Change In Body Mass Index Percentile Research Articles

Trends in Body Mass Index Among Individuals With Neurodevelopmental Disorders

Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are increasingly common. Individuals with NDDs have heightened obesity risks, but long-term data on body mass index (BMI) trends over time in this population are lacking. To assess secular BMI changes from 2004 to 2020 among children with NDDs compared with those without NDDs. This repeated cross-sectional study used data from the Child and Adolescent Twin Study in Sweden. Children born between January 1, 1992, and December 31, 2010, were screened for neurodevelopmental symptoms using the Autism-Tics, ADHD, and Other Comorbidities inventory between July 2004 and April 2020 when they were 9 or 12 years of age. Data analysis was conducted between September 27, 2023, and January 30, 2024. BMI percentiles (15th, 50th, and 85th) were modeled using quantile regression and compared between youths with and without NDDs. Secular changes in BMI percentiles over time spanning 2004 to 2020 were evaluated and stratified by NDD subtype. The cohort included 24 969 Swedish twins (12 681 [51%] boys) born between 1992 and 2010, with mean (SD) age of 9 (0.6) years. Of these, 1103 (4%) screened positive for 1 or more NDDs, including ADHD, ASD, and/or learning disability. Results indicated that at the 85th BMI percentile, there was a greater increase in BMI from 2004 to 2020 among youths with NDDs compared with those without NDDs (β for interaction [βint] between NDD status and time, 1.67; 95% CI, 0.39-2.90). The greatest divergence was seen for ASD (βint, 2.12; 95% CI, 1.26-3.70) and learning disability (βint, 1.92; 95% CI, 0.65-3.82). Within the latest cohort (2016-2020), the 85th BMI percentile was 1.99 (95% CI, 1.08-2.89) points higher among children with NDDs compared with those without NDDs. In this repeated cross-sectional study, at the higher end of the BMI distribution, children with NDDs had significantly greater increases in BMI compared with peers without NDDs over a 16-year period, highlighting an increasing risk of overweight over time in youths with NDDs compared with those without NDDs. Targeted obesity prevention efforts for this high-risk population are needed.

The relationship between the intestinal microbiome and body mass index in children with cystic fibrosis

BackgroundThe nutritional status of children with cystic fibrosis (CF), as assessed by their body mass index percentile (BMIp), is a critical determinant of long-term health outcomes. While the intestinal microbiome plays an important role in nutrition, little is known regarding the relationship of the microbiome and BMIp in children with CF. MethodsPediatric patients (< 18 years old) with CF and healthy comparison patients (HCs) were enrolled in the study and stool samples obtained. BMIp was categorized as Green Zone (BMIp > 50th), Yellow Zone (BMIp 25th–49th) and Red Zone (BMIp < 25th). Intestinal microbiome assessment was performed via 16S rRNA gene sequencing; microbial richness, diversity, and differential species abundance were assessed. ResultsStool samples were collected from 107 children with CF and 50 age-matched HCs. Compared to HCs, children with CF were found to have lower bacterial richness, alpha-diversity, and a different microbial composition. When evaluating them by their BMIp color zone, richness and alpha-diversity were lowest in those in the Red Zone. In addition, an unclassified amplicon sequence variant (ASV) of Blautia, a known butyrate-producing anaerobe, was of lowest abundance in children in the Red Zone. ConclusionChildren with CF have a dysbiotic intestinal microbiome with specific changes that accompany changes in BMIp. Longitudinal assessments of the microbiome and its metabolic activities over time are needed to better understand how improvements in the microbiome may improve nutrition and enhance long-term survival in children with CF.

Parental determinants associated with early growth after the first year of life by race and ethnicity.

To investigate maternal and parental factors associated with changes in children's body mass index percentile (BMI-P) from 12 to 24 months. Data from a prospective cohort of racially and ethnically diverse mothers, fathers, and children (n = 245) were used. Changes in BMI-P from 12 to 24 months of age were examined using height and weight measurements collected at both times. Separate longitudinal mixed-effects models with maximum likelihood were introduced to examine the determinants introduced by mothers and determinants from both parents among all children, and by race and ethnicity. Models that examine maternal and parental factors showed that children's overall BMI-P decreased from 12 to 24 months [β = -4.85, 95% confidence interval (CI), -7.47 to -2.23]. Stratified tests showed that White children whose parents graduated high school or completed a 4-year college degree or higher had greater decreases in BMI-P than White children born to parents with less than high school education (β = -60.39, 95% CI, -115.05 to -5.72; β = -61.49, 95% CI, -122.44 to -0.53). Among Hispanic/Latinx children, mean BMI-P significantly decreased from 12 to 24 months (β = -7.12, 95% CI, -11.59 to -2.64). Mother's older age (β = 1.83, 95% CI, 0.29-3.36) and child female sex (β = 11.21, 95% CI, 1.61-20.82) were associated with gains in children's BMI-P, while father's older age was associated with decreases (β = -1.19, 95% CI, -2.30 to -0.08). Parental determinants associated with children's early growth varied by children's sex and racial and ethnic background. Results highlight the importance of understanding racial and ethnicity-specific obesity risks and including fathers in research.

Elective Sports Surgery Leads to Postoperative Weight Changes in Pediatric Patients

Background:Patients who undergo orthopaedic surgeries often have activity restrictions during postoperative recovery. It is unknown whether these extended periods of reduced activity lead to postoperative weight changes in pediatric patients.Purpose:The purpose of this study was to evaluate changes in body mass index (BMI) percentile in children and adolescents following primary sports surgeries.Methods:After institutional review board (IRB) approval was obtained, institutional records for utilized current procedural terminology (CPT) codes were used to identify patients who underwent elective sports surgery at a single pediatric orthopaedic institution between October 2016 and December 2018. Non-primary surgeries and patients without preoperative BMI measurements were excluded. Demographic characteristics, height, weight, and BMI at every follow-up visit within 30 months of surgery were collected. To account for expected growth with age, BMI percentiles were calculated. Statistical analysis of changes in BMI percentile at follow-up intervals of 3-7 months, 9-18 months, and 24-30 months after surgery was performed. Analyses were also performed based on preoperative BMI category (underweight, normal-weight, overweight, or obese, per Centers for Disease Control definitions) and upper- or lower-extremity surgery.Results:A total of 468 patients (50.4% female, average age 14.5 years) were available for study. Seven patients (1.5%) were underweight at the time of surgery, 262 normal-weight (56%), 87 overweight (18.6%), and 112 obese (23.9%). Sixty-nine surgeries were performed on the upper extremity, while 399 were on the lower extremity. While on average patients demonstrated a tendency to increase BMI percentile at each follow-up interval, these values did not reach significance. However, analysis by preoperative BMI category revealed that at 24-30 months after surgery, normal-weight patients had increased BMI percentile by 6.74 points (p = .041) compared to baseline, while overweight patients had decreased BMI percentile by 17.65 points (p = .020) (Table 1). By final follow-up, 32 of 262 initially normal-weight patients had increased their weight category to overweight or obese, while 40 patients who were initially overweight or obese had favorable decreases in weight category.Conclusion:Children and adolescents undergoing primary sports surgeries may experience postoperative changes in BMI percentile. Normal-weight patients tend to increase weight, while overweight patients may decrease weight over 2.5 years after surgery.Table 1.Change in BMI Percentile by Preoperative BMI Category

CYP2D6 Phenotype Influences Aripiprazole Tolerability in Pediatric Patients with Mood Disorders.

Objective: To determine the effect of CYP2D6 metabolizer status on aripiprazole tolerability in pediatric patients with mood disorders. Methods: We retrospectively reviewed electronic medical record data for 277 patients ≤18 years of age (at the time of CYP2D6 testing) with a mood disorder, receiving oral aripiprazole, and CYP2D6 genotyped as part of routine care. The maximum aripiprazole dose and concomitant medications were extracted from the medical record. The reason for aripiprazole discontinuation was determined to be from side effects (e.g., weight gain, akathisia, GI upset), nonresponse, or other reasons (e.g., financial). Associations with CYP2D6 were analyzed using multivariate linear regression models and chi-square tests. Results: Of the 277 patients (mean age: 14.3 ± 2.4), 57% were normal metabolizers (NMs), 37% were intermediate metabolizers (IMs), 5% were poor metabolizers (PMs), and 1.4% were ultrarapid metabolizers (UMs). A total of 72.2% of the cohort were concomitantly taking a CYP2D6 inhibitor, resulting in phenoconversion. Accounting for phenoconversion resulted in 27% phenoconverted NMs (pNMs), 24% phenoconverted IMs (pIMs), 48% phenoconverted PMs (pPMs), and <1% phenoconverted ultrarapid metabolizers. CYP2D6 pPMs discontinued treatment due to side effects more often than any other CYP2D6 group (67% for pPM, 51% pIM, 57% pNM, chi-square p = 0.024). Body mass index percentile change was associated with the CYP2D6 phenotype (p = 0.038), the time on aripiprazole (p = 0.001), and the number of concomitant CYP2D6 substrates (p = 0.044) in multivariable models. Conclusions: Phenoconverted CYP2D6 metabolizer status is associated with aripiprazole discontinuation. In addition, dose adjustments based on CYP2D6 metabolizer status and concomitant medications could improve aripiprazole treatment outcomes.

Dietary Magnesium Intake and Risk of Type 2 Diabetes Mellitus Using Data from the HEALTHY Study

Abstract Objectives Type 2 diabetes mellitus (T2DM) in children and adolescents has increased dramatically worldwide. Diet plays a key role in the development of T2DM, but little is known about the contribution of dietary magnesium intake in the risk of T2DM among children and adolescents. We conducted secondary analyses using the HEALTHY Study data. The HEALTHY Study was a multi-component, school-based intervention designed to reduce modifiable risk factors for T2DM in middle school students from 6th through 8th grades. The purpose of our study was to examine whether the difference in dietary magnesium intake, body mass index (BMI) percentile, and plasma glucose and insulin concentrations from 6th to 8th grade were related in the intervention schools and in the control schools that participated in the HEALTHY Study. Methods A total of 2181 students from intervention and control schools with completed dietary records, BMI percentile, plasma glucose and insulin concentrations, at 6th and 8th grades were included in these analyses. Dietary magnesium intake was self-reported using the Block Kids Food Frequency Questionnaire. A hierarchical multiple regression model was used to determine whether the difference in dietary magnesium intake, BMI percentile, and plasma glucose and plasma insulin concentrations from 6th to 8th grades were related, while adjusting for dietary calcium intake. Results The difference in dietary magnesium intake was a significant predictor for changes in BMI percentile in control schools from 6th to 8th grade (β = −0.07, 95% confidence interval [CI] = −0.03 to −0.01, P = 0.007; R2 [regression coefficient effect size] = 0.24, 95% CI for R2 = 0.19 to 0.28) indicating a small-to-medium effect size. Conclusions We concluded that changes in dietary magnesium intake from 6th to 8th grades were negatively related to changes in BMI percentile among middle school students. Funding Sources The original research related to this abstract was funded by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) of the National Institutes of Health (NIH), with additional support from the American Diabetes Association.

Orange Juice Consumption Is Not Associated with Excess Weight Gain in a Large Prospective Cohort of US Children and Adolescents

Abstract Objectives Given the conflicting evidence regarding fruit juice consumption and childhood obesity, we sought to evaluate associations between 100% orange juice (OJ) consumption and changes in anthropometric parameters in a large prospective cohort of US children and adolescents. Methods Participants from the Growing Up Today Study II (n = 7301) completed a baseline questionnaire in 2004 and follow-up questionnaires in 2006 and 2008. Data from these questionnaires were then used to assess mean 2-year changes in anthropometric characteristics in relation to OJ consumption. Changes in body mass index (BMI) percentile and height-for-age z-score (HAZ) were computed across OJ consumption categories using mixed linear regression modeling. Results Girls’ 2-year mean (SD) change in BMI percentile was not associated with OJ consumption after full adjustment: −0.44 (0.36) for OJ non-consumers, 0.20 (0.41) for 1–3 glasses/month, −0.04 (0.34) for 1–6 glasses/week, and −0.77 (0.62) for ≥1 glass/day (P-trend = 0.49). Meanwhile, girls’ 2-year mean (SD) change in HAZ was positively associated with OJ consumption: 0.03 (0.01) for non-consumers, 0.03 (0.02) for 1–3 glasses/month, 0.06 (0.01) for 1–6 glasses/week, and 0.09 (0.02) for ≥1 glass/day after full adjustment (P-trend = 0.02). There were no significant associations in boys. Conclusions These results indicate that OJ consumption was not associated with BMI percentile but was positively associated with HAZ change in girls, suggesting that OJ consumption is unlikely to contribute towards obesity. Funding Sources This study was supported by the Florida Department of Citrus, an executive agency of the state of Florida.

Lisdexamfetamine in Pediatric Binge Eating Disorder: A Retrospective Chart Review.

The purpose of this retrospective chart review was to evaluate lisdexamfetamine dimesylate (LDX) in the treatment of pediatric binge eating disorder (BED). We examined the clinical records of 25 patients, 12 to 19 years of age, who were prescribed LDX and had a diagnosis of BED between 2014 and 2017. Binge eating disorder in adolescents was highly comorbid with attention deficit hyperactivity disorder, mood and anxiety disorders, and severe obesity. Fifteen participants reported some level of improvement of their BED symptoms with LDX treatment. Posttreatment body mass index (BMI) percentile was not significantly reduced, and all but 2 participants remained in their same BMI classification. Lisdexamfetamine dimesylate treatment duration was not associated with change in BMI percentile, and the medication was well tolerated. Lisdexamfetamine dimesylate may have clinical utility for BED in adolescents, but randomized, placebo-controlled studies of its efficacy, tolerability, and safety in this population are needed.

Weight Gain After ACL Reconstruction in Pediatric and Adolescent Patients.

Adolescent athletes who sustain an anterior cruciate ligament (ACL) tear have significantly reduced activity levels during recovery. Activity level is linked to body mass index (BMI); however, it is unclear how recovery from an ACL reconstruction (ACLR) affects relative BMI and whether these changes persist after return to activity. Patients' BMI percentile will significantly increase after ACLR, but will trend toward baseline after return to activity. Cross-sectional study. Level 3. A retrospective review of 666 pediatric and adolescent patients who underwent ACLR was performed. Body mass was assessed by evaluating change in BMI percentile at 8 standard-of-care time windows relative to BMI percentile at time of surgery. Linear regression and bivariate and multivariate analyses were used to assess the effect of time window and other demographic factors on the change in BMI percentile. These analyses were rerun after dividing patients by clinical obesity categorization (underweight, normal, overweight, or obese) at time of surgery to assess the effect of preinjury body mass levels. BMI percentile of all BMI categories tended to increase postoperatively, peaking 6 to 9 months after surgery, with a median increase of 1.83 percentile points. After this peak, BMI approached baseline but remained elevated at 0.95 percentile points 2 years postoperatively. Beginning 3 months after surgery, the normal-weight group had significantly larger changes in BMI percentile at each time window, peaking at 4.15 points above baseline at 9 months. This BMI increase among normal-weight patients persisted in the second postoperative year, with a median percentile increase of 2.63 points. Pediatric and adolescent patients, especially those with a normal BMI, undergo significant changes to their BMI during recovery from ACLR. Patients' failure to return to their presurgical BMI percentile 2 years postoperatively suggests that ACLR may have long-reaching and often unappreciated effects on body mass.

Trends in Obesity and Overweight in Oregon Children With Down Syndrome.

Background. Although obesity is a commonly discussed issue in the medical management of children with Down syndrome, there have been no large studies published on its prevalence in the United States or associations with other common comorbidities in this population. Methods. Using a database of children from a single medical center Down syndrome specialty clinic and the standard Centers for Disease Control and Prevention definitions, we calculated rates of obesity and overweight by age group and examined possible associations with common comorbidities including cardiac disease, thyroid disease, sleep apnea, autism, and visual and hearing impairment. We also examined mean body mass index (BMI) percentile and change in BMI percentile by age. Results. Data were obtained from 823 visits from 412 unique patients ranging in age from 2 years to 23 years of age. A total of 1.2% were underweight, 55.2% were normal weight, 23% were overweight, and 20.6% were obese. BMI percentile increased with female gender, age, and height percentile for age. Sleep apnea was associated with higher BMI percentile, while autism was associated with lower BMI percentile. Conclusions. Children with Down syndrome have higher rates of obesity than the general population, with especially high risk for girls. Much of the increase in obesity occurs between ages 2 and 6 years. Further research needs to target interventions for prevention in this vulnerable population, particularly in young girls.

Sex-Specific Association between Childhood BMI Trajectories and Asthma Phenotypes.

Background Asthma and obesity are two common health problems in the pediatric population. Obesity is associated with several comorbidities which are of great consequence. Excess adipose tissue has been linked to asthma in a number of studies. However, little is known about childhood body mass index (BMI) trajectories and the development of asthma phenotypes. Objective The current study aims to investigate the significance of BMI trajectories over childhood and the risk of asthma phenotypes. Methods The current study is a prospective cohort of children aged 0-2 years who were followed every two years for eight years through cycles one to five in the National Longitudinal Survey of Children and Youths (NLSCY). Statistical analysis: a latent class growth modelling (LCGM) method was used to identify BMI trajectory patterns from cycles one to five. Multiple imputation (number of imputations=5) was carried out to impute children with missing values on height or weight information. Sampling weights and 1,000 bootstrap weights were used in SAS PROC SURVEYLOGISTIC to examine the association between BMI trajectory and asthma phenotypes (persistent or transient asthma) in a multivariate analysis. Results The study consisted of 571,790 males and 549,230 females. Among them, 46% of children showed an increasing trajectory in terms of change in BMI percentile during childhood, followed by the stable-trajectory group (41%) and decreasing-trajectory group (13%). After controlling for confounding factors, females in the increasing BMI trajectory group were four times more likely to be associated with persistent asthma (OR = 4.09; 95% CI:1.04-16.15; p = 0.0442) than females in the stable BMI trajectory group. No such relationship was found in males. The BMI trajectory was not significantly associated with risk of transient asthma for either sex. Conclusion We report a female-specific association between increasing adiposity, measured by BMI, and persistent asthma.

Racial Differences in Rates of Change of Childhood Body Mass Index and Blood Pressure Percentiles

To assess whether racial differences in rates of change in body mass index (BMI) and blood pressure (BP) percentiles emerge during distinct periods of childhood. In this retrospective cohort study, we included children aged 5-20 years who received regular outpatient care at a large academic medical center between January 1996 and April 2016. BMI was expressed as age- and sex-specific percentiles and BP as age-, sex-, and height-specific percentiles. Linear mixed models incorporating linear spline functions with 2 breakpoints at 9 and 12 years of age were used to estimate the changes in BMI and BP percentiles over time during age periods: <9, 9-<12, and >12 years of age. Among 5703 children (24.8% black, 10.1% Hispanic), Hispanic females had an increased rate of change in BMI percentile per year relative to white females during ages 5-9 years (+2.94%; 95% CI, 0.24-5.64; P = .033). Black and Hispanic males also had an increased rate of change in BMI percentile per year relative to white males that occurred from ages 5-9 (+2.35% [95% CI, 0.76-3.94; P = .004]; +2.63% [95% CI, 0.31-4.95; P = .026], respectively). There were no significant racial differences in the rate of change of BP percentiles, although black females had higher hypertension rates compared with white females (10.0% vs 5.7%; P < .001). Childhood patterns in BMI percentiles differ by race. Racial differences in rates of change in BMI percentile emerge early in childhood. Further study of early patterns could help to identify critical periods during childhood where disparities begin to emerge.

Healthy apple program to support child care centers to alter nutrition and physical activity practices and improve child weight: a cluster randomized trial

BackgroundNorth Carolina Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) resources improve child body mass index (BMI) when the resources are introduced by nurses to child care providers, and offered with workshops and incentives. In San Francisco, public health and child care agencies partnered to adapt NAP SACC resources into an annual “Healthy Apple” quality improvement program (HAP).MethodsThis cluster randomized controlled trial pilot-tested integration of the HAP with bi-annual public health screenings by nurses. All child care centers that participated in Child Care Health Program (CCHP) screenings in San Francisco in 2011–2012 were offered routine services plus HAP in 2012–2013 (CCHP + HAP, n = 19) or routine services with delayed HAP in 2014–2015 (CCHP + HAP Delayed, n = 24). Intention-to-treat analyses (robust SE or mixed models) used 4 years of screening data from 12 to 17 CCHP + HAP and 17 to 20 CCHP + HAP Delayed centers, regarding 791 to 945 children ages 2 to 5y, annually. Year-specific, child level models tested if children in CCHP + HAP centers had greater relative odds of exposure to 3 index best practices and smaller Autumn-to-Spring changes in BMI percentile and z-score than children in CCHP + HAP Delayed centers, controlling for age, sex, and Autumn status. Multi-year, child care center level models tested if HAP support modified year-to-year changes (2013–2014 and 2014–2015 vs 2011–2012) in child care center annual mean Autumn-to-Spring BMI changes.ResultsIn 2011–2012, the CCHP + HAP and CCHP + HAP Delayed centers had similar index practices (<15% of children were exposed to a physical activity curriculum, staff joining in active play, and drinking water pitchers) and annual BMI changes. In 2013–2014: 60% of children in CCHP + HAP centers were exposed to the 3 index practices vs 19% in CCHP + HAP Delayed centers; Mean (SE) child BMI percentile (−2.6 (0.9), p = 0.003) and z-score (−0.08 (0.03), p = 0.007) decreased more in CCHP + HAP vs CCHP + HAP Delayed centers. In 2014–2015, after all centers were offered HAP, the index practices and BMI changes were improved for all centers vs 2011–2012.ConclusionsIntegration of the HAP with existing public health nursing services was associated with significantly more children exposed to best practices and improvement in child BMI change. The results warrant continued integration of HAP into local public health infrastructure.Trial registrationISRCTN18857356 (24/04/2015) Retrospectively registered.

Primary Care Group Visits for Childhood Obesity: Clinical Program Evaluation.

We conducted 29 group visits targeting children with elevated body mass index (BMI) and their families. Visit activities focused on social support, mind-body techniques, exercise, and nutrition. Measures included attendance, family satisfaction scores, and per-patient change in BMI percentile. Ninety-six patients attended ≥1 group visit, mean 2.0 (SD ±1.8; range 1-14). Mean patient age was 9.6 years (SD ±2.4; range 4-15 years); 53.1% were female; 44.8% had a BMI 95th to 99th percentile for age/sex; 35.4% had a BMI >99th percentile. Mean attendance per group visit was 6.8 patients (SD ±3.8; range 1-16 patients). Mean family satisfaction scores were 9.8 (SD ±0.8) with 10/10 "would recommend to family or friends." Of 42 patients who attended ≥2 group visits, 5 (11.9%) experienced a ≥5 BMI percentile reduction between first and last visits; 3 (7.1%) maintained this reduction 2 years later. Group visits were associated with high family satisfaction scores, though few patients experienced a reduction in BMI percentile.

Effectiveness of Nutrition Intervention in a Selected Group of Overweight and Obese African-American Preschoolers.

High prevalence of childhood obesity persists as a public health concern in the USA. However, limited study has been conducted on the effectiveness of nutrition education focused on African-American (AA) preschoolers (PSLRs) in the preschool settings. The aim of this pilot study was to explore the effectiveness of nutrition education on AA PSLR's health. A convenience sample of 164 PSLRs (95% AA, 44% female) from six Head Start (HS) centers in a Midwestern metropolitan area was randomly assigned to 3 groups: intervention group A, standard curriculum plus nutrition education for PSLRs; intervention group B, standard curriculum plus nutrition education for PSLRs and their caregivers (CGs); and control group, standard curriculum. Baseline and post-intervention differences within each group and differences among the three groups in body mass index (BMI) percentiles, blood lipid profile, and food preference/knowledge were analyzed. No significant changes in BMI percentiles among the three groups were observed. When only overweight and obese PSLRs were considered, there was a significant reduction in BMI percentile in group B (PSLR + CG) and control group. More PSLRs in all three groups had blood lipid levels in the acceptable with few in the high-risk levels. There were no changes in nutrition knowledge and healthy eating behavior post-intervention. This pilot study supports including both PSLRs and CGs in future preschool-based interventions and the need for more intense intervention to optimize healthy outcomes, especially for those AA PSLRs who are overweight or obese.

The effect of body mass index at diagnosis on clinical outcome in children with newly diagnosed acute lymphoblastic leukemia

The impact of body mass index (BMI) at diagnosis on treatment outcome in children with acute lymphoblastic leukemia (ALL) is controversial. We studied 373 children with ALL enrolled on the Total XV study, which prospectively used minimal residual disease (MRD) for risk assignment. MRD on day 19 and at the end of remission induction (day 46), cumulative incidence of relapse/refractory disease (CIR), event-free survival (EFS) and overall survival (OS) were evaluated using sets of four, three and two subgroups based on BMI at diagnosis, along with BMI percentile change during remission induction. Higher BMI was associated with older age and higher treatment risk. There was no association between MRD on days 19 or 46 and BMI for four, three or two BMI subgroups (P>0.1 in all cases), nor was BMI associated with CIR or EFS. Obese patients had worse OS compared with non-obese (P=0.031) due to treatment-related mortality and less salvage after refractory disease or bone marrow relapse. No association between BMI change during remission induction and MRD, CIR, EFS or OS was seen. BMI at diagnosis does not predict poorer response or relapse in a contemporary MRD-directed ALL regimen. Improvements in supportive care and innovative, less-toxic frontline/salvage therapies are needed, especially for obese patients.

Stand-Biased Versus Seated Classrooms and Childhood Obesity: A Randomized Experiment in Texas.

To measure changes in body mass index (BMI) percentiles among third- and fourth-grade students in stand-biased classrooms and traditional seated classrooms in 3 Texas elementary schools. Research staff recorded the height and weight of 380 students in 24 classrooms across the 3 schools at the beginning (2011-2012) and end (2012-2013) of the 2-year study. After adjustment for grade, race/ethnicity, and gender, there was a statistically significant decrease in BMI percentile in the group that used stand-biased desks for 2 consecutive years relative to the group that used standard desks during both years. Mean BMI increased by 0.1 and 0.4 kilograms per meter squared in the treatment and control groups, respectively. The between-group difference in BMI percentile change was 5.24 (SE = 2.50; P = .037). No other covariates had a statistically significant impact on BMI percentile changes. Changing a classroom to a stand-biased environment had a significant effect on students' BMI percentile, indicating the need to redesign traditional classroom environments.

The Fit Family Challenge: A Primary Care Childhood Obesity Pilot Intervention.

Childhood obesity has increased dramatically over several decades, and the American Academy of Pediatrics has recommended primary care practices as ideal sites for the identification, education, and implementation of therapeutic interventions. The objective of this study was to describe the implementation and results for the Fit Family Challenge (FFC), a primary care-based childhood obesity intervention. A single-intervention pilot project that trains primary care practices on childhood obesity guidelines and implementation of a family-focused behavior modification curriculum. A total of 29 family medicine and pediatric community practices in Colorado participated. Participants included 290 patients, aged 6 to 12 years, with a body mass index (BMI) above the 85th percentile. The main outcome measure included the feasibility of implementation of a childhood obesity program in primary care; secondary outcomes were changes in BMI percentile, BMI z-scores, blood pressure, and changes in lifestyle factors related to childhood obesity. Implementation of FFC is feasible, statically significant changes were seen for decreases in BMI percentile and BMI z-scores for participants who completed 9 to 15 months of follow-up; lifestyle factors related to childhood obesity in proved Spanish-speaking families and food insecurity were associated with less follow-up time (P < .01). A primary care-based childhood obesity intervention may result in significant clinical and lifestyle changes.

Body Mass Index Is Not Associated with Early Treatment Response or Clinical Outcome in Children with Acute Lymphoblastic Leukemia

▪Background: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, with survival rates exceeding 90% in recent trials. Obesity is increasingly prevalent in the general population, and studies in children with ALL have correlated obesity with higher risk of persistent minimal residual disease (MRD) at the end of induction as well as worse outcome. We, therefore, determined whether obesity affected treatment response in children with ALL who were enrolled in a recent trial including MRD-guided therapy.Methods: Patients enrolled in the Total XV study at St. Jude Children's Research Hospital from 2000 to 2007 were included in the analysis. The protocol used MRD levels prospectively for risk assignment together with age, white blood cell counts, and cytogenetic profiles. Drug dosages were based on actual (rather than ideal) body surface area. Body mass index (BMI) was calculated by using height and weight for patients older than 2 years at diagnosis. Four BMI categories (underweight, normal, overweight, and obese) based on Center for Disease Control and Prevention guidelines were used. The association between BMI categories at diagnosis and MRD, cumulative incidences of refractory/relapsed disease (CIR), and event-free survival (EFS) were evaluated. The changes in BMI percentile from diagnosis to the end of induction were also calculated.Results: Among 409 patients enrolled, 26 who were younger than 2 years with no available BMI and 9 with Down syndrome were excluded. Of the 374 evaluable patients, 26 (7.0%) were underweight; 245 (65.5%) had normal BMI; 45 (12.0%) were overweight; and 58 (15.5%) were obese. Older age at diagnosis (P = 0.008) and being on the standard/high-risk treatment arm (P = 0.040) were associated with higher BMI categories.Among the 4 BMI categories, there was no significant difference in the proportion of patients with MRD ≥1% on day 19 of remission-induction therapy (P = 0.437) or MRD ≥0.01% at the end of induction (P = 0.182). There were also no differences in CIR (P = 0.259) or EFS (P = 0.158) among the 4 categories. EFS was significantly worse in male patients (P = 0.027) and in those with T-cell phenotype (P = 0.006), standard/high risk (P < 0.001), MRD ≥1% on day 19 (P < 0.001), or MRD ≥0.01% at the end of induction (P < 0.001).We reanalyzed the data by using 2 BMI categories (non-obese and obese). No significant differences were observed in the proportions of patients with MRD ≥1% on day 19 (P = 0.766) or MRD ≥0.01% at the end of induction (P = 0.177), and there was no difference in CIR between the 2 categories (P = 0.395). Although not statistically significant, EFS was marginally worse in obese patients (P=0.053).EFS among 4 or 2 BMI categories was evaluated by using a multiple Cox regression model including treatment arm, sex, race, and BMI categories as variables. No differences were observed for analysis by 4 (P = 0.368) or 2 (P = 0.151) BMI categories. In these analyses, only treatment arm (standard/high risk) remained a significant predictor (all P< 0.001).BMI percentile change from diagnosis to the end of induction also lacked significant association with MRD, CIR, and EFS.Conclusion: In contrast to published reports, body mass index had no effect on early treatment response as measured by MRD, incidence of relapse, or EFS in children with ALL enrolled in the Total XV study. These results indicate that obesity should not be considered an adverse prognostic factor in children with ALL in the context of contemporary treatment programs. [Display omitted] DisclosuresEvans:Prometheus Labs: Patents & Royalties: Royalties from licensing TPMT genotyping.

Effectiveness of a publicly funded clinical paediatric weight management program on obesity outcomes.

To determine the effectiveness of a publicly funded, paediatric weight management clinic in decreasing obesity. A retrospective chart review of patients four to 16 years of age, from 2006 to 2009, was performed at a medically supervised weight management clinic (n=121). Patients participated in monthly visits and were educated about the cognitive behavioural and nutritional aspects of weight management. The sample included 51 male and 70 female patients with a mean (± SD) initial age of 11.7±3.0 years. Patients participated in 6.4±6.5 visits (range one to 31 visits) over 13.7±15.5 months and 7.4% of patients discontinued treatment after their initial visit. Of the patients who attended the clinic >1 time, 66.1% attended for at least four months, 48.2% attended for >8 months and 33.0% attended for >1 year. Over the course of their treatment, patients experienced a weight gain of 3.8±9.5 kg, but a reduction in body mass index (BMI) percentile (-1.1±3.6%). Post-treatment, the prevalence of obesity decreased from 96.7% to 87.5%. Patients with longer treatment times (>12 months) attained significantly lower final BMI percentiles than patients with shorter treatment times; however, there was no difference in the rate of reduction. Initial treatment age, sex and medical conditions were not related to BMI percentile change. This paediatric weight management program effectively reduced the prevalence of obesity. Patients who had longer treatment times experienced greater reductions in obesity. Overall, the present study highlights that long-term patient attendance may be needed to better support paediatric weight management patients.