Vegetable behavioral tool demonstrates validity with MyPlate vegetable cups and carotenoid and inflammatory biomarkers.

Young children are not meeting recommendations for vegetable intake. Our objective is to provide evidence of validity and reliability for a pictorial vegetable behavioral assessment for use by federally funded community nutrition programs. Parent/child pairs (n=133) from Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children [WIC] provided parent-administered vegetable tools, three child 24-hour diet recalls, child blood sample and measured heights/weights. The 10-item Focus on Veggies scale, with an alpha of .83 and a stability reliability coefficient of .74, was positively related to vegetables in cup equivalents [p≤.05]; dietary intakes of folate, vitamin C, ß-carotene, potassium and magnesium [p≤.05-.01]; and soluble fiber [p≤.001]. The child vegetable scores were related to the parent's mediators [p≤.00001] and vegetable behaviors [p≤.00001]. Children's plasma inflammatory markers were negatively related to the 10 item scale [p≤.05] and are indicators of the child's health status. The positive relationship between the serum carotenoid index and a sub-scale of child vegetable behaviors offered additional support for criterion validity [p≤.05]. Finally, the inverse relationship of BMI-for-age percentile one year post baseline and a sub-scale of child vegetable behaviors supported the predictive validity [p≤.05]. Focus on Veggies, a simple assessment tool, can inform practitioners about the child's health status. A child with a high score, shows a healthful profile with a lower inflammation index, higher carotenoid index, lower BMI and higher vegetable intake. In conclusion, validity of Focus on Veggies has been demonstrated using vegetable cup equivalents and micronutrient intakes, anthropometry and blood biomarkers.

Building research capacity with members of underserved American Indian/Alaskan Native communities: training in research ethics and the protection of human subjects.

OBJECTIVE: To develop a research ethics training course for American Indian/Alaskan Native health clinic staff and community researchers who would be conducting human subjects research. METHOD: Community-based participatory research methods were used in facilitated discussions of research ethics centered around topics included in the Collaborative Institutional Training Initiative research ethics course. RESULTS: The community-based participatory research approach allowed all partners to jointly develop a research ethics training program that was relevant for American Indian/Alaskan Native communities. All community and clinic partners were able to pass the Collaborative Institutional Training Initiative course they were required to pass so that they could be certified to conduct research with human subjects on federally funded projects. In addition, the training sessions provided a foundation for increased community oversight of research. CONCLUSIONS: By using a collaborative process to engage community partners in research ethics discussions, rather than either an asynchronous online or a lecture/presentation format, resulted in significant mutual learning about research ethics and community concerns about research. This approach requires university researchers to invest time in learning about the communities in which they will be working prior to the training.

Obesity Risk Assessment for Spanish-Speaking Immigrant Families with Young Children in the United States: Reliability and Validity with Nutrient Values.

The purpose is to examine validity and reliability for an obesity risk assessment tool developed in Spanish for immigrant families with children, 3-5 years old using an 8-week cross-sectional design with data collected over 1 year at Head Start and Special Supplemental Nutrition Program for Women, Infants and Children [WIC]. Parent/child dyads (206) provided a child obesity risk assessment, three child modified 24 h dietary recalls, three child 36+ h activity logs and one parent food behavior checklist. Main outcome measures were convergent validity with nutrients, cup equivalents, and diet quality and three assessments of reliability that included item difficulty index, item discrimination index, and coefficient of variation. Validity was demonstrated for assessment tool, named Niños Sanos. Scales were significantly related to variables in direction hypothesized [p ≤ 0.05]: Healthy Eating Index, fruit/vegetable cup equivalents, folate, dairy cup equivalents, vitamins D, ß-carotene, fiber, saturated fat, sugar, time at screen/ sleep/physical activity and parent behaviors. Three measures of reliability were acceptable. The addition of nutrient values as an analytical validation approach adds strength and consistency to previously reported Niños Sanos validation results using children's blood biomarkers and body mass index. This tool can be used by health professionals as an assessment of obesity risk in several capacities: (1) screener for counseling in a clinic, (2) large survey, (3) guide for participant goal setting and tailoring interventions, and (4) evaluation.

Addressing food insecurity in a Native American reservation using community-based participatory research.

The food insecurity faced by many Native American communities has numerous implications for the health and welfare of families. To identify and address upstream causes of food insecurity in a rural California reservation, we conducted a community assessment using the Tool for Health and Resilience in Vulnerable Environments (THRIVE). Guided by a community-based participatory research orientation, the THRIVE tool was adapted using digital storytelling and implemented in a series of focus groups. As a result of the THRIVE assessment, community members identified racial injustice and physical and financial barriers to accessing healthy and culturally appropriate foods as areas of greatest importance. Subsequently, the project partnership developed policies to reduce identified barriers which included an integrated community supported agriculture and commodity food program, the introduction of Electronic Benefits Transfer and culturally appropriate foods at the local farmers' market and reallocation of shelf space at the grocery store to include vegetables and fruits as well as special foods for diabetics. Results suggest that a participatory research orientation coupled with the use of a culturally adapted THRIVE tool may be an effective means for identifying structural determinants of food insecurity and initiating novel policy interventions to reduce health disparities experienced by Native American communities.

Parental marital relationship satisfaction predicts glycemic outcomes in children with type 1 diabetes.

OBJECTIVES: Glycemic outcomes in children with type 1 diabetes (T1D) vary widely, despite uniform care. We hypothesized that glycemic outcomes in children with T1D are affected by the marital relationship satisfaction of the child's parents. METHODS: We evaluated a prospective sample of 51 families with a child with newly diagnosed T1D, including 36 married parent families. We assessed indicators of marital relationship satisfaction and used multiple regression models to determine whether marital relationship satisfaction at diagnosis was associated with mean HbA1c 18-24 months after diagnosis. RESULTS: Marital status and parental relationship satisfaction at the time of the child's T1D diagnosis were associated with HbA1c 18-24 months later. These differences persisted after adjusting for demographic factors associated with glycemia. CONCLUSIONS: The quality of the primary diabetes caregiver's relationship with a spouse predicts glycemic outcomes for children with T1D. Interventions to improve spousal relationships and caregiver support could improve glycemic control in children with T1D.

Parental marital relationship satisfaction is associated with glycemic outcomes in children with type 1 diabetes.

Objectives: We hypothesized that glycemic outcomes in children with type 1 diabetes are linked to marital satisfaction of primary caregivers above and beyond parent neuroticism and child effortful control. Methods: We evaluated a cross-sectional sample of 73 married parent families with a child (ages 7-18 years) with type 1 diabetes of at least 2 years duration. We assessed marital relationship satisfaction, parent neuroticism, and child effortful control through the use of validated questionnaires. We used univariate comparisons and multivariable models to determine whether marital relationship satisfaction was associated with hemoglobin A1c [HbA1c] and whether this association persisted after adjusting for demographic factors and parent neuroticism/child effortful control. Results: In univariate analyses, HbA1c was associated with marital relationship satisfaction of the primary caregiver. In multivariable models adjusting for demographic factors, marital satisfaction remained associated with HbA1c, whereas none of the other factors tested (including family income and race/ethnicity) retained significance. In univariate analyses, child effortful control was also associated with HbA1c. When child effortful control was added to the multivariable model, marital satisfaction remained associated with HbA1c with similar coefficient and confidence intervals describing the relationship between marital satisfaction and hemoglobin A1c. Conclusions: Higher levels of marital satisfaction of the primary diabetes caregiver are associated with glycemic outcomes for children with type 1 diabetes. Interventions to improve spousal relationships may have downstream benefits that could include promoting more optimal child HbA1c levels.

High frequency of cardiac and behavioral complaints as presenting symptoms of hyperthyroidism in children.

OBJECTIVE: Descriptive data characterizing the frequency of various chief complaints and presenting symptomatology in children with hyperthyroidism are lacking. Furthermore, difficulties in recognizing atypical presentations may delay diagnosis and increase morbidity. METHODS: We performed a retrospective review of the medical records of 76 children with hyperthyroidism to characterize their chief complaints at initial presentation to care and document other presenting symptomatology. RESULTS: Cardiac symptoms were the most frequent chief complaint, accounting for 23% of presenting complaints. Major mood and behavior disturbances were also frequently present (21%), but were infrequently cited as the chief complaint (6%). CONCLUSIONS: This study is the first to describe chief complaints separately from the other signs and symptoms of hyperthyroidism noted at the time of presentation to medical attention. Cardiac complaints were the most common: however, complaints associated with behavioral and mood disorders also occurred frequently. Clinicians should be aware of these presentations so that hyperthyroidism is diagnosed promptly to avoid morbidity associated with delayed diagnosis.

Feasibility of Colocating a Nutrition Education Program into a Medical Clinic Setting to Facilitate Pediatric Obesity Prevention.

PURPOSE: Within a medical clinic environment, pediatric obesity prevention education for families faces challenges. Existing long-term government-funded nutrition education programs have the expertise and staff to deliver. The purpose is to determine feasibility of colocating the Expanded Food and Nutrition Education Program (EFNEP) into a medical clinic setting to support pediatric obesity prevention. METHODS: Physicians from a large university teaching and research hospital (n = 73) and 4 small Medicaid-serving community clinics (n = 18) in the same geographic area in northern California were recruited and trained in the patient-referral protocol for a primary prevention intervention provided by EFNEP. The 8-week intervention deployed in the medical clinics, included general nutrition, physical activity and parenting topics anchored with guided goal setting and motivational modeling. Referral, enrollment, and attendance data were collected for 2 years. Parent and physician feasibility surveys, parent interviews and parent risk assessment tools were administered. Paired-sample t-test analysis was conducted. RESULTS: Twenty intervention series with parents of patients (n = 106) were conducted at 5 clinics. Physicians (n = 92) generated 686 referrals. Every 6 referrals generated 1 enrolled parent. Physicians (91%, n = 34) reported the intervention as useful to families. Parents (n = 82) reported improved child behaviors for sleep, screen time, physical activity, and food and beverage offerings (P < .0001) and at family mealtime (P < .001). Focus group interviews (n = 26) with 65 participants indicated that parents (97%) reacted positively to participating in the intervention with about a third indicating the classes were relevant to their needs. CONCLUSION: The intervention is a feasible strategy for the 5 medical clinics. Physicians referred and parents enrolled in the intervention with both physicians and parents indicating positive benefits. Feasibility is contingent upon physician awareness of the intervention and motivation to refer patients and additional EFNEP and clinic staff time to enroll and keep parents engaged.

Prevalence and risk factors for vitamin D deficiency among healthy infants and young children in Sacramento, California.

This cross-sectional study assessed vitamin D status of healthy infants and young children undergoing routine care in a medical center pediatric clinic in Sacramento, CA, and evaluated associations of status with markers of vitamin D function. Such data have not recently been reported from similar locations with sunny climates that should minimize risk of deficiency. Exposures included diet, supplement use, and sun exposure, and outcomes included plasma 25-hydroxy vitamin D (25[OH]D), parathyroid hormone (PTH), bone-specific alkaline phosphatase, and eight markers of immune activation. The median age of the 173 subjects was 12 months (range, 6-19); 49% were female. The median 25(OH)D was 85 nmol/l (range, 9-198); five subjects (2.9%) had <27.5 nmol/l, indicative of deficiency; 14 (8.1%) had <50 nmol/l, and 49 (28.3%) had <75 nmol/l. Most subjects (154; 89%) received some vitamin-D-fortified cow's milk or formula while 19 (11%) received breast milk as the only milk source. Breastfeeding was associated with risk of vitamin D deficiency (p < 0.001). Subjects with 25(OH)D <27.5 nmol/l had elevated PTH (p = 0.007). Only four of 35 breastfed infants (11%) consuming <500 ml/day vitamin-D-fortified formula or milk received vitamin D supplements. Plasma interleukin (IL)-1ß was significantly higher (p = 0.036) in infants in the highest vs. lowest 25(OH)D decile. In conclusion, this study demonstrates that vitamin D deficiency with elevated PTH remains a risk for breastfed subjects not receiving supplemental vitamin D even in a region with a sunny, temperate climate. Strategies to improve supplementation should be sought.

Childhood obesity in American Indians.

American Indian youth are affected disproportionately by the epidemic of obesity and its comorbidities compared with other ethnic groups in the United States. Before 10 years of age, 40% to 50% of Indian children of many communities are classified as either overweight or obese by modern definitions in contrast to data from a century ago in which Caucasian and Lakota children were equivalent in weight and body mass index. Multiple etiologies must be addressed to build programs to decrease the prevalence of childhood obesity. While awaiting definitive results from prevention and treatment trials, common-sense approaches such as encouraging healthy diets and increased activity are appropriate. A long-term approach to the community is necessary to improve the health of Indian children: short-term programs that come and go along with varying personnel may not be accepted by the community. We have achieved acceptance in Native American communities, utilizing telecommunications to introduce a family directed program that is then modified and administered by members of the community to ensure that it is culturally acceptable.

Obesity Risk Assessment Tool among 3-5 Year Olds: Validation with Biomarkers of Low-Grade Chronic Inflammation.

Background: Many families with young children practice nutrition, parenting, and lifestyle behaviors that set their children on trajectories for unhealthful weight gain. Potential adverse health effects of excessive body fat can result in the secretion of proinflammatory molecules and increased risk of inflammation and metabolic diseases. A pediatric obesity risk assessment tool named Healthy Kids (HK), demonstrated validity in a longitudinal study with child's measured BMI and 36-hour diet, screen, sleep, and activity logs. Our objective was to provide additional evidence of validity with low-income families with literacy issues using an inflammation index composed of four proinflammatory biomarkers. Methods: Parent/child pairs (n = 104) from Head Start and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provided HK, blood samples, and measured heights/weights. Select child inflammatory markers were discretized into two groups of HK scores. Data were analyzed with a mixed model adjusted for children's age and BMI. Results: A significant HK-time interaction effect was shown for the child inflammation index with two data collection points 1 year apart (pdid = 0.039). This index increased over 12 months in children with less healthful behaviors (p = 0.007), but not in children with more healthful profiles (p = 0.58). Conclusions: Children with less healthful HK scores had an elevated inflammation index indicating a low-grade chronic systemic inflammatory state. Taken together with our previously published findings, the HK tool has potential as a rapid and easy-to-administer assessment of the family environment and the child's obesity risk. HK can be useful for federal nutrition programs for evaluation, risk assessment, goal setting, and/or program planning in clinical and community environments.

Obesity Risk Assessment Tool for Low-Income Spanish Speaking Immigrant Parents with Young Children: Validity with BMI and Biomarkers of Obesity.

Children of Hispanic origin bear a high risk of obesity. Child weight gain trajectories are influenced by the family environment, including parent feeding practices. Excessive body fat can result in unhealthful metabolic and lipid profiles and increased risk of metabolic diseases. The objective was to estimate criterion validity of an obesity risk assessment tool targeting Spanish-speaking families of Mexican origin using anthropometric measures and blood values of their young children. A cross-sectional study design with five data collection sessions was conducted over an eight-week period and involved 206 parent/child dyads recruited at Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children in Northern California. Main outcome measures were criterion validity of Niños Sanos, a pediatric obesity risk assessment tool, using anthropometric measures and blood biomarkers. Niños Sanos scores were inversely related to child BMI-for-age percentiles (p = 0.02), waist-for-height ratios (p = 0.05) and inversely related to blood biomarkers for the metabolic index (p = 0.03) and lipid index (p = 0.05) and positively related to anti-inflammatory index (p = 0.047). Overall, children with higher Niños Sanos scores had more healthful lipid, metabolic and inflammatory profiles, as well as lower BMI-for-age percentiles and waist-to height ratios, providing evidence for the criterion validity of the tool. Niños Sanos can be used by child obesity researchers, by counselors and medical professionals during clinic visits as a screening tool and by educators as a tool to set goals for behavior change.

An oral sulfonylurea in the treatment of transient neonatal diabetes mellitus.

BACKGROUND: Neonatal diabetes mellitus (NDM) is rare, with a prevalence of approximately 1 in 500,000 infants worldwide. NDM may be caused by several different genetic abnormalities, and might either be transient (TNDM) or permanent. Until recently, clinical management of most permanent types of NDM required lifelong subcutaneous insulin treatment. However, due to activating mutations in the genes that encode the adenosine triphosphate-sensitive K(+) channel, some permanent types of NDM have been found to be amenable to oral sulfonylurea therapy. TNDM can last for a median of 12 weeks and completely resolve by 18 months. Although TNDM is typically treated with subcutaneous insulin, this mode of therapy might be difficult for some caregivers. CASE SUMMARY: A small for gestational age male infant born at term developed NDM on day of life (DOL) 3. No other factors, such as sepsis, infection, or dextrose-containing intravenous fluids, that could have accounted for the hyperglycemia were present. In addition, there was no family history of DM or hyper-glycemic disorders. The patient was initially treated with subcutaneous regular insulin (0.25 U at a concentration of 10 U/L) q4h PRN for blood glucose concentrations >200 mg/dL. However, due to persistent blood glucose concentration fluctuations, a continuous insulin infusion (0.05 U/kg/h) was started on DOL 7. Because subcutaneous insulin injections could not be administered by the parents outside of the hospital, oral sulfonylurea therapy was attempted. A glyburide oral suspension, prepared by dissolving half of a 1.25-mg tablet in 1 mL of preservative-free, sterile water, was started at 0.2 mg/kg/d in 2 divided doses. The suspension was prepared immediately prior to each dose and was administered via syringe during feedings. On DOL 21, the patient's NDM was managed solely with an oral sulfonylurea, target blood glucose concentrations of 150 to 250 mg/dL were achieved with glyburide 0.7 mg/kg/d in 2 divided doses, and insulin administration was no longer required. On DOL 25, the glyburide dosage was decreased to 0.5 mg/kg/d in 2 divided doses. On DOL 27, the patient was discharged on the same dosage. The patient's NDM subsequently resolved by DOL 49. CONCLUSION: An oral sulfonylurea was a useful treatment option in the management of TNDM in this patient.

For debate: childhood obesity - is there hope for therapy and prevention?

The diagnosis and treatment of co-morbidities of obesity that were once the province of clinicians who treated adult patients, are now among the daily activities of pediatricians. The approach to therapy usually involves changes in diet and activity, or medical or surgical therapies. However, limited proven effect of most efforts at treatment and limited personnel to handle the overwhelming needs make it clear that overweight and obesity in youth must be addressed by significant public health measures rather than primarily by a medical model of disease. This editorial argues that given the limited proven long-term efficacy of most treatment programs once obesity develops, the prevention of obesity should be at the forefront of our efforts to address this epidemic of chronic disease.

Yes We Can: Eating Healthy on a Limited Budget.

OBJECTIVE: This study determined how people who live in low-income households can consume an affordable, nutritious diet. DESIGN: A community-based participatory research (CBPR) project was completed that developed and priced 2 weeks of healthy menus that met US Department of Agriculture Dietary Guidelines for Americans. Prices were collected from a market basket survey of 13 stores in the city of Chico during October, 2010. Initial menu development began in 2011-2012. Menus were reviewed in 2017 and reflect current guidelines. SETTING: Chico, CA. MAIN OUTCOME MEASURES: Macro dietary objectives including the caloric content and servings of fat, sugar, whole grains, and fruits and vegetables. The cost of purchasing the market basket of goods for a family of 4 that achieved those objectives was determined. RESULTS: The 2 weeks of menus all met dietary objectives on average. The daily cost varied from $19 to $31 when food was purchased from a bulk supermarket, with an average daily cost of $25. Average monthly cost was $756 in 2010 dollars, or $838 in 2015 dollars. CONCLUSIONS AND IMPLICATIONS: People living in low-income households can afford to eat healthily. Using CBPR principles, daily targets, and technical support, public health partners can partner with community members for member-defined solutions that are affordable and meet dietary guidelines. Access to stores that sell low-price bulk items is important to being able to afford a healthy diet.

Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion.

OBJECTIVE: Our objective was to formulate practice guidelines for the treatment and prevention of pediatric obesity. CONCLUSIONS: We recommend defining overweight as body mass index (BMI) in at least the 85th percentile but < the 95th percentile and obesity as BMI in at least the 95th percentile against routine endocrine studies unless the height velocity is attenuated or inappropriate for the family background or stage of puberty; referring patients to a geneticist if there is evidence of a genetic syndrome; evaluating for obesity-associated comorbidities in children with BMI in at least the 85th percentile; and prescribing and supporting intensive lifestyle (dietary, physical activity, and behavioral) modification as the prerequisite for any treatment. We suggest that pharmacotherapy (in combination with lifestyle modification) be considered in: 1) obese children only after failure of a formal program of intensive lifestyle modification; and 2) overweight children only if severe comorbidities persist despite intensive lifestyle modification, particularly in children with a strong family history of type 2 diabetes or premature cardiovascular disease. Pharmacotherapy should be provided only by clinicians who are experienced in the use of antiobesity agents and aware of the potential for adverse reactions. We suggest bariatric surgery for adolescents with BMI above 50 kg/m(2), or BMI above 40 kg/m(2) with severe comorbidities in whom lifestyle modifications and/or pharmacotherapy have failed. Candidates for surgery and their families must be psychologically stable and capable of adhering to lifestyle modifications. Access to experienced surgeons and sophisticated multidisciplinary teams who assess the benefits and risks of surgery is obligatory. We emphasize the prevention of obesity by recommending breast-feeding of infants for at least 6 months and advocating that schools provide for 60 min of moderate to vigorous daily exercise in all grades. We suggest that clinicians educate children and parents through anticipatory guidance about healthy dietary and activity habits, and we advocate for restricting the availability of unhealthy food choices in schools, policies to ban advertising unhealthy food choices to children, and community redesign to maximize opportunities for safe walking and bike riding to school, athletic activities, and neighborhood shopping.

An Obesity Risk Assessment Tool for Young Children: Validity With BMI and Nutrient Values.

OBJECTIVE: Demonstrate validity and reliability for an obesity risk assessment tool for young children targeting families' modifiable home environments. DESIGN: Longitudinal design with data collected over 100 weeks. SETTING: Head Start and the Special Supplemental Nutrition Program for Women, Infants, and Children. PARTICIPANTS: Parent-child pairs (n = 133) provided food behavior assessments; 3 child-modified, 24-hour dietary recalls; 3 ≥ 36-hour activity logs; and measured heights and weights. MAIN OUTCOME MEASURE: Five measures of validity and 5 of reliability. RESULTS: Validity was excellent for the assessment tool, named Healthy Kids, demonstrating an inverse relationship with child body mass index percentile-for-age (P = .02). Scales were significantly related to hypothesized variables (P ≤ .05): fruit or vegetable cup equivalents; folate; vitamins A, C, and D; ß-carotene; calcium; fiber; sugar; screen, sleep, and physical activity minutes; and parent behaviors. Measures of reliability were acceptable. CONCLUSIONS AND IMPLICATIONS: Overall, children with higher Healthy Kids scores had a more healthful profile as well as lower body mass index percentiles-for-age 1.5 years later. Healthy Kids has potential for use by nutrition professionals as a screening tool to identify young children most at risk for excess weight gain, as an evaluation to assess intervention impact, and as a counseling tool to tailor intervention efforts. Future research should include validation in other settings and with other populations.

Aerobic fitness and upper extremity strength in patients aged 11 to 21 years with spinal cord dysfunction as compared to ideal weight and overweight controls.

OBJECTIVE: To determine whether the aerobic fitness, upper extremity strength, and body composition in groups of adolescents with mobility impairment due to thoracic and upper lumbar spinal cord injury (SCI) or spina bifida (SB) are significantly different from those in groups of adolescents without mobility impairment who are of normal weight (CTRL) or overweight (OW). SUBJECTS: One hundred fifteen total subjects were evaluated including 59 female (19 SB, 9 SCI, 17 OW, and 14 CTRL) and 56 male (18 SB, 10 SCI, 8 OW, and 20 CTRL) participants aged 11 to 21 years. METHODS: Aerobic fitness was assessed using a ramp protocol with a magnetically braked arm ergometer. Heart rate and oxygen uptake (VO2) were recorded. Peak isokinetic upper arm and shoulder strength values were determined with a dynamometer. Body composition was estimated using dual energy x-ray absorptiometry (DEXA). Male and female subjects were categorized as overweight if their percent body fat by DEXA exceeded 25% and 30%, respectively. Results were analyzed with an ANOVA using the Bonferroni correction. Significance was accepted at P < 0.05. RESULTS: The percent body fat of both the male and female SB and SCI subjects was significantly higher than CTRL but was not different than OW. In general, the shoulder extension and flexion strength in both the SB and SCI males and females was significantly lower than that of the CTRL and OW. The SCI and SB subjects had significantly reduced aerobic capacity (VO2/kg) compared to the CTRL subjects but were not different than the OW subjects. During the maximal exercise test, the SB and SCI subjects reached exhaustion at significantly lower workloads than the CTRL and OW subjects. CONCLUSIONS: Patients age 11 to 21 years with SB and SCI had reduced aerobic capacity that was associated with being overweight and having reduced upper extremity strength. These data suggest that interventions to increase strength and fitness and to manage weight should be recommended in this population.

Body composition and resting energy expenditure in patients aged 11 to 21 years with spinal cord dysfunction compared to controls: comparisons and relationships among the groups.

OBJECTIVES: To compare body composition in patients aged 11 to 21 years with spinal dysfunction due to spinal cord injury (SCI) and spina bifida (SB) vs. able-bodied control (CTRL) and able-bodied overweight (OW) groups and to examine the relationships between resting energy expenditure (REE) and total lean mass (TLM) in the SCI, SB, CTRL, and OW groups. METHODS: Two hundred fifteen subjects, including 85 CTRL, 31 OW, 33 SCI, and 66 SB, were evaluated. Body composition was estimated by dual energy x-ray absorptiometry (DXA). Measurements included height, weight, total lean mass (TLM), fat tissue mass (FTM), body mass index (BMI), BMI percentile (BMI%tile), and % fat. Resting energy measurements were obtained in fasting subjects with an open-circuit indirect calorimeter. RESULTS: There were gender differences in height, weight, BMI, TLM, fat mass, % fat, and REE. The REE in the SCI and SB groups was significantly different from that in the CTRL and OW groups, but no significant difference was found between the SCI and SB groups. The SB group had significantly higher REE/TLM ratios than did the other groups. The % fat was significantly higher in the SB and OW groups as compared to the CTRL and SCI groups. TLM was significantly higher in CTRL and OW groups as compared to SCI and SB groups, with the lowest TLM found in the SB group. CONCLUSION: Patients aged 11 to 21 years with SB or SCI have significant lean tissue mass deficits by DXA as compared to able-bodied CTRL and OW groups, with the greatest deficits in total lean mass measured in SB. The absolute REE values were significantly reduced in both SCI and SB groups in association with their lean tissue deficits. Interestingly, REE/TLM ratios were remarkably constant in the CTRL, OW, and SCI groups but significantly elevated in the SB group. One would expect an even greater degree of adiposity in the SB group if their REE/TLM ratios were not elevated relative to those without congenital paralysis.

Metabolic syndrome in adolescents with spinal cord dysfunction.

OBJECTIVE: The purpose of this study was to determine the prevalence of components of the metabolic syndrome in adolescents with spinal cord injury (SCI) and spina bifida (SB), and their associations with obesity in subjects with and without SCI and SB. METHODS: Fifty-four subjects (20 SCI and 34 SB) age 11 to 20 years with mobility impairments from lower extremity paraparesis were recruited from a hospital-based clinic. Sixty able-bodied subjects who were oversampled for obesity served as controls (CTRL). Subjects were categorized as obese if their percent trunk fat measured by dual x-ray absorptiometry (DXA) was > 30.0% for males and > 35.0% for females. Ten SCI, 24 SB, and 19 CTRL subjects were classified as obese. Fasting serum samples were collected to determine serum glucose, insulin, and lipid concentrations. Metabolic syndrome was defined as having > or =3 of the following components: (a) obesity; (b) high-density lipoprotein (HDL) <45 mg/dL for males; <50 mg/dL for females; (c) triglycerides 2100 mg/dL; (d) systolic or diastolic blood pressure > or =95th percentile for age/ height/gender, and (e) insulin resistance determined by either fasting serum glucose 100-125 mg/dL; fasting insulin > or =20 microU /mL; or homeostasis model assessment of insulin resistance > or = 4.0. RESULTS: Metabolic syndrome was identified in 32.4% of the SB group and 55% of the SCI group. Metabolic syndrome occurred at a significantly higher frequency in obese subjects (SB = 45.8%, SCI = 100%, CTRL = 63.2%) than nonobese subjects (SB = 0%, SCI = 10%, CTRL = 2.4%). CONCLUSIONS: The prevalence of metabolic syndrome in adolescents with SB/SCI is quite high, particularly in obese individuals. These findings have important implications due to the known risks of cardiovascular diseases and diabetes mellitus associated with metabolic syndrome in adults, particularly those with spinal cord dysfunction.