Body Mass Index Percentile Research Articles

Prevalence of Being Obese, Overweight, and Underweight Among Jordanian Children and Adolescents Based on International Growth Standards

Objectives: The rise of obesity and other nutrition-related conditions among children and adolescents is a global challenge, particularly in the Middle East. This study aimed to determine the prevalence of being underweight, overweight, and obese among Jordanian children and adolescents using the body mass index (BMI) percentiles of the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) standards. Methods: This retrospective cross-sectional/longitudinal study analyzed 58,474 (42.6% males; 57.4% females) height, weight, and BMI-for-age records from 31508 healthy Jordanian children and adolescents aged 2–19 years. The data were retrieved from the Ministry of Health’s nationwide electronic database (2017–2023) and assessed using the CDC and WHO growth standards. Logistic regression was performed to assess the variables associated with overweight/obese status. Results: The prevalence of being underweight, overweight, and obese varied by the reference used, as more cases of being obese and underweight were reported when applying the CDC standards. The regression models showed the males had significantly lower odds of being overweight and obese than the females. Increased age was associated with higher odds of being overweight and obese, with annual increases observed across all age groups. Conclusions: Using the WHO and CDC standards, the prevalence of being underweight was higher in the males aged 6 years and older, while being overweight and obese was more prevalent in the females. The observed annual increase in the prevalence of being overweight and obese underscores the need for targeted strategies. Growth references tailored to regional profiles may improve national nutrition policies for Jordanian children and adolescents.

Back pain disability and PROMIS scores in children with hyperkyphosis are worse than children with idiopathic scoliosis.

To compare health-related quality-of-life (HRQOL) between children with hyperkyphosis and idiopathic scoliosis using 9-item Oswestry Disability Index (ODI-9) and Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference, Mobility, and Anxiety. Children with hyperkyphosis, idiopathic scoliosis, and controls with no structural diagnosis ages 10-18years who completed the PROMIS Pediatric Pain Interference, Mobility, and Anxiety domains were retrospectively evaluated from April 2021 to June 2023. Comparisons were made between hyperkyphosis, idiopathic scoliosis, and control groups. Within the hyperkyphosis group, comparisons were made between Scheuermann kyphosis and postural kyphosis subgroups. 304 children with hyperkyphosis, 1134 with idiopathic scoliosis, and 1493 controls were included. Children with hyperkyphosis had increased age, male sex, BMI percentile, Spanish than English speakers, and public insurance type. They also had worse ODI-9, PROMIS Pain Interference and Mobility scores which remained significant after multivariate regression analysis included age, sex, BMI percentile, language, insurance type, and race/ethnicity (p < 0.01). The Scheuermann kyphosis (n = 67) subgroup had increased age, male sex, area deprivation index (ADI), BMI percentile, concern by their appearance, and worse PROMIS Pain Interference and Mobility scores than the postural kyphosis (n = 237) subgroup. However, Scheuermann kyphosis subgroup score differences did not remain significant after considering age, sex, ADI, and BMI percentile. Children with hyperkyphosis (both Scheuermann and postural kyphosis subtypes) have worse HRQOL scores than their peers with idiopathic scoliosis. Worse ODI-9, PROMIS Pain Interference and Mobility scores remained significant only in the hyperkyphosis group as a whole after adjusting for confounding variables, but not between hyperkyphosis subgroups.

Relationships Between Gonadotropins, Sex Hormones, and Vascular Health in Adolescents with Normal Weight or Obesity.

Objective: Relationships between gonadotropins, sex hormones, and vascular structure and function in adolescents of varying weight statuses have not been fully investigated. In the present study, we examined associations among these in female and male adolescents with normal weight or obesity. Methods: We performed a cross-sectional analysis of adolescents (n = 58; 12-<18 years) grouped according to BMI percentile (BMI%) into normal weight (5th-<85th BMI%; n = 25) and obesity (≥95th BMI%; n = 33) categories. Fasting blood samples were collected to measure follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estradiol. Vascular function was measured via ultrasonography for measures of carotid artery diameter compliance (cDC), incremental elastic modulus (cIEM), and brachial artery flow mediated dilation (FMD). Results: Females with obesity had a significantly (p = 0.009) greater mean FMD compared with those with normal weight. FSH, LH, testosterone, and estradiol did not differ between normal weight and obesity groups in either sex. After adjusting for age and multiple comparisons, higher testosterone was associated with decreased cDC (R2 = 0.189; p = 0.018) and increased cIEM (R2 = 0.346; p = 0.002) across all females. In all males, higher estradiol was associated with decreased cDC (R2 = 0.404; p = 0.006) and increased cIEM (R2 = 0.411; p = 0.003). Conclusion: We found that testosterone and estradiol were associated with vascular measures in female and male adolescents, respectively. Future studies are needed to confirm these relationships in larger cohorts and among those with BMIs in the overweight (85th-<95th BMI%) and severe obesity (BMI ≥120% of the 95th percentile and/or ≥35 kg/m2) categories.

Impact of COVID-19 Diagnosis on Weight Trajectories of Children in the US National COVID Cohort Collaborative.

The COVID-19 pandemic has exacerbated the obesity epidemic, with both adults and children demonstrating rapid weight gain during the pandemic. However, the impact of having a COVID-19 diagnosis on this trend is not known. Using longitudinal data from January 2019 to June 2023 collected by the US National Institute for Health's National COVID Cohort Collaborative (N3C), children (age 2-18 years) with positive COVID-19 test results (n=11,474, 53% male, mean [SD] age 5.57 [±3.29] years, 54% white, mean [SD] 5.2 [±2.9] BMI observations per participants) were matched with COVID-19 negative children with identical demographic characteristics and similar observation window. We compared BMI percentile trajectories between the COVID-19 positive and COVID-19 negative cohorts, with further evaluation performed on COVID-19 positive patients stratified by hospitalization status. COVID-19 positive patients had a greater increase in %BMI p95 than COVID-19 negative patients (average increase of 2.34 (±7.73) compared to 1.46 (±6.09), p<0.0005). COVID-19 positive patients gained more weight after their diagnosis of COVID-19 than before. Non-hospitalized children gained more weight than hospitalized children (average increase in %BMI p95 of 2.38 (±7.65)) compared to 1.87 (±8.54)). Mixed effect regression analyses demonstrated that these associations remained even after adjusting for time, demographics, and baseline %BMI p95 . Having a COVID-19 diagnosis was associated with more rapid weight gain, especially after diagnosis and early in the pandemic. Future research should explore the reasons for this association and the implications for future health emergencies. M.M.M. drafted the initial manuscript and assisted with the data curation, formal analysis, methodology, and visualization. T.T.P. assisted with the study design, interpretation of results, funding acquisition, and manuscript drafting and editing. C.T.B. and C.G.C assisted with formal analysis and interpretation of results. L.A.P. assisted with the interpretation of results and manuscript editing. R.B. supervised the study with study design, resources, funding acquisition, and manuscript editing. All authors assisted in the conceptualization of the study and approved it for publication. The authors declare no conflicts of interest. This study investigating the weight trajectories of children during the COVID-19 pandemic shows that the pandemic has led to a significant increase in weight gain among US children aged 6-11, with boys gaining more weight than girls. Non-hospitalized COVID-19-positive children were found to be at greater risk of gaining weight. The analyses described in this publication were conducted with data or tools accessed through the NCATS N3C Data Enclave https://covid.cd2h.org and N3C Attribution & Publication Policy v 1.2-2020-08-25b supported by NCATS U24 TR002306, Axle Informatics Subcontract: NCATS-P00438-B, [DUR RP-0BDD0E] and was supported by NIH awards, P20GM103446 and U54-GM104941. This research was possible because of the patients whose information is included within the data and the organizations ( https://ncats.nih.gov/n3c/resources/data-contribution/data-transfer-agreement-signatories ) and scientists who have contributed to the ongoing development of this community resource [ https://doi.org/10.1093/jamia/ocaa196 ].

Chrononutrition patterns and their association with body weight: Differences across multiple chronotypes.

In recent years, the focus of research on obesity and its management has expanded beyond traditional dietary factors to include the timing of food intake - in relation to the body's circadian rhythms - known as chrononutrition. However, chrononutrition patterns remain largely unexplored in low-medium income countries. Our study aimed to investigate the association between chrononutrition patterns and BMI. Utilizing data from the virtual Survey SONAR-Brazil (n=2137,18-65 y), we defined the following chrononutrition patterns: 1. The clock time of the first, mid, and last eating events; 2. Morning and evening latencies (from wake-up time until the first eating event, and from the last eating event until bedtime); and 3. Eating window. Linear regression analyses assessed associations between chrononutrition variables and BMI. Quantile regression and restricted cubic splines were used to explore distributional correlations and association shapes. Among all participants, BMI increased with each additional hour of the first eating event (β=0.17; 95% CI, 0.05,0.29; P=0.005), morning latency (β=0.27; 95% CI, 0.12,0.42; P<0.001), and eating midpoint (β=0.21; 95% CI, 0.05,0.38; P=0.01) and the effect was even stronger with higher BMI percentiles. There was no effect of eating times among intermediate and late chronotypes. However, among early types, positive associations were seen between the BMI and the timing of the first eating event, morning latency, and eating midpoint, as well as a negative association with evening eating. Our findings suggest that delaying the first eating event, the eating midpoint, and extending morning latency are associated with higher BMI, particularly in early chronotypes. These results highlight the importance of aligning eating patterns with chronotypes and support personalized dietary recommendations.

Longitudinal analysis of anthropometric measures over 5 years in patients with Friedreich ataxia in the EFACTS natural history study.

Friedreich ataxia is a rare neurodegenerative disorder caused by frataxin deficiency. Both underweight and overweight occur in mitochondrial disorders, each with adverse health outcomes. We investigated the longitudinal evolution of anthropometric abnormalities in Friedreich ataxia and the hypothesis that both weight loss and weight gain are associated with faster disease progression. Participants were drawn from the European Friedreich's Ataxia Consortium for Translational Studies (EFACTS). Age- and sex-specific BMI and height scores were calculated using the KIGGS-BMI percentiles for children. Height correction was applied for scoliosis. Longitudinal data were analysed using linear mixed effects models and incremental standard deviation scores and growth mixture models identified subclasses with varying BMI trajectories. Five hundred and forty-three adults and fifty-nine children were assessed for up to 5 years. In children, severe underweight (26%), underweight (7%), severe short stature (16%) and short stature (23%) were common. The corrected BMI percentile was stable in children, although 48% had negative incremental BMI scores over 1 year and 63% over 3 years versus 10%/year in a normal reference cohort. Overweight was common in adults (19%), with a slight increase in BMI over time. Longer GAA repeat size was linked to lower BMI in adults. Weight trajectory was not associated with ataxia progression in adults. Significant anthropometric abnormalities were identified, with underweight and short stature prevalent in children and overweight in adults. These findings highlight the need for regular nutritional monitoring and interventions to manage underweight in children and promote healthy weight in adults.

Impact of COVID-19 Diagnosis on Weight Trajectories of Children in the US National COVID Cohort Collaborative.

Background: The COVID-19 pandemic has exacerbated the obesity epidemic, with both adults and children demonstrating rapid weight gain during the pandemic. However, the impact of having a COVID-19 diagnosis on this trend is not known. Methods: Using longitudinal data from January 2019 to June 2023 collected by the US National Institute for Health's National COVID Cohort Collaborative (N3C), children (age 2-18 years) with positive COVID-19 test results {n = 11,474, 53% male, mean [standard deviation (SD)] age 5.57 [±3.29] years, 54% White, mean [SD] 5.2 [±2.9] BMI observations per participant} were matched with COVID-19-negative children with identical demographic characteristics and similar observation window. We compared BMI percentile trajectories between the COVID-19-positive and COVID-19-negative cohorts, with further evaluation performed on COVID-19-positive patients stratified by hospitalization status. Results: COVID-19-positive patients had a greater increase in than COVID-19-negative patients (average increase of 2.34 (±7.73) compared to 1.46 (±6.09), p < 0.0005). COVID-19-positive patients gained more weight after their diagnosis of COVID-19 than before. Nonhospitalized children gained more weight than hospitalized children [average increase in of 2.38 (±7.65) compared to 1.87 (±8.54)]. Mixed-effect regression analyses demonstrated that these associations remained even after adjusting for time, demographics, and baseline . Conclusions: Having a COVID-19 diagnosis was associated with more rapid weight gain, especially after diagnosis and early in the pandemic. Future research should explore the reasons for this association and the implications for future health emergencies.

Symptoms, Quality of Life, and Executive Function in Children Who Snore

Mild sleep-disordered breathing (mSDB) in children is associated with both neurobehavioral morbidity and reduced quality of life (QOL). However, the association between symptom burden and QOL with executive function is not well understood, and it is not known whether QOL and symptom burden may help identify children with neurocognitive dysfunction. To assess associations among executive function, QOL, and symptom burden in children with mSDB. This cross-sectional study was a secondary analysis of the multicenter Pediatric Adenotonsillectomy Trial for Snoring, which included children aged 3 to 12 years randomized to watchful waiting or adenotonsillectomy for mSDB (snoring and an obstructive apnea-hypopnea index <3) between June 29, 2016, and February 1, 2021. The data for this report were analyzed between December 22, 2020, and October 3, 2024. Pediatric mSDB. Quality of life was assessed using the Obstructive Sleep Apnea-18 (OSA-18), and symptom burden was assessed using the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder Scale (PSQ-SRBD). Executive function, including self-control and working memory, was measured using the Behavior Rating Inventory of Executive Function Global Executive Composite (BRIEF GEC), and inhibitory control and sustained attention were measured by the GoNoGo vigilance test. Partial Pearson correlations and multiple linear regression models were used to assess the associations among QOL, symptoms, and executive function. The sample included 459 children (mean [SD] age, 6.1 [2.3] years; 230 female [50.1%]). Moderate correlations were found between the BRIEF GEC and the PSQ-SRBD and OSA-18 (r = 0.58 [95% CI, 0.51-0.64] and 0.59 [95% CI, 0.52-0.64], respectively). After adjusting for age, sex, race and ethnicity, body mass index percentile, household income, maternal education, attention-deficit/hyperactivity disorder, test characteristics, and disease severity, both OSA-18 and PSQ-SRBD scores were associated with the BRIEF GEC (β = 0.41 [95% CI, 0.36-0.47] and 3.66 [95% CI, 3.17-4.15], respectively). In the fully adjusted model, PSQ-SRBD was also associated with GoNoGo inhibitory control (β = -0.04 [95% CI, -0.08 to -0.01]) and sustained attention (β = -0.05 [95% CI, -0.10 to -0.01]). In this study, disease-specific QOL and symptom burden were associated with executive function in children with mSDB. These findings may be useful in identifying those children who are at risk for neurocognitive dysfunction.

Classification of childhood obesity using longitudinal clinical body mass index and its validation.

Persistence of childhood adiposity is known to be associated with long-term adverse cardiometabolic risks. Yet, cross-sectional body mass index (BMI) is often used to classify obesity in clinical care and research. This study aimed to develop and validate a childhood obesity classification system using longitudinal clinical data. This observational study used electronic health record data from a tertiary care hospital, with replication in an independent cohort. For individuals with ≥ 3 BMI measurements, the median BMI percentile and persistence in the obesity class were used for longitudinal classification. The association between longitudinal BMI class and early onset obesity, socioeconomic status (SES), and adverse cardiometabolic risk was analyzed. Height, weight, and cardiometabolic risk measures were obtained for 22 352 children from 2014-18 in the primary cohort and 24 444 children in the replication cohort. Obesity (BMI ≥ 95th percentile [BMIpct95]) was observed in 24.1% and severe obesity (BMI ≥ 120% of BMIpct95) in 10.6%. Individuals with early onset obesity (age ≤ 6 years) remained in the same or higher obesity class; those in the high-SES group had lower odds of obesity. The proportion of individuals with cardiometabolic risk increased with increasing obesity severity (p-value 0.01 - < 0.001). The AUC for cardiometabolic risk by longitudinal BMI class was higher compared to that for cross-sectional BMI (80.0% vs. 75.8%, p < 0.001). The Longitudinal BMI classification may better reflect long-term cardiometabolic risk in children. This classification can be useful for focused intervention strategies and for profiling of individuals for genetic testing.

The Association Between Obesity and the Unified Airway in Children.

Introduction: Chronic rhinosinusitis (CRS) and asthma frequently coexhist in children leading to the unified airway theory. Although obesity has been associated with CRS and asthma in adults, studies exploring that association in children are limited. The goal of this study was to evaluate the association between obesity and the unified airway in children. Methods: A retrospective case-control study was performed in children aged 2 to 18 years presenting to our clinic between July 2020 and February 2024. Patient's demographics and comorbidities were reviewed. Children's obesity was classified based on their percentile body mass index of 95% and more. Asthma and CRS diagnoses were determined based on published guidelines. Results: A total of 406 pediatric patients met criteria, with 130 children (32%) with obesity. Children with CRS had a mean computed tomography (CT) Lund-Mackay score of 7.2 (SD of 6.3) and a mean endoscopy modified Lund-Kennedy score of 2.7 (SD of 2.9). Children with obesity were older (11.3 years vs 10.2 years, P = .039) and more likely to have asthma (28.5% vs 15.2%, P = .002) and obstructive sleep apnea (26.2% vs 13%, P = .001). Multivariate logistic regression showed an association between obesity and asthma (OR = 1.84, P = .029), but not with CRS (OR = 1.08, P = .856) or allergic rhinitis (OR = 1.05, P = .856). Conclusion: This study suggests an association between obesity and asthma but not with CRS in children. Further studies should explore whether there is any role for obesity in the treatment of CRS.

Daily glucose variability is associated with intrahepatic fat content, β cell sensitivity, and biomarkers of glycolysis in youth with obesity.

Pediatric obesity is associated with insulin resistance, which, in turn, impacts glucose and lipid metabolism. This study sought to assess how glucose variability relates to intrahepatic fat content, β cell insulin sensitivity, and glycolysis in youth with obesity. A total of 27 youth with obesity (11 girls, BMI percentile, median [25th-75th percentiles]: 99.0 [97.9-99.0]) wore a continuous glucose monitoring device for 10 days and underwent a 3-h oral glucose tolerance test. β cell function was assessed using the oral minimal model, and liver proton density fat fraction was measured by magnetic resonance imaging. Average sensor-derived glucose and glucose standard deviation (STDEV) and coefficient of variation (CV) were associated with liver proton density fat fraction(p = 0.0130, p = 0.0005, and p = 0.0028, respectively). First-phase insulin secretion, basal insulin secretion, and insulin sensitivity were associated with STDEV (p = 0.0344, p = 0.0091, and p = 0.0031, respectively) and CV (p = 0.0128, p = 0.0012, and p = 0.0022, respectively). STDEV and CV were also associated with 2-h glucose (p = 0.0067 and p = 0.0324, respectively) and plasma lactate (p = 0.0030 and p = 0.0123, respectively). Daily glucose variability is associated with the degree of intrahepatic fat content, postprandial glucose, and plasma lactate concentrations.

Does the intervention of the school-based health promotion programme “Join the Healthy Boat” have equal or differential effects on weight status and health-related behaviours in children from a high or low socio-economic background? – A randomised controlled trial

BackgroundWorldwide, the prevalence of childhood overweight and obesity increases. Children with low socioeconomic status (SES) are more often affected by overweight and obesity. SES is also associated with health behaviours. In order to avoid health disparities, school-based health promotion programmes such as “Join the Healthy Boat” can help. Intervention outcomes can differ by SES; therefore, the purpose of this study was to investigate whether the intervention had equal or differential effects both on weight status and health-related behaviours in children from high and low SES.MethodsOne thousand six hundred twenty children’s data (7.1 ± 0.6 years; 50.6% male) was analysed; anthropometric data was taken on-site, other health-related parameters, such as physical activity, nutrition, and screen media use, as well as SES were assessed subjectively. Logistic regression models and GEEs were calculated.ResultsComparisons by SES show that there were significant differences in children’s characteristics and health behaviours such as migration background, height, weight, BMI percentiles, weight status, family education level, household income, physical activity behaviour, screen media use, soft drink intake and breakfast skipping. After one year, there were no intervention effects for overweight status, physical activity, or screen media use, but children with high SES in the intervention group skipped breakfast significantly less often than in the control group (5.34 [1.44;19.85], p = 0.01). Parental education level and household income were also assessed separately, with similar results. Interaction analysis revealed no significant effects apart from an interaction effect for breakfast behaviour (p = 0.02).ConclusionsThe health-promotion programme “Join the Healthy Boat” has the potential to promote children’s health via a school-based intervention and therefore, reach all children independent from their background. This study shows vast gaps between several health behaviours of primary school children depending on their SES, favouring those children coming from more privileged families. A longer implementation may possibly show more effects.Trial registrationDRKS00000949.

Lifestyle Factors Associated With Childhood Obesity in South Asian Expatriates of Dubai: A Cross-Sectional Study.

Background Obesity, a chronic disease caused by excessive fat deposits, increases the risk of various health conditions. Childhood obesity is a growing global concern, affecting millions of children. There is a paucity of research on the determinants of childhood obesity in the expatriate population of Dubai. This study aimed to explore modifiable key lifestyle factors contributing to childhood obesity in Dubai's South Asian expatriates. Methodology Based on prior research, we decided to evaluate the role of three most commonly associated lifestyle factors: physical activity, fast food consumption, and daily screen time. The hypothesis was that higher screen time and fast food intake would positively correlate with body mass index (BMI), while physical activity would show a negative correlation. The study applied a non-probability convenience sampling method and included 208 South Asian children aged 5-17 who visited a Dubai clinic between January and March 2024 and who didnot have any serious physical or mental health illness requiring long-term medication or any genetic disorder. Results Results showed that one-third of the children had a BMI of ≥85 percentile with no significant gender differences. Age was positively correlated with BMI percentile. Higher daily screen time is significantly associated with a higher prevalence of overweight and obesity as per the Centers for Disease Control and Prevention (CDC), International Obesity Task Force (IOTF), and World Health Organization (WHO) classifications. The frequent intake of fast food is associated with a higher prevalence of overweight and obesity only as per the IOTF classification. Physical activity, however, was not significantly different between the two groups. Conclusion We concluded that children who have a BMI of ≥85 percentile tend to have significantly higher daily screen time. The association between frequent fast food consumption and higher BMI was significant only under the IOTF criteria. Larger multicentric studies are needed to further validate these associations and to look for causal relationships. Nevertheless,this study underscores modifiable risk factors for childhood obesity, suggesting that small lifestyle changes could mitigate this epidemic.

Plaque Induced Gingivitis in Relation to Body Mass Index among School Children Aged 7-10 Years in Mosul City

Aim and objective: The objective of this study was to examine the correlation between periodontal disorders and body mass index (BMI) in schoolchildren living in Mosul City. Materials and methods: The present study employed a cross-sectional design to investigate a sample of schoolchildren aged 7–10 years. The clinical indicators, including the plaque index (PI) and gingival index (GI), were assessed. After accounting for age, gender, height, and weight, the BMI-age percentiles were determined using the BMI Percentile Calculator for Children and Teens. Based on these calculations, children were grouped into underweight, normal weight, overweight, or obese groups, taking into account their age and sex. In the statistical analysis, The Kruskal-Wallis Test was applied to examine differences among categorical variables. Results: The mean results for PI (Plaque index) and GI (Gingival index) were shown to be greater in children with obesity. Furthermore, our analysis revealed that the variances between the weight groups for both PI and GI were shown to be statistically significant with a high level of confidence (p=0.000). Conclusion: The combination of obesity and oral health issues in children is influenced by shared risk factors, demanding a thorough, mixed strategy involving both medical and dental healthcare professionals.

Cardiometabolic Health in Children with Pre-existing Dyslipidemia: Trends and Disparities.

In orderto evaluate the impact of a child's proximity to an urban center on their cardiometabolic health status and their response to treatment of cardiometabolic risk factors, retrospective review of the institutional pediatric lipid clinic database was conducted for all subjects receiving care from 1/1/2011 to 12/31/2023, with subgroup analysis of subjects with ≥ 2 clinical encounters and/or set of laboratory values. Subjects were classified as rural/urban and advantaged/middle/underserved based on their zip code using the Wisconsin Collaborative for Healthcare Quality classification system. Multivariate linear regression was used to examine disparities in baseline cardiometabolic health parameters by urban/rural groupings. Among subjects with multiple encounters, baseline and final available values were analyzed using paired t tests. 2419 subjects were included in the initial analysis with 75.4% living in urban environments and 51.9% having advantaged status. Urban advantaged children had lower BMI percentiles and waist circumference, but higher LDL-C values compared to other urban groups (p < 0.05). Rural advantaged and middle groups had higher TC, non-HDL-C, and LDL-C than the urban groups (p < 0.05). 1522 subjects had ≥ 2 encounters, with significant decreases in all lipid parameters (p < 0.006 for all). There was no change in fasting glucose, HbA1c, or ALT. Disparities in cardiometabolic parameters were seen at time of presentation based on rural/urban and advantaged/middle/underserved status, but all groups had similar improvements in cardiometabolic parameters throughout the course of treatment.

Examination of Sex Differences in Energy Availability, Disordered Eating, and Compulsive Exercise Among Male and Female Adolescent Athletes.

The primary aim of this study was to examine sex differences in energy availability (EA) and its relationships with disordered eating, compulsive exercise, and body mass index (BMI) among adolescent athletes. Cross-sectional study. University hospital pediatric sports medicine center. Sixty-four participants (61% female) of ages 13 to 18 years, actively participating in at least 1 organized sport. Participant sex. Average 7-day EA (kcal/kg FFM/d; calculated using participant-recorded dietary intake and exercise expenditure from a wrist-worn heart rate/activity monitor), Eating Disorder Examination Questionnaire (EDE-Q) score (range 0-6), Compulsive Exercise Test (CET) score (range 0-25), and age- and sex-adjusted BMI percentile. There were no significant sex differences in EA (females: 40.37 ± 12.17 kcal/kg FFM/d; males: 35.99 ± 12.43 kcal/kg FFM/d; P = 0.29), EDE-Q (females: 0.68 ± 0.70; males: 0.68 ± 0.83; P = 0.99), or CET scores (females: 11.07 ± 0.44; males: 10.73 ± 0.63; P = 0.66). There were low and insignificant negative correlations between EA and EDE-Q and CET scores for female athletes (EDE-Q: r = -0.22, P = 0.18; CET: r = -0.21, P = 0.09) and male athletes (EDE-Q: r = -0.09, P = 0.66; CET: r = -0.35, P = 0.08). EA and BMI-for-age percentile were inversely correlated in both male (r = -0.451, P = 0.009) and female (r = -0.37, P = 0.02) participants. In our sample of adolescent athletes, lower EA occurred in the absence of notable disordered eating or compulsive exercise behaviors, suggesting unintentional underfueling (and/or underreporting of energy intake), without significant sex differences. Low BMI can be an imperfect surrogate marker for low EA. These findings inform risk factors and screening practices for low EA among adolescent athletes.

Differences in physical activity, sedentary time, and anthropometric variables among children and adolescents: The TUBON project.

Although physical inactivity may lead to increasing obesity prevalence, research on anthropometric variables changes based on physical activity (PA) in children and adolescents is limited. PA decreases with age, while sedentary behavior increases. The study aimed to examine differences in objectively measured sedentary time, light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA) between children and adolescents, and the differences in the percentiles of anthropometric variables between physically active and inactive groups according to World Health Organization PA recommendations. A total of 759 participants aged 6-17 years (boys, n=358; girls, n=401) were included in the study. The ActiGraph wGT3x-BT accelerometer was used to measure sedentary time, LPA, and MVPA. Height, weight, waist circumference (WC), triceps skinfold thickness (T-SFT), and medial-calf skinfold thickness (M-SFT) were measured. Body fat percentage (BF%) and body mass index (BMI) were calculated, and the percentiles of anthropometric variables were categorized. The findings showed that children had less sedentary time and a higher LPA than adolescents for both genders (p<0.05). Children had a higher MVPA than adolescents in girls (p<0.05), but the difference was insignificant in boys (p>0.05). In boys, physically active children were in lower percentiles for T-SFT and BF% than those who did not (p<0.05). In boys, adolescents who were physically inactive were in higher percentiles for BMI, T-SFT, M-SFT, and BF% (p<0.05). In addition, in girls, adolescents who were physically active were in lower percentiles of BMI, M-SFT, and BF%, whereas children who were physically active were in lower percentiles of M-SFT and BF% (p<0.05). Sedentary time increases while PA decreases with age. Children and adolescents who met the WHO PA recommendation had lower percentiles of anthropometric variables, indicating the importance of PA in preventing obesity in these age groups.

Prednisolone impairs trabecular bone score changes in adolescents with 21-hydroxylase deficiency.

Individuals with 21-hydroxylase deficiency (21OHD) require lifelong glucocorticoid (GC) therapy, which increases their risk of fragility fractures. However, fractures in GC-treated individuals can occur at normal bone mineral density (BMD) levels, suggesting an alteration in the bone microarchitecture. To evaluate trabecular bone microarchitecture and its changes in adolescents with 21OHD. We enrolled 38 adolescents with 21OHD for whom complete clinical data and baseline and follow-up lumbar spine bone mineral density (LSBMD) measurements were available. The mean duration was 1.5 ± 0.6 years. Trabecular bone score (TBS), an indirect measurement of bone microarchitecture, was analyzed using iNsight™ software version 3.0. Impaired BMD and TBS were defined at Z-scores ≤ -1.5. At baseline, participants (55% female; 68% salt-wasting type; mean age, 15.2 ± 3.8 years; bone age, 17.5 ± 2.8 years; mean GC dose, 18.5 ± 6.5 mg/m2/day) had the prevalence of impaired BMD and TBS of 5% and 18%, respectively. During follow-up, adolescents with 21OHD receiving prednisolone showed a lower annual percentage change in TBS than those who received hydrocortisone (p = 0.028). A stepwise regression analysis showed that body mass index percentile (p < 0.001) and testosterone concentration (p = 0.002) were independent positive predictors of the baseline TBS Z-score, whereas prednisolone use was the only negative predictor of the annual percentage change in TBS (p = 0.002). Adolescents with 21OHD have a high prevalence of impaired bone microarchitecture. Furthermore, prednisolone therapy is associated with impaired bone microarchitecture development, suggesting that hydrocortisone may better preserve bone microarchitecture and should be considered the first-line treatment for this population.

Abstract 4144597: Cardiovascular Health Among Youth with Neurodevelopmental Disability: Analysis of National Survey of Children's Health (NSCH) – 2021

Introduction: The National Survey of Children's Health (NSCH) provides data for key measures of child health and well-being. The aim of this study is to characterize the cardiovascular health (CVH) status of youth with neurodevelopmental disabilities (NDD) compared to those without neurodevelopmental disabilities (non-NDD). Hypothesis: Youth with NDD are more likely to have poor CVH status compared to non-NDD youth. Methods: We compared the odds of poor CVH status in youth with NDD vs non-NDD, using 2021 NSCH data, according to a modified AHA Life’s Essential 8 (LE8) scoring system. Participants were identified as having NDD based on the Diagnostic and Statistical Manual of Mental Disorders and diagnosis of an intellectual, communication, autism spectrum, attention-deficit/hyperactivity, specific learning, or neurodevelopmental motor disorder, including Tic disorder. The CVH status of each youth was scored according to a modified LE8 score- range 0 to 100 points, with higher scores indicating good health. Individual scores were generated for sleep (sleep duration), smoking (smoking/exposure), diabetes mellitus (yes/no), obesity (BMI percentile), heart condition (yes/no), and dyslipidemia (yes/no). A composite CVH score was generated using scores for sleep, smoking, diabetes mellitus, and obesity. Logistic regression was used to analyze the relationship between NDD and CVH status. Propensity score techniques were applied to address the potential selection bias between NDD and non-NDD. Results: 12,134 youth, 3 to 17 years of age, were identified as having NDD and 44,960 without. Compared to those with NDD, non-NDD participants were less likely to have age-inappropriate sleep duration (63.4 vs. 55.3, p &lt;0.0001 ), smoking/exposure (94.5 vs. 90.7, p&lt;0.0001 ), diabetes mellitus (95.2 vs. 90.2, p &lt;0.0001 ), obesity (80.0 vs. 73.2, p &lt;0.0001 ), a heart condition (95.4 vs. 93.8, p=0.021 ), or dyslipidemia (98.1 vs. 95, p&lt;0.0001 ). Overall CVH status was (93.9 vs. 91.0, p&lt;0.0001 ) among non-NDD vs NDD participants. NDD participants had a greater odds of having a heart condition (OR=1.91, 95% CI: 1.51-2.42) and poor CVH status (OR=1.53, 95% CI: 1.45-1.62). Propensity score matching showed similar results. Conclusions: Neurodevelopmental disability is associated with poorer CVH status in youth. Efforts to improve CVH status in youth should include greater focus on youth with NDD.

Abstract 4136799: Disparities in Diagnosis and Treatment of Heterozygous Familial Hypercholesterolemia

Introduction: The prevalence of heterozygous familial hypercholesterolemia (HeFH) is 1:250. Untreated individuals have up to a 20-fold increased risk for premature coronary artery disease (CAD). In adults, low socioeconomic status (SES) individuals, bear a disproportionate share of the CAD burden. In this context, we sought to examine the association of social determinants of health and age at HeFH diagnosis and treatment. Methods: We performed a retrospective single-center study of children with HeFH who presented to the Lipid Heart Clinic at the Children’s Hospital of Philadelphia (2012-2022). The primary outcome was age at HeFH diagnosis. The secondary outcome was age at statin initiation. Multivariable linear regression models were used to examine the association between the primary exposure of interest, Child Opportunity Index (COI) and the outcomes. Secondary exposures included race, ethnicity, health insurance, and primary language. To explore potential referral bias, we compared the COI of the study cohort to that of the institution’s catchment area, defined as within a two-hour drive of the primary clinic. Results: We evaluated 577 patients. The median age at presentation was 12 (9, 14) years and the median LDL-C was 199 (169, 235) mg/dL; 58% were prescribed a statin with a median age of statin initiation of 13 (10, 15) years. The median COI for the cohort was 84 (62, 95). There was no association between COI, ethnicity, health insurance, or primary language and the age at HeFH diagnosis or statin initiation. On multivariable analysis, black race was associated with older age at HeFH diagnosis compared to white race (adjusted estimate 1.2 +/- 0.49 yrs, p = 0.014). There was no difference in age at statin initiation by race. Higher LDL-C, male sex, and lower BMI percentile were associated with younger age at statin initiation. The COI distribution of the study cohort was significantly different than that of the catchment area (p &lt; 0.001). 70% of the study cohort were of high and very high COI compared to 57% of the catchment area. Conclusion: Black race was associated with older age at HeFH diagnosis, however, there were no disparities in age at statin initiation. The COI of the cohort was significantly higher than that of the catchment area suggesting that low COI populations are under-referred for HeFH evaluation. Future efforts should focus on improving barriers to universal screening and identifying obstacles to HeFH diagnosis and referrals.