Rapid increase in the prevalence of obesity in elementary school children

OBJECTIVE: Three critical periods have been suggested for the development of obesity during childhood: fetal, ages 4-6 y, and adolescence. The prevalence of obesity in elementary school children is increasing in Japan, and the present study examines whether this rising prevalence occurs during the elementary school period (age 6-11 y) or is occurring prior to entry into elementary school. DESIGN: Repeated cross-sectional sampling of cohorts of children for the prevalence of obesity. SETTING AND PARTICIPANTS: The data from 81 264 first grade and 87 849 seventh grade children (94 and 87% of the total populations, respectively) between 1989 and 2002 in Kagoshima City were analyzed. Data were also obtained from nationwide surveys published by the Ministry of Japan between 1989 and 2001. MEASUREMENTS: Obesity was defined by the body mass index for an age- and sex-specific 95th percentile cutoff point in Japanese children. Trends in obesity and odds ratios of the prevalence of obesity were also determined. RESULTS: The period 1989-2001/2 showed significant increases in the prevalence of obesity for both genders, in both first and seventh grades, and in both Kagoshima City and nationwide. The odds ratios for the prevalence of obesity of 12-y-old children calculated against the prevalence of obesity within the same cohort at 6 y old revealed that a significant risk for development of obesity during the elementary school years applied only to boys from around 1993 onward in Kagoshima City and applied throughout the study period in nationwide Japan. CONCLUSION: Obesity prevalence increases for boys during elementary school years but does not significantly increase for girls. A rising trend for becoming obese before starting elementary school was present for both boys and girls over the period 1989-2001. Educational programs to improve nutrition and physical activity, especially for boys, are becoming increasingly necessary.     

Risk factors for childhood obesity in elementary school-age Taiwanese children

A cross-sectional study design was used to examine factors that contribute to high relative weight in children in Taiwan. A total sample of 331 Chinese children (ages 7 and 8) and their parents participated in the study. Parents completed questionnaires regarding demographic information, family functioning, parenting styles, physical activity, and dietary intake. Children completed physical fitness tests and questionnaires regarding physical activity, dietary intake, coping strategies, and self-esteem. The weight-for-length index was used to measure children's relative weight. The findings revealed that four variables contributed to higher weight-for-length index in boys compared with girls and explained 37.7% of the variance: high maternal body mass index, poor aerobic capacity, healthy family role functioning, and poor family affective responsiveness. Two variables were found to contribute to higher weight-for-length index in girls and explained 12.8% of the variance: high household income and high maternal body mass index. Taken together, the results indicate the importance of assessment of children's weight status, maternal weight status, and family functioning as part of routine child health care and the need for developmentally appropriate and gender-specific approaches to prevent childhood obesity.     

Physiological mechanisms underlying children's circannual growth patterns and their contributions to the obesity epidemic in elementary school age children

Several studies since the 1990s have demonstrated that children increase their body mass index at a faster rate during summer months compared with the school year, leading some to conclude that the out‐of‐school summer environment is responsible. Other studies, however, have suggested that seasonality may play a role in children's height and weight changes across the year. This article reviews evidence for seasonal differences in the rate of children's height and weight gain and proposes potential physiological mechanisms that may explain these seasonal variations.     

Predictive factors of virological success to salvage regimens containing protease inhibitors in HIV-1 infected children

Background  

The impact of HIV drug resistance mutations in salvage therapy has been widely investigated in adults. By contrast, data available of predictive value of resistance mutations in pediatric population is scarce.     

Evaluation of an education program for elementary school children with asthma.

To evaluate the effectiveness of a comprehensive asthma management education program for 7- to 12-year-old children with asthma, entitled Roaring Adventures of Puff (RAP), 18 elementary schools in Edmonton were randomized to intervention and control groups. Participating in the program were 76 students with asthma in the intervention schools and 86 in the control schools. Children in the intervention schools had statistically significant improvements in unscheduled doctor visits, missed school days, moderate-to-severe parent rating of severity, severity of shortness of breath, limitations in the kind of play, and correct use of medications. Unscheduled doctor visits and missed school days were the only significant improvements in the control group; however, improvements were about half that of the intervention group. The results showed that a comprehensive, school-based asthma education program is feasible and improves outcomes.     

Adipokines and the prediction of the accumulation of cardiovascular risk factors or the presence of metabolic syndrome in elementary school children

BACKGROUND: Information is limited about how adipokines predict the accumulation of cardiovascular (CV) risk factors or the presence of metabolic syndrome (MS) in children. METHODS AND RESULTS: The subjects were 321 children (200 boys and 121 girls; 109 normal and 212 obese) aged 6-12 years. Obesity was defined as a body mass index of >or= the 95(th) percentile for age and sex. MS was defined by using the newly established Task Force criteria. The levels of the adipokines--adiponectin, leptin, ghrelin, high sensitive C-reactive protein (CRP) and resistin--were measured. Regression analyses revealed that high leptin levels were predictive of the accumulation of CV risk factors in normal weight, obese, and entire (normal weight and obese) group of subjects. High CRP in the normal weight group and low adiponectin in the obese and the entire groups were also independently predictive of the accumulation of risk factors. A high leptin level was solely predictive of the presence of MS in obese and entire groups. CONCLUSIONS: Leptin was the most sensitive marker for predicting the accumulation of CV risk factors and the presence of MS in elementary school children. Primary prevention is important because both leptin and adiponectin levels abruptly worsened when children obtained any 1 risk factor.     

Radiofrequency ablation in auricular flutter. Predictive factors of primary success and medium term results

Ninety-one consecutive patients underwent radiofrequency ablation of chronic or paroxysmal atrial flutter. The average age of the patients was 66. There was a previous history of atrial fibrillation in 38% of cases and of cardiac surgery in 14.3% of cases. The primary success rate was 79% (92% in cases of common flutter). The predictive factors of success were the type of flutter (p < 0.001), left ventricular (p < 0.01) and left atrial dimensions (p < 0.01) at echocardiography. The length of the cavo-tricuspid isthmus measured by echocardiography had no influence on the initial result but, in primary success, did affect the parameters of the procedure (duration and number of applications of radiofrequency energy). After an average of 11 +/- 2 months, sinus rhythm was maintained in 67% of patients. There were recurrences of flutter in 27.5% of cases and of atrial fibrillation in 5.5% of cases: 85% of these episodes occurred during the first six months after ablation. A second procedure was carried out in 12 patients for recurrence of flutter (92% primary success rate). After an average follow-up of 8.4 months, 4 patients had a recurrence and required a third procedure (100% success rate). In cases of failure of ablation, the rhythm was converted by a shock or atrial pacing: 47.3% of these patients remained in sinus rhythm with antiarrhythmic therapy with a 12 month follow-up. Radiofrequency ablation of atrial flutter is, therefore, a safe method, the difficulty of which is mainly related to anatomical factors: the medium-term results are better than those of other therapeutic methods.     

Estimated overweight and obesity in Mexican American school children

The prevalence of overweight and obesity in Mexican American children 6 to 17 years of age was estimated in 1972 (n = 1269) and 1983 (n = 868). Children were classified as overweight or obese on the basis of the body mass index (weight/stature2), the triceps skinfold, or both, relative to reference data for white children in NHANES-1. Overweight was defined as greater than or equal to 90th percentiles, while obesity was defined as greater than or equal to 95th percentiles of age- and sex-specific reference data. Over the entire age range, there was a significant increase in the prevalence of overweight and obesity between 1972 and 1983, but there was variation with age and sex. Fewer children were classified as overweight or obese when the two criteria were used together than when they were used individually. The results suggest that the body mass index and the triceps skinfold may vary in sensitivity as indicators of overweight and obesity particularly in 10- to 17-year-old children. Children classified as obese by the body mass index had significantly larger estimated midarm muscle circumferences than those classified as obese by the triceps skinfold or by both the body mass index and the triceps skinfold.     

Retinal vessel diameter, obesity and metabolic risk factors in school children (JuvenTUM 3)

BackgroundThe prevalence of childhood obesity is high and its association with future cardiovascular disease in adulthood is well established. The cross-sectional data presented analyze the prevalence of obesity and the association between metabolic risk factors, physical inactivity and retinal vessel diameter in young school children.MethodsThe examination included 578 school children aged 11.1 ± 0.6 years from secondary schools in the District of Munich, Germany. Anthropometric measurements and blood sampling were conducted using standard protocols for children. Physical activity was evaluated by use of a questionnaire. Retinal microvascular diameters and the arteriolar to venular ratio (AVR) were assessed with a non-mydriatic vessel analyser (SVA-T) using a computer-based program.ResultsIn our population, 128 (22.2%) children were overweight (ow) or obese (ob). The mean retinal arteriolar and venular calibres were 208.0 ± 15.6 μm and 236.2 ± 16.2 μm, respectively, with a mean AVR of 0.88 ± 0.01. Girls had significantly wider arteriolar and venular diameters compared to boys (p < 0.001). ow and ob children had a lower AVR compared to normal weight (nw) children (mean(95% CI); nw: 0.89(0.88–0.89); ow: 0.87(0.86–0.88); ob: 0.85(0.83–0.87); p ≤ 0.05). Wider venular diameters were independently associated with higher BMI and higher hsCRP. Blood pressure was associated with retinal vessel constriction. Higher physical inactivity and BMI were independently associated with a reduced AVR (p = 0.032 and p < 0.001, respectively).ConclusionsCardiometabolic risk factors and physical inactivity are associated with retinal microvascular alterations in young children, comparable to associations in adults. Retinal vessel imaging seems to be a feasible assessment for the detection of microvascular impairments in children at risk of developing cardiovascular disease in adulthood.     

Pinworm prevalence in California elementary school children, and diagnostic methods

The pinworm prevalence among 302 children tested in 1980 in five Southern California elementary schools was determined to be 11.6%. The range was 7.3-15.4%. In a 1982 study involving 158 children in six schools, the prevalence was 21.6% (range 11.1-38.9%). The results of these studies are compared with those of a similar prevalence study done in the same area and in some of the same schools during the 5-year period 1960-1964. The prevalence for the earlier period, involving 700 children in six schools, was 34.6%, and ranged from 29.2-43.0%. A new, flexible, plastic pinworm slide was used in the 1980 and the 1982 studies. In the 1982 study, this diagnostic method was evaluated and compared for efficiency and use against the standard cellulose tape/glass slide. The two are equally effective in picking up eggs, and in reading quality. The plastic slide is easier to use and does not break.     

Usefulness of a salt check sheet for elementary school and junior high school children

There are no known methods to easily evaluate the dietary salt intake of children. We hypothesized that the salt check sheet, for which validity has been confirmed in both hypertensive outpatients and in the general population, can be used to assess dietary salt intake in children. We enrolled 188 healthy schoolchildren (mean age 11.2 ± 1.1 years, 53.2% boys) and asked them to answer both the salt check sheet and a brief self‐administered dietary history questionnaire for Japanese schoolchildren aged 6‐18 years (BDHQ15y). The mean total salt check‐sheet score was 12.7 ± 4.0 points (range: 4‐24 points), and the estimated daily salt intake from the BDHQ15y was 12.1 ± 3.7 g (range: 4.7‐27.2 g). The total check‐sheet score was significantly positively correlated with the estimated daily salt intake from the BDHQ15y (r = 0.408, P < 0.001). Thirty‐one study participants were assigned to the “low” salt group (total score on the salt check sheet was 0‐8 points), 78 participants to the “medium” salt group (9‐13 points), and 79 participants to the “high and very high” salt group (≥14 points), and a comparison estimating daily salt intake from the BDHQ15y among the three groups was performed. Daily salt‐intake levels tended to increase as the group of total check‐sheet scores increased: “low” vs “medium” vs “high and very high” salt group levels were 9.5 ± 3.1 vs 11.6 vs 13.5 ± 3.9, respectively (P < 0.001). This demonstrates that the salt check sheet is a useful tool to easily assess dietary salt intake in children.