Sleep problems in urban, minority, early-school-aged children more prevalent than previously recognized.

OBJECTIVES: To use the children's sleep habits questionnaire (CSHQ) to characterize sleep problems in a group of 5- to 6-year-old minority children living in urban communities and to compare our findings with data from 5- to 6-year-old children in the original CSHQ validation study. METHODS: A cross-sectional study design was used to collect sleep data from parents using the CSHQ. RESULTS: The CSHQ was completed by 160 parents; 150 (94%) scored ≥41, indicating a sleep problem. The prevalence of having sleep problems for our minority community sample was significantly higher than the original community sample (94% vs. 23%, P < .001). The minority sample also had significantly higher mean total CSHQ scores (51.5 vs 37.9, P < .001) and higher scores across all 8 subscales of the CSHQ (P < .001 for all comparisons). CONCLUSIONS: The results suggest that sleep problems may be more prevalent in urban, early-school-aged minority children than previously reported.

Patterns of moderate and vigorous physical activity in obese and overweight compared with non-overweight children.

OBJECTIVE: We determined whether overweight and obese children performed less combined moderate and vigorous physical activity (MVPA), less vigorous physical activity (VPA) alone, and had distinct patterns of sustained MVPA or VPA compared with non-overweight children. METHODS: We monitored 106 children (aged 8 to 10 years) for 7 consecutive days using accelerometers. Differences in mean daily MVPA and VPA were assessed by comparing non-overweight (NOW) with overweight and obese (OW/OB) participants using descriptive statistics and regression analysis. We used an algorithm to identify periods of consecutive minutes where MVPA or VPA was continuous, called bouts. We then compared the bouts performed by NOW versus OW and OB participants with respect to the mean of the counts·minute(-1) for the minutes included in the bout, their mean length in minutes, and the number of MVPA bouts performed in sequence. RESULTS: The non-overweight group averaged 143 minutes of MVPA per day versus 120 minutes among the OW/OB (p=0.004). The OW/OB group had fewer MVPA bouts per day compared with the NOW (11.6 versus17.6, p=0.012). Fewer VPA bouts were associated with greater body mass index z-score (p<0.001). The NOW children had more intense body motion during MVPA bouts and performed a greater proportion of MVPA bouts in sequences of five or more consecutive bouts, compared with the OW/OB (p=0.05 and p=0.002, respectively). CONCLUSIONS: In addition to performing less physical activity, we found that obese and overweight children had distinct patterns of MVPA and VPA bouts compared with non-overweight peers.

Do self- or parent-reported dietary, physical activity, and sedentary behaviors predict worsening obesity in children?

OBJECTIVE: To determine whether information gathered during routine healthcare visits regarding obesity related risk factors and risk behaviors predicts increases in BMI z-score over time among overweight and obese children. STUDY DESIGN: Medical records from 168 overweight and 441 obese patients seen for repeated visits between September 2003 and April 2006 were examined for reported dietary, physical activity, and sedentary behaviors, family history of obesity and diabetes mellitus, documented Acanthosis nigricans, and BMI values. Random-effects regression analysis was done to determine whether demographic, familial, or behavioral data predicted changes in BMI z-score over time. RESULTS: The presence of A nigricans and a family history of obesity were associated with an increase in BMI z-score (beta=0.56, SE=0.09, P<.001 and beta=0.31, SE=0.13, P=.021). These risk factors explained 8% and 7% of the variation in BMI z-score respectively. Self- or parent-reported dietary and physical activity behaviors did not predict change in BMI z-score. CONCLUSIONS: Our findings suggest that the risk factors and self- or parent-reported risk behaviors routinely assessed by pediatric clinicians have limited ability to predict future growth trends, demonstrating the difficulty in determining which patients have the greatest risk of progression of obesity.

Greater lean tissue and skeletal muscle mass are associated with higher bone mineral content in children.

BACKGROUND: To compare the relationship of skeletal muscle mass with bone mineral content in an ethnically diverse group of 6 to 18 year old boys and girls. METHODS: 175 healthy children (103 boys; 72 girls) had assessments of body mass, height, and Tanner stage. Whole body bone mineral content, non-bone lean body mass (nbLBM), skeletal muscle mass, and fat mass were assessed using dual-energy X-ray absorptiometry (DXA). Muscle mass was estimated from an equation using appendicular lean soft tissue measured by DXA, weight and height. Estimates of skeletal muscle mass and adipose tissue were also assessed by whole body multi-slice magnetic resonance imaging (MRI). Linear regression was used to determine whether skeletal muscle mass assessed by DXA or by MRI were better predictors of bone mineral content compared with nbLBM after adjusting for sex, age, race or ethnicity, and Tanner stage. RESULTS: Greater skeletal muscle mass was associated with greater bone mineral content (p < 0.001). The skeletal muscle mass assessed by MRI provided a better fitting regression model (determined by R2 statistic) compared with assessment by DXA for predicting bone mineral content. The proportion of skeletal muscle mass in nbLBM was significantly associated with greater bone mineral content adjusted for total nbLBM. CONCLUSIONS: This study is among the first to describe and compare the relationship of skeletal muscle to bone using both MRI and DXA estimates. The results demonstrate that the use of MRI provides a modestly better fitting model for the relationship of skeletal muscle to bone compared with DXA. Skeletal muscle had an impact on bone mineral content independent of total non-bone lean body mass. In addition, Hispanics had greater bone mineral content compared to other race and ethnic groups after adjusting for sex, age, adipose tissue, skeletal muscle mass, and height.

Applying practice recommendations for the prevention and treatment of obesity in children and adolescents.

To describe pediatric clinicians' adherence to practice recommendations for obesity prevention and treatment, we conducted a cross-sectional analysis of 227 medical records of 3- to 18-year-old patients (seen from September 2003 to April 2004) and a longitudinal analysis of data from 632 overweight and obese patients (followed through March 2006). The cross-sectional analysis showed that early practice adopters (n = 3) more frequently recorded BMI (91% of patients), a diagnosis (89%), and counseling (82%) compared with late adopters (n = 9; 34%, 51%, and 48% of patients, respectively; P < .001). The longitudinal analysis showed that among overweight and obese patients, documentation of BMI dropped from 96% at the first clinic visit to 27% by the fifth visit; documentation of individual risk behaviors fell from >or=72% at the first visit to

An algorithm for identifying physical activity patterns from motion data.

An algorithm was developed to describe how physical activity (PA) patterns relate to overall motion counts. Thirty-five children wore an accelerometer (7-days). Each motion count was compared with the mean of surrounding counts within 21 min. Counts per minute similar to the mean were grouped into bouts. Counts that differed by more than 20% of the coefficient of variations (based on the mean and SD of the 21 min period) indicated transitions between bouts. Children with more daily motion had more and longer moderate (MPA) and vigorous (VPA) bouts, higher counts during MPA bouts, and more transitions from VPA to VPA bouts. In addition to differences in PA levels, highly active and less active children perform PA differently.

Diagnosis, evaluation, and treatment of childhood obesity in pediatric practice.

OBJECTIVE: To determine rates of diagnosis and treatment, and types of treatment, among overweight children in clinical practice. DESIGN: Six hundred randomly selected records were reviewed. SETTING: Two community-based and 2 hospital-based clinics in New Haven. PARTICIPANTS: Children aged 3 to 17 years with a health maintenance visit from January 1, 1999, to December 31, 2000. Children classified according to body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) lower than the 85th percentile were designated as nonoverweight; 85th to 94th percentile, at risk of overweight; and 95th percentile or greater, overweight. MAIN OUTCOME MEASURES: We examined the text of the encounter note for documentation of BMI, corresponding diagnosis regarding overweight, examination for comorbid disease, and treatment for overweight. RESULTS: Among 600 patients, 52.6% were male, 34.5% were black, 35.1% were Latin American, 57.2% were in single-parent households, and 84.0% received Medicaid. Overall, 39.8% were at risk of overweight (n = 107; range across sites, 14.7%-20.0%) or were overweight (n = 132; range across sites, 18.0%-28.0%). The BMI was documented in 0.5% (n = 3) of medical records. Among the 239 children at risk of overweight or overweight, 20.5% had a documented diagnosis (range, 12%-37%) and 16.9% had documented treatment (range, 6%-34%). The most common strategies among the 41 subjects with documented treatment (overweight and at risk of overweight patients) were diet (74%) and increased activity (49%). Treatment recommendations were often limited to general advice (eg, "recommended diet" [n = 19] or "increase exercise" [n = 16]). CONCLUSION: Despite a high burden of overweight, routine screening with BMI was not documented and few children received a formal diagnosis or treatment.