Impact of weight management nutrition interventions on dietary outcomes in children and adolescents with overweight or obesity: a systematic review with meta-analysis.

BACKGROUND: The impact of obesity interventions on dietary intake in children and adolescents with overweight or obesity is unclear. This systematic review aimed to investigate the impact of the dietary component of weight management interventions on the change in diet in children and adolescents with overweight or obesity. METHODS: Eligible randomised controlled trials (RCTs) published between 1975 and 2020 were identified by a systematic search following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Meta-analyses of eligible study outcomes were performed using statistical software. A multilevel random effects model was used with three significant random effects fitted using restricted maximum likelihood estimation. RESULTS: This review identified 109 RCTs, including 95 that reported at least one statistically significant dietary outcome change and 14 reporting no significant dietary change. Results from the meta-analyses (n = 29 studies) indicated that, compared to control groups, intervention groups achieved significantly greater reductions in mean total energy intake at ≤6 months (-194 kcal day-1 , 95% confidence interval = -275.80 to -112.90 kcal day-1 , P < 0.001) and up to 12 months (-112 kcal day-1 95% confidence interval = -218.92 to -5.83 kcal day-1 ) P = 0.038), increases in fruit and/or vegetable intakes over 2-12 months (n = 34, range +0.6 to +1.5 servings day-1 ) and reductions in consumption of sugar-sweetened beverages (n = 28, range -0.25 to -1.5 servings day-1 ) at 4-24 months follow-up. CONCLUSIONS: Obesity interventions with a dietary component have a modest but sustained impact on reducing total energy intake and improving intakes of specific food groups in children and adolescents with overweight or obesity. High quality RCTs that are powered to detect change in diet as a primary outcome are warranted.

Metrics of progress in the understanding and management of threats to Australian birds.

Although evidence-based approaches have become commonplace for determining the success of conservation measures for the management of threatened taxa, there are no standard metrics for assessing progress in research or management. We developed 5 metrics to meet this need for threatened taxa and to quantify the need for further action and effective alleviation of threats. These metrics (research need, research achievement, management need, management achievement, and percent threat reduction) can be aggregated to examine trends for an individual taxon or for threats across multiple taxa. We tested the utility of these metrics by applying them to Australian threatened birds, which appears to be the first time that progress in research and management of threats has been assessed for all threatened taxa in a faunal group at a continental scale. Some research has been conducted on nearly three-quarters of known threats to taxa, and there is a clear understanding of how to alleviate nearly half of the threats with the highest impact. Some management has been attempted on nearly half the threats. Management outcomes ranged from successful trials to complete mitigation of the threat, including for one-third of high-impact threats. Progress in both research and management tended to be greater for taxa that were monitored or occurred on oceanic islands. Predation by cats had the highest potential threat score. However, there has been some success reducing the impact of cat predation, so climate change (particularly drought), now poses the greatest threat to Australian threatened birds. Our results demonstrate the potential for the proposed metrics to encapsulate the major trends in research and management of both threats and threatened taxa and provide a basis for international comparisons of evidence-based conservation science.

Medidas de Progreso en el Entendimiento y el Manejo de las Amenazas que Enfrentan las Aves Australianas Resumen Aunque los métodos basados en evidencias se han vuelto muy comunes para la determinación del éxito de las medidas de conservación del manejo de los taxones amenazados, hoy en día no existen medidas estandarizadas para la evaluación del progreso de la investigación o el manejo. Desarrollamos cinco medidas para cumplir con esta necesidad que tienen los taxones amenazados y para cuantificar la necesidad de una mayor acción y un alivio efectivo de las amenazas. Estas medidas (falta de investigación, éxito de la investigación, falta de manejo, éxito del manejo y porcentaje de reducción de amenazas) pueden agregarse para examinar las tendencias de un taxón individual o las tendencias de las amenazas para múltiples taxones. Probamos la utilidad de estas medidas por medio de su aplicación en aves australianas amenazadas, que parece ser la primera vez que se evalúa el progreso en la investigación y en el manejo de amenazas para el caso de varios taxones amenazados dentro de un grupo faunístico a escala continental. Se ha realizado algún tipo de investigación sobre casi tres cuartas partes de las amenazas conocidas para los taxones, y hay un claro entendimiento de cómo aliviar casi la mitad de las amenazas con el impacto más alto. Se ha intentado algún tipo de manejo con casi la mitad de las amenazas. Los resultados del manejo variaron desde ensayos exitosos hasta la mitigación completa de la amenaza, incluso para un tercio de las amenazas de alto impacto. Tanto el progreso en la investigación como en el manejo tendió a ser mayor para los taxones que estaban siendo monitoreados, o que ocurrían en islas oceánicas. La depredación por gatos tuvo el puntaje más como amenaza potencial. Sin embargo, ha habido poco de éxito en la reducción del impacto de la depredación por gatos, así que ahora el cambio climático (particularmente la sequía) es la mayor amenaza para las aves amenazadas en Australia. Nuestros resultados demuestran el potencial que tienen las medidas propuestas de encapsular las tendencias más importantes en la investigación y en el manejo tanto de las amenazas como de los taxones amenazados y de proporcionar una base para comparaciones internacionales de la ciencia de la conservación basada en evidencias.

30-year cross-sectional trends in waist-to-height ratio in Australian school age children; 1985 to 2015.

AIM: To report 30-year changes in the proportion of children with abdominal obesity measured by waist-to-height ratio (WHtR) ≥ 0.5. METHODS: Secondary analysis of WHtR ≥ 0.5 data on Australian children age 7 to 15 years from five national cross-sectional population surveys conducted in 1985, 1995, 2007, 2012 and 2015. Changes in the proportions of children with a WHtR ≥ 0.5 across survey years, by age and sex were assessed using chi-squared tests. RESULTS: Between 1985 and 2012, the proportion of children with WHtR ≥ 0.5 increased from 8.6% [95%CI: 8.0, 9.2] to 25.1% [95%CI: 23.5, 26.7]. An increase of ~5% each decade was observed between 1985 and 2007, and a 6.6% increase was observed between 2007 and 2012. Overall, there was a non-significant decrease in the proportion of children with WHtR ≥ 0.5 between 2012 (25.1% [95%CI: 23.5, 26.7] and 2015 (23.3% [95%CI: 21.6, 25.2]. CONCLUSION: Abdominal obesity has increased over the last 30 years in Australian children. In 2015, one in five children had WHtR ≥ 0.5, a marker of cardiometabolic risk in children. Our finding highlights the importance of including WHtR as a routine measurement in primary health care and population health surveys. This information is needed to guide policy and practice to manage long-term cardiovascular risk in children.

p53 loss does not permit escape from BrafV600E-induced senescence in a mouse model of lung cancer.

Lung cancer arises through the acquisition of a number of genetic lesions, with a preponderance of activating mutations in the canonical mitogen-activated protein kinase (MAPK) cascade (RTK-RAS-RAF-MEK). BrafV600E expression induces benign lung adenomas that fail to progress to adenocarcinoma because of oncogene-induced senescence (OIS). BrafV600E expression, coupled with simultaneous p53 ablation, permits bypass of senescence and progression to lung adenocarcinoma. However, spontaneous human tumors sustain mutations in a temporally separated manner. Here, we use a mouse lung cancer model where oncogene activation (BrafV600E expression) and tumor suppressor loss (p53 ablation) are independently controlled through the actions of Flp and Cre recombinase, respectively. We show that p53 loss before OIS is permissive for the transition from lung adenoma to adenocarcinoma. In contrast, p53 loss after senescence is established fails to enable escape from senescence and disease progression. This study demonstrates that BrafV600E induced senescence is irreversible in vivo and suggests that therapy-induced senescence would halt further tumor progression.

Nutritional adequacy of diets for adolescents with overweight and obesity: considerations for dietetic practice.

BACKGROUND/OBJECTIVES: Adolescents have unique nutrient requirements due to rapid growth and development. High rates of obesity in adolescents require a variety of diet interventions to achieve weight loss under clinical supervision. The aim of this study is to examine the nutritional adequacy of energy-restricted diets for adolescents. SUBJECTS/METHODS: Three popular diets were modelled for 7 days and assessed by comparing the nutrient profile to the Australian Nutrient Reference Values. Three diets were: (1) a standard energy restricted diet based on current dietary guidelines; (2) a modified carbohydrate diet; and (3) a modified alternate day fasting diet. RESULTS: Initial modelling revealed limiting nutrients (that is, not meeting the recommended intakes) across the diets. Subsequent modelling was required to achieve nutritional adequacy for all three diets. The dietary guidelines diet design met most nutrient targets except essential fatty acids before subsequent modelling, however this diet also provided the highest energy (8.8 vs 8.0 MJ and 6.8 MJ for the modified carbohydrate and modified alternate day fasting diet, respectively). CONCLUSIONS: Energy-restricted diets need careful consideration to meet nutritional requirements of adolescents. A variety of eating patterns can be adapted to achieve nutritional adequacy and energy restriction, however health practitioners need to consider adequacy when prescribing diet interventions for weight loss during adolescence.

Zinc status, dietary zinc intake and metabolic risk in Australian children and adolescents; Nepean Longitudinal Study.

PURPOSE: Zinc is essential for normal growth and metabolism. We aimed to characterise the total and bioavailable dietary zinc intake and plasma zinc concentrations in healthy children, longitudinally, and to examine the association between plasma zinc concentrations, dietary zinc intake and cardiometabolic markers in the same cohort. METHODS: A secondary data analysis of a prospective cohort study, the Nepean Longitudinal Study, which followed an Australian birth cohort at ages 8 (n = 436) and 15 years (n = 290) collecting dietary, anthropometry and biochemistry data (plasma zinc, fasting glucose, insulin and lipid profile). Diet was assessed by a 3-day food record and a food frequency questionnaire at 8 and 15 years, respectively. Zinc bioavailability was determined by the phytate/zinc molar ratio. RESULTS: At 8 years, the median zinc intake was 7.84 mg (interquartile range 6.57-9.35) for boys and 7.06 mg (5.98-8.30) for girls. Three of 345 children reported inadequate absorbable zinc intake, and none reported inadequate total zinc intake. At 15 years, median zinc intake was 11.8 mg (9.41-14.8) for boys and 8.54 mg (6.76-10.7) for girls. The prevalence of inadequate intakes of absorbable zinc and total zinc was 19 and 29 %, respectively. Plasma zinc concentration was not correlated with dietary zinc intake, adiposity nor lipids at either time point, but it was inversely correlated with fasting glucose at 8 year and with insulin at 15 years. CONCLUSIONS: Australian children had an overall adequate zinc status. However, adolescents who reported suboptimal dietary zinc intakes were more likely to have raised insulin concentrations.

Australasian nutrition research for prevention and management of child obesity: innovation and progress in the last decade.

BACKGROUND/OBJECTIVE: The Food and Nutrition stream of Australasian Child and Adolescent Obesity Research Network (ACAORN) aims to improve the quality of dietary methodologies and the reporting of dietary intake within Australasian child obesity research (http://www.acaorn.org.au/streams/nutrition/). METHODS/RESULTS: With 2012 marking ACAORN's 10th anniversary, this commentary profiles a selection of child obesity nutrition research published over the last decade by Food and Nutrition Stream members. In addition, stream activities have included the development of an online selection guide to assist researchers in their selection of appropriate dietary intake methodologies (http://www.acaorn.org.au/streams/nutrition/dietary-intake/index.php). CONCLUSIONS: The quantity and quality of research to guide effective child obesity prevention and treatment has increased substantially over the last decade. ACAORN provides a successful case study of how research networks can provide a collegial atmosphere to foster and coordinate research efforts in an otherwise competitive environment.

Waist-to-height ratio and cardiometabolic risk factors in adolescence: findings from a prospective birth cohort.

OBJECTIVE: To examine the associations between body mass index (BMI) and waist-to-height ratio (WHtR) measured in childhood and adolescence and cardiometabolic risk factors in adolescence. METHODS: Secondary data analysis of the Avon Longitudinal Study of Parents and Children, a population based cohort. Data from 2858 adolescents aged 15.5 (standard deviation 0.4) years and 2710 of these participants as children aged 7-9 years were used in this analysis. Outcome measures were cardiometabolic risk factors, including triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol, insulin, glucose and blood pressure at 15 years of age. RESULTS: Both BMI and WHtR measured at ages 7-9 years and at age 15 years were associated with cardiometabolic risk factors in adolescents. A WHtR ≥0.5 at 7-9 years increased the odds by 4.6 [95% confidence interval 2.6 to 8.1] for males and 1.6 [0.7 to 3.9] for females of having three or more cardiometabolic risk factors in adolescence. Cross-sectional analysis indicated that adolescents who had a WHtR ≥0.5, the odds ratio of having three or more cardiometabolic risk factors was 6.8 [4.4 to 10.6] for males and 3.8 [2.3 to 6.3] for females. The WHtR cut-point was highly specific in identifying cardiometabolic risk co-occurrence in male children and adolescents as well as female children (90 to 95%), but had poor sensitivity (17 to 53%). Similar associations were observed when BMI was used to define excess adiposity. CONCLUSIONS: WHtR is a simple alternative to age and sex adjusted BMI for assessing cardiometabolic risk in adolescents.

The case for fencing remains intact.

Creel et al. argue against the conservation effectiveness of fencing based on a population measure that ignores the importance of top predators to ecosystem processes. Their statistical analyses consider, first, only a subset of fenced reserves and, second, an incomplete examination of 'costs per lion.' Our original conclusions remain unaltered.

Conserving large carnivores: dollars and fence.

Conservationists often advocate for landscape approaches to wildlife management while others argue for physical separation between protected species and human communities, but direct empirical comparisons of these alternatives are scarce. We relate African lion population densities and population trends to contrasting management practices across 42 sites in 11 countries. Lion populations in fenced reserves are significantly closer to their estimated carrying capacities than unfenced populations. Whereas fenced reserves can maintain lions at 80% of their potential densities on annual management budgets of $500 km(-2) , unfenced populations require budgets in excess of $2000 km(-2) to attain half their potential densities. Lions in fenced reserves are primarily limited by density dependence, but lions in unfenced reserves are highly sensitive to human population densities in surrounding communities, and unfenced populations are frequently subjected to density-independent factors. Nearly half the unfenced lion populations may decline to near extinction over the next 20-40 years.

The prevalence of increased central adiposity in Australian school children 1985 to 2007.

The epidemic of obesity as measured by body mass index (BMI) maybe plateauing. However, studies using skin-fold and waist circumference measurements suggest that BMI may underestimate changes in fatness in children. In this study we examine changes in waist circumference and waist-to-height ratio (WHtR) in Australian children between 1985 and 2007, by undertaking secondary data analysis of three national data sets. The mean waist circumference z-score for boys increased from -0.02 (95% CI -0.05 to 0.01) in 1985, to 0.33 (0.26 to 0.40) in 1995 and 0.41 (0.35 to 0.47) in 2007 and was greater (P<0.001) than the increase in BMI z-score. The increase in mean waist circumference z-score for girls was greater (P<0.001) than boys and increased from -0.02 (0.05 to 0.01) in 1985, to 0.33 (0.26 to 0.41) in 1995 and to 0.57 (0.51 to 0.63) in 2007. The number of children with a WHtR ≥ 0.5 increased from 8.6% in 1985, to 13.6% in 1995 and 18.3% in 2007. Between 1985 and 2007 central adiposity increased at a faster rate than total adiposity, particularly in girls. The secular increase in waist circumference and WHtR is concerning as measures of central adiposity are associated with metabolic and cardiovascular risk.

Treatment of clinical insulin resistance in children: a systematic review.

The objective of this study was to evaluate the effectiveness of interventions aimed at improving clinical insulin resistance and/or pre-diabetes in children. This study is a systematic review and meta-analysis. Five electronic databases were searched for randomized controlled trials of at least 2-months' duration. The outcomes were fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), body mass index (BMI) and adverse outcomes. Four randomized controlled trials were identified. All compared the effect of 6 months of metformin plus or minus lifestyle intervention with placebo plus or minus lifestyle intervention. After pooling results from three trials, the mean difference after 6 months favoured the intervention with a statistically significant mean decrease in fasting insulin, HOMA-IR and BMI of 9.6 µU mL(-1) (95% confidence interval [CI]: 6.3, 13.0 µU mL(-1) ; I(2) = 76%), 2.7 (95% CI: 1.7, 3.6; I(2) = 74%) and 1.7 kg m(-2) (95% CI: 1.1, 2.3 kg m(-2) ; I(2) = 75) respectively. Mild gastrointestinal symptoms were reported in 19% (2-29%; median and range) of participants taking metformin. Metformin improves markers of insulin sensitivity and reduces BMI in children and adolescents with clinical insulin resistance or pre-diabetes. Stronger evidence from high-quality studies of longer duration and larger sample size are required before clinical conclusions about the optimal treatment protocol in this population can be drawn.

Do screen-detected lobular and ductal carcinoma present with different mammographic features?

The aim of this study is to investigate any difference in the shape and location of infiltrating lobular carcinoma (ILC) with respect to the parenchymal density between the cranio-caudal (CC) and medio-lateral oblique (MLO) mammographic views. Six film-readers independently re-read 59 ILC mammograms and a matched sample of 59 infiltrating ductal carcinoma (IDC) mammograms from one 3-year screening round to quantify lesion characteristics. There is fair to moderate reader agreement for parenchymal pattern, lesion shape and location (kappa = 0.41-0.60). Both ILC (33/60, 55%) and IDC (22/65, 37%) appear as a spiculate mass more often on the CC view than on the MLO view. 41% (25/60) of the ILC spiculate masses become architectural distortions or asymmetric densities on the MLO view. No more ILC lesions (4/60, 7%) are seen in dense breasts than IDC (5/65, 8%), but ILC is mainly associated with (58/60, 97%), and rarely isolated from (2/60, 3%), the main glandular density. The appearance of ILC is significantly different between the MLO and CC views (paired Wilcoxon test: z = -17.059; significance level

Rates of movement of threatened bird species between IUCN red list categories and toward extinction.

In recent centuries bird species have been deteriorating in status and becoming extinct at a rate that may be 2-3 orders of magnitude higher than in prehuman times. We examined extinction rates of bird species designated critically endangered in 1994 and the rate at which species have moved through the IUCN (World Conservation Union) Red List categories of extinction risk globally for the period 1988-2004 and regionally in Australia from 1750 to 2000. For Australia we drew on historical accounts of the extent and condition of species habitats, spread of invasive species, and changes in sighting frequencies. These data sets permitted comparison of observed rates of movement through the IUCN Red List categories with novel predictions based on the IUCN Red List criterion E, which relates to explicit extinction probabilities determined, for example, by population viability analysis. The comparison also tested whether species listed on the basis of other criteria face a similar probability of moving to a higher threat category as those listed under criterion E. For the rate at which species moved from vulnerable to endangered, there was a good match between observations and predictions, both worldwide and in Australia. Nevertheless, species have become extinct at a rate that, although historically high, is 2 (Australia) to 10 (globally) times lower than predicted. Although the extinction probability associated with the critically endangered category may be too high, the shortfall in realized extinctions can also be attributed to the beneficial impact of conservation intervention. These efforts may have reduced the number of global extinctions from 19 to 3 and substantially slowed the extinction trajectory of 33 additional critically endangered species. Our results suggest that current conservation action benefits species on the brink of extinction, but is less targeted at or has less effect on moderately threatened species.

Waist-to-height ratio: a simple option for determining excess central adiposity in young people.

Waist circumference is recommended as a means of identifying people at risk of morbidity associated with central adiposity. Yet, there are no universally agreed cut-points to determine when a waist circumference is too large in young people. In this study we examined the relation between sex- and age-specific waist circumference cut-points, the waist-to-height ratio (WHtR) cut-point of <0.5 and cardiovascular disease (CVD) risk clustering in 164 young people, mean age 14.9+/-0.2 years (mean+/-s.d.). In total 19 (11.6%) of the sample were identified as having CVD risk clustering. These young people were significantly (P<0.001) heavier and had higher body mass index (BMI) and waist circumference z-scores compared to those without CVD risk clustering. The WHtR cut-point of 0.5 estimated CVD risk clustering to a similar extent to sex- and age-adjusted cut-points for waist circumference and BMI. Young people with excess central adiposity (WHtR> or =0.5) were 11 times (OR 11.4, P<0.001), more likely to have CVD risk clustering compared to those who did not have excess central adiposity. The WHtR has several advantages; it is easy to calculate, does not require sex- and age-specific centiles and as has been previously suggested, it is a simple message, easily understood by clinicians and families, to 'keep your waist circumference to less than half your height'.

Drivers of professional mobility in the Northern Territory: dental professionals.

INTRODUCTION: Attracting and retaining an efficient allied health workforce is a challenge faced by communities in Australia and overseas. High rates of staff turnover in the professional workforce diverts resources away from core business and results in the loss of valuable skills and knowledge. Understanding what attracts professionals to a particular place, and why they leave, is important for developing effective strategies to manage turnover and maximise workforce productivity. The Northern Territory (NT) faces particular workforce challenges, in part because of its geographic location and unusual demography. Do these factors require the development of a tailored approach to recruitment and retention? This article reports on a study undertaken to examine the motivations for coming to, staying in and leaving the NT for dental professionals, and the implications of results on workforce management practices. METHODS: In 2006, dentists, dental specialists, dental therapists and dental hygienists who were working or had worked in the NT, Australia, in the recent past were surveyed to collect demographic and workforce data and to establish the relative importance of social and work-related factors influencing their migration decisions. Multivariate logistic regression models were generated to describe the demographic characteristics of dental professionals who stayed in the NT for more than 5 years and to analyse why dental professionals left. The analyses, based on a 42% response rate, explained 60-80% of the variation in responses. RESULTS: Generally dental professionals who had stayed for more than 5 years were older, had invested in the purchase of homes and were more involved in social and cultural activities. Those who moved to the NT as a result of financial incentives or who had strong expectations that working in the NT would be an exciting, novel experience tended to stay for no more than 5 years, often leaving because they found the work environment too stressful. In contrast, those who stayed longer came because they had existing social networks and were familiar with the NT environment, staying primarily because they have enjoyed the NT lifestyle, particularly the sense of community and the opportunities available through living in smaller centres. CONCLUSION: There are benefits in actively engaging newly recruited professionals and their families in social networks. Work related stress and departure was associated with administrative deficiencies within the management system. Despite the NT's unusual demographic profile, the factors influencing recruitment and retention are not markedly different from those reported elsewhere.

Soft drink consumption and excess weight gain in Australian school students: results from the Nepean study.

We studied the relation between soft drink/cordial (a sweet, flavoured, concentrated syrup that is mixed with water to taste), fruit juice/drink and milk consumption in mid-childhood, and body mass index (BMI) status in early adolescence in a contemporary Australian cohort. In 1996/7, 268 children (136 males) were recruited from western Sydney at baseline (mean+/-s.d.: 7.7+/-0.6 years), and at follow-up 5 years later (13.0+/-0.2 years). Height and weight were measured at both time periods and overweight and obesity defined using the International Obesity TaskForce criteria. Beverage consumption was calculated from a 3-day food record at baseline. Median carbohydrate intake from soft drink/cordial was 10 g higher (P=0.002) per day in children who were overweight/obese at follow-up compared to those who had an acceptable BMI at both baseline and follow-up. Intakes of soft drink/cordial in mid-childhood, but not fruit juice/fruit drink and milk, were associated with excess weight gain in early adolescence.

Increasing central adiposity: the Nepean longitudinal study of young people aged 7-8 to 12-13 y.

BACKGROUND: Estimates of the prevalence of overweight and obesity in young people are typically based on body mass index (BMI). However, BMI may not indicate the level of central adiposity. Waist circumference has therefore been recommended to identify young people at risk of morbidity associated with central adiposity. OBJECTIVE: To investigate (a) change in total and central adiposity between 7-8 and 12-13 y (b) agreement between classifying young people as overweight or obese based on total adiposity and central adiposity, and (c) risk factors associated with the development of total and central adiposity. DESIGN: Anthropometric measurements were taken on 342 children in 1996/97 and 5 y later. Risk factors examined included birth weight, physical activity, TV viewing, pubertal status, parental adiposity, diet and socio-economic status. RESULTS: Between 7-8 and 12-13 y indices of central adiposity increased more than total adiposity; waist circumference z-score increased by (mean+/-s.d.) 0.74+/-0.92 and BMI z-score increased by 0.18+/-0.67. At 12-13 y there was moderate agreement between the two measures of adiposity (weighted kappa=0.64). However, waist circumference identified a greater number of young people as overweight or obese compared to BMI (41.2 vs 29.3%, P<0.001). Adiposity status at 7-8 y, maternal obesity, and pubertal stage were the strongest predictors of BMI status at 12-13 y. Risk factors associated with increased central adiposity were similar. CONCLUSIONS: Overweight and obesity, as measured by waist circumference, is a bigger problem than is currently assessed by BMI. Targeting known risk factors for total adiposity may be an appropriate strategy for preventing increased central adiposity.

Features of the metabolic syndrome after childhood craniopharyngioma.

Obesity and multiple pituitary hormone deficiency are common complications after surgery for childhood craniopharyngioma. We hypothesized that post craniopharyngioma surgery, children are at high risk for the metabolic syndrome, including insulin resistance due to excess weight gain and GH deficiency. This study characterized body composition (anthropometry and dual energy x-ray absorptiometry) and metabolic outcomes in 15 children (10 males and 5 females; age, 12.2 yr; range, 7.2-18.5 yr) after surgical removal of craniopharyngioma. In 9 subjects, outcomes were compared with those of healthy age-, sex-, body mass index-, and pubertal stage-matched controls. Insulin sensitivity was measured by 40-min iv glucose tolerance test. Seventy-three percent of subjects were overweight or obese. Sixty-six percent had normal growth velocity without GH treatment. Subjects had increased abdominal adiposity (P = 0.008) compared with controls. However, there was no significant difference in total body fat. Subjects had higher fasting triglycerides (P = 0.02) and lower high density lipoprotein cholesterol to total cholesterol ratio (P = 0.015). Insulin sensitivity was equally reduced for subjects and controls (P = 0.86). After craniopharyngioma removal, patients had more features of the metabolic syndrome compared with controls. This could be a result of hypothalamic damage causing obesity and GH deficiency. Further studies exploring predictors of the metabolic syndrome after craniopharyngioma surgery are required.