Higher Body Mass Index Z-score Research Articles

Factors associated with referral for polysomnography in children with Down syndrome

ObjectivesChildren with Down syndrome (DS) are recommended to undergo polysomnography (PSG) by the age of four years due to the high prevalence of obstructive sleep apnea (OSA) in this group, but compliance is incomplete. To further understand referral patterns for PSG in this condition, we aimed to compare demographics, PSG results, OSA severity, behavior, daytime functioning and quality of life (QOL) between children with DS referred for sleep testing and those recruited from the community. Study designChildren 3–19 years with DS was included: 20 referred clinically for assessment of OSA and 24 volunteers from the community. Demographic and anthropometric data, PSG parameters, sleep-related symptoms and QOL, behavior and daytime functioning were compared between groups. ResultsOSA severity did not differ between groups: 50% of the clinical and 42% of the community group had moderate/severe OSA. The clinical group had a higher weight z-score, BMI z-score, waist and hip circumference and neck-to-waist ratio. Questionnaire scores for daytime functioning, behavior and QOL were not different between groups. ConclusionsDespite not being referred for clinical sleep assessment, 42% of children with DS recruited from the community had moderate/severe OSA. There was no difference in the QOL, behavior, daytime functioning and sleep symptoms questionnaires although the clinical group had a higher BMI-Z score and overt signs of obesity. These findings underscore the importance of PSG screening of all children with DS.

Sleep and BMI in South African urban and rural, high and low-income preschool children

BackgroundThe extent to which income setting or rural and urban environments modify the association between sleep and obesity in young children is unclear. The aims of this cross-sectional observational study were to (i) describe and compare sleep in South African preschool children from rural low-income (RL), urban low-income (UL) and urban high-income (UH) settings; and (ii) test for associations between sleep parameters and body mass index (BMI).MethodsParticipants were preschoolers (5.2 ± 0.7y, 49.5% boys) from RL (n = 111), UL (n = 65) and UH (n = 22) settings. Height and weight were measured. Sleep, sedentary behaviour and physical activity were assessed using accelerometery.ResultsUL children had higher BMI z-scores (median: 0.39; interquartile range: − 0.27, 0.99) than the UH (− 0.38; − 0.88, 0.11) and RL (− 0.08; − 0.83, 0.53) children (p = 0.001). The UL children had later bedtimes (p < 0.001) and wake-up times (p < 0.001) and shorter 24 h (p < 0.001) and nocturnal (p < 0.001) sleep durations than the RL and UH children. After adjusting for age, sex, setting, SB and PA, for every hour less sleep obtained (24 h and nocturnal), children were 2.28 (95% CI: 1.28–4.35) and 2.22 (95% CI: 1.27–3.85) more likely, respectively, to belong to a higher BMI z-score quartile.ConclusionsShorter sleep is associated with a higher BMI z-score in South African preschoolers, despite high levels of PA, with UL children appearing to be particularly vulnerable.

The fetal origins of disease: a prospective cohort study on the association of preeclampsia and childhood obesity.

Cardiovascular diseases are the main cause of mortality worldwide, and childhood excess weight/obesity are strong correlators of accumulated risk in later life. A relationship between maternal preeclampsia and offspring's childhood obesity is recognized, but most studies fail to control for strong confounders. Our goal is to analyze the association between preeclampsia and childhood excess weight/obesity, after accounting for important confounders. We recruited 5133 women with singleton pregnancies during admission for delivery. Sixty-seven pregnancies were complicated by preeclampsia. Maternal and children outcomes were assessed at 10 years of age. We analyzed the association between preeclampsia and childhood excess weight/obesity by fitting a linear regression model (using offspring body mass index (BMI) z-score at 10 years of age) and a logistic regression model (using excess weight/obesity status). We then controlled both models for known confounders, namely maternal prepregnancy BMI, parity, and smoking during pregnancy. At 10 years of age, offspring of preeclamptic mothers had a higher BMI z-score and were more likely classified as overweight/obese, but these differences were not statistically significant. After controlling for maternal prepregnancy BMI, parity, and smoking during pregnancy, there was a high magnitude change in the beta coefficient of preeclampsia in the linear (0.175; -0.014) and the logistic regression models (1.48; 1.23) suggesting that the association between preeclampsia and childhood excess weigh/obesity is significantly confounded by these variables. These confounders also showed a significant association with childhood obesity. This finding suggests that in utero exposure to preeclampsia seems to have less impact in childhood obesity than the previously described confounders.

Mediating effect of milk intake between family socioeconomic status and body mass index of children and adolescents

Objective To examine the association between family socioeconomic status (SES) and body mass index (BMI) z-score of children and adolescents, and the mediating effect of milk intake in this association. Methods In the study, 2 496 students and their parents were selected from 16 schools (4 urban middle schools, 4 rural middle schools, 4 urban primary schools, and 4 rural primary schools) using a stratified cluster sampling method. The frequency and amount of weekly milk intake from the 7-day Food Records reported by the students were extracted. The parents' education and household income were the indicators of family SES. The mediating effect of milk intake between family SES and BMI z-score of children and adolescents were tested using the PROCESS add-on SPSS software. Results Parents' education level and household income were positively correlated with BMI z-score of children and adolescents (P=0.001 and 0.038, respectively). The overall average daily intake of milk was (0.92±0.84) servings, and the frequency was (4.43±2.70) days per week. The students of primary school, in urban areas, with higher parents' education level, with higher household income, and being non-obese were likely to have higher frequency and amount of milk intake. Milk intake was one of the mediating factors in the relationship between family SES and BMI z-score of children and adolescents. Specifically, the mediating effect of the frequency of milk intake accounted for -6.57% and -10.21% of the total effects of the association between the parents' education and the household income with BMI z-score of children and adolescents, respectively. The mediating effect of the daily intake of milk accounted for -3.63% and -5.86% of the total effects of the association between the parents' education and the household income with BMI z-score of children and adolescents, respectively. Conclusion The milk intake of Chinese children and adolescents still needs to be improved. High family SES was found to contribute to high BMI z-score, mediated by the milk intake which was the protective factors of BMI z-score. Further research is needed to study other dietary or physical exercise behaviors that mediate the relationship between family SES and BMI z-score of children and adolescents in order to adopt more targeted interventions.

Temperament, socioeconomic adversity, and perinatal risk as related to preschoolers' BMI.

Disparities in childhood obesity necessitate identification of risk-protective and risk- augmenting factors for young children experiencing socioeconomic adversity born with perinatal risk. Temperamental reactivity is a biological marker of susceptibility to environmental characteristics. This study tested whether temperamental reactivity moderated the relation between socioeconomic risk and children's body mass index (BMI). This study examined 100 Head Start preschoolers (Mage = 4.07 years, SD = 0.56) with perinatal risk, defined as preterm birth (PT, <37 weeks gestation) or low birth weight (LBW, <2500g). Anthropometric measurements were collected from children and parents. Parents completed questionnaires on family level demographics and household food insecurity to create a cumulative socioeconomic risk variable. Parents also completed the Children's Behavior Questionnaire to assess preschoolers' temperamental reactivity. Results supported a differential susceptibility hypothesis such that preschoolers' temperamental reactivity significantly moderated the relation between socioeconomic risk and child BMI z-score (BMIz). Higher BMIz was observed in highly reactive children exposed to higher socioeconomic risk. Alternatively, lower exposure to socioeconomic risk was related to lower BMIz for highly reactive children. Findings suggest that highly reactive PT/LBW preschoolers are differentially susceptible to early socioeconomic adversity in a for better or for worse manner regarding BMIz. Thus, consideration of temperament as a marker of biological sensitivity to context may be necessary to inform obesity prevention for PT/LBW preschoolers from low-income families. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

EXCESSIVE WEIGHT GAIN IN PEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS ON ANTI-TNF THERAPY

Abstract Background Limited studies in patients with inflammatory bowel disease (IBD) suggest that anti-TNF therapy may be associated with excessive weight gain. The objective of this study was to compare the change in BMI z-score in children with Crohn Disease (CD) on anti-TNF therapy (CD exposed) to those not on anti-TNF therapy (CD unexposed) over time. We also sought to determine if anti-TNF exposure is a risk factor for excessive weight gain and obesity. Methods This was a retrospective cohort study utilizing the RISK database, a longitudinal inception cohort of pediatric patients with CD. Multivariable logistic, linear random mixed effects, and multilevel mixed effects generalized linear regression models were used to evaluate the association of anti-TNF therapy with excessive weight gain, change in BMI z-score, and obesity, respectively. Excessive weight gain was defined as patients with a normal baseline BMI z-score who became overweight/obese or had a delta BMI z-score &amp;gt;1 at the end of follow-up, underweight patients who became overweight/obese, and overweight patients who became obese or had a delta BMI z-score &amp;gt;0.5 at the end of follow-up. Results 625 (61%) exposed and 404 (39%) unexposed patients were included. There was no difference in age at diagnosis or sex between groups, however the CD exposed group had lower BMI z-score [-0.9 (IQR -1.8, 0.0) vs -0.5 (IQR -1.4, 0.3)] as well as higher disease activity index [52.5 (IQR 35.0, 72.5) vs 40.0 (IQR 25, 57.5)] and C-reactive protein (CRP) [4.5 (IQR 1.4, 13.0) vs 2.7 (IQR 0.7, 9.0)] at baseline. 28% of the group exposed to anti-TNF therapy met criteria for excessive weight gain. Exposed patients were at 1.43 (CI 1.06, 1.93) greater odds of excessive weight gain as compared to the unexposed group, controlling for baseline BMI z-score and sex. BMI z-score increased with anti-TNF exposure, particularly in the first year of follow-up and in children who were underweight at baseline, controlling for baseline BMI z-score, sex, CRP, and steroid exposure (Table 1). Male sex was associated with higher BMI z-score, while CRP and steroid exposure were inversely related to BMI z-score. Exposed patients had increased adjusted odds of obesity and morbid obesity: OR 1.72 (CI 1.34, 2.20) and OR 5.72 (CI 2.77, 11.33), respectively (Table 2). Male sex and baseline BMI z-score also increased the odds of obesity and morbid obesity. Conclusion CD patients with anti-TNF exposure have a significant increase in BMI z-score over time as compared to patients unexposed to anti-TNF therapy. While for most patients this increase in BMI z-score is restorative, a subset of patients gain excessive weight or become obese. Anti-TNF therapy may be a risk-factor for this phenomenon. BMI z-score at diagnosis and male sex may also be risk factors. Future studies evaluating changes in adiposity and energy expenditure should be pursued. Note: Interaction term between anti-TNF and baseline BMI z-score. Interaction term between anti-TNF and time. Interaction term between anti-TNF and quadratic time. Note: Table for risk factors for morbid obesity in CD patients not included due to text constraints but with similar findings.

Prenatal exposure to organochlorine pesticides and infant growth: A longitudinal study

BackgroundThe association between exposure to organochlorine pesticides (OCPs) and infant growth has been reported contradictorily in previous studies. Few studies have investigated the effects of prenatal exposure to OCPs on infant growth assessed longitudinally at multiple time points. ObjectivesThe purpose of the study was to examine the associations between prenatal exposure to OCPs and infant growth at birth, 6, 12 and 24 months of age, and further to explore the potential sex-specific effects. MethodsThe study population included 1039 mother-infant pairs who participated in a birth cohort study in Wuhan, China. The weight, length and body mass index (BMI) z-score of infants were measured and calculated at birth, 6, 12 and 24 months of age. The overweight status was defined as BMI z-score ≥ 85th percentile according to the standard of World Health Organization. The concentrations of OCPs were measured in cord serum, including hexachlorocyclohexanes (HCHs, consisted of α-HCH, β-HCH, and γ-HCH), p,p′-dichlorodiphenyltrichloroethane (p,p′-DDT) and its metabolites: p,p′-dichlorodiphenyldichloroethane (p,p′-DDD), and p,p′-dichlorodiphenyldichloroethylene (p,p′-DDE). Generalized linear models were applied to estimate the associations of cord OCPs with infant growth parameters. A group-based semiparametric mixture model was used to estimate growth patterns of infants. Linear-mixed growth curve models were used to examine relationships between predicted growth trajectories and prenatal exposure to OCPs. Weighted quantile sum regression (WQSR) analyses were used to estimate the mixture effects of OCPs on infant growth. ResultsHigher cord serum β-HCH concentrations were associated with higher BMI z-score at 12 [β = 0.07, 95%CI: 0.01, 0.13] and 24 months of age [β = 0.08, 95% CI: 0.02, 0.14]. Similar patterns were observed for relationships of γ-HCH [β = 0.04, 95%CI: 0.01, 0.07] and p,p′-DDT [β = 0.03, 95% CI: 0.00, 0.06] with BMI z-score at 6 and 12 months of age, respectively. However, higher cord serum p,p′-DDE concentrations were associated with a reduction of BMI z-score at 6 months of age [β = −0.07, 95% CI: −0.12, −0.01]. Cord serum β-HCH was also positively associated with the risk of overweight at 12 months of age [RR = 1.16, 95% CI (1.02, 1.33), for the medium vs the lowest tertile]. Among girls, the effects of β-HCH on BMI z-score and overweight status were stronger than boys at 12 and 24 months of age. No statistically significant relationships of other OCPs with infant growth were observed. ConclusionsPrenatal exposure to β-HCH was associated with increased BMI z-score and higher risk of overweight status in infants especially at 12 and 24 months of age, which seemed to be stronger in girls.

Urinary phthalates and body mass index in preschool children: The MIREC Child Development Plus study.

Childhood exposure to phthalates, a class of chemicals with known reproductive and developmental effects, has been hypothesized to increase the risk of obesity, but this association is not well understood in preschool children. We examined the association between urinary concentrations of phthalate metabolites and concurrently measured body mass index (BMI) and skinfolds among children between the ages of two and five years. We collected anthropometric measures and biomonitoring data on approximately 200 children enrolled in the Maternal-Infant Research on Environmental Chemicals Child Development Plus study. We measured 22 phthalate metabolites in children's urine and used the 19 metabolites detected in at least 40% of samples. Our primary outcome was BMI z-scores calculated using the World Health Organization growth standards. Skinfold z-scores were secondary outcomes. We used multivariable linear regression to evaluate the association between tertiles of phthalate concentrations and each anthropometric measure. We also used weighted quantile sum regression to identify priority exposures of concern. Our analytic sample included 189 singleton-born children with complete anthropometric data. Children with concentrations of the parent compound di-n-butyl phthalate (∑DnBP) in the third tertile had 0.475 (95% CI: 0.068, 0.883) higher BMI z-scores than those in the lower tertile. ∑DnBP was identified as a priority exposure in the weighted quantile sum regression BMI model. In this population of Canadian preschool aged children, we identified DnBP as a potential chemical of concern in regard to childhood obesity. Future research with serial phthalate measurements and anthropometric measurements in young children will help confirm these findings.

The Role of Children\u2019s Dietary Pattern and Physical Activity in the Association Between Breastfeeding and BMI at Age 5: The GECKO Drenthe Cohort

ObjectivesBreastfeeding is protective against childhood obesity, but the role of childhood lifestyle in this association is unclear. We investigated whether physical activity and dietary pattern at age 5 differed between breastfed and non-breastfed children, and how they relate to Body Mass Index (BMI) Z-scores.Methods1477 children of the Dutch GECKO Drenthe birth cohort were included. At one month, children were categorized as breastfed (receiving breast milk exclusively or in combination with formula milk) or non-breastfed (receiving formula milk exclusively). At age 5, height and weight were objectively measured, physical activity was measured by ActiGraph GT3x and dietary patterns were assessed with a parent-reported food pattern questionnaire, assessing the consumption frequency of selected food items at seven occasions over the day.ResultsNon-breastfed children had higher BMI Z-scores (0.36 ± 0.90 vs. 0.20 ± 0.80 SD, p = 0.002), more frequently consumed sugar-sweetened beverages (25.0 ± 10.5 vs. 22.5 ± 9.71 times per week, p < 0.001), and consumed relatively less whole-wheat or brown bread (p = 0.007). Differences in sugar-sweetened beverage consumption were most pronounced during main meals. Total fruit consumption, sedentary time and moderate-to-vigorous physical activity levels did not differ between the groups. Multivariable adjusted linear regression analyses showed that the differences in BMI-z score between non-breastfed and breastfed children were not explained by the differences in sugar-sweetened beverages or type of bread consumed.ConclusionsInfant breastfeeding itself is indicative of healthy dietary behaviors in early life, and is also more likely to be followed by a favorable dietary pattern at toddler age. However, the differences in dietary habits between breastfed and non-breastfed children did not explain the difference in BMI Z-score at the age of 5.

Longitudinal Associations Among Diet Quality, Physical Activity and Sleep Onset Consistency With Body Mass Index z-Score Among Toddlers in Low-income Families.

Habits surrounding health behaviors (i.e., sleep, physical activity, diet) are developed in toddlerhood. Lack of consistent health habits may increase obesity risk among toddlers in low-income families. To compare the role of sleep onset consistency, physical activity and diet quality as mediators between household poverty and toddler weight. Two hundred and seven toddlers (mean age = 20.2 months, 46% female, 68.1% Black) participating in an obesity prevention trial were assessed at three time points over 12 months. Using Actical accelerometers, we assessed sleep and physical activity at each time point for up to 1 week. We defined sleep onset consistency as the standard deviation of sleep onset across all days. We calculated the Healthy Eating Index-2015 from a 24-hr dietary recall. We used WHO standards to calculate BMI-for-age z-scores from toddlers' weight/length, and calculated poverty ratio from parent-reported income and family size. Multilevel mediation models tested toddler sleep onset consistency, physical activity, and diet quality as mediators between household poverty and toddler BMI z-score. Toddlers from households with higher poverty ratios had more inconsistent sleep onset times. Toddlers with more inconsistent sleep onset times had higher BMI z-scores across all timepoints, even when accounting for physical activity and diet quality. Sleep onset consistency indirectly explained the association between household poverty and BMI z-score. Inconsistent sleep schedules could help explain the association between poverty and BMI. Future research should examine strategies to support low-income families to develop and maintain routines as a mechanism to prevent obesity and reduce disparities. NCT02615158.

Early ventricular contraction in children with primary hypertension relates to left ventricular mass.

In hypertensive adults, first-phase ejection fraction (EF1), a measure of early ventricular contraction is reduced and associated with prolonged systolic contraction and diastolic dysfunction. Whether this is true in children with primary hypertension is unknown. Echocardiography was performed in 47 normotensive and 81 hypertensive children. Hypertensive children were stratified according to tertiles of LVMi (g/m2.7). EF1 was calculated from the fraction of LV volume ejected up to the time of peak aortic flow. E/e' was used as a measure of diastolic function. Myocardial wall stress (MWS) was calculated in a subsample of children from LV volumes and central aortic pressure. Time to onset of relaxation (TOR) was defined as time to peak MWS over ejection time. Normotensive and hypertensive children were of similar age. Hypertensive children in tertiles 2 and 3 of LVMi had higher BMI z-score than normotensives. EF1 was significantly increased in hypertensive children in tertile 1 compared with normotensive children (P < 0.001), whereas in those in tertile 3, it was significantly lower than in normotensive children (P < 0.001). EF1 was negatively associated with LVMi (β = -0.505, P < 0.001), LVM (β = -0.531, P = 0.001) and E/e' ratio (β = -0.409, P < 0.001); in children who had MWS measured, TOR was negatively associated with EF1 (β = -0.303, P = 0.007) and positively associated with E/e' (β = 0.459, P < 0.001). EF1 is preserved or enhanced in hypertensive children with similar LVMi to normotensive children but is increasingly reduced in those with greater LVMi. This reduction of EF1 is associated with prolonged myocardial wall stress and reduced diastolic function.

Digital technology use and adolescent body weight: Evidence from the SCAMP cohort study

Background/Aim: Use of digital technologies such as mobile phones is ubiquitous in adolescents. We aimed to assess the social predictors of digital technology use and its association with body weight in a large cohort of adolescents.Methods: We used baseline data from a subset of a large adolescent cohort of 39 schools across Greater London who participated in the Study of Cognition Adolescents and Mobile Phone (SCAMP) (n=1,474). Digital technology use included phone call, internet use on mobile phone, and video gaming on any device. Multi-level regression was used to assess the association between digital technology use and age- and sex-specific body mass index (BMI) z-score and overweight (including obesity) derived from objectively measured height and weight. We examined whether the associations were mediated by insufficient sleep.Results: Generally, participants with lower socioeconomic status reported more use of digital technologies. Internet use on mobile phone for more than 3 hours per day was associated with higher BMI z-score and greater odds of being overweight, compared to low use (≤30 min). Similar association between video gaming and body weight was found. Weekday insufficient sleep partly mediated the associations between internet use and video gaming and BMI z-score by an indirect effect.Conclusions: We found an association between digital technologies and body weight, partly mediated by insufficient sleep, suggesting underlying mechanisms may be multi-factorial. Further research with longitudinal data is essential to explore the direction of relationships.

Rural-urban differences in body mass index and obesity-related behaviors among low-income preschoolers.

With one in eight preschoolers classified as obese in the USA, childhood obesity remains a significant public health issue. This study examined rural-urban differences in low-income preschoolers' body mass index z-scores (BMIz), eating behaviors, dietary quality, physical activity (PA) and screen time. Pre-intervention data from 572 preschooler-parent dyads participating in a randomized, controlled obesity prevention trial in the Midwest USA were analyzed. We examined the associations among living in rural versus urban areas, child BMIz and child obesity-related behaviors, including eating behaviors, dietary quality, PA and screen time. Rural children had higher BMIz, more emotional overeating behaviors and more time spent playing outdoors compared with urban children. We found no associations between children living in rural versus urban areas and dietary quality and screen time. The study found that rural-urban differences in BMIz may start as early as 3-4years of age, if not earlier. To reverse the weight-related health disparities between rural and urban low-income preschoolers, structural changes in rural locations and family supports around coping skills may be needed.

Weight-status Related Differences in Reflective and Impulsive Determinants of Physical Activity in Youngsters (8–18 years old)

Objective: To investigate associations between weight status and physical activity, psychosocial impulsive, and reflective determinants of exercise behavior in youngsters (8–18 years old), distinguishing between strength exercises and aerobic exercises.Method: Cross-sectional survey of 133 youngsters (89 girls – 59 youngsters who are being treated for obesity in an outpatient lifestyle intervention program, plus 74 youngsters from the general population). In order to identify reflective determinants, participants completed questionnaires. For the impulsive determinants, participants completed two computerized reaction time sorting-tasks (‘Implicit Association Tests’).Results: Exercise intentions, including those for aerobic and strength exercises, were positively correlated with BMI z-scores. Youngsters with a higher BMI z-score often reported that their friends think they should exercise and were more confident that they could exercise more if they wanted to. No other determinants, including impulsive determinants, were correlated with BMI z-scores.Conclusion: In terms of reflective determinants, few differences were found between youngsters with higher BMI z-scores as compared to youngsters with lower BMI z-scores. There was no significant correlation between BMI z-score and the impulsive determinants of aerobic versus strength exercise. This suggests that youngsters, independent from weight status feel that they could be reached by the same kind of physical activity intervention.

Dynamics of sleep, sedentary behavior, and moderate-to-vigorous physical activity on school versus nonschool days.

Studies examining time-use activity behaviors (sleep, sedentary behavior, and physical activity) on school days compared with nonschool days have examined these behaviors independently, ignoring their interrelated nature, limiting our ability to optimize the health benefits of these behaviors. This study examines the associations of school-day (vs. nonschool day) with time-use activity behaviors. Time series data (6,642 days) from Fitbits (Charge-2) were collected (n = 196, 53% female, 5-10 years). We used a variable-centered dynamic structural equation modeling approach to estimate day-to-day associations of time-use activity behaviors on school days for each child. We then used person-centered cluster analyses to group individuals based on these estimates. Within-participant analysis showed that on school days (vs. nonschool days), children (1) slept less (β = -0.17, 95% CI = -0.21, -0.13), (2) were less sedentary (β = -0.05, 95% CI = -0.09, -0.02), and (3) had comparable moderate-to-vigorous physical activity (MVPA; β = -0.05, 95% CI = -0.11, 0.00). Between-participant analysis showed that, on school days, children with higher sleep carryover experienced greater decreases in sleep (β = 0.44, 95% CI = 0.08, 0.71), children with higher body mass index z-score decreased sedentary behavior more (β = -0.41, 95% CI = -0.64, -0.13), and children with lower MVPA increased MVPA more (β = -0.41, 95% CI -0.64, -0.13). Cluster analysis demonstrated four distinct patterns of connections between time-use activity behaviors and school (High Activity, Sleep Resilient, High Sedentary, and Dysregulated Sleep). Using a combination of person-centered and more traditional variable-centered approaches, we identified patterns of interrelated behaviors that differed on school, and nonschool days. Findings can inform targeted intervention strategies tailored to children's specific behavior patterns.

Physical Activity, Sedentary Behaviour and Sleep, and Their Association with BMI in a Sample of Adolescent Females in New Zealand.

Despite activity guidelines moving towards a 24-h focus, we have a poor understanding of the 24-h activity patterns of adolescents. Therefore, this study aims to describe the 24-h activity patterns of a sample of adolescent females and investigate the association with body mass index (BMI). Adolescent females aged 15–18 years (n = 119) were recruited across 13 schools in 8 locations throughout New Zealand. Actigraph GT3X+ accelerometers were worn 24-h a day for seven days and the output was used to identify time spent in each 24-h component (sleep, sedentary, light-intensity physical activity and moderate-to-vigorous intensity physical activity). In a 24-h period, adolescent females spent approximately half their time sedentary, one third sleeping and the remainder in light-intensity physical activity (15%) and moderate-to-vigorous intensity physical activity (5%). Higher BMI z-scores were associated with 16 min more time spent in light-intensity physical activity. Additionally, those with higher BMI were less likely to meet the sleep and physical activity guidelines for this age group. Compliance with the moderate-to-vigorous intensity physical activity guidelines, sleep guidelines, or both, was low, especially in those classified as overweight or obese. The association between BMI and light activity warrants further investigation.

The impact of maternal obesity and breast milk inflammation on developmental programming of infant growth.

Background:Little is known about how maternal obesity impacts breast milk (BM) composition and how BM composition may impact growth. We sought to determine the role of maternal body mass index (BMI) on BM inflammatory and oxidative stress markers and to delineate the role of these BM markers on infant growth.Methods:This was a secondary analysis of 40 mother-infant dyads. We first assessed the association between maternal BMI and BM marker (omega-6:omega-3 polyunsaturated fatty acid ratio (n-6:n-3 PUFA), leptin, interleukin (IL)-8, IL-6, IL-1β and malondialdehyde (MDA)) concentration at one (V1) and four (V4) months postpartum. We then examined the association between BM markers on infant growth trajectory from birth to seven months.Results:Higher maternal BMI was associated with higher BM n-6:n-3 PUFA (V1 β=0.12, 95% CI 0.01, 0.2; V4 β=0.13, 95% CI 0.01, 0.3) and leptin (V1 β=107, 95% CI 29, 184; V4 β=254, 95% CI 105, 403) concentrations. Infants exposed to high BM n-6:n-3 PUFA had higher BMI z-scores over time (p=0.01). Higher BM leptin was associated with lower infant percent fat mass at V4 (β=−9, 95% CI −17, −0.6). Infants exposed to high BM IL-8, IL-6, or IL-1β had higher weight z-scores over time (IL-8 p<0.001; IL-6 p<0.001; IL-1β p=0.02). There was no association between BM MDA and maternal BMI or infant growth.Conclusions:Higher maternal BMI is associated with higher BM n-6:n-3 PUFA and leptin concentrations. In addition, higher BM n-6:n-3 PUFA and inflammatory cytokines were associated with accelerated weight gain in infancy.

Sex modifies the association between the CLOCK variant rs1801260 and BMI in school-age children.

Disruption of circadian rhythms and variations in the FTO gene may interfere with energy homeostasis and play a role in the development of obesity. The current study assessed the association of common polymorphisms in the CLOCK and FTO genes with standardized body mass index scores (BMI z-scores) and their potential modification of the impact of a culinary nutrition and physical activity intervention in school-age children. Anthropometric measurements were collected in 121 children at the baseline and one-year follow-up of a controlled trial of a school-based culinary nutrition and physical activity intervention. Genotypes of the CLOCK polymorphism (rs1801260) and the FTO polymorphism (rs9939609) were obtained from buccal swabs. Linear mixed-effects regression was applied to evaluate the genetic association and adjust for clusters within families and schools. In our participants, obesity affected 6.6% (8/121) of the children at the baseline and 6.4% (7/109) of the children at the follow-up. The associations between the age- and sex-adjusted BMI z-scores and the two polymorphisms did not reach statistically significance. Yet, sex potentially modified the association between rs1801260 and BMI z-scores. In girls, the G allele carriers had a higher BMI z-scores at the baseline and the follow-up. These polymorphisms did not modify the effect of our culinary nutrition and physical activity intervention on BMI z-scores. Sex is a potential modifier for the association between the CLOCK polymorphism, rs1801260, and BMI z-scores in school-age children. Further investigation is warranted to delineate the sex-dependent role of the CLOCK polymorphisms in the development of childhood obesity.

Is adherence to the 24-hour movement guidelines associated with a reduced risk of adiposity among children and adolescents?

BackgroundLittle is known about the combined effect of physical activity (PA), recreational screen time (ST), and sleep in preventing childhood obesity. Hence, this study aimed to analyze the associations between meeting the PA, ST, and sleep recommendations within the 24-hour movement guidelines and adiposity indicators among children and adolescents.MethodsA total of 679 children and adolescents aged 8–18 years were included. The time spent in moderate-to-vigorous PA and the sleep duration were estimated from raw data from a wrist-worn accelerometer. Recreational ST was reported by the child or parent. Body mass index (BMI) z-score, fat mass percentage (FM%), and visceral adipose tissue (VAT) were used as adiposity indicators. Participants with ≥ 60 min/day of moderate-to-vigorous PA, < 2 h/day of recreational ST, and uninterrupted sleep for 9–11 h/day (for children) or 8–10 h/day (for adolescents) were considered to meet the overall 24-hour movement guidelines.ResultsMeeting the ST only recommendation was associated with reduced odds of a high BMI z-score (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.17–0.89), excess FM% (OR = 0.34, 95% CI: 0.13–0.93), and excess VAT (OR = 0.27, 95% CI: 0.10–0.74) in adolescents. Significantly reduced odds of a high BMI z-score was associated with meeting the combination of the ST and sleep recommendations (OR = 0.11, 95% CI: 0.01–0.89). Adolescents who met one recommendation (OR = 0.51, 95% CI: 0.27–0.96) or any two recommendations (OR = 0.33, 95% CI: 0.11–0.94) had reduced ORs of having a high BMI z-score. Adolescents had lower odds of having excess VAT if they met one recommendation (OR = 0.39, 95% CI: 0.19–0.81) or any two recommendations (OR = 0.25, 95% CI: 0.07–0.90). No significant associations were found in children.ConclusionsThe present study showed no associations between meeting all three recommendations within the 24-hour movement guidelines and adiposity indicators. However, meeting ST only recommendation and the combination of the ST and sleep recommendations was associated with a reduced risk of excess adiposity. This finding should be considered when designing effective strategies and interventions to prevent childhood obesity.

Risk factors of malnutrition in children with severe motor and intellectual disabilities

BackgroundChildren with severe motor and intellectual disabilities (SMID) are at a high risk of malnutrition and often require tube feeding to maintain their nutritional status. However, determining their energy requirements is difficult since inadequate dietary intake, severe neurological impairment, respiratory assistance, and cognitive impairment are all factors that affect malnutrition in SMID. AimThis study investigated the factors affecting malnutrition and identified problems affecting the nutritional status of children with SMID. MethodsForty-two children with SMID with oral motor dysfunction who were receiving home medical care at one of four hospitals were enrolled. Their nutritional status was assessed using a 3-day dietary record, anthropometric measurements, and laboratory tests. The clinical findings associated with malnutrition were compared, and a body mass index (BMI) z-score less than −2SD was defined as malnutrition. The relationship between BMI z-score and other potential predictors was also investigated. ResultsThirty-three (79%) children received tube feeding, and 20 (48%) experienced malnutrition. The median age of the malnourished children was older than that of non-malnourished children. Respiratory assistance was significantly correlated with higher BMI z-score, independent of other potential confounders such as nutrition method, muscle tonus, and energy intake. Cholesterol levels were significantly higher in children receiving a standard infant formula beyond 3 years of age than in those who switched to enteral formula before 3 years of age. ConclusionsMalnutrition in children with SMID was mainly associated with age or respiratory condition. Energy requirements should be regularly re-evaluated with considering these factors.