Calculation of resting energy expenditure in obese children

For the calculation of resting energy expenditure, which is the main part of total energy expenditure in children with low physical activity, Fusch et al. have developed an equation.
Conclusion : This equation might be useful for research but not in daily work with obese patients.     

Evaluation of rate-pressure product in obese children

The purpose of this study was to evaluate the relationship between rate-pressure product (RPP) and degree of obesity in 511 obese 7 and 12 year old Chinese children. Obesity was assessed by anthropometry and skinfold thickness. The children were defined obese by relative weight (RW) > 120%. Bodyweight (W) and height (H) were used to derive body mass index (W/H²). Brachial systolic and diastolic pressures in these children were measured by cuff sphygmomanometry. RPP was calculated by the formula: heart rate x mean arterial pressure. More obese children (RW ≥ 150%) had greater mean RPP (7 year old: 6389 vs 5976 beats/min x mmHg, P < 0.05; 12 year old: 7024 vs 6686 beats/min x mmHg) than those with RW < 150%. Children in the upper 25 percentiles of RPP had significantly larger BMI (7 and 12 year olds) and RW (12 year olds), thicker biceps, triceps and subscapular skinfolds (12 year olds) (P < 0.01 - < 0.05). The results indicate that RPP is, to some extent, related to the degree of obesity in obese children. The differences in RPP may imply varying degrees of hemodynamic stress to the heart. Whether such differences may contribute to the long-term development of cardiovascular morbidity in more obese individuals is uncertain.     

Effect of the energy source on changes in energy expenditure, respiratory quotient, and nitrogen balance during total parenteral nutrition in children

The effects of three isocaloric intravenous nutritional regimens were studied in seven infants and children, ages 2 months to 9 yr, with congenital gastrointestinal anomalies (four patients) or with prior history of malignant disease admitted in remission for bone marrow transplantation (three patients). Energy metabolism, as measured by the basal metabolic rate (BMR), and substrate utilization, as measured by the respiratory quotient (RQ), were studied to determine the effect of different levels of carbohydrate and fat on nitrogen retention in each patient. Solution A provided 8% of energy as amino acids, 87% as carbohydrate, and 5% as fat. Solution B provided 8% of energy as amino acids, 60% as carbohydrate, and 32% as fat. Solution C provided 8% of energy as amino acids, 34% as carbohydrate, and 58% as fat. Administration of solution A (high carbohydrate, low fat) was associated with moderately increased mean (+/- SD) BMR and RQ and with low nitrogen retention (19.1 +/- 12.7%, 1.06 +/- 0.14, and 98 +/- 28 mg N/kg/day). Both the BMR and the RQ decreased when less carbohydrate and more lipid was given: BMR 4.3 +/- 11.6% (p less than 0.005), RQ 0.92 +/- 0.09 (p less than 0.001) for solution B; BMR 3.94 +/- 10.6% (p less than 0.005), RQ 0.86 +/- 0.09 (p less than 0.001) for solution C. Among the solutions tested, optimal nitrogen retention [163 +/- 60 mg N/kg/day (p less than 0.01)] was noted with solution B. Our data support the conclusion that a physiologic balance of fat and carbohydrate results in optimal nitrogen retention.     

Evaluation of lean body mass in obese children

Multiple skinfold anthropometry (MSA) and bioelectrical impedance analysis (BIA) are useful as clinically non-invasive, inexpensive and portable techniques, although it is not clear if they can be used interchangeably in the same patient to routinely assess her/his body composition. In order to compare BIA, MSA and DXA in the estimation of lean body mass (LBM) of a pediatric obese population, 103 obese [body mass index (BMI) > 97th percentile] children (median age: 11 years; range: 5.4–16.7 years) underwent nutritional evaluation. After an overnight fast, the subjects’ anthropometric measurements were performed by the same investigator: body weight (BW), height, skinfold thickness (four sites); fat body mass (FBM) using Brook or Durnin equations and dual X-ray absorptiometry (DXA). BIA was performed using a bioelectrical impedance analyzer (Analicor-Eugedia, 50 kHz) and Houtkooper’s equation to calculate LBM. Linear regression analysis was performed to evaluate the relationship between the prediction of LBM by MSA, DXA and BIA. The differences between the three techniques were analysed using Student’s t-test for paired observations and the Bland and Altmann method. A considerable lack of agreement was observed between DXA- and BIA-LBM (δ = −4.37 kg LBM; δ−2σ = −11.6 kg LBM; δ+2σ = +2.8 kg LBM); between DXA- and MSA-LBM (δ = −1.72 kg LBM; δ−2σ = −8.2 kg LBM; δ+2σ = +4.8 kg LBM) and between BIA- and MSA-LBM (δ = −2.65 kg LBM; δ−2σ = −10.5 kg LBM; δ+2σ = +5.2 kg LBM). Conclusion: In obese children, DXA, BIA and MSA should not be used interchangeably in the assessment of LBM because of an unacceptable lack of agreement between them. The discrepancies between methods increase with the degree of obesity.     

Evaluation of lung function in Singapore obese children

In this study, 65 obese children with a mean age of 12.1 years and mean relative weight (RW) of 156.1% had their lung function evaluated in comparison to predicted normal values. There were substantial changes in forced expiratory flow rates (FEF's) and maximum voluntary ventilation (MVV), with reductions to between 60% to 70% of predicted normal values. The more obese children (RVV greater than or equal to 150%) had significantly lower FEF's and MVV and a significantly greater proportion of the more obese children had FEF50 and MVV of less than 60% of predicted normal values. The results were suggestive of narrowing of small airways and increased respiratory inertance possibly due to excessive accumulation of fat in the chest wall and abdomen leading to respiratory limitation.     

Evaluation of adipocytokines in obese children with insulin resistance

Obesity and overweight are among the most serious health problems in western societies and an increasing problem in developing countries. Recent studies indicate an important role of adipose tissue hormones, or "adipokines", in obesity-associated complications. To investigate the relation of two circulating adipokines (visfatin, adiponectin) with markers of insulin sensitivity and obesity in children, 40 obese children and 40 control children were recruited. Homeostasis model assessment for insulin resistance (HOMA-IR) and visfatin levels (4.99 +/- 2.08 vs. 1.47 vs. 0.7, p < 0.001; 31.3 +/- 11.1 vs. 18.5 +/- 10.7, p < 0.001, respectively) were significantly elevated and adiponectin levels (2.01 +/- 1.02 vs. 12.5 +/- 6.2, p < 0.001) were significantly lower in the obese group. Comparisons of the clinical and metabolic characteristics between insulin-resistant and noninsulin-resistant groups in obese children are summarized. The insulin-resistant group had higher visfatin levels (36 +/- 9.7 vs. 22.9 +/- 7.6, p < 0.001) and lower adiponectin levels (1.7 +/- 1.05 vs. 2.5 +/- 0.77, p: 0.016). Visfatin was correlated positively and adiponectin was correlated negatively with body mass index standard deviation score (BMI-SDS) and HOMA-IR. The role of various adipokines as connectors between obesity and diabetes mellitus has been better elucidated in recent years. Based on the findings of this study, visfatin and adiponectin levels can be used as specific markers for insulin sensitivity.     

The effect of a weight management program on postural balance in obese children

The present study aimed to investigate whether obese children improve their balance and postural performance following a 6-month-weight management program. Twenty-nine obese children aged 6–14 years were examined posturographically before and after participation in weight management program. The interactive balance system evaluated the stability index, Fourier spectral analysis, weight distribution index, and falling index. The performance was evaluated for eight positions requiring closure of eyes, standing on pillows, as well as head turns. Anthropometric measurements (e.g., weight, height, BMI, and BMI percentiles) were also determined before and after the intervention. We found significant increase in height and significant decreased in BMI percentile following the intervention program (p?<?.05). Pre-intervention BMI percentile was found to be correlated with stability index in most of the positions measured (e.g., normal open position?=?.464; p?=?.011). Following the intervention program, an interaction was found between BMI percentile differences (pre- versus post-interventional) and balance (stability index and F2–F4 frequencies of most standing positions). Furthermore, a correlation was found between general stability and the falling index (.446; p?=?.015). Regression analysis showed that only initial weight distribution index and post-intervention BMI entered the equation as predictors of post-intervention weight distribution index. Conclusion: Weight management program for childhood obesity improved stability, reduced potential vestibular stress/disturbances, and decreased falling probability of the participants. Further longitudinal studies are needed to verify the relationship between physical activity, weight loss, and reduction of subsequent injuries in obese children.     

单纯性肥胖症儿童糖耐量及胰岛素分泌功能测定

目的　了解单纯性肥胖症儿童胰岛素分泌功能与糖耐量减低 (IGT)的发生。方法　测定单纯性肥胖症儿童 3 0例空腹及餐后血糖、胰岛素水平。如空腹血糖 (FPG) <6.1mmol/L ,服糖后 2h血糖≥ 7.8mmol/L并 <11mmol/L即为IGT ,若服糖后 2h血糖 <7.8mmol/L为糖耐量正常 (NGT)。计算胰岛素敏感性指数。结果　葡萄糖耐量 (OGTT)结果显示 ,单纯性肥胖症例 3 0中 ,IGT 14例 ( 48% ) ;肥胖儿童FPG( 4.92±1.2 3mmol/L)和正常儿童 ( 4.5 1± 0 .5 8mmol/L)无差异 (P >0 .0 5 ) ;空腹胰岛素 (FINS) ( 3 0 .99± 2 7.71) μIU/L水平明显高于正常儿童 ( 10 .2 3± 2 .3 5 ) (P <0 .0 1)。胰岛素敏感性指数 (IAI) ( - 5 .0 2± 0 .2 3 )明显低于正常儿童 ( - 3 .83± 0 .19) (P <0 .0 1)。肥胖儿童IGT组BMI、FINS、FPG较NGT组高 ,无显著性差异 (P >0 .0 5 ) ;服糖 2h胰岛素 (INS 2 )及 2h血糖明显高于NGT组 (P <0 .0 1) ;IGT组ISI(由OGTT计算 )明显低于NGT组 (P<0 .0 0 1)。 3 0例肥胖儿童BMI与FINS、INS2、2h血糖明显正相关 (分别为r =0 .69　P <0 .0 1;r =0 .41　P <0 .0 5 ;r =0 .3 9　P <0 .0 5 ) ,与ISI明显负相关 (r =- 0 .3 8　P <0 .0 5 )。结论　肥胖儿童存在明显的胰岛素抵抗现象 ,且肥胖程度越重 ,机体对胰岛素     

Evaluation of an outpatient treatment program for obese children and adolescents

BACKGROUND: In Germany the number of children with elevated body weights has significantly increased in the last 10 to 15 years. Resulting comorbidities lead to increasing costs for the community. The quality of life of these children is reduced. PATIENTS: 84 children and their families have been included in the study. In addition to anthropometric data informations on eating behaviour and psychosocial data of the family have been documented. At the beginning of the intervention the children had an age of 10.36 +/- 3,27 years and a BMI-SDS of 4,78 +/- 1,16. The mean time period for follow-up has been 28,7 months (mean). METHODS: Children have been treated within a family-based intervention program in a setting focusing on behaviour modification over 6 months (sessions every 4 th week). Patients have been treated in four different intervention groups (behaviour modification and eating counselling (a),a' plus one parent group session (b),b' plus two courses in cooking and preparing meals for parents and children, (c), the fourth group has been treated in addition within a more intensive inpatient setting for 6 weeks. RESULTS: Drop out rate has been 37,1 %. The weight reduction during the treating period has resulted in a reduction of the BMI-SDS of 0.57 +/- 0.51 (p = 0.0001). 33.7 % of the patients investigated during follow-up (n = 30) have not changed or even reduced their achieved body weights (BMI-SDS). In a stepwise multiple regression analysis the variables age of the patient, self-control of eating behavior and weight of the father explained 70 % of the variance of weight changes during the follow-up period. There have been no differences between the changes in BMI-SDS during follow-up between patients in groups,a',b' or,c' and the group taking part in addition in the in-patient setting. CONCLUSIONS: Treatment programs for obese children and adolescents have to focus on the specific living conditions and eating behaviours of the family especially on age, capacity for self control of the child and the eating behaviour of the father. Local networks to be established within the country for treating obese children coordinated by the paediatrician seem to be best possibilities to provide individual support. In this local networks the prevention of extreme eight increases must be a predominant task.     

Evaluation of oxidant-antioxidant status in overweight and morbidly obese Saudi children

AIM: To evaluate the antioxidant enzymes and oxidative products in overweight and obese Saudi children before the onset of metabolic complications.METHODS: The study was carried out on 231 Saudi children. They were classified into three groups: uncomplicated overweight, uncomplicated morbid obesity, and the matched age group as control. All subjects underwent anthropometric measurements and activities of superoxide dismutase, catalase, glutathione peroxidase (GSH-Px), glutathione reductase, the concentrations of reduced GSH, malondialdehyde (MDA) oxidized low-density lipoprotein (ox-LDL) and advanced oxidation protein products (AOPPs) were measured in the blood of these groups.RESULTS: Overweight and obese children had a significantly higher body mass index, while obese children only had a significantly higher waist-to-hip ratio compared to that of the control group. The enzyme activities under study were significantly elevated in the overweight group, although they were significantly reduced among obese children. The concentration of GSH was reduced in both the overweight and obese groups. The mean values of ox-LDL, MDA and AOPP were non-significantly increased in overweight children, while they were significantly elevated in obese children compared to that of normal weight children. A significant disturbance of oxidant-antioxidant status was observed in severely morbid children.CONCLUSION: The increase of oxidative stress in obese children is associated with the increase in AOPPs and MDA which reflects an imbalance between reactive oxygen species production and antioxidant defense.     

Greek immigrant children in southern Sweden in comparison with Greek and Swedish children. II. Meal pattern and food habits

Greek immigrant children (GI) belonging to the second generation of immigrants in Sweden have been compared with Swedish children (S) and Greek children in Greece (G) regarding meal pattern and food habits. Interviews were performed in the homes. Meal pattern and frequency of consumption of various food items were studied by 24-hour recalls, and the food frequency interview method. The meal pattern and the distribution of meals and snacks during the day did not show large differences between the groups. In the GI and G groups it was common to start the day with milk and sugar. The same habit was reported before going to bed. It was common in the GI and G groups to have a prepared meal (dinner) relatively late in the evening. Of the S children only 55% had dinner. GI children had a less frequent intake of vegetables compared to S and G children. GI and G children were heavy consumers of sweets and snacks. In conclusion, the Greek immigrant group had food habits similar to those of Greek rural children with few distinctive exceptions. Greek immigrant families had no difficulties in preparing Greek food.     

Appetite regulation and energy balance

The decision to begin eating or to stop eating is a complex process. Hunger is primarily driven by hunger signals, like ghrelin and neuropeptide Y, originating from the gastrointestinal tract and from the hypothalamus. The hunger signals stimulate the seeking of food and the eating, being activating for the body and mind. Thirty minutes after the start of eating, satiety signals arise from the intestinal tract and, in between meals, from the adipose tissue and liver. Satiety signals are sedative and arrest the processing of food in the intestine, hence leading to termination of eating. One problem with overeating today is the ready access to palatable food, such as sucrose and fat. The palatable food works by weakening the satiety signals and activating the hunger signals. The reward system with endogenous opiates may also be activated.
Conclusions: Food and drinks rich in sucrose and fat should be given in a restricted way to children, since there is no biological control feedback to regulate the intake of such products.     

Appetite regulation and energy balance

The decision to begin eating or to stop eating is a complex process. Hunger is primarily driven by hunger signals, like ghrelin and neuropeptide Y, originating from the gastrointestinal tract and from the hypothalamus. The hunger signals stimulate the seeking of food and the eating, being activating for the body and mind. Thirty minutes after the start of eating, satiety signals arise from the intestinal tract and, in between meals, from the adipose tissue and liver. Satiety signals are sedative and arrest the processing of food in the intestine, hence leading to termination of eating. One problem with overeating today is the ready access to palatable food, such as sucrose and fat. The palatable food works by weakening the satiety signals and activating the hunger signals. The reward system with endogenous opiates may also be activated. Conclusions: Food and drinks rich in sucrose and fat should be given in a restricted way to children, since there is no biological control feedback to regulate the intake of such products.     

Evaluation of the training program "OBELDICKS" for obese children and adolescents

The evaluation of treatment programs in obese children and adolescents is uncommon but necessary to prove effectiveness and to improve treatment modalities. We studied the effectiveness of the a one-year structured outpatient training programme "OBELDICKS" consisting of physical exercise, nutrition education and behaviour therapy in 132 participants based on the criterions developed by the Institute of Medicine and German Obesity Group (degree of weight reduction, improvement of comorbidity and health behaviour, minimising of side effects). Furthermore, we analysed degree of overweight (SDS-BMI) two years after the end of the outpatient training (n = 60). - 74 % of participants reduced their overweight (intention to treat). The mean reduction of SDS-BMI was 0.43. 34 % of the participants was not obese any more at end of the training. The degree of overweight was significantly (p < 0.001) lower two years after intervention compared to baseline. The comorbidity was improved (significant reduction of the frequencies of hypertension, dyslipidaemia and hyperuricaemia). The nutrition, exercise and eating habits (cognitive control and disinhibition of control) were significantly improved. Side effects were not found. CONCLUSION: The effectiveness based on the criterions of the Institute of Medicine and the German Obesity Group was proven for the outpatient training "OBELDICKS". Long-term weight reduction can be achieved in most of the obese participating children due to this long-term, specialised treatment.     

Neonatal anthropometrics and body composition in obese children investigated by dual energy X-ray absorptiometry

Epidemiological and animal studies have suggested an effect of the intrauterine milieu upon the development of childhood obesity. This study investigates the relationship between body composition measured by dual energy X-ray absorptiometry expressed as body fat percent, body fat mass index (BFMI), and fat free mass index (FFMI) in obese children and the preceding in utero conditions expressed by birth weight, birth length, and birth weight for gestational age. The study cohort consisted of 776 obese Danish children (median age 11.6 years, range 3.6–17.9) with a mean Body Mass Index Standard Deviation Score (BMI SDS) of 2.86 (range 1.64–5.48) treated in our national referral centre. In a linear general regression model adjusted for age, gender, socioeconomic status, and duration of breastfeeding, we found the body fat percent, FFMI, and BFMI at the time of enrolment in childhood obesity treatment to be significantly correlated with both birth weight and birth weight for gestational age. Conclusion: These results indicate a prenatal influence upon childhood obesity. Although there are currently no sufficient data to suggest any recommendations to pregnant women, it is possible that the prenatal period may be considered as a potential window of opportunity for prevention of childhood overweight and obesity.