Prevalence of Overweight and Obesity in a Large Clinical Sample of Children With Autism

BackgroundOverweight and obesity are major pediatric public health problems in the United States; however, limited data exist on the prevalence and correlates of overnutrition in children with autism.MethodsThrough a large integrated health care system's patient database, we identified 6672 children ages 2 to 20 years with an assigned ICD-9 code of autism (299.0), Asperger syndrome (299.8), and control subjects from 2008 to 2011 who had at least 1 weight and height recorded in the same visit. We calculated age-adjusted, sex-adjusted body mass index and classified children as overweight (body mass index 85th to 95th percentile) or obese (≥95th percentile). We used multinomial logistic regression to compare the odds of overweight and obesity between groups. We then used logistic regression to evaluate factors associated with overweight and obesity in children with autism, including demographic and clinical characteristics.ResultsCompared to control subjects, children with autism and Asperger syndrome had significantly higher odds of overweight (odds ratio, 95% confidence interval: autism 2.24, 1.74–2.88; Asperger syndrome 1.49, 1.12–1.97) and obesity (autism 4.83, 3.85–6.06; Asperger syndrome 5.69, 4.50–7.21). Among children with autism, we found a higher odds of obesity in older children (aged 12–15 years 1.87, 1.33–2.63; aged 16–20 years 1.94, 1.39–2.71) compared to children aged 6 to 11 years. We also found higher odds of overweight and obesity in those with public insurance (overweight 1.54, 1.25–1.89; obese 1.16, 1.02–1.40) and with co-occurring sleep disorder (obese 1.23, 1.00–1.53).ConclusionsChildren with autism and Asperger syndrome had significantly higher odds of overweight and obesity than control subjects. Older age, public insurance, and co-occurring sleep disorder were associated with overweight or obesity in this population.     

不同参考标准下重庆城区儿童超重／肥胖检出率比较

目的比较3种筛查标准下重庆城区儿童超重/肥胖现况,寻求适宜的儿童肥胖筛查标准。方法按照整群抽样原则抽取本市3个城区的12534名2～18岁儿童作为调查对象,测量其身高及体质量。并分别采用WHO的身高标准体质量法标准(标准1)、国际肥胖工作组(IOTF)的超重/肥胖体质量指数(BMI)标准(标准2)和国立卫生统计中心/疾病预防控制中心(NCHS/CDC)的BMI标准(标准3)评价儿童的超重/肥胖。结果按照标准1、2和3的规定,重庆城区儿童的超重检出率分别为13.0%、9.8%、9.8%;肥胖检出率分别为9.8%、2.9%、6.0%,均有显著性差异(Pa<0.001),且男童超重/肥胖检出率均高于女童。3种标准间,健康儿童、超重儿童或肥胖儿童的BMI均值均有显著性差异(Pa<0.001)。采用标准1和2得到的超重检出率,或采用标准1和3得到的超重检出率均在6岁前和14岁后2个年龄段存在统计学差异(Pa<0.01)。在2～6岁各年龄组,采用标准1和3得到的儿童肥胖检出率比较无显著性差异;在6～18岁各年龄组,采用标准1得到的肥胖检出率均显著高于采用标准2和3得到的肥胖检出率(Pa<0.01);在3～6岁、8～10岁、13岁组采用标准2和3得到的儿童肥胖检出率比较有显著性差异。结论儿童肥胖已经成为重庆城区重要的健康问题之一。采用3种标准筛查的儿童超重/肥胖检出率在2～18岁各年龄组均有所不同,应谨慎使用。     

Prevalence trends of obesity and overweight among 10-year-old children in western Sweden and relationship with parental body mass index

AIM: To determine the regional prevalence, secular and family-related trends of obesity and overweight among 10-y-old children. METHODS: A cross-sectional study of 10-y-old children, born in 1990, was performed during September 2000 to June 2001 at school health centres in three communities in the western part of Sweden. Evaluation was performed in 6311 children, or 81% of the target population. Data from a cohort of children, born in 1974, who form the national growth charts, were available for comparison. RESULTS: The mean body mass index was 17.9 kg/m2 in 10-y-old children born in 1990 and 17.0 kg/m2 for 10-y-olds born in 1974 (p < 0.0001). Of the 10-y-old children in 2000-2001, born in 1990, 18% were overweight and 2.9 % obese, which corresponds to a twofold increase in presence of overweight and a fourfold increase in presence of obesity among 10-y-old children from 1984 to 2000. There was a significant correlation between parental and child body mass index. The prevalence of obesity and being overweight appeared to be higher in children whose parents did not participate in the study. CONCLUSION: During a 16-y period, from 1984 to 2000, a twofold increase in being overweight and a fourfold increase in obesity were seen among 10-y-old children in the western part of Sweden. Parental ponderosity or reluctance to participate in the study was related to a higher prevalence of being overweight or obese in the children. There is a need for the healthcare system to recognize the threats to the health of the population of this new "epidemic" and initiate preventive measures and treatment programmes.     

Depression in the School-Aged Child With Type 1 Diabetes: Implications for Pediatric Primary Care Providers

Depression is a common comorbid condition experienced by children with type 1 diabetes that, if undiagnosed, can lead to deterioration in glycemic control and other serious health complications. Although it is documented that children with type 1 diabetes experience high rates of depression, a comprehensive clinical guide does not exist to help direct the pediatric provider on how to best care for these children. The purpose of this article is to synthesize current evidence to aid the pediatric primary care provider in the detection and management of depression in the school-aged child with type 1 diabetes.     

Pediatric Nurse Practitioners' Assessment and Management of Childhood Overweight/Obesity: Results from 1999 and 2005 Cohort Surveys

Little is known about current PNP practices and perceived barriers regarding the assessment and management of childhood and adolescent overweight and obesity. Available research, however, has suggested that recommended guidelines are not being fully implemented and adhered to ([Bauer, 2002], [Cabana et al., 1999] and [Cook et al., 2005]), suggesting that provider practice behavior skills need to be strengthened. Continuing education offerings and conference forums might be used to provide the most up-to-date information about new practice techniques and provide participants the opportunity to practice those new skills. These and other opportunities (such as Web-based programs and frequently updated Web sites) may offer information to assist providers in overcoming frequently encountered barriers (e.g., billing codes frequently accepted by third-party payers and methods to track patient outcomes following treatment sessions) to decrease the sense of futility when working with overweight children and their families. Multiple strategies will be needed to address the increased prevalence of childhood overweight and obesity and the growing prevalence of associated co-morbid health conditions occurring in the child population. Pediatric health care providers have frequent contact with many children and families and thus are in a unique position to affect child health at the individual or family level. Additionally, through active involvement in various professional and community organizations, child health care providers can provide accurate information regarding the increasing prevalence of child overweight and obesity to parents and families, which may affect parental attitudes and recognition of this national health dilemma.     

超重及肥胖儿童综合干预效果

目的 观察健康教育、行为矫正、膳食调整、运动处方等综合干预措施对控制超重及肥胖儿童形态指标、围度指标及血液指标的效果.方法 组织暑期夏令营,由具备研究能力的教练、医师、营养师及心理教师共10人,对23例北京市8～14岁超重及肥胖的中小学生进行为期21 d的封闭式综合干预,观察干预前后学生身体形态指标、围度指标及血液指标的变化.结果 23例超重及肥胖中小学生干预后体质量、体质量指数、体脂率等形态指标均优于干预前,且差异均有统计学意义(Pa<0.01);干预后相关围度指标,包括上臂皮脂厚度、肩胛下角皮脂厚度、腹部皮脂厚度及上臂围、胸围、腰围、臀围围度较干预前均降低,且差异均有统计学意义(Pa<0.05),大腿围亦有降低,但差异不显著(P>0.100);总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白优于干预前,但差异均无统计学意义(Pa>0.100).结论 采取系统、有效、简便的综合干预措施可显著改善超重及肥胖儿童的形态指标和围度指标,短期综合干预对血液指标的改善效果不明显,提示要从根本上改善超重及肥胖儿童的体质健康需要持久的综合干预.     

综合减肥对超重和肥胖女学生性激素和生长激素的影响

目的探讨综合减肥处方对单纯性超重和肥胖女学生性激素和生长激素(GH)的影响。方法对超重和肥胖女学生采取有氧运动、合理饮食、心理矫正等疗法进行为期10个月的减肥活动,采用放射免疫法分别测定试验前、中、后性激素和GH的变化。结果超重和肥胖女学生血GH、雌二醇(E2)水平明显低于正常同龄人,而睾酮(T)水平明显高于正常同龄人(P<0.05),减肥后GH、E2水平显著升高,而T水平显著降低(P<0.05)。结论综合减肥处方可升高超重和肥胖女学生体内雌激素和GH含量,降低雄激素含量,起到调节生殖内分泌代谢紊乱的作用。     

Assessment of individual changes in body fatness in boys during early pubertal period

BACKGROUND: In order to know whether the changes in indexes of overweight, body mass index (BMI; kg/m2) and percentage of overweight (POW) (%), really represent the tendency toward obesity, we examined longitudinal individual changes in these indexes, and the change in body composition in boys during early pubertal period. METHODS: The subjects were 50 school boys who lived in Shizuoka, Japan. Standing height and weight were measured, and BMI and POW were obtained. Body fat percentage (BF%), fat mass (FM) and lean body mass (LBM) were estimated by bioelectrical impedance method. The influence of predictive variables (LBM, FM) on the changes in BMI and POW was investigated by multiple regression analysis. We examined the 3-year changes in BMI, POW and predictive variables in each individual, from 9 to 12 years of age. RESULTS: The mean change of BMI was 1.7 +/- 0.3 (mean +/- SEM) kg/m2 and that of POW was 2.2 +/- 1.9%. The influence of predictive variables on the changes in BMI and POW was determined. The variance of the change in POW could be explained by that in FM (r(2) = 0.737, P < 0.0001), while the change in BMI was influenced by both LBM and FM (r2 = 0.891, P < 0.0001). CONCLUSIONS: Based on the definition of obesity, POW is the better index of body fatness to assess its individual change for boys during early pubertal period, because the index independent from the change in LBM is supposed to be the appropriate index for obesity in practical use.     

Prevalence of overweight and obesity in the Netherlands in 2003 compared to 1980 and 1997

Objective

To assess the prevalence of overweight and obesity in children living in the Netherlands and compare the findings with the Third and Fourth National Growth Studies carried out in 1980 and 1997, respectively.

Design and methods

Data were obtained from the child health care system. International cut‐off points for body mass index (BMI) were used to determine overweight and obesity. Cases were weighted for ethnicity and municipality size in such a way that the sample matched the distribution in the general population. The LMS method was used to calculate the age‐related distribution of BMI, and the prevalence was calculated from the fitted distribution.

Patients

Data on 90 071 children aged 4–16 years were routinely collected by 11 community health services during 2002–2004.

Results

On average, 14.5% of the boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9%, girls 6.9%) and 1997 (boys 9.7%, girls 13.0%). Similarly, 2.6% of the boys and 3.3% of the girls aged 4–16 years were obese, which is much higher than in 1980 (boys 0.2%, girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). At the age of 4, 12.3% of the boys and 16.2% of the girls were already overweight.

Conclusions

The prevalence of overweight and obesity in the Netherlands is still rising, and at an even faster rate than before. Evidence‐based interventions are needed to counter the obesity epidemic, and there is an urgent need for pre‐school intervention programmes.