Defining childhood obesity: the relative body mass index (BMI)

This article is a statement from the European Childhood Obesity Group after discussion with the participants at the 3rd ECOG Workshop in St Polten, Austria, 1993: W Burniat, M Caroli, C Catassi, ML Frelut, E Locard, E Malecka-Tendera, C Maffeis, D Molnar, EME Poskitt, IM Raetsch, MF Rolland-Cachera, C Van Aelst, L Vido, M Wabitsch, K Zwiauer.-     

学龄前儿童颈围与体重指数的相关性

目的 探讨学龄前儿童颈围与体重指数的相关性及颈围对学龄前儿童超重/肥胖的诊断价值。方法 采用分层整群抽样的方法抽取乌鲁木齐市10所幼儿园3 719名7岁以下儿童,收集儿童一般资料并进行体格测量,采用Pearson相关分析法评估颈围与体重指数的相关性,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析颈围判断超重/肥胖的准确性,采用Kappa一致性检验评价颈围与体重指数判断超重/肥胖的一致性。结果 各年龄阶段的男童、女童颈围与体重指数均呈正相关(r≥0.50,均P<0.001)。以体重指数作为判断超重/肥胖的标准分为超重/肥胖组与非超重/肥胖组,各年龄阶段的超重/肥胖组颈围均大于非超重/肥胖组(P<0.001)。ROC曲线分析显示,男童和女童颈围判断超重/肥胖的曲线下面积均大于0.7。Kappa一致性检验显示,各年龄阶段男童、女童的颈围和体重指数判断超重/肥胖的Kappa值均大于0.40。结论 学龄前儿童颈围与体重指数呈正相关;颈围可较好地判断学龄前儿童超重/肥胖。[中国当代儿科杂志,2022,24 (9):1042-10...     

Comparison of body mass index and triceps skinfold at 5 years and young adult body mass index, waist circumference and blood pressure

Aim: To examine which measure of obesity at 5 years, body mass index (BMI) or triceps skinfold thickness, is most strongly associated with 21‐year risk factors for cardiovascular disease (CVD), including BMI, waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods: Longitudinal birth cohort study with BMI and triceps skinfold measurements at age 5, and BMI, WC and blood pressure at 21 years. Overweight and obesity at 5 years were determined according to Cole‐International Obesity Task Force standards, at 21, by World Health Organization definitions. Triceps skinfold thickness measurements were converted to a z‐score, and cut‐offs for overweight and obesity were chosen to reflect similar proportions to the BMI subgroups. BMI, WC, SBP and DBP were also measured at 21 years. Results: Five‐year BMI and triceps skinfold thickness were both significantly associated with the CVD risk measures at 21 years. For overweight/obesity at 5 years, the adjusted odds ratio (95% confidence interval) for 21‐year overweight/obesity was 5.6 (4.2, 7.4), for 21‐year WC was 1.5 (1.2, 2.0). Mean difference (95% CI) in BMI was 4.4 (3.9, 5.0), in WC 8.3 cm (6.8, 9.8), in SBP 2.4 mm Hg (0.5, 4.3), in DBP 1.1 mm Hg (0.1, 2.2). For skinfold, the similar findings were odds ratio 2.6 (2.0, 3.4) and 1.2 (0.9, 1.6) for 21‐year BMI and WC, and mean differences of 2.6 (2.0, 3.2), WC 4.8 cm (3.3, 6.3), SBP 2.3 mm Hg (0.5, 4.2) and DBP 0.7 mm Hg (?0.4, 1.8). Conclusions: In children with overweight/obesity, BMI rather than triceps skinfold is the preferred epidemiological measure for identifying young adult CVD risk markers of BMI, WC and blood pressure.     

Changes in body weight and body mass index (BMI) in teenage girls prior to the onset and diagnosis of an eating disorder

Growth charts from the school health services were used to study weight changes prior to the onset and diagnosis of eating disorders (ED) with weight loss in 122 teenage girls. In these girls menarche started at 12.6 +/- 1.0 y (mean +/- SD), which is the same for the general population. At their maximal premorbid weight, the girls were 14.6 +/- 1.2 y of age and had a higher weight and body mass index (BMI) than the general population, as evidenced by standard deviation scores (SDS) above zero for weight (0.65 +/- 0.95, p < 0.001) and BMI (0.61 +/- 0.94, p < 0.001). Weight gain prior to the onset of weight loss followed two different patterns. Eighty-three (68%) girls tracked upwards through the weight curves to reach their maximal weight, thus putting on weight at a higher rate than expected. Thirty-nine (32%) girls tracked downwards through the weight curves to reach their maximal weight, but did so starting from a weight and BMI at well above average. Conclusions: Weight gain in teenage girls prior to the onset of an ED deviates from that of the general population. Being or becoming heavier and less lean than their peers could influence body image and decisions on dieting, which, in turn, may be the start of the development of an ED in the otherwise predisposed. The deviation from normal tracking patterns prior to the onset of disease also causes problems in diagnostic procedures and in setting treatment targets for weight gain, since "normal" or expected weight becomes more difficult to establish.     

Association between birth weight and birth arm circumference of neonates in rural Egypt

In many developing countries including Egypt, the birth weights (BWs) of most babies go unrecorded because they are born at home. Since it is difficult to record BW in the community setting, birth arm circumference (BAC) has been used as a valid proxy for BW to identify at risk babies with low birth weight (LBW). However, the validity of BAC as an indicator of the actual BW has not been assessed fully. We did this study among neonates in rural Bilbeis, Egypt, to examine the association between BW and BAC, to assess whether BAC can serve as an indicator of the actual BW, and to determine the validity indices of 3 different cut-off levels of BAC as indicators of LBW. During 1987–88, the weights and arm circumference of 148 neonates were recorded within 2 weeks of birth. We observed a strong and highly significant positive linear correlation between BW and BAC (r=0.6188, p=0.0001). The BAC cut-off value of <9.5 cm was associated with the optimal combination of sensitivity (50%) and specificity (88.4%) as an indicator of LBW. In linear regression analysis BAC was found to be a significant (p=0.00001) predictor of BW. The means of the model predicted weights for males, females, and both genders together were identical to the corresponding means of the observed values. In contingency table analysis, for 78 (52.7%) of the 148 neonates studied the observed and predicted BW categories were identical. For another 59 (39.9%) neonates, agreement with the next lower or higher BW category was observed. We feel that BAC can be used as an indicator of the actual BW in settings where routine recording of BW is currently not practicable.     

Preschool children born moderately preterm have increased waist circumference at two years of age despite low body mass index

Aim: To investigate the development of waist circumference (WC) in preschool children born preterm compared with a population‐based reference. Background: Children born preterm are reported to be insulin resistant, despite being lean during early childhood. We hypothesize that the mechanism is through increased visceral adiposity. Methods: Data from 4446 preschool children (2169 girls/2277 boys) born in 2001–2006 from a population‐based study were compared with longitudinal measurements of body mass index (BMI) and WC from a cohort of 152 children (64 girls/88 boys) born moderately preterm in 2002–2004 (gestational age, 32–37 weeks). Results: In the preterm children, the mean WC was 2.8 cm larger compared with the reference group (p < 0.001) at 2 years of age but not at 5 years of age. There was no significant difference in the mean BMI at 2 years of age. The preterm group was significantly leaner at 5 years of age, with a mean BMI of 15.13 compared with 15.98 in the reference group (p < 0.001). Conclusion: Children born moderately preterm present as lean during early childhood but have an increased waist circumference in infancy, pointing towards a change in fat distribution with more abdominal fat. This may have implications for their metabolic status.     

体质量指数和腰围与肥胖儿童心血管危险因素关系的研究

目的 探讨体质量指数(BMI)、腰围与肥胖儿童心血管危险因素的关系.方法 回顾性分析2001年1月至2005年12月在上海交通大学医学院附属仁济医院肥胖病专科门诊就诊的6～18(11.8±3.0)岁患儿283例,其中男179例(11.4±3.0)岁,女104例(12.3±3.0)岁,测体重、身高、腰围、臀围、血压、血清总三酰甘油(甘油三酯,TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),并计算BMI和腰臀比.结果 283例患儿血脂水平异常147例(51.9%),其中1项指标异常100例,2项异常34例,3项异常和4项全部异常为11例和2例.131例患儿TG升高,42例TC升高,HDL-C降低和LDL-C升高分别为20例和17例.283例患儿中高血压131例(46.3%),收缩压(SP)增高112例,舒张压(DP)增高88例,69例两者均增高.校正年龄和性别后,BMI与血清TG水平正相关(r=0.13,P<0.05).腰围不仅与血清TG水平呈正相关(r=0.21,P<0.01),还与血清HDL-C负相关(r=-0.14,P<0.05).腰围与血脂紊乱程度也呈正相关,而BMI则无类似关系.BMI和腰围均与SP、DP呈正相关.腰围异常患儿SP、DP和血清TG明显增高,而HDL-C明显降低.高血压组儿童腰围、血清Tc、LDL-C水平明显高于血压正常组儿童.结论 肥胖儿童易并发脂质代谢紊乱和高血压等心血管危险因素.BMI和腰围与肥胖儿童心血管危险因素关系密切.不同年龄、性别,腰围第95百分位值可作为腰围正常与否的临界点.     

Documentation of growth parameters and body mass index in a paediatric hospital

BACKGROUND

New recommendations suggest that the 2000 Centers for Disease Control and Prevention (CDC) growth charts and body mass index (BMI) for age be used for Canadian children. Little information is available on how often growth parameters are documented in hospital settings.

OBJECTIVE

To determine the frequency of documentation of growth parameters in the medical records of a tertiary care paediatric hospital.

METHODS

A prospective, 14-day audit of 491 charts of children seen in the emergency department (ED) or admitted to a ward was performed to determine the frequency of documentation of height/length, weight, head circumference, BMI or weight for height, and presence of growth charts. Similar data were sought from the most recent clinic visit for all ward charts.

RESULTS

Growth parameters, aside from weight, were infrequently documented in the medical record. Height/length was documented in no ED charts and in 42% of ward charts. BMI or weight for height were almost never found, and growth charts were present in only 23% of ward charts, one clinic chart and one ED chart.

CONCLUSIONS

Rates of documentation of growth parameters in the teaching hospital setting were unacceptably low. Implementation of the use of the 2000 CDC growth charts will require not only education regarding BMI but also steps to encourage more regular measurement of height and use of shared growth charts in all areas of the hospital. A simple conceptualization framework for health care providers to use as a counselling tool is presented.     

Associations between vitamin D status in infants and blood lipids, body mass index and waist circumference

Aim: To study the relationships between 25‐hydroxyvitamin D status and blood lipids, insulin, glucose, body mass index and waist circumference in infants. Methods: In a cross‐sectional study, 255 infants aged 9 months with a blood sample for 25‐hydroxyvitamin D were examined. Plasma 25‐hydroxyvitamin D concentrations were analysed by chemiluminescent immunoassay. Associations between plasma 25‐hydroxyvitamin D and high‐density lipoprotein (HDL), low‐density lipoprotein, total cholesterol, triglycerides, insulin, glucose, body mass index and waist circumference were analysed. Results: Mean plasma 25‐hydroxyvitamin D was 77.2 ± 22.7 nM. At the time of examination, 97% received vitamin D supplementation. 25‐Hydroxyvitamin D was negatively associated with HDL (p = 0.003), cholesterol (p = 0.002) and triglycerides (p = 0.010) in multivariate analysis controlled for gender, season, body mass index, length, birth weight and breastfeeding. There were no associations between 25‐hydroxyvitamin D and glucose or insulin (all p > 0.05). 25‐hydroxyvitamin D was negatively associated with body mass index (p = 0.005) and waist circumference (p = 0.002) controlled for gender, season, breastfeeding, birth weight and length. Conclusion: Vitamin D status is negatively associated with blood lipids, body mass index and waist circumference in infants where nearly all received vitamin D supplements. Whether this has long‐term health effects remains to be elucidated.     

Predictive value of body mass index and waist circumference for metabolic syndrome in 6-12-year-olds

Aim: To determine the predictive value of body mass index (BMI) and waist circumference (WC) and their optimal cut‐off points for metabolic syndrome (MetS), and also the incidence of MetS. Methods: This study included 888 children, aged 6–12 years, who were followed for a mean of 6.6 years. BMI, WC and their optimal cut‐off points to predict MetS were investigated. Results: The cumulative incidence of MetS was 10.7%. The adjusted ORs for age, sex and family history to predict MetS for BMI and WC z‐scores were 2.6 (95% CI, 2.0–3.5) and 2.6 (95% CI, 1.9–3.5), respectively. In their correspondent models, area under the receiver operating characteristic (ROC) curve was 0.73 (95% CI, 0.68–0.79) for BMI z‐scores and 0.72 (95% CI, 0.67–0.78) for WC z‐scores with no statistically significant difference. The optimal cut‐off values for BMI were 16.5 kg/m² for boys and 16.3 kg/m² for girls and those for WC were 57.5 cm for boys and 56.5 cm for girls. Conclusions: Our findings suggest that both BMI and WC have the same power to predict MetS and also children with higher BMI or WC are more susceptible to MetS. Moreover, a high incidence of MetS in children highlights the importance of interventional strategies during early childhood.     

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目的比较儿童青少年腰围与体重指数(BMI)在代谢综合征(MS)诊断中的实用价值。方法采用随机抽样的方法于2009年6月至2010年10月从南宁市14所中小学中抽取6～18岁儿童青少年7893人,分析腰围、BMI与MS各检测指标的相关性。以中华医学会糖尿病学分会(CDS)及国际糖尿病联盟(IDF)(2007)建议的MS标准应用受试者工作特征曲线(ROC),比较腰围及BMI的ROC曲线下面积,反映腰围及BMI诊断MS的准确性大小。结果 (1)除高密度脂蛋白胆固醇(HDL-C)均值随肥胖增加而降低外,MS的各检测指标均值比较[除外空腹血糖(FBG)和天冬氨酸转移酶(AST)]均为肥胖组>超重组>正常组,3组间差异有统计学意义(P<0.05)。(2)腰围、BMI均与臀围、腰臀比、收缩压(SBP)、舒张压(DBP)、FBG、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)呈正相关,与HDL-C呈负相关,其中腰围与FBG、TG、HDL-C、FINS、HOMA-IR的相关程度较BMI密切。(3)腰围检出MS各组分异常的灵敏性明显高于BMI,阳性预测值(除外HDL-C异常)均相对好于BMI。(4)腰围及BMI的ROC曲线下面积在CDS标准下分别为0.949和0.951;在IDF标准下分别为0.941和0.921。结论儿童青少年MS的诊断中,腰围较BMI更具诊断价值,腰围测量有助于儿童青少年MS的筛查。     

Birth anthropometric measures, body mass index and allergic diseases in a birth cohort study (BAMSE)

Objective

We aimed to assess increased birth weight or birth length in relation to allergic diseases at 4 years of age, taking body mass index (BMI) at age 4 as a covariate in the adjustment.

Methods

The parents of a large prospective birth cohort answered questionnaires on environmental factors and allergic symptoms when their children were 2 months and 1, 2 and 4 years old. Perinatal data on weight and length at birth were received from the child care health centres. The children were clinically examined at 4 years of age and height and weight recorded. Blood was drawn for analysis of specific IgE antibodies to common inhalant allergens. Risk associations between birth anthropometric measures and wheeze, allergic diseases or sensitisation were estimated in multivariate logistic regression analyses (n = 2869).

Results

There were no clear overall associations between birth weight and allergic diseases at 4 years of age. Birth length ⩾90th percentile was inversely associated with any wheeze at age 4 (adjusted OR 0.64, 95% CI 0.44 to 0.92) but was significantly associated only with late‐onset wheeze (adjusted OR 0.40, 95% CI 0.21 to 0.77). No such associations were seen for persistent or transient wheeze, eczema, rhinitis or allergic sensitisation. Transient wheeze during the first 2 years of age tended to be associated with increased BMI at age 4.

Conclusion

Increased birth weight was not associated with wheeze or allergic disease. Increased birth length may play a protective role in late‐onset wheeze in early childhood.