International Obesity Task Force Cut-points Research Articles

Internalized weight bias in the relationship between mental health and obesity in UK adolescents

Abstract Background It is crucial to promote mental and physical health during adolescence to protect against lifetime risks of mental health problems and obesity. Internalized weight bias (self-directed stigmatizing attitudes about perceived weight status) and bullying are implicated as potential mechanisms in the relationship between mental health and obesity in adolescence. We examined internalized weight bias and bullying as potential mediators of the relationship between mental health and weight status across adolescence in the United Kingdom (UK). Methods We analysed data on 8,688 adolescents from the UK Millennium Cohort Study. Weight status was defined using sex and age specific International Obesity Taskforce cut points for body-mass index (not overweight/obese; overweight; obese) at 11 and 17 years. Mental health was defined using parental reported emotional (anxiety and depression), and externalizing (aggression and impulsivity) symptoms at 11 and 17 years (low; moderate; high). Self-reported measures of internalized weight bias captured via body-dissatisfaction and self-esteem and bullying at 14 years were tested as mediators. We used Generalized Structural Equation Models to examine longitudinal pathways between weight status and mental health across 11 and 17 years, whilst accounting for concurrent associations and potential confounders. Results Adolescents with high emotional (relative risk (RR) 1.98, 95% CI 1.28 to 3.07) or externalizing symptoms (RR 2.07, 95% CI 1.23 to 3.48) at 11 years were twice as likely to be obese at 17 years compared with those who had low symptoms. The impact of emotional and externalizing symptoms on weight status was found to be partially attributable to internalized weight bias, but not bullying, with significant mediation for body-dissatisfaction and low self-esteem. Conclusions Internalized weight bias partially explains the relationship between mental health and weight status across adolescence. Key messages There is a need for a holistic, early prevention strategy to focus on reducing weight stigma to encourage healthy mental and physical development of children. The relationship between mental health and weight status across adolescence is partly attributable to internalized weight bias.

Is earlier obesity associated with poorer executive functioning later in childhood? Findings from the Millennium Cohort Study.

Children affected with overweight or obesity have been associated with having lower educational achievement compared to peers who are non-overweight/obese. One of the drivers of this association could be a link between obesity and poorer executive function. Evidence is limited to small, cross-sectional studies which lack adjustment for important common causes. We investigate the association between weight status and executive function longitudinally in mid-childhood, accounting for potential common causes. Linear regression analyses were conducted to examine associations between weight status between 5 and 7 years and executive functioning at 11 years in members of the Millennium Cohort Study (n=7739), accounting for a wide range of potential common causes. Age- and sex-specific International Obesity Taskforce cut-points for body mass index (BMI) were used. Executive function, including decision-making, impulsivity and spatial working memory, was assessed using the Cambridge Neuropsychological Test Automated Battery. There were no unadjusted associations between weight status and decision-making or impulsivity. After adjustment for all potential common causes, there was a lack of consistent evidence to support an association between persistent obesity (including overweight) between 5 and 7 years and spatial working memory task at 11 years. We found little evidence that poorer spatial working memory contributes to the association of children with obesity having lower educational achievement.

Alarming Rates of Obesity and Diabetes in Urban Africa: A Case Study in Bamako, Mali

Abstract Objectives Sahelian cities are growing very fast with changes in lifestyles and rise in obesity and associated chronic diseases. Reliable data on the nutritional situation in African cities is dreadfully missing. The aim of this study was to estimate overweight and obesity rates and the risk of pre-diabetes and diabetes in Bamako in order to trigger appropriate prevention measures. Methods From November 2019 to January 2020, a cross-sectional survey was conducted among a representative sample of 2040 households in Bamako, Mali. In each household, a random selection of individuals was stratified on age groups: 12–17 y, 18–29 y, 30–49 y, ≥50 y. Anthropometric measurements (weight, height, waist circumference) and plasma fasting glycemia (PFG) using Hemocue® devices were performed according to international procedures. The prevalence of overweight and obesity were defined by Body Mass Index (BMI) values using WHO cut-points for adults (25 kg/m2 ≤ BMI < 30 kg/m2 and BMI ≥ 30 kg/m2, respectively) and International Obesity Task Force cut-points for adolescents (IOTF-25 and IOTF-30, respectively). Abdominal obesity was defined by a waist circumference ≥88 cm for women and ≥102 cm for men. Risks of pre-diabetes and diabetes were defined by a PFG between 100 and 125 mg/dl and ≥126 mg/dl, respectively. Results All ages combined, the prevalence of overweight was 19.5% among men (n = 1933) and 24.4% among women (n = 2724) (P < 0.0001). The prevalence of obesity was 6.2% among men and 21.0% among women (P < 0.0001). We also found that 29.9% of women presented abdominal obesity vs 5.7% in men (P < 0.0001). Women older than 30 y (n = 1395) were the most affected, however women aged 12–17 y (n = 670) and 18–29 y (n = 881) presented alarming figures too (11.5% and 21.2% of them were overweight, respectively). Globally, 13.3% of individuals were at risk of pre-diabetes and 2.5% at risk of diabetes, with no significant gender differences. The risk of pre-diabetes ranged from 10.2% in the 12–17 y age-group to 17.8% in the ≥50 y age-group. Conclusions Our data calls for urgent actions to tackle the burden of overweight and obesity, especially among women, and to minimize the risk of diabetes and other associated non-communicable diseases in Bamako. Funding Sources French Embassy of Mali, French Institute of Research for sustainable Development (IRD).

Early clinical markers of overweight/obesity onset and resolution by adolescence.

We examined how combinations of clinical indicators at various ages predict overweight/obesity development, as well as resolution, by 10-11 and 14-15 years of age. Data were derived from Birth (N = 3469) and Kinder (N = 3276) cohorts of the Longitudinal Study of Australian Children, followed from ages 2-3 and 4-5 years, respectively. Every two years, 25 potential obesity-relevant clinical indicators were quantified. Overweight/obesity was defined using International Obesity Taskforce cutpoints at 10-11 years and 14-15 years. In both cohorts, three factors predicted both development and resolution of overweight/obesity in multivariable models. Among normal weight children, increased odds of developing overweight/obesity were associated with higher child (odd ratio (OR) 1.67-3.35 across different study waves) and maternal (OR 1.05-1.09) BMI, and inversely with higher maternal education (OR 0.60-0.62, when assessed at age 2-7 years). Lower odds of resolving existing overweight/obesity were related with higher child (OR 0.51-0.79) and maternal (OR 0.89-0.95) BMI, and inversely with higher maternal education (OR 1.62-1.92, when assessed at age 2-5 years). The prevalence of overweight/obesity at the age of 14-15 years was 13% among children with none of these risk factors at age 6-7 years, compared with 71% among those with all 3 risk factors (P < 0.001). From early childhood onwards, child and maternal BMI and maternal education predict overweight/obesity onset and resolution by adolescence. A simple risk score, easily available to child health clinicians, could help target treatment or prevention.

Developing Global Standards for Predicting Adult Overweight and Obesity from Childhood Body Mass Index - A Comparison of Estimates Obtained from Follow Up of a Pooled International Longitudinal Cohort to Current Standards Derived from Cross-Sectional Survey Data

Background: Historically, cut-points for childhood and adolescent overweight and obesity have been based on population-specific percentiles derived from cross-sectional data. To obtain cut-points that might better predict overweight and obesity in adulthood, we examined the association between childhood body mass index (BMI) and adult BMI status in a longitudinal cohort. Methods: Using data from the International Childhood Cardiovascular Cohort (i3C) Consortium pooled cohort we determined childhood overweight and obesity cut-points that best predict BMI status at the age of 18. Logistic regression analysis was used to assess the association between BMI in childhood and adult obesity. Area under the Receiver Operating Characteristic curve was used to assess the ability of fitted models to discriminate different BMI status groups in adulthood. The cut-points were then compared to those defined by the International Obesity Task Force (IOTF) using cross-sectional data, and tested for sensitivity and specificity in a separate, independent longitudinal sample with BMI measurements available from both childhood and adulthood. Findings: The cut-points derived from the longitudinal i3C Consortium data were lower than the IOTF cut-points. Consequently, a larger percentage of the sample was classified as overweight or obese when using the i3C cut-points in the independent sample. The i3C cut-points were better than the previously used IOTF cut-points at discriminating those who would later become overweight or obese in early adulthood from those whose BMI was normal when tested in the independent sample. Interpretation: The childhood BMI cut-points based on the i3C Consortium longitudinal data provide better predictors of future risk of adult overweight and obesity than estimates based on cross-sectional data. The result is more specific identification of the childhood population at risk of adult overweight or obesity than the currently used IOTF standards. Funding: Authors Kartiosuo, Ramakrishnan, Lemeshow, Juonala, Daniels, Sabin, Hu, Prineas and Dwyer declare no support from funding organisations for their work. Authors Woo, Jacobs, Steinberger, Urbina, Bazzano and Sinaiko declare their work was supported by the National Institutes of Health (NHLBI) grant no. i3C R01 HL121230. Dr Burns declares the acquisition and management of historic Muscatine Study data was supported by a Specialized Center of Research (SCOR) in Atherosclerosis, Lipids and Thrombosis grant from the National Heart, Lung and Blood Institute (NHLBI) HL-14230; M01-FR59 and RR-00059 from the General Clinical Research Centers Program, NCRR, NIH; and the Lipid Research Clinics Program (NIH-NHLBI-N01-HV-2-2913-L). Dr Raitakari declares The Young Finns Study has been financially supported by the Academy of Finland: grants 286284, 134309 (Eye), 126925, 121584, 124282, 129378 (Salve), 117787 (Gendi), and 41071 (Skidi); the Social Insurance Institution of Finland; Competitive State Research Financing of the Expert Responsibility area of Kuopio, Tampere and Turku University Hospitals (grant X51001); Juho Vainio Foundation; Paavo Nurmi Foundation; Finnish Foundation for Cardiovascular Research ; Finnish Cultural Foundation; The Sigrid Juselius Foundation; Tampere Tuberculosis Foundation; Emil Aaltonen Foundation; Yrjo Jahnsson Foundation; Signe and Ane Gyllenberg Foundation; Diabetes Research Foundation of Finnish Diabetes Association; EU Horizon 2020 (grant 755320 for TAXINOMISIS); European Research Council (grant 742927 for MULTIEPIGEN project); and Tampere University Hospital Supporting Foundation. Dr Venn declares the CDAH follow-up study received grant support from the National Health and Medical Research Council (APP211316). Dr. Bazzano is also supported in part by the following grants from the National Institutes of Health: R01AG041200, R21057983, R01062309, K12HD043451, and P20GM109036. Declaration of Interest: All authors have declared no conflict of interest. Ethical Approval: The following studies used in the work were covered by ethical approval detailed as follows: The protocols for all relevant Muscatine Study data acquisition were approved by the University of Iowa Institutional Review Board. Informed consent was obtained from all parents and adult participants; assent was obtained from participants while they were children/adolescents. The Princeton and NGHS studies were approved by the IRB at Cincinnati Children’s Hospital Medical Center. The NGHS cohort all study participants or their legal guardian if <18 years, provided written informed consent according to local IRB requirements. The Young Finns Study was approved by the institutional ethics committees, and written informed consent was obtained from all the study participants. The CDAH study was approved by the Tasmanian Health and Medical Human Research Ethics Committee. Participants gave informed consent. The Bogalusa Heart Study was approved by the institutional review board at Tulane University.

Childhood Excess Weight in Spain From 2006 to 2012. Determinants and Parental Misperception

Introduction and objectivesDue to the high prevalence of childhood obesity in Spain, we analyzed changes in its prevalence from 2006 to 2007 and from 2011 to 2012, as well as diet, sleep, and sedentary habits in 5- to 14-year-olds and parental misperceptions about their children's excess weight. MethodsThe sample was from the Spanish National Health Surveys for 2006 to 2007 (n=5590) and for 2011 to 2012 (n=3601). Data were collected by trained personnel through telephone interviews with parents/guardians. Weight and height were self-reported and the International Obesity Task Force cutpoints were used to define overweight and obesity. ResultsThe prevalence of childhood excess weight was 30.1% from 2006 to 2007 and 29.7% from 2011 to 2012, while that of childhood obesity was 9.6% and 9%, respectively. Parental misperception of childhood excess weight increased from 60.8% to 71.4% (P<.001). Daily consumption of vegetables increased by 7.8%, while that of soft drinks and snacks decreased. This decrease was greatest in children from families with a low socioeconomic status, who also decreased their consumption of sweets and fast food. Adherence to sleep recommendations decreased by 5%, but adherence to recommended sedentary time did not change. ConclusionsHigh childhood overweight and obesity rates remained stable in Spain from 2006 to 2007 and from 2011 to 2012, but there was an increase in parental misperception of childhood excess weight. Despite reduced consumption of soft drinks and snacks, there was low adherence to dietary recommendations, hours of sleep, and sedentary habits.

Exceso de peso infantil en España 2006-2012. Determinantes y error de percepción parental

Introduction and objectivesDue to the high prevalence of childhood obesity in Spain, we analyzed changes in its prevalence from 2006 to 2007 and from 2011 to 2012, as well as diet, sleep and sedentary habits in 5- to 14-year-olds, and parental misperceptions about their children's excess weight. MethodsThe sample was from the Spanish National Health Surveys for 2006 to 2007 (n = 5590) and for 2011 to 2012 (n = 3601). Data were collected by trained personnel through telephone interviews with parents/guardians. Weight and height were self-reported and the International Obesity Task Force cutpoints were used to define overweight and obesity. ResultsChildhood excess weight was 30.1% from 2006 to 2007 and 29.7% from 2011 to 2012, while that of obesity was 9.6% and 9%, respectively. Parental misperception of childhood excess weight increased from 60.8% to 71.4% (P < .001). Daily consumption of vegetables increased by 7.8%, while that of soft drinks and snacks decreased. This decrease was greatest in children from families with a low socioeconomic status, who also decreased their consumption of sweets and fast food. Adherence to sleep recommendations decreased by 5%, but adherence to recommended sedentary time did not change. ConclusionsHigh childhood overweight and obesity rates remained stable in Spain from 2006 to 2007 and from 2011 to 2012, but there was an increase in parental misperception of childhood excess weight. Despite reduced consumption of soft drinks and snacks, there was low adherence to dietary recommendations, hours of sleep and sedentary habits.Full English text available from: www.revespcardiol.org/en

The use of a dietary quality score as a predictor of childhood overweight and obesity.

BackgroundThe use of dietary quality scores/indices to describe diet quality in children has increased in the past decade. However, to date, few studies have focused on the use of these scores on disease outcomes such as childhood obesity and most are developed from detailed dietary assessments. Therefore, the aims of this study were: firstly to construct a diet quality score (DQS) from a brief dietary assessment tool; secondly to examine the association between diet quality and childhood overweight or obesity; thirdly we also aim to examine the associations between individual DQS components and childhood overweight or obesity.MethodsA secondary analysis of cross sectional data of a sample of 8,568 9-year-old children and their families as part of the Growing Up in Ireland (GUI) study. Subjects were drawn from a probability proportionate to size sampling of primary schools throughout Ireland over the school year 2007–2008. Height and weight were measured by trained researchers using standardised methods and BMI was classified using the International Obesity Taskforce cut-points. The DQS (un-weighted) was developed using a 20-item, parent reported, food frequency questionnaire of foods consumed over the past 24 h. Adjusted odds ratios for overweight and obesity were examined by DQS quintile, using the first quintile (highest diet quality) as the reference category.ResultsThe prevalence of normal weight, overweight and obese was 75, 19 and 6 % respectively. DQS ranged from -5 to 25, higher scores indicated higher diet quality in the continuous score. In analyses adjusted for gender, parent’s education, physical activity and T.V. viewing, child obesity but not overweight was significantly associated with poor diet quality: OR of 1.56 (95 % CI 1.02 2.38) in the 5th compared to the 1st DQS quintile. Findings from individual food items were inconsistent.ConclusionsThe findings suggest that diet quality may be an important factor in childhood obesity. A simple DQS developed from a short dietary assessment tool is significantly associated with childhood obesity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1907-y) contains supplementary material, which is available to authorized users.

Abstract P048: Sodium Intake is Associated with Weight Status in Australian Schoolchildren Aged 4-12 Years

Introduction: A high sodium intake stimulates thirst and in turn may promote greater consumption of high energy sugary beverages, which are linked to obesity risk in children. In this study we assessed the hypothesis that sodium intake, as measured by 24-hr urinary sodium excretion, would be positively associated with weight status in primary school-aged children. Methods: Cross-sectional study completed within a convenience sample of Victorian primary schools (n=43). Sodium intake was assessed via one 24-hr urine collection. Fourteen percent of samples were deemed invalid and excluded. BMI was calculated from measured weight and height and converted to BMI z-scores using the 2000 Centers for Disease Control and Prevention reference growth charts. Participants were grouped into weight categories using the International Obesity Task Force cut-points. Differences in sodium intake and weight status were assessed using multi-level linear and logistic regression analysis with adjustment for random effects (gender, age) and fixed effect (school cluster). Results: Of the 667 children with valid urine samples 55% were male and the average age was 9.3±(SD) 1.8 years. Ten percent were classified as underweight, 73% healthy weight, 14% overweight and 3% obese. Average sodium intake differed across weight categories, underweight 82±29 mmol/day (salt equivalent 4.8±1.7 g/day); healthy weight 102±43 mmol/day (salt 6.0±2.5 g/day); overweight 125±55 mmol/day (salt 7.3±3.2 g/day); obese 148±97 mmol/day (salt 8.7±5.7 g/day) (p=0.001). In the fully adjusted model sodium intake (mmol/d) was significantly associated with BMI z-score (b=0.006, P&lt;0.001). A 17 mmol/day increase in sodium intake (salt 1 g/day) was associated with a 23% (OR: 1.23; 95% CI 1.16, 1.31) greater risk of being overweight or obese, adjusted for age and gender. Conclusions: Higher sodium intake is associated with overweight and obesity in Victorian schoolchildren. This may be related to increased energy intake, and this association should be explored further.

Dairy food consumption and blood pressure among adolescents

Dairy food consumption and blood pressure among adolescents

Physical activity, diet and BMI in children aged 6–8 years: a cross-sectional analysis

ObjectiveTo assess relationships between current physical activity (PA), dietary intake and body mass index (BMI) in English children.Design and settingLongitudinal birth cohort study in northeast England, cross-sectional analysis.Participants425 children (41%...

Abstract P246: Determinants of Remission of Overweight Status in Youth

Introduction and hypothesis: Spontaneous remission to normal weight status occurs in ~10-20% of overweight youth. The factors that predict remission, particularly modifiable factors such as diet and physical activity (PA) are poorly understood. We hypothesized that the time spent in moderate to vigorous physical activity (MVPA), high fitness and better diet quality would be associated with an increased likelihood of remission to normal weight status among overweight youth. Design and Methods: This was a three year prospective cohort study of 114 youth aged 9-15 years who were overweight or obese (International Obesity task Force (IOTF) cut-points) at baseline. We performed a series of regression analyses to test for predictors of remission to normal weight status at the 3-year follow up visit. The primary exposure variables were accelerometer (Actical) determined physical activity (PA) intensity, cardiorespiratory fitness assessed with a 20m shuttle run and diet quality determined from a web-based 24-hr recall tool that estimated diet quality based on meeting recommendations for daily intake of food groups. The primary outcome measure was remission to normal weight status defined as a BMI within the “healthy weight” range for age and sex in year 3 of the cohort study according to IOTF cut-points. We also tested for differences in BMI Z-score and systolic blood pressure (SBP) between youth that experienced remission and those that didn’t. We adjusted for the potential confounding effects of sedentary time, age and sex. Results: Among the 114 overweight youth studied (12 ± 2 years; BMI Z score = 1.55 ± 0.35), 18 (16%) returned to normal weight status at year 3. Remission did not occur in any youth considered obese (BMI [[Unable to Display Character: &amp;#707;]] 95th percentile) at baseline. Neither MVPA nor dietary quality was associated remission. However, remission was associated with a lower BMI Z score at baseline (1.31 ± 0.15 vs. 1.60 ± 0.35, p &lt; 0.05) and a higher cardiorespiratory fitness (shuttle run score = 6.4 ± 2.3 vs. 4.9 ± 1.9, p &lt; 0.05). The odds of remission were 4-fold higher (OR: 4.2 95% CI=1.04-16.7) among youth in the two upper quintiles of cardiorespiratory fitness compared to those in the lowest quintile. Despite a significant decline in BMI Z score over 3 years (-0.67 ± 0.53 vs. -0.019 ± 0.23, p &lt; 0.05) in youth that experienced remission, no differences in SBP were observed compared to youth that remained overweight. Conclusions: Remission to normal weight status was observed in 16% of youth who were overweight at their initial assessment. Obesity and low cardiorespiratory fitness reduced the likelihood of spontaneous remission to normal weight status in overweight youth. The identification of BMI and fitness thresholds at which spontaneous remission is unlikely to occur will tailor interventions to youth with the greatest need to improve lifestyle behaviours, weight status, and overall well-being.

Canadian childhood obesity estimates based on WHO, IOTF and CDC cut-points

This article compares prevalence estimates of excess weight among Canadian children and youth according to three sets of body mass index (BMI) reference cut-points. The cut-points are based on growth curves generated by the World Health Organization (WHO), the International Obesity Task Force (IOTF), and the US Centers for Disease Control (CDC). A secondary objective is to compare estimates by method of data collection. Prevalence estimates of overweight and obesity were produced for 2- to 17-year-olds using the three sets of BMI cut-points. Estimates are based on data from 8 661 respondents from the 2004 Canadian Community Health Survey and 1 840 respondents from the 1978/79 Canada Health Survey. In both surveys, the height and weight of children were measured. The 2004 prevalence estimate for the combined overweight/obese category is higher (35%) when based on the WHO cut-points compared with the IOTF (26%) or CDC (28%) cut-points. Estimates of the prevalence of obesity are similar based on WHO and CDC cut-points (13%), but lower when based on IOTF cut-points (8%). Absolute differences in excess weight estimates between 1978/79 and 2004 are similar based on the three sets of cut-points, but the relative increase is greater when based on the IOTF cut-points. Estimates vary substantially by method of data collection. When interpreting prevalence estimates of overweight and obesity for children and youth, it is important to consider the definitions used and the method of data collection.

Age, sex and ethnic differences in the prevalence of underweight and overweight, defined by using the CDC and IOTF cut points in Asian children

No nationally representative data from middle- and low-income countries have been analyzed to compare the prevalence of underweight and overweight, defined by using the Centers for Disease Control and Prevention (CDC) and the International Obesity TaskForce (IOTF) body mass index cut points. To examine the consistency in the prevalence of underweight and overweight, defined by using the CDC and IOTF cut points in Chinese, Indonesian and Vietnamese children. We used data from 1600 Chinese, 11 756 Indonesian and 53 826 Vietnamese children aged 2-18 years, who participated in three recent, representative surveys in China, Indonesia and Vietnam. A smaller difference between prevalence and a higher kappa-statistic indicated a higher consistency level. The prevalence of underweight was higher with the IOTF than the CDC cut points; absolute differences in the Chinese, Indonesian and Vietnamese were 6, 10 and 13% (boys), and 10, 13 and 19% (girls), respectively. The prevalence of overweight was more consistent (absolute differences were <2%, except for the 2-5.9-year-old Chinese and Indonesian children (from 2 to <5%)). Values of kappa-statistic (from 0.55 to 0.88) varied by age, sex and ethnicity. The consistency was gradually improving from the Vietnamese to Indonesians and to Chinese boys and girls, from girls to boys, from the younger to older boys and from the older to younger girls. The age, sex and ethnic differences in the prevalence of underweight and overweight suggest a systematic evaluation of the cut points.

The CDC and IOTF cut points show inconsistent prevalence of underweight and overweight in Chinese, Indonesian, and Vietnamese children

No nationally representative data from middle and low income countries have been analyzed to compare prevalence of underweight and overweight defined by the Centers for Disease Control and Prevention (CDC) and the International Obesity TaskForce (IOTF) BMI cut points. We evaluated the consistency in nutrition status classifications derived from the CDC and IOTF cut points, using data from 1600 Chinese, 11756 Indonesian, and 53826 Vietnamese children aged 2‐18 y, who participated in recent, representative surveys in China, Indonesia, and Vietnam. A smaller difference between prevalence and a higher Kappa statistic indicated a higher consistency level between the CDC and IOTF classification systems. The prevalence of underweight defined by the IOTF was higher compared to those defined by the CDC cut points (absolute differences were 6, 10, and 13% in Chinese, Indonesian, and Vietnamese boys; 10, 13, and 19% in girls). Kappa statistic values were largest in Chinese boys (0.81‐0.88) compared to those in Indonesian (0.74‐0.82) and Vietnamese (0.69‐0.79) boys. Smaller Kappa statistics were found in girls from China (0.65‐0.80), Indonesia (0.63‐0.76), and Vietnam (0.55‐0.68). With an increase in age, Kappa statistics tended to increase in boys and decrease in girls. The differential findings from the CDC and IOTF cut points suggest that a validation of the cut points by using disease risk or body fat outcomes is needed. Supported by the Vietnam Educational Foundation (VEF) and USDA.

Comorbities of overweight/obesity in Australian preschoolers: a cross-sectional population study

Objective:To determine relationships between body mass index (BMI) status and indicators of health and morbidity in a nationally-representative population sample of preschool children.Methods:Data from the 4–5-year-old cohort in the first...

Screen time and physical activity during adolescence: longitudinal effects on obesity in young adulthood

BackgroundThe joint impact of sedentary behavior and physical activity on obesity has not been assessed in a large cohort followed from adolescence to adulthood.MethodsNationally representative longitudinal data from Waves II (1995; mean age: 15.9) and III (2001; mean age: 21.4) of the National Longitudinal Study of Adolescent Health (n = 9,155) were collected. Sex-stratified multivariate logistic regression analysis assessed the odds of obesity associated with Wave II MVPA and screen time, controlling for sociodemographic characteristics and change in MVPA and screen time from Wave II to III. Obesity was defined using body mass index (BMI, kg/m2) International Obesity Task Force cut-points at Wave II and adult cut-points at Wave III (BMI ≥ 30).ResultsIn males, adjusted odds of prevalent obesity was strongly predicted by MVPA bouts [OR (95% CI): OR6 vs. 1 MVPA bouts = 0.50 (0.40, 0.62); OR4 vs. 40 hrs screen time = 0.83 (0.69, 1.00)]. In females, greater MVPA bouts and lower screen time correlated with lower prevalent obesity [OR (95% CI): OR6 vs. 1 MVPA bouts = 0.67 (0.49, 0.91); OR4 vs. 40 hrs screen time = 0.67 (0.53, 0.85)]. Longitudinally, adolescent screen time hours had a stronger influence on incident obesity in females [OR (95% CI): OR4 vs. 40 hrs = 0.58 (0.43, 0.80)] than males [OR (95% CI): OR4 vs. 40 hrs = 0.78 (0.61, 0.99)]. Longitudinal activity patterns were not predictive of incident obesity.ConclusionReducing screen time during adolescence and into adulthood may be a promising strategy for reducing obesity incidence, especially in females.

Overweight and obesity prevalence in children based on 6- or 12-month IOTF cut-points: does interval size matter?

The International Obesity Taskforce (IOTF) recommends using age- and gender-specific body mass index (BMI) cut-points for defining the prevalence of overweight and obesity in children. These are given in both 6- and 12-month age intervals. Since the BMI-for-age curves are nonlinear, a degree of bias will be introduced when age intervals are wide. We aimed to quantify this bias in prevalence estimates in 2178 Australian children aged 4-12 years using 12- versus 6-month age intervals. Using the 12-month interval, the prevalence of overweight and obesity was underestimated by 1.4% compared to the 6-month interval estimates; however, this was age-dependent. It overestimated prevalence for 4-year olds, but underestimated it for older ages by up to 2.6%. Overweight prevalence was generally affected more than obesity prevalence. The use of different age intervals for IOTF cut-points introduces a small but systematic bias in prevalence estimates of overweight and obesity.

Obesity in children and adolescents with acquired brain injury

To measure the prevalence of obesity and to assess associated clinical factors in children and adolescents with acquired brain injury (ABI). This cross-sectional study included 88 subjects aged between 2.4-17.7 years attending the Brain Injury Clinic at a tertiary paediatric hospital. Body mass index (BMI) and BMI z-scores were calculated. Obesity and overweight were defined using the International Obesity Taskforce cut-points. Associations were examined between BMI z-scores and the following: ABI severity, mobility level, duration from injury and presence of radiological injury. The prevalence of obesity in this population (obese = 15%) was higher than those in Australian children and adolescents (1995 National Nutrition Survey) while the prevalence of overweight (19.3%) was comparable. There was a linear trend for the participants to have a higher BMI z-score with increasing level of mobility (F = 6.91, df 1.70, p = 0.011). There is no data about obesity in children and adolescents with ABI. The study with limited statistical power suggests that obesity is prevalent in this population and increases with increasing level of mobility. Further studies are required to address the issue of obesity and related complications in this population.

Early intrauterine exposure to tobacco-inhaled products and obesity.

An association between maternal smoking during pregnancy and offspring obesity has been reported. This study assessed the impact of maternal smoking during the first trimester. Data on 4,974 German children aged 5-6 years were obtained at school entry health examinations in 2001-2002 in Bavaria. Obesity was defined by body mass index using International Obesity Task Force cutpoints. Prevalence of obesity was 1.9% (95% confidence interval (CI): 1.5, 2.4) in offspring of never smokers, 4.5% (95% CI: 2.9, 6.7) for maternal smoking during the first trimester only, and 5.9% (95% CI: 3.8, 8.7) for maternal smoking throughout pregnancy. Unadjusted odds ratios were higher for maternal smoking throughout pregnancy (odds ratio = 3.23, 95% CI: 2.00, 5.21) compared with the first trimester only (odds ratio = 2.41, 95% CI: 1.49, 3.91). Adjusted odds ratios were similar: 1.70 (95% CI: 1.02, 2.87) for maternal smoking throughout pregnancy and 2.22 (95% CI: 1.33, 3.69) for maternal smoking in the first trimester only. When modeled together, no statistically significant difference in obesity risk was found between maternal smoking in the first trimester compared with throughout pregnancy. The effect of intrauterine tobacco exposure on childhood obesity may depend largely on cigarette smoking during the first trimester, whereas the additional impact of smoking throughout pregnancy might be due to confounding by sociodemographics. Women should be encouraged to quit smoking prior to conception.