BMI-for-age Percentile Research Articles

Relationship between Slip Severity and BMI in Patients with Slipped Capital Femoral Epiphysis Treated with In Situ Screw Fixation.

Background: Slipped capital femoral epiphysis (SCFE) is a hip disorder that occurs in adolescence before epiphyseal plate closure, causing anatomical changes in the femoral head. Obesity is known to be the single most important risk factor for idiopathic slipped capital femoral epiphysis (SCFE), which is highly related to mechanical factors. Meanwhile, as increased slip angle increases major complications in patients with SCFE, slip severity is an important factor to evaluate prognosis. In obese patients with SCFE, higher shear stress is loaded on the joint, which increases the likelihood of slip. The study aim was to assess the patients with SCFE treated with in situ screw fixation according to the degree of the obesity and to find any factors affecting the severity of slip. Methods: Overall, 68 patients (74 hips) with SCFE who were treated with in situ fixation screw fixation were included (mean age 11.38, range: 6-16) years. There were 53 males (77.9%) and 15 females (22.1%). Patients were categorized underweight, normal weight, overweight, and obese depending on BMI percentile for age. We determined slip severity of patients using the Southwick angle. The slip severity was defined as mild if the angle difference was less than 30 degrees, moderate if the angle difference was between 30 and 50 degrees, and severe if the angle difference was greater than 50 degrees. To examine the effects of several variables on slip severity, we used a univariable and multivariate regression analysis. The following data were analyzed: age at surgery, sex, BMI, symptom duration before diagnosis (acute, chronic, and acute on chronic), stability, and ability to ambulate at the time of the hospital visit. Results: The mean BMI was 25.18 (range: 14.7-33.4) kg/m2. There were more patients with overweight and obese than those with normal weight in SCFE (81.1% vs. 18.9%). We did not find significant differences between overall slip severity and degree of obesity or in any subgroup analysis. Conclusions: We did not find a relationship between slip severity and degree of obesity. A prospective study related to the mechanical factors affecting the slip severity according to the degree of obesity is needed.

An Assessment of the Relationship Between BMI and Children Undergoing Surgical Procedures: A Retrospective Study.

Background: While multiple studies have documented that obesity increases the risk of operative complications among adults, little data exist on how obesity impacts surgical outcomes among children. We aimed to determine if children with obesity have different postoperative outcomes than their peers. Methods: A retrospective chart review was conducted of 875 patients aged between 2 and 18 years who underwent surgery during 2018. Patients were stratified, based on BMI percentile for age, as having less than healthy weight (<5th percentile), healthy weight (5th-84th percentile), excess weight (85th-94th percentile), or obesity (≥95th percentile). Demographic information and data on medical comorbidities and postoperative complications were collected. All analyses were conducted using chi-square or Kruskal-Wallis testing. Results: Eighty-two patients were excluded due to lack of BMI data and 56 were excluded as they had below healthy weight. Of the remaining 737 patients, 475 (64.4%) had healthy weight, 124 (16.8%) had excess weight, and 138 (18.70%) had obesity. Children with obesity had more tonsillectomy/adenoidectomy (p < 0.01) and vascular access (p = 0.04) procedures compared with peers. Additionally, patients with obesity were more likely to have a pre-existing history of liver disease (p < 0.01) and more frequently developed postoperative wound dehiscence (p < 0.01). No other complications occurred more frequently among children with obesity. Conclusions: Children with obesity required more tonsillectomy/adenoidectomy and vascular access procedures. Wound dehiscence was the only complication that was associated with obesity. This suggests that children with obesity are not inherently more prone to experience surgical complications and therefore elective procedures should likely not be deferred until preoperative weight loss is achieved.

The complicated relationship among parent and child disinhibited eating behaviors

Disinhibited eating behaviors (e.g., loss of control eating (LOC) and eating in the absence of hunger (EAH)) contribute to overeating and obesity. This study aimed to evaluate whether these traits are related in parent-child dyads and how the reporter of child eating behavior (parent or child) impacts this relationship. Two-hundred and ninety treatment-seeking children, ages 8–13, with overweight or obesity (BMI percentile for age and sex 85–99.9%) and their parents were included. LOC and EAH were assessed by child report for self, parent report for self, and parent report for child. Parent and child disinhibited eating behaviors were related only when parents reported on both their own and their child's eating behaviors (p-values < 0.04). Child report of LOC and EAH for self was not associated with parent report of LOC and EAH for self (p-values > 0.05). There was a significant interaction between parent's EAH and BMI as it related to parent report of child EAH (B = 0.02; SE = 0.005; p = 0.004) such that parents with lower BMI reported their own EAH to be lower than parents with higher BMI, but parent report of child EAH was similar regardless of the parent's BMI. Disinhibited eating behaviors were related only when a single parent reported on both their own and their child's behavior, suggesting a potential reporting bias. Given that the relation between parent and child disinhibited eating behaviors varies based on who is reporting the child's behavior, it may be important to consider both parent and child report when designing research studies or in clinical settings while also recognizing potential reporting biases.

Nutritional Status of Children (5 - 18 Years) by Using Anthropometric Indices: A Cross-Sectional Study Among the Sartang and Miji, Lesser Known Tribes of Arunachal Pradesh, India

Introduction: In this era of globalization, planners often fail to understand the importance of community specific nutritional intervention among children due to dearth of study specifically among the lesser known communities in tribal dominated Indian state like Arunachal Pradesh. In order to find out the present condition of nutritional status in such lesser known tribal groups in the state, this present cross-sectional study was conceptualized to assess the nutritional status by using anthropometric indices in the Sartang and Miji tribal children in Arunachal Pradesh, India. Methods: A total of 452 children aged five to 18 years living in rural areas of West Kameng district of Arunachal Pradesh, India were considered for the present analysis. The international standards were used to collect height and weight data and height for age and BMI for age percentile were calculated. Results: The results revealed that the prevalence of stunting (&lt; - 2 SD height for age) was higher among the Sartang male (34.0%) and female (46.3%) compared to Miji male (26.7%) and female (23.1%), respectively. Conversely the prevalence of overweight (percentile of BMI for age &gt; 85) was also higher among the Sartang male (19.1%) and female (27.8%) compared to Miji children. It may be due to the alteration of traditional food habits, consumption of regular fast food and increasing less socio-economic equity and higher inequality in both the communities. Conclusions: Therefore, undernutrition as well as over nutrition are prevalent among studied children perhaps correlated with rapid change in their food habits and lifestyle in the early age.

CHARACTERIZING PRIMARY AMENORRHEA IN A LARGE DIVERSE COHORT

To our knowledge, no recent large studies in the US have reexamined the etiologies of primary amenorrhea; particularly, in the context of increasing obesity rates and diverse ethnic backgrounds. The purpose of this study is to identify and characterize underlying causes of primary amenorrhea amongst a large, diverse cohort. We performed a retrospective chart review of the Kaiser Permanente Southern California database for patients with primary amenorrhea using ICD9 and ICD10 diagnosis codes 626.0 and N91.0, selecting for females ages 0-21 years old at first diagnosis from 2008-2019. Charts were then reviewed to determine which patients met diagnostic criteria for primary amenorrhea, as defined by the American Academy of Pediatrics (AAP): lack of menarche by age 15 years old or by >3 years after onset of secondary sexual characteristics. BMI-for-age percentile (BMIPCT) was used per CDC and AAP guidelines for patients ages 2-19 to account for differences in body composition with sex and age. Medical records were reviewed for demographics and clinical characteristics. Data were analyzed using ANOVA and Tukey analysis; p<0.05. Out of 936 patients from initial search, 748 were diagnosed with primary amenorrhea by chart review. Of those diagnosed, 45% identified as Hispanic (n=340), 32% as White (n=238), 10% as Black (n=73), and 7% as Asian (n=51). The remaining 6% (n=46) identified as Native American/Alaskan, Pacific Islander, Multiple, Other, or Unknown were excluded from final statistical analyses due to small sample size. Within ethnicity groups, patients were normally distributed by age. There was no significant difference in age of presentation between ethnicity groups. BMIPCT ranged from <1 to >99 with a median percentile of 69. The mean BMIPCT was 71 for Hispanic, 46 for White, 63 for Black, and 45 for Asian patients. There was a significant difference for both BMI and BMIPCT when comparing Hispanic vs. White (P<.001) and Hispanic vs. Asian patients (P<.001). A similar trend was seen comparing Black vs. Asian (P<.001) and Black vs. White patients (P<.001). There was no significant difference comparing Hispanic vs. Black, nor White vs. Asian patients. Hispanic and Black populations have significantly higher BMI and BMI-for-age percentiles at time of primary amenorrhea diagnosis when compared to White and Asian populations. However, there is no difference in age of presentation between ethnicity groups. Traditionally, the most common diagnosis underlying primary amenorrhea is hypogonadotropic hypogonadism or gonadal dysgenesis, followed by Mullerian anomaly, physiologic delay, and polycystic ovarian syndrome. Over the past 10 years, limited research in Europe and Asia evaluating differing ethnicities suggest alternative etiologies for primary amenorrhea.

Weight as a Risk Factor for Mortality in Critically Ill Patients.

To explore the hypothesis that obesity is associated with increased mortality and worse outcomes in children who are critically ill. Secondary analysis of the Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology study, a prospective, multinational observational study. Patients between 3 months and 25 years across Asia, Australia, Europe, and North America were recruited for 3 consecutive months. Patients were divided into 4 groups (underweight, normal weight, overweight, and obese) on the basis of their BMI percentile for age and sex. A total of 3719 patients were evaluated, of whom 542 (14%) had a primary diagnosis of sepsis. One thousand fifty-nine patients (29%) were underweight, 1649 (44%) were normal weight, 423 (11%) were overweight, and 588 (16%) were obese. The 28-day mortality rate was 3.6% for the overall cohort and 9.1% for the sepsis subcohort and differed significantly by weight status (5.8%, 3.1%, 2.2%, and 1.8% for subjects with underweight, normal weight, overweight, and obesity, respectively, in the overall cohort [P < .001] and 15.4%, 6.6%, 3.6%, and 4.7% in the sepsis subcohort, respectively [P = .003]). In a fully adjusted model, 28-day mortality risk was 1.8-fold higher in the underweight group versus the normal weight group in the overall cohort and 2.9-fold higher in the sepsis subcohort. Patients who were overweight and obese did not demonstrate increased risk in their respective cohorts. Patients who were underweight had a longer ICU length of stay, increased need for mechanical ventilation support, and a higher frequency of fluid overload. Patients who are underweight make up a significant proportion of all patients in the PICU, have a higher short-term mortality rate, and have a more complicated ICU course.

Abstract P484: The Role of Excessive Body Weight in Hypertension Risk Among Youth

Objective: To determine the hypertension risk associated with elevated body mass index (BMI) for age in children. Study design: In a retrospective cohort of 706,903 children ages 3-18 years in an integrated health care system in Southern California between 2008 and 2017, Cox proportional hazard models with age as time scale were fitted to assess the risk of hypertension (based on 2017 Blood Pressure Guidelines by the American Academy of Pediatrics using 3 blood pressures of independent consecutive visits), by baseline BMI-for-age category (starting at their first available BMI) and BMI change over time, adjusted for sex, race, socioeconomic status and baseline year. Children were followed up until end of membership, onset of hypertension, death, or end of study period. Results: During 3,121,299 person-years, we identified 19,158 youth with incident hypertension. The adjusted hazard ratio (HR) for hypertension was 0.842 (95%CI 0.755, 0.938) for children with a baseline BMI-for-age &lt;5th percentile, 0.864 (95%CI 0.814, 0.917) for 5-39th percentile, 1.00 (reference) for 40-59th percentile, 1.216 (95%CI 1.153, 1.282) for 60-84th percentile, 1.721 (95%CI 1.629, 1.817) for 85-94th percentile, 2.418 (95%CI 2.261, 2.586) for 95-96th percentile, and 3.816 (95%CI 3.624, 4.019) for ≥97th percentile. The adjusted HR for change in BMI over time was 1.095 (95%CI 1.090, 1.100) per kg/m2. Conclusions: In this large cohort study, we found that even moderate elevations in BMI-for age percentile conferred an increased risk of hypertension in children. Results also indicate an escalation of hypertension risk as BMI increased over time. Our results suggest that normal body weight in children ranging from the 5th to the 85th percentile of BMI-for-age and modest increases in BMI over time may increase the risk for hypertension.

Adult Tourniquet for Use in School-Age Emergencies.

Gunshot injuries are a leading cause of morbidity and mortality in the pediatric population. The Pediatric Trauma Society supports the use of tourniquets for exsanguinating hemorrhage in severe extremity trauma. The Combat Application Tourniquet (CAT) used with success in adults has not been prospectively tested in children. Our objective with this study was to determine if the CAT is successful in arresting extremity arterial blood flow in school-aged children. Sixty school-aged volunteers (ages 6-16 years) recruited by age cohort had the CAT applied to an upper arm and thigh while peripheral pulse was monitored by Doppler. The number of windlass turns (maximum allowed: 3 [1080°]) required to arrest arterial pulse was recorded. Success was analyzed by BMI percentile for age and extremity circumference. The CAT was successful in occluding arterial blood flow as detected by Doppler pulse in all 60 (100%) of the upper extremities tested. In the lower extremity, 56 (93%) had successful occlusion. The 3-turn maximum allowed by the protocol was not adequate in some obese, older subjects (BMI >30). In both the upper and lower extremity, the number of turns required to occlude blood flow gradually increased with an increase in arm and thigh circumference. Prospective testing of a cohort of school-aged children 6 to 16 years revealed the CAT tourniquet to be suitable for use in both the upper and lower extremity.

Abstract P222: Vitamin D and Airway Inflammation in Adolescent Asthmatics

Background: Over 25 million people are afflicted with asthma in the U.S. alone, with a higher incidence among adolescents, especially among the African American and Latino population. There has been a focus on the role of low levels of vitamin D (25(OH)D) and asthma severity. The high prevalence of vitamin D insufficiency has been shown to correlate with the high prevalence of asthma in urban youth. Although underlying mechanisms are not clear, vitamin D may regulate inflammation by increased production of anti - inflammatory compounds (Il-10, cAMP, MKP1). Therefore, the objective of this study is to determine which anti-inflammatory mediators are differentially expressed in asthmatic epithelium when exposed to 25(OH)D in conjunction with dexamethasone. The hypothesis is that low levels of vitamin D will be associated with a more pronounced inflammatory milieu and reduced anti-inflammatory response. Methods: Nasal epithelial cells and demographic data were collected as part of the NIMHD R01 grant funded AsthMaP2 project (pediatric asthma cohort study lead by Robert Freishtat M.D) from urban youth between ages six and 20 years of age with physician-diagnosed asthma for &gt;1 year. Cells were cultured for 90 minutes ex vivo with varying levels of Dexamethasone with or without 25(OH)D (6 conditions). mRNA was profiled using Illumina and validated using NanoString. Network and functional analyses were performed using Ingenuity Pathway Analysis. Confirmatory experiments were performed on human asthmatic and non-asthmatic bronchial epithelial cells exposed to 25(OH)D with or without Dex. Intracellular cAMP was measured with ELISA. Results: Of 214 AsthMaP2 participants, 53% were male and (97%) had persistent asthma. The mean (SE) age=10.9(0.4) years, BMI percentile for age=72.1(3)%, and serum 25(OH)D=19.5(0.9) ng/mL. Whole transcriptome analyses of nasal epithelial cells (n=7) showed 34 transcripts differentially expressed in all exposure conditions (p≤0.01). Pathways analysis identified cAMP signaling as a top activated pathway impacted by 25(OH)D. Intracellular cAMP levels were 10-fold higher in asthmatic (n=3) vs. non-asthmatic (n=3) tracheal bronchial epithelial cells at baseline (p=0.009). While this difference persisted through 15 minutes of exposure to 25(OH)D with or without DEX, there were no significant changes in intracellular cAMP from baseline in response to exposure conditions. Conclusions: The average level of 25(OH)D among both asthmatics and non-asthmatics were deficient. While data show that cAMP is constitutively expressed higher in asthmatics in comparison to non-asthmatics, manipulations of vitamin D level did not alter cAMP levels. Additional experiments using a larger sample size are required to further test the proposed effects of vitamin D, with special focus on cAMP as a transient mediator of inflammation regulation in asthmatic airways.

LDL cholesterol level in fifth-grade schoolchildren associates with stature

Short stature is associated with increased LDL-cholesterol levels and coronary artery disease in adults. We investigated the relationship of stature to LDL levels in children in the West Virginia Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project to determine whether the genetically determined inverse relationship observed in adults would be evident in fifth graders. A cross-sectional survey of schoolchildren was assessed for cardiovascular risk factors. Data collected at school screenings over 18 years in WV schools were analyzed for 63,152 fifth-graders to determine relationship of LDL to stature with consideration of age, gender, and BMI. The first (shortest) quartile showed an LDL level of 93.6 mg/dl compared with an LDL level of 89.7 mg/dl for the fourth (tallest) quartile. Each incremental increase of 1 SD of height lowered LDL by 0.049 mg/dl (P < 0.0001). Multivariate analysis showed LDL to vary inversely as a function of the first (lowest) quartile of height after controlling for gender, median age, BMI percentile for age and gender, and year of screening. The odds ratio for LDL ≥ 130 mg/dl for shortest versus tallest quartile is 1.266 (95% CL 1.162-1.380). The odds ratio for LDL ≥ 160 mg/dl is 1.456 (95% CL 1.163-1.822). The relationship between short stature and LDL, noted in adults, is confirmed in childhood.

Comparison of MRI and DXA for Measurement of Visceral Adipose Tissue in Adolescent Females

Increased adiposity is associated with metabolic complications, but it may be depot-specific fat that is more relevant than generalized obesity in the assessment of related metabolic disorders. For example, excess visceral adipose tissue (VAT) has been identified as a risk factor for type-2 diabetes and other health complications. Magnetic resonance imaging (MRI) and computed tomography are accurate methods for assessment of VAT, but the procedures are expensive, lengthy and not widely available. Measurement of VAT by dual energy X-ray absorptiometry (DXA) is a practical alternative because of the lower cost, short testing time and minimal radiation exposure for the participant, but limited data are available. The aim of this study was to determine if DXA-derived VAT measurements could serve as accurate surrogate measurements of VAT as compared to MRI in late-adolescent females. VAT was measured by 3T MRI (General Electric 16-channel fixed-site Signa HDx 3.0 Tesla magnet) and DXA (Discovery A; APEX software, version 3.3; Hologic Inc., Waltham, MA) in 24 females ages 18 to 19 years. Pearson correlations were conducted to examine the relationships between DXA-derived VAT and MRI-derived VAT. The Bland-Altman analysis was used to assess agreement between the two methods. The participants’ mean (± SD) BMI was 27.0 ± 5.6 kg/m2, BMI for age percentile, 72.8 ± 25.7% and waist circumference, 88.4 ± 14.5 cm. DXA derived VAT and MRI VAT were strongly correlated (r = 0.893, p <.001). Additionally, MRI and DXA derived VAT were highly correlated with waist circumference (r = 0.826, p <.001; r = 0.910, p<.001, respectively). The Bland-Altman analysis revealed the bias of the sample, +20.14 cm2 and the 95% limits of agreement, −21.66 to 61.94 cm2 (Figure 1). Our data show that DXA can be used in place of MRI to measure VAT in late adolescent females, however, as the average VAT increases, there is less agreement between the two methods. Support or Funding Information National Institute of Food and Agriculture, HATCH project GEO00647 Figure 1Open in figure viewerPowerPoint Bland-Altman plots and linear regression estimate, with 95% prediction bands, between VAT measured by MRI (MRI-VAT) and VAT measured by DXA (DXA-VAT). VAT, visceral adipose tissue; MRI, magnetic resonance imaging; DXA dual-energy X-ray absorptiometry.

The neuropsychological profile of adolescent males with anorexia nervosa – a case series

ABSTRACTThe identification of neurocognitive difficulties in females with anorexia nervosa (AN) has emphasised the importance of the potential neurodevelopmental factors of this illness, and the need for treatments which are tailored to ameliorate these challenges. However, these difficulties do not seem to be present in all cases, and it is unknown whether males with AN display a similar neuropsychological profile to that of females. The aim of the current case series was to explore the neuropsychological profile of adolescent males with a diagnosis of AN. The participants were selected from a database of patients with eating disorders – out of which ten were males with an AN diagnosis, mean age 15 years and 9 months. Mean BMI percentile for age was 4.5 (SD = 8.5). Participants were assessed using the neuropsychological test battery ‘the Ravello Profile’, and psychometric measures to assess eating disorder psychopathology, anxiety, obsessive–compulsive symptoms and depression. The patients displayed a br...

Correlates of food patterns in young Latino children at high risk of obesity.

The present paper examines the influence of age and gender on food patterns of Latino children. Data are from baseline of a 5-year, quasi-experimental obesity prevention study: Niños Sanos, Familia Sana (NSFS; Healthy Children, Healthy Families). In 2012, the researchers interviewed Latino parents, using a thirty-item questionnaire to ask about their children's food consumption and feeding practices. Statistical tests included t tests and ANCOVA. Rural communities in California's Central Valley, USA. Two hundred and seventeen parents (87-89% born in Mexico) and their children (aged 2-8 years). Fifty-one per cent of the children were overweight or obese (≥85th percentile of BMI for age and gender). Mean BMI Z-scores were not significantly different in boys (1·10 (SD 1·07)) and girls (0·92 (SD 1·04); P=0·12). In bivariate analysis, children aged 2-4 years consumed fast and convenience foods less often (P=0·04) and WIC (Supplemental Nutrition Program for Women, Infants, and Children)-allowable foods more often than children aged 5-8 years (P=0·01). In ANCOVA, neither age nor gender was significantly related to food patterns. Mother's acculturation level was positively related to children's consumption of fast and convenience foods (P=0·0002) and negatively related to consumption of WIC foods (P=0·01). Providing role modelling and structure in scheduling meals and snacks had a positive effect on the vegetable pattern (P=0·0007), whereas meal skipping was associated with more frequent fast and convenience food consumption (P=0·04). Acculturation and child feeding practices jointly influence food patterns in Latino immigrant children and indicate a need for interventions that maintain diet quality as children transition to school.

Lymphocele after pediatric kidney transplantation: incidence and risk factors.

Lymphocele is a well-known postoperative complication after kidney transplantation. The aim of this study was to analyze time trend incidence, risk factors, and outcome of post-transplant lymphocele in a large pediatric cohort. This is a retrospective single institution review of 241 pediatric kidney transplants performed from 2000 to 2013. Etiology of end-stage renal disease, recipient age and gender, transplant year, BMI percentile for age, type of dialysis, living/non-living related donor, acute rejection, and multiple transplantations were analyzed in association with lymphocele formation. Fourteen of 241 (5.81%) children developed a postoperative lymphocele. There has been a reduction in the incidence of lymphocele after 2006 (3.22% vs. 8.55%, p<0.05). Significant risk factors for lymphocele were older age (≥11yr), transplant before 2006, male gender, BMI percentile for age ≥95%, and multiple transplantations (p<0.05). The one-yr graft survival was significantly reduced in the group with lymphocele compared with control (81.2% vs. 92.51%, p<0.04). This is the first pediatric report showing the following risk factors associated with post-transplant lymphocele: age ≥11yr, male gender, BMI for age ≥95%, and multiple transplantations. A lymphocele can contribute to graft loss in the first-year post-transplant.

Stability of relative weight category and cardiometabolic risk factors among moderately and severely obese middle school youth

ObjectiveTo examine the stability of severe pediatric obesity relative to moderate obesity and associated changes in cardiometabolic risk from the beginning of 6th to the end of 8th grade.Design and MethodsParticipants in HEALTHY, a multi-site, cluster randomized school-based study designed to mitigate risk for type 2 diabetes, completed standardized assessments of height, weight, glucose, insulin, lipids and blood pressure at the beginning of 6th grade and the end of 8th grade. Youth were classified as moderately obese (100–119% of the 95th percentile of BMI for age and gender) or severely obese (≥120% of the 95th percentile of BMI for age and gender). Generalized linear mixed models (GLMM) that controlled for relevant covariables were used to examine the relation between baseline demographic and cardiometabolic risk factors and BMI status, as well as changes in relative weight category and risk factors during middle school.ResultsSevere obesity was more likely to endure over the course of middle school than was moderate obesity, and was associated with significantly higher levels of cardiometabolic risk.ConclusionsResearch with a specific focus on understanding, preventing, and treating severe obesity in children is warranted.

Long-Term Obesity Prevention and the Motivating Adolescents with Technology to CHOOSE Health™ Program

The Motivating Adolescents with Technology to CHOOSE Health™ (MATCH) intervention integrates lifestyle behavior change curriculum within academic subjects taught in seventh grade. This study assesses obesity prevention in participants into high school. The study compares four- to five-year longitudinal data from a single-site cohort (N=106, 54% retained from 195 participants at baseline; 82% of those still at the school) pre- and postintervention in a rural middle school with high obesity rates with data from the 2006 Child Survey and 2010 Child and Young Adult Surveys from the National Longitudinal Survey of Youth 1979 (N=600), which serves as a nationally representative comparison group. Outcome measures include pre- and postchanges in weight category, BMI, BMI z-score, BMI percentile for age and gender, and rates of change per month in BMI measures. At follow-up, change in percent overweight was significantly different between groups, with the MATCH group decreasing (20-12%) and the comparison group increasing (17-19%). Overall, the MATCH group had significantly higher decrease rates in BMI z-scores (p=0.002) and BMI percentile (p=0.01) than the comparison group. Of all adolescents at healthy weight at baseline, 2% from MATCH became overweight after five years, whereas 13% of the comparison group increased to overweight or obese (p=0.02) after four years. Despite a small sample size and a high-risk setting, at long-term follow-up, a greater proportion of MATCH participants than in the comparison group decreased from overweight to healthy weight or remained at healthy weight. The MATCH results suggest that some proportion of high-risk adolescents can have their growth trajectory follow a healthier path than expected.

Nutritional status of school children aged 8-12 years in deprived areas of Mauritius

This study investigated the nutritional status of school children in deprived areas of Mauritius and determined whether specific socio-economic factors were associated with poor nutritional status among children. A cross-sectional survey was conducted among 240 primary school children aged 8-12 years old. Out of 27 schools located in the deprived regions of Mauritius, eight of them were selected for the study. The data collection tools included a questionnaire, anthropometric measurements (weight and height) and a 24-hour dietary recall. A questionnaire was used to gather information on the socioeconomic profile of the children and their eating patterns. The Centre for Disease Control (CDC) BMI-for-age and stature-for-age percentiles were used to identify children who were stunted (&lt;5th percentile stature-for-age), underweight (&lt;5th BMI-for age percentile), overweight (85th to 95th percentile BMI-for age) or obese (≥95th percentile BMI-for-age). Findings revealed that the main meals taken by the children included breakfast, lunch and dinner. Ninety two percent of the children mentioned taking breakfast in the morning; the most commonly consumed food commodities being bread, margarine, cheese, jam and tea; milk, yoghurt, fruits or fruit juice were rarely consumed. Packed lunches consisted mainly of eggs and convenience foods such as sausages without any vegetables. Poor snacking habits, that is, high consumption of salty corn-based snacks, were identified among these children. Age of school children was significantly associated (p&lt;0.05) with the amount of money spent on snacks at school. Anthropometric measurements revealed the prevalence of both undernutrition and overnutrition among the children. Thirty seven per cent of the children were underweight, four per cent were overweight, three per cent were obese and there were no cases of stunting. The study findings indicate that the children are being fed the wrong kinds of foods or the wrong proportions. Thus, there is a need for local education and health authorities to develop nutrition education programmes that are contextually sensitive to specifically target school children and parents in deprived areas of Mauritius.

Evaluation of propofol anesthesia in morbidly obese children and adolescents.

BackgroundPoor characterization of propofol pharmacokinetics and pharmacodynamics in the morbidly obese (MO) pediatric population poses dosing challenges. This study was conducted to evaluate propofol total intravenous anesthesia (TIVA) in this population.MethodsAfter IRB approval, a prospective study was conducted in 20 MO children and adolescents undergoing laparoscopic surgery under clinically titrated propofol TIVA. Propofol doses/infusion rates, hemodynamic variables, times to induction and emergence, and postoperative occurrence of respiratory adverse events (RAE) were recorded, along with intraoperative blinded Bispectral Index/BIS and postoperative Ramsay sedation scores (RSS). Study subjects completed awareness questionnaires on postoperative days 1 and 3. Propofol concentrations were obtained at predetermined intra- and post-operative time points.ResultsStudy subjects ranged 9 – 18 years (age) and 97 - 99.9% (BMI for age percentiles). Average percentage variability of hemodynamic parameters from baseline was ≈ 20%. Patients had consistently below target BIS values (BIS < 40 for >90% of maintenance phase), delayed emergence (25.8 ± 22 minutes), increased somnolence (RSS ≥ 4) in the first 30 minutes of recovery from anesthesia and 30% incidence of postoperative RAE, the odds for which increased by 14% per unit increase in BMI (p ≤ 0.05). Mean propofol concentration was 6.2 mg/L during maintenance and 1.8 mg/L during emergence from anesthesia.ConclusionsOur findings indicate clinical overestimation of propofol requirements and highlight the challenges of clinically titrated propofol TIVA in MO adolescents. In this setting, it may be advantageous to titrate propofol to targeted BIS levels until more accurate weight-appropriate dosing regimens are developed, to minimize relative overdosing and its consequences.

Strength of association of dietary factors and physical activity with obesity and body fat in school children in Mexico City

IntroductionSeveral diet and physical activity (PA) factors have been associated with obesity, however, is not clear which factors impact the most among children.ObjectiveCompare the diet and PA between normal weight (NW) and obese (OB) children and determine the strength of association between dietary and PA and obesity/body composition in NW and OB 8 to 10 year old children in Mexico City.MethodsCross sectional study. PA and dietary intake were directly measured for 7 days and by two 24‐hour recalls respectively. Weight, height and body fat by bioimpedance analysis were obtained. Preliminary data from 40 OB and 40 NW children is presented.ResultsThe percentage of daily energy intake recommendation was higher in NW than in OB children (107% vs 90.2%). Dairy, fruit, vegetable and sugar‐sweetened beverages consumption was not different between groups neither was associated with obesity or body composition. Total PA was significantly higher in NW children (p&lt;0.05); performing ≥15 min of moderate to vigorous PA daily was associated with NW (OR=0.28). Mean daily sedentary time was associated with BMI percentile for age and body fat (r=0.136, p&lt;0.05); Carbohydrate intake ≥53.5% of the total energy intake was a protective factor (OR=0.42).ConclusionsIncreasing moderate to vigorous PA and reducing sedentariness are the factors that can lower the most the risk for obesity.

Identifying Red Flags

Childhood obesity is predictive of adulthood obesity, hypertension, and cardiovascular disease risk. The purpose of this study was to examine BMI for age as an independent risk factor for elevated blood pressure (EBP) and pre-EBP in children, controlling for sex, race/ethnicity, and age. The secondary objective was to identify associations among BMI, BP, race/ethnicity, and sex. EBP was defined as having a BP ≥95th percentile for age, gender, and height; measurements ≥90th percentile were considered indicative of pre-EBP. The study sample included 166 fifth-grade students from 5 low-income elementary schools in northern California. It was found that 32% of students were either overweight ( ≥85th percentile BMI for age) or obese ( ≥95th percentile BMI for age), with significantly higher rates (55%) among Hispanic children (P &lt; .01). Also, 22% of students presented with pre-EBP/EBP. Obese students were more likely than normal-weight students to present with a systolic pre-EBP reading (P &lt; .05). Overweight and obese students were more likely than normal-weight students to present with a diastolic pre-EBP reading (P &lt; .05). BMI is independently predictive of EBP. Fitness testing with anthropometric measurements should incorporate BP screenings for students with a BMI ≥85th percentile.