Higher Body Mass Index Percentile Research Articles

Characterizing differential risk effects of body mass index for Asian patients in the United States undergoing breast reconstruction

BackgroundAsian patient populations continue to be underrepresented in both plastic surgery research and rates of breast reconstruction. Better elucidation of reconstruction in Asian women may help guide patient-directed counseling. This study investigates the differential effect of body mass index (BMI), a well-known risk factor, for Asian patients in outcomes after breast reconstruction. MethodsAsian and White breast reconstruction patients were identified by CPT code in the National Surgical Quality Improvement Program. Within each cohort, BMI was converted into percentile ranks for standardized comparisons between cohorts. The effects of BMI on occurrence of complications for Asian and White patients were then quantified with multivariate logistic regression models. ResultsThe final cohort included 86,514 White patients and 4,813 Asian patients, of which 9,876 (11%) and 424 (8.8%) experienced at least one postoperative complication. The average BMI of White patients who experienced complications was 29.2±6.3kg/m2, a higher average than that of Asian patients, 25.6±4.8kg/m2. Higher BMI percentile was a significant predictor of increased risk of complications in White patients (OR: 1.005, 95% CI: 1.004-1.006, p<0.001). In Asian patients, however, BMI percentile was not a significant predictor of postoperative complications (OR: 1.001, 95% CI: 0.997-1.005, p=0.62). BMI percentile significantly predicted risk of unplanned reoperation in both cohorts (p<0.001 and p=0.029, respectively). ConclusionsWhereas BMI is a direct predictor of complications in White populations, this effect is held more inconsistently for Asian patients. Such trends can guide more informed interpretations of BMI in current risk algorithms. Data availability statementThe data that support the findings of this study are publicly available.

Analysis of possible risk factors for the severity of paediatric obstructive sleep apnoea syndrome.

This study aimed to determine the effect of body mass index (BMI) percentile, asthma, sex, and age on the paediatric obstructive sleep apnoea (OSA) severity. Furthermore, to determine the possible predictive role of the BMI percentile and age in severe OSA. This retrospective study included 921 children aged 2-18years diagnosed with OSA by polysomnography. Analysis of Covariance (ANCOVA), Spearman's correlation, Receiver Operating Characteristics (ROC) analyses were performedand area under the curve (AUC) was determined. We observed a significant association between a higher BMI percentile and the severity of OSA (p < 0.001, ρ = 0.15). The correlation also was significant under (p = 0.007, ρ = 0.11) and over 7 (p = 0.0002, ρ = 0.23) years of age. There was no association between the severity of OSA and the presence of asthma (p = 0.9) or sex (p = 0.891), respectively. Age was significantly related to OSA severity (p = 0.01, ρ = 0.08). Although both the BMI percentile (0.59 AUC [0.54-0.65]) and age (0.58 AUC [0.52-0.63]) predicted severe OSA, according to the sensitivity and specificity values of the ROC curve, the association presents a slight clinical relevance. OSA severity is determined by the BMI percentile and age in children; however, these factors are unsuitable for predicting severe OSA in clinical practice. Based on our results, obesity is also a significant risk factor for OSA in younger children. Our study highlights that older, overweight, and obese children have a higher risk for severe OSA.

High plasma IL-6 levels may enhance the adverse effects of mouse allergen exposure in urban schools on asthma morbidity in children

Few data on the relationships between environmental exposures, asthma morbidity, and systemic IL-6 inflammation exist. We sought to determine whether baseline plasma IL-6 level is associated with increased asthma morbidity in children exposed to mouse allergen in inner-city classrooms. Data from the longitudinal School Inner-City Asthma Studies of 215 children with asthma, aged 4 to 14 years and recruited from urban elementary schools, were analyzed. Given the unknown threshold of IL-6 risk levels and skewness of the distribution, the children were stratified into tertiles as follows: low baseline IL-6 level (<0.013 pg/mL), moderate baseline IL-6 level (0.013-0.302 pg/mL), and high baseline IL-6 level (>0.302 pg/mL). Relationships between plasma IL-6 level and body mass index (BMI) percentile, inflammatory markers, lung function, mouse allergen exposure, and asthma outcomes were assessed. Cross-sectional analysis demonstrated that increasing IL-6 level was associated with higher BMI percentile (P< .0001), C-reactive protein level (P= .0006), and blood neutrophil count (P= .0024). IL-6 was not associated with type 2 inflammatory markers, including blood eosinophil count, allergic sensitization, or fractional exhaled nitric oxide level. Longitudinal analysis showed that children with high IL-6 levels had a higher number of days with asthma symptoms than did those children with moderate (incidence rate ratio= 1.74 [95% CI= 1.10-2.77]; P= .0187) or low (incidence rate ratio=1.83 [95% CI= 1.21-2.77]; P= .0043) IL-6 levels. Children with high IL-6 levels who were exposed to increasing levels of mouse allergen exhibited lower ratios of FEV1 value to forced vital capacity than did children with moderate IL-6 levels (β= -0.0044 [95% CI= -0.0073 to -0.0015]; pairwise interaction P= .0028) or low IL-6 levels (β= -0.0042 [95% CI= - 0.0070 to -0.0013]; pairwise interaction P= .0039). Inner-city children with asthma and high plasma IL-6 levels are more likely to have an increased BMI, elevated C-reactive protein level, elevated blood neutrophil count, and greater asthma symptoms. High IL-6 level appears to increase susceptibility to the effects of classroom exposure to mouse allergen on lung function in urban children.

1116-P: Increase in the Incidence of Type 2 Diabetes in Children &amp;lt;11 Years during the COVID-19 Pandemic

Objectives: To analyze the incidence and characteristics of new-onset type 2 diabetes (T2D) in youth &amp;lt; 11years prior to and during the COVID-19 pandemic, and to compare the metabolic parameters at presentation in younger (&amp;lt; 11 years) versus older youth (11-21 years). Study methods: We performed a retrospective chart review of newly diagnosed T2D among youth &amp;lt; 21 years at Hasbro Children's Hospital between 1/1/2017 and 12/31/2021. We analyzed the incidence of cases presenting at &amp;lt; 11 years pre (1/1/2017 to 2/29/20) and during (3/1/20-12/31/21) the COVID-19 pandemic. We compared metabolic parameters of those presenting &amp;lt; 11years to ≥ 11 years during the pandemic. Results:Eight youth &amp;lt; 11 years (8/145, (5.5 %)) presented with new-onset T2D during the study period (Table1), and all presented during the pandemic (8/89, 9%). Compared to older youth, those &amp;lt; 11years had higher BMI percentile (166% of the 95th%tile ± 38.4 vs. 139.4% ± 42.6, p=0.03), and were more likely to have diastolic hypertension (62.5% vs. 23.8%, p=0.03). Conclusions: We report an abrupt rise in the incidence of new-onset T2D in children &amp;lt; 11 years during the COVID-19 pandemic. Compared to older youth, younger children were more obese, and were more likely to have diastolic hypertension. Further study is needed to elucidate contributing factors to this concerning finding, and to further aid in pediatric T2D prevention. Disclosure S.Sasidharan pillai: None. P.Has: None. L.S.Topor: None. M.E.Fredette: None.

Association of body mass index with COVID-19 outcome in a pediatric tertiary referral hospital in Iran

BackgroundOne of the challenging risk factors for severe COVID-19 infection is obesity and high body mass index (BMI). In this study we assessed the association between BMI and outcomes of hospitalized pediatric patients with COVID-19 in Iran. MethodThis retrospective cross-sectional study was performed in the biggest referral pediatric hospital in Tehran from March 7 to August 17, 2020. All hospitalized children ≺18 years of age with laboratory-confirmed COVID-19 were included in the study. We evaluated the association of BMI with COVID-19 outcomes (death, severity of clinical course, oxygen therapy, intensive care unit [ICU] admission, ventilator requirement). The secondary objectives were investigating the association of gender, underlying comorbidity, and patient age with COVID-19 outcomes. The limits for obesity, overweight, and underweight were set at BMI >95 percentile, 85≤ BMI ≤ 95, and BMI<5 percentile, respectively. ResultsIn total, 189 confirmed pediatric cases of COVID-19 (0.1–17 years) with a mean age of 6.4 ± 4.7 years were included. Overall, 18.5% of the patients were obese and 33% were underweight. We found that BMI had no significant relation with COVID outcomes in pediatric cases but after subgrouping the participants, underlying comorbidities and lower BMI in previously ill children were independently associated with a poor clinical outcome of COVID-19. In addition, the previously ill children with higher BMI percentiles were at a relatively lower risk of ICU admission (95% CI: 0.971–0.998, OR: 0.98, p = 0.025) and better clinical course of COVID-19 (95% CI: 0.970–0.996, OR: 0.98, p = 0.009). The BMI percentile had a statistically significant direct relationship with age (Spearman correlation coefficient= 0.26, p<0.001). When we separated the children with underlying comorbidity, the BMI percentile was significantly lower (p<0.001) in comparison to the previously healthy children. ConclusionBased on our results, obesity is not related to COVID-19 outcomes in pediatric patients, but after controlling for confounding effects, underweight in children with underlying comorbidities was more likely to be associated with a poor prognosis of COVID-19.

Association of Physical Activity and Screen Time With Body Mass Index Among US Adolescents

The Physical Activity Guidelines Advisory Committee Scientific Report identified important research gaps to inform future guidance for adolescents, including limited evidence on the importance of sedentary behaviors (screen time) and their interactions with physical activity for adolescent health outcomes, including overweight and obesity. To identify the independent associations of physical activity and screen time categories, and the interactions between physical activity and screen time categories, with body mass index (BMI) and overweight and obesity in adolescents. This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) Study collected from September 10, 2018, to September 29, 2020. Data were analyzed from July 8 to December 20, 2022. A total of 5797 adolescents aged 10 to 14 years from 21 racially and ethnically diverse study sites across the US were included in the analysis. Categories of total step count per day (with 1000 to 6000 steps per day indicating low, >6000 to 12 000 steps per day indicating medium, and >12 000 steps per day indicating high), as measured by a wearable digital device (Fitbit), and categories of self-reported screen time hours per day (with 0 to 4 hours per day indicating low, >4 to 8 hours per day indicating medium, and >8 hours per day indicating high). Participant BMI was calculated as weight in kilograms divided by height in meters squared and converted into sex- and age-specific percentiles in accordance with the Centers for Disease Control and Prevention growth curves and definitions. Individuals were classified as having overweight or obesity if their BMI was in the 85th percentile or higher for sex and age. Among 5797 adolescents included in the analytic sample, 50.4% were male, 61.0% were White, 35.0% had overweight or obesity, and the mean (SD) age was 12.0 (0.6) years. Mean (SD) reported screen time use was 6.5 (5.4) hours per day, and mean (SD) overall step count was 9246.6 (3111.3) steps per day. In models including both screen time and step count, medium (risk ratio [RR], 1.24; 95% CI, 1.12-1.37) and high (RR, 1.29; 95% CI, 1.16-1.44) screen time categories were associated with higher overweight or obesity risk compared with the low screen time category. Medium (RR, 1.19; 95% CI, 1.06-1.35) and low (RR, 1.30; 95% CI, 1.11-1.51) step count categories were associated with higher overweight or obesity risk compared with the high step count category. Evidence of effect modification between screen time and step count was observed for BMI percentile. For instance, among adolescents with low screen use, medium step count was associated with a 1.55 higher BMI percentile, and low step count was associated with a 7.48 higher BMI percentile. However, among those with high screen use, step count categories did not significantly change the association with higher BMI percentile (low step count: 8.79 higher BMI percentile; medium step count: 8.76 higher BMI percentile; high step count: 8.26 higher BMI percentile). In this cross-sectional study, a combination of low screen time and high step count was associated with lower BMI percentile in adolescents. These results suggest that high step count may not offset higher overweight or obesity risk for adolescents with high screen time, and low screen time may not offset higher overweight or obesity risk for adolescents with low step count. These findings addressed several research gaps identified by the Physical Activity Guidelines Advisory Committee Scientific Report and may be used to inform future screen time and physical activity guidance for adolescents.

Association of Perceived Neighbourhood Walkability with Self-Reported Physical Activity and Body Mass Index in South African Adolescents.

Adolescence is a life stage critical to the establishment of healthy behaviours, including physical activity (PA). Factors associated with the built environment have been shown to impact PA across the life course. We examined the sociodemographic differences in, and associations between, perceived neighbourhood walkability, PA, and body mass index (BMI) in South African adolescents. We recruited a convenience sample (n = 143; 13-18 years; 65% female) of students from three high schools (middle/high and low-income areas). Participants completed a PA questionnaire and the Neighbourhood Environment Walkability Scale (NEWS)-Africa and anthropometry measurements. Multivariable linear regression was used to examine various relationships. We found that, compared with adolescents living in middle/high income neighbourhoods, those living in low-income neighbourhoods had lower perceived walkability and PA with higher BMI percentiles. The associations between neighbourhood walkability and PA were inconsistent. In the adjusted models, land use diversity and personal safety were associated with club sports participation, street connectivity was positively associated with school sports PA, and more favourable perceived walkability was negatively associated with active transport. Overall, our findings suggest that the perceived walkability of lower income neighbourhoods is worse in comparison with higher income neighbourhoods, though the association with PA and BMI is unclear.

SMART SCREEN EXPOSURE AND ITS ASSOCIATION WITH ADDICTIVE FOOD BEHAVIOR AND SLEEP DISORDERS IN CHILDREN. WHAT’S BEYOND THE SCENE?

In today’s digital age, the increasing currency of smart screen exposure in our children’s lives is becoming a global public health concern. The reciprocal ability, and enjoyment value, with the increased demand for using smart screen devices have led to their rising merge into day-to-day activities. This study is an observational cross-sectional study conducted in 632 children, aiming to comprehensively investigate Egyptian children’s attitude towards smart screens and whether children who are more exposed to smart screens are prone to have a higher BMI percentile, addictive eating behavior, and disturbed sleep. The research results have shown that 69.6% of the children had a high exposure rate, 1.9% had a low exposure rate and 28.5% were in-between. Furthermore, 51% of the children demanded the products seen on smart screens every day, 32% had a demand a few times per week while 17% demanded those products once a week. In addition, 56% of the participants had obesity while 44% had normal BMI, out of which 35.9% had both obesity and addictive food behavior. Smart screen exposure is associated with disturbed sleep and short sleep duration. A statistically significant correlation was revealed between the periods in which children were most exposed to smart screens and disturbed sleeping habits in all participants in this study. To conclude, it is important to monitor children’s media exposure and identify the negative consequences of smart screens to support behavioral changes and alter communication styles, prompt strategies, and set goals toward a better healthy life.

Maternal prenatal cortisol trajectories predict accelerated growth in infancy

Higher maternal cortisol in pregnancy has been linked to childhood obesity. Much of the previous research has been limited in that cortisol in pregnancy is only measured at one time-point, precluding the ability to examine critical timing effects of prenatal maternal cortisol. To fill this gap, this longitudinal study measured maternal plasma cortisol at 15, 19, 25, and 31 weeks of pregnancy, and assessed infant body mass index percentile (BMIP)11Body mass index percentile. at birth, 3, 6, 12, and 24 months in 189 mother-infant pairs. Three distinct patterns of maternal cortisol in pregnancy (typical, steep, and flat trajectories) were identified using general growth mixture modeling (GGMM)22General growth mixture modeling. and then used to predict child growth patterns using multilevel modeling. Infants of mothers who had flat cortisol trajectories, characterized by relatively high cortisol in early gestation that plateaus by mid-gestation, experienced more rapid increases in BMIP from birth to 6 months, and had higher BMIPs at 3 and 6 months, than infants whose mothers had the typical slow cortisol rise over gestation, or steep (rapidly accelerating) trajectories. These results suggest that it is not just the total amount of maternal cortisol in pregnancy that shapes early infant growth, but instead the timing and trajectory of prenatal cortisol exposure. To better understand the early origins of obesity risk, future research is needed to investigate the factors that shape mothers’ prenatal cortisol trajectories.

Changes in Cone-Beam Computed Tomography Pediatric Airway Measurements After Adenotonsillectomy in Patients With OSA

Early intervention using cone-beam computed tomography (CBCT) and adenotonsillectomy for children with obstructive sleep apnea (OSA) may prevent impaired growth, adverse cardiovascular consequences, learning deficits, and poor quality of life. To assess changes in CBCT airway measurements and polysomnography (PSG) parameters that occur after adenotonsillectomy in children with OSA and to determine whether CBCT changes are correlated with apnea-hypopnea index (AHI) reduction. This prospective cohort study was conducted at a tertiary medical center from 2013 to 2016. Children aged 7 to 13 years with PSG-confirmed OSA (ie, AHI ≥1) were recruited. Data analysis was performed from March to July 2021. All participants underwent CBCT and PSG before and after adenotonsillectomy. Changes in PSG and CBCT parameters after adenotonsillectomy were analyzed. A total of 49 children (mean [SD] age, 9.5 [1.8] years; 34 boys [69.4%]) were recruited. Eighteen participants (36.7%) had obesity. After adenotonsillectomy, AHI significantly decreased from 11.4 to 1.2 events per hour (mean difference, -10.24 events per hour; 95% CI, -13.84 to -6.64 events per hour). The following CBCT parameters significantly increased: total airway volume (from 11 265 to 15 161 mm3; mean difference, 3896.6 mm3; 95% CI, 2788.0 to 5005.2 mm3), nasopharyngeal volume (from 2366 to 3826 mm3; mean difference, 1459.7 mm3; 95% CI, 1122.9 to 1796.5 mm3), minimal nasopharyngeal airway area (from 128 to 191 mm2; mean difference, 63.1 mm2; 95% CI, 47.4 to 78.8 mm2), mean nasopharyngeal airway area (from 144 to 231 mm2; mean difference, 86.8 mm2; 95% CI, 67.0 to 106.5 mm2), oropharyngeal volume (from 8898 to 11 335 mm3; mean difference, 2436.9 mm3; 95% CI, 1477.0 to 3396.8 mm3), minimal oropharyngeal airway area (from 82 to 158 mm2; mean difference, 76.2 mm2; 95% CI, 57.0 to 95.4 mm2), and mean oropharyngeal airway area (from 182 to 234 mm2; mean difference, 52.5 mm2; 95% CI, 33.6 to 71.4 mm2). Among all parameters, only body mass index percentile showed large effect size between the group with residual OSA (postoperative AHI ≥1) and the group with resolved disease, with the residual OSA group having a higher body mass index percentile (87.8 vs 61.4; mean difference, 26.33; 95% CI, 10.00 to 42.66). A quantile regression model revealed that total airway volume and minimal oropharyngeal airway area were significantly correlated with reductions in AHI. These findings suggest that in children undergoing adenotonsillectomy, improvements in total airway volume and oropharyngeal minimal airway area were correlated with reduction of AHI. Future studies are needed to assess whether CBCT has a role in the evaluation of children with OSA who are being considered for adenotonsillectomy.

Infant Predictors of Childhood Overweight

Previous studies have identified numerous risk factors to be associated with early obesity, among them high birth weight and energy intake, low activity or energy expenditure, high maternal body mass index, rapid early infant growth, short duration of sleep, and overly controlling feeding styles. The aim of the present study was to examine these various factors as predictors of overweight in early childhood. Ninety-one mothers were observed feeding their infants at 12-months, with infants weighed and measured again at 36-months. Motor activity, sleep duration, and difficultness were also assessed. The results revealed that nearly all the factors showed some associations with higher BMI percentiles, such that multiple factors are at work in promoting early excess weight gain in the early years of development.

The Perception of Snack Healthiness and Preferences in Children is Related to Health Parameter Measures

The relationship between snack preferences/healthiness and health parameters is still poorly defined. Most children choose snacks low in nutritional value, which may contribute to the rise in childhood obesity. This study has examined children’s snack preferences and healthiness by age and gender and correlated them with their health parameters. Scottish Nursery and Primary children aged 3–12 years (n = 472) performed snack card sorting exercises in which they were presented with 18 different colored snack images, which counted as one portion, followed by two main snack questions related to snack healthiness and preferences. Health parameters were measured. Older children were better able to determine which snacks were healthier based on their energy content. Children with a higher body mass index percentile were not found to have a specific preference for unhealthy snacks based on the four nutritional components. However, snacks high in fat and sugar (and low in energy and salt) were preferred by children with higher body fat. A positive relationship was observed between the energy content of the children’s top five snacks selected for healthiness and their weight, waist circumference, hip circumference, waist-to-hip ratio, and waist-to-height ratio. There was only a negative relationship with height and body fat. The relationship between children’s perceptions of snack preferences and healthiness and their health parameters is still unclear and needs further investigation.

Parenting Practices and Adolescents' Eating Behaviors in African American Families.

Parents play an important role in developing the eating behaviors of their children by adopting specific parenting practices. As the prevalence of obesity is high amongst African American adolescents, investigations into associations of specific parenting practices and adolescents’ eating behaviors are essential. In this exploratory study, 14 African American parent–adolescent dyads were interviewed to characterize the influence of eight different parenting practices on the consumption of three main food categories (dairy, fruits and vegetables, and unhealthy snacks). The results revealed that authoritarian parenting practices were correlated with a higher BMI percentile in adolescents, whereas modeling and monitoring are correlated with a higher parent BMI. In addition, reasoning, monitoring, modeling, and authoritative parenting practices were associated with less unhealthy snack consumption among adolescents. Reasoning and monitoring were the only parenting practices associated with higher fruit and vegetable consumption. Finally, a significant correlation was found between eating fruits and vegetables and unhealthy snacks and the location of eating. In conclusion, different parenting practices and environmental factors may impact BMI and food consumption of African American dyads. The results of this study can be used to guide improvement in, and/or development of, nutritional education interventions considering the cultural differences of racial minorities.

Relationship between Skeletal Maturity, BMI Percentile and Dental Caries Experience among Taster and Non-taster Children

Introduction: Ability of an individual to taste phenylthiocarbamide (PTC) substance divides the population in tasters and non-tasters. The objective of this study was to investigate the relationship between the taste ability for PTC substance with BMI percentile, skeletal maturity and dental caries experience within taster and non-taster children of age 8-12 years.&#x0D; Hypotheses: Tasting ability for PTC affects the BMI percentile, skeletal maturity and dental caries experience and emerge as a useful caries risk assessment tool.&#x0D; Evaluation of Hypotheses (Materials and Method): One hundred children of 8-12 years were randomly selected and their taste perception was assessed using PTC sensitivity test. Radiovisiography (RVG) of middle phalanx was obtained to determine the skeletal maturity by using Rajgopal and Kansal modification 2005. Anthropometric measurements were recorded to obtain BMI value and then BMI percentile was calculated using CDC Pediatric growth charts. For dental caries assessment, deft/DMFT scores were recorded.&#x0D; Results: The non-tasters had early skeletal maturation, higher caries experience and higher BMI percentile than the tasters.&#x0D; Conclusion and Clinical Relevance: PTC Sensitivity is a genetically controlled trait showing strong association with dental caries. From the results of this study we can conclude that the genetic ability of tasting PTC affects the BMI percentile, skeletal maturity and dental caries experience. Thus it can emerge as a useful caries risk assessment tool helping in planning the preventive measures and interceptive orthodontics in children.

Gestational body weight gain and risk of low birth weight or macrosomia in women of Japan: a nationwide cohort study

ObjectiveBoth maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) influence maternal and pediatric outcomes. We sought to clarify the impact of prepregnancy BMI-specific GWG and its patterns on the risk of low birth weight (LBW) or macrosomia using data from a large nationwide study in Japan.MethodsThis cohort study (n = 98,052) used data from the Japan Environment and Children’s Study (JECS). The outcome variables in this study were LBW and macrosomia. We stratified the subjects into groups according to prepregnancy BMI.ResultsGWG from pre-pregnancy to the first trimester had a small effect on the risk of LBW and macrosomia. From the first to second trimesters, insufficient GWG was associated with the risk of LBW, and from the second trimester to delivery, a GWG of less than 2 kg was associated with the risk of LBW. These associations were commonly observed in all prepregnancy BMI categories. Irrespective of the GWG from pre-pregnancy to the first trimester, GWG from the first to second trimesters affects LBW and/or macrosomia. Irrespective of the GWG from the first to second trimesters, GWG from the second trimester to delivery affects LBW and/or macrosomia. LBW or macrosomia was associated with the prevalence of a sustained low or high BMI percentile until three years of age, respectively.ConclusionsThe present large national cohort study indicates that the risk of LBW or macrosomia is associated with GWG in women in Japan; the significance of this risk depends on the GWG patterns.

Contemporary screen time usage among children 9-10-years-old is associated with higher body mass index percentile at 1-year follow-up: A prospective cohort study.

There is a paucity of prospective research exploring the relationship among contemporary screen time modalities (e.g., video streaming, video chatting, texting and social networking) and body mass index (BMI) percentile. The objective of this study was to determine the prospective associations between screen time behaviours in a large and demographically diverse population-based cohort of 9-10-year-old children and BMI percentile at 1-year follow-up. We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N=11 066). Multiple linear regression analyses were conducted to estimate associations between baseline screen time behaviours (exposure) and BMI percentile at 1-year follow-up, adjusting for race/ethnicity, sex, household income, parent education, depression, binge-eating disorder and baseline BMI percentile. Each additional hour of total screen time per day was prospectively associated with a 0.22 higher BMI percentile at 1-year follow-up (95% CI 0.10-0.34) after adjusting for covariates. When examining specific screen time behaviours, each additional hour of texting (B=0.92, 95% CI 0.29-1.55), video chat (B=0.72, 95% CI 0.09-1.36) and video games (B=0.42, 95% CI 0.06-0.78) was significantly prospectively associated with higher BMI percentile. Screen time is prospectively associated with a higher BMI percentile 1 year later among children 9-10 years old.

Correlation between Body Mass Index and Left Ventricular Remodeling and Function in Children with Sickle Cell Disease

Background:Cardiovascular complications play an important role in morbidity and mortality of patients with sickle cell disease (SCD). Historically, patients with SCD were underweight, but due to changes in the diet and advances in therapies there is a trend of increasing BMI, with some patients developing metabolic syndrome (MS). We hypothesized that obesity, MS, and SCD are associated with left ventricular (LV) remodeling and dysfunction and the presence of these conditions may increase the risk of cardiac disease.Objective:We aimed to evaluate the association between BMI and LV remodeling and dysfunction in pediatric patients with SCD, as well as the association with laboratory markers and clinical outcomes.Methods:We performed a retrospective study that included patients 10 to 22 years old with SCD followed at St. Christopher's Hospital for Children. Data collected included BMI, markers of MS, hemolysis, and inflammation, clinical outcomes and 2D and Doppler echocardiographic parameters. Echocardiogram parameters included those of cardiac structure, geometry, systolic function, and diastolic function. Analysis of variance (ANOVA) tests were performed to examine the differences between biomarkers and various weight categories. Pearson correlations were calculated to evaluate associations of BMI percentile with biomarkers and LV remodeling variables. A chi square test was used to assess differences in geometry by weight categories. Differences in BMI percentile associated with MS status was explored with a T-Test. ANOVA was used to assess differences in mean LV remodeling and functional variables associated with the various weight categories.Results:Demographic and laboratory data was collected on all 139 patients who met inclusion criteria, 35 had both pediatric cardiology evaluation and complete echocardiography. Of the 139 patients, 17 (12%) were obese, with 5 of them meeting the criteria for MS as defined by the International Diabetes Federation. Blood pressure was found to be significantly higher in obese patients when compared to non-obese patients (p = 0.026). Hemoglobin was statistically different among weight groups (underweight, normal weight, overweight, obese), with higher mean values being seen in the overweight and obese groups (p = 0.006). No significant correlations were found between cardiac biomarkers, BMI percentile and MS. In 35 patients with echocardiographic data, BMI percentile was positively correlated with relative wall thickness and negatively correlated with peak early LV filling and peak early LV filling/septal annuli early peak (E/Ea) velocities. Relative wall thickness was also positively associated with age. Partial correlations of BMI percentile with these variables were therefore calculated and remained significant in the same directions: Relative wall thickness (r = 0.345, p = 0.046), peak early LV filling velocity (r = -0.473, p = 0.011) and E/Ea (r = -0.415, p = 0.015). E/Ea was also significantly associated with weight category, with higher values in the normal and underweight groups (p = 0.020). Weight category and geometry were not significantly related.Conclusions:Obese patients were found to have significantly higher blood pressures and higher BMI percentiles were associated with LV remodeling, contributing to the risk of cardiac disease. Conversely, higher BMI percentile was associated with lower diastolic function measures (improved LV diastolic function) and the trend of higher mean hemoglobin values. This study suggests a complex relationship between BMI, hemoglobin and cardiovascular risks in children with SCD. Further prospective studies with larger sample size are necessary to validate our findings and to develop preventive strategies for cardiovascular risks in SCD. DisclosuresNo relevant conflicts of interest to declare.

Effectiveness of a Weight Loss Program Using Digital Health in Adolescents and Preadolescents.

Objective: To identify an efficacious intervention on treating adolescents with overweight and obesity, this might result in health benefits.Methods: Adolescents with overweight or obesity aged 10–17 years with BMI percentile ≥85th were included in this historical observational analysis. Subjects used an entirely remote weight loss program combining mobile applications, frequent self-weighing, and calorie restriction with meal replacement. Body weight changes were evaluated at 42, 60, 90, and 120 days using different metrics including absolute body weight, BMI, and BMI z-score. Chi-square or Fisher exact tests (categorical variables) and Student's t-test (continuous variables) were used to compare subjects.Results: In total, 2,825 participants, mean age 14.4 ± 2.2 years, (54.8% girls), were included from October 27, 2016, to December 31, 2017, in mainland China; 1355 (48.0%) had a baseline BMI percentile ≥97th. Mean BMI and BMI z-score were 29.20 ± 4.44 kg/m2 and 1.89 ± 0.42, respectively. At day 120, mean reduction in body weight, BMI, and BMI z-score was 8.6 ± 0.63 kg, 3.13 ± 0.21 kg/m2, and 0.42 ± 0.03; 71.4% had lost ≥5% body weight, 69.4% of boys and 73.2% of girls, respectively. Compared with boys, girls achieved greater reduction on BMI z-score at all intervals (p < 0.004 for all comparisons). Higher BMI percentile at baseline and increased frequency of use of the mobile application were directly associated with more significant weight loss.Conclusions: An entirely remote digital weight loss program is effective in facilitating weight loss in adolescents with overweight or obesity in the short term and mid term.

Low Health Literacy Is Associated With Energy-Balance-Related Behaviors, Quality of Life, and BMI Among Rural Appalachian Middle School Students: A Cross-Sectional Study.

Many studies document associations between low health literacy (HL) and poor health behaviors and outcomes. Yet, HL is understudied among adolescents, particularly from underserved, rural communities. We targeted rural adolescents in this cross-sectional study and explored relationships between HL and (1) energy-balance-related health behaviors and (2) body mass index (BMI) and quality of life (QOL). Surveys were administered to 7th graders across 8 middle schools in rural Appalachia. HL was assessed using the Newest Vital Sign. Energy-balance-related behaviors and QOL were assessed using validated instruments. Height and weight were objectively measured. Analyses were conducted using the Hodges-Lehmann nonparametric median difference test. Of the 854 adolescent students (mean age=12; 55% female), 47% had limited HL. Relative to students with higher HL, students with lower HL reported significantly lower frequency of health-promoting behaviors (water, fruit and vegetable intake, physical activity, sleep), higher frequency of risky health behaviors (sugar-sweetened beverages, junk food, screen time), and had higher BMI percentiles and lower QOL (all p < .05). Low HL is associated with energy-balance-related behaviors, BMI, and QOL among rural, Appalachian adolescents. Findings underscore the relevance of HL among rural middle school students and highlight implications for school health.

Effects of participation level and physical activity on eating behavior and disordered eating symptoms in the Brazilian version of the New Moves intervention: data from a cluster randomized controlled trial.

Childhood and adolescent obesity is a worldwide public health concern. The New Moves program aims to change eating behavior (EB) and physical activity (PA). To evaluate the effectiveness of an intervention and predictors of better outcomes relating to EB and PA levels. Secondary data from a cluster randomized controlled trial in 10 public schools in São Paulo, Brazil. 270 female adolescents, aged 12 to 14 years, were analyzed. Participation levels were categorized as presence in 1 to 9 sessions or 10 to 17 sessions, or control. Effectiveness was evaluated through improvement in disordered EB (DEB) and EB. Predictors of better outcomes relating to PA levels were evaluated through clustering of individual characteristics that affected changes in PA scores. Participation level was not significantly associated with changes in DEB or EB. Girls with higher body mass index percentile (BMI-P) percentile tended to have increases in sedentary lifestyles through the program. Girls with less body image dissatisfaction presented higher increases in daily PA. Girls with higher BMI-P percentile and higher self-esteem showed reductions in sedentary lifestyles. The program seemed to have more effect on daily PA among older girls than among younger girls. This program could be used as a structured action plan in schools, with the aims of improving eating behaviors and physical activity, in addition to promoting self-acceptance. The results indicate the importance of evaluating determinants of adherence, as these metrics might influence the effectiveness and future design of lifestyle programs.