Higher Body Mass Index Percentile Research Articles

PP15.12 – 2382: Chronic daily headache in children: Association with obesity, medication overuse and disability

Objective To examine the association between obesity, medication overuse and chronic daily headaches (CDH) in children, and the relation to headache type and disability. Methods The authors retrospectively evaluated 108 children with chronic daily headaches from their Pediatric Neurology Clinic. Data regarding age, gender, headache type, duration, disability and use of medication, along with height and weight were collected. Body mass index (BMI) was calculated, and percentiles were determined for age and sex. Headache type, disability and use of medications were compared between normal weight, at risk for overweight and overweight children. Results A higher prevalence (39. %) of obesity was found in the whole study group compared to the general population. The diagnosis of transformed migraine, but not of chronic tension type headache, was significantly associated with being at risk for overweight (OR=2.39, 95% CI: 1.2–4.69, P=0.01) or overweight (OR=2.3, 95% CI: 1.3–5.61, P=0.04). Regardless of headache type, a high BMI percentile was associated with increased headache disability and overuse of medications, but not with duration of attacks. Conclusion Obesity and CDH in children are associated. Although obesity seems to be a risk factor for transformed migraine more than for chronic tension type headache, it is associated with increased headache disability and medication overuse regardless of headache type.

Prevalence and Correlates of Suspected Nonalcoholic Fatty Liver Disease in Chinese American Children

The aim of this study was to evaluate the prevalence and clinical correlates of nonalcoholic fatty liver disease (NAFLD) in children of Chinese immigrants. NAFLD is increasing in prevalence and is frequently identified in children. High rates of NAFLD were found in adult Chinese immigrants. However, there are limited data regarding NAFLD in Chinese American children. Clinical and laboratory data were collected from 407 children, aged 6 to 18 years, who had routine office visits at a Chinatown medical practice. Children were classified as having suspected NAFLD if common causes of liver disease were excluded, alanine aminotransferase levels exceeded established thresholds (>22.1 IU/L for girls and >25.8 IU/L for boys), and elevated alanine aminotransferase levels were confirmed by repeat measurement. 6.1% of Chinese American children had suspected NAFLD, including 33% of obese children. Seventeen percent of children were overweight, 14% were obese, and 52% had 25-hydroxy vitamin D levels <20 ng/mL. In univariable analysis, children with suspected NAFLD were more frequently male, had higher body mass index percentile and lipid levels, and lower vitamin D levels compared with children without evidence of NAFLD. In multivariable analysis, suspected NAFLD was associated with higher BMI percentile and lower vitamin D levels when adjusting for other factors. Chinese American children with obesity are at high risk for NAFLD. They should be screened accordingly, including testing for metabolic disorders and low vitamin D levels. Early identification of NAFLD in childhood will allow for intervention with lifestyle modification, providing a means to reduce the prevalence of NAFLD in children and adults.

Family Meal Frequency, Practices, and BMI of Mothers of Preschoolers

Family mealtimes (FM) are important mediators of diet and weight, yet little is known about FM practices of households with preschool children and factors that mediate FM frequency. A sample of 550 mothers of preschoolers reported mother and child height and weight; FM frequency, location, importance, and atmosphere; time/energy for FM; family conflict and cohesion; general household organization; and family support for healthy behaviors. Children's mean BMI percentile=66.16+32.78SD. Mother's mean BMI=27.69+7.90. Most families (93%) shared >7 meals/week; 1% never had FMs. Most FMs were at the kitchen/dining room table (4.69+2.5 days/week), and fewer in front of TV, at fast food restaurants, or in cars. Most reported a positive FM environment in their homes and felt they had a lot of time & energy to share FMs. Mothers reported little family conflict, moderate household disorganization and high family support for healthy behaviors. ANOVA and post-hoc tests indicated children in families with the lowest quartile of FM (<10/week) tended to have higher BMI percentiles than those in the highest quartile (>15/week; p=0.09). FM frequency was not associated with mother's BMI but was significantly positively correlated with eating meals in the kitchen/dining room more often, placing higher importance on FM, positive FM atmospheres and more time and energy for FM. Frequency of FM was significantly negatively correlated with family conflict and household disorganization. FM were associated with healthier child BMI percentiles and maternal attitudes and practices were associated with greater FM frequency. Promoting FM benefits to parents, encouraging positive mealtime environments & emphasizing planning skills to facilitate more frequent FMs could promote healthier child BMIs. USDA NIFA #2011-68001-30170

Hypovitaminosis D in healthy children in Central Thailand: prevalence and risk factors.

BackgroundThere are limited data regarding the prevalence and risk factors relating to hypovitaminosis D in children of Thailand, a tropical country with abundant sunlight. The objective of this study was to assess the prevalence of hypovitaminosis D and examine factors associated with hypovitaminosis D in school-aged children in Bangkok, Thailand – a centrally located capital city.MethodsThis cross-sectional study evaluated 159 healthy children (33.3% boys and 66.7% girls), aged 6 to 12 years, in Bangkok, Thailand (located at 13.45°N). Fasting plasma samples were examined for total 25-hydroxyvitamin D [25(OH)D] using electrochemiluminescence immunoassay. Demographic characteristics (age, sex, household income), past medical history (birth weight, allergic diseases, hospitalization), amount of sun exposure, anthropometric data, and selected biochemical tests were used to investigate for factors associated with hypovitaminosis D.ResultsOverall, the mean ± SD level of plasma 25(OH)D was 64.0 ± 15.1 nmol/L. Hypovitaminosis D (< 75 nmol/L) was presented in 79.2% of subjects. Of these, the prevalence of vitamin D insufficiency and vitamin D deficiency were 59.7% and 19.5%, respectively. In univariate analysis, children with hypovitaminosis D (< 75 nmol/L) had a higher mean body mass index (BMI) percentile than the vitamin D-sufficient group (56.7 ± 33.9 vs. 42.6 ± 36.0; P-value = 0.04). Plasma PTH levels in the children with hypovitaminosis D were significantly higher than in the children with normal levels of vitamin D (4.34 ± 1.38 vs 3.78 ± 1.25 pmol/L; P-value = 0.04). In multivariate analysis, high BMI percentile and high PTH concentration were the parameters associated with 25(OH)D level < 75 nmol/L.ConclusionThe prevalence of hypovitaminosis D in healthy Thai children is very high, despite their exposure to sunlight, and that prevalence increases in children with a high BMI percentile. As a result, a formal recommendation for vitamin D supplementation in Thai children should be considered.

Relationship between parental perception and concern for child weight and influence on obesogenic parenting practices

Background: Parents’ perception of whether children are overweight can influence parenting practices. The purpose of this study was to examine parental perception of and concern for child weight in relation to parenting practices. Methods: A cross-sectional study of parents (n=75) with pre-school age children. Parents completed the Child Feeding Questionnaire and Parenting Strategies for Obesogenic Behaviors Questionnaire. Perception (overweight vs. not overweight) and concern (concerned vs. not concerned) of child weight were examined in relation to individual strategies (Chi-square) and feeding practices (independent t-tests). Findings were confirmed in analyses adjusted for child race, sex, and weight status. Results: Five percent of parents perceived their child as overweight; 61.3% of parents were concerned about their child becoming overweight; 36% of children were overweight. Parents who perceived their child as overweight agreed their child should always eat all of the food on his/her plate (75%, p=0.031). Concerned parents made sure their child did not eat too many sweets (89%, p=0.005), high fat foods (78%, p=0.001), or favorite foods (59%, p=0.009); kept some foods out of reach (76%, p=0.014); kept track of sweets eaten (87%, p=0.012) and television watched (83%, p=0.046). Parents with concern used restrictive feeding practices (3.6% vs. 2.9%, p=0.003) and had children with a higher BMI percentile (75.0 vs. 51.0, p=0.001). Adjustment for multiple analyses was more conservative (p≤0.003). Conclusions: Parents’ concern as to whether their child is overweight was associated with overall restrictive feeding practices and children with higher body mass. Individual strategies employed by parents with a perception of or concern for overweightness included restriction, monitoring, and pressure to eat.

It's always snack time: An investigation of event scripts in young children.

This study examined whether young children include eating in their cognitive scripts for various events, and whether food-related scripts are associated with body mass index (BMI) percentile. Data were collected in a structured interview format. Participants, recruited from area preschools and day cares, provided a four-activity sequence for each of three events, and responses were recorded verbatim. Forty-four children (45% female) participated, with an average BMI percentile of 73.3% (SD = 25.9). Data were binarily coded to indicate whether each response was food-related. Frequencies were obtained, and responses were correlated with BMI percentile. Over 22% of the activities in the children's scripts involved food. The number of food-related activities reported was positively correlated with children's BMI percentile (r = 0.53, p = 0.03). Results provide preliminary evidence that food features prominently in young children's event scripts and that children with higher BMI percentiles may possess scripts that feature more food-related themes. Future researchers should investigate the causal nature of this relationship.

Sleep, but not other daily routines, mediates the association between maternal employment and BMI for preschool children

BackgroundIt has been established that the more time mothers spend working outside of the home, the more likely their preschool-aged children are to be overweight. However, the mechanisms explaining this relationship are not well understood. Our objective was to explore child sleep, dietary habits, TV time, and family mealtime routines as mediators of the relationship between maternal employment status (full-time, part-time, and no or minimal employment) and child body mass index (BMI) percentile. MethodsData were drawn from waves 1 and 2 of STRONG Kids, a prospective panel study examining childhood obesity among parent–preschooler dyads (n = 247). Mothers reported their own work hours, their child's hours of nighttime sleep, dietary habits, TV time, and mealtime routines. Trained staff measured child height and weight. ResultsCompared to working 0–19 h/week, both full-time (>35 h/week) and part-time (20–34 h/week) employment predicted higher child BMI percentile 1 year later. Hours of child nighttime sleep partially mediated the association between maternal full-time employment and child BMI percentile. Adjusting for individual and family characteristics, children whose mothers were employed full time were less likely to sleep longer hours than children whose mothers were employed 0–19 h/week (b = −0.49, p < 0.04). Shorter child nighttime sleep was associated with higher BMI percentile (b = −7.31, p < 0.001). None of the other mediation pathways tested were significant. ConclusionsThese findings add to the growing literature on the importance of adequate sleep for young children's health.

The relationship between premorbid body weight and weight at referral, at discharge and at 1-year follow-up in anorexia nervosa.

Body mass index (BMI) is one of the most important outcome predictors in patients with anorexia nervosa (AN). A low premorbid BMI percentile calculated by the patients recalled premorbid weight and the height at first admission has been found to predict the BMI at first inpatient admission. In this study, we sought to confirm this relationship. We additionally analyze the relationship between premorbid BMI percentile and BMI percentile at discharge from the first inpatient treatment and at 1-year follow-up or alternatively if applicable upon readmission within this time period. We included 161 female patients aged 11-18years of the multisite ANDI-trial with a DSM-IV diagnosis of AN. We used a multivariate statistical model including the independent variables age, duration of illness, duration of treatment, BMI at admission and BMI percentile at discharge. The relationship between premorbid BMI percentile and BMI at admission was solidly confirmed. In addition to premorbid BMI percentile, BMI at admission and age were significant predictors of BMI percentile at discharge. BMI percentile at discharge significantly predicted BMI percentile at 1-year follow-up. An additional analysis that merely included variables available upon referral revealed that premorbid BMI percentile predicts the 1-year follow-up BMI percentile. Further studies are required to identify the underlying biological mechanisms and to address the respective treatment strategies for AN patients with a low or high premorbid BMI percentile.

Weight's up? Predictors of weight-related communication during primary care visits with overweight adolescents

ObjectivePhysicians’ use of Motivational Interviewing (MI) techniques when discussing weight with adolescent patients is unknown. MethodsWe coded audio-recorded encounters between 49 primary care physicians and 180 overweight adolescent patients. During weight discussions, we used the MITI 3.0 to assess: Empathy, MI Spirit, open-ended questions, reflections, MI consistent behaviors (e.g., praising) and MI inconsistent behaviors (e.g., confronting). We examined associations of patient and physician characteristics with (1) MI techniques, (2) time discussing weight, and (3) encounter time. ResultsPhysicians used more MI consistent techniques with female patients (p=0.06) and with heavier patients (p=0.02). Physicians with prior MI training also used more MI consistent techniques (p=0.04) and asked more open-ended questions (p=0.05). Pediatricians had a higher MI Spirit score than family physicians (p=0.03). Older patient age was associated with physicians spending less time discussing weight-related topics (p=0.04) and higher BMI percentile was associated with physicians spending more time discussing weight-related topics (p=0.01). Increased use of MI inconsistent techniques was associated with longer encounters (p=0.02). ConclusionPhysicians’ weight discussions vary based on adolescent and physician characteristics. Importantly, not using MI lengthened encounter time. Practice implicationsPhysicians might consider using MI techniques more and attempt to use these equally with all adolescents.

Parent-adolescent conversations about eating, physical activity and weight: prevalence across sociodemographic characteristics and associations with adolescent weight and weight-related behaviors.

This paper aims to describe the prevalence of parent-adolescent conversations about eating, physical activity and weight across sociodemographic characteristics and to examine associations with adolescent body mass index (BMI), dietary intake, physical activity and sedentary behaviors. Data from two linked epidemiological studies were used for cross-sectional analysis. Parents (n = 3,424; 62% females) and adolescents (n = 2,182; 53.2% girls) were socioeconomically and racially/ethnically diverse. Fathers reported more parent-adolescent conversations about healthful eating and physical activity with their sons and mothers reported more weight-focused conversations with their daughters. Parents of Hispanic/Latino and Asian/Hmong youth and parents from lower socioeconomic status categories engaged in more conversations about weight and size. Adolescents whose mothers or fathers had weight-focused conversations with them had higher BMI percentiles. Adolescents who had two parents engaging in weight-related conversations had higher BMI percentiles. Healthcare providers may want to talk about the types of weight-related conversations parents are having with their adolescents and emphasize avoiding conversations about weight specifically.

Inhibitory control effects in adolescent binge eating and consumption of sugar-sweetened beverages and snacks

Inhibitory control and sensitivity to reward are relevant to the food choices individuals make frequently. An imbalance of these systems can lead to deficits in decision-making that are relevant to food ingestion. This study evaluated the relationship between dietary behaviors – binge eating and consumption of sweetened beverages and snacks – and behavioral control processes among 198 adolescents, ages 14 to 17. Neurocognitive control processes were assessed with the Iowa Gambling Task (IGT), a generic Go/No-Go task, and a food-specific Go/No-Go task. The food-specific version directly ties the task to food cues that trigger responses, addressing an integral link between cue-habit processes. Diet was assessed with self-administered food frequency and binge eating questionnaires. Latent variable models revealed marked gender differences. Inhibitory problems on the food-specific and generic Go/No-Go tasks were significantly correlated with binge eating only in females, whereas inhibitory problems measured with these tasks were the strongest correlates of sweet snack consumption in males. Higher BMI percentile and sedentary behavior also predicted binge eating in females and sweet snack consumption in males. Inhibitory problems on the generic Go/No-Go, poorer affective decision-making on the IGT, and sedentary behavior were associated with sweetened beverage consumption in males, but not females. The food-specific Go/No-Go was not predictive in models evaluating sweetened beverage consumption, providing some initial discriminant validity for the task, which consisted of sweet/fatty snacks as no-go signals and no sugar-sweetened beverage signals. This work extends research findings, revealing gender differences in inhibitory function relevant to behavioral control. Further, the findings contribute to research implicating the relevance of cues in habitual behaviors and their relationship to snack food consumption in an understudied population of diverse adolescents not receiving treatment for eating disorders.

Acculturation Determines BMI Percentile and Noncore Food Intake in Hispanic Children1–3

Hispanic children in the United States are disproportionately affected by obesity. The role of acculturation in obesity is unclear. This study examined the relation between child obesity, dietary intake, and maternal acculturation in Hispanic children. We hypothesized that children of more acculturated mothers would consume more unhealthy foods and would have higher body mass index (BMI) percentiles. A total of 209 Hispanic mothers of children aged 2–4 y (50% female, 35.3 ± 8.7 mo, BMI percentile: 73.1 ± 27.8, 30% obese, 19% overweight) were recruited for an obesity prevention/reversal study. The associations between baseline maternal acculturation [Brief Acculturation Rating Scale for Mexican Americans-II (Brief ARSMA-II)], child BMI percentile, and child diet were examined. Factor analysis of the Brief ARSMA-II in Puerto Rican mothers resulted in 2 new factors, which were named the Hispanic Orientation Score (4 items, loadings: 0.64–0.81) and U.S. Mainland Orientation Score (6 items, loadings: −0.61–0.92). In the total sample, children who consumed more noncore foods were more likely to be overweight or obese (P < 0.01). Additionally, children of mothers with greater acculturation to the United States consumed more noncore foods (P < 0.0001) and had higher BMI percentiles (P < 0.04). However, mothers with greater Hispanic acculturation served fewer noncore foods (P < 0.0001). In the Puerto Rican subgroup of mothers, Puerto Rican mothers with greater acculturation to the United States served more noncore foods (P < 0.0001), but there was no association between acculturation and child BMI percentile in this subgroup. These mothers, however, served fewer sugar-sweetened beverages (P < 0.01) compared with non-Puerto Rican mothers, and this may have negated the effect of noncore food consumption on BMI percentile. These data suggest a complex relation between acculturation, noncore food consumption, and child BMI percentile in Puerto Rican and non-Puerto Rican Hispanic children.

Spiritual coping predicts 5-year health outcomes in adolescents with cystic fibrosis

BackgroundPositive spiritual coping in adolescent patients with cystic fibrosis (CF) is associated with better emotional functioning, but its role in health outcomes is unknown. MethodsAdolescents diagnosed with CF (n=46; M=14.7years) reported on their use of positive and negative spiritual coping. Measures of nutrition status (BMIp), pulmonary function (%FEV1), and hospitalizations were obtained for a five-year follow up period. Changes in BMIp and %FEV1 scores were estimated with hierarchical linear models; days hospitalized were modeled with negative binomial regression. ResultsPositive spiritual coping was associated with slower decline in pulmonary function, stable vs. declining nutritional status, and fewer days hospitalized over the five-year period. Negative spiritual coping was associated with higher BMI percentile at baseline, but not with health outcomes over time. ConclusionsThese results suggest that positive spiritual coping plays a key role in maintaining long-term health of adolescent patients with CF.

Obesity in Children With Headaches: Association With Headache Type, Frequency, and Disability

To examine the association between obesity and the different types of primary headaches, and the relation to headache frequency and disability The association between obesity and headache has been well established in adults, but only a few studies have examined this association in children, in particular, the relationship between obesity and different types of primary headaches. The authors retrospectively evaluated 181 children evaluated for headaches as their primary complaint between 2006 and 2007 in their Pediatric Neurology Clinic. Data regarding age, gender, headache type, frequency, and disability, along with height and weight were collected. Body mass index was calculated, and percentiles were determined for age and sex. Headache type and features were compared among normal weight, at risk for overweight, and overweight children. A higher prevalence (39.8%) of obesity was found in our study group compared with the general population. The diagnosis of migraine, but not of tension-type headache, was significantly associated with being at risk for overweight (odds ratio [OR] = 2.37, 95% confidence interval 1.21-4.67, P = .01) or overweight (OR = 2.29, 95% confidence interval 0.95-5.56, P = .04). A significant independent risk for overweight was present in females with migraine (OR = 4.93, 1.46-8.61, P = .006). Regardless of headache type, a high body mass index percentile was associated with increased headache frequency and disability, but not with duration of attack. Obesity and primary headaches in children are associated. Although obesity seems to be a risk factor for migraine more than for tension-type headache, it is associated with increased headache frequency and disability regardless of headache type.

Parental feeding practices in Mexican American families: initial test of an expanded measure

BackgroundAlthough obesity rates are high among Latino children, relatively few studies of parental feeding practices have examined Latino families as a separate group. Culturally-based approaches to measurement development can begin to identify parental feeding practices in specific cultural groups. This study used qualitative and quantitative methods to develop and test the Parental Feeding Practices (PFP) Questionnaire for use with Mexican American parents. Items reflected both parent’s use of control over child eating and child-centered feeding practices.MethodsIn the qualitative phase of the research, 35 Latino parents participated in focus groups. Items for the PFP were developed from focus group discussions, as well as adapted from existing parent feeding practice measures. Cognitive interviews were conducted with 37 adults to evaluate items. In the quantitative phase, mothers and fathers of 174 Mexican American children ages 8–10 completed the PFP and provided demographic information. Anthropometric measures were obtained on family members.ResultsConfirmatory factor analyses identified four parental feeding practice dimensions: positive involvement in child eating, pressure to eat, use of food to control behavior, and restriction of amount of food. Factorial invariance modeling suggested equivalent factor meaning and item response scaling across mothers and fathers. Mothers and fathers differed somewhat in their use of feeding practices. All four feeding practices were related to child body mass index (BMI) percentiles, for one or both parents. Mothers reporting more positive involvement had children with lower BMI percentiles. Parents using more pressure to eat had children with lower BMI percentiles, while parents using more restriction had children with higher BMI percentiles. Fathers using food to control behavior had children with lower BMI percentiles.ConclusionsResults indicate good initial validity and reliability for the PFP. It can be used to increase understanding of parental feeding practices, children’s eating, and obesity among Mexican Americans, a population at high risk of obesity.

BMI and Waist Circumference; Cross-Sectional and Prospective Associations with Blood Pressure and Cholesterol in 12-Year-Olds

ObjectiveChildhood and adolescent overweight, defined by body mass index (BMI) are associated with an increased risk of cardiovascular disease in later life. Abdominal adiposity may be more important in associations with cardiovascular diseases but waist circumference (WC) has been rarely studied in children. We studied associations between BMI and WC and blood pressure (BP) and cholesterol in 12-year-old children and prospectively changes in BMI or WC status between age 8 and 12 years and BP and cholesterol at age 12.Study DesignWeight, height, WC, BP and cholesterol concentrations were measured in 1432 children at age 12 years. Linear regression was used to study the associations between high BMI and large WC (>90th percentile) and BP and cholesterol.ResultsSystolic BP was 4.9 mmHg higher (95% (CI 2.5, 7.2) in girls and 4.2 mmHg (95%CI 1.9, 6.5) in boys with a high BMI. Large WC was also associated with higher systolic BP in girls (3.7 mmHg (95%CI 1.3, 6.1)) and boys (3.5 mmHg (95%CI 1.2, 5.8)). Diastolic BP and cholesterol concentrations were significantly positively (HDL cholesterol negatively) associated with high BMI and large WC, too. Normal weight children with a history of overweight did not have higher blood pressure levels or adverse cholesterol concentrations than children that were normal weight at both ages.ConclusionA high BMI and large WC were associated with higher BP levels and adverse cholesterol concentrations. WC should be taken into account when examining cardiovascular risk factors in children.

Multiple Indicators of Poor Diet Quality in Children and Adolescents with Type 1 Diabetes Are Associated with Higher Body Mass Index Percentile but not Glycemic Control

BackgroundDiet is a cornerstone of type 1 diabetes treatment, and poor diet quality may affect glycemic control and other health outcomes. Yet diet quality in children and adolescents with type 1 diabetes remains understudied. ObjectiveTo evaluate multiple indicators of diet quality in children and adolescents with type 1 diabetes and their associations with hemoglobin A1c and body mass index percentile. DesignIn this cross-sectional study, participants completed 3-day diet records, and data were abstracted from participants' medical records. Diet quality indicators included servings of fruit, vegetables, and whole grains; Healthy Eating Index-2005 (HEI-2005) score; Nutrient Rich Foods 9.3 score (NRF 9.3); and glycemic index. Participants/settingChildren and adolescents with type 1 diabetes ≥1 year, aged 8 to 18 years, were recruited at routine clinic visits. Of 291 families enrolled, 252 provided diet data. Statistical analysesAssociations of diet quality indicators to HbA1c and body mass index percentile were examined using analysis of covariance and multiple linear regression. ResultsParticipants demonstrated low adherence to dietary guidelines; mean HEI-2005 score was 53.4±11.0 (range=26.7 to 81.2). Intake of fruit, vegetables, and whole grains was less than half the recommended amount. Almost half of the participants' daily energy intake was derived from refined-grain products, desserts, chips, and sweetened beverages. Higher fruit (P=0.04) and whole-grain (P=0.03) intake were associated with lower HbA1c in unadjusted, but not adjusted analyses; vegetable intake, HEI-2005 score, NRF 9.3 score, and glycemic index were not associated with HbA1c. Higher fruit (P=0.01) and whole-grain (P=0.04) intake and NRF 9.3 score (P=0.02), but not other diet quality indicators, were associated with lower body mass index percentile in adjusted analyses. ConclusionsData demonstrate poor diet quality in youth with type 1 diabetes and provide support for the importance of diet quality for weight management. Future research on determinants of dietary intake and methods to promote improved diet quality would be useful to inform clinical care.

The prevalence and potential determinants of obesity among school children and adolescents in Abu Dhabi, United Arab Emirates

To estimate the prevalence and determinants of obesity in childhood and adolescence and their association with blood pressure (BP) in Abu Dhabi, United Arab Emirates (UAE). A cross-sectional population-representative study. A total of 1541 students (grades 1-12; aged 6-19 years) were randomly selected from 246 schools (50% male). Anthropometric and demographic variables were measured, and CDC criteria were used to classify children's weights. A total of 1440 (93%) students provided complete results. Crude prevalences were: 7.6% underweight, 14.7% overweight and 18.9% obesity. Further analyses were restricted to UAE nationals (n=1035), of whom these figures were: 8.3% underweight (females 6.5%, males 10.1%; P=0.06), 14.2% overweight (females 16.7%, males 11.6%; P<0.01), 19.8% obesity (females 18.1%, males 21.4%; P=0.09). Obesity significantly (P<0.001) increased with age. The majority (61.3%) of students had body mass index (BMI) percentiles above the 50th CDC percentile. Stepwise linear regression of BMI percentile on age, sex, dairy consumption, exercise and family income showed a significant (P<0.01) positive association with age and lack of dairy consumption, but not exercise and income. BP significantly (P<0.01) increased with BMI percentile. The prevalence of childhood obesity is high across the age spectrum in the UAE. Older age, male sex, lack of dairy intake and higher parental BMI, are independent determinants of childhood obesity in this population. Higher BMI percentile is associated with a higher BP. Prevention strategies should focus on younger children, particularly children of obese parents. Longitudinal studies are needed to investigate trends and the impact of childhood obesity on the risk of non-communicable diseases.

National School Lunch Program Participation and Child Body Weight

This paper examines the relationship between National School Lunch Program (NSLP) participation and body weight using longitudinal data for public school children in grades 1–12. NSLP participation is associated with higher body weight among girls, but not boys. Quantile regression results show higher body mass index percentile for girls between the 25th–90th quantiles (whereas associations occur at the 75th–85th quantiles for boys and are smaller in magnitude compared to girls. Accounting for time-invariant unobserved heterogeneity, individual-level fixed effects models found no significant effect of NSLP participation for the full sample or by gender, suggesting that the associations are not causal.

Effect of body mass index on the outcome of children with acute myeloid leukemia

The effect of body mass index (BMI) on the treatment outcomes of children with acute myeloid leukemia (AML) is unclear and needs further evaluation. Children with AML (n = 314) who were enrolled in 4 consecutive St. Jude protocols were grouped according to BMI (underweight, <5th percentile; healthy weight, 5th to 85th percentile; and overweight/obese, ≥ 85th percentile). Twenty-five patients (8%) were underweight, 86 patients (27.4%) were overweight/obese, and 203 patients (64.6%) had healthy weight. The 5-year overall survival rate of overweight/obese patients (46.5% ± 7.3%) was lower than the rate of patients with healthy weight (67.1% ± 4.3%; P < .001); underweight patients also tended to have lower survival rates (50.6% ± 10.7%; P = .18). In a multivariable analysis that was adjusted for age, leukocyte count, French-American-British classification, and study protocols, patients with healthy weight had the best survival rate among the 3 groups (P = .01). When BMI was considered as continuous variable, patients with lower or higher BMI percentiles had worse survival (P = .03). There was no difference in the occurrence of induction failure or relapse among BMI groups, although underweight and overweight/obese patients had a significantly higher cumulative incidence of treatment-related mortality, especially because of infection (P = .009). An unhealthy BMI was associated with worse survival and more treatment-related mortality in children with AML. Meticulous supportive care with nutritional support and education, infection prophylaxis, and detailed laboratory and physical examination is required for these patients. These measures, together with pharmacokinetics-guided chemotherapy dosing, may improve outcome.