Significant Higher Body Mass Index Research Articles

Positive end-expiratory pressure induced changes in airway driving pressure in mechanically ventilated COVID-19 Acute Respiratory Distress Syndrome patients

BackgroundThe profile of changes in airway driving pressure (dPaw) induced by positive-end expiratory pressure (PEEP) might aid for individualized protective ventilation. Our aim was to describe the dPaw versus PEEP curves behavior in ARDS from COVID-19 patients.MethodsPatients admitted in three hospitals were ventilated with fraction of inspired oxygen (FiO2) and PEEP initially adjusted by oxygenation-based table. Thereafter, PEEP was reduced from 20 until 6 cmH2O while dPaw was stepwise recorded and the lowest PEEP that minimized dPaw (PEEPmin_dPaw) was assessed. Each dPaw vs PEEP curve was classified as J-shaped, inverted-J-shaped, or U-shaped according to the difference between the minimum dPaw and the dPaw at the lowest and highest PEEP. In one hospital, hyperdistention and collapse at each PEEP were assessed by electrical impedance tomography (EIT).Results184 patients (41 including EIT) were studied. 126 patients (68%) exhibited a J-shaped dPaw vs PEEP profile (PEEPmin_dPaw of 7.5 ± 1.9 cmH2O). 40 patients (22%) presented a U (PEEPmin_dPaw of 12.2 ± 2.6 cmH2O) and 18 (10%) an inverted-J profile (PEEPmin_dPaw of 14,6 ± 2.3 cmH2O). Patients with inverted-J profiles had significant higher body mass index (BMI) and lower baseline partial pressure of arterial oxygen/FiO2 ratio. PEEPmin_dPaw was associated with lower fractions of both alveolar collapse and hyperinflation.ConclusionsA PEEP adjustment procedure based on PEEP-induced changes in dPaw is feasible and may aid in individualized PEEP for protective ventilation. The PEEP required to minimize driving pressure was influenced by BMI and was low in the majority of patients.

Clinical and neuroendocrine correlates of childhood maltreatment history in adults with bipolar disorder

IntroductionChildhood maltreatment (CM) has been associated to an increased risk of developing bipolar disorder (BD). A role of the hypothalamus-pituitary-adrenal (HPA) axis in mediating trauma-related risk for adult psychopathology has been suggested but scarcely investigated in BD.ObjectivesThe aim of this study is to explore the impact of childhood maltreatment on clinical features of BD and on the activity of the HPA axis.MethodsOne hundred and six patients participated in the study. On the basis of their history of childhood trauma, as assessed by the Childhood Trauma Questionnaire (CTQ), they were divided into a group with a history of childhood maltreatment (CM+) and a group without (CM−). Twenty-nine participants (16 with a history of childhood trauma and 13 without) underwent the cortisol awakening response (CAR) test. Saliva cortisol concentrations were determined by an enzyme immunoassay method, using a commercially available ELISA kit.ResultsAccording to CTQ, 62 had a history of childhood maltreatment and 44 had not. CM was significantly more frequent in females than males. CM+ patients showed significant higher body mass index (p = .01), number of suicide attempts (p = .03), and more severe mania symptoms (p = .01) than CM− ones. Significant associations between lifetime suicide attempts and any type of childhood maltreatment (OR = 2.79; CI = 1.01-7.73) and between emotional abuse and the presence of psychotic symptoms (OR = 2.74, CI = 1.11-6.74) or mixed mood episodes were found (OR = 2.62, CI = 1.07-6.43). Moreover, CM+ individuals with BD exhibited a significantly reduced CAR with respect to CM− ones.ConclusionsOur results add to literature findings showing a worse clinical course in BD patients with a history of childhood maltreatment and show for the first time that childhood trauma exposure is associated to impaired CAR in adults with BD.Disclosure of InterestNone Declared

Thyroid dysfunction in pregnancy - a retrospective observational analysis of a Maltese cohort

BackgroundThyroid dysfunction is known to adversely affect pregnancy. This studyevaluates the prevalence of thyroid disorders and explores their associationwith pregnancy complications/comorbidities and modes of delivery in the Maltesepregnant population over a ten year period.DesignA population based observational study.MethodWe analysed data from the National Obstetrics Information Service of theDepartment of Health Informations and Research (NOIS) for all births deliveredin Malta between 2006 and 2016. Cases identified and recorded by NOIS to have had some form of thyroiddysfunction during pregnancy were confirmed by cross-referencing with laboratory results found in patients’medical records and/or iSOFT® database system. Using the Statistical Packagefor the Social sciences (SPSS®) demographic data, pastobstetric and medical history and obstetric outcomes were analysed forpregnancies with thyroid dysfunction and compared to data pertaining to pregnancies in euthyroid patients, that is those with no recorded thyroid dysfunction on NOIS. Chi square/Fisher'sexact test were used to compare categorical variables while ANOVA/Mann-WhitneyU test was used to compare continuous variables. Statistical significance wasdefined by a two-sided p value <0.05.ResultsData was available for 46,283 women (mean [SD] age = 29.2 [5.4] years).587 pregnancies (1.3%) suffered from thyroid dysfunction. Of these, 67.3% werehypothyroid, 3.2% had hyperthyroidism, 28.3% had isolated hypothyroxinaemia(IHT) while 1.2% had a history of thyroid carcinoma. Patients with IHT andhypothyroidism were older than euthyroid patients (p < 0.001). IHT and hypothyroid patients had astatistically significant higher body mass index (BMI) than euthyroid women(p=0.001 for hypothyroid women, p = 0.035 for IHT). Hypothyroid and IHT women were more likely to have had aprevious lower segment caesarean section (p=0.043, and 0.006respectively). Type 1 diabetes and gestational diabetes p = 0.012) were more common associatedcomorbidities in hypothyroid pregnancies. Offspring of patients with IHT had ahigher birth weight than those born to euthyroid patients (p=0.009). Patients with hyperthyroidism were found to havea significantly increased risk of early preterm delivery before 34 weeks ofgestation and were also more likely to have suspected intrauterine growthrestriction and low mean birth weight. We report no significantdifferences in past history of obstetric loss, antenatal complications, mode ofdelivery, gestational age at delivery and postpartum haemorrhage rates acrossthyroid categories.ConclusionsAvailable evidence suggests that thyroid dysfunction is more likely in thesetting of older age, and higher body mass index. Moreover, it impacts on neonatalbirth weight, rates of early preterm delivery and intrauterine growthrestriction.

Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy.

ObjectiveTo investigate the prevalence and predictors of postictal confusion (PIC) in patients who received electroconvulsive therapy (ECT).MethodsWe conducted chart reviews for 79 patients who were receiving inpatient ECT. Subjects with PIC were identified. PIC was defined by confusion, disorientation, motor restlessness, purposeless movement, and nonresponse to verbal commands following ECT within an hour, intravenous benzodiazepine was necessary to manage disturbed behavior. Multivariable logistic regression analysis was used to examine the association of PIC with demographic and clinical variables.ResultsPrevalence of PIC was 36.7%. In 912 ECT sessions, the occurrence of PIC was 86 times. Patients with PIC (n = 29) had significant higher body mass index (BMI) (27 ± 6.6 kg/m2 vs 24.1 ± 5.2 kg/m2, t = −2.22, df = 77, p = 0.029) than patients without PIC (n = 50). PIC associated with BMI (Pearson correlation = 0.25, p = 0.029). BMI was significant predictor of PIC after adjusting for other covariates (odds ratio = 0.91, 95% CI= 0.83–0.99, p < 0.035).ConclusionPIC was not uncommon in patients receiving ECT. BMI was an independent predictor of PIC. Psychiatrists should be aware of the risks of PIC in patients with high BMI receiving ECT.

Clinical and neuroendocrine correlates of childhood maltreatment history in adults with bipolar disorder.

Childhood maltreatment has been associated to an increased risk of developing bipolar disorder (BD). A role of the hypothalamus-pituitary-adrenal (HPA) axis in mediating trauma-related risk for adult psychopathology has been suggested but scarcely investigated in BD. Therefore, we explored the impact of childhood maltreatment on clinical features of BD and on the activity of the HPA axis. One hundred and six patients participated in the study. On the basis of their history of childhood trauma, as assessed by the Childhood Trauma Questionnaire (CTQ), they were divided into a group with a history of childhood maltreatment (CM+) and a group without (CM-). Twenty-nine participants (16 with a history of childhood trauma and 13 without) underwent the cortisol awakening response (CAR) test. Sixty-two patients had a history of childhood maltreatment and 44 had not. Maltreatment was significantly more frequent in females than males. CM+ patients showed a significant higher body mass index, a significant higher number of suicide attempts, and more severe mania symptoms than CM- ones. Logistic regression indicated a significant association between lifetime suicide attempts and any type of childhood maltreatment and between emotional abuse and the presence of psychotic symptoms or mixed mood episodes. CM+ individuals with BD exhibited a significantly reduced CAR with respect to CM- ones. Our results add to literature findings showing a worse clinical course in BD patients with a history of childhood maltreatments and show for the first time that childhood trauma exposure is associated to an impaired CAR in adults with BD.

Cardio-metabolic risk factors among young infertile women: a systematic review and meta-analysis.

There is currently no concise systematic review or meta-analysis addressing cardio-metabolic risk factors in women experiencing infertility. To determine whether infertile women have higher levels of cardiovascular risk factors compared with fertile women. We performed a systematic literature search using PubMed, Embase and CINAHL, Scopus and additional manual and bibliographic searches for relevant articles (end search date 6 November 2019). We selected studies that compared cardio-metabolic risk factors in fertile and infertile women of reproductive age. At least two authors independently screened potentially eligible studies. There was an increased presence of several cardio-metabolic risk factors in infertile women compared with fertile women. Infertile women had statistically significant higher body mass index (BMI), increased total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) compared with fertile women. Fasting glucose, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR) and mean arterial pressure were not found to be different between fertile and infertile women. A subgroup analysis revealed that TC, fasting glucose and fasting insulin were increased, and high-density lipoprotein was decreased only in women with polycystic ovarian syndrome compared with fertile women, whereas BMI, TG and LDL-C were statistically significantly increased in women with any indication of infertility compared with fertile women. Infertile women have a higher level of cardio-metabolic risk factors compared with fertile women. This finding has clinical implications for infertile women in general, and those attempting to conceive through medically assisted reproduction. Infertile women appear to have a higher level of cardio-metabolic risk factors compared with fertile women.

Sleep Complaints and Sleep Quality in Spinal Cord Injury: A Web-Based Survey.

The purpose of this study was to determine sleep quality and presence of sleep disorders in participants with spinal cord injury (SCI). A web-based survey, available online from February 2011 to July 2013, using validated sleep questionnaires, advertised via the internet and locally through SCI consumer organizations in the United States, Australia, New Zealand, and Canada, was designed to evaluate sleep in adults with self-reported SCI. Demographic characteristics and medical history were obtained from participant self-report. In our study population, 70% of the 304 participants were male with a mean age of 45 ± 13 years. The mean duration of injury was 16 ± 12 years. Cervical injuries were reported by 49% and thoracic injuries noted in 40% of participants. Increased sleep apnea risk was noted in 31% of participants, with 66% reporting snoring. Insomnia symptoms were reported by 54% of the respondents. Almost 40% of participants ranked their sleep quality as "fairly bad" to "very bad" in the previous month, 29% reported "often" or "almost always" waking up because of pain, and 22% had difficulty falling asleep because of leg cramps. In the past year, 27% of the respondents reported daily uncomfortable leg sensations and 28% found these leg symptoms to be "moderately to extremely distressing." This study increases the awareness that insomnia, sleep apnea, and poor sleep quality are common in individuals with chronic SCI; often coexisting. There is a need for increased screening for sleep problems by healthcare providers taking care of individuals living with SCI.

Evaluation of lipid profile and its relationship with blood pressure in patients with Cushing's disease.

IntroductionThe purpose of the study was to describe lipid profile and explore pathogenetic role of LDL-c on hypertension in patients with Cushing’s disease (CD). Hypertension is a common feature in patients with CD. Previous study found low-density lipoprotein cholesterol (LDL-c) uptake in vascular cells might be involved in vascular remodeling in patients with CD. Therefore, we evaluated the relationship between lipid profile and the blood pressure in patients with CD.MethodsThis retrospective study included 84 patients referred to Huashan Hospital for the evaluation and diagnosis of CD from January 2012 to December 2013. All subjects had detailed clinical evaluation by the same group of endocrinology specialists to avoid subjective influences.ResultsWe found that high LDL-c patients had significant higher body mass index (BMI), systolic blood pressure (SBP), cholesterol (CHO), triglyceride (TG), and apolipoproteinB (apoB) (P < 0.05). An association was detected between SBP values and lipids profile including CHO, TG, LDL-c, apolipoproteinA (apoA), apoB and lipoprotein(a) (LP(a)). After adjustment for all covariates, the LDL-c remained positively associated with SBP. In patients with or without taking statins, patients with LDL-c ≥3.37 mmol/L had higher SBP than patients with LDL-c <3.37 mmol/L. Then, LDL-c was coded using restricted cubic splines (RCS) function with three knots located at the 5th, 50th and 95th percentiles of the distribution of LDL-c. Compared to individuals with 3.215 mmol/L of LDL-c, individuals with 4.0, 4.5 and 5.0 mmol/L of LDL-c had differences of 3.86, 8.53 and 14.11 mmHg in SBP, respectively.ConclusionsAn independent association between LDL-c and SBP was found in patients with CD. We speculate that LDL-c may be a pathogenic factor for hypertension in those patients.

Activity behavior, nutritional status and perceived health in older Brazilian adults: Does the number of chronic diseases matter?

The present study examined activity behavior, nutritional status and perceived health in relation to the number of chronic diseases (ChrD) in a representative sample of Brazilians aged ≥60 years. A cross-sectional, population-based study was carried out in a midsize Brazilian city to evaluate different health risk factors. Using a stratified random sampling procedure to select a representative sample of adults, this study interviewed 1572 individuals face-to-face. Our analytical sample focused on those aged ≥60years (n=355). Statistical procedures were carried out using spss software, with the significance level set as P<0.05. Older adults diagnosed with ≥2 ChrD were significantly less active during leisure time physical activity (P=0.03), presented with significant higher body mass index values (P<0.001) and were approximately fivefold (1.69-17.93) more likely to perceive their health as poor compared with those with zero ChrD. The group with ≥2 ChrD reported a similar amount of sitting time compared with older adults with zero or one ChrD (P>0.05). Having multiple ChrD has a negative impact on older adults' leisure time physical activity, body mass index and the perception of health. The findings of the present study underscore the need for more infusive approaches tackling ChrD in Brazil focusing on healthy lifestyle behaviors, such as physical activity. Geriatr Gerontol Int 2017; 17: 2376-2382.

Average heart rates of hispanic and caucasian adolescents during sleep: longitudinal analysis from the TuCASA cohort.

The current study describes sleeping heart rate patterns in an adolescent cohort of Hispanic and Caucasian children over approximately a 5-year period to determine how sex, ethnicity, and body mass index (BMI) contribute to sleeping heart rate patterns over time. Participants were recruited from a large urban school district in the southwest United States as part of the Tucson Children's Assessment of Sleep Apnea Study (TuCASA). Heart rate data was obtained through electrocardiogram (ECG) recordings during in-home polysomnography, approximately 5 years apart. Second-wave cohort data were analyzed to determine how age, sex, ethnicity, physical activity, and BMI contribute to average sleeping heart rates. The same variables were used to investigate how sleeping heart rate patterns change longitudinally from school-age (6-11 years) to adolescence (10-17 years) during sleep. Female adolescents had significantly faster average heart rates during sleep. Sleeping heart rate decreased significantly with increasing age in the adolescent cohort. Although the Hispanic group had a statistically significant higher body mass index than Caucasians, there were no significant differences in heart rate observed between ethnicities or in those who were classified as obese (BMI ≥ 95(th) percentile for age). Longitudinal analysis between the school-aged and adolescent cohort revealed a significant overall decrease in heart rate across a 5-year period. Hispanic and Caucasian adolescents experience a similar decrease in sleeping heart rate with age. Female adolescents had significantly faster heart rates than males, and no significant differences were observed between Caucasians and Hispanics, or obese vs. nonobese adolescents.

Adnexal Masses in Pregnancy

INTRODUCTION: Adnexal mass in pregnancy is a common finding with now routine ultrasound use. Incidence of adnexal mass=1–2% with malignancy complicating is reported in 2–3% of cases. We sought to determine if the size of persistent adnexal mass can be used as a predictor of patients requiring surgical intervention. METHODS: We performed an institutional review board-approved retrospective cohort analysis of all women with persistent adnexal mass found on ultrasonography during pregnancy at our institution over the 5-year period, January 2008 to March 2013. Charts reviewed for maternal demographics, operative characteristics, and neonatal outcomes. Ultrasound mass size, septae, echogenicity, wall thickness, and papillary projections were evaluated. Statistical analyses were then performed using NCSS software. RESULTS: Thirteen thousand six hundred seventy-seven births occurred over the study period. Forty-one women were identified with persistent adnexal mass. Twenty-five of these adnexal masses were 5 cm or greater and 14 adnexal masses less than 5 cm. A significant higher body mass index in the large mass group (34.5 compared with 26.5 kg/m2, P=.01) was found. Patients with large masses were more likely to undergo surgery. Average cyst volume was 769 cc (range 220–9,216 cc). The large adnexal mass group was more likely to deliver preterm (36.6 compared with 38.2 weeks of gestation, P=.01) with significant lower birth weight neonates (2,944 compared with 3,169 g, P=.01). CONCLUSIONS: Routine ultrasonography has increased detection of adnexal masses during pregnancy. Large-sized masses may be predictors of preterm birth. Ultrasound characteristics, including size, may help differentiate need for surgical intervention. Risk factors and symptomatology dictate the need for operative intervention.

Serum uric acid as a predisposing factor of clinico- radiological severity of osteoarthritis knee

Serum uric acid as a predisposing factor of clinico- radiological severity of osteoarthritis knee

Mandibular advancement splint for the treatment of obstructive sleep apnea

Mandibular Advancement Splint (MAS) is a simpler alternative to continuous positive airway pressure (CPAP) for the treatment of mild and moderate OSA. The aim of the study was to evaluate the effectiveness of MAS for the treatment of OSA and determine if sleep apnea symptoms, cephalometric measurements and sleep study data are associated with MAS treatment outcome. We included 100 patients, 82 men and 18 women, mean age 47.9 ± 10.8 years, 57% with mild and 38% with moderate OSA. MAS are personalized and advance the mandible 75% of maximum protusion and provide approximately 5–10 mm opening vertically (between incisor edges). All patients had cephalometric evaluation and nocturnal sleep study at baseline and under treatment with MAS. According to the variation of respiratory disturbance index (RDI), with and without MAS, patients were divided into three groups: complete responders (if RDI with MAS was reduced to less than 5 events per hour), partial responders (reduction of 50% or more in RDI but remaining above 5 per hour) and non-responders (less than 50% reduction in RDI). The main symptoms of OSA were snoring (43%) and excessive daytime sleepiness (34%). There was a statistically significant reduction of Epworth Sleepiness Scale (ESS) with MAS. On the follow-up sleep study there was also a statistically significant reduction in RDI and increase in minimum oxygen saturation (MinSaO2) with MAS. Thirty-seven patients were considered complete responders, 31 partial responders and 32 non-responders. Comparison between these three groups revealed that they were not statistically different in terms of age, body mass index or ESS score. Eighty-eight per cent of patients referred clinical improvement with MAS. Patients without clinical improvement had statistically significant higher Body Mass Index, ESS score, RDI and apnea index and lower MinSaO2 with MAS. Reduction of RDI with MAS was also less in this group. With regard to the sagittal skeletal relationships, there was a statistically significant alteration in ANB angle, ANS-Gn and PNS-P with MAS. Patients with no clinical improvement had statistically significant lower SNB angle and higher ANB angle with MAS. There was an association between clinical response and clinical Improvement (p = 0.002). MAS is an effective treatment for mild and moderate OSA. Evaluation of Epworth Sleepiness Scale (ESS), nocturnal sleep study indices and cephalometric measurements could predict successful outcome.

The status of Vitamin D in medical students in the preclerkship years of a Saudi medical school

Background:The prevalence of vitamin D deficiency has recently been recognized in different parts of the world, even affecting healthy populations. The deficiency of vitamin D can lead to rickets in children and osteomalacia in adults. Few studies have been done to evaluate the status of vitamin D in the medical community. The objective of this study was to evaluate the prevalence of low levels of vitamin D in healthy Saudi medical students.Materials and Methods:A cross-sectional study was carried out in November 2009 on male and female students in the preclerkship years of medical school at the King Faisal University, Dammam. Data on age, consumption of dairy products and seafood, and exposure to sunlight were collected. The body mass index was calculated. Approximately, 15 ml of blood was extracted for the measurement of serum calcium, serum albumin, serum phosphorus, alkaline phosphatase, fasting parathyroid hormone, and vitamin D levels. Vitamin D deficiency was defined as serum 25-hydroxy vitamin D < 50 nmol/l. Comparison between groups was done for statistical significance using an unpaired t-test. Significance was set at P < 0.05 using 95% CI for all comparisons.Results:The data from 95 male and 103 female students were analyzed. The mean age for all students was 19.54 years. In 100% of the students, the vitamin D level was low. The prevalence of vitamin D deficiency in all students was 96.0% (92.64% in males and 99.03% in females), while the remaining 4% had vitamin D insufficiency. The mean 25-hydroxy vitamin D level was 26.83 ± 12.60 nmol/l in males and 16.03 ± 8.28 nmol/l in females (P-value = 0.0001). Males had a statistically significant higher body mass index as well as consumption of dairy products, while the consumption of seafood was significantly higher in females. There was no difference between the two groups in terms of exposure to the sun.Conclusion:Vitamin D deficiency was highly prevalent among medical students included in this study. An urgent action has to be taken in order to prevent adverse consequences of low vitamin D in the young, otherwise healthy populations.

Anthropometric Predictors of High Risk of Obstructive Sleep Apnea Syndrome in a Rural Population

Anthropometric Predictors of High Risk of Obstructive Sleep Apnea Syndrome in a Rural PopulationObjective.To evaluate which anthropometric parameter better predicts the high risk of obstructive sleep apnea syndrome (OSA) in a rural population.Material and Method.254 subjects were enrolled. We measured weight, height, waist circumference (WC) and neck circumference (NC) and calculated body mass index (BMI), waist-to-height ratio (WHtR) and neck circumference/height ratio (NC/Height). The risk of OSA was assessed by using Berlin Questionnaire.Results.Subjects with high risk of OSA had a significant higher BMI, WC, WHtR, NC, and NC/Height. A higher percentage of those with large WC (≥80cm and ≥94cm for women and men, respectively) (p&lt;0.001), WHtR ≥0.5 (p&lt;0.001), NC ≥40cm (p=0.004), NC/Height ratio ≥0.23 (p=0.002) had a high risk of OSA. Using ROC curves of anthropometric parameters studied we found that WHtR was the best predictor for high risk of OSA, with AUC of 0.760, 95% CI: 0.699 to 0.815.Conclusions.WHtR was the best predictor for high risk of OSA as assessed by the Berlin Questionnaire.

Correlation between white blood cell count and metabolic syndrome in adolescence

Metabolic syndrome (MetS) is associated with increased risk for diabetes and coronary heart disease. Data suggest that MetS starts even in children. Thus, it is important to understand the role of MetS and the risks related to it. Furthermore, white blood cell count (WBCC) is available in routine examination and it has been proved to be related to risks of MetS. A total of 1657 subjects aged 14-19 years were enrolled, with normal WBCC (< or =10 x 10(9) cells/L). The subjects were divided into four quartiles according to WBCC (WBCC1-4, from the lowest to highest WBCC) in both genders. The female subjects had significantly lower systolic blood pressure, fasting plasma glucose (FPG), triglyceride (TG), body mass index (BMI) and higher high-density lipoprotein-cholesterol (HDL-C) than the male subjects. When comparing the risks of the quartiles of WBCC, WBCC4 had significant higher BMI than WBCC1 and WBCC2 in both genders; and lower HDL-C than WBCC3 in male subjects. On multiple regression WBCC was positively related with BMI and TG and negatively related to HDL-C in male subjects. In female subjects only BMI was positively correlated with WBCC. Subjects with MetS did not have significant higher WBCC than those without MetS. In adolescents with normal WBCC, BMI is significantly related to the levels of WBCC and is the earliest component of MetS to be noted in adolescents. Elevated TG and decreased HDL-C could also be important markers for future risk factors only in male subjects.

Longitudinal Relationship of Parental Hypertension with Body Mass Index, Blood Pressure, and Cardiovascular Reactivity in Children

To investigate whether parental hypertension (HTN) affects children's body mass index (BMI) and cardiovascular reactivity (CVR) over time. A longitudinal study of 315 students (black: 23 females, 19 males; white: 142 females, 131 males) was conducted in the public schools of Obion County, Tennessee, between 1987 and 1992. BMI and BMI z scores were calculated. The CVR task was a series of video games (taking approximately 10 minutes to play) given to the same students in their third-, fourth-, fifth-, seventh-, and eighth-grade years. CVR was defined as the change in blood pressure (delta_BP) or heart rate (delta_HR) between before playing and while playing the video game. Positive parental history of HTN (27.6%) was defined as at least 1 parent with HTN. Multivariable regression analyses were performed to estimate the effects of parental HTN on children's BMI and CVR over time. Children with parental HTN had significant higher BMI, BMI z score, and R_BP than did children without parental HTN (BMI: 21.6 vs 19.9, P = .001; BMI z score: 1.6 vs 1.1, P = .003; R_SBP: 112.6 vs 110.4 mm Hg, P = .01; R_DBP 62.7 vs 60.6 mm Hg, P = .003) after adjustment for covariates. Increased CVR was observed in children with parental HTN compared with children without parental HTN but was statistically significant only for SBP (delta_SBP: 17.2 vs 14.9 mm Hg; P = .01) after adjustment for covariates. Parental HTN independently predicted children's BMI, BMI z score, resting BP, and BP reactivity.

Height, weight, and body mass index of American Indian schoolchildren, 1990–1991

Objective To describe the current height and weight status of American Indian children who live on or near Indian reservations nationwide. Subjects 9,464 American Indian schoolchildren aged 5 through 18 years. Statistical analyses performed Data for height, weight, and body mass index of the schoolchildren were compared with two national reference data sets, the second National Health and Nutrition Examination Survey (NHANES II) and the Mexican-American population of the Hispanic Health and Nutrition Examination Survey (HHANES-MA). Results The three populations were similar in height, but the American Indian children weighed more, although not at a statistically significant level, and had a statistically significant higher body mass index than the NHANES II reference population for nearly every age and sex group. The overall prevalence of overweight in the American Indian children (exceeding the 85th percentile of the reference population) was 39.3% compared with the NHANES II population and 28.6% compared with the HHANES-MA population. The overall prevalence of underweight in the American Indian sample was substantially less than the expected 15% compared with either the NHANES II or HHANES-MA population. Applications/conclusions Overweight is much more prevalent in American Indian children than among other children in the United States at all ages and in both sexes. This may have important implications for chronic disease risk and emphasizes the need for targeting obesity prevention efforts to American Indian children.