumption increased with decreasing social class on weekdays (p = 0.05) and during the weekend (p = 0.01), but was not related to the amount of daily PA. A multivariate regression with BMI-SDS as independent variable and gender, age, amount of PA>6 MET, parental BMI, media time and socioeconomic status as explanatory variables revealed that only SES had a significant contribution. CONCLUSION: The negative impact of obesity-promoting factors in older children is rather low for preschoolers, but there is evidently a gradient in PA between weekdays and weekends already in this age group. Weight status of preschoolers is already considerably influenced by SES, but not physical activity levels.

Pharmacoeconomics of obesity management in childhood and adolescence.

The level of fatness of a child at which morbidity acutely increases is operationally determined by calculating the body mass index (BMI). An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been > 75(th) percentile as adolescents. Childhood obesity seems to substantially increase the risk of subsequent morbidity whether or not obesity persists into adulthood. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidaemia, back pain and psychosocial problems. Environmental/exogenous factors largely contribute to the development of body fatness early in life. Therapeutic strategies include psychological and family therapy, lifestyle/behaviour modification and nutrition education. The role of regular exercise and exercise programmes is emphasised. Surgical procedures and drugs used in adult obesity are not generally recommended in children and adolescents. Appetite suppressants and thermogenic drugs have not been approved for use in children. Digestive inhibitors such as lipase inhibitors and fat substitutes have been used in children and adolescents in off-label use and in only a few clinical studies. As obesity is the most common chronic disorder in the industrialised societies, its impact on individual lives, as well as on health economics, has to be recognised more widely. One should aim to increase public awareness of the ever increasing health burden and economic dimension of the childhood obesity epidemic that is present around the globe.