Combined Overweight Research Articles

Overweight in epilepsy as a risk factor for pregnancy and delivery complications.

To investigate whether prepregnancy overweight in women with epilepsy increases their risk for complications during pregnancy and delivery. This study is based on The Norwegian Mother and Child Cohort Study (MoBa) linked to the Medical Birth Registry of Norway. A diagnosis of epilepsy was reported in 706 pregnancies. Overweight was defined as body mass index≥25 prepregnancy. Overweight women with epilepsy (n=259) were compared to normal-weight women with epilepsy (n=416), and to women without epilepsy with and without overweight (n=30,516 and n=67,977, respectively). The risks of pregnancy and delivery complications were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for adverse socioeconomic factors, age, parity, and smoking. Women with epilepsy were more often overweight than women without epilepsy (38.4% vs. 31.3%, p<0.001). The majority of pregnancy and delivery complications were more frequent in overweight women with epilepsy. Compared to overweight women without epilepsy, the risk was increased for cesarean section (OR 1.6, CI 1.2-2.2, p<0.001), excessive bleeding (OR 1.4, CI 1.0-1.8, p=0.04), peripartum anxiety and depressive symptoms (OR 1.9, CI 1.3-2.8, p<0.001), small for gestational age children (OR 2.4, CI 1.2-4.8, p=0.02), and transfer of the infant to a neonatal ward (OR 1.5, CI 1.1-2.2, p=0.02). Compared to normal-weight women with epilepsy, the risk of cesarean section (OR 1.6, CI 1.1-2.3, p<0.05), gestational hypertension (OR 2.0, CI 1.1-3.5, p<0.05), preeclampsia (OR 2.3, CI 1.2-4.5, p<0.05), and transfer of the infant to a neonatal ward (OR 2.2, CI 1.3-3.6, p<0.01) was increased. Prepregnancy overweight in combination with epilepsy entails a strong negative effect on risk of complications during pregnancy and delivery. In women with epilepsy and overweight referral to a nutritionist should be considered when an antiepileptic drug is started as well as when pregnancy is planned. These women should be regarded as a high-risk group.

Setting the Context for Obesity Prevention in Rural Oregon Elementary Schools

PURPOSE: Baseline data collected from students attending six elementary schools in rural Oregon are presented (N=2006). Data provide the baseline for intervention activities associated with GROW Healthy Kids & Communities, a 5-year, multi-level, rural obesity prevention program delivered via Cooperative Extension. METHODS: Data were collected in spring 2013. Weight was measured and recorded in 0.1kg increments; height was measured and recorded in 0.1cm increments. Schools provided classroom rosters, including child birthdate, sex, and grade. BMI was calculated using kg/m2, BMI z-scores using the CDC growth charts, and BMI percentiles from z-scores (underweight 95%). Binary variables were created to represent normal weight, combined overweight and obese, overweight only, and obese only categories. Proportional t-tests were run to compare prevalence of normal weight, overweight or obese, overweight only, and obese only by: sex, condition (control vs intervention), county (n=3), and grade (K-6). RESULTS: Table 1 presents BMI prevalence data by sex, condition, county, and grade. Boys and girls had similar proportions across all categories and obesity rates increased with grade level beginning at grade 2 and compared to grade K. Intervention schools had a higher combined prevalence of overweight and obesity compared to control schools.Table 1: Healthy Weight, Overweight, and Obesity PrevalenceCONCLUSIONS: High obesity rates at baseline support the need for obesity prevention efforts in rural Oregon elementary schools. Abstract supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, under award number 2011-68001-30020

Changes in the nutritional status of children and adolescents in Shandong, China.

Nutritional status during childhood plays an important role in the human life cycle. The present study examined the prevalence trends in different grades of nutritional status (thinness, normal weight, overweight and obesity) among children and adolescents in Shandong, China. Data for the study were obtained from six cross-sectional surveys of schoolchildren carried out in 1985, 1995, 2000, 2005, 2010 and 2014. Height and weight of all children were measured; BMI was calculated from their height and weight. International BMI cut-offs were used to define thinness, overweight and obesity. Shandong Province, China. A total of 56 045 students aged 7-18 years were included in the current analysis. In the past 29 years, the prevalence of thinness decreased from 18·22 % and 23·45 % in 1985 to 7·18 % and 9·49 % in 2014 for boys and girls, respectively. Conversely, the prevalence of combined overweight and obesity increased from 1·79 % and 1·66 % in 1985 to 31·12 % and 20·11 % in 2014 for boys and girls, respectively. The nutritional profile of Shandong children and adolescents had an obvious change over the past 29 years. Special attention should be paid to controlling the rapid rise of childhood overweight and obesity.

Prevalence of Overweight and Obesity among Children and Adolescents in Shandong, China: Urban-Rural Disparity.

The pattern of urban-rural disparity in childhood obesity varies across countries. The present study examined the change trend of urban-rural disparity in childhood overweight and obesity from 1985 to 2014 in Shandong, China. Data for this study were obtained from four cross-sectional surveys of school children carried out in 1985, 1995, 2005 and 2014 in Shandong Province, China. In this study, 39943 students aged 7-18 years were included (14 458 in 1985, 7198 in 1995, 8568 in 2005 and 9719 in 2014). Height and weight of all subjects were measured; body mass index (BMI) was calculated from their height and weight. The BMI cutoff points recommended by the International Obesity Task Force were used to define overweight and obesity. The prevalence of overweight and obesity was increasing continuously both in urban and rural areas over the past 29 years (1985-2014). The prevalence of combined overweight and obesity was significantly higher in urban than in rural children and adolescents in 1985, 1995 and 2005 (p < 0.01). However, a rapid increase in the prevalence of combined overweight and obesity was observed in rural areas after 2005; as a result, the urban-rural disparity was getting narrower, and no significant urban-rural disparity was observed in 2014 (p > 0.05). The change trend of urban-rural disparity should be concerned in the future; policies and interventions focused on childhood overweight and obesity should pay attention to rural areas.

Association of overweight and obesity with patient mortality after acute myocardial infarction: a meta-analysis of prospective studies.

The obesity paradox, which suggests that overweight and obesity exert protective effects on patient survival after acute myocardial infarction (AMI), is controversial in the existing researches. The aim of our study was to evaluate the associations of overweight and obesity with all-cause mortality in patients after AMI. The PubMed and Embase databases were searched for original articles published in English prior to March 2015, using the terms ('myocardial infarction' and ('body mass index' or BMI)) and ('mortality' or 'death'). Prospective studies that reported the relationship between overweight and obesity at baseline (immediately after AMI) and all-cause mortality outcomes were eligible. Two authors separately performed the extraction of the data, and any differences were discussed and resolved. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were computed either by fixed effects or random effects models. Twenty studies were included in the present analysis. Comparing a healthy weight group to a combined overweight and obese group, the pooled RRs were 0.72 (95% CI: 0.57-0.90) for in-hospital mortality, 0.39 (95% CI: 0.28-0.55) for short-term mortality, 0.66 (95% CI: 0.55-0.78) for medium-term mortality and 0.68 (95% CI: 0.57-0.81) for long-term mortality. However, the RRs were 0.82 (95% CI: 0.64-1.06) for in-hospital mortality and 0.94 (95% CI: 0.55-1.58) for short-term, 0.82 (95% CI: 0.65-1.04) for medium-term and 0.98 (95% CI: 0.88-1.09) for long-term mortality when the obese group was compared with the overweight group, which were not significant. This meta-analysis identified an inverse association between overweight and obesity with all-cause mortality after AMI compared with healthy weight, which indicated an obesity paradox. Another notable finding is that obesity is associated with neither an increased nor a decreased risk of death in patients after AMI compared with overweight patients.

Assessment of Body Mass Index, Sugar Sweetened Beverage Intake and Time Spent in Physical Activity of American Indian Children in Oklahoma.

American Indian (AI) children have a combined overweight and obesity prevalence of 53%. Behaviors that contribute to obesity, such as sugar sweetened beverage (SSB) intake and time spent in physical activity (PA), have been poorly explored in this population. The purpose of this study is to report body mass index (BMI), SSB intake, and time spent in PA of 7-to-13-year-old AI children who reside in rural and urban areas in Oklahoma. Cross-sectional survey study. Self-reported SSB intake in the last month, and time spent in PA were collected via questionnaires. Height and weight were professionally measured. The sample included 124 7-to-13-year-old AI children who attended a diabetes prevention summer camp in 2013. BMI percentile, overweight and obesity prevalence, SSB intake, time spent in PA, and number of participants meeting the Physical Activity Guidelines for Americans. Descriptive characteristics for BMI percentile, overweight and obesity, SSB intake, time spent in PA, and meeting PA recommendations were calculated using means, standard deviations, and frequencies. Independent t test and Chi square analyses were used to test for gender differences. Participants were 10.2 ± 1.5 years old and 57% female. Sixty-three percent were overweight or obese. Children consumed 309 ± 309 kcal/day of SSB and spent 4.4 ± 3.8 h per week in moderate-to-vigorous PA. Approximately 32% met the 2008 Physical Activity Guidelines for Americans. No gender differences were observed. The prevalence of overweight and obesity was higher than previously reported in a similar population, and higher than that of US children in the general population. SSB intake and physical activity levels were also found to be higher in this group than in the general population.

Prevalence of Growth Disorders in a Nationally Representative Sample of Iranian Adolescents According to Socioeconomic Status: The CASPIAN-III Study

This study aims to assess the prevalence of growth disorders among a nationally representative sample of Iranian adolescents according to the socioeconomic status (SES) of their living area. This nationwide cross-sectional survey was conducted among a representative sample of 5624 adolescents aged 10-18 years. They were selected by multistage cluster sampling from 27 provinces of Iran. Subnational classification of the country was based on geography and social class of each region. Analysis of variance and Chi-square tests were used to compare the prevalence of growth disorders according to sex and SES of the living regions. The mean and standard deviation for body mass index was 19.42 (4.09) kg/m(2), with a significant trend from the Southeast region with lowest SES to the Central part with highest SES (p(trend) < 0.001). The prevalence of obesity, combined overweight and obesity, as well as abdominal adiposity increased with a significant trend from low to high SES (all p(trend) < 0.001, except for girls' height, p(trend) = 0.003). The opposite direction was documented for the prevalence of underweight and short stature, with the highest frequencies in the Southeast (lowest SES) and the lowest in Central part (highest SES). Excess weight was more prevalent in high SES regions, whereas underweight and short stature were more prevalent in low SES regions. These findings underscore the necessity of implementing evidence-based health promotion programs and preventive strategies according to SES.

Association between obesity and sexual maturation in Chinese children: a muticenter study.

We aimed to evaluate the current status of sexual maturation of Chinese children, to examine the association between obesity and early sexual maturation in boys and compare it with girls and to test the hypothesis that the associations differ by gender. Cross-sectional study. A representative sample involving 9812 boys and 8895 girls aged 6-18 years who participated in the Chinese Children and Adolescent Metabolic Syndrome Epidemiologic Study (July 2009- July 2010) were surveyed. All subjects had complete anthropometry and sexual maturation data. SUBJECTS who reached Tanner stage 2 or more (5601 boys and 6538 girls) were divided into tertiles based on the timing of sexual maturation. The subjects in the earliest tertile were included into the early-maturing group, and the middle tertile and the latest tertile into the not early-maturing group. Overweight was defined as a body mass index (BMI) ⩾85th percentile and obesity ⩾95th percentile. Logistic regression analysis was used to test how early maturation affected the risk of overweight. Multiple linear regression was used to examine the association between fatness (BMI Z-score) and sexual maturation. Slightly more boys were obese than girls (P<0.01). The median age for girls of the Tanner stage 2 was 9.69 years, and for boys of Tanner stage 2 was 11.25 years. BMI Z-score were higher (P<0.01) in both early-maturing girls and boys, compared with the non-early maturers, respectively. Early sexual maturation was positively associated with obesity in both girls and boys. With covariates adjusted and using non-early maturing as the reference group, odds ratios for combined overweight were 1.48 for boys and 2.64 for girls, and for obesities were 1.61 for boys and 3.49 for girls, respectively. Obesity is positively associated with sexual maturation in both boys and girls, and the association does not differ by gender, but the association is stronger in girls than in boys.

Geographic Variation of Overweight and Obesity among Women in Nigeria: A Case for Nutritional Transition in Sub-Saharan Africa

BackgroundNutritional research in sub-Saharan Africa has primarily focused on under-nutrition. However, there is evidence of an ongoing nutritional transition in these settings. This study aimed to examine the geographic variation of overweight and obesity prevalence at the state-level among women in Nigeria, while accounting for individual-level risk factors.MethodsThe analysis was based on the 2008 Nigerian Demographic and Health Survey (NDHS), including 27,967 women aged 15–49 years. Individual data were collected on socio-demographics, but were aggregated to the country's states. We used a Bayesian geo-additive mixed model to map the geographic distribution of overweight and obesity at the state-level, accounting for individual-level risk factors.ResultsThe overall prevalence of combined overweight and obesity (body mass index ≥25) was 20.9%. In multivariate Bayesian geo-additive models, higher education [odds ratio (OR) & 95% Credible Region (CR): 1.68 (1.38, 2.00)], higher wealth index [3.45 (2.98, 4.05)], living in urban settings [1.24 (1.14, 1.36)] and increasing age were all significantly associated with a higher prevalence of overweight/obesity. There was also a striking variation in overweight/obesity prevalence across ethnic groups and state of residence, the highest being in Cross River State, in south-eastern Nigeria [2.32 (1.62, 3.40)], the lowest in Osun State in south-western Nigeria [0.48 (0.36, 0.61)].ConclusionsThis study suggests distinct geographic patterns in the combined prevalence of overweight and obesity among Nigerian women, as well as the role of demographic, socio-economic and environmental factors in the ongoing nutritional transition in these settings.

High prevalence of overweight and obesity among inner city Chinese children in Shanghai, 2011

Background: In China, the prevalence of overweight and obesity appears to be increasing at unacceptable levels among young people living in major cities undergoing rapid economic growth.Objective: To report the prevalence of overweight and obesity among Shanghai inner city youth using the recently published International Obesity Task Force (IOTF) Asian definition.Methods: Secondary analysis of children aged 8–15 years who participated in the Shanghai Schools’ Physical Fitness Examinations, a representative school-based survey. Height and weight were measured and body mass index (kg/m2) was calculated. The prevalence of overweight and obesity was determined using the IOTF children’s BMI cut-points for Asian populations, equivalent to an adult BMI of 23 kg/m2 (overweight) and 27 kg/m2 (obese).Results: The prevalence of combined overweight and obesity was 49.1% for boys and 30.8% for girls aged 8–15-years. Almost one-in-five boys were obese, compared with 8.4% of girls. In boys the prevalence of overweight appeared to increase from age 10 years.Conclusion: The high prevalence of combined overweight and obesity among urban Chinese youth, especially among boys, requires immediate health promotion intervention.

Prevalence of young child overweight and obesity in the U.S.‐affiliated Pacific region: a meta analysis from the Children's Healthy Living Program (621.6)

A meta‐analysis of published literature and publicly available agency reports was conducted to estimate overweight and obesity prevalence of 2‐8 year (y) old US Affiliated Pacific (USAP) Region (USAP Islands, Hawai`i and Alaska) children. Contiguous US data served as reference. The search was limited to resources in English and 2‐8y on USAP children data from 2000 and newer and used CDC 2010 overweight and obesity reference data. USAP region sources (n=23) and NHANES articles (n=3; the contiguous U.S reference) were included. Data were disaggregated into single years of age. The children measured for the age group were divided equally and the prevalence was assigned to each individual age. A mixed model regressed the prevalence on a polynomial in age, accounting for the prevalence variance and another model compared jurisdictions. Overweight and obesity increased from 21.0% at 2y, to 39.2% at 8y (p&lt;0.0001) for the USAP. In comparison, combined overweight and obesity increased from 24.2% at 2y to 34.8% at 8y (p&lt;.0001) for NHANES. USAP data showed with a sharp increase in prevalence at 5y. Obesity alone increased from 10.2% at 2y, doubling to 23.6% at 8y (p&lt;0.0001) whereas overweight prevalence was stable from 2y (12.6%) to 8y (14.6%). Jurisdiction differences were dramatic. Further examination of USAP young child obesity is needed.Grant Funding Source: Supported by USDA Grant 2011‐68001‐30335

Abstract P086: Urbanization and Geographic Variation of Overweight/Obesity in India: the 2005-06 India Demographic Health Survey

Background: Obesity and overweight are considered to be the fifth leading risk factor for deaths worldwide. In India, the prevalence of overweight and obesity is growing, along with an ongoing nutritional transition as more people adopt urban lifestyles or migrate to urban areas for economic opportunities. Objective: This study examined the geographic variation of overweight/obesity in India, as well as a wide range of potential risk factors and correlates of overweight-obesity, including socio-demographics and level of urbanization. Methods: We conducted cross-sectional analyses of the 2005-06 India Demographic Health Survey (DHS), using anthropometric data from 161,050 individuals to determine prevalence of obesity and overweight, and demographics with regards to urban or rural settings. We then used a multivariate logistic regression model to determine the odds of combined overweight and obesity in urban settings as adjusted for age, sex, education level, standard of living, religion and zone for 111,730 individuals (after excluding underweight subjects [BMI &lt; 18.5] and missing cases) for India overall, and then for each zone separately. Results: The overall prevalence of combined overweight/obesity (BMI ≥ 25) was 15.5%. The odds of overweight/obesity in urban settings after adjusting for confounders as age, sex, education level, standard of living, religion and zone were nearly twice that of rural settings (OR 1.95, 95% CI: 1.88-2.02). We also found significant associations between overweight/obesity and higher education (OR 2.11 95% CI: 2.62-2.87), and higher standard of living (OR 6.71 95% CI: 6.25-7.21). Individuals from the southern zone were most likely to be overweight/obese when compared to the northern zone in multivariate analyses (OR 1.44, 95% CI: 1.36-1.52). While urban settings were consistently and significantly associated with higher risks of overweight/obesity across all zones, the risk was highest for individuals from the eastern zone (OR 2.57, 95% CI: 2.30-2.87). Conclusions: The results demonstrate significant associations between overweight/obesity and urbanization in India, with high risk estimates for overweight/obesity in urban settings even for the least urban zones. Socioeconomic prowess and the resulting nutritional transition in India make a compelling case for administrative policy on nutrition and healthy lifestyles to avert future burden of non-communicable diseases associated with overweight/obesity.

Abstract MP73: Geographic Variation of Overweight and Obesity among Women in Sub-Saharan Africa: a Case Study of Nigeria

Background: Nutritional research in sub-Saharan Africa has primarily focused on under-nutrition, particularly among vulnerable population subgroups such as women and children. However, there is growing evidence of an ongoing epidemiological and nutritional transition in these settings. Objective: This study aimed to examine the geographic variation of combined overweight and obesity prevalence at the state-level among women in Nigeria, while accounting for individual-level risk factors. Methods: Our analysis was based on the 2008 Nigerian Demographic and Health Survey (NDHS), including 27,967 women aged 15 and over. Individual data were collected on socio-demographic variables, but were aggregated to the 31 states. We used a Bayesian geo-additive mixed model to map the geographic distribution of overweight/obesity at the state-level, accounting for individual-level risk factors. Results: The overall prevalence of combined overweight and obesity (body mass index ≥ 25) was 20.9%. In multivariate Bayesian geo-additive models, there were several significant associations between socio-demographic variables and prevalence of overweight/obesity. Specifically, higher education [odds ratio (OR) &amp; 95% Credible Region (CR): 1.68 (1.38, 2.00)], higher wealth index [3.45 (2.98, 4.05)], living in urban settings [1.24 (1.14, 1.36)] and increasing age were all significantly associated with a higher prevalence of overweight/obesity. There was also a striking variation in overweight/obesity prevalence across ethnic groups and state of residence, the highest being in Cross River State, in south-eastern Nigeria [2.32 (1.62, 3.40)], the lowest in Osun State in south-western Nigeria [0.48 (0.36, 0.61)]. Conclusions: This study suggests distinct geographic patterns in the prevalence of combined overweight and obesity among Nigerian women, as well as the potential role of demographic, socio-economic and environmental factors driving the ongoing nutritional transition in these settings.

Ten-year changes in the prevalence of overweight, obesity and central obesity among the Chinese adults in urban Shanghai, 1998–2007 — comparison of two cross-sectional surveys

BackgroundIn China, obesity is expected to increase rapidly in both urban and rural areas. However, there have been no comprehensive reports on secular trends in obesity prevalence among Chinese adults in urban Shanghai, which is the largest city in southern China.MethodsIn 1998–2001 and again in 2007–2008, two independent population-based cross-sectional surveys were conducted in Shanghai to investigate the prevalence of metabolic disorders. These surveys obtained height, waist circumference (WC), and weight measurements for Chinese adults aged between 20 and 74 years who lived in urban communities. From the 1998–2001 survey, 4,894 participants (2,081 men and 2,813 women, mean age: 48.9 years) were recruited, and 4,395 participants (1,599 men and 2,796 women, mean age: 49.8 years) were recruited from the 2007–2008 survey. Using the World Health Organization criteria, overweight was defined as 25 kg/m2 ≤ BMI < 30 kg/m2 and obesity as BMI ≥ 30 kg/m2. Central obesity was defined as WC ≥ 90 cm in men or ≥85 cm in women. The differences in prevalence of obesity, central obesity and overweight between the two surveys were tested using multivariable logistic regression analyses.ResultsCompared to the 1998–2001 survey, in the 2007–2008 survey the BMI distribution for men and the WC distribution for both genders is shifted significantly to the right along the x-axis (all p < 0.001). Over the ten years, the prevalence of combined overweight and obesity increased 24% (from 31.5% to 39.1%, p < 0.001) in men, but decreased 8% (from 27.3% to 25.0%; p < 0.01) in women. The prevalence of central obesity increased 40% in men (from 19.5% to 27.3%; p < 0.01), but the increase was not significant in women (15.0% to 17.1%; p = 0.051). In the total population, only central obesity showed a significant change between the populations in the two surveys, increasing 29% (from 17.3% to 22.4%; p < 0.001).ConclusionsOver this 10 year period, central obesity increased significantly in the Shanghai adult population. However, the prevalence of combined overweight and obesity was significantly increased in men but not in women.

Decreased prevalence of overweight and obesity in the newfoundland and labrador preschool population.

This study was conducted to determine the prevalence of overweight and obesity in preschool-aged (42-66 months) children in Newfoundland and Labrador in 2009/10. Second, 2009/10 rates were compared to those reported for 2001/02 and 1988/89 to ascertain whether the previous rising trend had continued, stabilized or decreased while public health prevention and intervention efforts increased. Heights and weights of children measured in clinics in 2009/10, 2001/02 and 1988/89 were sampled, representing 29%, 77% and 45% of provincial births in 2005, 1997 and 1984, respectively. Body mass indices were calculated and classified as overweight, obese or neither, using World Health Organization (WHO) growth charts. ANOVA and regression procedures were used to compare cohorts. Combined overweight and obesity was significantly lower in 2009/10 (35.7%) than in 2001/02 (38.9%), (OR 0.87, 95% CI 0.76-0.99). Considered separately, both overweight and obesity rates stabilized. Boys were 1.4 times more likely to be overweight or obese than girls in all samples. In 2009/10, combined overweight and obesity was higher in rural areas (OR 1.67, 95% CI 1.28-2.18). In three of four public health jurisdictions, prevalence in 2009/10 remained significantly higher than 20 years earlier. In one region, rates returned to 1988/89 levels. Progress has been made in stabilizing, even reversing, overweight and obesity in the Newfoundland and Labrador preschool population, however, prevalence rates remain high. Surveillance and intervention efforts must continue. Given the jurisdictional and regional differences found, further research should compare ecological contexts and thus attempt to isolate and identify important contributing factors and effective interventions.

Birth weight, growth and feeding pattern in early infancy predict overweight/obesity status at two years of age: a birth cohort study of Chinese infants.

ObjectivesTo investigate the early determinants of overweight and obesity status at age two years.MethodsA total of 1098 healthy neonates (563 boys and 535 girls) were involved in this community-based prospective study in China. Data on body weight and length were collected at birth, the 3rd and 24th month. A self-administered questionnaire was used to collect data on social demography and feeding patterns of children, etc. Three multivariable logistic regression models were employed to make various comparisons of weight status, i.e., model 1 (obesity vs. non-obesity), model 2 (combined overweight and obesity vs. normal weight, and model 3 (obesity, overweight and normal weight).ResultsPrevalences of overweight/obesity (95th >BMI ≥85th p and BMI ≥95th p, referring to WHO BMI standards) at 2 years of age are 15.8%/11.2% for boys and 12.9%/9.0% for girls, respectively. Being born with macrosomia (OR: 1.80–1.88), relatively greater BMI increment in the first 3 months (OR: 1.15–1.16) and bottle emptying by encouragement at age two (OR: 1.30–1.57) were found in all three models to be significant risk factors for higher BMI status at 2 years. Pre-pregnancy maternal BMI (OR: 1.09–1.12), paternal BMI (OR: 1.06), and mixed breastfeeding (OR: 1.54–1.57) or formula feeding (OR: 1.90–1.93) in the first month were identified as significant in models 2 and 3. Child-initiated bottle emptying at age two was observed to increase the risk of obesity by 1.31 times but only in model 1.ConclusionFetal and early postnatal growth and feeding pattern appear to have significant impacts on early childhood overweight and obesity status independent of parental BMI. Policy-based and multidisciplinary approaches to promote breastfeeding and enhancement of feeding skills of care takers may be promising intervention strategies.

Comparing three body mass index classification systems to assess overweight and obesity in children and adolescents

To compare the International Obesity Task Force (IOTF) 2005, Centers for Disease Control and Prevention (CDC) 2000, and World Health Organization (WHO) 2007 body mass index (BMI) classification systems in terms of prevalence estimation and association with demographic factors. The 18 265 children and adolescents ages 5 to 18 years (mean = 11.2 years, standard deviation = 3.9 years) in the nationally representative Colombian National Nutrition Survey of 2005 were classified as overweight or obese according to IOTF, CDC, and WHO criteria. Prevalence estimates were compared according to each system and associations with age, sex, socioeconomic status, and population density were tested. Prevalence estimates of combined overweight and obesity differed by system (males: IOTF = 8.5%, CDC = 10.8%, WHO = 14.1%; females: IOTF = 14.6%, CDC = 13.8%, WHO = 17.1%; P < 0.001). The association between combined overweight and obesity and age and sex varied by system. The odds of having overweight and obesity in children (5 to 10 years) compared with adolescents (11 to 18 years) were: IOTF, odds ratio (OR) = 0.87 and 95% confidence interval (CI) = 0.77-0.98; CDC, OR = 1.27 and CI = 1.14-1.42; WHO, OR = 1.21 and CI = 1.08-1.35. The values for females compared with males were: IOTF, OR = 1.84 and CI = 1.6-2.10; CDC, OR = 1.33 and CI = 1.17-1.51; WHO, OR = 1.25 and CI = 1.12-1.41. There is a lack of consistency among the three main international systems in assessing overweight and obesity in children and adolescents. Appreciably different estimates of prevalence and associations with age and sex are obtained depending on which system is used. Future studies should assess how well each system reflects valid measures of body composition.

Overweight and obesity among public and private primary school children in Nairobi, Kenya

Obesity is on the rise in developing countries, especially in urban areas. In this study, a cross-sectional study was conducted in two divisions in Nairobi province to determine the prevalence of and some risk factors associated with overweight and obesity among school children in Nairobi, Kenya. It involved 344 school children aged 9-14 years drawn from four randomly selected public and private primary schools. Weight and height were measured and body mass index was calculated. Nutrition status was determined using the World Health Organization age and gender specific BMI-for-age Z-scores (BAZ). The chi-square test was used to determine the relationship between overweight/obesity and selected socio-demographic characteristics. Complete anthropometric measurements were available for 321 children. Prevalence of combined overweight and obesity (BAZ > +1SD) was 19.0%, with prevalence being higher among girls (21.0%) than boys (16.9%) (p = 0.632). The prevalence among children in private schools was significantly higher (29.0%) than among those in public schools (11.5%) (p = 0.000). In addition, being a single child (p = 0.020), birth order (p = 0.017), mother’s occupation (p = 0.023) and type of residence (p = 0.028) were positively associated with overweight/obesity. The prevalence of overweight/obesity determined in this study is high and is a public health concern, with girls particularly at risk of becoming overweight.

Prevalence and regional distribution of childhood overweight and obesity in Shandong Province, China

The rising prevalence of childhood obesity was observed in China. This study assessed the prevalence and district distribution of childhood obesity in Shandong Province, China. A cross-sectional study was conducted in the province. A total of 42 275 students (21 222 boys and 21 053 girls) aged 7-18 years from 16 districts participated in this study. Height and body weight of all subjects were measured, and the body mass index (BMI) was calculated. The prevalence of overweight and obesity was obtained according to the International Obesity Task Force (IOTF) cut-offs. In 2010, the prevalence rates of combined overweight and obesity reached 26.86% in urban boys, 18.32% in rural boys, 14.36% in urban girls, and 11.31% in rural girls, respectively. An increasing trend was observed in the prevalence of overweight and obesity from the low socioeconomic status (SES) group to the moderate and high SES groups. The prevalence rates of combined overweight and obesity in the three SES groups were 18.46%, 21.08% and 27.31% in boys and 10.43%, 12.42% and 15.18% in girls, respectively. There is a high level of overweight and obesity among children and adolescents in Shandong Province, China. The distribution of childhood obesity is positively associated with the regional SES.

Effect of Weight on Outcomes of Children Undergoing Hematopoietic Cell Transplantation

Chemotherapy dosing in hematopoietic cell therapy (HCT) conditioning regimens is based on patient weight. We hypothesized that potential underdosing or overdosing of patients with significant deviation of weight from normal might alter HCT outcomes, such as early mortality, overall or organ-specific toxicity, and/or relapse. We therefore conducted a retrospective analysis of 400 children between the ages of 2 and 18 years who underwent HCT for malignant or nonmalignant disease at Boston Children's Hospital over a 10-year period. Using the Centers for Disease Control and Prevention standard weight classification schema, we found no evidence to suggest a difference in survival or in time to engraftment or in relapse in patients with malignant disease. In the subgroups of patients either receiving autologous HCT or with underlying malignancy, combined overweight and obese patients had a higher rate of any organ, but not organ-specific, Grade 3–5 toxicity compared with the normal weight group. The study was not powered to detect a difference between underweight and normal weight patients. These data suggest that multiple outcome measures over the first year after HCT are unaffected by weight.