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Anthropometric Parameters and Mediterranean Diet Adherence in Preschool Children in Split-Dalmatia County, Croatia-Are They Related?
Bučan Nenadić, D, Kolak, E, Selak, M, Smoljo, M, Radić, J, Vučković, M, Dropuljić, B, Pijerov, T, Babić Cikoš, D
Nutrients. 2021;(12)
Abstract
Obesity is a rapidly growing problem in European countries, Croatia being among them. According to the latest CroCOSI data, every third child in Croatia aged 8.0-8.9 years is overweight or obese. The Mediterranean diet (MeDi) and its impact on nutritional status and health has been the focus of recent research. Therefore, the aim of this cross-sectional, observational study was to determine the nutritional status and adherence to the MeDi of preschool children in Split, Croatia. We included 598 preschool children aged 3 to 7 years and, for each child, parents completed a lifestyle questionnaire and the Mediterranean Diet Quality Index (KIDMED) in order to assess adherence to the MeDi. The anthropometric assessment included the measurement of weight, height, mid-upper arm circumference (MUAC), waist circumference (WC) and the z-score was calculated. According to the z-score, 420 (70.2%) children had a healthy body weight with 54 (9%) underweight and 124 (20.8%) overweight or obese children. Almost half (49%) of the study participants had a low KIDMED index score, indicating a low MeDi adherence, 37% had an average score, while only 14% had high MeDi compliance. Statistically significant negative correlations between MUAC and WC and the consumption of a second daily serving of fruit (p = 0.04) as well as a daily serving of vegetables (p = 0.03) were found. In conclusion, low compliance to the MeDi principles in preschool children is concerning. Considering the beneficial effects of the MeDi on overall health, further education, and the adoption of healthy eating habits in preschool children in this Mediterranean region are required.
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Evaluation of Kisspeptin levels in prepubertal obese and overweight children: sexual dimorphism and modulation of antioxidant levels.
Mancini, A, Currò, D, Cipolla, C, Barini, A, Bruno, C, Vergani, E, Di Segni, C, Guidi, F, Nicolotti, N, Silvestrini, A, et al
European review for medical and pharmacological sciences. 2021;(2):941-949
Abstract
OBJECTIVE Kisspeptin, neuropeptide involved in puberty beginning and regulation of pituitary-gonadal axis, has been shown to stimulate antioxidant defenses in murine models. Its levels are greater in females than males and also in obese prepubertal girls. Therefore, our aim was to evaluate sex-related differences in prepubertal obese patients and the relationships of Kisspeptin with metabolic/hormonal parameters. PATIENTS AND METHODS We studied Kisspeptin concentrations in 54 children (22 males and 32 females, Tanner stage 1), 5-12 ys, classified according to Cole's criteria into 17 overweight and 37 obese; 25 normal-weight children, aged 6-12 years, were studied as controls. We evaluated metabolic (glucose and insulin levels after oral glucose load, total- LDL- HDL-cholesterol, triglycerides, uric acid) and hormonal (fT3, fT4, TSH, IGF-1, leptin) parameters. Moreover, total antioxidant capacity (TAC) was evaluated by spectrophotometric method, using the system H202-metmyoglobin-ABTS. Kisspeptin levels were measured by RIA. RESULTS We did not find significant differences between obese and normal-weight children, but obese males presented significantly lower levels than females. Kisspeptin did not correlate with BMI, HOMA-IR, Insulin peak levels and TAC; a significant correlation was found between Kisspeptin and fT3 (r2=0.25; p=0.003) in the obese group; leptin levels, significantly greater in obese vs. overweight and control children, significantly correlated with TAC (r2=0.39; p=0.03). CONCLUSIONS These data suggest that both hormones could modulate antioxidants, Kisspeptin indirectly via influence on thyroid hormones, and Leptin by a direct effect. This mechanism seems to be sex-related, not attributable to peripheral steroid levels. Further studies can clarify the complex interrelationship between central and peripheral Kisspeptin secretion and oxidative stress in children obesity.
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Outcomes of Bariatric Surgery in Older Versus Younger Adolescents.
Ogle, SB, Dewberry, LC, Jenkins, TM, Inge, TH, Kelsey, M, Bruzoni, M, Pratt, JSA
Pediatrics. 2021;(3)
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Abstract
OBJECTIVES In this report, we compare weight loss, comorbidity resolution, nutritional abnormalities, and quality of life between younger and older adolescents after metabolic and bariatric surgery. METHODS From March 2007 to December 2011, 242 adolescents (≤19 years of age) who underwent bariatric surgery at 5 clinical centers in the United States were enrolled in the prospective, multicenter, long-term outcome study Teen-Longitudinal Assessment of Bariatric Surgery. Outcome data from younger (13-15 years; n = 66) and older (16-19 years; n = 162) study participants were compared. Outcomes included percent BMI change, comorbidity outcomes (hypertension, dyslipidemia, and type 2 diabetes mellitus), nutritional abnormalities, and quality of life over 5 years post surgery. RESULTS Baseline characteristics, except for age, between the 2 cohorts were similar. No significant differences in frequency of remission of hypertension (P = .84) or dyslipidemia (P = .74) were observed between age groups. Remission of type 2 diabetes mellitus was high in both groups, although statistically higher in older adolescents (relative risk 0.86; P = .046). Weight loss and quality of life were similar in the 2 age groups. Younger adolescents were less likely to develop elevated transferrin (prevalence ratio 0.52; P = .048) and low vitamin D levels (prevalence ratio 0.8; P = .034). CONCLUSIONS The differences in outcome of metabolic and bariatric surgery between younger and older adolescents were few. These data suggest that younger adolescents with severe obesity should not be denied consideration for surgical therapy on the basis of age alone and that providers should consider adolescents of all ages for surgical therapy for obesity when clinically indicated.
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Association of Multisetting Community Programs and Policies With Child Body Mass Index: The Healthy Communities Study.
Collie-Akers, VL, Fawcett, SB, Schultz, JA, Fleming, KK, Swinburne Romine, RE, Ritchie, LD, Frongillo, EA, Arteaga, SS
Preventing chronic disease. 2020;:E34
Abstract
INTRODUCTION Expert opinion suggests that efforts to address childhood obesity should seek to transform the environments in which children operate. The objective of this study was to describe the extent to which multisetting programs and policies interact with community and child predictors and are associated with child body mass index (BMI) in the 130 US communities participating in the Healthy Communities Study. METHODS For 2 years beginning in fall 2013, we collected data through key informant interviews on community programs and policies related to healthy weight among children that occurred in the 10 years before the interview. We characterized community programs and policies by intensity of efforts and the number of settings in which a program or policy was implemented. Child height and weight were measured during household data collection. We used multilevel modeling to examine associations of community programs and policies in multiple settings and child and community predictors with BMI z scores of children. RESULTS The mean number of settings in which community policies and programs were implemented was 7.3 per community. Of 130 communities, 31 (23.8%) implemented community programs and policies in multiple settings. Higher-intensity community programs and policies were associated with lower BMI in communities that used multiple settings but not in communities that implemented programs and policies in few settings. CONCLUSION Efforts to prevent childhood obesity may be more effective when community programs and policies are both intensive and are implemented in multiple settings in which children live, learn, and play.
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[Phenotype proposal for early diagnosis of possibility of metabolic syndrome in school children aged 6 to 15 years].
Aguirre Palacios, FA, Aguirre Caamaño, MF, Celis, G
Hipertension y riesgo vascular. 2020;(3):115-124
Abstract
INTRODUCTION AND OBJECTIVES Obesity and metabolic syndrome (MS) continue to be a problem at a socioeconomic level, causing high morbidity and mortality in the adult population. Prevention of risk factors should be carried out from an early age. Currently, there is no consensus on the opportune moment to start an intervention or treatment, regarding metabolic syndrome. The objective of the study is to describe the phenotype to predict early diagnosis of metabolic syndrome in schoolchildren. MATERIAL AND METHODS Observational, prospective, cross-sectional and analytical study in schoolchildren from 6 to 15 years old, conducted in Guayaquil. Anthropometric measurements and a survey were performed, obtaining signing informed consent. The IBM Watson artificial intelligence (AI) platform with its software Modeler Flow, were used for the analysis. RESULTS A population of 1025 students between 6 and 15 years old (mean of 12 years for men and 13 years for women) was examined, of whom 62.3% were men and 37.7% women. 23.9% of the population was overweight and 14% obese. A greater tendency to weight alteration was observed in men than in women (51.37% vs 47.79%), and a lower waist circumference in men (85 cm vs 87 cm, respectively). Males had a higher level of systolic blood pressure (SBP), being within the 90th percentile (mean SBP of 123 mmHg) 61.2%, compared to 38.8% of women, with a p < 0.001. Sedentary lifestyle is similar in both groups, with an average of 4.79 hours in front of the screen and/or video games. A statistically significant correlation was demonstrated between SBP and the waist/height ratio (WHtR) in the 90th percentile and 95th percentile (X2 9.075, p < 0.028, and X2 23,54, p < 0,000 respectively), as well as a relationship between 95th percentile and sex (X2 11.57, p < 0.001). The Modeler Flow software showed us that if WHtR, > 0.46, weight > 56.1 kg and height > 1.61 m, the probability of presenting metabolic syndrome, was of 82.4%. The statistic of this study has a predictive accuracy of 90% (error deviation of 0.009). The importance in the predictors of metabolic syndrome, range from 97.57% to 100%. CONCLUSIONS A prevalence of 33.9% of metabolic syndrome was observed in schoolchildren from 6 to 15 years old, with pathological cut-off points of: WHtR > 0.46, weight > 56.1 kg, pure sedentary lifestyle > 3 hours in front of the screen/playing video games, and SBP within the 90th percentile (> 123 mmHg). With these four indicators, we can predict a probability of early diagnosis of metabolic syndrome of 97% to 100%.
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[Which variables influence compliance with physical activity recommendations in young children?].
Gutierrez-Hervas, A, Cortés-Castell, E, Juste-Ruíz, M, Rizo-Baeza, M
Anales de pediatria. 2020;(3):156-164
Abstract
INTRODUCTION There are established European guidelines for physical activity in childhood. The main goal of our study was to determine the factors that may influence compliance with European recommendations for physical activity in young children. METHODS We included 136 children (aged 2-8 years) classified by weight status, calculated based on the body mass index z-score using the growth standards of the World Health Organization. We measured physical activity over 5 consecutive days with accelerometers and recorded the food intake. RESULTS A greater level of physical activity was associated with a lower weight status category (B=-1.55; 95% CI: -2.02 to -1.08; P<.001), lower age (B=-1.33; 95% CI: -1.72 to -0.93; P<.001) and greater energy expenditure (B=0.02; 95% CI: 0.02 to 0.03; P<.001). The overall physical activity in the sample was light (mean=589 cpm/day). Children with overweight and obesity spent less time engaged in moderate to vigorous physical activity (P=.005) and more time engaged in sedentary activities (P=.005) compared to children with normal weight. All groups spent between 90 and 130minutes a day in sedentary activities, with a mean time spent that amounted to 15.5% of their time (excluding time spent sleeping). The adherence to European recommendations varied in association with sex (P=.010) and weight status (P=.038). CONCLUSION Young children spent more than 100minutes a day engaged in sedentary activities. Most of the sample met the European recommendations for daily moderate to vigorous physical activity. However, the degree of adherence depended on sex and weight status.
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Health Outcomes of Youth in Clinical Pediatric Weight Management Programs in POWER.
Kumar, S, King, EC, Christison, AL, Kelly, AS, Ariza, AJ, Borzutzky, C, Cuda, S, Kirk, S, ,
The Journal of pediatrics. 2019;:57-65.e4
Abstract
OBJECTIVE To describe treatment outcomes of children and adolescents enrolled in the Pediatric Obesity Weight Evaluation Registry, a consortium of multicomponent pediatric weight management programs in the US. STUDY DESIGN This multicenter prospective observational cohort study, established in 2013, includes youth (2-18 years of age) with obesity enrolled from 31 Pediatric Obesity Weight Evaluation Registry (POWER) sites over a 2-year period and followed up to 12 months. Weight status was evaluated by the percentage of the 95th percentile for body mass index (%BMIp95). Associations of weight status outcomes with patient characteristics and program exposure were analyzed with multivariable mixed effects modeling. RESULTS We included 6454 children and adolescents (median age, 11 years; IQR, 9-14 years; 53% white, 32% Hispanic; 73% with severe obesity) who were enrolled in POWER. Median changes in %BMIp95 for this cohort were -1.88 (IQR, -5.8 to 1.4), -2.50 (IQR, -7.4 to 1.8), -2.86 (IQR, -8.7 to 1.9), at 4-6, 7-9, and 10-12 of months follow-up, respectively (all P < .05). Older age (≥12 years), greater severity of obesity, and Hispanic race/ethnicity were associated with better improvement in %BMIp95. A 5-percentage point decrease in %BMIp95 was associated with improvement in cardiometabolic risk factors. CONCLUSIONS Overall, treatment in pediatric weight management programs is associated with a modest median decrease in BMI as measured by change in %BMIp95. Further studies are needed to confirm these findings, as well as to identify additional strategies to enhance the effectiveness of these multicomponent interventions for youth with severe obesity. TRIAL REGISTRATION ClinicalTrials.gov: NCT02121132.
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Associations between physical activity and asthma, eczema and obesity in children aged 12-16: an observational cohort study.
Jago, R, Salway, RE, Ness, AR, Shield, JPH, Ridd, MJ, Henderson, AJ
BMJ open. 2019;(1):e024858
Abstract
OBJECTIVES To compare the physical activity of adolescents with three common long-term conditions (asthma, eczema and obesity) with adolescents without these conditions. DESIGN Cross-sectional and longitudinal analyses of adolescents at ages 12, 14 and 16 in a large UK cohort study. SETTING The Avon Longitudinal Study of Parents and Children. PARTICIPANTS 6473 adolescents with complete accelerometer data at at least one time point. METHODS Mean minutes of moderate to vigorous intensity physical activity (MVPA) and sedentary time per day were derived from accelerometer-based measurements at ages 12, 14 and 16. Obesity was defined at each time point from height and weight measurements. Parents reported doctor-assessed asthma or eczema. Cross-sectional and longitudinal regression models examined any differences in MVPA or sedentary time for adolescents with asthma, eczema or obesity compared with those without. RESULTS In longitudinal models, boys engaged in an average of 69.7 (95% CI 67.6 to 71.7) min MVPA at age 12, declining by 3.1 (95% CI 2.6 to 3.6) min/year while girls' average MVPA was 47.5 (95% CI 46.1 to 48.9) min at age 12, declining by 1.8 (95% CI 1.5 to 2.1) min/year. There was no strong evidence of differences in physical activity patterns of those with and without asthma or eczema. Obese boys engaged in 11.1 (95% CI 8.7 to 13.6) fewer minutes of MVPA, and obese girls in 5.0 (95% CI 3.3 to 6.8) fewer minutes than their non-obese counterparts. Cross-sectional models showed comparable findings. CONCLUSIONS Mean minutes of MVPA per day did not differ between adolescents with asthma or eczema and those without, but obese adolescents engaged in fewer minutes of MVPA. Findings reinforce the need for strategies to help obese adolescents be more active but suggest no need to develop bespoke physical activity strategies for adolescents with mild asthma or eczema.
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Complementary feeding, consumption of industrialized foods and nutritional status of children under 3 years old in Pelotas, Rio Grande do Sul, Brazil, 2016: a descriptive study.
Neves, AM, Madruga, SW
Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil. 2019;(1):e2017507
Abstract
OBJECTIVE to verify how and when complementary feeding (CF) begins, its profile, consumption of processed foods and nutritional status of children aged 1-3 years. METHODS children enrolled at public schools in Pelotas, RS, Brazil, were evaluated; length/height-for-age and weight-for-age scores, and body mass index (BMI)/age were used, and a structured questionnaire was administered to parents/caregivers; CF was considered early when started before the age of six months; data were presented in a descriptive way. RESULTS 79 children were evaluated, of whom 13 were overweight and 6 obese; 11 had high weight-for-age; mean age for beginning CF was 5.3 months; when aged <6 months, 43% received gelatin, and 12.7% juice from cartons; when aged 6-24 months, 96.2% received filled biscuits and 91.1% salty snacks. CONCLUSION CF and consumption of processed foods began early; obesity and overweight were more prevalent than malnutrition.
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Results of a referral-based weight management program targeted toward children aged 2 to 6 years with obesity or severe obesity.
Wickel, EE, Ali, L, Hawkins, H, Hemming, E
BMC pediatrics. 2019;(1):504
Abstract
BACKGROUND Relatively little is known about weight management programs targeted toward young children with obesity. Using data from the Early Lifestyles Intervention program, we report outcomes from a referral-based, multi-disciplinary weight management program targeted toward children aged 2 to 6 years with obesity or severe obesity. METHODS Data from 55 children (4.5 ± 1.3 years) medically referred to the ELI program were examined in this non-randomized investigation. At baseline, a nurse collected demographic, anthropometric and clinical measures from the study child, while parents/guardians completed questionnaires regarding their child's nutrition and activity behavior. Follow-up sessions were conducted to discuss healthy behavior strategies and collect anthropometrics from the study child. Body mass index (BMI) values were reported relative to the 95th BMI percentile (%BMIp95) and children were classified as obese (≥ 100% of 95th BMI percentile) or severely obese (≥ 120% of 95th BMI). Questionnaire data were analyzed to report group-level differences and to determine whether individual items predicted changes in %BMIp95 from baseline to follow-up. Regression models were used to examine the change in %BMIp95 by sex, ethnicity, and baseline body size. RESULTS Certain behaviors were more frequent among non-Hispanic children compared to Hispanic children (demanding certain foods), whereas other behaviors were more frequent among children with severe obesity compared to children with obesity (requesting a second helping, getting own snack and sneaking food). Greater reductions in the study child's %BMIp95 were found among parents indicating their child requests a second helping, is a faster eater, or complains of being hungry. Among the combined sample, %BMIp95 significantly decreased from baseline to final follow-up. On average, the decrease in %BMIp95 did not differ by sex, ethnicity, or baseline body size. CONCLUSIONS Modest improvements in body size were observed. Additional studies are needed to identify best practices for pediatric interventions seeking weight management.