Change In Body Mass Index Z-score Research Articles

BMI changes in pediatric type 1 narcolepsy under sodium oxybate treatment.

Pediatric type 1 narcolepsy (NT1) is often associated with overweight and obesity. Sodium oxybate (SO), approved for the treatment of narcolepsy with cataplexy from the age of 7 years old in the United States, has been associated with weight loss, although longitudinal pediatric studies are lacking. We report a retrospective cohort of 129 consecutive patients with a 4-year follow-up, to analyze the impact of different pharmacological treatments on body mass index (BMI) z-score. At baseline, the prevalence of obesity and overweight was 26.4% (34/129) and 29.5% (38/129), respectively. Patients were divided into three groups: children treated with SO alone (group 1), with SO-combined therapy (group 2), and without SO (group 3). At the end of the first year of follow-up, group 1 and group 2 showed a significant BMI z-score reduction compared to baseline: from 1.2 ± 1.1 to 0.4 ± 1.4 for group 1 (p < 0.001), and from 1.4 ± 1.1 to 1 ± 1.3 for group 2 (p = 0.002), independently from baseline clinical features. In the second year, only group 2 experienced a further and significant BMI z-score decrease (from 1.0 ± 1.2 to 0.6 ± 1.2, p = 0.037). No further significant BMI z-score changes were observed in SO-treated patients in the following years. Instead, children treated without SO developed a significant weight increase between the second and third year of therapy (BMI z-score from 0.3 ± 0.9 to 0.5 ± 0.9). In conclusion, SO treatment in pediatric NT1 is associated with a favorable weight reduction in the first year of treatment.

Preliminary Results of the Planet Nutrition Program on Obesity Parameters in Mexican Schoolchildren: Pilot Single-School Randomized Controlled Trial.

School-based obesity prevention programs are key to promoting healthy habits. The aim of this study was to evaluate the effect of the Planet Nutrition program on BMI z-score and other parameters compared to a control group of Mexican schoolchildren after 9 weeks of intervention. The effect of the summer holidays on the BMI z-score was also evaluated at 23 weeks. A pilot randomized controlled trial design was used and 41 schoolchildren were randomized (21 intervention group and 20 control). The program included 18 nutrition education sessions, 20 physical activity classes and six brochures for parents. At 9 weeks, no significant differences were found between the intervention and control groups in the change in BMI z-score (−0.11, 95% CI −0.23, 0.01). Significant differences were observed in some secondary outcomes: body fat percentage (−1.72, 95% CI −3.42, −0.02), waist circumference (−3.45, 95% CI −5.55, −1.36), physical activity (0.44, 95% CI 0.01, 0.88) and nutrition knowledge (1.15, 95% CI 0.27, 2.03). Summer holidays negatively affected the BMI z-score in both groups, reducing the difference observed between groups at 9 weeks (−0.07, 95% CI −0.22, 0.07). The Planet Nutrition program showed favorable effects in some obesity and lifestyle parameters in the short term.

Family-based lifestyle interventions: What makes them successful? A systematic literature review.

Nearly one in five young people in the United States has obesity, putting one-fifth of America’s children at higher risk of having chronic health conditions and of having obesity into adulthood. Family-based lifestyle interventions (FBLI) have been proposed as effective mechanisms to improve the health through health education and the adoption of healthier behaviors. The aim of this review is to identify and summarize effective intervention activities and lessons learned that organizations can adopt when planning health promotion interventions for families, and to assess the effect of family-based lifestyle interventions on BMI z-score. A systematic review on lifestyle health-promotion interventions for families was conducted following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) statements. Inclusion criteria were: duration ≥12 weeks and inclusion of family members. Summary data about the assessment tools, intervention strategies, and outcomes in parents and children were extracted and compared for all studies. A meta-analysis of BMI z-score change was conducted. Thirty-four articles were included in this review. Frequent strategies used were delivering education and training on healthy habits and well-being (94%), engaging community in the planning and implementation phases (80.6%) and providing reminders and feedback (47.2%). BMI z-score mean differences were reported in 40 cohorts and included in a meta-analysis, with no statistically significant differences between groups. The findings of this systematic review and meta-analysis indicate that components of a successful family lifestyle intervention program include duration between six to twelve months and delivery in a community setting. Other key factors include constructing a multidisciplinary team, using a mentor/role model approach, and reinforcing messaging with technology.

A longitudinal study investigating change in BMI z-score in primary school-aged children and the association of child BMI z-score with parent BMI

BackgroundThis paper aims to explore change in BMI z-score through childhood and the association between parent BMI and child BMI z-score. This is important to understand for the development of effective obesity interventions.MethodsData from the longitudinal B-ProAct1v study (1837 participants) were analysed. A paired sample t-test examined changes in child BMI z-score between Year 1 and 4. Multivariable linear regression models examined the cross-sectional associations between child BMI z-score and parent BMI in Year 1 and 4. The influence of change in parental BMI between Year 1 and Year 4 on child BMI z-score in Year 4 was explored through regression analyses, adjusted for baseline BMI z-score.ResultsThere was a strong association between child BMI z-score at Year 1 and 4. Child mean BMI z-score score increased from 0.198 to 0.330 (p = < 0.005) between these timepoints. For every unit increase in parent BMI, there was an increase in child BMI z-score of 0.047 in Year 1 (p = < 0.005) and of 0.059 in Year 4 (p = < 0.005). Parental BMI change was not significantly associated with Year 4 child BMI z-score.ConclusionThe key indicator of higher child BMI at Year 4 is high BMI at Year 1. Further studies are needed to explore the impact of parental weight change on child BMI z-score and whether interventions targeted at overweight or obese parents, can improve their child’s BMI z-score.

The impact of summer vacation on children\u2019s obesogenic behaviors and body mass index: a natural experiment

BackgroundChildren’s BMI gain accelerates during summer. The Structured Days Hypothesis posits that the lack of the school day during summer vacation negatively impacts children’s obesogenic behaviors (i.e., physical activity, screen time, diet, sleep). This natural experiment examined the impact of summer vacation on children’s obesogenic behaviors and body mass index (BMI).MethodsElementary-aged children (n = 285, 5-12 years, 48.7% male, 57.4% African American) attending a year-round (n = 97) and two match-paired traditional schools (n = 188) in the United States participated in this study. Rather than taking a long break from school during the summer like traditional schools, year-round schools take shorter and more frequent breaks from school. This difference in school calendars allowed for obesogenic behaviors to be collected during three conditions: Condition 1) all children attend school, Condition 2) year-round children attend school while traditional children were on summer vacation, and Condition 3) summer vacation for all children. Changes in BMI z-score were collected for the corresponding school years and summers. Multi-level mixed effects regressions estimated obesogenic behaviors and monthly zBMI changes. It was hypothesized that children would experience unhealthy changes in obesogenic behaviors when entering summer vacation because the absence of the school day (i.e., Condition 1 vs. 2 for traditional school children and 2 vs. 3 for year-round school children).ResultsFrom Condition 1 to 2 traditional school children experienced greater unhealthy changes in daily minutes sedentary (∆ = 24.2, 95CI = 10.2, 38.2), screen time minutes (∆ = 33.7, 95CI = 17.2, 50.3), sleep midpoint time (∆ = 73:43, 95CI = 65:33, 81:53), and sleep efficiency percentage (−∆ = 0.7, 95CI = -1.1, − 0.3) when compared to year-round school children. Alternatively, from Condition 2 to 3 year-round school children experienced greater unhealthy changes in daily minutes sedentary (∆ = 54.5, 95CI = 38.0, 70.9), light physical activity minutes (∆ = − 42.2, 95CI = -56.2, − 28.3) MVPA minutes (∆ = − 11.4, 95CI = -3.7, − 19.1), screen time minutes (∆ = 46.5, 95CI = 30.0, 63.0), and sleep midpoint time (∆ = 95:54, 95CI = 85:26, 106:22) when compared to traditional school children. Monthly zBMI gain accelerated during summer for traditional (∆ = 0.033 95CI = 0.019, 0.047) but not year-round school children (∆ = 0.004, 95CI = -0.014, 0.023).ConclusionsThis study suggests that the lack of the school day during summer vacation negatively impacts sedentary behaviors, sleep timing, and screen time. Changes in sedentary behaviors, screen time, and sleep midpoint may contribute to accelerated summer BMI gain. Providing structured programming during summer vacation may positively impact these behaviors, and in turn, mitigate accelerated summer BMI gain.Trial registrationClinicalTrials.gov Identifier: NCT03397940. Registered January 12th 2018.

Readiness to Change and Prospective Effects of Weight Management Programs in Pediatric Nonalcoholic Fatty Liver Disease.

Non‐alcoholic fatty liver disease (NAFLD) is an increasing problem in pediatrics with limited treatment options. We prospectively assessed outcomes in patients managed in a hepatology clinic (HC) alone vs. those managed in combination with a multidisciplinary weight management program (MWMP). We describe each group’s readiness to change at the time of NAFLD diagnosis. Patients diagnosed with NAFLD were given a modified Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) at enrollment (T1) to assess readiness to change. They were then followed at 3–9 months (T2) and at 10–15 months (T3). Linear mixed models were used to evaluate changes in body mass index (BMI), BMI z‐score, and transaminases over time and between the two groups. There were no significant treatment group main effects or treatment × time interactions for our primary end points for HC alone (n = 75) or with MWMP (n = 18). There was a significant main effect for time for BMI z‐score, with BMI z‐scores declining on average by 0.0568 (P = 0.004) from visit to visit. Low SOCRATES subscales scores in HC alone (n = 33) or with MWMP (n = 4) suggested a patient population with low recognition of disease and likelihood of taking steps for change. Patients with obesity and NAFLD had low scores on all three SOCRATES subscales. Despite this, both groups had improvement in BMI z‐score without significant difference between the two treatment groups in other primary end points. Further study is needed to identify the most effective patient selection and treatment strategies for pediatric patients with NAFLD, including pharmacotherapy and surgery.

School-based Greenness and its Association with Overweight and Obesity in Children and Adolescents: a National Cross-Sectional Study in China

Background: Prior investigations on the associations of greenness exposure, which is generally assessed at participants’ home addresses, with obesity are still controversial. Furthermore, few documented evidences have focused on the association between childhood obesity and school-based greenness exposure.Objective: This study aimed to assess the associations between school-based greenness and markers of adiposity in children and adolescents in China.Method: We performed a national cross-sectional analysis of a representative sample including 56,620 children and adolescents aged 6-18 years in seven municipalities/provinces across China. We utilized the Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI) within 100-, 500-, and 1,000m circular buffers around each school’s address to evaluate greenness exposures. We estimated the associations of greenness with changes in BMI z-scores and waist circumference as well as odds ratio of overweight and/or obesity using two-level logistic and generalized linear mixed regression models. We also took consideration of the modifying effects of ambient air pollution and physical activity into the greenness-adiposity associations. Result: We found that BMI z-scores (-0.13, 95%CI:-0.13, -0.07) and waist circumference (-0.63, 95%CI:-1.2, -0.06) were decreased when NDVI-1000m per interquartile (IQR, 0.13 unit) increase in adjusted model. And an IQR increase in NDVI of three different buffers was associated with 10-21% lower odds ratio (OR) of overweight and/or obesity. We also found that the associations were more pronounced in boys, urban dwellers and children with lower parental education levels. Air pollution mediated 9.8-56.9% of the greenness-obesity associations, but no mediating effects were observed for physical activity.Conclusion: Higher school-based greenness exposure was associated with decreased BMI z-scores and lower relative prevalence of overweight and/or obesity in children and adolescents. Ambient air pollutants may partially mediate the greenness-adiposity associations.

Pediatric Cushing's syndrome: greater risk of being overweight or obese after long-term remission and its predictive factors.

Due to the rarity of Cushing's syndrome (CS) in children and adolescents, data are scarce about BMI during active disease and following remission. Therefore, our aim was to analyze BMI after long-term remission and determine predictive factors for promptly identifying patients at risk of being overweight or obese after remission for CS. Retrospective cohort study. 73 patients: 58 (79.4%) had Cushing disease, 40 males (58%), median age of 12 years (IQR: 9-15). The mean follow-up time was 22.4 ± 18.2 months (range: 4-98). Main outcome measures: BMI, lipid profile, blood pressure, HOMA-IR. At diagnosis, only eight (11%) patients had a normal weight. Although the BMI z-score at the last follow-up improved (2.0 ± 0.7 to 1.0 ± 1.2, P < 0.001), 44% remained overweight or obese after 2 years of remission according to the Kaplan-Meier curves. The BMI z-scores at the last follow-up correlated only with HOMA-IR levels (r: 0.49, P = 0.027). We found two independent factors related to reaching a normal weight: BMI z-score at diagnosis (HR: 0.156, 95% CI: 0.038-0.644; P = 0.01) and BMI z-score change at 6 ± 2 months (HR: 2.980, 95% CI:1.473-6.028; P = 0.002), which had high accuracy when a cut-off of 0.5 was used for ROC analysis (AUC = 0.828 (0.67-0.97); P < 0.001). Children and adolescents with CS have a high risk of being overweight or obese after successful treatment for their disease. At risk patients can be identified quickly based on their baseline BMI and initial weight loss after surgery. Efforts should focus on adopting healthy diet and lifestyle in the immediate postoperative period.

Longitudinal Assessment of Childhood Dietary Patterns: Associations with Body Mass Index z-Score among Children in the Samoan Ola Tuputupua'e (Growing Up) Cohort.

Background: Intervention strategies to prevent childhood obesity in the Pacific Islands encourage eating a variety of local and traditional foods, but context-specific data to support this approach are limited. The objective was to assess the association between 2-year adherence to modern and neotraditional dietary patterns and body mass index z-scores (BMIz) among Samoan children. Methods: A convenience sample of 214 Samoan biological mother-child dyads who participated in the Ola Tuputupua'e "Growing Up" cohort study in 2015 and 2017 was included. At each time point, modern and neotraditional dietary patterns were identified using food frequency data and factor analysis. Children were assigned to categories based on diet pattern adherence: consistently high, high to low, low to high, and consistently low. Associations between 2-year adherence to dietary patterns, BMIz (in 2017 and 2015-2017), and weight and height z-scores were examined using linear models adjusted for potential confounders. Results: Consistently high adherence to the modern pattern was associated with a 0.36 standard deviation (SD)-adjusted change in BMIz between 2015 and 2017 (95% confidence interval [CI]: 0.04-0.69, p = 0.03). While the estimates for the individual components of BMI were imprecise, on average, children with consistently high adherence to the modern pattern had a 0.13 SD greater change in weight z-score (95% CI: -0.10 to 0.37) and 0.15 SD lower change in height z-score (95% CI: -0.43 to 0.13). The change in BMIz between 2015 and 2017 did not significantly differ by adherence to the neotraditional pattern. Conclusion: A neotraditional dietary pattern, comprising local produce, should be encouraged as a possible childhood obesity prevention strategy in Samoa.

Individual-, family-, and contextual-level variables do not explain the protective effect of parental nativity status on changes in 3-15-year-old children's BMI.

Individual-, family-, and contextual-level factors can simultaneously and interactively affect a child's body mass index (BMI). We examine parental nativity as a key determinant of changes in children's BMI over time. Prior research on this topic has been inconclusive. A longitudinal sample of households with children residing in four low-income, high minority New Jersey cities provided data on demographics, socioeconomic status, anthropometric measures, as well as dietary and physical activity behaviors for one randomly selected child. The baseline interview for two separate cohorts took place in 2009/10 and 2014-15, with a follow-up interview 2–5 years later. The outcome variable, change in BMI z-score was divided into three categories (decrease in BMI z-score; no meaningful change; increase in BMI z-score) and analyzed using ordinal logistic regressions. About 28% of the children in the sample had at least one foreign-born parent. For the two major racial/ethnic groups, i.e., Hispanics and non-Hispanic blacks, having a foreign-born parent was associated with a favorable change in BMI—children of foreign-born parents were more likely to experience a decrease BMI z-score between baseline and follow-up. Multivariate analyses reveal that the initial association between parental nativity and children's BMI change (OR = 0.20; p < 0.001) persists after controlling for an extensive set of covariates, such as child dietary and physical activity behaviors, family-level variables, census tract characteristics, and measures of food environment (OR = 0.17; p < 0.001). Through a series of sensitivity analyses, we verified that our results are consistent across different model specifications. In our sample, having a foreign-born parent was a protective factor for children's BMI change that operates through different pathways than might be anticipated.

Systematic review and meta-analyses of the relationship between short sleep and incidence of obesity and effectiveness of sleep interventions on weight gain in preschool children.

The aim of this study is to determine (a) whether short sleep is associated with the incidence of obesity and (b) whether interventions beneficial for sleep reduce weight gain in preschool children. We systematically searched PubMed, Embase, Web of Science and Cochrane up to 12/09/2019. (a) Studies that were included were prospective, had follow-up ≥1 year, with sleep duration at baseline and required outcome measures. (b) Intervention trials with sleep intervention and measures of overweight or obesity were included. Data were extracted according to PRISMA guidelines. (a) The risk of developing overweight/obesity was greater in short sleeping children (13 studies, 42 878 participants, RR: 1.54; 95% CI, 1.33 to 1.77; p < 0.001). Sleep duration was associated with a significant change in BMI z-score (10 studies, 11 cohorts and 29 553 participants) (mean difference: -0.02 unit per hour sleep; -0.03 to -0.01; p < 0.001). (b) Four of the five intervention studies reported improved outcomes: for BMI (-0.27 kg/m2 ; -0.50 to -0.03; p = 0.03); for BMI z-score (-0.07 unit; -0.12 to -0.02; p = 0.006). Short sleep duration is a risk factor or marker of the development of obesity in preschool children. Intervention studies suggest that improved sleep may be beneficially associated with a reduced weight gain in these children.

Association between Sleep Timing and Weight Status among 14- to 19-Year-Old Adolescents in Wuhan, China.

This study examined the cross-sectional and longitudinal association of sleep timing with weight status in 14- to 19-year-old adolescents in Wuhan, China. A prospective school-based study was conducted in Wuhan, China between 28 May and 29 September 2019. Data on sociodemographic information, academic performance, diet, mental health status, physical activity, sleep characteristics, body weight, and height were collected. A linear regression model and binary logistic regression model were performed. A total of 1194 adolescents were included in the analysis. Adolescents who woke up before 05:45 had higher body mass index (BMI) Z-score (odds ratio (OR) with 95% confidence interval (CI) = 1.28 (1.05, 1.57), p = 0.02) and higher odds of overweight/obesity (odds ratio (OR) with 95% confidence interval (CI) = 1.74 (1.10, 2.76), p = 0.02) at baseline after fully adjustment for covariates, compared with those who woke up after 05:45. Longitudinal data showed a nonsignificant association between waking up time and change in BMI Z-score (p = 0.18). No association of bedtime with weight status was observed in this sample after full adjustment (p > 0.1). Earlier waking up time might contribute to overweight and obesity in adolescents; however, more data are needed to test and elucidate this relationship.

Effects of rapid growth in early childhood on metabolic and cardiovascular diseases among preschool-aged children.

To investigate whether the tempo of weight gain of children during infancy (from birth up to two years of age) or childhood (between two and five years old) is associated with metabolic and cardiovascular disease. Cluster sampling was employed to obtain a random sample of preschool children. In total, 1450 children aged five to six years participated in this survey. We obtained data on body weight, height, blood pressure (BP), and serum levels of total cholesterol, triglycerides, glucose, and uric acid, as well as anthropometry at birth and at age 2. The prevalence of obesity at five years old was 14.5%. At five years of age, children with rapid growth (change in body mass index, BMI z-score >0.67) during infancy had a higher odds ratio (OR) of childhood obesity (OR: 2.97 [95% CI: 2.15-4.11]) compared to children with non-rapid growth (change in BMI z-score ≤0.67). Also, children with rapid growth during childhood had a higher OR of childhood obesity (OR: 17.90 [95% CI: 12.31-26.04]), higher systolic BP (OR: 2.38 [95% CI: 1.68-3.39]), higher diastolic BP (OR: 2.42 [95% CI: 1.53-3.83]), and higher triglycerides (OR: 4.09 [95% CI: 1.47-11.33]) or hyperuricemia (OR: 2.23 [95% CI: 1.51-3.29]). Rapid growth in early childhood is associated with risk factors for both cardiovascular outcomes and metabolic outcomes among preschool children. Developing effective prevention and intervention programs for pre-school children might be important to reduce incidence of long-term metabolic and cardiovascular disease as adults.

Integration of an interpretable machine learning algorithm to identify early life risk factors of childhood obesity among preterm infants: a prospective birth cohort

BackgroundThe early life risk factors of childhood obesity among preterm infants are unclear and little is known about the influence of the feeding practices. We aimed to identify early life risk factors for childhood overweight/obesity among preterm infants and to determine feeding practices that could modify the identified risk factors.MethodsA total of 338,413 mother-child pairs were enrolled in the Jiaxing Birth Cohort (1999 to 2013), and 2125 eligible singleton preterm born children were included for analyses. We obtained data on health examination, anthropometric measurement, lifestyle, and dietary habits of each participant at their visits to clinics. An interpretable machine learning-based analytic framework was used to identify early life predictors for childhood overweight/obesity, and Poisson regression was used to examine the associations between feeding practices and the identified leading predictor.ResultsOf the eligible 2125 preterm infants (863 [40.6%] girls), 274 (12.9%) developed overweight/obesity at age 4–7 years. We summarized early life variables into 25 features and identified two most important features as predictors for childhood overweight/obesity: trajectory of infant BMI (body mass index) Z-score change during the first year of corrected age and maternal BMI at enrollment. According to the impacts of different BMI Z-score trajectories on the outcome, we classified this feature into the favored and unfavored trajectories. Compared with early introduction of solid foods (≤ 3 months of corrected age), introducing solid foods after 6 months of corrected age was significantly associated with 11% lower risk (risk ratio, 0.89; 95% CI, 0.82 to 0.97) of being in the unfavored trajectory.ConclusionsThe trajectory of BMI Z-score change within the first year of life is the most important predictor for childhood overweight/obesity among preterm infants. Introducing solid foods after 6 months of corrected age is a recommended feeding practice for mitigating the risk of being in the unfavored trajectory.

Mobile Health for Pediatric Weight Management: Systematic Scoping Review.

BackgroundThe prevalence and consequences of obesity among children and adolescents remain a leading global public health concern, and evidence-based, multidisciplinary lifestyle interventions are the cornerstone of treatment. Mobile electronic devices are widely used across socioeconomic categories and may provide a means of extending the reach and efficiency of health care interventions.ObjectiveWe aimed to synthesize the evidence regarding mobile health (mHealth) for the treatment of childhood overweight and obesity to map the breadth and nature of the literature in this field and describe the characteristics of published studies.MethodsWe conducted a systematic scoping review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, by searching nine academic databases in addition to gray literature for studies describing acceptability, usability, feasibility, effectiveness, adherence, or cost-effectiveness of interventions assessing mHealth for childhood obesity treatment. We also hand searched the reference lists of relevant articles. Studies aimed at the prevention of overweight or obesity were excluded, as were studies in which mHealth was not the primary mode of treatment delivery for at least one study arm or was not independently assessed. A random portion of all abstracts and full texts was double screened by a second reviewer to ensure consistency. Data were charted according to study characteristics, including design, participants, intervention content, behavior change theory (BCT) underpinning the study, mode of delivery, and outcomes measured.ResultsWe identified 42 eligible studies assessing acceptability (n=7), usability (n=2), feasibility or pilot studies (n=15), treatment effect (n=17), and fidelity (n=1). Change in BMI z-scores or percentiles was most commonly measured, among a variety of dietary, physical activity, psychological, and usability or acceptability measures. SMS, mobile apps, and wearable devices made up the majority of mobile interventions, and 69% (29/42) of the studies specified a BCT used.ConclusionsPediatric weight management using mHealth is an emerging field, with most work to date aimed at developing and piloting such interventions. Few large trials are published, and these are heterogeneous in nature and rarely reported according to the Consolidated Standards of Reporting Trials for eHealth guidelines. There is an evidence gap in the cost-effectiveness analyses of such studies.

Stabilization of BMIz Score is Associated with a Decrease in Visceral Fat in Children with Obesity.

BMIz-score (BMIz) is commonly used to assess childhood obesity. Whether change in BMIz score predicts change in visceral fat remains unclear. The objective of the work was to study changes in visceral fat, cardiovascular fitness (CVF), and metabolic health over 6 months in children with stable/decreased-BMIz vs. increased-BMIz. Ninety children with obesity, referred for lifestyle intervention were studied (mean age 11±3.1 years, 50% girls, 22% Hispanic). Assessment included abdominal and total fat by dual X-ray absorptiometry (DXA), sub-maximal VO2 for CVF, anthropometrics, and fasting insulin, glucose, HDL-C, triglycerides, AST and ALT at 0 and 6 months. Sixty-three children (70%) showed a stable/decrease in BMIz over 6 months. There was no significant change in total body fat between groups (-1.3±2.9% in BMIz-stable/down vs. - 0.6 ± 2.6% BMIz-up, p=0.459); however, BMIz-stable/down group showed a decrease in visceral fat compared to the BMIz-up group (-258±650 g vs.+137±528 g, p=0.009). BMIz-stable/down group also demonstrated increased CVF (+1.2 ml/kg/min, p<0.001), not seen in the BMIz-up group. Neither group had significant changes in metabolic markers. Preventing BMIz increase in obese children predicts a significant decrease in visceral fat even if total body fat is unchanged. This is often associated with increased fitness. Thus, increasing fitness level and keeping BMI stable are strategic initial goals for obese children.

Integration of Machine-Learning Algorithm to Identify Early Life Risk Factors for Future Overweight or Obesity Among Preterm Infants: A Prospective Birth Cohort

Abstract Objectives To identify early life risk factors for childhood overweight/obesity among preterm infants and to determine feeding practices that could modify the identified risk factors. Methods Jiaxing Birth Cohort is a prospective cohort involving 338,413 mother-child pairs who were enrolled in between 1999 and 2013, of whom 2125 singleton preterm born children with adequate information documented were included in the analyses. Infant and maternal variables were summarized into 25 features. The LightGBM model based on a gradient-boosting framework was used to link input features with future overweight/obesity and a novel unified framework, SHAP (Shapley Additive exPlanations), was used to interpret predictions and identify predictive factors from the summarized features. Poisson regression model was used to examine the association between feeding practices and the identified leading predictive factor. Results Of the eligible 2125 preterm infants, 274 (12.9%) developed overweight/obesity at age 4–7 years. Using an interpretable machine learning-based analytic framework, we identified two most important features as predictors of Childhood overweight/obesity: trajectory of infant BMI Z-score change during the first year of corrected age and maternal BMI at enrollment. The identified features in the model showed similar predictive capacity compared with all features. According to the impacts of different BMI Z-score trajectories on model outputs, we classified this feature into favored and unfavored trajectory. Compared with early introduction of solid foods (≤3 months of corrected age), introducing solid foods after 6 months of corrected age was significantly associated with 11% lower risk (risk ratio, 0.89; 95% CI, 0.82 to 0.97, P &amp;lt; 0.01) of being in the unfavored trajectory. Conclusions Our results suggest that the trajectory of BMI Z-score change within the first year of life is the most important predictor for childhood overweight/obesity among preterm infants. Introducing solid foods after 6 months of corrected age is a recommended feeding practice for mitigating the risk of unfavored trajectories of BMI Z-score change early in life. Funding Sources This study was funded by the Open Project Program of China-Canada Joint Lab of Food Nutrition and Health, Beijing Technology and Business University (BTBU) (KFKT-ZJ-201,801).

Early life weight patterns and risk of obesity at 5 years: A population-based cohort study

Childhood obesity is a major public health problem in industrialized countries. The aim of this study was to estimate the risk of obesity at age 5 based on BMI categories at age 3 and changes in BMI z-score from birth to 3 years of age. In this population-based study BMI data of 5173 children were collected at ages 3 and 5 and were linked to information relative to birth weight. The prevalence of obesity at age 5 was 3.8%. The risk of obesity for children born large for gestational age was 6.5%, while it was 18.6% for children overweight at age 3 and 62% for children who were obese at 3. An increase in BMI z-score from birth to 3 years increases the risk of obesity at age 5 (OR for increase of one standard deviation 2.8%; 95% CI: 2.46–3.20), but adjusting for BMI z-score at age 3, the effect of trajectory disappears (OR 1.08 95% CI: 0.9–1.29). In other words, if one targeted early preventive interventions to 3-year-olds affected by overweight/obesity (only 9.8% of the study cohort), one could possibly address 71% of children potentially affected by obesity at age 5.

Time-Course Evaluation of Body Mass Index in Japanese Children With Obstructive Sleep Apnea Syndrome After Adenotonsillectomy: A Three-Years Follow-Up Study.

Delayed physical growth is a common complication of pediatric obstructive sleep apnea syndrome (OSAS). Adenotonsillectomy (AT) is the first-line treatment for pediatric OSAS. Only a few studies have performed time-course BMI evaluation in pediatric OSAS patients post-operatively. Thus, we aimed to evaluate the time-course changes in pediatric OSAS patients after AT. Thirty-three children with OSAS who underwent AT were included and divided into two groups on the basis of their BMI z-scores (delayed physical growth group, n = 15; non-delayed physical growth group, n = 18). Clinical records of height and weight were collected before AT and at 6, 12, 24, and 36 months after AT. Changes in the mean BMI z-scores of the two groups were assessed up to 36 months. The mean BMI z-score was significantly increased in the delayed physical growth group at 6 months after AT. In contrast, the increase in mean BMI z-score was not observed in the non-delayed physical growth group. Growth improvement was noted in pediatric OSAS patients with delayed physical growth after AT. Our results suggest that AT is a promising therapy for improving the physical growth of pediatric OSAS patients with such problems.

Resistin/Uric Acid Index as a Prognostic Factor in Adolescents with Obesity after Lifestyle Intervention

To evaluate the resistin/uric acid index as a prognostic factor associated with body mass index (BMI) z-score change after 1year of lifestyle interventions for obesity. In this prospective cohort study, we included 102 adolescents with overweight or obesity (BMI ≥85th percentile). Weight and height were measured at the start of the lifestyle change intervention and 12months later. Serum levels of resistin and uric acid were quantified at the beginning of the intervention. The intervention consisted of nutrition education, exercise, and physical activity promotion. The sample included 54 girls and 48 boys; the median age was 11years (range 10-16years). The BMI z-score decreased during follow-up (median BMI z-score at baseline was 1.81 vs 1.70 after 1year, P < .001). The resistin/uric acid index was positively correlated with BMI z-score change (r=0.27, P < .01). In the linear regression analysis, the resistin/uric acid index was significantly associated with BMI z-score modification at the 12-month follow-up (β=0.17; 95% CI 0.08-0.26; P < .01). The resistin/uric acid index can be considered a prognostic factor for identifying adolescents with overweight or obesity with a greater probability of improving their BMI. This index could help establish different interventions for adolescents with overweight and obesity; however, additional studies are needed to confirm the usefulness of this index.