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.     

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.     

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.     

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.     

Breast-feeding history and overweight in Latino preschoolers.

OBJECTIVE: Describe the relationship between breast-feeding history and risk of overweight in the preschool years in a sample of primarily Mexican-origin Latinos. METHODS: Children's breast-feeding history, health history, and demographics were obtained in interviewer-administered questionnaires of a convenience sample of 364 parents of children ages 2-5 in an outpatient clinic waiting room serving a predominantly Mexican immigrant population in a large Midwestern city. Child weight status was determined by weighing and measuring each child and calculating age- and sex-specific body mass index (BMI) percentile using 2000 Centers for Disease Control reference values, with children > or =95th percentile defined as overweight. RESULTS: Seventy-six of 364 children (21%) were overweight. Eighty-seven percent of children had been breast-fed. Increased duration of breast-feeding was associated with a linearly decreased risk of overweight in bivariate analysis, ranging from an overweight prevalence of 35% for those never breast-fed to 12% for those breast-fed for at least a year. This inverse relationship remained significant in the smaller sample for which maternal BMI data were available (n = 127), as each additional month of breast-feeding was associated with a 10% decreased odds ratio (OR) of overweight (adjusted OR = 0.90; 95% CI = 0.81, 0.99) after controlling for child's sex, current age, prematurity, birth-weight category, maternal education level, and maternal weight status. CONCLUSION: This sample of children of Mexican-origin immigrant families had high rates of overweight at very young ages but also very high rates of breast-feeding. Duration of breast-feeding was strongly and inversely related with prevalence of overweight as a preschooler.     

Do mothers of overweight Argentinean preschool children perceive them as such?

Childhood overweight is rapidly on the rise and underlies the younger presentation of diabetes. The aim of this study was to determine the association between overweight and age, sex, and the perception of the overweight children by their mothers. Three hundred and twenty-one (160 males) children (mean age 4.39 +/- SD 0.83 yr) [body mass index (BMI) 16.6 +/- 2.11] from schools at the kindergarten level were evaluated. Data on age, sex, weight, and height were recorded. At risk for overweight and overweight were defined as a BMI of > or = 85th or > or = 95th percentile, respectively. Written questionnaires for mothers' perceptions about their children's eating habits (a lot, right, little, or very little) and shape (very fat, fat, normal, and thin) were performed. The prevalence of at risk of overweight and overweight was 19 and 18.4%, respectively. There was a significant difference in the proportion of distorted perception of shape between mothers of normal-weight children vs. those of at risk of overweight and overweight children (17 vs. 87.5%, p < 0.001). Seventy-six and 98% of mothers of overweight and at risk of overweight children, respectively, rated them as normal or thin. Mothers exhibited poor overall ability to estimate the way at risk of overweight and overweight children ate. There was a significant difference in the proportion of distorted perception of eating habits between mothers of normal-weight children vs. those of at risk of overweight and overweight children (36.3 vs. 90.8%, p < 0.001). Eighty-four and 96% of mothers of obese and overweight children, respectively, thought that their children ate right or little. A multiple regression analysis using BMI > 95th percentile as the dependent variable showed that the mothers' perceptions of shape and eating habits [odds ratio 4.5; 95% confidence interval (CI) 2.5-7.8; p < 0.0001] were both significant independent risk factors for overweight, adjusted for age and sex. The agreement between the perception of shape and eating habits vs. the medical records BMI > 95th percentile was poor; for shape: kappa 0.31 + 0.07; 95% CI 0.17-0.44, and for nutrition: 0.14 + 0.06; 95% CI 0.02-0.27. This suggests that the mothers' perceptions of shape and eating behavior is a predictor of obesity and could be used in clinical practice as a simple tool to identify children at high risk for overweight.     

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.     

Physical activity and body mass index among US adolescents: youth risk behavior survey, 1999

OBJECTIVE: To investigate associations of underweight and overweight with physical activity among high school students in the United States. METHODS: A nationally representative sample of 15 349 US high school students participated in the 1999 Youth Risk Behavior Survey; 13 295 were included in these analyses. Five measures of physical activity were examined as dichotomous variables: (1) vigorous-intensity physical activity (>/=3 vs <3 sessions lasting at least 20 minutes each per week); (2) moderate-intensity physical activity (>/=5 vs <5 sessions lasting at least 30 minutes each per week); (3) strength training (>/=3 vs <3 sessions per week); (4) enrollment in physical education (yes or no); and (5) sports participation (yes or no). Using body mass indexes, students were categorized by percentiles as underweight (5th to 15th to <85th percentiles), at risk for overweight (>/=85th to <95th percentiles), or overweight (>/=95th percentile). Potential associations between physical activity and body mass index were examined using logistic regression. RESULTS: On several measures, adolescent boys who were underweight or overweight were less likely to be physically active than boys of normal weight (eg, odds ratio [OR], 0.23; 95% confidence interval [CI], 0.12-0.45; and OR, 0.75; 95% CI, 0.61-0.93; for boys who were underweight and overweight, respectively, for strength training). Adolescent girls who were overweight or at risk for overweight were less likely (OR, 0.62; 95% CI, 0.50-0.78; and OR, 0.63; 95% CI, 0.46-0.85; respectively) to be involved with sports than girls of normal weight; and girls who were underweight were less likely (OR, 0.44; 95% CI, 0.22-0.91) to be enrolled in physical education. CONCLUSIONS: Weight status among high school students is correlated with selected physical activity behavior, especially among adolescent boys. Interventions to increase physical activity for high school students should target adolescents of all shapes and sizes, and may best be achieved by school policies requiring physical education or after-school sports.     

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.     

Associations Between Obesity and Comorbid Mental Health,Developmental, and Physical Health Conditions in a Nationally Representative Sample of US Children Aged 10 to 17

ObjectiveThis large population-based study of US children considered the association of obesity with a broad range of comorbidities. This study examined relationships between weight status and health for US children.MethodsWe performed cross-sectional analysis of data on 43,297 children aged 10 to 17 from the 2007 National Survey of Children’s Health. Weight status was calculated from parent report of child height and weight. Logistic regression models assessed associations between weight status and 21 indicators of general health, psychosocial functioning, and specific health disorders, adjusting for sociodemographic factors.ResultsUsing body mass index (BMI) percentiles for age and sex, 15% of US children were considered overweight (BMI 85th to <95th percentile), and 16% were obese (BMI ≥95th percentile). Compared with children classified as not overweight, obese children were more likely to have reported good/fair/poor health (adjusted odds ratio [AOR] 2.18, 95% confidence interval [CI] 1.76–2.69), activity restrictions (AOR 1.39, 95% CI 1.10–1.75), internalizing problems (AOR 1.59, 95% CI 1.04–2.45), externalizing problems (AOR 1.33, 95% CI 1.07–1.65), grade repetition (AOR 1.57, 95% CI 1.24–1.99), school problems, and missed school days. Attention deficit/hyperactivity disorder, conduct disorder, depression, learning disability, developmental delay, bone/joint/muscle problems, asthma, allergies, headaches, and ear infections were all more common in obese children.ConclusionsObese children have increased odds of worse reported general health, psychosocial functioning, and specific health disorders. Physicians, parents, and teachers should be informed of the specific comorbidities associated with childhood obesity to target interventions that could enhance well-being. Future research should examine additional comorbidities and seek to confirm associations using longitudinal data and clinical measures of height and weight.     

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.     

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.     

Family and school determinants of overweight in 13-year-old Portuguese adolescents

AIMS: To identify familial and school determinants of overweight in 13-year-old adolescents. METHODS: All 27 public and 19 (79%) private schools allowed to contact age eligible students, 77.5% accepting to participate (1116 girls, 1045 boys). Self-administered questionnaires were completed and physical examination performed, including weight and height measurements. Overweight (> 95th percentile) and at risk of overweight (85th-95th) were defined using CDC standards. Its determinants were identified using logistic regression models, entering parents' education and all variables significantly associated in crude analysis. RESULTS: Prevalence of overweight (10.2%) and at risk of overweight (16.5%) was not influenced by type of school, vending machines and number of school canteen meals. In girls, the prevalence of body mass index (BMI) > 85th percentile increased significantly with decreasing age at menarche (45.7% if menstruating before 11-year and 13.2% when pre-menarche), and increasing parental BMI or time spent on sedentary activities. In multivariate analysis, age at menarche and increasing parental BMI remained significant risks in girls. In boys, besides parental BMI, ever smoking, sleeping < 9 h and sedentary leisure activities were significant determinants. CONCLUSIONS: Food offered at school had no significant impact on adolescents overweight, which was mainly dependent on parental anthropometrics and leisure time activities.     

Changes in body mass index in 11-12-year-old children in Hawkes Bay, New Zealand (1989-2000)

OBJECTIVE: To describe and compare the body mass index (BMI; weight/height2) profile of 11-12-year-old children in Hawkes Bay, New Zealand in 1989 and 2000. To subsequently determine the prevalence of overweight and obesity at the two time points using international definitions. METHODOLOGY: As part of asthma prevalence studies in Hawkes Bay data on height, weight and ethnicity were collected from 871 school children in 1989, and 894 children in 2000 who reached 12 years of age during the year of testing. RESULTS: In the total study population the geometric mean BMI increased from 18.1 kg/m2 (95% CI 17.9; 18.3) in 1989 to 19.8 kg/m2 (95% CI 19.6; 20.0) in 2000, a relative increase of 9.2% (95% CI 7.6; 10.9), P < 0.001. Significant relative increases were found for males (9.0%: 95% CI 6.8; 11.3), females (9.3%: 95% CI 6.8; 11.8), Maori (7.6%: 95% CI 4.3; 11.1), European (9.1%: 95% CI 7.3; 11.0) and Pacific Island children (11.0%: 95% CI 2.2; 20.5). In 2000 20.9% of Hawkes Bay children were classified as overweight and 9.1% as obese. The risk of being overweight in 2000 was 2.2 times greater than the risk in 1989, and the risk of being obese was 3.8 times greater, with these problems more pronounced among Maori (overweight 24.7%, obese 15.3%) and Pacific Island (overweight 35.0%, obese 15.0%) than European (overweight: 18.2%, obese 5.7%) children. However, the risk of being overweight (RR = 3.0, 95% CI 2.2-4.0) or obese (RR = 8.3, 95% CI 3.0-23.3) in 2000 compared to 1989 was greater among European children. CONCLUSION: Higher percentages of Maori and Pacific Island children are overweight or obese compared to European, but in all ethnic groups there has been a statistically significant increase in mean BMI over an 11-year period. This increase reflects the trend observed in other developed countries and underlines childhood obesity as a major health problem in New Zealand.     

Physician weight counseling for adolescents

Adolescent obesity prevalence is increasing, with minimal study of physician weight counseling with youth. This study examines adolescents' (n=110) perceptions of physicians' weight counseling. Overweight adolescents (> or =85th percentile for body mass index, BMI) report receiving counseling more than nonoverweight adolescents. Physicians more often have counseled obese (> or =95th BMI percentile) than overweight but not obese adolescents (85th-94th BMI percentile). Prior counseling and adolescents' ethnicity were related to greater perceived physician concern and adolescent receptivity to future counseling. Overweight adolescents report attempting weight loss strategies at rates similar to recommendations, but recommendations for specific weight control behaviors do not increase the likelihood of adolescent attempts. Clin Pediatr. 2002;41:575-585     

Can waist circumference identify children with the metabolic syndrome?

OBJECTIVE: To determine in children the association between waist circumference (WC) and insulin resistance determined by homeostasis modeling (HOMA-IR) and proinsulinemia and components of the metabolic syndrome, including lipid profile and blood pressure (BP). METHODS: Eighty-four students (40 boys) aged 6 to 13 years and matched for sex and age underwent anthropometric measurements; 40 were obese; 28, overweight; and 16, nonobese. Body mass index (BMI), WC, BP, and Tanner stage were determined. An oral glucose tolerance test, lipid profile, and insulin and proinsulin assays were performed. Children were classified as nonobese (BMI < 85th percentile), overweight (BMI, 85th-94th percentile), and obese (BMI > or = 95th percentile). RESULTS: There was univariate association (P < .01) between WC and height (r = 0.73), BMI (r = 0.96), Tanner stage (r = 0.67), age (r = 0.56), systolic BP (r = 0.64), diastolic BP (r = 0.61), high-density lipoprotein cholesterol level (r = 0.45), triglyceride level (r = 0.28), proinsulin level (r = 0.59), and HOMA-IR (r = 0.59). Multiple linear regression analysis using HOMA-IR as the dependent variable showed that WC (beta coefficient = 0.050 [95% confidence interval, 0.028 to 0.073]; P = .001) and systolic BP (beta coefficient = 0.033 [95% confidence interval, 0.004 to 0.062]; P = .004) were significant independent predictors for insulin resistance adjusted for diastolic BP, height, BMI, acanthosis nigricans, and high-density lipoprotein cholesterol level. CONCLUSION: Waist circumference is a predictor of insulin resistance syndrome in children and adolescents and could be included in clinical practice as a simple tool to help identify children at risk.     

Early rapid weight gain and current overweight in relation to asthma in adolescents born with very low birth weight

Early catch-up growth and subsequent overweight are suggested to be associated with later cardiovascular diseases and later type II diabetes. However, the impact of early catch-up growth and childhood overweight on the development of asthma has been less studied, particularly in children born with very low birth weight (VLBW). A birth cohort of 74 VLBW children (birth weight < or = 1500 g) was followed from birth and investigated on asthma at 12 yr of age. Early rapid weight gain was in one way defined as an increase of weight > or =1 standard deviation score (SDS) at 6 months of corrected postnatal age. Current overweight was defined by body mass index (BMI) exceeding 21.2 and 21.7 kg/m(2), respectively, for boys and girls at 12 yr of age. Current asthma was diagnosed by a pediatrician, according to asthma ever in combination with a positive response to hypertonic saline bronchial provocation test and/or wheeze at physical examination at 12 yr old. Being overweight at 12 yr of age was associated with an increased risk for current asthma in the VLBW children [crude odds ratio (OR): 5.5, 95% confidence interval (CI): 1.3-22.2]. After adjustment for early weight gain and neonatal risk, the OR of overweight increased nearly three times (adjusted OR: 15.3, 95% CI: 2.5-90.6). Early rapid weight gain seemed to be inversely associated with current asthma (adjusted OR: 0.49 for an increase of weight equal to 1 SDS, 95% CI: 0.23-1.02, p = 0.06). In addition, early rapid weight gain was inversely associated with the magnitude of bronchial responsiveness at 12 yr (coefficient -1.15, p < 0.01). There was a strong and positive association between overweight and asthma at 12 yr of age in the VLBW children. This strong association had been reduced by early rapid weight gain, possibly via the reduction of bronchial responsiveness.     

Childhood overweight and parent- and teacher-reported behavior problems: evidence from a prospective study of kindergartners

OBJECTIVES: To determine if there is a relationship between overweight and behavior problems among children as young as 5 years old by studying the association between overweight and behavioral health at entry into kindergarten and to determine whether overweight status is a risk factor for the onset of new behavior problems during the first 2 years in school. DESIGN: We use data from a nationally representative sample of kindergartners in the United States-the Early Childhood Longitudinal Study-Kindergarten class. Data on height, weight, and parent- and teacher-reported behavior problems were collected 3 times during their first 2 years in school for 9949 children. We use a multivariate regression analysis that controls for sociodemographic characteristics, parent-child interaction, birth weight, and mother's mental health. RESULTS: Among girls, but not boys, there is a significant association between overweight and teacher-reported externalizing behavior problems (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.23-2.68), teacher-reported internalizing behavior problems (OR, 1.54; 95% CI, 1.09-2.17), and parent-reported internalizing behavior problems (OR, 1.49; 95% CI, 1.08-2.06) at the beginning of kindergarten. However, overweight status was not a risk factor for the onset of new behavior problems over time for either girls (teacher-reported externalizing behavior problems: OR, 0.58 [95% CI, 0.25-1.33]; teacher-reported internalizing behavior problems: OR, 1.34 [95% CI, 0.88-2.03]; and parent-reported internalizing behavior problems: OR, 1.29 [95% CI, 0.82-2.01]) or boys (teacher-reported externalizing behavior problems: OR, 1.02 [95% CI, 0.67-1.57]; teacher-reported internalizing behavior problems: OR, 1.02 [95% CI, 0.68-1.52]; and parent-reported internalizing behavior problems: OR, 1.42 [95% CI, 0.94-2.15]), whereas low family income and maternal depression were strong predictors of such problems. CONCLUSIONS: Childhood overweight is already associated with behavior problems when girls start school, but not boys. In contrast to common belief, overweight status does not predict the onset of new internalizing or externalizing behavior problems during the first 2 years of school.     

Association between obesity and asthma in Japanese preschool children

Obesity may increase the risk of subsequent asthma. We have previously reported that there is a clear association between obesity and asthma in Japanese school-aged children. To evaluate whether a similar association exists in younger children, a nationwide cross-sectional questionnaire-based survey was performed focusing on children aged 4-5 yr. A child who had experienced wheezing during the past 12 months and had ever been diagnosed with asthma by a physician was defined as having current asthma. Overweight and underweight were defined as BMI ≥90th percentile and ≤10th percentile, respectively, according to the reference values for Japanese children from 1978 to 1981. After excluding 2547 children because of incomplete data, 34,699 children were analyzed. Current asthma was significantly more prevalent in overweight children compared with underweight and normal weight children (13.2% for overweight vs. 10.5% for underweight and 11.1% for normal weight; both p < 0.001). Even after adjusting for other variables, such as gender, other coexisting allergic diseases, and parental history of asthma, there was an association between overweight and current asthma (adjusted odds ratio: 1.23, 95% CI: 1.10-1.38, p < 0.001). Even in preschool children, obesity is already associated with asthma, and there was no gender effect on this association. Physicians should consider the impact of obesity when managing asthma in younger children.     

Prevalence of overweight in children with developmental disorders in the continuous national health and nutrition examination survey (NHANES) 1999-2002

OBJECTIVE: To estimate the prevalence of overweight in children identified with developmental disorders on the basis of nationally representative survey data. STUDY DESIGN: We estimated the prevalence of overweight in children with developmental disorders on the basis of a recent large nationally representative survey. The continuous National Health and Nutrition Examination Survey (NHANES) 1999-2002 included 4 questions to identify children with developmental disorders. Height and weight were used to calculate body mass index (BMI). BMI percentiles were estimated relative to the age- and sex-specific Centers for Disease Control and Prevention growth reference. The 85th percentile BMI defined at-risk-for-overweight and the 95th percentile BMI defined overweight. RESULTS: We found a higher prevalence of at-risk-for overweight and overweight among children with limitations in physical activity and a higher prevalence of overweight in girls with learning disabilities, compared with children without these conditions, after adjustment for age and race-ethnicity. CONCLUSION: To the extent that children with developmental disorders are included in large representative surveys, the data suggest that children with developmental disorders have a risk for overweight that is at least as great as that of typically developing children.