Body Mass Index Percentile Research Articles

Low prevalence of ideal levels in cardiovascular behavior metrics among Mexican adolescents

BackgroundLifestyle changes when transitioning from high-school to college expose students to unhealthy behaviors associated with high cardiovascular risk. The study aimed to assess the cardiovascular behavior metrics according to the AHA criteria, in freshman college adolescents from Northwest Mexico.MethodsThe study was cross-sectional. Demographics and health history were collected by questionnaires. Four behaviors were evaluated: diet quality using a duplicated FFQ, physical activity (PA) using the IPAQ, smoking, and body mass index (BMI) percentile; blood pressure was measured as a biological metric. Intakes were averaged and summed for each food group; sodium and saturated fat were calculated using the Mexican System of Food Equivalents or the USDA Database. Metrics were categorized into ideal, intermediate or poor level according to the AHA criteria. Diet outliers (± 3 SD) were trimmed and data was tested for normality. Mean±SD were calculated for continuous and percentages for categorical variables. Chi-square test compared the prevalence of demographic variables and levels of each cardiovascular metric by sex. Independent T-test evaluated differences in anthropometrics, dietary, and PA by sex, and the prevalence of ideal vs. non-ideal dietary intakes.ResultsParticipants were n = 228, 55.6% men, age = 18.5±0.4 y. A higher prevalence of men indicated working, playing sports, and family history hypertriglyceridemia (p < 0.05). Men showed higher weight, height, BMI, waist, blood pressure, and lower PA and body fat (p < 0.05). Concerning diet quality, significant differences by sex were observed in nuts and seeds (1.1±0.6 and 0.9±0.6 oz/week, p = 0.042) and processed meats (749.8±639 and 503.6±300.3 g/week, p = 0.002); only fish and shellfish group reached AHA recommendations (513.1 ± 450.7 vs. 501.7 ± 428 g/week, p = 0.671) for men and women, respectively. Ideal level was reached by 70.9% participants for BMI percentile, 87% for smoking, 67.2% for blood pressure, 25.9% for PA, and 12.2% for diet score. Regarding food groups and nutrients, the lower prevalence in the ideal level was for sugar-sweetened beverages (10%, p = 0.013) and processed meats (4.8%, p = 0.208), and the highest for fish and shellfish (87.8%, p = 0.281) .ConclusionsThe diet and PA patterns of Northwest Mexican freshman adolescents make them a high-risk group for developing long-term unhealthy habits and cardiovascular complications early in adulthood.

Macular Pigment Optical Density and Skin Carotenoids in a Childhood Sample

BackgroundCarotenoids are plant pigments with light filtering and antioxidant properties that deposit in human tissues, including retina and skin. Descriptive characteristics and covariates of carotenoid status in macula and skin have been examined in adults; however, similar studies in children are limited. Thus, this study aimed to delineate how factors of age, sex, race, weight status, and dietary carotenoid intake relate to macular and skin carotenoids in children. MethodsChildren (7–13 y, N = 375) completed heterochromatic flicker photometry to assess macular pigment optical density (MPOD). Participants underwent anthropometrics to measure weight status (BMI percentile [BMI%]), and parent/guardian provided demographic information. Subsample data were available for skin carotenoids (N = 181), assessed using reflection spectroscopy, and dietary carotenoids (N = 101) using the Block Food Frequency Questionnaire. Relationships between skin and macular carotenoids were assessed using partial Pearson’s correlations controlling for age, sex, race, and BMI%. Relationships between dietary carotenoids and macular and skin carotenoids were assessed using stepwise linear regression including age, sex, race, and BMI% in the model. ResultsMean MPOD was 0.56 ± 0.22 and skin carotenoid score was 282 ± 94.6. There was no significant correlation between MPOD and skin carotenoids (r = 0.02, P = 0.76). BMI% was negatively associated with skin (stdβ = −0.42, P < 0.001), but not macular carotenoids (stdβ = −0.04, P = 0.70). Neither MPOD nor skin carotenoids were associated with age, sex, or race (all P > 0.10). MPOD was positively associated with energy-adjusted reported lutein + zeaxanthin intake (stdβ = 0.27, P = 0.01). Skin carotenoids were positively associated with energy-adjusted reported carotenoid intake (stdβ = 0.26, P = 0.01). ConclusionsThe mean MPOD values in children were higher than what has been reported in adult populations. Previous studies in adult samples report an average MPOD of 0.21. Although macular and skin carotenoids were not related, they were associated with dietary carotenoids relevant to the respective tissues; however, skin carotenoids may be more susceptible negative influence from higher weight status.

Multifamily therapy for adolescent eating disorders: a study of the change in eating disorder symptoms from start of treatment to follow-up

BackgroundThis study aimed to evaluate multifamily therapy (MFT) for adolescents with eating disorders (EDs) in a clinical setting, by presenting the outcome of families participating in this treatment at a specialist ED service. MFT was an adjunct to treatment at local mental health services. In particular, the study aimed to present the change in eating disorder symptoms and psychological distress from before to after treatment and at a 6 months follow-up.MethodsParticipants were 207 adolescents receiving outpatient MFT (10 or 5 months) at Oslo University Hospital in Norway between 2009 and 2022. Adolescents had heterogeneous ED presentations, with a preponderance of anorexia nervosa (AN) and atypical AN. All participants completed pre- and post-treatment questionnaires [The eating disorder examination questionnaire (EDE-Q) and the strengths and difficulties questionnaire (SDQ)]. 142 adolescents additionally completed the same questionnaires at 6 months follow-up. Weight and height were measured at all time points.ResultsLinear mixed model analyses showed that from start of treatment to follow-up, there was a significant increase in BMI percentile (p < 0.001) and a significant decrease in EDE-Q global score (p < 0.001) and SDQ total score (p < 0.001).ConclusionsThe study shows that adolescents with an eating disorder who received adjunct outpatient MFT in a real world clinical setting, experienced reductions in ED symptoms comparable to that found in a randomized controlled trial.Trial registration: The data used in this study was collected as part of routine clinical procedures for quality assurance and trial registration is therefore not required.

Association of Place With Adolescent Obesity

Despite strong evidence linking place and obesity risk, the extent to which this link is causal or reflects sorting into places is unclear. To examine the association of place with adolescents' obesity and explore potential causal pathways, such as shared environments and social contagion. This natural experiment study used the periodic reassignment of US military servicemembers to installations as a source of exogenous variation in exposure to difference places to estimate the association between place and obesity risk. The study analyzed data from the Military Teenagers Environments, Exercise, and Nutrition Study, a cohort of adolescents in military families recruited from 2013 through 2014 from 12 large military installations in the US and followed up until 2018. Individual fixed-effects models were estimated that examined whether adolescents' exposure to increasingly obesogenic places over time was associated with increases in body mass index (BMI) and probability of overweight or obesity. These data were analyzed from October 15, 2021, through March 10, 2023. Adult obesity rate in military parent's assigned installation county was used as a summary measure of all place-specific obesogenic influences. Outcomes were BMI, overweight or obesity (BMI in the 85th percentile or higher), and obesity (BMI in the 95th percentile or higher). Time at installation residence and off installation residence were moderators capturing the degree of exposure to the county. County-level measures of food access, physical activity opportunities, and socioeconomic characteristics captured shared environments. A cohort of 970 adolescents had a baseline mean age of 13.7 years and 512 were male (52.8%). A 5 percentage point-increase over time in the county obesity rate was associated with a 0.19 increase in adolescents' BMI (95% CI, 0.02-0.37) and a 0.02-unit increase in their probability of obesity (95% CI, 0-0.04). Shared environments did not explain these associations. These associations were stronger for adolescents with time at installation of 2 years or longer vs less than 2 years for BMI (0.359 vs. 0.046; P value for difference in association = .02) and for probability of overweight or obesity (0.058 vs. 0.007; P value for difference association = .02), and for adolescents who lived off installation vs on installation for BMI (0.414 vs. -0.025; P value for association = .01) and for probability of obesity (0.033 vs. -0.007; P value for association = .02). In this study, the link between place and adolescents' obesity risk is not explained by selection or shared environments. The study findings suggest social contagion as a potential causal pathway.

Association of underweight and obesity with adverse postoperative renal outcomes in infants and young children undergoing congenital heart surgery.

Postoperative acute kidney injury (AKI) is a prevalent condition and associated with increased morbidity and mortality following cardiac surgery. This study aimed to investigate the association of underweight and obesity with adverse postoperative renal outcomes in infants and young children undergoing congenital heart surgery. This retrospective cohort study included patients aged from 1month to 5years who underwent congenital heart surgery with cardiopulmonary bypass at the Second Xiangya Hospital of Central South University from January 2016 to March 2022. On the basis of the percentile of body mass index (BMI) for age and sex, eligible participants were divided into three nutritional groups: normal bodyweight, underweight (BMI P5), and obesity (BMI P95). Primary outcomes included postoperative AKI and major adverse kidney events within 30days (MAKE30). Multivariable logistic regression was performed to determine the association of underweight and obesity with postoperative outcomes. The same analyses were reproduced for classifying patients using weight-for-height instead of BMI. A total of 2,079 eligible patients were included in the analysis, including 1,341 (65%) patients in the normal bodyweight group, 683 (33%) patients in the underweight group, and 55 (2.6%) patients in the obesity group. Postoperative AKI (16% vs. 26% vs. 38%; P < 0.001) and MAKE30 (2.5% vs. 6.4% vs. 9.1%; P < 0.001) were more likely to occur in the underweight and obesity groups. After adjusting for potential confounders, underweight (OR1.39; 95% CI 1.08-1.79; P = 0.008) and obesity (OR 3.85; 95% CI 1.97-7.50; P < 0.001) were found to be associated with an increased risk of postoperative AKI. In addition, both underweight (OR 1.89; 95% CI 1.14-3.14; P = 0.014) and obesity (OR 3.14; 95% CI 1.08-9.09; P = 0.035) were independently associated with MAKE30. Similar results were also found when weight-for-height was used instead of BMI. Conclusion: In infants and young children undergoing congenital heart surgery, underweight and obesity are independently associated with postoperative AKI and MAKE30. These results may help assess prognosis in underweight and obese patients, and will guide future quality improvement efforts. What is Known: • Postoperative acute kidney injury (AKI) is prevalent and associated with increased morbidity and mortality following pediatric cardiac surgery. • Major adverse kidney events within 30days (MAKE30) have been recommended as a patient-centered endpoint for evaluating AKI clinical trajectories. A growing concern arises for underweight and obesity in children with congenital heart disease. What is New: • Prevalence of underweight and obesity among infants and young children undergoing congenital heart surgery was 33% and 2.6%, respectively. • Both underweight and obesity were independently associated with postoperative AKI and MAKE30 following congenital heart surgery.

Measuring severe obesity in pediatrics using body mass index-derived metrics from the Centers for Disease Control and Prevention and World Health Organization: a secondary analysis of CANadian Pediatric Weight management Registry (CANPWR) data.

To examine the (i) relationships between various body mass index (BMI)-derived metrics for measuring severe obesity (SO) over time based the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) references and (ii) ability of these metrics to discriminate children and adolescents based on the presence of cardiometabolic risk factors. In this cohort study completed from 2013 to 2021, we examined data from 3- to 18-year-olds enrolled in the CANadian Pediatric Weight management Registry. Anthropometric data were used to create nine BMI-derived metrics based on the CDC and WHO references. Cardiometabolic risk factors were examined, including dysglycemia, dyslipidemia, and elevated blood pressure. Analyses included Pearson correlations, intraclass correlation coefficients (ICC), and receiver operator characteristic area-under-the-curve (ROC AUC). Our sample included 1,288 participants (n = 666 [52%] girls; n = 874 [68%] white). The prevalence of SO varied from 60-67%, depending on the definition. Most BMI-derived metrics were positively and significantly related to one another (r = 0.45-1.00); ICCs revealed high tracking (0.90-0.94). ROC AUC analyses showed CDC and WHO metrics had a modest ability to discriminate the presence of cardiometabolic risk factors, which improved slightly with increasing numbers of risk factors. Overall, most BMI-derived metrics rated poorly in identifying presence of cardiometabolic risk factors. Conclusion: CDC BMI percent of the 95th percentile and WHO BMIz performed similarly as measures of SO, although neither showed particularly impressive discrimination. They appear to be interchangeable in clinical care and research in pediatrics, but there is a need for a universal standard. WHO BMIz may be useful for clinicians and researchers from countries that recommend using the WHO growth reference. What is Known: • Severe obesity in pediatrics is a global health issue. • Few reports have evaluated body mass index (BMI)-derived metrics based on the World Health Organization growth reference. What is New: •Our analyses showed that the Centers for Disease Control and Prevention BMI percent of the 95th percentile and World Health Organization (WHO) BMI z-score (BMIz) performed similarly as measures of severe obesity in pediatrics. • WHO BMIz should be a useful metric to measure severe obesity for clinicians and researchers from countries that recommend using the WHO growth reference.

Defining longitudinal trajectory of body mass index percentile and predicting childhood obesity: methodologies and findings in the Boston Birth Cohort.

Overweight or obesity (OWO) in school-age childhood tends to persist into adulthood. This study aims to address a critical need for early identification of children at high risk of developing OWO by defining and analyzing longitudinal trajectories of body mass index percentile (BMIPCT) during early developmental windows. We included 3029 children from the Boston Birth Cohort (BBC) with repeated BMI measurements from birth to age 18 years. We applied locally weighted scatterplot smoothing with a time-limit scheme and predefined rules for imputation of missing data. We then used time-series K-means cluster analysis and latent class growth analysis to define longitudinal trajectories of BMIPCT from infancy up to age 18 years. Then, we investigated early life determinants of the BMI trajectories. Finally, we compared whether using early BMIPCT trajectories performs better than BMIPCT at a given age for predicting future risk of OWO. After imputation, the percentage of missing data ratio decreased from 36.0% to 10.1%. We identified four BMIPCT longitudinal trajectories: early onset OWO; late onset OWO; normal stable; and low stable. Maternal OWO, smoking, and preterm birth were identified as important determinants of the two OWO trajectories. Our predictive models showed that BMIPCT trajectories in early childhood (birth to age 1 or 2 years) were more predictive of childhood OWO (age 5-10 years) than a single BMIPCT at age 1 or 2 years. Using longitudinal BMIPCT data from birth to age 18 years, this study identified distinct BMIPCT trajectories, examined early life determinants of these trajectories, and demonstrated their advantages in predicting childhood risk of OWO over BMIPCT at a single time point.

P329 Audit of change in weight and BMI centile in children on elexacaftor/tezacaftor/ivacaftor in the Liverpool paediatric cystic fibrosis population

There is emerging evidence of increasing weight gain and BMI centiles in both the paediatric and adult CF population taking elexacaftor/tezacaftor/ivacaftor (ETI).

ACEs screening in adolescent primary care: Psychological flexibility as a moderator.

Screening for adverse childhood experiences (ACEs) is increasingly recommended in medical settings; however, there is more to learn about which patients experience negative outcomes following ACEs and how to intervene. This study sought to determine whether psychological flexibility moderated the relationship between ACEs and 2 important health outcomes: depression and elevated body mass index (BMI). Specifically, we hypothesized that as psychological flexibility increased, the relationship between ACEs and these mental and physical health outcomes would weaken. Exposure to ACEs, psychological flexibility (AFQ-Y8), depressive symptoms (PHQ9a), and BMI percentiles were assessed using validated, self-report rating scales during adolescent well-child checks in urban primary care practices. A total sample of 402 predominately Black (72.6%), publicly insured (81.8%), and female (63.4%) adolescents with complete data were included in analysis. Psychological flexibility moderated the relationship between self-reported ACEs and depressive symptoms. Patients with high psychological flexibility reported fewer depressive symptoms when they experienced more ACEs, those with average psychological flexibility demonstrated no relationship between ACEs and depressive symptoms, and those with low psychological flexibility reported more depressive symptoms when experiencing higher numbers of ACEs. ACEs were only related to BMIs greater than 99th percentile in this study and moderation was not supported. Psychological flexibility was helpful in differentiating those who experience increased depressive symptoms following ACE exposure in a primary care setting. Psychological flexibility is a modifiable process and may represent an important population health variable to develop prior to exposure or reduce negative outcomes following ACEs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Decline in the Age of Menarche in İstanbul Schoolgirls Over the Last 12 Years.

Menarche is the endpoint of a sequence of maturational events of female puberty. The timing of menarche is a strongly heritable trait. However, secular trends suggest that lifestyle and environmental factors are important. To assess the trend in age at menarche (AAM), and its associated factors in Istanbul over the last 12 years. A cross-sectional study was carried out between March and April 2022 on schoolgirls aged 9-18 years. A predesigned and self-administered questionnaire was filled out anonymously by the students. The data of AAM was included in the statistical analysis if the time of AAM is remembered for months and years. A probit model was used to calculate the median AAM. The findings were compared with those from the study performed 12 years ago in the same region of Istanbul. Among 9000 girls to whom the questionnaire was distributed, 1749 (19.5%) responded. The median AAM of 1374 girls whose AAM information was considered valid was 12.04 years (95% CI 12.01-12.13), 0.7 years lower than was reported 12 years ago (p<0.0001). AAM was correlated positively with maternal AAM, and negatively with body mass index (BMI) SDS and maternal educational status (p<0.0001, <0.0001, 0.002), respectively. There was no correlation between the AAM and birth weight. Girls with BMI percentile ≥85% (n=251) had earlier menarche than the ones with BMI percentile <85% (n=1072) (11.5 vs. 12.1 years, p<0.0001). Among the mother-daughter pairs (n=1162), AAM of girls was 0.91 years (median 0.94 years) earlier than their mothers. The present study demonstrates a significant downward trend in the menarcheal age in Istanbul over the last decade. Our findings support a strong contribution of genetic factors and BMI on AAM.

0755 The Relationships Between Sleep Duration, Sleep Efficiency, and Blood Pressure During Late Adolescence

Abstract Introduction Elevated blood pressure (BP) is an important modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in the world. Elevated BP in adolescence increases the risk for CVD in adulthood. Unfortunately, 1.3 million adolescents (ages 12 to 19) have extremely elevated blood pressure or hypertension (HTN). Evidence suggests that sleep duration is associated with HTN in adults, but less is known about these relationships during adolescence. Furthermore, there is limited research focused on specific developmental stages, particularly late adolescence, which is the last age group before adulthood. Also, there is a paucity of research on BP including other sleep variables like sleep efficiency. Therefore, the purpose of this secondary data analysis was to determine if sleep duration and sleep efficiency were associated with BP during late adolescence. Methods This secondary data analysis included older adolescents (16-18 years) who participated in the Cleveland Children’s Sleep and Health Study, a cohort study examining sleep disturbances and health outcomes. Height, weight, and BP (systolic (SBP) and diastolic (DBP)) were measured using standard clinical procedures. Objective sleep duration and sleep efficiency were measured by at least five days of actigraphy. Subjective sleep duration was averaged from daily self-report. The association was evaluated using Pearson correlations and multiple linear regressions. Results This sample included 259 adolescents (age 17.7±0.4, 63.3% White, 55.6% female). Pearson correlation analysis indicated a negative relationship between sleep efficiency and SBP (r = -0.210, p &amp;lt; 0.001) with a small-medium effect size (95% CI [-0.316, 0.098]). However, the negative correlation between sleep efficiency and SBP was no longer significant after controlling for assigned sex, race, and body mass index percentiles in a multiple linear regression model. Conclusion This secondary data analysis did not provide sufficient evidence on the associations between sleep duration and sleep efficiency with BP in older adolescents, possibly due to the homogenous sample with small variations in BP, sleep duration, and sleep efficiency. Therefore, there is a need for future studies including more heterogenous samples to evaluate the relationships between sleep and BP in this age group. Support (if any) 1st author - NHLBI T32HL105349 &amp; NICHD 5T32HD101397-03

0114 Interplay of School and Free Days on the Association of Circadian Misalignment with Heart Rate Variability in Adolescents

Abstract Introduction The circadian timing system, which governs the sleep-wake cycle, is involved in cardiometabolic and autonomic regulation. Heart rate variability (HRV), a marker of cardiac autonomic modulation (CAM), is known to predict cardiovascular morbidity. Therefore, circadian misalignment of the sleep-wake cycle, which is highly prevalent in adolescents and may express differently if youth are in school or free-days, is likely to impact CAM. We examined whether deviations in the circadian timing of sleep are associated with blunted HRV in adolescents as a function of being entrained to school or not. Methods We studied 337 population-based randomly-selected adolescents from the Penn State Child Cohort (median 16 years; 47% female; 21% racial/ethnic minority) who had at least 3-night at-home actigraphy (ACT), in-lab 9-h polysomnography (PSG) and 24-h Holter-monitoring heart rate variability (HRV) data. ACT-measured sleep midpoint (SM) was calculated as the midpoint of the sleep period for weekdays (5-nights) and weekends (2-nights), whereas ACT-measured sleep regularity (SR) was calculated as the intra-individual standard deviation of the SM across 5- and 7-nights. Frequency and time-domain HRV indices were primary outcomes. Linear regression models were stratified by “in school” and “on break” to test SM and SR as predictors of HRV indices while accounting for sex, race/ethnicity, age, BMI percentile, ACT-sleep duration, ACT-sleep variability, and PSG-apnea/hypopnea index. Results Lower SR on schooldays was associated with lower nighttime Log-HF, Log-LF and SDNN, yet higher HR (all p&amp;lt; 0.01); e.g., each standard deviation increase in SR on schooldays (i.e., 45m higher) was associated with -7.15ms (2.57) in nighttime SDNN (p=0.006). A later SM on free weekends was associated with lower nighttime Log-HF, Log-LF, SDNN and RMSSD, yet higher HR and LF-HF ratio (all p&amp;lt; 0.03); e.g., each standard deviation increase in SM on free weekends (i.e., 1.5h later) was associated with -7.33ms (2.85) in nighttime RMSSD (p=0.011). Conclusion A delayed and an irregular sleep midpoint during breaks and during schooldays, respectively, were associated with impaired CAM in adolescents. These data suggest that not only circadian misalignment contributes to adverse cardiovascular outcomes but its distinct metrics require measurement under different entrainment conditions in adolescents. Support (if any) NIH (R01HL136587,R01MH118308,UL1TR000127), American Heart Association (23PRE1011962).

0769 Multidimensional Sleep Health in Adolescents from the General Population: Definition, Thresholds and Construct Validity

Abstract Introduction The RU-SATED model – regularity, satisfaction, alertness, timing, efficiency, and duration – captures the 24-hour experience of sleep to asses multidimensional sleep health (MSH). However, most prior evidence comes from middle-aged adults. We provide updated MSH data in adolescents by leveraging objective and self-reported sleep measures. Methods We studied 377 adolescents (16.4±2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. Each MSH domain was categorized as “good” or “poor” using cut-offs informed by prior studies and expert consensus. Good cut-offs, assigned a score of 1, that were derived from actigraphy-measured data included: the standard deviation of sleep midpoint ≤1-h (RU), mean of sleep midpoint 2:00-4:00 (T), mean value of sleep efficiency ≥85% (E), and mean total sleep time ≥7.5-h (D). Good cut-offs derived from self-reported rating scales included the absence of insomnia symptoms (S) or excessive daytime sleepiness (A). Values considered poor based on these cut-offs were assigned a score of 0. Scores were summed across all domains to obtain a composite score ranging from 0 to 6, with higher scores indicating better MSH. Morningness and Tanner staging were self-reported, while Sleep and Arousal clusters scores on the Pediatric Behavior Scale were parent-reported. Results The mean composite score was 3.03 ± 1.30 and domains A and D were most commonly rated as poor (64.5% and 65.3%, respectively). Younger age (r=-0.13, p&amp;lt; 0.05) and identifying as non-Hispanic white (r=-0.14, p&amp;lt; 0.01) were significantly associated with higher MSH scores, while sex (r=-0.04, p=0.40), Tanner staging (r=-0.06, p=0.29) or BMI percentile (r=-0.07, p=0.15) were not. Greater morningness (r=-0.29, p&amp;lt; 0.01), less disturbed sleep (r=-0.28, p&amp;lt; 0.01) and higher arousal (r=-0.21, p&amp;lt; 0.01) scores were associated with higher MSH scores. Conclusion Our data-driven approach can be used to assess MSH in the adolescent population. Our definition captures previously identified health disparities in MSH in adults and shows optimal construct validity against self-reports of circadian preference and parent observations of adolescents’ degree of sleep disturbance and arousal. Improving sleep duration and daytime alertness appear to continue to be the most relevant domains impacting overall MSH in adolescents. Support (if any) NIH (R01HL136587,UL1TR000127)

0748 Using daily wearable cardio fitness and sleep data to predict obesity in early adolescence

Abstract Introduction Obesity, and its co-morbidities, is a serious health risk currently facing adolescents in the US, with increased risk for adult obesity and cardiovascular health problems. Sleep is crucial for energy restorative processes and insufficient sleep influences food intake and appetite regulation. Adolescents are at risk for poor/insufficient sleep, which could, therefore, contribute to obesity risk. Given multifactorial risk factors, there is a need to identify the most salient predictors of adolescent obesity. Predicting adolescent obesity using objective Fitbit data has not previously been investigated and is the aim of the current study. Methods We used data collected with the Fitbit Charge 2 device from 2491 participants (Year 2, Mean-age=11.95 years, SD=0.65, 49.5% female) in the Adolescent Brain Cognitive Development (ABCD) Study®. We trained machine learning models (Gradient Boosted Trees and Regularized Logistic Regression) to identify the most important measures that predict obesity (&amp;gt;95 BMI percentile). In addition to sleep (timing, efficiency, duration, and regularity across the week) and cardio fitness (step counts, resting heart rate) Fitbit measures, averaged across seven days, we included socio-demographic characteristics. We ran a grid search embedded in a 2x5 fold cross-validation and we evaluated the performance based on the area under the curve-AUC and accuracy-ACC metrics. Results 15% percent of the sample were classified as having obesity. Both classification models performed acceptably high, with the LogReg having better performance (AUC-LogReg=0.76, ACC=85%) than the GBT model (AUC-GBT=0.75, ACC=0.69). Shorter sleep duration, more day-to-day variability in sleep measures, low number of steps with low variability over the week, and higher resting heart rate, with high day-to-day variability, were important predictors. Sociodemographic factors (Hispanic/Latinx ethnicity, African American race, low access to food) were also important predictors. Conclusion Results show that there are socio-economic disparities in obesity risk and that shorter sleep duration and more variable sleep patterns, as detected with a wearable, are important predictors of obesity risk. Results highlight the clinical utility of wearable measures and the importance of continuous monitoring of sleep, physical activity, and cardio fitness in adolescents. Support (if any) NIH U01DA041022

Who Falls Through the Gap? Revisiting the Pulmonary Hypertension Nomenclature in Atrial Septal Defect Closure

Background: The incidence of atrial septal defect is 1.6 per 1,000 live births accounting for 8-10% of all congenital heart defects. For the majority of patients the clinical course is often benign. However, pulmonary arterial hypertension is known to complicate 9 to 35% of patients with a secundum type atrial septal defect. The purpose of the study is to apply the new definition of pulmonary hypertension to our cohort of atrial septal defect interventional closures. Objectives: We aim to see whether children with atrial septal defect who have a mean pulmonary artery pressure of <20 mmHg have differences in body habitus and outcomes compared with the children with mean pulmonary artery pressure of 21-25mmHg and children with mean pulmonary arterial pressure of >25 mmHg. Methods: The data collection took place from January to March 2022. A retrospective search was carried out at the archives of the hemodynamic laboratory of a large pediatric hospital in Athens, Greece, carrying out a large number of catheterizations for congenital heart disease. Results: In total, we retrieved 78 children, 30 boys and 48 girls with a diagnosis of atrial septal defect. In 17 cases the mean PAP was not documented so the remaining 61 children were stratified according to their mean PAP as mean PAP <20 mmHg, mean PAP >20mmHg but less than 25 mmHg and more than 25 mmHg. Conclusions: There was no difference in height, weight, BMI, BMI centile, sex age, hospital stay between the groups of no pulmonary hypertension, pulmonary hypertension and pulmonary pressures between 20-25 mmHg.

Overweight/obesity and socio-demographic disparities in children's motor and cognitive function.

Fundamental motor skills (FMS) and cognitive function are important indicators of development in early childhood. Using a cross-sectional design, the purpose of this study was to investigate obesity (healthy weight vs. overweight/obese) and socio-demographic (i.e., gender, SES) disparities in FMS (locomotor and ball skills) and cognitive function (reaction time [RT] and movement time [MT]), in preschoolers. There were 74 preschoolers (girl = 38; Mage = 4.02 ± 0.73) recruited from two childcare centers and were categorized into healthy weight (n = 58, BMI percentile < 85%) and overweight/obese (n = 16, BMI percentile ≥ 85%) categories. Children's FMS were assessed using the TGMD-3; cognitive function was assessed by the iPad-based CANTAB™ software using the Reaction Time Task (RTI), including reaction time (RT; Simple RT [SRT], choice RT [CRT]) and movement time (MT; simple MT [SMT], choice MT [CMT]). Children presented less FMS proficiency compared to recent data. Both weight groups performed comparably in FMS (ps > 0.05; ball skill Cohen's d = 0.40; locomotor Cohen's d = 0.02). Children in the overweight/obese group performed significantly worse on all cognitive tests compared to healthy weight peers (ps < 0.05; Cohen's d range from -0.93 to -1.43). No significant gender or SES disparities were observed. Maintaining healthy weight status is critical for cognitive development among preschoolers, which may influence their developmental trajectory and school readiness.

Changes in height, weight, and body mass index after posterior spinal fusion in juvenile and adolescent idiopathic scoliosis.

Posterior spinal fusion for idiopathic scoliosis is known to increase spinal height, but the impacts on weight and resulting body mass index are unknown. This study assesses body mass index, weight, and height percentile changes over time after posterior spinal fusion for idiopathic scoliosis. Body mass index, weight, and height age- and sex-adjusted percentiles for patients with idiopathic scoliosis undergoing posterior spinal fusion between January 2016 and August 2022 were calculated based on growth charts from the Centers for Disease Control for Disease Control and compared to preoperative values at 2 weeks, 3 months, 6 months, 1 year, and 2 years. The data were analyzed for normality with a Shapiro-Wilk test, and percentiles were compared with the Wilcoxon signed-rank tests. On average, 12.1 ± 2.3 levels were fused in 269 patients 14.4 ± 1.9 years, and percentiles for body mass index, weight, and height preoperatively were 55.5 ± 29.4%, 57.5 ± 28.9%, and 54.6 ± 30.4%, respectively. Body mass index and weight percentiles decreased at 2 weeks (-10.7%, p < 0.001; -4.6%, p < 0.001, respectively) and 3 months (-6.9%, p < 0.001; -3.2%, p < 0.001, respectively) postoperatively. Postoperative weight loss at 2 weeks averaged 2.25 ± 3.09% of body weight (0.98 ± 4.5 kg), normalizing by 3 months. Body mass index percentile normalized at 1 year, but height percentile was increased at 2 weeks (2.42 ± 1.72 cm, p < 0.001) and through 2 years. Despite initial height increase due to deformity correction, acute postoperative weight and body mass index percentile decreases postoperatively normalize by 1-year body mass index percentile. Physicians may benefit from utilizing this information when discussing the postoperative course of posterior spinal fusion with idiopathic scoliosis. 4, Retrospective Case Series.

Clinical and genetic features of cystic fibrosis in Japan.

Cystic fibrosis (CF) is an autosomal recessive disease caused by pathogenic variants in CF transmembrane conductance regulator (CFTR). While CF is the most common hereditary disease in Caucasians, it is rare in East Asia. In the present study, we have examined clinical features and the spectrum of CFTR variants of CF patients in Japan. Clinical data of 132 CF patients were obtained from the national epidemiological survey since 1994 and CF registry. From 2007 to 2022, 46 patients with definite CF were analyzed for CFTR variants. All exons, their boundaries, and part of promoter region of CFTR were sequenced and the presence of large deletion and duplications were examined by multiplex ligation-dependent probe amplification. CF patients in Japan were found to have chronic sinopulmonary disease (85.6%), exocrine pancreatic insufficiency (66.7%), meconium ileus (35.6%), electrolyte imbalance (21.2%), CF-associated liver disease (14.4%), and CF-related diabetes (6.1%). The median survival age was 25.0 years. The mean BMI percentile was 30.3%ile in definite CF patients aged < 18 years whose CFTR genotypes were known. In 70 CF alleles of East Asia/Japan origin, CFTR-dele16-17a-17b was detected in 24 alleles, the other variants were novel or very rare, and no pathogenic variants were detected in 8 alleles. In 22 CF alleles of Europe origin, F508del was detected in 11 alleles. In summary, clinical phenotype of Japanese CF patients is similar to European patients, but the prognosis is worse. The spectrum of CFTR variants in Japanese CF alleles is entirely different from that in European CF alleles.

Do Childcare Teachers Evaluate Children's Weight Status More Accurately Than Parents? A Brief Report.

Parents' underestimation of young children's weight can reduce their engagement and readiness to implement changes in children's diet and physical activity. Childcare teachers can support parents' identification of children at risk for being overweight only if they can accurately do this themselves. Quantitative, cross-sectional study. Fifteen kindergartens near Lisbon, Portugal. 319 parents, 32 teachers (47.5% and 100% response rate, respectively), and 319 children. Caregivers classified the children's weight, considering their height and age as underweight, healthy weight, or overweight; children's body mass index (BMI) status for age and sex was assessed. Differences in caregivers' accuracy of children's weight perception were assessed. Multilevel multivariate logistic regression models were used to analyze the predictors of the accuracy of teachers' and parents' weight perception as a binary outcome. The proportion of children with overweight correctly assessed differed significantly (P = 0.004) between teachers (31.1%) and parents (17.5%). The child's BMI percentile was the only significant positive predictor for both caregivers' weight perception accuracy (P < 0.001 and P = 0.004, for parents and teachers, respectively), holding the child's age and sex constant. Although childcare teachers were better raters than parents when evaluating children's weight status, the percentage of children with overweight that childcare teachers misclassified was still relatively high.

Severe combined immunodeficiency: improved survival leading to detection of underlying liver disease

BackgroundAdenosine deaminase deficiency (ADA) is an autosomal recessive disorder leading to severe combined immunodeficiency (SCID). It is characterized patho-physiologically by intracellular accumulation of toxic products affecting lymphocytes. Other organ systems are known to be affected causing non-immune abnormalities. We aimed to conduct a cross sectional study to describe liver disease in autosomal recessive ADA-SCID.MethodsSingle center retrospective analysis of genetically confirmed autosomal recessive ADA-SCID was performed. Liver disease was defined as ≥1.5x the gender specific upper limit of normal (ULN; 33 IU/L for males and 25 IU/L for females) alanine aminotransferase (ALT) or moderate and severe increase in liver echogenicity on ultrasound.ResultsThe cohort included 18 patients with 11 males. The median age was 11.5 (3.5–30.0 years) and median BMI percentile was 75.5 [36.75, 89.5]. All patients received enzyme replacement therapy at the time of evaluation. Seven (38%) and five (27%) patients had gene therapy (GT) and hematopoietic stem cell transplant (HSCT) in the past. Five patients had 1.5x ALT level more than 1.5x the U. Liver echogenicity was mild in 6 (33%), moderate in 2 (11%) and severe in 2 (11%) patients. All patients had normal Fibrosis-4 Index and Non-alcoholic fatty liver disease fibrosis biomarker scores indicating absence of advanced fibrosis in our cohort. Of 5 patients who had liver biopsies, steatohepatitis was noted in 3 patients (NAS score of 3,3,4).DiscussionNon-immunologic manifestations of ADA-SCID have become more apparent in recent years as survival improved. We concluded that steatosis is the most common finding noted in our ADA-SCID cohort.