Lower Body Mass Index Z-score Research Articles

Vascular Function and Distribution of Adiponectin Isomers during Puberty in Children and Adolescents with Obesity

Introduction: Youth with obesity have abnormal vascular function that relates to the anti-atherogenic adipose-derived hormone, adiponectin. The distribution of adiponectin isomers changes during normal puberty, but there are no data in relation to vascular function. We aimed to evaluate vascular function, adiponectin, and its isomers longitudinally in peri-pubertal youth with obesity and controls. Methods: The study is a cohort longitudinal study involving 30 children and adolescents with obesity (body mass index [BMI] z-score 2.31 ± 0.24; age 12.8 ± 3 years, 17 male participants) and 28 age-/sex-matched healthy controls (12.8 ± 3 years, 14 male participants). Vascular function (flow-mediated dilatation [FMD], glyceryl trinitrate-mediated dilatation [GTN]), total adiponectin and isomers, and laboratory and clinical variables were assessed at 0, 18, and 36 months. Results: FMD and GTN were stable during puberty in both groups, remaining consistently lower in obese children (p = 0.02, p < 0.001). The change in total (p = 0.02) and high-molecular weight (HMW) (p = 0.02) adiponectin differed between the groups: falling in controls by the end of puberty but not falling further during puberty in obesity. In obesity, impaired GTN was associated longitudinally with lower total (B = 7.85, p = 0.006) and HMW (B = 3.72, p = 0.03) adiponectin. In controls, more favourable GTN was longitudinally associated with a lower BMI z-score (B = −3.04, p = 0.027) and lower waist circumference (B = −0.35, p = 0.009). Conclusions: Vascular dysfunction and lower levels of adiponectin are associated in children and adolescents with obesity during puberty and do not deteriorate further. Healthy children’s better vascular function, within the normal range, is associated with a lower BMI z-score and waist circumference.

Trajectories in glycated hemoglobin and body mass index in children and adolescents with diabetes using the common data model

We evaluated trajectories of glycated hemoglobin (HbA1c) levels and body mass index z-scores (BMIz) for 5 years after diagnosis among Korean children and adolescents with type 1 diabetes (T1D) or type 2 diabetes (T2D) using the common data model. From the de-identified database of three hospitals, 889 patients < 15 years of age diagnosed with T1D or T2D (393 boys, 664 T1D patients) were enrolled. Diagnosis was defined as first exposure to antidiabetic drug at each center. Compared with T2D patients, T1D patients had lower BMIz at diagnosis (− 0.4 ± 1.2 vs. 1.5 ± 1.4, p < 0.001) and 3 months (− 0.1 ± 1.0 vs. 1.5 ± 1.5, p < 0.001), and higher HbA1c levels at diagnosis (10.0 ± 2.6% vs. 9.5 ± 2.7%, p < 0.01). After 3 months, HbA1c levels reached a nadir of 7.6% and 6.5% in T1D and T2D patients, respectively, followed by progressive increases; only 10.4% of T1D and 29.7% of T2D patients achieved the recommended HbA1c target (< 7.0%) at 60 months. T1D patients showed consistent increases in BMIz; T2D patients showed no significant change in BMIz during follow-up. Peri-pubertal girls with T1D had higher HbA1c and BMIz values. Achieving optimal glycemic control and preventing obesity should be emphasized in pediatric diabetes care.

Sleep duration, physical activity, and caloric intake are related to weight status in Mexican American children: a longitudinal analysis

BackgroundObesity is a serious issue, spanning all ages, and, in the U.S., disproportionately affects Latinos and African Americans. Understanding sleep, physical activity and dietary behaviors that may predict childhood obesity can help identify behavioral intervention targets.MethodsData were drawn from a U.S. cohort study of 323 Mexican American 8–10-year-old children and their mothers, who participated in a longitudinal study over a 2-year period. Measures were collected at baseline (BL; child mean age = 8.87, SD = 0.83), year 1 (FU1) and year 2 (FU2). Mothers reported on household income and acculturation at BL. Child height and weight were collected and BMI z-scores (BMIz) were calculated for weight status at BL, FU1, and FU2. Accelerometer-estimated sleep duration (hours) and moderate-to-vigorous physical activity (MVPA; minutes) were collected across 3 days at BL, FU1, and FU2. Two 24-h dietary recalls were performed at each time point; from these, average energy intake (EI, kcals/day) was estimated. Cross-lagged panel analysis was used to examine behavioral predictors on BMIz at each time point and across time.ResultsAt BL and FU1, longer sleep duration (β = − 0.22, p < 0.001; β = − 0.17, p < 0.05, respectively) and greater MVPA (β = − 0.13, p < 0.05; β = − 0.20, p < 0.01, respectively) were concurrently related to lower BMIz. At FU2, longer sleep duration (β = − 0.18, p < 0.01) was concurrently related to lower BMIz, whereas greater EI (β = 0.16, p < 0.01) was related to higher BMIz. Longer sleep duration at BL predicted lower BMIz at FU1 (β = − 0.05, p < 0.01).ConclusionsLonger sleep duration was concurrently related to lower weight status at each time point from ages 8–10 to 10–12. Higher MVPA was concurrently related to lower weight status in earlier childhood (ages 8–10 and 9–11) and higher EI was concurrently related to higher weight status toward the end of childhood (ages 10–12 years). Furthermore, longer sleep in earlier childhood was protective of children’s lower weight status 1 year later. These findings suggest that sleep duration plays a consistent and protective role against childhood obesity; in addition, MVPA and healthy EI remain important independent factors for obtaining a healthy weight.

The adherence to school meals is associated with a lower occurrence of obesity among Brazilian adolescents

This study aimed to verify the association between adherence to meals from the Brazilian National School Feeding Program (PNAE) and obesity indicators among adolescents. Data from 12,373 students attending public schools from the 2015 National Survey of School Health were used. Adherence to school meals was assessed using a self-administered questionnaire and classified as null (zero/rarely), low (1-2×/week), moderate (3-4×/week), and high (5×/week). Weight and height were measured and classified based on the World Health Organization's reference for Z-scores of body mass index (BMI) for age, overweight (≥ + 1 Z-score) and obesity (≥ + 2 Z-score). Linear and Poisson regression models adjusted for potential confounding factors (gender, race/ethnicity, age, region, goods score, maternal education, living with parents, eating outside of school profile and physical activity) were performed to assess the association between adherence to school meals and the indicators (Z-score, overweight and obesity). The prevalence of high adherence was 21.6% and obesity, 8%. An inverse and dose-response association were observed between adherence to the PNAE meals and obesity indicators. Adolescents with high adherence to school meals (5×/week) had a 0.10 lower BMI Z-score (coefficient = −0.10, CI -0.17;-0.03), 11% less prevalence of overweight (PR = 0.89, CI 0.80;0.99) and 24% less prevalence of obesity (PR = 0.76, CI 0.62;0.93) than those with a lower adherence (<5×/week). Our results showed that the adherence to PNAE meals may contribute to obesity prevention in Brazil.

High Prevalence of Severe Acute Malnutrition in Children with Sickle Cell Anemia over 5 Years of Age in Northern Nigeria

Introduction:Two of the most common and life-threatening non-communicable diseases (NCD) among children in Nigeria are malnutrition and sickle cell anemia (SCA). SCA is one of the most common monogenic disorders, with an annual 305,000 births worldwide, 150,000 births in Nigeria, as compared to 1,700 births in the United States. Severe acute malnutrition is a previously unrecognized epidemic in children with SCA living in Sub-Saharan Africa, the impact of which usually falls on children under the age of five. Previous studies have reported poor growth and delayed maturation in children with SCA when compared to children without SCA, due to increased resting metabolic rate (proposed mechanism includes; decreased intake, hypermetabolism, increased hemolysis, red cell turnover and cardiac demand) and poor nutritional intake. The World Health Organization (WHO), UNICEF and World Bank have not established standards of care for children with severe acute malnutrition above 5 years of age. Additionally, these organizations have not acknowledged that children with SCA could be at risk for severe acute malnutrition. A recent study in Nigeria conducted in children with SCA, using the WHO-growth standards, demonstrated a high prevalence of wasting and severe wasting, as well as, stunting and severe stunting, 22.7% and 11.6%, respectively. However, WHO expected normal ranges for height and weight describes the growth of healthy children, not children with SCA. In a multi-institution cross-sectional study, we tested the hypothesis that severe acute malnutrition is more prevalent in older children (5 to 12 years old) with SCA in Nigeria when compared to an age-matched multi-institutional pediatric cohort of SCA from high-income countries.Methods:The study population in Nigeria included children with SCA between 5 to 12 years old, who were being screened for eligibility for National Institute of Health (NIH)-funded randomized controlled trial; the Primary Prevention of Stroke in Children with SCD in Sub-Saharan Africa (SPRING trial), from July 2016 to July 2017. The study population in the high-income countries (the U.S. and U.K), the comparison group, included children enrolled in the Sickle Cell Anemia Sleep and Asthma Cohort (SAC). Height, weight, age and sex were used to calculate body mass index (BMI). Anthropometric indices included weight-for-age and height-for-age, BMI-for-age, and were expressed as Z-scores to assess the nutritional status. The following definitions were used; underweight; weight-for-age Z-score below −2, stunting; height-for-age Z-score below −2, wasting; weight-for-height or BMI-for-age Z-score below −2. Severe acute malnutrition was defined as a very low BMI Z-score of below -3. These values were set from the median values of the WHO international growth reference.Result:A total of 803 in the Nigerian cohort and 153 children in the high-income countries cohort with SCA were included in the study. The median age in the Nigerian and in the high-income countries cohort was 8.2 and 10 years (range 4.9-13.8), respectively, and half were male (49.6 and 51.3%). The mean BMI in the Nigerian cohort was significantly lower when compared to high-income countries (13.7 versus 16.9 kg/m2 (p<0.001) [Figure I].Of the 803 children in the Nigerian cohort, 34.2% were underweight, 36% had height-for-age below 2, and 42.6% had BMI-for-age Z-score below −2. A total of 20% in the Nigerian cohort met the criteria of severe acute malnutrition compared to 0.7% in the cohort in high-income countries (p <0.001) [Baseline characteristics and Nutritional Status are summarized in Table I].Conclusion:We demonstrate a significant unrecognized challenge of severe acute malnutrition among older children with SCA living in Nigeria, when compared to children with SCA living in high-income countries. Severe acute malnutrition is a devastating co-morbidity in children with SCA in northern Nigeria and perhaps in other regions of Africa. Future studies are needed to elucidate the public health impact, morbidity and mortality of severe acute malnutrition in this population. Currently no formal evidence-based strategies are available to treat severe acute malnutrition in children with SCA, but are greatly needed to decrease morbidity and even potentially mortality. [Display omitted] DisclosuresRodeghier:Rodeghier consultants: Consultancy.

Association of Maternal Dietary Patterns during Pregnancy and Offspring Weight Status across Infancy: Results from a Prospective Birth Cohort in China.

Literature on maternal dietary patterns during pregnancy and offspring weight status have been largely equivocal. We aimed to investigate the association of maternal dietary patterns with infant weight status among 937 mother–infant dyads in a Chinese birth cohort. We assessed maternal diet during pregnancy using food frequency questionnaires (FFQ) and three-day food diaries (TFD) and examined infants’ body weight and length at birth, 1, 3, 6, 8 and 12 months. Maternal adherence to the “protein-rich pattern (FFQ)” was associated with lower infant body mass index z-scores (BMIZ) at birth, 3 and 6 months and lower odds of overweight and obesity (OwOb) across infancy (quartile 3 (Q3) vs. quartile 1 (Q1): odds ratio (OR): 0.50, (95% confidence interval: 0.27, 0.93)). Maternal adherence to the “vegetable–fruit–rice pattern (FFQ)” was associated with higher BMIZ at birth, 3 and 6 months and higher odds of OwOb across infancy (Q3 vs. Q1: OR: 1.79, (1.03, 3.12)). Maternal adherence to the “fried food–bean–dairy pattern (TFD)” was associated with lower BMIZ at 3, 6, 8 and 12 months and lower odds of OwOb (Q3 vs. Q1: OR: 0.54, (0.31, 0.95)). The study results may help to develop interventions and to better define target populations for childhood obesity prevention.

933-P: Impact of Sleep and Activity on Glycemic Control and Quality of Life in Haitian Youth with Type 1 Diabetes

Background: Sleep and exercise affect overall health. In youth with type 1 diabetes (T1DM), physical activity and adequate sleep reportedly improve glycemic control. Data from low-income countries is lacking. Objective: To describe sleep and activity in Haitian youth with T1DM and examine their impact on glycemic control, health-related quality of life (HRQL) and Life Satisfaction (LS). Methods: Single-center cross-sectional study in Haiti, including youth diagnosed with T1DM between 0-25 years old. Wristbands tracked activity and sleep for 10 days. Diabetes Quality of Life in Youth (DQoLY) questionnaire was used to evaluate HRQL and LS. Point-of-care hemoglobin A1c (A1C) values (max. measure 14%) were recorded. Linear regression was used to assess sleep and activity as predictors of A1C, HRQL and LS. Results: We included 66 participants (59% female, mean age 17.8±4.8 years, mean diabetes duration 3.7±3.4 years, mean BMI Z-score -0.86±1.1). Mean HRQL was 63/100 and mean LS 65/100. Mean A1C was 11.3%, and 22 patients (34%) had A1C &amp;gt;14%. Mean daily step count was 9448±8431 and mean sleep duration 7h31±1h17. Higher A1C was predicted by younger age (p=0.005) and lower BMI Z-score (p=0.0016), but not sex or diabetes duration. Better HRQL was predicted by younger age (p=0.029), and marginally by male sex (p=0.07). None predicted LS. Sleep duration and step count did not predict either outcome. When excluding patients with A1C&amp;gt;14% (to eliminate a possible ceiling effect), shorter sleep duration was a significant predictor of higher A1C (p=0.03) in uni- and multivariate models adjusted for age, sex, BMI and diabetes duration. Conclusions: Youth with T1DM in Haiti have poor glycemic control, and low HRQL and LS. Their average sleep duration and daily activity is similar to reported values in peers. While activity level did not affect A1C, HRQL or LS, shorter sleep duration predicted higher A1C in youth with A1C&amp;lt;14%. Prospective studies with larger sample sizes are needed to validate our findings. Disclosure M. Babinski: None. R. Duperval: None. J. E. Von oettingen: None. K. Altenor: None.

Associations of diarised sleep onset time, period and duration with total and central adiposity in a biethnic sample of young children: the Born in Bradford observational cohort study

ObjectivesTo investigate associations of parent-reported sleep characteristics with adiposity levels in a biethnic sample of young children.DesignA cross-sectional observational study.SettingThe Born in Bradford 1000 study, UK.ParticipantsChildren aged approximately 18 months...

Segmented School Physical Activity and Weight Status in Children: Application of Compositional Data Analysis.

The purpose of this study was to apply compositional data analysis (CoDA) for the analysis of segmented school step counts and associate the school step count composition to body mass index (BMI) z-scores in a sample of children. Participants were 855 (51.8% female) children recruited from the fourth and fifth grades from four schools following a 7-h school schedule. Using piezoelectric pedometers, step count data were collected during physical education, recess, lunch, and during academic class time. A multi-level mixed effects model associated the step count composition with BMI z-scores. Compositional isotemporal substitution determined changes in BMI z-scores per reallocation of steps between pairs of school segments. A higher percentage of steps accrued during physical education (b = −0.34, 95%CI: −0.65–−0.03, p = 0.036) and recess (b = −0.47, 95%CI: −0.83–−0.11, p = 0.012), relative to other segments, was associated with lower BMI z-scores. Specifically, a 5% to 15% reallocation of steps accrued during lunchtime to either physical education or recess was associated with lower BMI z-scores, ranging from −0.07 to −0.25 standard deviation units. Focusing school-based promotion of physical activity during physical education and recess may have greater relative importance if targeted outcomes are weight-related.

Clinical Criteria Can Identify Children With Osteopenia in Newly Diagnosed Crohn Disease.

Chronic inflammation of Crohn disease (CD) is associated with reduced bone mineral density (BMD). As bone mass is almost exclusively accrued during childhood, early recognition of osteopenia is especially important in pediatric CD. We aimed to identify variables associated with osteopenia to guide dual-energy X-ray absorptiometry (DXA) scan screening to those who most need it. This was a retrospective inception cohort study of children newly diagnosed with CD, and routinely referred to DXA scans. Demographic and explicit clinical data were recorded along with whole-body less head BMD, adjusted for age, sex, and height by z-scores. Of the 116 included children (mean age 13 ± 3.1 years, 67 [58%] boys, mean body mass index [BMI] 16.7 ± 2.6), 63 (54%) had normal BMD (z-score > -1) or borderline osteopenia (-1 ≥ z-score > -2) and 53 (46%) had osteopenia (z-score ≤ -2). Osteopenia was associated with lower BMI z-score (-0.8 ± 1.2 vs -1.8 ± 1.1, P < 0.001) and higher PCDAI (33.7 ± 15.2 vs 25.7 ± 16.5; P = 0.009) than those with BMD z-score >-2. In total, 59% of children with BMI z-score <-0.5 had moderate-severe osteopenia and only 18% of those with higher z-scores. Multivariate logistic regression identified BMI z-score as the sole risk factor (OR 1.28 [95% CI 1.08-1.52], P = 0.005). BMI z-score ≥-0.5 excludes osteopenia with a sensitivity 87%, specificity 49%, NPV 82%, and PPV 59%. Osteopenia was found in nearly half of children with newly onset CD. BMI z-score <-0.5 should prompt referral to DXA screening.

Relationship between primary school healthy eating and physical activity promoting environments and children’s dietary intake, physical activity and weight status: a longitudinal study in the West Midlands, UK

ObjectiveWe aimed to examine the association between food and physical activity environments in primary schools and child anthropometric, healthy eating and physical activity measures.DesignObservational longitudinal study using data from a...

Better health indicators of FitSpirit participants meeting 24-h movement guidelines for Canadian children and youth.

This study aims to determine the proportion of girls who meet the recommendations for moderate-to-vigorous physical activity (MVPA), screen time and sleep duration among FitSpirit participants and evaluate the associations of these recommendations with perceived health-related quality of life (QOL), perceived health, physical activity (PA), self-efficacy and body mass index. Cross-sectional analyses of FitSpirit data were performed. All variables were collected through an online questionnaire. The proportion of girls meeting all recommendations was 2.2%, while 72.5% met either one or two and 25.4% met none. A greater percentage of girls with ≥3 years in FitSpirit met MVPA and sleep recommendations combined when compared with fewer years (12.9% vs. 1.7% with 1 year; vs. 10.1% with 2 years; p < 0.05). Meeting the combinations of MVPA and screen time (β = 0.19, 95% CI = 0.40, 1.68), MVPA and sleep (β = 0.20, 95% CI = 0.27, 1.04) and all three combined (β = 0.17, 95% CI = 0.33, 1.71) was the most significant predictors of better perceived QOL. Respecting MVPA recommendations predicted a better perceived health (β = 0.18, 95% CI = 0.18, 0.87) while girls who slept as recommended had a better PA-related self-efficacy (β = 0.23, 95% CI = 0.51, 2.11). Not meeting any recommendation was associated with inferior PA-related self-efficacy (β = -0.32, 95% CI = -3.03, -1.21). Lastly, meeting MVPA and sleep recommendations was significantly associated with lower body mass index z-scores (β = -0.14, 95% CI = -1.16, -0.11). There was a small percentage of girls following all of the recommendations. Furthermore, meeting individual and combined recommendations was associated with better perceived QOL and health, PA self-efficacy as well as healthier body mass index z-score.

Prenatal phthalate exposures and anthropometryduring adolescence: The HOME Study

Background/Aim: Phthalate exposures are ubiquitous in pregnant women and may be obesogenic. Although excess adolescent adiposity predicts obesity and cardiometabolic diseases during adulthood, few studies have examined associations between prenatal phthalate exposures and anthropometric outcomes during adolescence. We investigated the relationships between prenatal phthalate exposures and anthropometry at age 12 years.Methods: We used data from 219 mother-child pairs enrolled in the Health Outcomes and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort enrolled in Cincinnati, OH from 2003-2006. We measured monobutyl phthalate (MnBP), monobenzyl phthalate (MBzP), mono-(3-carboxypropyl) phthalate (MCPP), monoethyl phthalate (MEP), monoisobutyl phthalate (MiBP), and four metabolites of di-2-ethylhexyl phthalate (DEHP) in maternal urine samples collected at 16 and 26 weeks of pregnancy. At age 12 years, we measured child weight and height. We used multivariable linear regression to estimate covariate-adjusted associations of a 10-fold increase in average maternal urinary phthalate metabolite concentrations with age- and sex- standardized height, weight, and BMI z-scores. We assessed effect measure modification (EMM) by child sex using stratified models.Results: In adjusted analyses, maternal urinary phthalate metabolite concentrations were not associated with height, weight, or BMI z-scores in the overall sample. However, associations of MBzP concentrations with all anthropometry z-scores were modified by child sex, with lower z-scores among girls, but not boys. For example, a 10-fold increase in MBzP concentrations was associated with lower BMI z-scores in girls (β=-0.4; 95% CI: -0.9, 0.0) but not boys (β=0.2; 95% CI: -0.3, 0.7; EMM p-value=0.09). Additionally, a 10-fold increase in MiBP was associated with increased height z-scores among boys (β=0.7; 95% CI: 0.1, 1.3), but not girls (β=0.0; 95% CI: -0.6, 0.5; EMM p-value=0.09).Conclusions: In this prospective cohort study, higher prenatal phthalate exposures were not associated with adolescent anthropometry, but there may be sex-specific effects.

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.

88 Vegetarian diet, growth and micronutrient stores in childhood: A prospective cohort study

Abstract Background Vegetarian diets are becoming increasingly popular among Canadians, yet few studies have evaluated the relationship between a vegetarian diet and childhood growth and nutritional status. Since vegetarian diets can be less energy dense and may have lower micronutrient content, we hypothesized that a vegetarian diet may affect childhood growth including lower adiposity and height, as well as lower micronutrient stores. Objectives The primary objective of this study was to evaluate the relationship between vegetarian diet and growth, including adiposity and height among healthy children 6 months to 10 years of age. Secondary objectives included the examination of the relationship between vegetarian diet and iron and vitamin D stores. We also explored whether cow’s milk intake or age modified the associations between vegetarian diet and growth, and micronutrient stores. Design/Methods This was a prospective cohort study of healthy children age 6 months to 10 years. The primary exposure was vegetarian diet measured by parent report. The primary outcome was BMI z-score. Secondary outcomes included height-for-age z-score, serum ferritin, and serum 25-hydroxyvitamin D. Anthropometric measures and venous blood samples were collected at health supervision visits by trained research assistants. Linear mixed effect modelling was used to determine the association between vegetarian diet, growth, and micronutrient stores. Results A total of 8912 children (n = 248 vegetarian) participated. In the adjusted models there was no evidence of an association between vegetarian diet and BMI z-score (p = 0.605, 95% CI: -0.06, 0.10), height-for-age z-score (p 0.057, 95% CI: -0.16, 0.002), serum ferritin (p = 0.768, 95% CI: -3.84, 2.84), or 25-hydroxyvitamin D (p = 0.204, 95% CI: -2.14, 0.46). The relationship between vegetarian diet and serum 25-hydroxyvitamin D was modified by child age. Volume of cow’s milk intake did not modify the relationships between vegetarian diet and BMI z-score, height-for-age z-score, serum ferritin, or 25-hydroxyvitamin D. In a secondary analysis, we examined adiposity through weight status categories and found children with a vegetarian diet had higher odds of being underweight (BMI z-score &amp;lt;-2) (OR 1.9, p = 0.006, 95% CI 1.21-3.00). Conclusion In this prospective cohort study, evidence of an association between vegetarian diet and lower BMI z-score, height-for-age z-score, and micronutrient stores was not found. Our results suggest children with vegetarian diets had higher odds of being underweight. Future research is needed to evaluate dietary factors and patterns of children following vegetarian diets, especially those with an underweight weight status.

Sex-dependent associations of maternal androgen levels with offspring BMI and weight trajectory from birth to early childhood.

In preclinical studies, high androgen levels during pregnancy are associated with low birth weight and rapid postnatal weight gain in the offspring. However, human data linking prenatal androgens with birth weight and early life weight gain in the offspring are scarce. We evaluated 516 mother-child pairs enrolled in the New England birth cohorts of the Collaborative Perinatal Project (1959-1966). We assayed androgen bioactivity in maternal sera during third-trimester using a receptor-mediated luciferase expression bioassay. Age and sex-specific BMI Z-scores (BMIz), defined using established standards, were assessed at birth, 4 months, 1 year, 4 years, and 7 years. We used linear mixed models to evaluate the relation of maternal androgens with childhood BMIz overall and by sex. We examined the association of maternal androgens with fetal growth restriction. The association of weight trajectories with maternal androgens was examined using multinomial logistic regression. Higher maternal androgen levels associated with lower BMIz at birth (β = -0.39, 95% CI: -0.73, -0.06); this relation was sex-dependent, such that maternal androgens significantly associated with BMIz at birth in girls alone (β = -0.72, 95% CI: -1.40, -0.04). The relation of maternal androgens with fetal growth restriction revealed dose threshold effects that differed by sex. There was no significant association between maternal androgens and weight trajectory overall. However, we found a significant sex interaction (p = 0.01); higher maternal androgen levels associated with accelerated catch-up growth in boys (aOR = 2.14, 95% CI: 1.14, 4.03). Our findings provide evidence that maternal androgens may have differential effects on the programming of intrauterine growth and postnatal weight gain depending on fetal sex.

Evaluating dose delivered of a behavioral intervention for childhood obesity prevention: a secondary analysis

BackgroundCurrent recommendations for intensive behavioral interventions for childhood obesity treatment do not account for variable participant attendance, optimal duration of the intervention, mode of delivery (phone vs. face-to-face), or address obesity prevention among young children. A secondary analysis of an active one-year behavioral intervention for childhood obesity prevention was conducted to test how “dose delivered” was associated with body mass index z-score (BMI-Z) across 3 years of follow-up.MethodsParent-child pairs were eligible if they qualified for government assistance and spoke English or Spanish. Children were between three and 5 years old and were at risk for but not yet obese (BMI percentiles ≥50th and < 95th). The intended intervention dose was 18 h over 3-months via 12 face-to-face “intensive sessions” (90 min each) and 6.75 h over the next 9 months via 9 “maintenance phone calls” (45 min each). Ordinary least-squares multivariable regression was utilized to test for associations between dose delivered and child BMI-Z immediately after the 1-year intervention, and at 2-, and 3-year follow-up, including participants who were initially randomized to the control group as having “zero” dose.ResultsAmong 610 parent-child pairs (intervention n = 304, control n = 306), mean child age was 4.3 (SD = 0.9) years and 51.8% were female. Mean dose delivered was 10.9 (SD = 2.5) of 12 intensive sessions and 7.7 (SD = 2.4) of 9 maintenance calls. Multivariable linear regression models indicated statistically significant associations of intensive face-to-face contacts (B = -0.011; 95% CI [− 0.021, − 0.001]; p = 0.029) and maintenance calls (B = -0.015; 95% CI [− 0.026, − 0.004]; p = 0.006) with lower BMI-Z immediately following the 1-year intervention. Their interaction was also significant (p = 0.04), such that parent-child pairs who received higher numbers of both face-to-face intensive sessions (> 6) and maintenance calls (> 8) were predicted to have lower BMI-Z. Sustained impacts were not statistically significant at 2- or 3-year follow-up.ConclusionsIn a behavioral intervention for childhood obesity prevention, the combination of a modest dose of face-to-face sessions (> 6 h over 3 months) with sustained maintenance calls (> 8 calls over 9 months) was associated with improved BMI-Z at 1-year for underserved preschool aged children, but sustained impacts were not statistically significant at 2 or 3 year follow-up.Clinical trial registrationThe trial was registered on ClinicalTrials.gov (NCT01316653) on March 16, 2011, which was prior to participant enrollment.

Prospective associations with physiological, psychosocial and educational outcomes of meeting Australian 24-Hour Movement Guidelines for the Early Years

BackgroundSeveral countries have released movement guidelines for children under 5 that incorporate guidelines for sleep, physical activity and sedentary behavior. This study examines prospective associations of preschool children’s compliance with the 24-Hour Australian movement guidelines (sleep, physical activity, screen time) and physiological, psychosocial and educational outcomes during primary school.MethodsData were from the Healthy Active Preschool and Primary Years Study (Melbourne, Australia; n = 471; 3–5 years; 2008/9). Follow-ups occurred at 3 (2011/12; 6–8 years), 6 (2014/15; 9–11 years) and 7 (2016; 10–12 years) years post baseline. Multiple regression models assessed associations between compliance with guidelines at baseline and later outcomes.ResultsChildren were 4.6 years at baseline (53% boys; 62% high socio-economic families). Most children met physical activity (89%) and sleep (93%) guidelines; 23% met screen-time guidelines; and 20% met all guidelines at baseline. Meeting all of the three guidelines was associated with lower BMI z-scores at 9–11 years of age (b = − 0.26, 95%CI -0.47, − 0.05). Meeting physical activity guidelines was associated with higher total body bone mineral density (b = 0.64, 95%CI 0.15, 1.13), and total body bone mineral content (b = 183.19, 95%CI 69.92, 296.46) at 10–12 years of age. Meeting sleep guidelines was associated with better reading (b = 37.60, 95%CI 6.74, 68.46), spelling (b = 34.95, 95%CI 6.65, 63.25), numeracy (b = 39.09, 95%CI 11.75, 66.44), language (b = 44.31, 95%CI 11.77, 76.85) and writing (b = 25.93, 95%CI 0.30, 51.57) at 8–9 years of age. No associations were evident for compliance with screen-time guidelines or for psychosocial outcomes.ConclusionsCompliance with different movement behavior guidelines was associated with different outcomes. Strategies to support children in meeting all of the guidelines are warranted to maximize health and educational outcomes. Future research investigating dose-response associations, and potential mechanisms, is necessary.

Aortic dilatation in children with mild to moderate chronic kidney disease.

Children with mild to moderate chronic kidney disease are at an increased risk for cardiovascular sequelae, the leading cause of death in children with end-stage renal disease. We aimed to establish the prevalence of aortic dilatation, a newly recognized cardiovascular sequelae of renal disease, within a cohort of pediatric patients with mild to moderate kidney disease. A total of 501 children enrolled in the Chronic Kidney Disease in Children study contributed imaging data between April 2011 and February 2015. Aortic dilatation was defined as a dimension exceeding a z-score of 2 at any of three locations: aortic root, sinotubular junction, or the ascending aorta. At baseline echocardiographic evaluation, 30 (6%) children were identified to have aortic dilatation in at least one of the three locations. Multivariate analysis demonstrated an increased odds ratio for the presence of aortic dilatation associated with the following variables: high diastolic blood pressure z-scores, low weight z-score, and low body mass index z-score. Presense of protein energy wasting (modified definition, OR 2.41, 95%CI 1.23, 4.70) was the strongest independent predictor of aortic dilatation. In conclusion, aortic dilatation does occur early in the course of chronic kidney disease and associates with markers of poor nutrition. Future studies should continue to evaluate these risk factors longitudinally as the kidney disease progresses.

Compositional principal component analysis generates gut microbiota profiles that associate with children's diet and body composition

AbstractGut microbiota data obtained by DNA sequencing are not only complex because of the number of taxa that may be detected within human cohorts, but also compositional because characteristics of the microbiota are described in relative terms (e.g., “relative abundance” of particular bacterial taxa expressed as a proportion of the total abundance of taxa). Nutrition researchers often use standard principal component analysis (PCA) to derive dietary patterns from complex food data, enabling each participant's diet to be described in terms of the extent to which it fits their cohort's dietary patterns. However, compositional PCA methods are not commonly used to describe patterns of microbiota in the way that dietary patterns are used to describe diets. This approach would be useful for identifying microbiota patterns that are associated with diet and body composition. The aim of this study is to use compositional PCA to describe gut microbiota profiles in 5 year old children and explore associations between microbiota profiles, diet, body mass index (BMI) z-score, and fat mass index (FMI) z-score. This study uses a cross-sectional data for 319 children who provided a faecal sample at 5 year of age. Their primary caregiver completed a 123-item quantitative food frequency questionnaire validated for foods of relevance to the gut microbiota. Body composition was determined using dual-energy x-ray absorptiometry, and BMI and FMI z-scores calculated. Compositional PCA identified and described gut microbiota profiles at the genus level, and profiles were examined in relation to diet and body size. Three gut microbiota profiles were found. Profile 1 (positive loadings on Blautia and Bifidobacterium; negative loadings on Bacteroides) was not related to diet or body size. Profile 2 (positive loadings on Bacteroides; negative loadings on uncultured Christensenellaceae and Ruminococcaceae) was associated with a lower BMI z-score (r = -0.16, P = 0.003). Profile 3 (positive loadings on Faecalibacterium, Eubacterium and Roseburia) was associated with higher intakes of fibre (r = 0.15, P = 0.007); total (r = 0.15, P = 0.009), and insoluble (r = 0.13, P = 0.021) non-starch polysaccharides; protein (r = 0.12, P = 0.036); meat (r = 0.15, P = 0.010); and nuts, seeds and legumes (r = 0.11, P = 0.047). Further regression analyses found that profile 2 and profile 3 were independently associated with BMI z-score and diet respectively. We encourage fellow researchers to use compositional PCA as a method for identifying further links between the gut, diet and obesity, and for developing the next generation of research in which the impact on body composition of dietary interventions that modify the gut microbiota is determined.