Breast-feeding history and overweight in 11 to 13-year-old children in Iran

Background  The relationship between breast-feeding history and risk of overweight in pre-adolescent children was investigated. Methods  Children’s breast-feeding history and demographics were obtained in interviewer-administered questionnaires of a multistage cluster sample survey of 800 parents of children aged 11–13 years living in Yazd, Iran. Height and weight were measured in the children. Overweight was defined as body mass index ≥90th age- and sex-specific percentile of the 2000 Centers for Disease Control reference values. Results  One hundred and four (13.0%) of 800 children were overweight. A total of 783 (97.9%) of the children had been breast fed. There was a markedly lower overweight prevalence among breast-fed than non breast-fed children. Controlling for age and sex, children breast fed for at least 24 months were substantially less likely to be overweight than children breast fed for less than 12 months (OR 0.56, 95% CI 0.31–0.9). A longer overall duration and duration of exclusive breast-feeding were associated significantly with the decreasing prevalence of overweight. Conclusion  This sample of Iranian children shows high rates of overweight at young ages but also high rates of breast-feeding. The duration of breast-feeding is inversely related with the prevalence of overweight in pre-adolescent children.     

Overweight and obesity in 6- to 14-year-old Czech children in 1991: protective effect of breast-feeding

OBJECTIVE: To assess the impact of breast-feeding on childhood overweight/obesity in an Eastern European socialist society with relatively homogeneous lifestyles. STUDY DESIGN: Cross-sectional survey data collected in 1991 on 33,768 school-children aged 6 to 14 years in the Czech Republic were analyzed by using multiple logistic regression analyses (main outcome body mass index [BMI] >90th percentile [overweight] and BMI >97th percentile [obesity]). RESULTS: Overall prevalence of overweight (obesity) was lower in breast-fed children: ever breast-fed (9.3%; 95% CI, 8.9-9.6 [3.2%; 95% CI, 3.0-3.4]) compared with never breast-fed (12.4%; 95% CI, 11.3-13.6 [4.4%; 95% CI, 3.7-5.2]). The effect of breast-feeding on overweight/obesity did not diminish with age in children 6 to 14 years old and could not be explained by parental education, parental obesity, maternal smoking, high birth weight, watching television, number of siblings, and physical activity. Adjusted odds ratios for breast-feeding were for overweight 0.80 (95% CI, 0.71-0.90) and for obesity 0.80 (95% CI, 0.66-0.96). CONCLUSIONS: A reduced prevalence of overweight/obesity was associated with breast-feeding in a setting where socioeconomic status was homogeneous. This suggests that the effect of breast-feeding on the prevalence of obesity is not confounded by socioeconomic status.     

Breast-feeding and overweight in Singapore school children

Background:  Studies from developed Western countries have shown inconsistent associations between breast-feeding and overweight/obesity in children and adolescents. Few data are available from Asian populations. The purpose of the present study was therefore to evaluate the association between breast-feeding and overweight/obesity in a study of 10–12-year-old children in Singapore.
Methods:  A total of 797 school children (49% girls, 76% Chinese) who participated in the Singapore Cohort Study of the Risk Factors for Myopia (SCORM) were examined. Overweight/obesity ( n  = 179) was defined as age–sex-specific body mass index (BMI) cut-offs corresponding to BMI of 25 kg/m² for overweight and 30 kg/m² for obesity at age 18 based on the International Obesity Task Force (IOTF) reference.
Results:  The prevalence of overweight/obesity was 22.5%. Overall, breast-feeding was not found to be associated with overweight/obesity. After adjusting for potential confounders, the multivariable odds ratio (95% confidence interval) of overweight/obesity was 1.14 (0.80–1.63) for ever breast-fed compared with never breast-fed, 1.00 (0.57–1.72) for breast-fed for >3 months compared to ≤3 months and 0.79 (0.47–1.34) for exclusive/mostly breast-fed compared to partly breast-fed.
Conclusions:  No significant associations were detected among breast-feeding, its type, and duration with overweight/obesity in this Asian cohort of 10–12-year-old children.     

Decreased quality of life associated with obesity in school-aged children

OBJECTIVES: To examine the association between health-related quality of life and body mass index (BMI) in preadolescent school-aged children and to provide the possible risk factors among participant characteristics, BMI status, and health-related quality of life.Design, Setting, and PARTICIPANTS: Cross-sectional analysis of 371 (50% female; 32% minority) children from a community-based sample of 8- to 11-year-olds participating in an ongoing cohort study, excluding those who had sleep apnea or who were born prematurely. Using BMI percentiles for age and sex, 17.5% of the children were considered overweight (BMI > or =95th percentile), 12.4% were at risk for overweight (BMI 85th-94th percentile), 8.1% were relatively underweight (BMI <20th percentile), and the remaining 62.0% were of normal weight (BMI 20th-84th percentile). MAIN OUTCOME MEASURES: Health-related quality-of-life scores as determined by the Child Health Questionnaire-Parent Form 50, dichotomized into the bottom quartile or decile. RESULTS: After adjustment for covariates (host factors and health status measurements), overweight children compared with normal weight children scored lower on the Psychosocial Health Summary (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.6) and on subscales measuring self-esteem (OR, 3.5; 95% CI, 1.9-6.3), physical functioning (OR, 2.8; 95% CI, 1.7-6.8), and effect on the parent's emotional well-being (OR, 2.0; 95% CI, 1.1-3.6). Compared with the normal weight group, children who are at risk for overweight scored significantly lower for physical functioning. CONCLUSION: Overweight children have an increased odds of low scores for several health-related quality-of-life domains, suggesting the importance in considering such dimensions in programs aimed at further understanding obesity in children.     

High body mass index, asthma and allergy in Swedish schoolchildren participating in the International Study of Asthma and Allergies in Childhood: Phase II

AIM: To assess the relationship between high body mass index (BMI) and asthma and atopic manifestations in 12-y-old children. METHODS: The relationship between high BMI and asthma symptoms was studied in 457 sixth-grade children, with (n = 161) and without (n = 296) current wheeze. High BMI was defined as > or = 75th percentile of gender-specific BMI reference values for Swedish children at 12 y of age; overweight as a subgroup of high BMI was defined as > or = 95th percentile. Children with a BMI < 75th percentile served as controls. Questionnaires were used to assess asthmatic and allergic symptoms, and bronchial hyperresponsiveness was assessed by hypertonic saline provocation tests. RESULTS: Current wheeze was associated with high BMI after adjustment for confounding factors (adjusted OR 1.7, 95% CI 1.0-2.5) and overweight had an even more pronounced effect (adjusted OR 1.9, 95% CI 1.0-3.6). In addition, asthma severity was associated with high BMI, as evaluated by the number of wheezing episodes during the previous 12 mo among the wheezing children (adjusted OR 2.0, 95% CI 1.0-4.0). There was also an association between high BMI and the presence of eczema in wheezing children (adjusted OR 2.2, 95% CI 1.0-4.6). However, high BMI was not significantly associated with hay fever, positive skin prick tests or bronchial hyperresponsiveness. CONCLUSION: The study confirms and extends a previously observed relationship between BMI and the presence of wheezing and asthma.     

Overweight among young children in the Philadelphia health care centers: incidence and prevalence

OBJECTIVES: To estimate the prevalence and incidence of overweight among low-income, inner-city children aged 3 to 7 years and to determine predictors of changes in body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) percentile. DESIGN: Retrospective cohort study using administrative and medical records. SETTING: The Philadelphia Health Care Centers, 1996 through 2003. PARTICIPANTS: Three hundred eighty-six patients who had at least 2 well-child visits between the ages of 3 and 7 years, had at least 1 visit between September 2001 and 2003, and were between the ages of 5 and 7 years at the most recent visit. Mean follow-up time was 2.4 years. MAIN EXPOSURES: Age, sex, race/ethnicity, and BMI percentile at baseline. MAIN OUTCOME MEASURES: Prevalence and incidence of overweight and at risk of overweight and change in BMI percentile. RESULTS: Prevalence of overweight at the initial visit was 18%, with 16% at risk of overweight. At the last visit, the prevalence of overweight was 19%, with 15% at risk of overweight. Based on maximum BMI percentile, 29% were overweight at some point and an additional 19% were at risk of overweight at least once. Annualized incidence of overweight among those not overweight at baseline was 5% per year: 2% per year for normal-weight children and 14% per year for children in the at-risk category. The outcomes were not associated with sex, race/ethnicity, or age at first or last visit. Incident overweight was positively associated with BMI percentile at baseline. CONCLUSION: The early onset and frequent persistence of overweight demonstrated herein underline the need to prevent overweight among very young children.     

Gender, type of education, family background and overweight in adolescents.

OBJECTIVE: To examine gender-specific socio-educational correlations of overweight in adolescents enrolled in post-mandatory education. SUBJECTS AND METHODS: Data were drawn from the Swiss Multicenter Adolescent Survey on Health, a cross-sectional study conducted on a representative sample of 3439 females and 4109 males aged 16 to 20 and enrolled in either vocational education (apprentices) or full time school (students). Adolescents reporting a body mass index (BMI) > 85th percentile for age and gender were compared with those reporting a BMI around the median (25th-75th percentile). RESULTS: Multivariate logistic regression showed that apprentices of both genders were more likely to report a BMI > or = 85th percentile than students: odds ratio (OR) in females 1.49 (95% confidence interval [CI] 1.11, 1.99), OR in males 1.61 (95%CI 1.19, 2.19). In females, but not in males, reported BMI was associated with parental education level (father with baccalaureate or university degree, OR = 1.00; father with vocational proficiency certificate, OR = 1.48 [95% CI 1.06, 2.07] and father without post-mandatory education, OR =3.44 [95% CI 2.20, 5.38]). CONCLUSIONS: The observed differences in the correlation of parents' and adolescents' own educational status with overweight suggest that parental and adolescents' own education represent distinct risk factors for overweight. Apprentices' higher risk of being overweight might be of particular interest for prevention, as they represent a large number of adolescents, who enter the adult workforce at a young age. Overall, socio-educational characteristics explained only a small fraction of the variance in overweight, particularly in males.     

Birthweight, breast-feeding, parental weight and prevalence of obesity in schoolchildren aged 10–12 years, in Greece; the Physical Activity, Nutrition and Allergies in Children Examined in Athens (PANACEA) study

Background: The purpose of the present study was to determine the prevalence of overweight and obesity in a sample of Greek children aged 10–12 years, and to evaluate these rates in relation to parental weight and birthweight.
Methods: During the 2005–2006 school period, 700 schoolchildren (323 boys, 377 girls) were randomly recruited from 18 schools, in Athens. Height and weight were measured and body mass index (BMI) was calculated. Cut-off points for BMI defining obesity and overweight for gender and age were calculated in accordance with international standards.
Results: Overall, 8.6% of boys and 9.0% of girls were obese, and 33.9% of boys and 22.1% of girls were overweight. Having an obese parent increased the odds of having an overweight or obese child (P < 0.01). Compared to non-breast-fed, boys who were breast-fed for >3 months had 70% lower likelihood of being overweight or obese (P < 0.01) and breast-fed girls had 80% lower odds (P < 0.01). Excessive birthweight (>3500 g) increased by 2.5-fold the likelihood of being overweight or obese only in girls (P < 0.05).
Conclusions: Parental weight, lack of breast-feeding and excess birthweight (in girls) were significant predictors of overweight or obesity in Greek children aged 10–12 years.     

Ethnic differences in metabolic syndrome among overweight and obese children and adolescents: the Oslo Adiposity Intervention Study

Aim: Are there differences in the prevalence of metabolic syndrome between obese and overweight Norwegian and immigrant children and adolescents? Methods: Two hundred and three overweight and obese Norwegian, Pakistani, Tamil and Turkish patients aged 6–17 years living in Norway were included. Metabolic syndrome was defined as the presence of at least three abnormal values of waist circumference, blood pressure, fasting triglycerides, fasting glucose and HDL cholesterol. Results: The prevalence of metabolic syndrome was significantly higher among the immigrant compared to Norwegian subjects when adjusted for age, gender and BMI‐Z‐score (20.8 vs. 30.6%; OR = 2.2, 95% CI = 1.05–4.77). The prevalence of metabolic syndrome increased with increasing severity of obesity and reached 50% in severely obese immigrants and 30% in severely obese Norwegians. Among the overweight subjects metabolic syndrome prevalence was 23.5% among immigrants and 19.4% among Norwegians. Conclusion: Metabolic syndrome was found more frequently among children and adolescents with Middle Eastern and South Asian origins than Norwegians. Differences were found even after adjustment for age, sex and degree of obesity. This suggests that ethnic minorities may have an increased sensitivity to adiposity and need more aggressive prevention and treatment than their Norwegian counterparts.     

C-reactive protein and body mass index in children: findings from the Third National Health and Nutrition Examination Survey, 1988-1994

OBJECTIVES: To examine the relationship between C-reactive protein (CRP) concentration and body mass index (BMI) in children. STUDY DESIGN: With the use of data from 5305 children aged 6 to 18 years in the Third National Health and Nutrition Examination Survey (1988 to 1994), a cross-sectional health survey, we examined whether CRP concentrations were elevated among overweight children. RESULTS: Among children whose BMI was below the age- and sex-specific 15th percentile, 6.6% of boys and 10.7% of girls had an elevated CRP concentration (>2.1 mg/L) compared with 24.2% of boys and 31.9% of girls whose BMI was > or =95th percentile. After adjustment was done for age, sex, race or ethnicity, poverty income ratio, high-density lipoprotein cholesterol concentration, white blood cell count, and history of chronic bronchitis, the adjusted odds of having an elevated CRP concentration were 2.20 (95% CI 1.30, 3.75) for children with a BMI of 85th to <95th percentile and 4.92 (95% CI 3.39, 7.15) for children with a BMI of > or =95th percentile compared with children who had a BMI of 15th to <85th percentile. The associations did not differ significantly by age, sex, or race or ethnicity. CONCLUSIONS: In a large representative sample of US children, CRP concentration was significantly elevated among children with a BMI > or=85th percentile, thus confirming previous findings of this association in children and extending previous research in adults to children. Excess body weight may be associated with a state of chronic low-grade inflammation in children.     

Association between school children's overweight and maternal obesity and perception of their children's weight status

AIM: To determine the association between overweight children and a) other components of the mothers' metabolic syndrome, such as body mass index (BMI), waist circumference (WC), HDL-cholesterol, triglycerides, glucose, HOMA-IR, blood pressure (BP), and age; and b) the mothers' perception of their children's overweight. METHODS: Six hundred and twenty children (297 M) aged 9 +/- 2 years and their mothers aged 37.7 +/- 7 years were examined between April and August 2006. BMI, BP, fasting glucose and lipids and children's Tanner stage were determined. Questionnaires were filled in about the mothers' perceptions of their children's eating habits and of their children's shape. RESULTS: Ninety-five (17.4%) of the children were obese (> 95th percentile), 108 (15.3%) overweight (> 85th percentile) and 418 (67.3%) normal. One hundred and twelve (18%) of the mothers were obese and 183 (29.5%) overweight. Mean values for measures in mothers differed between normal vs overweight/obese children: z-BMI (-0.19 vs 0.42), triglycerides (84 vs 105 mg/dl), cholesterol (147 vs 157 mg/dl), glucose (78 vs 82 mg/dl) and insulin resistance (HOMA-IR 1.34 vs 1.72). There were significant differences in the proportion with distorted perception of shape (2.2% vs 47.5%) and eating habits (11.2% vs 37%) between mothers of normal versus overweight/ obese children. Logistic regression analysis using BMI > or = 85th percentile as the dependent variable showed that the mothers' perceptions of their children's shape (OR: 18.84; 95% CI: 5.0-69.6), eating habits (OR: 3.82; 95% CI: 1.5-9.5) and mothers' BMI (OR: 2.1; 95% CI: 1.3-3.4) were associated with children's overweight. CONCLUSIONS: There was an association between mothers' distorted perception of their children's shape and eating habits and mothers' obesity and their children's overweight. This observation provides clues for obesity prevention programs.     

The relationship of body mass index and blood pressure in primary care pediatric patients

OBJECTIVE: To determine whether an association of overweight, or risk of overweight, and blood pressure can be detected in children in the pediatric primary care practice setting. STUDY DESIGN: We examined electronic medical record (EMR) data from primary care practices on 18,618 children age 2 to 19 years. Each child was classified on the basis of age- and sex-specific body mass index (BMI) percentile as normal weight (BMI < 85th percentile), at risk for overweight (BMI > or = 85th and < 95th percentile), or overweight (BMI > or = 95th percentile). BMI Z-score and height Z-score were computed. Systolic and diastolic blood pressures were compared among age-sex-BMI groups. RESULTS: Among children in primary care pediatric practices, 16.7% were at risk of overweight and 20.2% were overweight. With increasing BMI status there was a significant increase in both systolic blood pressure (P < .001) and diastolic blood pressure (P < .001). The association of higher blood pressure with increasing BMI status was present in all age groups. CONCLUSIONS: Clinical data from pediatric primary care practices verify the high prevalence of childhood overweight. The effect of overweight on blood pressure is present in childhood and can be detected even in children as young as 2 to 5 years.     

Stature, weight, and body mass among young US children born at term with appropriate birth weights

OBJECTIVE: To describe weight, stature, and body mass index (BMI) changes occurring before the age of 7 years, which may influence the prevalence of overweight in adolescence and adulthood. METHODS: Regression models predicting height and weight at ages 2 months to 6. 75 years were based on the third National Health and Nutrition Examination Survey. Birth certificate data were used to adjust ethnic-specific models for birth weight for gestational age. RESULTS: Attained height is higher for non-Hispanic black children than for either non-Hispanic white or Mexican American children (P 85th percentile than either non-Hispanic white or black children (boys = 25.6%, SE = 2.7 compared with 14.1%, SE = 1.7 and 16.5%, SE = 1.7, respectively; girls = 21.9%, SE = 3.6 compared with 13.0%, SE = 1.7 and 13.7%, SE = 2.2, respectively). For non-Hispanic whites and Mexican Americans and for non-Hispanic black boys, BMI decreased slightly between ages 2 and 6.75 years; BMI for non-Hispanic black girls did not. CONCLUSION: Size differences before the age of 7 years may influence later ethnic-specific overweight prevalence, independent of prenatal influences.     

A study of growth parameters and prevalence of overweight and obesity in school children from delhi

OBJECTIVE: (1) To assess the height, weight and body mass index (BMI) of school children from Delhi and generate percentile charts as appropriate for age, gender and socio-economic status. (2) To determine the prevalence of overweight and obesity in school children from low and upper socioeconomic status (LSES and USES respectively). DESIGN: Cross sectional evaluation of anthropometric parameters in Delhi school children (5-18 years) from different geographical zones. SETTING: Government schools (non-fee paying) and Private Schools (fee paying) in Delhi. SUBJECTS: 21485 children, 8840 (3566 boys, 5274 girls) from government schools and 12645 (6197 boys, 6448 girls) from private schools. Methods: Subjects underwent assessment of height and weight and calculation of BMI. Children were classified as normal, overweight and obese as per IOTF guidelines. Height, weight and BMI percentile charts specific for the socioeconomic status were generated using the LMS method. Prevalence of overweight and obesity was assessed and compared between the two socio-economic groups. RESULTS: A significant difference was noted in height, weight and BMI between LSES and USES. The prevalence of overweight and obesity in USES children was 16.75 % and 5.59 % in boys and 19.01 % and 5.03 % in girls respectively. CONCLUSIONS: There is a significant disparity in anthropometric parameters between children from USES and LSES, with a high prevalence of overweight and obesity in USES children.     

Exposure to maternal smoking in the first year of life interferes in breast-feeding protective effect against the onset of respiratory allergy from birth to 5 yr

The aim of this study was to evaluate the interaction between the exclusive breast-feeding protective effect and the exposure to tobacco smoke at domicile in the first year of life, on the onset of respiratory allergy (asthma and rhinitis) in children until 5 yr of age. This is prospective cohort study, observational, institutional based. Three hundred children born in a public hospital of Salvador-Bahia (Brazil) were followed from birth to 5 yr of age. Data from 268 children at 60 months of life were analyzed. Occurrence of allergic symptoms were studied and correlated with gender, allergic relatives in first degree, exclusive breast-feeding duration, smoking mother, and presence of other smoker at home, considering the first year of life. Exclusive breast-feeding for at least 6 months showed a protection effect against the onset of respiratory allergy in children from birth to 5 yr (p < 0.05); odds ratio (OR): 0.33 (95% CI: 0.18–0.59). Breast-fed children for less then 6 months compared with those breast-fed for 6 months or more, presented a higher risk (OR: 2.34–95% CI: 1.4–3.74) for developing allergic respiratory symptoms just to 5 yr. The protective effect of exclusive prolonged breast-feeding on the onset of respiratory allergy in children from birth until 5 yr was lost when their mothers were smokers (OR: 2.50–95% CI 1.19–5.19). Therefore, the protective effect of breast-feeding in the first year of life on the onset of allergic symptoms until the age of 5 yr was confirmed. This study proposes a confounding effect of maternal smoking on this protection, exposed by a higher risk for present allergic symptoms until the age of 5 yr, in children exclusively breast-fed for 6 months or more, when their mothers smoked.     

Effect of activity restriction owing to heart disease on obesity

OBJECTIVE: To determine whether exercise intolerance and recommended activity restrictions are associated with development of overweight and obesity in children with congenital heart disease. DESIGN: Retrospective review. SETTING: Pediatric cardiology practice at a teaching hospital. PARTICIPANTS: A total of 110 pediatric congenital heart disease patients followed up for a mean of 8.4 years. MAIN OUTCOME MEASURES: Body mass index (BMI), sex-appropriate BMI percentiles, overweight (BMI percentile > or =85), and obesity (BMI percentile > or =95) at follow-up. RESULTS: As a group, the increase in BMI percentiles was close to 10 points, but the increase was 21.6 points for exercise intolerant children and 27.3 points for activity restricted children. Activity restriction was significantly associated with both overweight (risk ratio [RR], 2.60; 95% confidence interval [CI], 1.34-3.54) and obesity at follow-up (RR, 4.08; 95% CI, 1.42-7.38) after adjusting for weight at baseline. For the subset of 92 children at a healthy weight at baseline, activity restriction was again significantly associated with overweight (RR, 2.51; 95% CI, 1.24-3.52) and obesity (RR, 6.14; 95% CI, 2.54-8.82) at follow-up. Exercise intolerance did not attain statistical significance. CONCLUSIONS: Exercise intolerant and activity restricted children experienced larger increases in absolute BMI and BMI percentile than children with neither exercise intolerance nor activity restriction. Activity restriction was the strongest predictor of risk of overweight and obesity at follow-up. Elevated weight and obesity may cause these children significant additional health burdens. Therefore, when patients must be counseled against physical exertion, they also need to be educated about the importance of appropriate physical activity and good dietary practices.     

Obesity and type 2 diabetes mellitus: a population-based study of adolescents

A cross-sectional, population-based study was conducted on 1,647 Turkish adolescents to determine the prevalence of obesity, impaired fasting glucose (IFG) and type 2 diabetes mellitus (DM2), and to determine whether the recent increase in DM2 prevalence in some countries is applicable to this population. Information was gathered through a questionnaire. All children were screened with physical examination and fasting plasma glucose. 10.7% of adolescents were overweight (BMI 85-95th percentile) and 3.6% were obese (BMI > or =95th percentile). Mean BMI was 20.25 +/- 3.31 kg/m2 with maximum BMI 35.88 kg/m2. No child was diagnosed with DM2; 1.96% had IFG (110-126 mg/dl). No significant relationship was found between IFG and obesity, socio-economic status (SES) or family history of DM. The risk of obesity was increased among children with family history of DM or obesity, and among those who had low physical activity and were of high SES level. This analysis represents the population-based data upon which future studies will be based.     

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

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

Can the metabolic syndrome identify children with insulin resistance?

OBJECTIVE: The metabolic syndrome is associated with insulin resistance in adults. We defined pediatric metabolic syndrome using criteria analogous to Adult Treatment Panel III. The purpose of this study was to determine whether these criteria are reliable for insulin resistance in children. RESEARCH DESIGN AND METHODS: Out of 167 children (6.7 +/- 3 yr), 73 overweight [body mass index (BMI) > 95 percentile], 41 at risk of overweight (BMI > 85 < 95 percentile), and 53 normal-weight (BMI < 85 percentile) children matched for sex and age were examined. The results for waist circumference, blood pressure, oral glucose tolerance test, C-reactive protein, adiponectin, insulin, and lipids were obtained. RESULTS: There was a comparable prevalence of the metabolic syndrome in both sexes. The prevalence of the metabolic syndrome was 11.3% [95% confidence interval (CI) 6.56-16.19%] among the whole group and 21.9% (95% CI 12.24-31.0%) among overweight children. Waist circumference >75 percentile 53.2% (95% CI 45.73-60.86%) and low high-density lipoprotein 27.5% (95% CI 20.77-34.32%) were common in this sample. Compared with patients without any component of the metabolic syndrome, homeostasis model assessment insulin resistance (HOMA-IR) for patients with one through four components was higher (beta = 0.6, 95% CI 0.4-0.7, p < 0.0001, R(2) = 0.185). A logistic regression analysis using the metabolic syndrome as the dependent variable showed that HOMA-IR (odds ratio 1.52, 95% CI 1.2-2.0, p = 0.007) was the only independent risk factor for the metabolic syndrome, adjusted for age and sex. CONCLUSIONS: The importance of insulin resistance in the metabolic syndrome is supported by the results of logistic regression analysis. Early identification of children may be useful to predict future cardiovascular disease and type 2 diabetes.     

Ethnicity and comorbidities in an overweight and obese multiethnic childhood cohort in Berlin

Aim: This study aims to analyse the association between ethnicity, elevated metabolic parameters and metabolic syndrome (MS) in a multiethnic cohort of overweight to obese children and adolescents. Methods: For 1053 patients, standard deviation of body mass index (BMI‐SDS) was calculated and metabolic parameters (fasting blood glucose, fasting insulin, homeostasis model assessment‐IR, lipids, blood pressure) were measured. MS was defined by WHO criteria. Bivariate and multivariate analyses were performed. Adjusted differences in BMI‐SDS and metabolic parameters between different migration groups were assessed with linear regression models. The risk for MS was calculated with multiple logistic regression models. Results: Forty‐eight per cent of the children were German, 25% Turkish and 27% had another ethnicity. Concerning weight status, 23% are overweight, 31% obese and 46% extremely obese with higher rates among the immigrant population. Multivariable models indicate significant associations between elevated metabolic parameters and higher BMI‐SDS values. Overall prevalence of MS was 32.3%. MS was detected significantly more often among Turkish patients (40.4%) compared to Germans (27.3%; p = 0.02). Logistic regression analysis showed a greater risk for MS with older age (OR = 1.09; p = 0.003) and Turkish ethnicity (OR = 1.62; p = 0.02). Conclusion: Nearly all patients had symptoms of MS, and 40% had MS showing that this highly health‐threatening condition is quite common. Therefore, effective therapy and prevention efforts must be developed for this high risk group. More migration‐specific research regarding insulin resistance, MS and Type 2 DM is needed.