Breastfeeding and transmission of cytomegalovirus to preterm infants. Case report and kinetic of CMV-DNA in breast milk

Background

Obesity has been identified as a risk factor for higher prevalence of asthma and asthma-related symptoms in children. The objective of this study was to evaluate the relationship between the prevalence of asthma symptoms and obesity among school-age children in the city of Ahvaz, Iran.

Methods

A total of 903 children, 7 to 11 years of age, were enrolled in this study through cluster sampling. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to identify the children who were currently suffering from asthma. Height and weight were measured and body mass index (BMI) was calculated in kg/m². Overweight was defined as BMI greater than the age- and sex-specific 85th percentile, and obesity as BMI greater than the 95th percentile. We determined the relationship between obesity and asthma symptoms by chi-square tests.

Results

The prevalence of wheeze ever, current wheezing, obesity, and overweight was 21.56%, 8.7%, 6.87%, and 9.5%, respectively. The current prevalence of wheezing among obese and overweight children was 68.75% and 37%, respectively, and there was a statistical association between obesity and the prevalence of current wheezing (p < 0.001), night cough (p < 0.001), and exercise-induced wheezing (p = 0.009), but obesity and overweight were not associated with eczema and allergic rhinoconjunctivitis, so it seems that the pathophysiology of asthma in obese and overweight children is not related to allergy.

Conclusion

There is a strong association between asthma symptoms and both overweight and obesity in both sexes among school-age children.     

Overweight and obesity prevalence in children and adolescents from a private school in Recife

OBJECTIVES: To determine the prevalence of overweight and obesity in students from a private school in Recife; compare the prevalence rates of overweight and obesity in boys and girls and in different age groups (children and adolescents) and verify the correlation between body mass index and triceps skinfold thickness in this population. METHODS: Cross-sectional study with 762 students (332 children and 430 adolescents) from a middle/upper class school in Recife, in 1999. Overweight was defined as body mass index equal or above the 85th percentile for age and gender. Obesity was defined as body mass index and triceps skinfold thickness equal or above the 85th percentile. RESULTS: The prevalence rates were 26.2% (95%CI = 23 to 29%) for overweight, and 8.5% (CI95% = 6.5 to 10.5%) for obesity. Overweight was more prevalent among children (34.3%) than among adolescents (20.0%) (P<0.001). Obesity was more frequent among children (14.2%) than among adolescents (4.2%) (P<0.001). The prevalence of overweight in boys (34.6%) was higher than in girls (20.6%) (P<0.001). The prevalence of obesity was also higher in boys (14.7%) than in girls (4.4%) (P<0.001). The correlation coefficient between body mass index and triceps skinfold thickness was equal to 0.64 (95%CI = 0.60 to 0.68). CONCLUSIONS: The prevalence of overweight in our study population was as high as that found in industrialized countries; obesity, however, was less frequent.     

Prevalence of overweight and obesity in children and adolescents with type 1 diabetes mellitus

BACKGROUND: Information about the prevalence of obesity in children with type 1 diabetes mellitus (DM1) is inconsistent and limited. The burden of the concurrent problems of obesity and DM1 can have notable medical, psychological, and social implications for both patients and their families. AIMS: To determine prevalences of overweight and obesity in children with DM1 compared to a control population. METHODS: In a cross-sectional study, we compared the prevalence of overweight/obesity in 390 children with DM1 (males 54%) and 565 controls (CONT; males 60%) aged 6 to 16 years. Overweight and obesity were defined as body mass indices between the 85th and 95th percentiles, and greater than the 95th percentile for age, respectively. RESULTS: Overall, 29.5% DM1 and 18.1% CONT (p < 0.001) were either obese or overweight. The prevalence of obesity alone did not differ (DM1 5.4% vs CONT 8.2%), but a greater rate of overweight was seen in the DM1 group (DM 24.1% vs CONT 10.0%, p < 0.001). Rate's of overweight were higher in the DM1 than CONT across all age groups and in both genders (males: DM1 20.1% vs CONT 8.9%, p < 0.001; females: DM1 28.7% vs CONT 11.5%, p < 0.001). Only females showed an increase in overall overweight/obesity rate (DM1 34.8% vs CONT 16.4%, p < 0.001) and this was most evident in older girls. CONCLUSIONS: Children with DM1 are more overweight, but not more obese, than their nondiabetic counterparts. Additional research is warranted to evaluate the characteristics of DM1 and its management that may influence weight gain.     

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.     

Leptin and asthma in overweight children at 12 years of age

Obesity is suggested as a risk factor for asthma, but the mechanisms are unclear. The relationship between obesity and asthma has not been considered in children born with very low-birth weight (VLBW). We hypothesized that overweight was a contributing factor for asthma in VLBW children, and that leptin and leptin-associated cytokines might play roles in overweight-related asthma. Seventy-four VLBW and 64 normal birth weight (NBW) children participated in a 12-yr follow up study assessing asthma and allergy. Twenty-seven (12 VLBW) of the 138 children were overweight according to the proposed international definition. The diagnosis of current asthma was made by a pediatrician. Serum levels of leptin and interferon (IFN)-gamma were analyzed by enzyme-linked immunosorbent assay (ELISA). Leptin levels were considerably higher in the overweight than in the non-overweight children (median value: 18.1 vs. 2.8 ng/ml, p < 0.001). In the overweight children, current asthmatics had twice as high levels of leptin as children without current asthma (median value: 30.8 vs. 14.3 ng/ml, p = 0.14), but this was not the case in the non-overweight children. IFN-gamma was more often detected in the overweight than in the non-overweight children (61% vs. 12%, p < 0.001), and there was a positive correlation between the levels of leptin and the levels of IFN-gamma (Rho = 0.40, p < 0.001). In the VLBW group, the overweight children had a significantly increased risk for current asthma compared with the non-overweight children after adjustment for the neonatal risk factors [adjusted odds ratio (OR) 5.8, 95% confidence interval (CI): 1.2-27]. Thus, overweight was associated with asthma in the VLBW children. Our hypothesis remained that leptin might be involved in the pathogenesis of asthma in the overweight children, and IFN-gamma might be a pathway in the process of leptin-induced inflammation.     

Association of overweight with asthma symptoms in Japanese school children

Background: Most studies regarding the association of obesity with asthma have been performed in the Western countries. This study is a nationwide survey conducted in Japan. Methods: A cross‐sectional and questionnaire‐based survey was performed among children aged 6–7, 13–14, and 16–17 years, using the ISAAC questionnaire. Overweight was defined as BMI ≥ 90th according to the reference values for Japanese children obtained during 1978–1981. Results: Of a total of 179 218 children, 149 464 replied to the questionnaire (response rate 83.4%). After omitting incomplete data, 139 117 were analyzed. In all the age groups, being overweight was associated with current asthma after adjustment for confounding factors (adjusted OR: 1.24 in children 6–7 years of age, 1.31 in those 13–14 years, and 1.32 in those 16–17 years). These tendencies were observed in both genders. Overweight was a risk factor for nocturnal cough, independent of current asthma in the older age groups (adjusted OR: 1.21 in children 13–14 years, and 1.17 in those 16–17 years). Conclusions: There is a clear association between obesity and current asthma in Japanese school‐aged children. Mechanisms through which obesity related with nocturnal cough might be different from those of obesity‐associated asthma.     

Overweight does not increase asthma risk but may decrease allergy risk at school age after infantile bronchiolitis

Aim: Increasing evidence suggests that overweight children are at increased risk of asthma. The association between weight gain and allergy is more complex. The aim was to evaluate the association between overweight or obesity and asthma, allergy, bronchial reactivity or atopic sensitization at school age in children with bronchiolitis in infancy. Subjects and methods: Eighty‐one children hospitalized for bronchiolitis at <24 months of age attended control visits at 7.2 and 12.3 years of ages. The visits consisted of medical examinations, weight and height measurements, body mass index (BMI) calculations, skin prick tests and exercise challenge tests. BMI >1.3 SD from age‐ and gender‐specific references meant overweight and BMI >2.0 SD obesity. Results: Current or previous overweight or obesity did not increase the risk of asthma, allergy, bronchial reactivity or atopic sensitization at 7.2 or 12.3 years of age. Previous and current obesity decreased the risk of atopic dermatitis, and current overweight and obesity decreased the risk of sensitization to outdoor allergens at 12.3 years of age. Conclusion: Previous or current overweight does not increase asthma or allergy risk but current obesity may decrease allergy risk at school age after bronchiolitis in infancy.     

Decreased quality of life associated with obesity in school-aged children

OBJECTIVES: To examine the association between health-related quality of life and body mass index (BMI) in preadolescent school-aged children and to provide the possible risk factors among participant characteristics, BMI status, and health-related quality of life.Design, Setting, and PARTICIPANTS: Cross-sectional analysis of 371 (50% female; 32% minority) children from a community-based sample of 8- to 11-year-olds participating in an ongoing cohort study, excluding those who had sleep apnea or who were born prematurely. Using BMI percentiles for age and sex, 17.5% of the children were considered overweight (BMI > or =95th percentile), 12.4% were at risk for overweight (BMI 85th-94th percentile), 8.1% were relatively underweight (BMI <20th percentile), and the remaining 62.0% were of normal weight (BMI 20th-84th percentile). MAIN OUTCOME MEASURES: Health-related quality-of-life scores as determined by the Child Health Questionnaire-Parent Form 50, dichotomized into the bottom quartile or decile. RESULTS: After adjustment for covariates (host factors and health status measurements), overweight children compared with normal weight children scored lower on the Psychosocial Health Summary (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.6) and on subscales measuring self-esteem (OR, 3.5; 95% CI, 1.9-6.3), physical functioning (OR, 2.8; 95% CI, 1.7-6.8), and effect on the parent's emotional well-being (OR, 2.0; 95% CI, 1.1-3.6). Compared with the normal weight group, children who are at risk for overweight scored significantly lower for physical functioning. CONCLUSION: Overweight children have an increased odds of low scores for several health-related quality-of-life domains, suggesting the importance in considering such dimensions in programs aimed at further understanding obesity in children.     

Rise in childhood obesity with persistently high rates of undernutrition among urban school-aged Indo-Asian children.

BACKGROUND: Childhood obesity is an emerging global public health challenge. Evidence for the transition in nutrition in Indo-Asian developing countries is lacking. We conducted these analyses to determine the trends in nutritional status of school-aged children in urban Pakistan. METHODS: Data on the nutritional status of children aged 5 to 14 years from two independent population-based representative surveys, the urban component of the National Health Survey of Pakistan (NHSP; 1990-1994) and the Karachi survey (2004-2005), were analysed. Using normative data from children in the United States as the reference, trends for age- and gender-standardised prevalence (95% CI) of underweight (more than 2 SD below the weight-for-age reference), stunted (more than 2 SD below the height-for-age reference) and overweight and obese (body mass index (BMI) 85(th) percentile or greater) children were compared for the two surveys. The association between physical activity and being overweight or obese was analysed in the Karachi survey using logistical regression analysis. RESULTS: 2074 children were included in the urban NHSP and 1675 in the Karachi survey. The prevalence of underweight children was 29.7% versus 27.3% (p = 0.12), stunting was 16.7% versus 14.3% (p = 0.05), and prevalence of overweight and obese children was 3.0 versus 5.7 (p<0.001) in the NHSP and Karachi surveys, respectively. Physical activity was inversely correlated with being overweight or obese (odds ratio, 95% CI, 0.51, 0.32-0.80 for those who engaged in more than 30 minutes of physical activity versus those engaged in less than 30 minutes' activity). CONCLUSIONS: Our study highlights the challenge faced by Pakistani school-aged children. There has been a rapid rise in the number of overweight and obese children despite a persistently high burden of undernutrition. Focus on prevention of obesity in children must include strategies for promoting physical activity.     

Is obesity associated with asthma in young children?

OBJECTIVE: The aim of this study was to evaluate the association between obesity and asthma in a population-based sample of Canadian children. STUDY DESIGN: Baseline data from the National Longitudinal Survey of Children and Youth were used in this cross-sectional study. We included 11199 children age 4 to 11 years whose biological mother reported data on asthma, height, and weight. Body mass index was categorized, and obesity was defined as body mass index >or=85th percentile. Children with asthma had parents who reported the diagnosis, and they took prescribed inhalants, had wheezing or an attack in the previous year, or had their activities limited by asthma. Multiple logistic regression was used. RESULTS: The prevalence of asthma was 9.9%. Maternal history of asthma was a risk factor for asthma among all children. Single child status and maternal depression were risk factors for girls. The odds ratio for asthma, comparing highest and lowest body mass index categories, was 1.02 (99% confidence interval, 0.70-1.46) for boys and 1.06 (99% confidence interval, 0.67-1.69) for girls. CONCLUSION: This study suggests that there is no statistical association between obesity and asthma among Canadian children age 4 to 11 years.     

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.     

Identification of population subgroups of children and adolescents with high asthma prevalence: findings from the Third National Health and Nutrition Examination Survey

OBJECTIVES: To provide national estimates of asthma prevalence in African-American, Mexican American and white (non-Latino) children and adolescents using several common definitions; to evaluate familial, sociodemographic, and environmental risk factors that are independently associated with current asthma in children; and to identify subgroups at particular risk for current asthma using 2 complementary data analytic approaches. DESIGN: Cross-sectional study, using the Third National Health and Nutrition Examination Survey, 1988-1994. SETTING: Eighty-nine mobile examination centers in the United States. PARTICIPANTS: Twelve thousand three hundred eighty-eight African American, Mexican American, and white (non-Latino) children and adolescents, aged 2 months through 16 years, selected from a systematic random, population-based, nationally representative sample. MAIN OUTCOME MEASURE: Current asthma, defined by caregivers who reported that their child currently had doctor-diagnosed asthma. RESULTS: The overall prevalence of current asthma was 6.7% (95% confidence interval [CI], 5.6-7.8). Odds ratios for current asthma from the multiple regression analysis were 4.00 (95% CI, 2.90-5.52) for children with a parental history of asthma or hay fever, 1.94 (95% CI, 1.09-3.46) for children with body mass index (calculated as weight in kilograms divided by the square of height in meters) greater than or equal to the 85th percentile, and 1.64 (95% CI, 1.20-2.26) for children of African American ethnicity. African American and Mexican American children showed a consistent prevalence of current asthma across age while white children showed an increase in prevalence with age. The 2 highest-risk subgroups identified by the signal detection analysis were composed of children with a parental history of asthma or hay fever who were 10 years or older with a body mass index greater than or equal to the 85th percentile (31.0% current asthma), and children with a parental history who were 10 years or younger and of African American ethnicity (15.6% current asthma). CONCLUSIONS: The findings from this analysis show a strong independent association between obesity and current asthma in children and adolescents, and confirm previous reports of a parental history of asthma or hay fever and African American ethnicity as additional important risk factors.     

Prevalence of Obesity Among Patients With Congenital and Acquired Heart Disease

Overweight and obesity rates have risen dramatically in the United States, with subsequent detrimental comorbidity risks. The rates for obesity among children with congenital and acquired heart disease have rarely been reported. A retrospective cross-sectional study was conducted to determine the prevalence of overweight and obesity in children with heart disease and to identify subgroups at increased risk. A total of 795 cases were identified from a chart review of patients presenting to an urban center’s Pediatric Cardiology Program between 1 January and 31 December 2006. A body mass index (BMI) at the 85th percentile or higher was defined as overweight, and a BMI at the 95th percentile or higher was defined as obese. Subjects with comorbidities affecting body habitus were excluded from the study. Overall, overweight and obesity rates were similar to national data. No significant differences in overweight or obesity rates were detected between heart disease and non-heart disease groups (P = 0.50). According to multivariate analysis, Hispanic ethnicity and male gender were the only predictors of obesity. This study shows that children with heart disease are not immune to the common predictors of obesity such as gender and ethnicity and that the future care of children with heart disease should include general discussions about the risks for obesity.     

Body mass index and acute asthma severity among children presenting to the emergency department

Ginde AA, Santillan AA, Clark S, Camargo CA Jr. Body mass index and acute asthma severity among children presenting to the emergency department.
Pediatr Allergy Immunol 2010: 21: 480–488.
© 2009 John Wiley & Sons A/S To determine the prevalence of obesity among children presenting to the emergency department (ED) with acute asthma, and to examine the relationship between body mass index (BMI) and acute asthma severity in the ED setting. We analyzed data from a multicenter prospective cohort study during 1997–1998; 44 ED in 17 US states and two Canadian provinces enrolled 672 patients, age 5–17, with acute asthma. BMI and Pulmonary Index were collected in the ED. We defined overweight and obesity using age, sex, and race‐specific BMI values from national and international databases. The prevalence of obesity was significantly higher among ED patients with acute asthma as compared with children from the general population (23% vs. 9–15%; p < 0.001). Obese children with acute asthma did not differ from their non‐obese counterparts, by demographic factors or chronic asthma severity (all p > 0.2). Initial Pulmonary Index was the same across underweight, intermediate, and obese groups (3.7 ± 2.4, 3.8 ± 2.2, 3.7 ± 2.3; p = 0.70). Admission status also did not vary across groups (22%, 22% and 23%; p = 0.98). Stratifying the analysis by age group and sex did not change these results. The prevalence of obesity among children presenting to the ED with acute asthma was significantly higher compared with children from the general population. BMI was not associated with markers of chronic and acute asthma severity. The results of this study support a positive association between obesity and asthma, and suggest that asthma exacerbations among obese children are very similar to those experienced by other children.     

Psychiatric treatment: A risk factor for obesity?

BACKGROUND:

People with psychiatric diagnoses have increased physical health difficulties.

OBJECTIVES:

To examine the physical growth parameters documented in children receiving psychiatric treatment.

METHODS:

A chart review was performed on consecutive paediatric consultations in 1997 and 1998 on 34 children six to 12 years of age admitted to an intermediate-stay psychiatric inpatient service. Growth parameters of each child were plotted on standard growth curves. The prevalence of obesity (body mass index at or above the 95th percentile), absolute weight at or above the 95th and 50th percentiles, underweight status, tall and short stature, macrocephaly and microcephaly were calculated. The prevalence of atypical findings was compared with the expected prevalence of typical growth parameters in the general population. Risk factors for atypical growth parameters were recorded. An association between weight and specific medication use was explored.

RESULTS:

It was found that 11.8% of the children were obese. It was also found that 23.5% of the children had weight at or above the 95th percentile, 79.3% had weight at or above the 50th percentile, 14.7% had macrocephaly and 79.4% had a head circumference above the 50th percentile; these results were statistically significant. The mean number of psychotropic medications prescribed was 6.4, although there was no significant association between higher weight and current medication type.

CONCLUSIONS:

Children receiving inpatient psychiatric treatment were more likely to have higher weight than typical children. Monitoring growth parameters is an important component of the paediatric care of children with psychiatric diagnoses. Guidelines are required for obesity prevention and intervention in the context of the risk factors experienced by this high risk population.     

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.     

Macronutrient intake, physical activity, serum lipids and increased body weight in primary schoolchildren in Istanbul

BACKGROUND: The aim of this cross-sectional study was to record the prevalence of underweight, overweight and obesity in primary school children living in Istanbul and to examine the relationship between increased body weight and certain cardiovascular disease (CVD) risk factors. METHODS: A total of 510 randomly selected children aged 12 and 13 years of age (257 boys, 253 girls) were examined. Information regarding anthropometrical indices, energy and macronutrient intake, physical activity, physical fitness and lipid profile were collected. Classification of children in overweight and obese subgroups was based on the cut-off points proposed by Cole et al. RESULTS: The prevalence of underweight, overweight and obesity was found to be 15.3%, 10.6% and 1.6%, respectively. Both overweight boys and girls were found to have lower physical fitness compared to their normal-weight counterparts, but no difference was observed for energy and macronutrient intake. Overweight boys were found to have higher total cholesterol (P < 0.001), low-density lipoprotein cholesterol (P < 0.01), triglycerides (P < 0.01) and total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio (P < 0.05) compared to their normal-weight counterparts, while overweight girls were found to have lower HDL-C (P < 0.05) compared to their normal-weight peers. CONCLUSIONS: Underweight and overweight coexisted in the current population. Increased body weight was accompanied by unfavorable lipid profiles and lower fitness levels. Consequently, there is an emergent need for early identification and understanding of behavioral and physiological variables related to obesity and CVD, so that appropriate interventions can be targeted to children who are at risk for adult onset of these diseases.     

Trends in anthropometric measurements among Mescalero Apache Indian preschool children. 1968 through 1988.

OBJECTIVE--To determine if there were trends in underweight, short stature, and obesity among 1- through 5-year-old Mescalero (NM) Apache Indian children from 1968 through 1988. DESIGN--Cross-sectional review of hospital clinic charts for five cohorts. SETTING--General pediatric outpatient clinic at the Mescalero Indian Health Service Hospital. PARTICIPANTS--Sixty-nine patients aged 1 through 5 years in 1968, 1973, 1978, 1983, or 1988 for whom weight and height were recorded during a well-child visit that occurred in the respective year. SELECTION PROCEDURES--Approximately half the charts were screened for eligibility through systematic sampling for all years except 1988; for 1988 all available charts were screened for eligibility for the study. INTERVENTIONS--None. MEASUREMENTS AND RESULTS--We found trends of decreasing prevalence of both underweight (defined as weight-for-height below the fifth percentile) and short stature (defined as height-for-age below the fifth percentile) based on the Centers for Disease Control/World Health Organization growth reference. We found no secular trends in obesity (weight-for-height above the 95th percentile), although the prevalences throughout the 21-year period were as much as two to four times higher than expected when compared with the Centers for Disease Control/World Health Organization reference. There has been an upward shift in both weight-for-height and height-for-age distributions since 1968, indicating that Mescalero children today are, on average, heavier and taller. CONCLUSIONS--Underweight and short stature decreased among Mescalero preschool children from 1968 through 1988, suggesting nutritional improvements. However, given the current high prevalence of obesity, it is recommended that surveillance of nutritional status be continued and appropriate interventions be developed to treat and prevent obesity in this population.     

Association of body mass index with COVID-19 outcome in a pediatric tertiary referral hospital in Iran

BackgroundOne of the challenging risk factors for severe COVID-19 infection is obesity and high body mass index (BMI). In this study we assessed the association between BMI and outcomes of hospitalized pediatric patients with COVID-19 in Iran.MethodThis retrospective cross-sectional study was performed in the biggest referral pediatric hospital in Tehran from March 7 to August 17, 2020. All hospitalized children ≺18 years of age with laboratory-confirmed COVID-19 were included in the study. We evaluated the association of BMI with COVID-19 outcomes (death, severity of clinical course, oxygen therapy, intensive care unit [ICU] admission, ventilator requirement). The secondary objectives were investigating the association of gender, underlying comorbidity, and patient age with COVID-19 outcomes. The limits for obesity, overweight, and underweight were set at BMI >95 percentile, 85≤ BMI ≤ 95, and BMI<5 percentile, respectively.ResultsIn total, 189 confirmed pediatric cases of COVID-19 (0.1–17 years) with a mean age of 6.4 ± 4.7 years were included. Overall, 18.5% of the patients were obese and 33% were underweight. We found that BMI had no significant relation with COVID outcomes in pediatric cases but after subgrouping the participants, underlying comorbidities and lower BMI in previously ill children were independently associated with a poor clinical outcome of COVID-19. In addition, the previously ill children with higher BMI percentiles were at a relatively lower risk of ICU admission (95% CI: 0.971–0.998, OR: 0.98, p = 0.025) and better clinical course of COVID-19 (95% CI: 0.970–0.996, OR: 0.98, p = 0.009). The BMI percentile had a statistically significant direct relationship with age (Spearman correlation coefficient= 0.26, p<0.001). When we separated the children with underlying comorbidity, the BMI percentile was significantly lower (p<0.001) in comparison to the previously healthy children.ConclusionBased on our results, obesity is not related to COVID-19 outcomes in pediatric patients, but after controlling for confounding effects, underweight in children with underlying comorbidities was more likely to be associated with a poor prognosis of COVID-19.     

Trends of underweight,overweight, and obesity in Brazilian children and adolescents

ObjectiveTo describe and analyze the trends of occurrence of underweight, overweight, and obesity in schoolchildren.MethodsThis was a longitudinal study of trends conducted in a voluntary sample of Brazilian children and adolescents. The sample was grouped by year of collection (period I: 2005 and 2006; period II: 2007 and 2008, and period III: 2009-2011), age category (children: 7 to 10 years, and adolescents: 11 to 14 years), and stratified by gender. The body mass index was used to classify the nutritional profile. Trend analysis was verified using multinomial logistic regression (p < 0.05).ResultsMean occurrences were 2.11% for underweight, 22.27% for overweight, and 6.8% for obesity. There was a decrease of underweight in male adolescents from period I to II, as well as an increase in female children from period II to III. Regarding overweight, there was an increase followed by a decrease in male children. Regarding obesity, there was an increase from period I to II in all age groups and for both genders.ConclusionThe prevalence of underweight was less than 5% in all categories of age and gender. However, the categories of overweight and obesity showed higher values, and together comprised almost 30% of the young Brazilian population; moreover, a trend toward increase in prevalence of obesity was observed up to the year 2008, followed by the maintenance of these high prevalence rates.