SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
BACKGROUND: Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years. Purpose. This evidence synthesis examines the evidence for the benefits and harms of screening and early treatment of overweight among children and adolescents in clinical settings. METHODS: We developed an analytic framework and 7 key questions representing the logical evidence connecting screening and weight control interventions with changes in overweight and behavioral, physiologic, and health outcomes in childhood or adulthood. We searched the Cochrane Library from 1996 to April 2004. We searched Medline, PsycINFO, DARE, and CINAHL from 1966 to April 2004. One reviewer abstracted relevant information from each included article into standardized evidence tables, and a second reviewer checked key elements. Two reviewers quality-graded each article with US Preventive Services Task Force criteria. RESULTS: Although BMI is a measure of relative weight rather than adiposity, it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure. The risk of adult overweight from childhood overweight provides the best available evidence to judge the clinical validity of BMI as an overweight criterion for children and adolescents. BMI measures in childhood track to adulthood moderately or very well, with stronger tracking seen for children with >or=1 obese parent and children who are more overweight or older. The probability of adult obesity (BMI of >30 kg/m(2)) is >or=50% among children >13 years of age whose BMI percentiles meet or exceed the 95th percentile for age and gender. BMI-based overweight categorization for individuals, particularly for racial/ethnic minorities with differences in body composition, may have limited validity because BMI measures cannot differentiate between increased weight for height attributable to relatively greater fat-free mass (muscle, bone, and fluids) and that attributable to greater fat. No trials of screening programs to identify and to treat childhood overweight have been reported. Limited research is available on effective, generalizable interventions for overweight children and adolescents that can be conducted in primary care settings or through primary care referrals. CONCLUSIONS: BMI measurements of overweight among older adolescents identify those at increased risk of developing adult obesity. Interventions to treat overweight adolescents in clinical settings have not been shown to have clinically significant benefits, and they are not widely available. Screening to categorize overweight among children under age 12 or 13 who are not clearly overweight may not provide reliable risk categorization for adult obesity. Screening in this age group is compromised by the fact that there is little generalizable evidence for primary care interventions. Because existing trials report modest short- to medium-term improvements (approximately 10-20% decrease in percentage of overweight or a few units of change in BMI), however, overweight improvements among children and adolescents seem possible.
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 association between increased prepregnancy weight for height and seven pregnancy complications was studied in a multi-racial sample of more than 4100 recent deliveries. Body mass indices were calculated and used to classify women as average weight (90-119 percent of ideal or BMI 19.21-25.60), moderately overweight (120-135 percent ideal or BMI 25.61-28.90), and very overweight (greater than 135 percent ideal or BMI greater than 28.91) prior to pregnancy. Compared to women of average weight for height, very overweight women had a higher risk of diabetes, hypertension, pregnancy-induced hypertension and primary cesarean section delivery. Moderately overweight women were also at higher risk than average for diabetes, pregnancy-induced hypertension and primary cesarean deliveries but the relative risks were of a smaller magnitude than for very overweight women. With women of average prepregnancy body mass as reference, moderately elevated, but not significant relative risks were found for perinatal mortality in the very overweight group, for urinary tract infections in both overweight groups, and a decreased risk for anemia was found in the very overweight group. However, post-hoc power analyses indicated that the number of overweight women in the sample did not allow adequate statistical power to detect these small differences in risk. To overcome limitations associated with low statistical power, the results of three recent studies of these outcomes in very overweight pregnant women were combined and summarized using Mantel-Haenzel techniques. This second, larger analysis suggested that very overweight women are at significantly higher risk for all seven outcomes studied. Summary results for moderately overweight women could not be calculated, since only two of the studies had evaluated moderately overweight women separately. These latter results support other findings that both moderate overweight and very overweight are risk factors during pregnancy, with the highest risk occurring in the heaviest group. Although these results indicate that moderate overweight is a risk factor during pregnancy, additional studies are needed to confirm the impact of being 20-35 percent above ideal weight prior to pregnancy. The results of this analysis also imply that since the baseline incidence of many perinatal complications is low, studies relating overweight and pregnancy complications should include large enough samples of overweight women so that there is adequate statistical power to reliably detect differences in complication rates.
The objective of this study was to determine the prevalence of and possible risk factors for overweight in a sample of 5- to 6-year-old Hispanic (predominantly Mexican American) children in Chicago, Illinois, to see if overweight is more common in more highly acculturated immigrant families. There were 250 kindergarten students (92% of those eligible) attending two public elementary schools serving primarily Mexican American neighborhoods measured for height and weight. Consenting mothers were interviewed (n = 80) and measured (n = 38). The interview tool covered demography, acculturation, infant and toddler feeding practices, current eating patterns and food preparation habits, physical activity, and psychosocial family characteristics. Overweight was conservatively defined as weight-for-height at or above the National Center for Health Statistics 95th percentile. The data were used to describe the prevalence of overweight. Overweight and nonoverweight children were compared on all survey variables using appropriate statistical tests, with significance set at.05. There were 23% of the total sample of children (n = 250) and 26% of the subsample of children (those whose mothers were interviewed) who were overweight. Analysis limited to children in the subsample explored risk factors. The median score on the Acculturation Scale was 4.0 (range 2.4 - 10.4) on a scale of 2.4 (entirely not acculturated) to 12 (fully acculturated). There was no significant association between overweight and Acculturation Scale score. Overweight children were more likely than those not overweight to watch television for more than 3 hours during weekend days (48% vs. 22%, P =.03). Overweight children were also more likely to consume sweetened beverages (powdered drinks, soda pop, atole) daily (67% vs. 39%, P =.03). There was a trend indicating that free access to food at home increased the risk of overweight (P = 0.06). No other family- or child-level variables were related to overweight. Only 40% of mothers with an overweight child correctly assessed these children as overweight. Approximately one quarter of the children in the study were overweight. Our hypothesis that their obesity was linked to acculturation was not confirmed. Longer hours of child television viewing on weekends and higher levels of sweetened beverage consumption were important behaviors associated with the occurrence of overweight. These data should be considered when designing future studies in this population.
CONTEXT: The prevalence of childhood overweight status is increasing. Some have suggested that childhood overweight is associated with food insecurity, defined as limited or uncertain access to enough nutritious food. OBJECTIVES: The purpose of this work was to assess the association of household and child food insecurity with childhood overweight status. METHODS: The National Health and Nutrition Examination Survey 1999-2002 uses a stratified multistaged probability sample and collects a broad array of data from a nationally representative sample of US citizens. All children 3 to 17 years old in this sample are included in these analyses. We measured BMI categorized as at risk for overweight or greater (> or = 85%) or overweight (> or = 95%) and household and child food security/insecurity using the US Food Security Scale. RESULTS: When compared with children from food-secure households, children from food-insecure households were more likely to demonstrate significant associations with being at risk for overweight or greater in the following demographic categories: 12 to 17 years, girls, white, and in households with income < 100% and > 4 times the federal poverty level. Household food insecurity is associated with child overweight status in children aged 12 to 17, girls, and children who live in households with incomes > 4 times the federal poverty level. Child food insecurity demonstrated the same associations with being at risk for overweight or greater, as did household food insecurity, but associations were also seen in 3- to 5-year-old children, boys, and Mexican American children. Child food insecurity is significantly associated with child overweight status for children aged 12 to 17, girls, white children, and children in families with income < or = 100% poverty level. Controlling for ethnicity, gender, age, and family poverty index level, childhood food insecurity is associated with a child being at risk for overweight status or greater, but not overweight status. CONCLUSIONS: Household and child food insecurity are associated with being at risk for overweight and overweight status among many demographic categories of children. Child food insecurity is independently associated with being at risk for overweight status or greater while controlling for important demographic variables. Future longitudinal research is required to determine whether food insecurity is causally related to child overweight status.
The coexistence of child malnutrition and maternal overweight in the same households typifies rapid nutrition transition in developing countries (DCs). It is reportedly less common in Africa than in Latin America or Asia, but the phenomenon is still little documented. The purpose of our study in poor urban neighbourhoods of the capital city of Benin (West Africa) was to assess the magnitude of the overlap of child protein-energy malnutrition (PEM) and maternal overweight within households, and to compare these households with other nutritional phenotypes in terms of socio-economic circumstances and diet quality. Our hypothesis was that both child PEM and maternal overweight could stem from poor socio-economic conditions, including lack of sanitation, and poor diet quality. Food diversity was used as an index of diet quality, or the qualitative dimension of food security. A random sample of 148 households that included a least the biological mother, one child between 6 and 59 months of age and a second one between 5 and 11 years was selected in two poor neighbourhoods of the capital city of Cotonou to assess the prevalence of "double burden" households and of other nutritional phenotypes of households: with PEM only in at least one child; with maternal overweight only; and without PEM or overweight. Body weights and heights of mothers and of the two targeted children were measured. As long as one child had low weight-for-height or height-for-age (z-score <-2.0), the household came under the "PEM" type. In mothers, overweight was defined as body mass index (BMI) > or = 25, obesity > or = 30 and chronic energy deficiency <18.5. We retained 126 households for interviews with mothers on socio-economic circumstances and food diversity. A socio-economic status (SES) score was constructed on the basis of household amenities and maternal education. Food insecurity was based on reported shortage of food in the last year in the household. Based on the frequency of consumption of 13 different food groups in the previous week, a food diversity score was computed. Overall 35.5% of children were malnourished, and school-age children had a worse nutritional status than under-5 children: 41% and 30% PEM (chronic or acute or both), respectively. The rate of maternal overweight was 39.1% including 15.5% of obesity. Child PEM coexisted with maternal overweight or obesity in 16.2% of the households; 27.7% of households had PEM only, 23% overweight only, 20.3% showed no malnutrition or overweight, and 12.8% had an underweight mother. Maternal BMI status was significantly associated with both children's weight-for-height z-score, particularly the elder one. The rate of child malnutrition, particularly wasting, was significantly higher among underweight mothers and lower in overweight mothers . Underweight mothers were merged with mothers with BMI < or = 25 for the remaining analyses. Households with overweight mothers tended to enjoy relatively better socio-economic conditions--higher SES, higher maternal education, less food insecurity, better household sanitation; they also tended to have a more diversified diet. This is in contrast with PEM households. Dual burden households shared several socio-economic features with the PEM households, except for a higher (not significant) SES score. Dual burden households also had the lowest food diversity score of all household types. Logistical regression models revealed that a relatively higher SES level was associated with a higher likelihood of maternal overweight in PEM households, whereas poor household sanitation increased the odds of PEM among maternal overweight households. Food diversity appeared significantly associated with a lower likelihood of dual burden in all types of households. The study highlights the importance of addressing the double burden of malnutrition and overweight even in poor areas of low income countries of West Africa. It suggests that prevention efforts should be aimed at improving diet quality and sanitation in poor urban households.
INTRODUCTION: Obesity is a well-recognized risk factor for many chronic diseases. Pediatric overweight is an especially severe problem because its childhood onset increases the overall length of exposure to the detrimental effects of overweight, accelerates the onset of chronic disease, and affects children's physical, psychological, and social development. Several parental traits have been shown to be associated with an increased risk for childhood overweight. In our study, we quantified the mutual effects of parental education and smoking on the risk of filial overweight in a large population-based sample of Israeli schoolchildren, adjusting for the effects of age, sex, and immigration status. METHODS: Data were collected in 1997 and 2000 from 8623 Israeli schoolchildren aged 8 to 13 years in two cross-sectional samples. Overweight was defined as body mass index (BMI) of greater than the 85th percentile for age and sex, and severe overweight was defined as BMI greater than the 95th percentile for age and sex. RESULTS: Mean BMI was positively associated with number of parental smokers for a child. Parental smoking was an independent risk factor for both overweight and severe overweight, with a dose-response relationship between the number of parental smokers and the risk of filial overweight. Children whose parents did not attend college were at increased risk for overweight (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.03-1.42) and severe overweight (OR, 1.49; 95% CI, 1.09-2.05) compared with children whose parents both attended college. Children with one college-educated parent were at increased risk for severe overweight (OR, 1.31; 95% CI, 1.004-1.71) compared with children whose parents both attended college. CONCLUSION: Parental education and smoking are independent risk factors for filial overweight. Children of less-educated, smoking parents should be targeted for overweight prevention and intervention efforts. These findings should also be included as key messages in adult smoking prevention and cessation campaigns. Parents who smoke should be warned that not only is their own health at stake, but their children are also at increased risk for overweight and its associated diseases.
CONTEXT: The prevalence of overweight and obesity has increased markedly in the last 2 decades in the United States. OBJECTIVE: To update the US prevalence estimates of overweight in children and obesity in adults, using the most recent national data of height and weight measurements. DESIGN, SETTING, AND PARTICIPANTS: As part of the National Health and Nutrition Examination Survey (NHANES), a complex multistage probability sample of the US noninstitutionalized civilian population, both height and weight measurements were obtained from 4115 adults and 4018 children in 1999-2000 and from 4390 adults and 4258 children in 2001-2002. MAIN OUTCOME MEASURE: Prevalence of overweight (body mass index [BMI] > or =95th percentile of the sex-specific BMI-for-age growth chart) among children and prevalence of overweight (BMI, 25.0-29.9), obesity (BMI > or =30.0), and extreme obesity (BMI > or =40.0) among adults by sex, age, and racial/ethnic group. RESULTS: Between 1999-2000 and 2001-2002, there were no significant changes among adults in the prevalence of overweight or obesity (64.5% vs 65.7%), obesity (30.5% vs 30.6%), or extreme obesity (4.7% vs 5.1%), or among children aged 6 through 19 years in the prevalence of at risk for overweight or overweight (29.9% vs 31.5%) or overweight (15.0% vs 16.5%). Overall, among adults aged at least 20 years in 1999-2002, 65.1% were overweight or obese, 30.4% were obese, and 4.9% were extremely obese. Among children aged 6 through 19 years in 1999-2002, 31.0% were at risk for overweight or overweight and 16.0% were overweight. The NHANES results indicate continuing disparities by sex and between racial/ethnic groups in the prevalence of overweight and obesity. CONCLUSIONS: There is no indication that the prevalence of obesity among adults and overweight among children is decreasing. The high levels of overweight among children and obesity among adults remain a major public health concern.
OBJECTIVE: To determine whether overweight in infancy (0-11 months) and young childhood (12-35 months) persists through the preschool years. METHODS: Analysis of longitudinal surveillance data for 380 518 low-income children monitored in the U.S. Pediatric Nutrition Surveillance System from birth to age 59 months. Overweight was defined as weight-for-height > or = 95th percentile. We determined the proportion of the children (overweight vs non-overweight) above or below the 95th percentile of weight-for-height at the later ages. RESULTS: The relative risk (RR) for overweight among overweight infants (vs non-overweight infants) at 1, 2, 3 and 4 years old was 4.3, 3.5, 3.3, and 2.9, respectively. 62.5% of overweight 3-year-old was still overweight a year later, but only 4.1% non-overweight 3-year-old became overweight a year later (RR = 15.2). However, low birth weight children had the highest RR to remain overweight after they became overweight compared to normal and high birth weight children. CONCLUSIONS: Overweight during infancy persists through the preschool years. Tracking of overweight appears to become stronger as children get older and is more pronounced among low birth weight children than normal or high birth weight children. Monitoring preschoolers' height and weight status should be a strategy for preventing of obesity in adolescence and adulthood.
BACKGROUND: Laparoscopic appendectomy (LA) has been associated with a faster recovery and less postoperative pain than the open technique. However, few data are available on the clinical outcome of LA in overweight patients. METHODS: A group of 106 patients with a body mass index (BMI) > 26.4, representing the upper quintile of 500 prospectively randomized patients, were included in the study. They were randomized to undergo either laparoscopic or open appendectomy (OA). Operating and anesthesia times, postoperative pain, complications, hospital stay, functional index (1 week postoperatively), sick leave, and time to full recovery were documented. RESULTS: In OA, the operating time for overweight patients was significantly longer than that for patients in the normal weight range (40 vs 35 min, p < 0.05). In LA, there was no difference in operating time between the normal and overweight patients. Overweight patients who underwent LA had longer operating and anesthesia times than their OA counterparts (55 vs 40 min, p < 0.001; and 125 vs 100 min, p < 0.001, respectively). Postoperative pain was significantly greater in overweight patients who underwent OA than in those treated with the laparoscopic technique. Postoperative pain was also significantly greater in overweight patients subjected to OA than in patients of normal weight after 4 weeks; the clinical significance may, however, be of less importance since the values are low (0.26 vs 0.09, p < 0.05). There were no significant differences between the two operating techniques in terms of complications. Hospital stay was longer for overweight patients than for normal-weight patients undergoing OA (3.0 vs 2.0, p < 0.01). The functional index did not differ between any group of patients. Sick leave was longer for overweight patients who underwent OA than for normal-weight patients treated with the same technique (17 vs 13 days, p < 0.01). In the laparoscopic group, however, there were no differences between the overweight and normal-weight patients. Time to full recovery was greater in overweight patients subjected to OA than in the overweight patients in the LA group (22 vs 15 days, p < 0.001). CONCLUSION: In this study, overweight patients who were submitted to LA had less postoperative pain and a faster postoperative recovery than overweight patients who had OA. LA also abolished some of the negative effects that overweight had on operating time, hospital stay, and sick leave with the open technique. However, anesthesia and operating times were significantly longer in LA for both overweight patients and those with a normal BMI.
AIM: The purpose of this analysis was to estimate the magnitude of weight change required in the six-year period between 1994 and the Year 2000 if Americans are to reach the Healthy People 2000 goal for reduction of overweight among those ages 20-74 to no more than 20% among all adults and no more than 30% among black women. Prevention of weight gain among the non-overweight is compared with that of weight loss among the overweight as strategies for reaching this goal. DESIGN: Data from the First National Health and Nutrition Examination Survey (NHANES I) and the Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS) were used to estimate 6-year weight change of persons aged 20 to 72 at the Year 2000. Men, white women, and black women were examined in addition to the overall population. Given a baseline prevalence of 24.7%, overweight in the year 2000 was projected for three simulated interventions: no weight gain among non-overweight persons (prevention-only), weight loss among overweight persons (weight-loss-only), and prevention-plus-weight-loss. In addition, the Year 2000 overweight prevalence was projected under different baseline prevalence scenarios of 26% and 34%. OUTCOME MEASURE: Prevalence of overweight; overweight determined by body mass index (> or = 27.3 kg/m2 for women and > or = 27.8 kg/m2 for men). RESULTS: Prevention-only was successful in reducing the overall prevalence of overweight from 24.7% to 20%. Weight-loss-only required a 5.3 kg weight loss to achieve the overall goal of 20% and 8.4 kg weight loss to achieve the goal within all three race-sex strata. Prevention-plus-weight-loss required only 3.8 kg of weight loss to achieve the goals within the three race-sex strata. Prevention-only was not successful in reducing the overall prevalence of overweight to 20% when the 26% and 34% baseline scenarios were used. Weight-loss-only required 6.3 and 11.2 kg; prevention-plus-weight-loss required 1.2 and 6.6 kg of weight loss using the 26% and 34% baselines, respectively. CONCLUSIONS: Prevention of weight gain among those who are not already overweight could achieve substantial changes in the prevalence of overweight, even in a 6-year time period. However, given the increasing trend in overweight, the Year 2000 goal for the reduction in prevalence of overweight will not be reached.
OBJECTIVES: To estimate the prevalence and incidence of overweight among low-income, inner-city children aged 3 to 7 years and to determine predictors of changes in body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) percentile. DESIGN: Retrospective cohort study using administrative and medical records. SETTING: The Philadelphia Health Care Centers, 1996 through 2003. PARTICIPANTS: Three hundred eighty-six patients who had at least 2 well-child visits between the ages of 3 and 7 years, had at least 1 visit between September 2001 and 2003, and were between the ages of 5 and 7 years at the most recent visit. Mean follow-up time was 2.4 years. MAIN EXPOSURES: Age, sex, race/ethnicity, and BMI percentile at baseline. MAIN OUTCOME MEASURES: Prevalence and incidence of overweight and at risk of overweight and change in BMI percentile. RESULTS: Prevalence of overweight at the initial visit was 18%, with 16% at risk of overweight. At the last visit, the prevalence of overweight was 19%, with 15% at risk of overweight. Based on maximum BMI percentile, 29% were overweight at some point and an additional 19% were at risk of overweight at least once. Annualized incidence of overweight among those not overweight at baseline was 5% per year: 2% per year for normal-weight children and 14% per year for children in the at-risk category. The outcomes were not associated with sex, race/ethnicity, or age at first or last visit. Incident overweight was positively associated with BMI percentile at baseline. CONCLUSION: The early onset and frequent persistence of overweight demonstrated herein underline the need to prevent overweight among very young children.
BACKGROUND: The etiology of preeclampsia is unknown. It is controversial whether insulin resistance (IR) is present in preeclamptic patients, and it is unclear if hyperinsulinemia is dependent upon being overweight during pregnancy or on preeclampsia per se. METHODS: We performed a cross-sectional study in 140 pregnant patients and compared serum insulin concentrations. These women, 18-40 years old, were classified into four groups: 1) overweight patients with mild preeclampsia (n = 21), 2) overweight patients without preeclampsia (n = 23), 3) non-overweight patients with mild preeclampsia (n = 48), and 4) non-overweight patients without preeclampsia (n = 48). An oral glucose tolerance test (OGTT) was performed in all patients between 29 and 40 weeks of gestation. Blood samples were taken at 0, 60, 120 and 180 min after 100 g oral glucose to measure serum glucose and insulin levels. RESULTS: Basal and postload OGTT glucose values and basal insulin levels were similar in all groups. However, insulin levels at 60, 120 and 180 min were significantly higher (p = 0.009, p = 0.009, p = 0.046, respectively) in overweight patients with preeclampsia than in those without. Insulin levels at 60 and 180 min were also higher (p = 0.024, p = 0.023, respectively) in non-overweight patients with preeclampsia than in those without. The area under the curve (AUC) for glucose was not significantly different between both groups of overweight patients or between non-overweight patients with or without preeclampsia. In contrast, the AUC of insulin was significantly higher in preeclamptic patients in both overweight (p = 0.004) and non-overweight (p = 0.024) groups than in overweight and non-overweight groups without preeclampsia, respectively. CONCLUSIONS: Increased insulin levels observed in mild preeclamptic patients were independent of overweight-related hyperinsulinemia.
CONTEXT: It has been suggested that breastfeeding is protective against children becoming overweight, and that there is a dose-dependent effect of its duration. OBJECTIVE: To determine whether breastfeeding and its duration are associated with a reduced risk of being overweight among young children in the United States. DESIGN AND SETTING: Data on infant feeding and child overweight status were taken from the third National Health and Nutrition Examination Survey (NHANES III), a cross-sectional health examination survey conducted from 1988-1994. SUBJECTS: Sample of 2685 US-born children between the ages of 3 and 5 years, with birth certificates, height and weight measures, and information on infant feeding. MAIN OUTCOME MEASURES: A body mass index (BMI) between the 85th and 94th percentile was considered at risk of overweight and a BMI in the 95th percentile or higher was considered being overweight. RESULTS: After adjusting for potential confounders, there was a reduced risk of being at risk of overweight for ever breastfed children (adjusted odds ratio [AOR], 0.63; 95% confidence interval [CI], 0.41-0.96) compared with those never breastfed. There was no reduced risk of being overweight (AOR, 0.84; 95% CI, 0.62-1.13). There was no clear dose-dependent effect of the duration of full breastfeeding on being at risk of overweight or overweight and no threshold effect. The strongest predictor of child overweight status was the mother's concurrent weight. The rate of children being overweight nearly tripled with maternal overweight status (BMI, 25.0-29.9 kg/m(2); AOR, 2.95; 95% CI, 1.35-6.42) and more than quadrupled with maternal obesity status (BMI >/=30.0 kg/m(2); AOR, 4.34; 95% CI, 2.50-7.54). CONCLUSIONS: There are inconsistent associations among breastfeeding, its duration, and the risk of being overweight in young children. Breastfeeding continues to be strongly recommended, but may not be as effective as moderating familial factors, such as dietary habits and physical activity, in preventing children from becoming overweight.
BACKGROUND: The prevalence of obesity has increased at an epidemic rate, and obesity has become one of the most common health concerns in the United States. A few small studies have noted a possible association between iron deficiency and obesity. OBJECTIVE: To investigate the association between weight status, as measured by body mass index (BMI), and iron deficiency in a nationally representative sample of children and adolescents. DESIGN: National Health and Nutrition Examination Survey III (1988-1994) provides cross-sectional data on children 2 to 16 years of age. Recorded measures of iron status included transferrin saturation, free erythrocyte protoporphyrin levels, and serum ferritin levels. Children were considered iron-deficient if any 2 of these values were abnormal for age and gender. With the use of age- and gender-specific BMI percentiles, at risk for overweight was defined as a BMI of > or =85th percentile and <95th percentile, and overweight was defined as a BMI of > or =95th percentile. The prevalence of iron deficiency was compared across weight groups. Logistic regression was used to estimate the association between iron status and overweight, controlling for age, gender, ethnicity, poverty status, and parental education level. RESULTS: In this sample of 9698 children, 13.7% were at risk for overweight and 10.2% were overweight. Iron deficiency was most prevalent among 12- to 16-year-old subjects (4.7%), followed by 2- to 5-year-old subjects (2.3%) and then 6- to 11-year-old subjects (1.8%). Overweight 2- to 5-year-old subjects (6.2%) and overweight 12- to 16-year-old subjects (9.1%) demonstrated the highest prevalences of iron deficiency. Overall, the prevalence of iron deficiency increased as BMI increased from normal weight to at risk for overweight to overweight (2.1%, 5.3%, and 5.5%, respectively), and iron deficiency was particularly common among adolescents (3.5%, 7.2%, and 9.1%, respectively). In a multivariate regression analysis, children who were at risk for overweight and children who were overweight were approximately twice as likely to be iron-deficient (odds ratio: 2.0; 95% confidence interval: 1.2-3.5; and odds ratio: 2.3; 95% confidence interval: 1.4-3.9; respectively) as were those who were not overweight. CONCLUSIONS: In this national sample, overweight children demonstrated an increased prevalence of iron deficiency. Given the increasing numbers of overweight children and the known morbidities of iron deficiency, these findings suggest that guidelines for screening for iron deficiency may need to be modified to include children with elevated BMI.
BACKGROUND: Many studies have demonstrated that orthotic treatment is effective for the prevention of curve progression in patients with adolescent idiopathic scoliosis. However, the effect of being overweight on the outcome of orthotic treatment has not been reported. The purpose of the present study was to determine whether orthotic treatment of adolescent idiopathic scoliosis is less successful for patients who are overweight than it is for those who are not overweight. METHODS: A ten-year multicenter retrospective review of patients in whom adolescent idiopathic scoliosis had been treated with a Boston or a custom-molded thoracolumbosacral orthosis was performed. The inclusion criteria were no previous treatment, skeletal immaturity (a Risser sign of 0, 1, or 2), a curve of 25 degrees to 40 degrees at the time of orthotic initiation, and follow-up to skeletal maturity. Patients were divided into two groups according to body habitus, with overweight patients defined as those with a body mass index in the eighty-fifth percentile or greater. Curve progression was compared between the two groups. Successful orthotic treatment was defined as no more than a 5 degrees increase in the primary curve from the start of orthotic wear to skeletal maturity. Absolute curve progression to 45 degrees or greater also was considered to be an adverse outcome. RESULTS: Two hundred and seventy-six consecutive patients from two institutions were analyzed, and thirty-one patients were considered to be overweight. The mean curve progression was 9.6 degrees +/- 7.3 degrees for the patients who were overweight, compared with 3.6 degrees +/- 9.4 degrees for those who were not overweight (p < 0.01). Overweight patients were 3.1 times more likely to have an unsuccessful result than those who were not overweight. Curve progression to 45 degrees or greater occurred in fourteen (45%) of the thirty-one patients who were overweight, compared with sixty-nine (28%) of the 245 patients who were not overweight. CONCLUSIONS: The results of the present study suggest that overweight patients with adolescent idiopathic scoliosis will have greater curve progression and less successful results following orthotic treatment than those who are not overweight. The ability of an orthosis to transmit corrective forces to the spine through the ribs and soft tissue may be compromised in overweight patients. This factor should be taken into consideration when making treatment decisions. Additional study is warranted to determine a threshold effect.
OBJECTIVE: To study the dynamic processes that drive development of childhood overweight by examining the effects of prenatal characteristics and early-life feeding (breastfeeding versus bottle feeding) on weight states through age 7 years. We test a model to determine whether prenatal characteristics and early-life feeding influence the development of a persistent early tendency toward overweight and/or whether prenatal characteristics and early-life feeding factors influence the likelihood that children will change weight states as they get older. METHODS: Data from the National Longitudinal Survey of Youth's Child-Mother file were used to implement these analyses. A total of 3022 children were included in this sample. For inclusion in this sample, valid information on height and weight during 3 consecutive interviews when the child was aged 24 to 95 months as well as valid data on prenatal and birth characteristics were needed. The primary outcome measure was childhood overweight (BMI >95th percentile). Multivariate logistic models and first-order Markov models were estimated. RESULTS: Early development of childhood overweight was associated with race, ethnicity, maternal prepregnancy obesity, maternal smoking during pregnancy, and later birth years. In later years, the factor that contributed the most to being overweight was having been overweight in the previous observation period. However, with conditioning on the child's having been overweight in the previous observation period, the prenatal factors that contributed to early childhood overweight, except for birth cohort, were also associated with development of overweight among children who had previously been normal weight and perpetuated the persistence of overweight over time. CONCLUSIONS: This research suggests that prenatal characteristics, particularly race, ethnicity, maternal smoking during pregnancy, and maternal prepregnancy obesity, exert influence on the child's weight states through an early tendency toward overweight, which then is perpetuated as the child ages. These findings are intriguing as they provide additional clues to the genesis of childhood overweight and suggest that overweight prevention may need to begin before pregnancy and in early childhood.