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1.
PLoS Med ; 17(8): e1003182, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32810184

RESUMO

BACKGROUND: Fetal smoke exposure is a common and key avoidable risk factor for birth complications and seems to influence later risk of overweight. It is unclear whether this increased risk is also present if mothers smoke during the first trimester only or reduce the number of cigarettes during pregnancy, or when only fathers smoke. We aimed to assess the associations of parental smoking during pregnancy, specifically of quitting or reducing smoking and maternal and paternal smoking combined, with preterm birth, small size for gestational age, and childhood overweight. METHODS AND FINDINGS: We performed an individual participant data meta-analysis among 229,158 families from 28 pregnancy/birth cohorts from Europe and North America. All 28 cohorts had information on maternal smoking, and 16 also had information on paternal smoking. In total, 22 cohorts were population-based, with birth years ranging from 1991 to 2015. The mothers' median age was 30.0 years, and most mothers were medium or highly educated. We used multilevel binary logistic regression models adjusted for maternal and paternal sociodemographic and lifestyle-related characteristics. Compared with nonsmoking mothers, maternal first trimester smoking only was not associated with adverse birth outcomes but was associated with a higher risk of childhood overweight (odds ratio [OR] 1.17 [95% CI 1.02-1.35], P value = 0.030). Children from mothers who continued smoking during pregnancy had higher risks of preterm birth (OR 1.08 [95% CI 1.02-1.15], P value = 0.012), small size for gestational age (OR 2.15 [95% CI 2.07-2.23], P value < 0.001), and childhood overweight (OR 1.42 [95% CI 1.35-1.48], P value < 0.001). Mothers who reduced the number of cigarettes between the first and third trimester, without quitting, still had a higher risk of small size for gestational age. However, the corresponding risk estimates were smaller than for women who continued the same amount of cigarettes throughout pregnancy (OR 1.89 [95% CI 1.52-2.34] instead of OR 2.20 [95% CI 2.02-2.42] when reducing from 5-9 to ≤4 cigarettes/day; OR 2.79 [95% CI 2.39-3.25] and OR 1.93 [95% CI 1.46-2.57] instead of OR 2.95 [95% CI 2.75-3.15] when reducing from ≥10 to 5-9 and ≤4 cigarettes/day, respectively [P values < 0.001]). Reducing the number of cigarettes during pregnancy did not affect the risks of preterm birth and childhood overweight. Among nonsmoking mothers, paternal smoking was associated with childhood overweight (OR 1.21 [95% CI 1.16-1.27], P value < 0.001) but not with adverse birth outcomes. Limitations of this study include the self-report of parental smoking information and the possibility of residual confounding. As this study only included participants from Europe and North America, results need to be carefully interpreted regarding other populations. CONCLUSIONS: We observed that as compared to nonsmoking during pregnancy, quitting smoking in the first trimester is associated with the same risk of preterm birth and small size for gestational age, but with a higher risk of childhood overweight. Reducing the number of cigarettes, without quitting, has limited beneficial effects. Paternal smoking seems to be associated, independently of maternal smoking, with the risk of childhood overweight. Population strategies should focus on parental smoking prevention before or at the start, rather than during, pregnancy.


Assuntos
Pais , Obesidade Pediátrica/epidemiologia , Nascimento Prematuro/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Fumar/efeitos adversos , Fumar/epidemiologia , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , América do Norte/epidemiologia , Obesidade Pediátrica/diagnóstico , Gravidez , Nascimento Prematuro/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Fatores de Risco , Fumar/tendências
2.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32859735

RESUMO

OBJECTIVES: Food insecurity has been associated with obesity, but previous studies are inconsistent and few included infants. We examined associations between household food security and infant adiposity and assessed the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) as effect modifiers. We hypothesized that infants from food-insecure households would have greater adiposity, with attenuation by WIC and SNAP. METHODS: We repeatedly measured 666 infants from the southeastern United States in 2013-2017. We categorized households as high, marginal, low, or very low using the US Household Food Security Survey Module. Outcomes were BMI z score, subscapular and triceps skinfold-for-age z score, the sum of subscapular and triceps skinfolds, the ratio of subscapular and triceps skinfolds, and BMI z score ≥1 (at risk for overweight). We used covariate-adjusted repeated-measures linear and logistic regressions. RESULTS: Of infants, 68.6% were Black and 60.5% had household incomes <$20 000. Interactions between food security and WIC and/or SNAP were not significant. Compared with infants from high food security households, infants from very low food security households had higher BMI z scores (0.18 U; 95% confidence interval [CI] 0.01 to 0.35), higher subscapular skinfold-for-age z scores (0.31 U; 95% CI 0.04 to 0.59), a higher sum of subscapular and triceps skinfolds (0.53 mm; 95% CI 0.002 to 1.07), and greater odds of being at risk for overweight (odds ratio 1.55; 95% CI 1.14 to 2.10). Infants from low food security households had greater odds of being at risk for overweight (odds ratio 1.72; 95% CI 1.17 to 2.10). CONCLUSIONS: In larger and longer studies, researchers should examine food security and adiposity in young children.


Assuntos
Adiposidade/fisiologia , Características da Família , Abastecimento de Alimentos/economia , Inquéritos Nutricionais/economia , Obesidade Pediátrica/economia , Obesidade Pediátrica/epidemiologia , Adulto , Estudos de Coortes , Feminino , Assistência Alimentar/economia , Assistência Alimentar/tendências , Humanos , Lactente , Masculino , Inquéritos Nutricionais/tendências , Obesidade Pediátrica/diagnóstico , Sudeste dos Estados Unidos/epidemiologia
3.
Lancet Diabetes Endocrinol ; 8(9): 793-800, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32822601

RESUMO

Gestational diabetes, the most common medical disorder in pregnancy, is defined as glucose intolerance resulting in hyperglycaemia that begins or is first diagnosed in pregnancy. Gestational diabetes is associated with increased pregnancy complications and long-term metabolic risks for the woman and the offspring. However, the current diagnostic and management strategies recommended by national and international guidelines are mainly focused on short-term risks during pregnancy and delivery, except the Carpenter-Coustan criteria, which were based on the risk of future incidence of type 2 diabetes post-gestational diabetes. In this Personal View, first, we summarise the evidence for long-term risk in women with gestational diabetes and their offspring. Second, we suggest that a shift is needed in the thinking about gestational diabetes; moving from the perception of a short-term condition that confers increased risks of large babies to a potentially modifiable long-term condition that contributes to the growing burden of childhood obesity and cardiometabolic disorders in women and the future generation. Third, we propose how the current clinical practice might be improved. Finally, we outline and justify priorities for future research.


Assuntos
Saúde da Criança/tendências , Diabetes Gestacional/terapia , Saúde Materna/tendências , Criança , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Hiperglicemia/terapia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Gravidez
4.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32796097

RESUMO

OBJECTIVES: To explore the longitudinal association of neonatal adiposity (fat mass percentage) with BMI trajectories and childhood overweight and obesity from ages 2 to 6 years. METHODS: We studied 979 children from the Healthy Start cohort. Air displacement plethysmography was used to estimate fat mass percentage. Child weight and recumbent length or standing height were abstracted from medical records. Overweight and obesity were defined as BMI levels ≥85th percentile for age and sex. Mixed-effects models were used to examine the association between neonatal fat mass percentage and BMI trajectories from age 2 to 6 years. We tested for effect modification by sex, race and/or ethnicity, and breastfeeding duration. We estimated the proportion of children classified as overweight or obese at specific levels of neonatal fat mass percentage (mean ± SD). RESULTS: The mean neonatal adiposity level was 9.1% ± 4.0%. Child BMI levels differed by neonatal adiposity. Each SD increase in neonatal adiposity resulted in a 0.12 higher overall BMI level between ages 2 to 6 years (95% confidence interval: 0.03 to 0.20; P < .01), and this association was not modified by offspring sex, race and/or ethnicity, or breastfeeding duration. Increasing neonatal adiposity was associated with an increasing proportion of childhood overweight and obesity by age 5 years (P = .02). CONCLUSIONS: We provide novel evidence that higher neonatal adiposity is significantly associated with higher overall BMI levels and an increased likelihood of overweight or obesity from ages 2 to 6 years. Because various prenatal exposures may specifically influence offspring fat accretion, neonatal adiposity may be a useful surrogate end point for prenatal interventions aimed at reducing future childhood overweight and obesity.


Assuntos
Adiposidade , Índice de Massa Corporal , Obesidade Pediátrica/etiologia , Adulto , Fatores Etários , Composição Corporal , Tamanho Corporal , Aleitamento Materno , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Sobrepeso/diagnóstico , Sobrepeso/etiologia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/etnologia , Pletismografia/métodos , Gravidez , Prevalência , Fatores Sexuais
5.
Med Care ; 58(8): 722-726, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692138

RESUMO

BACKGROUND: Childhood obesity is linked with adverse health outcomes and associated costs. Current information on the relationship between childhood obesity and inpatient costs is limited. OBJECTIVE: The objective of this study was to describe trends and quantify the link between childhood obesity diagnosis and hospitalization length of stay (LOS), costs, and charges. RESEARCH DESIGN: We use the National Inpatient Sample data from 2006 to 2016. SUBJECTS: The sample includes hospitalizations among children aged 2-19 years. The treatment group of interest includes child hospitalizations with an obesity diagnosis. MEASURES: Hospital LOS, charges, and costs associated with a diagnosis of obesity. RESULTS: We find increases in obesity-coded hospitalizations and associated charges and costs during 2006-2016. Obesity as a primary diagnosis is associated with a shorter hospital LOS (by 1.8 d), but higher charges and costs (by $20,879 and $6049, respectively); obesity as a secondary diagnosis is associated with a longer LOS (by 0.8 d), and higher charges and costs of hospitalizations (by $3453 and $1359, respectively). The most common primary conditions occurring with a secondary diagnosis of obesity are pregnancy conditions, mood disorders, asthma, and diabetes; the effect of a secondary diagnosis of obesity on LOS, charges, and costs holds across these conditions. CONCLUSIONS: Childhood obesity diagnosis-related hospitalizations, charges, and costs increased substantially during 2006-2016, and obesity diagnosis is associated with higher hospitalization charges and costs. Our findings provide clinicians and policymakers with additional evidence of the economic burden of childhood obesity and further justify efforts to prevent and manage the disease.


Assuntos
Custos de Cuidados de Saúde/normas , Tempo de Internação/economia , Obesidade Pediátrica/economia , Adolescente , Criança , Pré-Escolar , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Obesidade Pediátrica/diagnóstico , Estados Unidos
6.
Pediatr Clin North Am ; 67(4): 647-654, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650862

RESUMO

Telehealth is well positioned to address the common challenges of providing high-quality care to children and adolescents with obesity. The potential benefits of telehealth for pediatric obesity are applicable across the full spectrum of care from diagnosis and assessment to ongoing management. This article reviews the emerging field of telehealth for the treatment of pediatric obesity. The challenges of the current approach to pediatric obesity care are explored, and the potential benefits of incorporating and implementing telehealth in this field are presented. The care of pediatric patients with obesity is particularly well suited for telehealth.


Assuntos
Obesidade Pediátrica/terapia , Telemedicina/métodos , Adolescente , Criança , Humanos , Aplicativos Móveis , Estudos Observacionais como Assunto , Obesidade Pediátrica/diagnóstico , Qualidade da Assistência à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , População Rural , Envio de Mensagens de Texto
7.
PLoS One ; 15(6): e0235063, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574192

RESUMO

BACKGROUND: Adolescent overweight and obesity is a global public health problem, associated with an increased risk of metabolic syndrome. Recently, mid-upper arm circumference (MUAC) has been suggested as a screening tool to identify overweight and obesity among school-age children and early adolescents (5-14 years). However, little is known about the potential use of MUAC in the late adolescence period (15-19 years). Therefore, the present study aimed to evaluate the performance of MUAC to identify overweight (including obesity) in the late adolescence period in Ethiopia. METHODS: We conducted a cross-sectional study among 851 adolescents aged 15 to 19 years. We collected anthropometric data including MUAC, weight and height with the help of trained field workers. The receiver operating characteristic (ROC) curve analysis was used to examine the validity of MUAC compared to BMI Z score in identifying adolescents with overweight or obesity. Furthermore, we calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), proportion of correctly classified, positive, and negative likelihood ratio for the proposed optimal cut-offs. RESULTS: MUAC was strongly correlated with BMI Z score with a correlation coefficient (r) of 0.81 (95% CI; 0.79-0.84). The optimal MUAC cut-off for identifying adolescents with overweight or obesity was 27.7 cm for males and 27.9 cm for females. The area under the ROC curve (AUC) was 0.96 (95% CI; 0.93-0.98) for males and 0.96 (95% CI; 0.94-0.98) for females. The accuracy level of MUAC to identify adolescents with overweight (including obesity) was high for both sexes (overall a sensitivity of 91.1% and a specificity of 90.3%). CONCLUSIONS: MUAC has relatively equivalent accuracy with BMI Z score to identify overweight and obesity in adolescents. Hence, MUAC could be used as an alternative tool for surveillance and screening of overweight in adolescents aged 15-19 years.


Assuntos
Braço/anatomia & histologia , Índice de Massa Corporal , Peso Corporal/fisiologia , Programas de Rastreamento/métodos , Obesidade Pediátrica/diagnóstico , Adolescente , Antropometria/métodos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Curva ROC , Adulto Jovem
8.
Nutr Metab Cardiovasc Dis ; 30(7): 1196-1200, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32482455

RESUMO

BACKGROUND AND AIM: Exercise timing has been suggested to affect appetite and energy intake (EI). The aim of this study was to examine the impact of exercising immediately before or after a meal on EI, appetite sensations and food reward (FR) in adolescents with obesity. METHODS AND RESULTS: Seventeen adolescents with obesity completed 3 experimental sessions (randomized controlled trial): rest + lunch (CON); exercise + lunch (EX-MEAL); lunch + exercise (MEAL-EX). The exercise consisted of cycling 30 min at 65%V̇O2peak. Outcomes included ad libitum EI (weighed lunch and dinner), FR (Leeds Food Preference Questionnaire at pre- and post-combination of exercise/rest and lunch, and pre-dinner) and appetite sensations (visual analogue scales). EI was not different between conditions. Compared with CON, relative EI at lunch was lower in EX-MEAL and MEAL-EX (p ≤ 0.05) and daily only in MEAL-EX (p < 0.01). Postprandial fullness was higher in EX-MEAL compared to CON. Compared with CON, both EX-MEAL and MEAL-EX attenuated the increase in wanting for sweet food and reduced explicit liking for fat. CONCLUSIONS: These preliminary results suggest that exercising immediately before or after a meal produce few differences in appetite and have small beneficial effects on overall energy balance in adolescents with obesity, as well as on FR. CLINICAL TRIALS: NCT03967782.


Assuntos
Comportamento do Adolescente , Comportamento Infantil , Ingestão de Energia , Exercício Físico , Comportamento Alimentar , Obesidade Pediátrica/terapia , Período Pós-Prandial , Adolescente , Fatores Etários , Regulação do Apetite , Ciclismo , Criança , Feminino , França , Humanos , Masculino , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/fisiopatologia , Obesidade Pediátrica/psicologia , Recompensa , Fatores de Tempo
9.
PLoS One ; 15(5): e0232990, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384097

RESUMO

BACKGROUND: Underlying medical causes of obesity (endocrine disorders, genetic obesity disorders, cerebral or medication-induced obesities) are thought to be rare. Even in specialized pediatric endocrinology clinics, low diagnostic yield is reported, but evidence is limited. Identifying these causes is vital for patient-tailored treatment. OBJECTIVES: To present the results of a systematic diagnostic workup in children and adolescents referred to a specialized pediatric obesity center. METHODS: This is a prospective observational study. Prevalence of underlying medical causes was determined after a multidisciplinary, systematic diagnostic workup including growth charts analysis, extensive biochemical and hormonal assessment and genetic testing in all patients. RESULTS: The diagnostic workup was completed in n = 282 patients. Median age was 10.8 years (IQR 7.7-14.1); median BMI +3.7SDS (IQR +3.3-+4.3). In 54 (19%) patients, a singular underlying medical cause was identified: in 37 patients genetic obesity, in 8 patients cerebral and in 9 patients medication-induced obesities. In total, thirteen different genetic obesity disorders were diagnosed. Obesity onset <5 years (p = 0.04) and hyperphagia (p = 0.001) were indicators of underlying genetic causes, but only in patients without intellectual disability (ID). Patients with genetic obesity with ID more often had a history of neonatal feeding problems (p = 0.003) and short stature (p = 0.005). BMI-SDS was not higher in patients with genetic obesity disorders (p = 0.52). Patients with cerebral and medication-induced obesities had lower height-SDS than the rest of the cohort. CONCLUSIONS: To our knowledge, this is the first study to report the results of a systematic diagnostic workup aimed at identifying endocrine, genetic, cerebral or medication-induced causes of pediatric obesity. We found that a variety of singular underlying causes were identified in 19% of the patients with severe childhood obesity. Because of this heterogeneity, an extensive diagnostic approach is needed to establish the underlying medical causes and to facilitate disease-specific, patient-tailored treatment.


Assuntos
Obesidade Pediátrica/etiologia , Adolescente , Instituições de Assistência Ambulatorial , Encefalopatias/complicações , Criança , Pré-Escolar , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Doenças do Sistema Endócrino/complicações , Feminino , Testes Genéticos , Humanos , Lactente , Recém-Nascido , Deficiência Intelectual/complicações , Masculino , Países Baixos , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/genética , Fenótipo , Estudos Prospectivos
10.
Nutr Metab Cardiovasc Dis ; 30(6): 948-959, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32402589

RESUMO

BACKGROUND AND AIMS: Fat mass and obesity-associated protein (FTO) variants are among genetic variants frequently associated with obesity. We analyzed the association between FTO rs1421085 polymorphism and obesity, dietary intake, cardiorespiratory fitness (CRF), physical activity, and socioeconomic status (SES) from the age of 9-25 years. METHODS AND RESULTS: The sample included both birth cohorts (originally n = 1176) of the Estonian Children Personality Behaviour and Health Study. The association between FTO rs1421085 and obesity, dietary intake, CRF, physical activity, and SES from the age of 15-25 years was assessed using linear mixed-effects regression models. Associations at ages 9 (younger cohort only), 15, 18, and 25 years were assessed by one-way ANOVA. Male C-allele carriers had significantly (p < 0.05) higher body mass index (BMI), sum of 5 skinfolds, body fat percentage, and hip circumference from the age of 15-25 years. Findings were similar at the age of 9 years. In female subjects, waist-to-hip ratio was significantly greater in CC homozygotes. Interestingly, female CC homozygotes had a greater decrease in the rate of change in daily energy intake and lipid intake per year and higher physical activity score at every fixed time point. Moreover, in females, an effect of FTO × SES interaction on measures of obesity was observed. CONCLUSION: The FTO rs1421085 polymorphism was associated with obesity and abdominal obesity from childhood to young adulthood in males, and with abdominal obesity from adolescence to young adulthood in females. This association is rather related to differences in adipocyte energy metabolism than lifestyle.


Assuntos
Dioxigenase FTO Dependente de alfa-Cetoglutarato/genética , Dieta/efeitos adversos , Metabolismo Energético/genética , Exercício Físico , Obesidade Abdominal/genética , Obesidade Pediátrica/genética , Polimorfismo de Nucleotídeo Único , Comportamento Sedentário , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Adolescente , Adulto , Fatores Etários , Criança , Estônia/epidemiologia , Feminino , Interação Gene-Ambiente , Predisposição Genética para Doença , Humanos , Estudos Longitudinais , Masculino , Obesidade Abdominal/diagnóstico , Obesidade Abdominal/epidemiologia , Obesidade Abdominal/metabolismo , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/metabolismo , Medição de Risco , Fatores de Risco , Fatores Sexuais , Adulto Jovem
11.
Nutr Metab Cardiovasc Dis ; 30(7): 1188-1195, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32448719

RESUMO

BACKGROUND AND AIMS: Glomerular hyperfiltration (GH) is proposed as one of the earliest events in obesity (OB)-associated renal disease. Children with GH and type-1 diabetes showed increased chemokine levels. Chemokine associations with glomerular filtration rate (GFR) and metabolic features in prepubertal children with overweight (OW)/OB are unknown. METHODS AND RESULTS: Cross-sectional study. 75 prepubertal children (aged: 9.0 ± 1.7 years) with OW/OB were studied. Clinical and metabolic characteristics (including non-esterified fatty acids, NEFA) and GFR (combined Zappitelli equation) were assessed. GH was defined as GFR >135 ml/min.1.73 m2. Serum levels of regulated on activation, normal T cell expressed and secreted (RANTES)/CCL5, interleukin-8 (IL-8)/CXCL8 and monokine-induced by interferon-γ (MIG)/CXCL9 were measured by ELISA. Age- and sex-adjusted correlations and differences were tested. 48% of the cohort was female and 13% were OW, 54% OB and 33% severe OB. Prepubertal children with GH showed lower z-BMI (-12%), NEFA (-26%) and uric acid (-22%) than those without GH (all p < 0.05). Similarly to high sensitivity C-reactive protein (hsCRP), there were no differences in serum chemokines between children with GH or not (all p > 0.05). Adjusted correlations were significant for RANTES and z-BMI (r = 0.26; p < 0.05) and for MIG with z-BMI (r = -0.26; p < 0.05) and with NEFA (r = 0.27; p < 0.05). CONCLUSION: GH was not associated with higher chemokine levels in prepubertal children with OW/OB. Decreased rather than elevated GFR values were correlated with obesity and worse metabolic profiles. Chemokines levels in children with severe OB suggest a regulation of the immune response. Follow-up studies are needed to address the clinical implications of these findings.


Assuntos
Quimiocinas/sangue , Desenvolvimento Infantil , Metabolismo Energético , Taxa de Filtração Glomerular , Nefropatias/fisiopatologia , Rim/fisiopatologia , Obesidade Pediátrica/sangue , Fatores Etários , Biomarcadores/sangue , Criança , Estudos Transversais , Ácidos Graxos não Esterificados/sangue , Feminino , Humanos , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Masculino , Obesidade Pediátrica/complicações , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/imunologia , Estudos Prospectivos , Fatores de Risco
12.
Arch Endocrinol Metab ; 64(2): 171-178, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32236304

RESUMO

Objective Body mass index (BMI) and tri-ponderal mass index (TMI) are anthropometric measures to evaluate body adiposity in the various age groups. The present study aims to compare the predictive value of TMI and BMI for metabolic syndrome (Mets) in children and adolescents of both genders. Subjects and methods A cross-sectional study conducted on 3731 Iranian children and adolescents aged 7-18 years obtained from the fifth survey of 'Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease' (CASPIAN-V) study. The predictive value of BMI and TMI for MetS were determined using Receiver-operator curves. Logistic regression analysis was used to assess the relationship between these indices with MetS. Results 52.6% of participants were boys. The mean (standard deviations) age for boys and girls were 12.62 (3.02) and 12.25 (3.05) years, respectively. In boys, the area under the curve (AUC) of TMI was greater than BMI for all age groups. AUC of TMI was also greater than BMI for age group of 11-14 years (AUC = 0.74; 95% CI (0.67, 0.81)) in girls. Furthermore, our findings showed that odds ratio of Mets for TMI was greater than BMI in age groups of 11-14 years (OR = 1.33 vs 1.22) and 15-18 years (1.16 vs 1.15) in girls and boys, respectively. Conclusion TMI and BMI had moderate predictive value for identifying MetS. However, TMI was a better predictor of MetS than BMI in both genders, especially in age groups of 11-14 and 15-19 years for girls and boys.


Assuntos
Índice de Massa Corporal , Síndrome Metabólica/diagnóstico , Obesidade Pediátrica/diagnóstico , Adiposidade , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Valores de Referência , Fatores de Risco , Sensibilidade e Especificidade
13.
High Blood Press Cardiovasc Prev ; 27(3): 239-249, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32266707

RESUMO

INTRODUCTION: This study examined the prevalence of pre-hypertension (PHT) and hypertension (HT) in urban youth, and assessed the effects of sodium intake and obesity on blood pressure (BP) by ethnicity. METHODS: A convenience sample of 557 multiethnic youth, aged 11-23 years, was recruited from 12 schools and institutions in Edmonton, Alberta, Canada. Participants were divided by self-identified ethnicity into four groups (Indigenous, African and Middle Eastern (AME), Asian, and European). RESULTS: Between October 2013 and March 2014, one-on-one interviews were conducted to collect data on demographics, physical activity, diet, and Body Mass Index (BMI). BP was obtained at two different times during the interview and measured a third time in cases of high variability. The standard deviation scores (SDS) of systolic BP (SBP) and diastolic BP (DBP) were used to estimate associations with sodium intake (per 1000 mg/day). Overall, 18.2% and 5.4% of the participants had PHT and HT, respectively. Indigenous and AME participants showed the highest rates of PHT (23.1%). Indigenous and European participants showed higher rates of HT (8.3% and 5.3%, respectively) than other ethnic groups (AME = 4.4%, Asian = 3.9%). There was a positive association between 1000 mg/day increase in sodium intake and SDS of SBP by 0.041 (95% CI 0.007-0.083; p = 0.04) among pre-hypertensive participants. Over 85% of participants exceeded the recommended dietary sodium intake. Mean BMI and dietary sodium intake were higher among pre-hypertensive participants (4219 mg/day) than normotensive (3475 mg/day). CONCLUSIONS: The prevalence of HT varied by ethnicity. High dietary sodium intake was of concern. There is a need for culturally-tailored, population-based interventions to reduce sodium intake.


Assuntos
Pressão Sanguínea , Hipertensão/etnologia , Estilo de Vida/etnologia , Pré-Hipertensão/etnologia , Sódio na Dieta/efeitos adversos , Saúde da População Urbana/etnologia , Adolescente , Grupo com Ancestrais do Continente Africano , Fatores Etários , Alberta/epidemiologia , Grupo com Ancestrais do Continente Asiático , Criança , Estudos Transversais , Dieta Hipossódica/etnologia , Grupo com Ancestrais do Continente Europeu , Exercício Físico , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Inquéritos Epidemiológicos , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão/prevenção & controle , Índios Norte-Americanos , Masculino , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/etnologia , Pré-Hipertensão/diagnóstico , Pré-Hipertensão/fisiopatologia , Pré-Hipertensão/prevenção & controle , Prevalência , Fatores Raciais , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Adulto Jovem
14.
N Z Med J ; 133(1513): 97-100, 2020 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-32325473

RESUMO

Childhood obesity is common in New Zealand with one in three 4-5 year-old children identified as overweight or obese in the before school check (B4SC) programme. Recently, the use of BMI for assessing childhood obesity in the B4SC programme has been questioned. This article provides evidence in support of the assessment of BMI during the B4SC, including specific key points: 1. BMI is currently the only appropriate field tool for assessing overweight and obesity.2. Our New Zealand data show that BMI is reliable at measuring adiposity in all ethnic groups. 3. High childhood BMI often leads to adult obesity and is associated with increased adult morbidity and mortality. 4. We believe parents do want to know information regarding their child's obesity risk, based on recent findings in our New Zealand study.


Assuntos
Índice de Massa Corporal , Obesidade Pediátrica , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Nova Zelândia , Pais , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Fatores de Risco
15.
Nutr Metab Cardiovasc Dis ; 30(5): 822-828, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32278607

RESUMO

BACKGROUND AND AIM: This study aimed to: i) examine the differences in insulin resistance (IR) across adiposity levels; and ii) ascertain whether high levels of adiponectin attenuate the detrimental association of adiposity with IR in adolescents. METHODS AND RESULTS: A total of 529 adolescents aged 12-18 years participated in this cross-sectional study (267 girls). Anthropometry and body adiposity parameters [body mass index (BMI), sum of skinfolds, body fat percentage (BF %) by bio-impedance analysis and waist circumference (WC)], were measured according to standardized procedures and categorized into age- and sex-specific quartiles. Socioeconomic status, pubertal stage and lifestyle determinants (Mediterranean diet adherence and cardiorespiratory fitness) were gathered and used as confounders. Serum adiponectin and IR (homeostasis model assessment of insulin resistance [HOMA-IR] estimated from fasting serum insulin and glucose were assessed. Analysis of covariance (ANCOVA) showed that HOMA-IR increased in a linear fashion throughout the quartiles of all adiposity measures (p < 0.001 for all), independently of age, sex, pubertal stage, socioeconomic status, adherence to the Mediterranean diet and cardiorespiratory fitness. Two-way ANCOVA showed that adolescents in the higher quartile of adiposity for BF%, BMI, WC and skinfolds sum (Q4) presented the highest adiponectin levels, and had 0.77 Standard Deviation (SD), 0.8 SD, 0.85 SD and 0.8 SD lower HOMA-IR, respectively (p < 0.01) than their low adiponectin group counterparts, after adjustments for potential confounders. CONCLUSION: Higher adiponectin levels may attenuate the detrimental association between adiposity and IR, particularly in subjects with higher adiposity.


Assuntos
Adiponectina/sangue , Adiposidade , Resistência à Insulina , Síndrome Metabólica/sangue , Obesidade Pediátrica/sangue , Adolescente , Fatores Etários , Biomarcadores/sangue , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/fisiopatologia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/fisiopatologia , Portugal/epidemiologia , Medição de Risco , Fatores de Risco , Regulação para Cima
16.
PLoS Med ; 17(3): e1003036, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32163412

RESUMO

BACKGROUND: Excessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal. METHODS AND FINDINGS: We performed a national market analysis and population-wide modelling study using market data for the years 2014-2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015-2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40-78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases-despite our efforts to mitigate them-related to the methodological differences between these sources. CONCLUSIONS: The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population.


Assuntos
Comércio , Comportamento do Consumidor , Obesidade Pediátrica/prevenção & controle , Bebidas Adoçadas com Açúcar/efeitos adversos , Bebidas Adoçadas com Açúcar/economia , Impostos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Ingestão de Energia , Humanos , Incidência , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Modelos Teóricos , Valor Nutritivo , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Portugal/epidemiologia , Fatores de Proteção , Fatores de Risco , Fatores de Tempo , Adulto Jovem
17.
PLoS Med ; 17(3): e1003078, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32187177

RESUMO

BACKGROUND: Pediatric obesity is associated with increased risk of premature death from middle age onward, but whether the risk is already increased in young adulthood is unclear. The aim was to investigate whether individuals who had obesity in childhood have an increased mortality risk in young adulthood, compared with a population-based comparison group. METHODS AND FINDINGS: In this prospective cohort study, we linked nationwide registers and collected data on 41,359 individuals. Individuals enrolled at age 3-17.9 years in the Swedish Childhood Obesity Treatment Register (BORIS) and living in Sweden on their 18th birthday (start of follow-up) were included. A comparison group was matched by year of birth, sex, and area of residence. We analyzed all-cause mortality and cause-specific mortality using Cox proportional hazards models, adjusted according to group, sex, Nordic origin, and parental socioeconomic status (SES). Over 190,752 person-years of follow-up (median follow-up time 3.6 years), 104 deaths were recorded. Median (IQR) age at death was 22.0 (20.0-24.5) years. In the childhood obesity cohort, 0.55% (n = 39) died during the follow-up period, compared to 0.19% (n = 65) in the comparison group (p < 0.001). More than a quarter of the deaths among individuals in the childhood obesity cohort had obesity recorded as a primary or contributing cause of death. Male sex and low parental SES were associated with premature all-cause mortality. Suicide and self-harm with undetermined intent were the main cause of death in both groups. The largest difference between the groups lay within endogenous causes of death, where children who had undergone obesity treatment had an adjusted mortality rate ratio of 4.04 (95% CI 2.00-8.17, p < 0.001) compared with the comparison group. The main study limitation was the lack of anthropometric data in the comparison group. CONCLUSIONS: Our study shows that the risk of mortality in early adulthood may be higher for individuals who had obesity in childhood compared to a population-based comparison group.


Assuntos
Obesidade Pediátrica/mortalidade , Adolescente , Adulto , Fatores Etários , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/psicologia , Prognóstico , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Suicídio/psicologia , Suécia/epidemiologia , Adulto Jovem
18.
Nutr Metab Cardiovasc Dis ; 30(5): 810-821, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32143895

RESUMO

BACKGROUND AND AIMS: Atherosclerosis begins early in life, thus optimal cardiovascular health needs to be promoted early. We investigated whether appetitive behaviors among 7 year olds are associated with their cardiometabolic health years later. METHODS AND RESULTS: A sample of 2951 children from a Portuguese birth cohort was analyzed. The Children's Eating Behavior Questionnaire assessed eating behaviors, and a measure of cardiometabolic risk (higher risk group: those in the upper quartile of triglycerides, homeostatic model assessment-insulin resistance, waist circumference and systolic blood pressure and in the lower quartile of high-density lipoprotein cholesterol z-scores) was created. Linear and logistic regressions were run. Children with more food avoidant behaviors had lower cardiometabolic risk (Satiety Responsiveness - boys: OR = 0.39, 95% CI 0.16; 0.93, girls: OR=0.37, 95% CI 0.17; 0.82 and Slowness in eating - boys: OR = 0.49, 95% CI 0.25; 0.95, girls: OR = 0.49, 95% CI 0.27; 0.91). Food approach behaviors (Food responsiveness (CEBQ-FR), Enjoyment of food (CEBQ-EF) and Emotional overeating (CEBQ-EOE)) increased cardiometabolic risks (e.g. CEBQ-FR: boys: OR = 2.50, 95% CI 1.45; 4.32, girls: OR = 2.33, 95% CI 1.46; 3.71). CEBQ-EF had stronger effects in boys, while CEBQ-EOE was positively associated with cardiometabolic risk among girls. When adjusting for BMIz at 7y, associations did not remain significant. Appetitive behaviors were also associated with isolated cardiometabolic parameters; the strongest association being with waist circumference. CONCLUSIONS: Appetitive behaviors at 7-years are associated with cardiometabolic risk at age 10. While 'food avoidant' behaviors protect against cardiometabolic risk and 'food approach' behaviors increase cardiometabolic risk, these associations are largely dependent of child's adiposity.


Assuntos
Regulação do Apetite , Doenças Cardiovasculares/epidemiologia , Comportamento Infantil , Comportamento Alimentar , Doenças Metabólicas/epidemiologia , Obesidade Pediátrica/epidemiologia , Fatores Etários , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Criança , Emoções , Feminino , Seletividade Alimentar , Preferências Alimentares , Humanos , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/prevenção & controle , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/prevenção & controle , Portugal/epidemiologia , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Fatores Sexuais
19.
Nutr Metab Cardiovasc Dis ; 30(4): 674-682, 2020 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-32139252

RESUMO

BACKGROUND AND AIMS: Spexin (SPX) is a novel peptide recently discovered as an important regulatory adipokine in obesity and related metabolic diseases. The aim of the current study was to determine the potential role of Circulating levels of SPX in obese children and explore its relationships with obesity-related risk factors, and its potential role in preventing obesity. METHODS AND RESULTS: Forty-five obese children and 45 normal-weight children of similar age and sex, with mean age of 13.73 (2.68) were recruited in this Study. Weight and height, blood pressure, resting metabolic rate (RMR), physical activity level, stress, anxiety and depression, appetite status, daily energy intake, pubertal stage, serum Spexin, Interleukin-10 (IL-10), IL-1ß, high-sensitivity C-reactive protein (hs-CRP), fasting glucose, insulin and lipid profile, were measure during standard techniques. Median (IQR) of Spexin levels were significantly lower in obese vs. normal-weight children [120.70 (77.7) pg/mL vs.145 (186.7)pg/mL; P = 0.03]. Based on the tertiles of the serum Spexin levels, a protective independent effect was observed for the highest tertile of serum Spexin concentrations. Crude OR (CI): 0.33 (0.11-0.95), P-trend = 0.04. Model 1 OR (CI): 0.20 (0.05-0.73), P- trend = 0.01, Model 2 OR (CI): 0.22 (0.05-0.86), P -trend = 0.03. Serum Spexin concentration was significantly associated with IL-10, IL-1ß, fasting Insulin and HOMA-IR (P < 0.05). CONCLUSION: The lower circulating levels of Spexin in obese children compared to their normal-weight peers, the protective independent effect found for the highest tertile of serum Spexin, and its association with glucose metabolism and immune function observed in our study, suggest a potential role for this novel peptide in childhood obesity and its related metabolic disorders.


Assuntos
Obesidade Pediátrica/sangue , Hormônios Peptídicos/sangue , Adiposidade , Adolescente , Fatores Etários , Biomarcadores/sangue , Estudos de Casos e Controles , Criança , Regulação para Baixo , Feminino , Humanos , Resistência à Insulina , Masculino , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/fisiopatologia , Fatores de Risco , Ganho de Peso
20.
BMC Med Genet ; 21(1): 34, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-32059710

RESUMO

BACKGROUND: Epigenetics could facilitate greater understanding of disparities in the emergence of childhood obesity. While blood is a common tissue used in human epigenetic studies, saliva is a promising tissue. Our prior findings in non-obese preschool-aged Hispanic children identified 17 CpG dinucleotides for which differential methylation in saliva at baseline was associated with maternal obesity status. The current study investigated to what extent baseline DNA methylation in salivary samples in these 3-5-year-old Hispanic children predicted the incidence of childhood obesity in a 3-year prospective cohort. METHODS: We examined a subsample (n = 92) of Growing Right Onto Wellness (GROW) trial participants who were randomly selected at baseline, prior to randomization, based on maternal phenotype (obese or non-obese). Baseline saliva samples were collected using the Oragene DNA saliva kit. Objective data were collected on child height and weight at baseline and 36 months later. Methylation arrays were processed using standard protocol. Associations between child obesity at 36 months and baseline salivary methylation at the previously identified 17 CpG dinucleotides were evaluated using multivariable logistic regression models. RESULTS: Among the n = 75 children eligible for analysis, baseline methylation of Cg1307483 (NRF1) was significantly associated with emerging childhood obesity at 36-month follow-up (OR = 2.98, p = 0.04), after adjusting for child age, gender, child baseline BMI-Z, and adult baseline BMI. This translates to a model-estimated 48% chance of child obesity at 36-month follow-up for a child at the 75th percentile of NRF1 baseline methylation versus only a 30% chance of obesity for a similar child at the 25th percentile. Consistent with other studies, a higher baseline child BMI-Z during the preschool period was associated with the emergence of obesity 3 years later, but baseline methylation of NRF1 was associated with later obesity even after adjusting for child baseline BMI-Z. CONCLUSIONS: Saliva offers a non-invasive means of DNA collection and epigenetic analysis. Our proof of principle study provides sound empirical evidence supporting DNA methylation in salivary tissue as a potential predictor of subsequent childhood obesity for Hispanic children. NFR1 could be a target for further exploration of obesity in this population.


Assuntos
Biomarcadores/metabolismo , Metilação de DNA/genética , Epigênese Genética , Obesidade Pediátrica/genética , Adulto , Índice de Massa Corporal , Pré-Escolar , Ilhas de CpG/genética , Feminino , Humanos , Masculino , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/fisiopatologia , Gravidez , Saliva/metabolismo
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